Complex mental health journey - to diagnose or not to diagnose

Wow @Chickalily .

Why I'm saying Wow is not because anything is surprising, but because I have BPD, and I can see through much of what you have written in that it comes down to an unstable sense of self, emotional dysregulation, and her mood/behaviour changes rapidly with whatever is going on in her environment. That is, it can flip from idolising a person to completely hating them in a matter of moments.

There is some truth in saying it is a teenage phase. I can see why specialists are reluctant to label it as BPD. Usually, the diagnosis is given from early adulthood e.g. from 19 years onwards? This is because specialists want to ensure that BPD is not 'confused' with the brain changes in teenagers.

With DBT, unless your daughter wants to have it and is ready to change, you may as well save the money for later use. Psychotherapy usually doesn't work if there is no 100% commitment and buy-in from the person. For my BPD, I had mentalisation-based therapy in it's entirety. That was about 3 solid hours of therapy each week - both individual and group therapy. It was a not easy at all. It was intense. And many dropped out. I continued this therapy and it lasted just over 18 months. Even when I was discharged, it was still very unstable. I had to sort of be thrown out into the deep end to just be me.

Over time, things changed, and I'm in a much better place now.

I also had ongoing DBT and ACT skills learning which was helpful in a way, but MBT was the main therapy.

Unless you are looking at a good 12-18 months of weekly DBT therapy of both group and individual, then it most likely isn't the whole therapy, but moreso someone teaching a few DBT skills here and there.

Bottom line, unless she is totally committed, it's unlikely things will change.

At this time, it's about keeping her safe and letting her know you are there to support her but also setting boundaries. She may kick against the boundaries, but inside, boundaries keep people safe - this was my experience as a borderline anyway.

I could go on forever about this, but I don't want to overwhelm you.

Feel free to ask anything BPD-related. I'm all ears.

Thanks @tyme fpr taking the time to respond.
My daughter is happy to participate in therapy but I do wonder about the likelihood of her participating fully. She has had access to one to one therapy for 9 months but never applies anything from sessions and is still pretty firmly in the ‘it is everybody else’s fault’ camp. She ‘gets over’ therapists when they challenge her thinking. What has seemed to work is having a therapist who can work through anst experiences and help understand the connection to the way she responds to things.
at the moment I am trying to focus on our relationship. We are best buds now, mostly because I am 100% available at nearly all times. I am happy to do that for now as it seems to be the only thing keeping things on track (sort of, mostly).
Are there any approaches you think I can take to help her have perspective when she is seeing things from a narrow, rigid perspective (without invalidating)?

Did you have periods of exhaustion and depressive type symptoms? My girl has been in bed for a week. Mainly to avoid contact with others due to the voice she is hearing. I don’t know when to push and when to trust she knows her limitations. It is a bit of a tightrope.
I would like her to be able to take a moment between a moment of perceived rejection (declined invitation to hang out) and hurting herself. Is there anything you think works? She has one strategy but she doesn’t use it in those moments.

any other thoughts you have about how to help her understand what is happening and work through it, would be appreciated.

thanks

You daughter is so lucky to have you @Chickalily . It's important to maintain that relationship.

I've learnt from my experiences that the people closest to me were the ones I hurt most. I was grateful for those who kept their standards and set boundaries. I kicked against the boundaries big time, but I needed them. It was what helped me feel safe.

As for approaches to help her with perspective, the BIGGEST hint is, DON'T try when she is heightened. This will only escalate things and make it worse. What worked for me is my therapists always 'invited' me to try things e.g. "I invite you to think about XYZ, however, if you don't feel you can, that's okay". But using this type of language, I was empowered to still be in control. When people told me what to do, I kicked and bucked because I felt they were trying to take control of me. Power and control was huge for me. Emotionally, I was so out of control that I needed to just know I could hold onto some form of control.

As for periods of exhaustion - yes. I didn't leave home for many years. I ended up taking anti-depressants, and after finding the 'right' anti-depressant, only then did I have the energy to heal. It took quite a few months to stabilise though.

I absolutely hear you about the perceived rejection and the space before self-harming. For me, the strategy the mental health team put in place was to remove most of what I could use for self-harm. This way, I still had the choice to self harm, bit I had to go to more lengths before I could obtain the things. This meant I had to wait before self-harming - and hopefully by then, I'd be too exhausted to go through with it. I know this sounds obvious, but only when I reflect on it now, I realise I was saved many times because of it.

Talking to her about this BEFORE she is triggered is probably the best way.

The main thing - allows allow choice.

Click to read. TW: Self-Harm

Above all, take care of yourself. It can be so exhausting.

Thanks so much.

I feel more confident with the approach I am taking and you have given me some great tips.

I will advocate a more considered approach to the medication than the one that’s been taken. The psychiatrist told us to remove the antipsychotic (slowly) but my daughter starts to hear voices within a day of that occurring. We have tried three times and it has taken me some time to work out that the fear that ‘something will go wrong’ is causing the reaction, not the actual change in dosage (as there is no impact if she misses a whole dose). The anti-anxiety medication is the one that has made the biggest difference but is still not quite right, I think. As I am getting the message ‘BPD can’t be medicated’ I have not advocated well in this space.

Thanks for the tip about control. We parent this child so differently to our other. We cannot direct or appear to try to ‘control’. Everything needs to be facilitated choice-making. Last year it was extremely difficult to do that because she was so out of control. We were trying to have logical conversations with someone who could not reason. I have found other ways to do this and now she is not as heightened all the time, it is easier. It is effortful and I know it is perceived by other parents and by school as weak but it is a disaster when we try to enforce our agenda.

I will use that sentence around the use of strategies for self management as that is one thing I had not found a way to discuss without push-back.

Thanks again.

I really appreciate your responses.

Hey @Chickalily ,

By the way, I should clarify that I’m only answering your questions from a borderline’s perspective. I, too, cannot say whether your daughter has BPD or not.

With medication, it’s true that it does little for the BPD itself, but for me, if I didn’t take the concoction of anti depressants, anti anxiety/anti psychotics, I don’t think I would have been fit to undergo the MBT treatment I had.

What makes the difference with treatment is the willingness to push past the discomfort to do practice things that feel unnatural. I think this is why it’s so hard.

One thing I know for certain is that BPD is very treatable and the long term prognosis is positive (from my experience anyway).

Key thing as a carer is: strike while the iron is cold - not hot.

A BPD meltdown is truly a meltdown. This means the individual has moved beyond their reasoning brain and into their emotional brain. This is not a good time to ask them to see things from a different perspective. Rather, let her know you care and when SHE is ready, she can speak to you. Otherwise you will check in in half an hour. Knowing that you are coming back will be the biggest comfort in that you haven’t rejected or abandoned her. However, for me, if you said you would check in in 30 mins, and you came back in 35 mins instead, in my mind, I have ‘proven’ you don’t care because you were 5 mins late. This was when I turned to self harm…

Looking back, my brain was… ‘strange’. I don’t know what else to call it.

I have to admit though that once my brain moved on from this stage, I’ve never gone back.

The best way I can describe how I felt is I was an emotional child stuck in an adult’s body. My body grew up, but emotionally I didn’t. Hence the meltdowns, the insecurity, the anxiety, the tears…

Hope this helps a little.