Borderline Personality Disorder

[MicheleB]

Have we ever discussed this? Is there anyone who knows a lot about this or who has experience with this?

 

It is being suggested that my 15yo dd has this, which I mentioned in another thread briefly.

 

My main concerns right now are her schooling. Well, that and her mental health. But she seems SO unable to cope with anything! When she feels overwhelmed, she melts down so quickly there's no use pushing anything. She's not motivated unless it's something very creative that she is interested in. She does read voraciously, however.

 

From what I understand, BPD's either love or hate, and once they 'hate' it's hard to get them to see it otherwise. Which is one of the problems with school. If she decides she hates something, there's no getting her to really do it.

 

I know Laurie mentioned dialectic therapy, which I've asked dd's therapist about. Haven't received an answer yet. But as far as school, I just don't know what to do.

 

We live in PA and I had planned to go with one of the state's accredited diploma programs for her. She's in 9th grade this year. However, I don't see how she'd ever cope with all the requirements. But even still, there are lots of credit requirements just for a parent issuesd diploma.

 

Is there something else I can do with her? Can I, perhaps, look more into a vocational type program for her that would focus on her strong interests and abilities? She's an excellent writer... short stories, poems, song lyrics. That's what she wants to do and she excels at it.

 

Any suggestions?

[Terabith]

Well, at fifteen, by definition she cannot be diagnosed with borderline personality disorder. You must be 18 to receive a dx of a personality disorder.

 

However, in practice, there are many teens who display many symptoms of BPD. It's very challenging to live with someone with it. It's also hard to be someone with it.

 

What were the specific symptoms that led to that being suggested? Is she on any medication? Was there a lot of trauma early in life? (BPD has a pretty high correlation with childhood sexual abuse.)

 

Dialectical behavioral therapy is considered the best treatment. It's a difficult diagnosis because of the strong stimga that is associated with it. Most therapists don't like treating it, as clients can be *difficult* to work with. It has a pretty high rate of suicide, unfortunately. But it does seem to improve dramatically with age. It's not something that one grows out of, exactly, but in some instances, age and experience can ameliorate it.

[MicheleB]

Well, at fifteen, by definition she cannot be diagnosed with borderline personality disorder. You must be 18 to receive a dx of a personality disorder.

The therapist did mention that to me. And she was not willing to 'officially' diagnosis. Currently the dx is bipolar disorder and generalized anxiety disorder.

 

What were the specific symptoms that led to that being suggested? Is she on any medication? Was there a lot of trauma early in life? (BPD has a pretty high correlation with childhood sexual abuse.)

No trauma or sex abuse/physical abuse. However, at age 12 she was the primary witness for a sex abuse case involving her friend. That seems to be when things went a different direction for her. The symptoms her therapist pointed out (and that I agree with) is a strong tendency to love or hate but no middle ground. Once she 'hates' it's very difficult to change her opinion about it (be it a person, a book, a food, etc). Very moody... moods change a lot during the day, everyday. She felt it was more than rapid cycling bipolar. Dd used to have lots of friends and be outgoing. Since the sex abuse incident, she became afraid to trust people, more paranoid, seemingly more unable to relate to people who want to be her friend. For example, there are two very nice girls who really have gone out of their way to invite dd to functions. Dd has decided that really do NOT like her and that she thinks they're fake. But it's this intense opinion about people that causes a problem.

 

 

Dialectical behavioral therapy is considered the best treatment. It's a difficult diagnosis because of the strong stimga that is associated with it. Most therapists don't like treating it, as clients can be *difficult* to work with. It has a pretty high rate of suicide, unfortunately. But it does seem to improve dramatically with age. It's not something that one grows out of, exactly, but in some instances, age and experience can ameliorate it.

I have a friend who's a doctor and she said the same thing about it being difficult to treat, hard to work with and that the medical profession would tend to shy away from treating her. She actually advised fighting tooth and nail against a BPD dx. How does dialectical behavioral therapy work?

[Terabith]

http://en.wikipedia.org/wiki/Dialectical_behavior_therapy

 

It combines individual and group therapy. There's a fair amount of mindfulness training that goes on. It teaches persons to tolerate discomfort and just stay with it.

 

Why is the therapist leaning towards BPD? Is she self-mutilating? (Which is NOT only or even primarily in BPD, but that's a common preconception.)

 

It's quite common to have all or nothing/ good or bad thinking in teens, especially if trauma has been involved. (Trauma sort of freezes the emotional development at age of trauma.)

 

I'm wondering about the possibility of PTSD, especially if it is combined with bipolar and anxiety. (And with teens, it is pretty common to have very rapid cycling with bipolar.) In something where there is such a clear point trauma and obvious change of behavior, well, that seems somewhat suspicious.

[Laurie4b]

Dialectical behavior therapy is a talk therapy. It's reality-based, almost common sense approach. The group therapy seems to be the most important aspect, as it is done with other BPD folks. The woman I know who went through it is doing so much better.

 

If I'm recalling correctly, bipolar disorder runs in your family, so that makes it the likely diagnosis, with a highly traumatic event to deal with . The combination of bipolar and treatment of trauma in an adolescent is not your run-of-the mill case. I would see how much experience your dd's therapist has with that. If she is not experienced with helping teens with mood disorders process trauma, switch therapists.

 

You have a clear precipiating incident where she began to change. I'd set aside the BPD stuff and work to get the trauma dealt with. The therapist can't dx a personality disorder at her age, so you don't have to "fight against the diagnosis"; I would move on to a new therapist who understands treatment of trauma.

 

If she was a witness in a legal case, I'm betting that there is money from the legal system for her therapy through a victim's fund, etc.

[MicheleB]

I sure wish this whole thing just came with an instruction manual and gave me clear answers. :confused:

 

Yes, she has self-mutiliated in the past though she says she is not currently. However, she did ask me the other day what I would do IF she were cutting again. I have not yet determined if she is or isn't, or if it's just 'a question'. She spent five days in a children's psych. ward before her bipolar diagnosis (which was tentative at the hospital) and she absolutely hated it, of course. She was really in with a bunch of kids that were there for more social behavior problems than she had, if that makes sense. She could hear the violent ones in the padded room or something, I remember her saying. Anyway... she's looking for reassurance that she won't have to go back. And I digressed... sorry.

 

Her 'official' bipolar dx wsa a combination of the hospital, her regular doctor and now initially, her new therapist. Now, after a few months, the therapist is saying maybe it's BPD instead. Dd was scheduled with a neuropsych for testing (she also needs some academic testing, mainly for math) but we had to cancel due to weather, so now it will be April till we get back in. Her therapist and I were hoping that would give us a more definitive idea of a diagnosis.

 

It's hard to say what her 'normal' behavior was as a bipolar because she wasn't diagnosed until age 11 and the trauma happened right before she turned 12. See what I mean? She didn't witness the act but her friend shared her diary with her and told her several times that her father was molesting her. It took dd several months to finally tell us. The man did go to jail but we were very much left out of the loop in this case and abandoned by our church and support systems, which is dd mainly struggled with.

 

The current focus of dd's therapy is this abuse trauma. Her therapist's main job is in adolescent residential treatment, so I imagine she deals with all kinds of trauma. Is there a specific question to ask, or just, "Do you deal with trauma?"

 

The therapist feels that dd is still holding back on her, though she has made some progress. She feels dd isn't always honest with her about what's going on.

 

So what do you think? Thanks so much. :)

[MicheleB]

Just wanted to add... As far as I know, the cutting didn't begin until *after* the sex abuse incident. I did not realize she was cutting and she didn't tell me later.

[Terabith]

That is a unique combination of issues. Does your daughter LIKE this therapist? I think it's important for her to like and trust her. I think she should definitely be seeing a child psychiatrist as well, NOT a regular doctor. This kind of complexity, especially in a teen, very much needs to be treated by a specialist.

 

Actually, I'm kind of relating to your daughter. I have bipolar disorder, which in my case wasn't diagnosed until late college, but was clearly a factor as early as about age seven. And I have some issues with abuse/ PTSD. So, I know how complex this can be. Have you heard about C-PTSD? There is some overlap of symptoms with BPD. http://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder

 

I hate to hint at this, but sometimes people who have been abused, especially sexually, don't tell anyone about it. I'm wondering if there was any possibility that her friend's father could have abused *her?* I'm just wondering. Not at all necessarily the case by any stretch. Just know that that is sometimes the case.

 

Dialectical behavioral therapy can be very helpful, even if the person is not borderline. There are several components. They see a therapist individually each week, but there is also a group session, that focuses on developing different skills.

 

Do you think that her medications are working well for her?

[MicheleB]

That is a unique combination of issues. Does your daughter LIKE this therapist? I think it's important for her to like and trust her. I think she should definitely be seeing a child psychiatrist as well, NOT a regular doctor. This kind of complexity, especially in a teen, very much needs to be treated by a specialist.

*SIGH* I hate living where we live. I mean, I like where we live, but the distance from specialists and other out of the ordinary providers is about 2 hours. There is a psychiatrist in conjunction with the therapist she is seeing, but I don't believe he is a bona fide child psych. I am certain he sees teens, though, as I see a lot of teens in and out of there.

 

Actually, I'm kind of relating to your daughter. I have bipolar disorder, which in my case wasn't diagnosed until late college, but was clearly a factor as early as about age seven. And I have some issues with abuse/ PTSD. So, I know how complex this can be. Have you heard about C-PTSD? There is some overlap of symptoms with BPD. http://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder

I haven't heard of C-PTSD. I will look at this link.

 

Dd has *always* been 'intense'. Even as an infant. If anything was scratchy, if she got too hot and sweat a little bit, if her diaper was just the tiniest bit wet... she howled. She was early on all her milestones, but she was a serious little baby. She spoke at 9 months (she said 'cow' and 'what's that' and more)... she recognized all her letters by age 2, all her colors. Spoke almost perfectly at age 2. Taught herself to read at age 4. But just a very intense child. If she got hurt, she'd cry for hours. I mean, looking back, and compared with my other three (she's the oldest), she was different.

 

I hate to hint at this, but sometimes people who have been abused, especially sexually, don't tell anyone about it. I'm wondering if there was any possibility that her friend's father could have abused *her?* I'm just wondering. Not at all necessarily the case by any stretch. Just know that that is sometimes the case.

I think it's something I need to ask her again. You are very right... And unfortunately, my kids spent time over there and spent overnight over there a few times. They seemed like such a wonderful, homeschooling, Christian family and they went to our church. I thought we knew them.

 

Dialectical behavioral therapy can be very helpful, even if the person is not borderline. There are several components. They see a therapist individually each week, but there is also a group session, that focuses on developing different skills.

Thanks. I'll have to see if they even have that around here.

 

Do you think that her medications are working well for her?

Yes and no. It works well as in, if she does *not* take it, I can tell. It makes her tired and unmotivated. I feel bad for her. I also have bipolar disorder and I'm tired, too. It's hard to be motivated when you struggle so much with your moods. We've tried several things and this seems to be the best so far.

[Terabith]

This week's TIME Magazine has an article on BPD. Nothing exciting, but it's there and somewhat informative. It talks about dialectical behavioral therapy.