Does this seem like BPD?

My 15 year old daughter has been is basic psychotherapy for the past 1 1/2 years for anxiety, after having 2 panic attacks. This began after she switched to a new high school, having had to leave her two best friends, who went to other schools. Her psychologist believed she was getting worse and suggested a psychiatrist. I took her to a psychiatrist after she "switched" one evening from being her "normal" anxious self, to having flu-like symptoms and depersonalization that put her into a a 2-week morning depression, including more panic attacks that occurred only during evening were and always triggered by an external factor. Mind you, she is constantly sleep deprived being addicted to Facebook (and the computer in general) where she stalks people left and right and is constantly comparing herself to others. She was also becoming increasingly obsessed with making sure she was "acting like herself."

After going to the psychiatrist, he put her on anti-anxiety first, which took her feeling of dread away, but in my opinion, increased her rage and anger. Within two weeks she was cutting herself, always in reaction to an external factor (something either her father, a friend, or I said, or, her perception of a situation being way out of control in comparison to what it actually is). A mood stabilizer (Lamictal) was added, and so far, no change. Her day consists of waking up exhausted, agitated, and depressed-like, which wears off around 11am. She seems pretty normal during the day, and at night she is acting as if she is crazy. She refuses to go to bed, even after being heavily drugged with sleep aids, and refuses to get off the computer until anywhere from 4-5:30am. When we take it away, she goes insane, behaves like an addict, cuts herself, and punches things.

Other factors I have noticed: intense fear of being abandoned by her father and friends, and interprets things like a friend hanging out with another friend as rejection; only sees black and white and when asked to compromise, acts crazy, as if I am suggesting something appalling; misinterprets others' actions and expressions; paranoid that friends and teachers are out to get her, but mostly when she does not get her way; insatiable need for attention; non-stop talker; hyper; ADHD-ish; lack of focus and concentration and her grades went from all A's to barely passing some classes; mostly fine in public and a complete mess at home; able to attend theater classes and tutoring without a problem, but for the most part, has been out of school for 7 weeks; extremely self-absorbed; lack of empathy; very creative and talented; has, in the past, burst into tears out of nowhere for no obvious reason to anyone, including herself; has a very narcissistic father and I suspect; feels like she has demons in her head (no voices); thinks she is evil at times; one minute will be talking to me nicely, the next, calling me every name in the book; trusts no one; still experiences depersonalization and feels like she is in a dream; suicidal and wishes she were dead, but wishes desperately that she could be her old self; emotionally very young; a very fearful and worried child; wants revenge on people she feels have hurt her; refuses to do anything people tell her to do simply because they are telling her to do it; but, luckily has some nice friends who are trying to help her.

Her psychiatrist is treating her with the lean toward her having bipolar disorder, but think this in incorrect. She has never had a distinct depressive or manic episode, with the exception of feeling depressed in the mornings for some weeks (sleep deprivation is part of this I believe). And, all of her feelings are in reaction to what is going on around her, not just because.

This has become unbearable to live with and I am trying to get her all the help I can. But, I am in fear that she is being misdiagnosed.

Any advice? Suggestions? Does this all sound familiar to anyone?

You've obviously read the DSM criteria......so you have told us all those things that make you think she has BPD. You've pretty much made up your mind that she has it so it's really difficult to get through that bias in your view. That's not your fault - it's what every "normal" person tends to do when they come on here to ask "Is this BPD?"

From what you've said - she appears to meet criteria for BPD. BUT she is a teenager and that could also explain a lot. IN developmental terms she is trying to work out her identity and that's a difficult time. So I would say it will be difficult to get a diagnosis just yet. Sorry I can't help you more.

At this point, you should just concentrate on helping with the symptoms that she's portrayed so far. She's too young to be diagnosed as having a personality disorder due to mood swings & identity disturbance that comes along with the teenage years.

Thank you for your reply. Yes, I have read the criteria, but that does not mean I am convinced that she has it. It just seems to me, by looking at symptoms of the different dx that exist, and those that her therapists have considered (no one really knows what is going on), that BPD seems very much like my daughter, whereas other considerations, like bipolar or anxiety, don't really seem to fit. I am less concerned with the label, than I am with her getting the proper treatment, although clearly the two go hand in hand. Partly why I am concerned, is because I believe she needs some sort of cognitive therapy, not just a bunch of drugs and basic talky talk with the psychiatrist, which so far, despite this all being fairly new, is doing nothing while she is getting worse.

I understand it is difficult to dx teenagers, and yes, she is still trying to figure herself out. But, in the meanwhile, she is feeling tortured and begging her father and me for help. She is also close to losing her friends (luckily she some very understanding friends), and beginning to fail in school which she has been absent from for most of 7 weeks, despite wanting to go. I know that no one here can tell me one way or another what is going on with my daughter, but in hearing others' experiences with this, perhaps it can help me find the right treatment for her. Perhaps I should have titled/reworded my concern differently. I am sure you all get sick of this question, especially if you have been on this forum awhile, but this is all new to me, and I am just trying to find some help.

Thanks

From what you have told us, I think she definitely has BPD. No question in my mind. And she is also going through adolescent hell (changing schools, losing friends, missing classes, being perceived as different). The meds are not going to really do much for her core symptoms, which is probably what she has figured out already. The psychiatrist who thinks she is bipolar frankly sounds like an idiot. She probably feels that no one and nothing is helping her through this hell other than her friends on Facebook, which is why she is using it so much.

Here's my (nonprofessional) advice: get her some books on BPD and drop the psychiatrist and get a therapist who specializes in BPD. Encourage her to take care of her physical health, if possible. Also, reconnecting with old friends in person may help her a bit. I would focus on lowering her distress levels with all these tactics, and eventually getting her back to a normal routine in school. Last, I would watch for signs of PTSD or some kind of hidden trauma that might have affected her.

Good luck, she sounds like she has a very dedicated and caring mother supporting her...

Thank you all for your helpful responses. This may be a naive question, but can teenagers experience BPD symptoms, but not actually have it, and then outgrow these symptoms as they get older? Is this why professionals are hesitant to dx BDP in younger people? I guess I just don't understand the hesitation, if the symptoms are blatant, when in hesitating, a child could be missing out on proper care. While I understand that labeling can be dangerous to a young mind, my daughter is desperate to know what is going on with her, as without a dx, she is assuming that she is going absolutely crazy, and this is scaring her half to death. To me, her thinking that she is going crazy seems a lot worse than having some sort of explanation that, I assume, would add some understanding to all of this. When the psychiatrist began considering bipolar, she was relieved to know that "something" was causing al of this, as opposed to her having no idea what was happening and assuming that this is just who she is now.

Also, is a psychiatrist or a psychologist who specializes in BDP best? Or, does it make no difference as long as they specialize in the disorder and treatment? And, is medication beneficial at all? We have just started going down this road about 6 weeks ago, with great hesitation from both her father and I (to the point of being reprimanded by the psychiatrist---that was fun). The only benefit I see, is that my daughter's feeling of dread is gone on the Klonopin (and she says this feeling is the worst symptom of all of this), but, in exchange for this, she has become way more angry and says the Klonopin is making her unable to feel, which is why she started cutting herself (her words). Plus, I am concerned about the addiction factor with Klonopin, and have noticed my daughter acting like a junkie, begging for more, and taking more than prescribed the minute she feels any anxiety, because she is afraid she is going to have a panic attack in public (I have since had to hide the Klonopin). As far as the Lamictal, I haven't really seen a difference for better or worse, and the psychiatrist wants to switch her to lithium (to speed up the mood stabilizing process), for which I am not on board for various reasons.

Lastly, has anyone here used melatonin, valerian, or any other alternatives for anxiety? My daughter takes melatonin at night, but has been popping them during the day b/c she says they make her really calm. I have told her that melatonin is not for use during the day, but she could care less. I am wondering if anyone here has ever switched from an anti-anxiety to something more natural, as I really don't want her on this stuff.

Thank you so much for any input.

HI,
I'm sorry if I upset you with my original repsonse - I didn't mean to imply that you were fitting the symptoms to the criteria; it's just that's what some people do when they're desperate for an answer.

can teenagers experience BPD symptoms, but not actually have it, and then outgrow these symptoms as they get older?

No. If they stop displaying symptoms when older then it wasn't BPD i the first place, more likely normal teenage identity problems with possibly a bit of depression or other mood disorder. BPD is lifelong IMO. It's your genes that determine your temperament and your ability to control your emotions. If you don't have the genes for it, you will never have the genes for it. I know that from my earliest memories i got upset much more and much more often than other kids my age. It was noticeable from my first school report aged 5 that "isoko gets upset when she can't do something". I didn't realise HOW disordered my emotions were until I started therapy and now I can see it in everyday situations. Criticism, belitlling, abandonment and rejection - all major triggers for exaggerated emotional reactions from me. I become irrational because the emotions take over and I am helpless to stop it from happening. What I CAN do though (after 2 years of therapy) is recognise that it is happening/has happened and give myself space to bring my rational side back into play. But it is very hard work and with BPD you need to be taught these skills because we just don't have them built into our programming like normal people do. You will probably notice that your daughters emotional reaction is far greater than necessary - and if lots of 'little' upsets happen over the space of a day, by night it can be unbearable because you are living on sheer emotions.

I guess I just don't understand the hesitation, if the symptoms are blatant, when in hesitating, a child could be missing out on proper care.

Hesitation is not necessarily a bad thing at this stage. It COULD be normal teenage identity issues. She is still developing so you just can't say 100% at that age. However, that doesn't mean you can't help her out with some therapy so she can learn to identify how she is feeling, why she is feeling that way, and how to deal with the emotion in a helpful, healthy way.

BPD is not something you grow out of - and you will always have a more disordered way of thinking and reacting. therapy gives you the skills so that it stops being a problem in your day to day life. That is when you have "recovered".

Also, is a psychiatrist or a psychologist who specializes in BDP best? Or, does it make no difference as long as they specialize in the disorder and treatment? And, is medication beneficial at all?

Psychiatrists dole out the medicine. they are the ones who will probably give a dx. Psychologists - they're the ones who actually help you learn the skills. The best therapy is NOT Cognitive Behavioural Therapy but something called Dialectic Behaviour Therapy. There are DBT skills workbooks (plug it into Amazon) which you can do yourself at home with your daughter until you can find a psychologist or group for her to attend. Another helpful therapy is called Schema therapy and it works on your core beliefs about yourself as those are the ones that cause longstanding problems. It may be that circumstances are causing the problem, and once circumstances have changed, your daughter could recover and not display any of the symptoms of BPD. Or it could be she has BPD and the circumstances are making things worse. But therapy from a psychologist will help unravel what's going on in her mind.

Medication - will not cure her. As you've discovered. It can help get rid of some of the anxiety, but in the long-term it just masks the problem. If she wants to get on in life, she needs to work out WHY she is anxious and gradually increase her t]olerance to situations where she feels anxious. It's best to start this now, before she gets to the point of not wanting to leave the house. But there's a lot of cognitive reasoning to get you used to exposing yourself to the anxiety and then recognising that nothing bad happened, then increasing the anxiety level a bit more. If she gets too dependent on meds to do that, she'll never come off them. Mood stabilisers like Lamictal and lithium help some people but not others. I was on lithium for about 8 months and all it did was b&gger up my thyroid. If she's still THINKING in negative ways then medication will not really help solve the problem. I take an anti-depressant (mirtazapine) and it does keep me at a reasoable level; if I miss a few days then I wake up feeling low and then my negative thinking is more likely to take over and things spiral out of control.

It took over a year in hospital to get my diagnosis and then another year and a half to reach a point where I believed I could manage on my own....and another 7 months out of hospital to actually think about muttering the words "recovering". The most important thing I think is to make sure your daughter is aware that only SHE can make herself better. There is no magic pill if her thinking is distorted. She has to be willing to put in the work and then she WILL see results. I know because this time last year I was in a locked ICPU, believing that I was never going to get out of hospital and I was never going to be able to do half the stuff I now do every day. I was made to feel like I had no power over my life whereas it's the converse that is true - I am the ONLY one to have power over my life.

I hope that helps.

Thank you Isoko. That is very helpful, and I agree that she has to want to help herself. She says that she does, begs for help, but then does everything opposite of what has been suggested. Her thinking is very negative with no flexibility whatsoever, she sees no hope (and unfortunately thinks the medicine will just snap her out of it, which she has repeatedly been told is not the case, and is so far proving not to be the case), and has a very distorted way of thinking that, to me and others, seems very irrational.

She was not a temper tantrum kind of kid growing up, but in early grade school (and now), would get upset if she could not do something right away. It is hard to know if she is copying her father's behavior (as I highly suspect), as he also reacts 100x beyond what is appropriate in many situations. She has seen this her whole life, and now, at this age hates him, as she fears she is becoming him. He has never been dx with BDP, but when I mentioned the symptoms to him, he said, "Hmmm, sounds like me." In reality, he way more fits the bill of someone with Narcissitic Personality Disorder. My daughter has said to me that he was her best friend growing up, that she idolized him, and that whatever he said to or about her, she assumed was right, even all the negative things he said to her, which were many (he also talks about humans terribly in general, saying that people suck, people are a terrible species, and that you can trust noone––she has heard this her entire life. When she was about 11 or 12, she pulled away from him, realizing that he was not all that (shattering her image of him as an idol), but felt immense guilt for doing so. By 14, she rebelled against him with no problems in the guilt department, but because of her rejection of him, he acted more and more nasty to her, thus making the relationship worse. By 15, with the added stress of yet another new school, she could handle nothing, felt like she was nothing, that he does not see her for who she is, that he is impossible to speak to as everything he says is right and he constantly manipulates and twists conversations. It seems like no coincidence that the day she "switched" into a very noticeable downward spiral, was the week he was out of town working. She said, during this time, that he won't even allow her to let go and be the sick one, since it is him who needs all the attention all of the time. She also worries about him killing himself (she saw him have 3 horrific panic attacks (I assume that is what they were) where he was saying he wanted to die, although he is not suicidal), or that he can't handle her being ill right now. It is a mess, and I often wonder if he should be removed from house at this time (I know, it's seems like a no brainer), although, him leaving her is one of her worst fears. Right now, he is remaining calm and trying to be there for her, but the truth is, he does not totally understand the gravity of her situation, and really, does not have the emotional capacity to ever put anyone but himself first ––he proves this over and over again, and both she and I know it. To add to the picture, the first and worst panic attack (if that is what it was) that she saw/heard her father have, was during the night and woke her up. She was terrified and said it was the worst night of her life. She had her first panic attack about 2-3 months after, and all others have always been at night, and now, she refuses to go to sleep. PTSD? What are the difference between PTSD and BPD? Sorry I am blabbing, but just wondering if all of this sounds familiar to others and what can I make of it. Thanks for listening.

PS. Isoko- I am amazed at how much you have been through and how incredibly strong you are.

PTSD is post-traumatic stress disorder. I'm not totally clued up on it but it's basically exactly what it says. If you have had a traumatic event, or series of traumatic events in your life, they can cause a mood disorder (e.g. anxiety or depression). The brain remembers the event, triggering the emotions that went along with the event, so that you feel like you're re-living it....although sometimes you don't actually know WHAT the event was, your body just remembers the horrible feelings....and that can make it worse because you have no idea what is going on. I think that's roughly the idea.....there is a PTSD forum as well.

I can understand that she feels she has no hope - when you're feeling that bad all the time, it's almost impossible to remember a time when you felt better (that's one of the big problems with BPD). We all hope for a magic pill, I know I did, because it's a lot to get your head around. To suddenly be told that you're not ill in the traditional sense, but it's a lifelong condition...takes a bit of getting used to. I think my Dad still wishes there was a magic pill.

My Dad, when I got my dx, read up on it along with my step-mum and he feels he can meet 4 or 5 of the criteria too. But they're not enduring problems for him as such. He may feel awkward in social situations but it's not the dysphoria that I feel and he has the skills to regulate his emotions. BUT my step-mum reckons he has Asperger's traits (she has worked all her life with kids with autism etc) which are quite similar to BPD traits in some ways. So there may very well be something in the genetics of my family and in yours.

I can understand the getting upset when you can't get something right - that's my main problem....but it's teasing apart what is "natural" and what has developed from her Dad......it doesn't really matter which one it is if it's causing her a problem in her life. It's gradual re-teaching that it's OK to get something wrong.....every fibre of my being cringes even typing that!

It's hard, because it could be that genetically she's got a bit of a dodgy set where she is perhaps more sensitive than "normal" to criticism. Then she's had stressful situations reinforcing negative thinking, plus changing school.....it's not necessarily full blown BPD but, if she doesn't get some sort of therapy to help her work out her thoughts and emotions, it could very easily develop into it. it's often a combination of genetics and childhood problems/abuse that leads to a dx of BPD in adults. Me - I just got a really lousy set of genetics that meant I couldn't fit into normal society so I got negative reactions for me being me....but not abuse really. Just misunderstanding. It was only a really bad set of circumstances (moving house, best friend being murdered, not having a job, then having a sick baby, post-natal depression, GPs not listening to my concerns over said sick baby) that led to me having a full blown BPD crisis episode. When life is going OK - in that I feel accepted, I am confident of what I am doing and what I am expected to do - then I function almost as normal. Sure I still get upset more easily than those around me and I hate social situations, but I would be considered normal. I can function. I have just learned what my particular triggers are, and I try to adjust my life so I have the best set of variables around me.