Bipolar or Borderline?

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  • Question

     

    Cindy writes:

     

    I am concerned that my daughter, aged 20, is bi-polar. She has been treated for depression, but will not take her medication. She has been cutting herself for about three years now. Her moods change from high to low rapidly, she cares nothing about her surroundings, can't hold down a job for longer than a few months, has dropped out of art school twice, abuses alcohol and drugs, is not eating or sleeping properly, is sexually promiscuous and becomes aggressive and abusive if I attempt to criticise any of her behaviour or suggest ways she could improve her life. She seems incapable of shouldering any of the responsibility for things going wrong in her life, it is always someone else's fault. And most of this does sound like typical teenage behaviour. The thing is, this young woman is 20, and is amazingly talented at art, writes incredible poetry (mostly suicidal though), and up until a couple of years ago seemed to be a relatively untroubled young woman. I love my daughter no matter what, and for a long time have felt that it was just bad behaviour, and that eventually she would grow out of it. I now feel that there is more to it than that, and I would welcome any comments or suggestions. There is no way I could talk to her about this, and to get her to see a doctor would be next to impossible right now. She is living at home with my partner, my son and I, and although I do love her dearly, there is now a huge strain on everyone in the house, and it seems that her state of mind overshadows anyone and anything else. It is like living with a volcano, never knowing when it will erupt next. What do I do to help her?

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    Answer

     

    Hi, Cindy. This is the hardest question in the world to answer and you have my sympathy. Teens and young adults often don't listen, and often need to fall down hard before they do. The behavior you describe could also be attributable to borderline personality disorder, which superficially resembles bipolar. The cutting behavior sent up a red flag. Individuals with borderline typically have their loved ones walking on eggshells.

     

    I would ordinarily suggest a psychiatric opinion, but too many psychiatrists tend to save the diagnosis for smart patients who stand up for themselves (which is a form of psychiatric abuse). Otherwise, they are very hesitant to apply the diagnosis.

     

    You may want to try a talking therapist who specializes in treating borderline.

     

    If the behavior stems from borderline, your chances of engaging in rational discussion with your daughter is way less than for bipolar (this is my personal view, based on my own experience, not on any medical knowledge). Bipolars at least come back down to earth when their episodes recede. By contrast, it is virtually impossible to know what will provoke someone with borderline and for how long.

     

    It sounds like you have exhausted your patience. Feel free to resort to tough love. Your house, your rules. If she is willing to go along with your rules, the compassionate approach is to make the environment as safe for her as possible. Try to make her feel comfortable in her own space without letting her control you or the other members of your household.

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    For more on borderline, check out the article I wrote on my website.

Published On: October 06, 2007