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Mother needs some advice.

A

Absynith

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My daughter has struggled with her mental health since she was 12. She has been in and out of psychiatric hospitals. Many different and multiple diagnoses. She is now 18. I now no longer have the ability to force her to get the help she so desperately needs. She has been diagnosed as Bipolar Type 2.
Tonight was a bad night. I haven’t even been to bed yet. I’m terrified. I had to take her to the hospital. I had to practically force her to go. It was her current boyfriends birthday party. She said he was driving and they got into an argument. That he grabbed a gel candle that was in the car and attacked her with it. She had multiple lacerations on her arm. One deep and wide that needed stitches. He refuses to tell me what happened until he retains a attorney. My daughter swears up and down that she did not do this to herself. And I want so desperately to believe her. But I can’t. I’ve seen her go into psychosis many times in the past. The kind where she starts to hurt herself or someone else and I have to call EMS to come help. Usually that means a trip to the ER and a psych evaluation. And then they would admit her into a RTC. Now that she is 18 I no longer have the right to get her to do a psych evaluation. And I’m horribly afraid just based on past experiences with her and her illness that she did in fact so this to herself. She is planning on filing charges against the young man today. Charges that could possibly ruin his life. If he did in fact do this to her, he does need to face the consequences. I went and viewed the car that this incident happened in. And I just can’t wrap my head around things happening the way that she said that they did, based on the location of the busted glass, which is next to the passenger side door. And the fact that the boyfriend in question is a small guy. Very short, and I just do not see him having the kind of reach that he would need to do this to her while driving.
And now I am dealing with the guilt of not being able to fully believe the story that she told me. I want to believe her. But with all the stuff I have had to deal with for years, well, it is incredibly hard. I haven’t told her I doubt her story. But I do. And I have no clue on what to do. Or how to proceed. Or even how to get her the help she so desperately needs. She refuses to take meds. I am really not sure what to do anymore. I would appreciate any advice. I’m so lost and scared right now. I just want her to be okay. I probably seem like a horrible parent. But I really do not know where to turn for help. I’m the only person in our family that has not left her because of her illness. Everyone else including her father have nothing to do with her. I would really appreciate any advice or any resources that anyone knows of that might help me find something that would help her be okay. I’m so incredibly scared for her. Thanks so much.
 
Tawny

Tawny

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You can request a psychiatric evaluation for an adult. I would do that although if this event goes to court, they will do that anyway.

Is it possible you can call the police, where she is reporting this, and fill them in on her history? I think they would value your input and also be able to call in their nurse or doctor to asses her if they think it necessary.

Clearly you cannot deal with all of this on your own, nor should you have to. We all need someone to share this type of responsibility with.
 
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Absynith

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Thanks for the reply. I talked to a local NAMI group a few weeks ago and in my state I have to go to court to get them to do the psych evaluation. And then possibly have her involuntarily committed. Which takes time to do apparently. I’m afraid that if I do that and if she finds out somehow she will hurt herself, or possibly myself. She has such a good heart. I know it’s there. But she won’t make any appointments with her Drs or take any meds and she has been so manic lately. It’s always worse when she thinks that people are abandoning her. I think she might have BPD but gonna stick with the label they first gave her that has stuck around the longest. Are there any resources out there to help parents with adult children who have mental illness that you are aware of? And you are correct, I cannot keep doing this alone. It is so incredibly unbearable at times. So overwhelming. Thanks again.
 
Tawny

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That's a different procedure to here, we just call the police or contact their doctor or nurse.

I will see what i can find out.
 
Tawny

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The diagnosis doesn't really matter but it sounds like she needs some help and medication works quickly, unlike any talking therapy or other therapies.

Have you spoken to the boyfriend?
 
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Absynith

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He refuses to talk to me without getting a attorney first. But he has been getting on social media talking bad about her. Saying she harmed him and then herself.
 
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timing

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If someone is a danger to self or others the police can force the person into immediate treatment.

A court can also order someone into outpatient treatment. I believe this is the case in Mississippi.

You are a truly concerned mother and remind youself of that everyday.
 
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Orpington

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Absynith: I feel so sad for you and your daughter. I am simply writing as the parent of a son with a mental illness, and I want you to know you are not alone. I know it is hard to know if you're being told the truth, how to read the vacant eyes, not knowing how to explain things/actions to others, etc. I also know what it feels like to simply refuse to give up. My son had some troubles that seemed larger than life at the time. Unfortunately there were some consequences, but they played a role in forcing him to get help. Stay strong.
 
A

Absynith

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Absynith: I feel so sad for you and your daughter. I am simply writing as the parent of a son with a mental illness, and I want you to know you are not alone. I know it is hard to know if you're being told the truth, how to read the vacant eyes, not knowing how to explain things/actions to others, etc. I also know what it feels like to simply refuse to give up. My son had some troubles that seemed larger than life at the time. Unfortunately there were some consequences, but they played a role in forcing him to get help. Stay strong.
Yes! Exactly. I’m trying. But man oh man, what I would give for some peace. I hope your son is doing well now. Thank you!
 
S

Shlink

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Thanks for the reply. I talked to a local NAMI group a few weeks ago and in my state I have to go to court to get them to do the psych evaluation. And then possibly have her involuntarily committed. Which takes time to do apparently. I’m afraid that if I do that and if she finds out somehow she will hurt herself, or possibly myself. She has such a good heart. I know it’s there. But she won’t make any appointments with her Drs or take any meds and she has been so manic lately. It’s always worse when she thinks that people are abandoning her. I think she might have BPD but gonna stick with the label they first gave her that has stuck around the longest. Are there any resources out there to help parents with adult children who have mental illness that you are aware of? And you are correct, I cannot keep doing this alone. It is so incredibly unbearable at times. So overwhelming. Thanks again.
When you say so manic, do you technically mean hypomanic? As the diagnosis is type II bipolar, that means never full mania right? (impairing of functioning, needing hospitalisation, can be psychotic)? Unless caused by drugs/meds.

And so when you mention psychosis, I guess you mean when in a depressed state?

I'm interested in the vaguenesss around this and 'bpd' as well. I imagine you've checked into it a lot, I just had another look and this article was out the end of last year and in the full text there's a table summarising the latest findings on average differences between people with the different diagnoses, if that might help I could paste the table here I guess Differential Diagnosis of Bipolar II Disorder and Borderline Personality Disorder - PubMed
 
A

Absynith

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I’ve done sooooo much reading on it that everything all spends together sometimes. Always looking for an answer. Always.
Manic as in super impulsive. No thought to risk factors regarding herself or anyone else. Horrible horrible decisions and choices.
She does has psychotic episodes. When she does, everything changes about her. She even looks different! It’s incredibly scary to witness. And that is when it is worse, and she usually tries to hurt herself or someone else with no memory of her actions.
When she was first diagnosed it was with MDD because they would not label her with BP until she was almost an adult. She has also been diagnosed with CD and a few other things before finally getting the BP2 disorder when she was 17. That was by a psychiatrist in RTC. But her therapist in RTC thinks that she has BPD based on her response to rejection and how she worries so much about what people think of her. Sometimes everyone gets a different girl based on who she is talking to. After reading about BPD I tend to agree that is a better fit sometimes.
 
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Absynith

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She can never be without a partner. And when her and whoever her current partner is part ways she doesn’t handle it very well. Becomes more impulsive. More destructive. It is heartbreaking to watch. She is very very codependent. I am not.
 
S

Shlink

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The diagnostic category/stereotype system is still quite problematic scientifically isn't it. Social anxiety is common with bipolarity, now specifically noted in the latest DSM, but the dramatic/psychotic reactivity to rejection I can see what you mean re Borderline.

How does your daughter think the therapy is going in the residential treatment center?

What reasons does she give for not wanting to take a medication to hopefully avoid harming herself or others?

I might as well stick the recent research summary here (pasted with some reformatting).

1. Heritability

Bipolar type 2: More likely for there to be a first-degree relative with Bipolar disorder (especially Bipolar type 2).

Borderline PD: Less likely to have a first-degree relative with Bipolar disorder; more likely for relatives to have impulse control disorders (antisocial personality and substance abuse), unipolar depression or borderline features.

2. Age of onset

Bipolar2: Onset usually in late teenage years with a distinct ‘trend-break’

Borderline: Lack of clear onset, with emotional difficulties since childhood

3. Mood state precipitant

Bipolar2: More likely autonomous (but can also be reactive)

Borderline: More likely to be triggered by interpersonal interactions (such as perceived abandonment)

4. History of childhood sexual abuse

Bipolar2: Lower likelihood

Borderline: Higher likelihood

5. Gender

Bipolar2: Slight female predominance

Borderline: Female preponderance in clinical settings

6. History of other developmental trauma (e.g. physical and emotional abuse)

Bipolar2: Lower likelihood

Borderline: Higher likelihood

7. Early parental relationships

Bipolar2: Distant/rejecting parent unlikely

Borderline: Distant/rejecting parent likely

8. Childhood depersonalization

Bipolar2: Unlikely

Borderline: Likely

9. Psychotic features

Bipolar2: Hypomanic states lack psychotic features by definition; Bipolar II depressive states may rarely include psychotic features

Borderline: Transient psychotic features are common, especially under stress

10. Phenomenology of ‘highs’

Bipolar2: Grandiosity, euphoria (can be irritable); anxiety typically abates

Borderline: Euphoria rare or brief (i.e. < 48 h); anxiety often distinctive

11. Depressive symptoms

Bipolar2: More likely melancholic in nature

Borderline: More likely non-melancholic in nature

12. Affective instability

Bipolar2: Severity: May be present but generally not severe. Quality: Shifts from euthymia to depression or elation. Triggers: More likely autonomous

Borderline: Severity: Commonly high. Quality: Shifts from euthymia to anxiety or anger. Triggers: More likely interpersonally driven

13. Emotional regulation

Bipolar2: Maladaptive strategies less severe; adaptive strategies superior

Borderline: Maladaptive strategies more severe; adaptive strategies impaired

14. Deliberate self-harm and suicide attempts

Bipolar2: Less likely

Borderline: More likely

15. Neuropsychological deficits

Bipolar2: Both trait and mood-state dependent deficits; broad deficits in executive function and sustained attention

Borderline: Executive function deficits less clear. Sustained attention intact

16. Impulsivity

Bipolar2: More likely during a hypomanic episode; ‘attentional impulsiveness’

Borderline: Not necessarily related to mood state; ‘non-planning impulsiveness’

17. Personality variables

Bipolar2: No distinctive personality traits

Borderline: Distinct sensitivity to criticism by others

18. Social cognition

Bipolar2: Impaired theory of mind; likely moderated by mood state

Borderline: Failure of ‘mentalization’

19. Relationships

Bipolar2: Generally stable relationships; less avoidance due to fear of rejection

Borderline: Distinctive relationship difficulties; avoidance due to fear of rejection

20. Self-identity

Bipolar2: May be impacted during mood episodes, but more stable when euthymic

Borderline: ‘Painful incoherence’

21. Prognosis

Bipolar2: Does not remit with age, and can often worsen

Borderline: Tends to improve over time, and criteria for the disorder may not be met by middle age

22. Treatment response

Bipolar2: Mood episodes likely to respond to mood stabilizers and atypical antipsychotic drugs.

Borderline: Poor response to mood stabilizers; non-specific response to medications (e.g. sedation)
 
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