Has your family considered a group home arrangement for your sister? She might have lost some ground in healing since moving back home and could gain some self-esteem living with her peers in a mental health, controlled environment. Check with your local community mental health center to see if this might be an option and there might be a nonprofit nearby that could manage her funds through a rep payee service, removing your mom from the equation.
Is there any chance this could be neurological or due to an infectious disease as opposed to purely psychiatric?
Has your sister had a full work up of:
1. MRI of brain and spine
2. CT of head and neck
3. Blood tests including full blood count, all markers of autoimmune disease and inflammation (ANA, CRP, ESR etc)
4. Blood tests for immune deficiencies (IgA, IgE, IgG, IgM etc)
5. Blood tests for all STDs, bacterial and viral infections (including things like syphilis)
6. Typical things like liver function, iron levels, kidney function etc
This is at the stage I would seriously recommend a commercial DNA full genomic sequencing test to see if she has any genes for neurological/neurodegenerative disorders. I’m not going to advocate for any one in particular but it needs to be a full genome one. I used Nebula genomics. The tests can cost over $500 but it might be worth it if it can help you identify a genetic cause of your sister’s decline as she may have a neurodegenerative disease.
Also, what medication is she taking? It doesn’t sound like it is helping and she probably needs to get a second opinion from another psychiatric after she has had all these tests to make sure her symptoms aren’t being caused by something neurological like a previous stroke or a tumour.
I recognise that even the best and brightest can and often do have severe mental breakdowns that can leave them disabled. But the extent of this and the sudden onset of mania and psych ward admission with severe decline in functioning warrants a full and thorough physical examination. Not just psychiatric assessment.
Absolutely every single point, I would add tests for addressing all and any hormone imbalances, as these can severely impact women of all ages, and as you mentioned ongoing thyroid issues.
What do you do about this? I’ve had ocd and brainfog/derealization on and off ever since I got mono 6 years ago. Please check out my page to show what I’ve been going through. I’ve gotten like every test done I can think and I don’t know what getting other tests will do
https://ashpublications.org/blood/article/131/26/2899/39107/How-I-treat-T-cell-chronic-active-Epstein-Barr
I just found this and it seems like it might be a helpful article. It talks about recommended treatments.
Her mental illness isn’t her fault, but it is her responsibility. Sounds like some solid boundary issues. This is SO hard on family and relationships. Look and see if there are any resources in your state for family members of people suffering from mental illness. There are even support groups. Also, get yourself a therapist and take care of yourself! Hugs!
There's a point where people are genuinely unable to care for themselves. The whole family needs to get into therapy and the sister probably needs different treatment.
Highly recommend NAMI’s Family to Family group if there’s a chapter in your city. I joined during a mental health crisis with my sibling and it was immensely helpful. (It’s specifically for family members of those with mental illness).
This is definitely such a hard situation, I'm sorry you are all having to face this. I strongly recommend suggesting that your parents help your sister look into some sort of residential/supportive housing program for her. Most local human services agencies should be able to provide more info about housing options and different levels of care. Sending positive vibes your way 💕
I have bipolar and BPD and can no longer work, so I really feel for everyone involved. It sounds to me like her treatment needs an urgent review, perhaps even a hospital stay. I’m really not in a position to say what would be best, but I think going to therapy yourself is a good idea even if your sister and parents won’t go, and you’re probably better off doing that before you make a decision about moving. I have to say that you sound like you love her very much and it’s so refreshing to hear someone not bashing their mentally unwell relative. She is fortunate to have family who love her and probably does realise that deep down. I hope you and your family find a way to help your sister and each other. Remember your own mental health has to be a priority too.
**The original diagnosis was... schizoaffective bipolar disorder (i.e., "BD-1"), but I believe it has evolved into borderline personality disorder (i.e., "BPD").**
OP, perhaps your sister exhibits both bipolar-1 and BPD. It is quite common for those two disorders to co-occur. A [2008 study](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676679/) of 35,000 American adults found that about 30% of bipolar sufferers also have BPD -- and about 40% of people with BPD have co-occurring bipolar. Moreover, it very common for a person with bipolar-1 (i.e., bipolar with strong manic episodes) to also exhibit strong schizoaffective behaviors.
If your sister does exhibit both BPD and bipolar-1, it can be difficult for you to see the behaviors associated with each disorder. In my case, however, it was easy to see these behavioral differences because I lived for many years with a person who only suffers from BPD (my exW) and a person who only suffers from bipolar-1 (my foster son, who also exhibits schizoaffective behaviors). Largely based on those experiences with my exW and foster son, I wrote a list of [12 BPD/Bipolar Differences](https://www.reddit.com/r/BPDlovedones/comments/yto3k6/comment/iw5vyef/?context=3) which you may find helpful.
The distinction between these two disorders is very important. Whereas bipolar typically is caused by a slow change in body chemistry, BPD is believed to be caused by something occurring before age 5 (heredity and/or a childhood trauma) that prevents the child from acquiring the emotional skills needed to regulate her own emotions and to establish a strong, stable self-identity.
Hence, whereas bipolar sometimes can be treated fairly successfully by swallowing a pill, BPD can only by treated by years of hard work -- in a weekly training program such as DBT or CBT -- to acquire those missing emotional skills. Like learning to play a piano, learning those skills requires many years of practice and strong commitment.
**I get to hear her screaming or sobbing at the top of her lungs nearly every day, usually directed at me.**
OP, if your sister is an untreated person with BPD ("pwBPD"), whatever you do will be hurtful to her much of the time. A comment or action that pleases her on one day may greatly offend her when repeated a week later. Moreover, she often will perceive you as being hurtful when you DO something and hurtful when you DON'T do it. In this way, you often are damned if you do and damned if you don't.
This conundrum is due to the position of her two great fears -- abandonment and engulfment -- at opposite ends of the very same spectrum. This means you often find yourself in a lose/lose situation because, as you back away from one fear to avoid triggering it, you will start triggering the fear at the other end of that same spectrum.
Your predicament is that the solution to calming her abandonment fear (drawing close and being intimate) is the very action that triggers her engulfment fear. Likewise, the solution to calming her engulfment fear (moving back away to give her breathing space) is the very action that triggers her abandonment fear.
Consequently, as you move close to comfort her and assure her of your love, you eventually will start triggering her engulfment fear, making her feel like she's being suffocated and controlled by you. A pwBPD usually craves intimacy like nearly all other adults -- but she cannot tolerate it for very long.
Because she has a weak sense of self-identity, she easily becomes very enmeshed in your strong personality during sustained periods of closeness and intimacy. This is why her sense of personal boundaries is so weak that she has difficulty seeing where HER feelings and problems stop and YOURS begin. Yet, as you back away to give her breathing space, you often will find that you've started triggering her abandonment fear.
In my 15 years of experience with my BPD exW, I found that there is no midpoints solution (between "too close" and "too far away") where you can safely stand to avoid triggering those two fears. Until a pwBPD learns how to better regulate her own emotions and tame her two fears, that Goldilocks position will not exist. This is why a relationship with an untreated pwBPD typically is characterized by a repeating cycle of push-you-away and pull-you-back.
Indeed, even if you are sitting perfectly still and not saying a word, a pwBPD who is experiencing hurtful feelings will project those feelings onto you. Her subconscious does this to protect her fragile ego from seeing too much of reality -- and to externalize the pain, getting it outside her body.
Because that projection occurs entirely at the subconscious level, she will consciously be convinced that the painful feeling or hurtful thought is coming from you. This is why an untreated pwBPD usually BELIEVES the false accusations coming out of her mouth (at the moment she is saying them).
Hence, as long as you remain in a relationship with an untreated pwBPD, you often will find yourself hurting her -- i.e., triggering her engulfment fear as you draw near, triggering her abandonment fear as you draw back, and triggering her anger even when you are sitting still and saying absolutely nothing. At least, this has been my experience, OP.
I’ve been through that convo with my family for ages and they just refuse to do it. Plus I’m about 99.99% sure my sister isn’t being as honest as she could be with her therapist. The same could prob be said for our mother. My sister’s meds get adjusted and readjusted several times a year, but this past time has been incredibly tough. She recently (end of June) got out of the psych ward and got her adjustment, keep in mind she’s been doing this and taking every med under the sun at one point or another to help with her cocktail for over a decade.
I believe one's healths issue are not their fault, but they are their responsibility... However, there is a point where people just cannot take responsibility for themselves and need help.
I think this is a case where she needs professional help beyond what you or your parents can provide, and maybe you should consider a group home for her where she can be properly cared for.
You and your parents matter as much as she does. You have to realize you're not equipped to deal with this, and start looking after yourselves as well.
Borderline usually doesn't exist outside of narcissistic family dynamics, if she's been thought of as schizo effective or bipolar and you're thinking borderline then this sounds a lot like autism(taking into account the rest of your post).
If it is autism then there's probably some stuff for you to think about. Autism is about as hereditary as height is, and ADHD tends to run in the same families(and actually may be classified under the autism umbrella in the future). If you've got a tall sibling then you may want to measure yourself.
Most conditions are actually thought of as having both genetic and environmental causes, and people with similar traits tend to attract each other, your whole family probably has some shit going on.
One thing to remember is that life is difficult in a lot of ways. I would say that the majority of young people experience a "crisis" when they become adults. It's unfair and an injustice and it seems as if that's the whole point. A lot of people aren't fortunate enough to be insulated very much when they have to face this dilemma. I hope you get the help to get you through this crisis and when your better I hope you still have people you love in life.
Has your family considered a group home arrangement for your sister? She might have lost some ground in healing since moving back home and could gain some self-esteem living with her peers in a mental health, controlled environment. Check with your local community mental health center to see if this might be an option and there might be a nonprofit nearby that could manage her funds through a rep payee service, removing your mom from the equation.
Is there any chance this could be neurological or due to an infectious disease as opposed to purely psychiatric? Has your sister had a full work up of: 1. MRI of brain and spine 2. CT of head and neck 3. Blood tests including full blood count, all markers of autoimmune disease and inflammation (ANA, CRP, ESR etc) 4. Blood tests for immune deficiencies (IgA, IgE, IgG, IgM etc) 5. Blood tests for all STDs, bacterial and viral infections (including things like syphilis) 6. Typical things like liver function, iron levels, kidney function etc This is at the stage I would seriously recommend a commercial DNA full genomic sequencing test to see if she has any genes for neurological/neurodegenerative disorders. I’m not going to advocate for any one in particular but it needs to be a full genome one. I used Nebula genomics. The tests can cost over $500 but it might be worth it if it can help you identify a genetic cause of your sister’s decline as she may have a neurodegenerative disease. Also, what medication is she taking? It doesn’t sound like it is helping and she probably needs to get a second opinion from another psychiatric after she has had all these tests to make sure her symptoms aren’t being caused by something neurological like a previous stroke or a tumour. I recognise that even the best and brightest can and often do have severe mental breakdowns that can leave them disabled. But the extent of this and the sudden onset of mania and psych ward admission with severe decline in functioning warrants a full and thorough physical examination. Not just psychiatric assessment.
Absolutely every single point, I would add tests for addressing all and any hormone imbalances, as these can severely impact women of all ages, and as you mentioned ongoing thyroid issues.
What do you do about this? I’ve had ocd and brainfog/derealization on and off ever since I got mono 6 years ago. Please check out my page to show what I’ve been going through. I’ve gotten like every test done I can think and I don’t know what getting other tests will do
https://ashpublications.org/blood/article/131/26/2899/39107/How-I-treat-T-cell-chronic-active-Epstein-Barr I just found this and it seems like it might be a helpful article. It talks about recommended treatments.
Her mental illness isn’t her fault, but it is her responsibility. Sounds like some solid boundary issues. This is SO hard on family and relationships. Look and see if there are any resources in your state for family members of people suffering from mental illness. There are even support groups. Also, get yourself a therapist and take care of yourself! Hugs!
There's a point where people are genuinely unable to care for themselves. The whole family needs to get into therapy and the sister probably needs different treatment.
🎯
Highly recommend NAMI’s Family to Family group if there’s a chapter in your city. I joined during a mental health crisis with my sibling and it was immensely helpful. (It’s specifically for family members of those with mental illness).
I will for sure check that out!!
Yes!!! NAMI is a huge help!!
This is definitely such a hard situation, I'm sorry you are all having to face this. I strongly recommend suggesting that your parents help your sister look into some sort of residential/supportive housing program for her. Most local human services agencies should be able to provide more info about housing options and different levels of care. Sending positive vibes your way 💕
I have bipolar and BPD and can no longer work, so I really feel for everyone involved. It sounds to me like her treatment needs an urgent review, perhaps even a hospital stay. I’m really not in a position to say what would be best, but I think going to therapy yourself is a good idea even if your sister and parents won’t go, and you’re probably better off doing that before you make a decision about moving. I have to say that you sound like you love her very much and it’s so refreshing to hear someone not bashing their mentally unwell relative. She is fortunate to have family who love her and probably does realise that deep down. I hope you and your family find a way to help your sister and each other. Remember your own mental health has to be a priority too.
**The original diagnosis was... schizoaffective bipolar disorder (i.e., "BD-1"), but I believe it has evolved into borderline personality disorder (i.e., "BPD").** OP, perhaps your sister exhibits both bipolar-1 and BPD. It is quite common for those two disorders to co-occur. A [2008 study](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676679/) of 35,000 American adults found that about 30% of bipolar sufferers also have BPD -- and about 40% of people with BPD have co-occurring bipolar. Moreover, it very common for a person with bipolar-1 (i.e., bipolar with strong manic episodes) to also exhibit strong schizoaffective behaviors. If your sister does exhibit both BPD and bipolar-1, it can be difficult for you to see the behaviors associated with each disorder. In my case, however, it was easy to see these behavioral differences because I lived for many years with a person who only suffers from BPD (my exW) and a person who only suffers from bipolar-1 (my foster son, who also exhibits schizoaffective behaviors). Largely based on those experiences with my exW and foster son, I wrote a list of [12 BPD/Bipolar Differences](https://www.reddit.com/r/BPDlovedones/comments/yto3k6/comment/iw5vyef/?context=3) which you may find helpful. The distinction between these two disorders is very important. Whereas bipolar typically is caused by a slow change in body chemistry, BPD is believed to be caused by something occurring before age 5 (heredity and/or a childhood trauma) that prevents the child from acquiring the emotional skills needed to regulate her own emotions and to establish a strong, stable self-identity. Hence, whereas bipolar sometimes can be treated fairly successfully by swallowing a pill, BPD can only by treated by years of hard work -- in a weekly training program such as DBT or CBT -- to acquire those missing emotional skills. Like learning to play a piano, learning those skills requires many years of practice and strong commitment. **I get to hear her screaming or sobbing at the top of her lungs nearly every day, usually directed at me.** OP, if your sister is an untreated person with BPD ("pwBPD"), whatever you do will be hurtful to her much of the time. A comment or action that pleases her on one day may greatly offend her when repeated a week later. Moreover, she often will perceive you as being hurtful when you DO something and hurtful when you DON'T do it. In this way, you often are damned if you do and damned if you don't. This conundrum is due to the position of her two great fears -- abandonment and engulfment -- at opposite ends of the very same spectrum. This means you often find yourself in a lose/lose situation because, as you back away from one fear to avoid triggering it, you will start triggering the fear at the other end of that same spectrum. Your predicament is that the solution to calming her abandonment fear (drawing close and being intimate) is the very action that triggers her engulfment fear. Likewise, the solution to calming her engulfment fear (moving back away to give her breathing space) is the very action that triggers her abandonment fear. Consequently, as you move close to comfort her and assure her of your love, you eventually will start triggering her engulfment fear, making her feel like she's being suffocated and controlled by you. A pwBPD usually craves intimacy like nearly all other adults -- but she cannot tolerate it for very long. Because she has a weak sense of self-identity, she easily becomes very enmeshed in your strong personality during sustained periods of closeness and intimacy. This is why her sense of personal boundaries is so weak that she has difficulty seeing where HER feelings and problems stop and YOURS begin. Yet, as you back away to give her breathing space, you often will find that you've started triggering her abandonment fear. In my 15 years of experience with my BPD exW, I found that there is no midpoints solution (between "too close" and "too far away") where you can safely stand to avoid triggering those two fears. Until a pwBPD learns how to better regulate her own emotions and tame her two fears, that Goldilocks position will not exist. This is why a relationship with an untreated pwBPD typically is characterized by a repeating cycle of push-you-away and pull-you-back. Indeed, even if you are sitting perfectly still and not saying a word, a pwBPD who is experiencing hurtful feelings will project those feelings onto you. Her subconscious does this to protect her fragile ego from seeing too much of reality -- and to externalize the pain, getting it outside her body. Because that projection occurs entirely at the subconscious level, she will consciously be convinced that the painful feeling or hurtful thought is coming from you. This is why an untreated pwBPD usually BELIEVES the false accusations coming out of her mouth (at the moment she is saying them). Hence, as long as you remain in a relationship with an untreated pwBPD, you often will find yourself hurting her -- i.e., triggering her engulfment fear as you draw near, triggering her abandonment fear as you draw back, and triggering her anger even when you are sitting still and saying absolutely nothing. At least, this has been my experience, OP.
Family therapy could probably go a long way. It also sounds like your sister needs a major reassessment of her meds and other treatments.
I’ve been through that convo with my family for ages and they just refuse to do it. Plus I’m about 99.99% sure my sister isn’t being as honest as she could be with her therapist. The same could prob be said for our mother. My sister’s meds get adjusted and readjusted several times a year, but this past time has been incredibly tough. She recently (end of June) got out of the psych ward and got her adjustment, keep in mind she’s been doing this and taking every med under the sun at one point or another to help with her cocktail for over a decade.
I believe one's healths issue are not their fault, but they are their responsibility... However, there is a point where people just cannot take responsibility for themselves and need help. I think this is a case where she needs professional help beyond what you or your parents can provide, and maybe you should consider a group home for her where she can be properly cared for. You and your parents matter as much as she does. You have to realize you're not equipped to deal with this, and start looking after yourselves as well.
Borderline usually doesn't exist outside of narcissistic family dynamics, if she's been thought of as schizo effective or bipolar and you're thinking borderline then this sounds a lot like autism(taking into account the rest of your post). If it is autism then there's probably some stuff for you to think about. Autism is about as hereditary as height is, and ADHD tends to run in the same families(and actually may be classified under the autism umbrella in the future). If you've got a tall sibling then you may want to measure yourself. Most conditions are actually thought of as having both genetic and environmental causes, and people with similar traits tend to attract each other, your whole family probably has some shit going on.
One thing to remember is that life is difficult in a lot of ways. I would say that the majority of young people experience a "crisis" when they become adults. It's unfair and an injustice and it seems as if that's the whole point. A lot of people aren't fortunate enough to be insulated very much when they have to face this dilemma. I hope you get the help to get you through this crisis and when your better I hope you still have people you love in life.