# What's the 1st step



## 4sure (Aug 8, 2010)

We, the family believe my neice has some kind of mental issue. We aren't sure what. 

She is angry most the time. She has extreme violent rages. 
She has mood swings. Depressed, hopeless, etc...

What is the 1st step to get her help? What kind of dr. does she need to see.

I am ignorant when it comes to issues like this. Any advice will be appreciated. Thanks all.


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## 4sure (Aug 8, 2010)

She is 21
Parents are into themselves. They give her what she wants, so they don't have to deal with the bad behavior.


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## Uptown (Mar 27, 2010)

> What is the 1st step to get her help? What kind of dr. does she need to see.


4Sure, I agree with Homemaker. Because I took care of a bipolar foster son for many years, I had to deal with the police and ER on many occasions. I also lived for 15 years with my exW, who suffers from BPD (Borderline Personality Disorder). Both of these disorders can produce outbursts, anger, and strong mood swings. Homemaker correctly suggests that the niece begin with a psychiatrist because, unlike a psychologist, a psych also has a medical degree and thus can prescribe medications. This is important, particularly if the mental disorder is caused by changes in body chemistry as occurs in bipolar disorder. Until the body chemistry is stabilized, therapy from a psychologist will be ineffective. Of course, the psychiatrist will likely refer her to a psychologist for behavioral therapy.


> She is angry most the time. She has extreme violent rages. She has mood swings. Depressed, hopeless, etc...


If your niece is suffering from bipolar or BPD, only a professional can determine whether her behavioral traits are so severe as to meet the diagnostic threshold. If you know her very well, however, it is not difficult to distinguish between bipolar and BPD mood changes and anger. I find that there are several clear differences between the two disorders. 

First, bipolar mood swings are very slow because they are caused by gradual changes in body chemistry. They are considered rapid if as many as four occur in a year. In sharp contrast, four BPD mood changes can easily occur in four days. BPD rages, for example, typically last about 5 hours and rarely as long as 36 hours. 

A second difference is that the onset is very different. Whereas a bipolar change usually will occur over two weeks, a BPD change typically occurs in less than a minute -- often in only 10 seconds -- because it is event-triggered by some innocent comment or action. That is, a comment will trigger a quick release of the enormous rage that the person has been carrying inside since early childhood.

A third difference is that, whereas bipolar can cause people to be irritable and obnoxious during the manic phase, it does not rise to the level of meanness and vindictiveness you see when a BPD is splitting you black. The difference is HUGH: while a manic person may regard you as an irritation, a BPD person can perceive you as Hitler and will treat you accordingly. 

Fourth, the BPDer is always convinced she is a victim. She therefore is forever in need in having a "perpetrator" around to blame for every misfortune. Hence, a BPDer is always blaming her loved ones for every misfortune and she will refuse to take responsibility for her own actions. This trait is not characteristic of folks who are bipolar (unless, of course, they also have BPD).

Finally, a fifth difference is that a bipolar sufferer -- whether depressed or manic -- usually is able to trust you if she knows you well. Untreated BPDs, however, are unable to trust -- even though they sometimes may claim otherwise. This lack of trust means there is no foundation on which to build a relationship. Moreover -- and I learned this the hard way -- when a person does not trust you, you can never trust them because they can turn on you at any time -- and almost certainly will.

Yet, despite these five clear differences between the two disorders, many people confuse the two. One source of this confusion seems to be the fact that a substantial share of BPD sufferers also have the bipolar disorder. But these disorders are separate and distinct. 

Lastly, I should note that extreme anger problems can be caused by a brain injury, i.e., a blow to the head. Although it is highly unlikely, it is a possibility. Take care, 4sure.


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## 4sure (Aug 8, 2010)

Thank you very much. Homemaker and Uptown you have helped tremendously.
From what you describe Uptown she acts like she suffers from BPD. We do have psych ward at the hospital. I'm going to talk to her about going there to be evaluated.

She is a beautiful young woman, but this disorder is ruining her life.


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## Uptown (Mar 27, 2010)

> She acts like she suffers from BPD.


I was afraid you would come to that conclusion. I am so sorry. I would not wish this disorder on my worst enemy. Please do not get your hopes up too high. If she has strong BPD traits, they've been there since childhood, causing her emotional development to be frozen at the level of a four year old. Moreover, she likely is incapable of trusting anyone for any extended period of time. Since trust is the basis of all LTRs, this disorder destroys all LTRs if left untreated. This is why the disorder usually is not apparent until the mid-teens, when the victim is trying to establish LTRs outside the home.

As to treatment, even if she has BPD at the diagnostic level, it is unlikely that a therapist will tell her -- much less you -- that is what she suffers from. One reason is that insurance companies usually do not cover BPD treatments, claiming (falsely) that it is untreatable. Another is that, if your niece is a high functioning BPDer (most are), they know that she likely will immediately terminate therapy on hearing that dreaded diagnosis. A third reason is that the social stigma is so negative that putting it in a medical record can affect current or future employment opportunities. Hence, in my experience here in the States, the therapists tend to "diagnose" BPD by calling it "depression," PTSD, or bipolar disorder. 

That is, they list one of the accompanying symptoms instead of the main disorder itself. This implies that, if you are absolutely determined to get a candid professional opinion as to whether she likely "has BPD" at the diagnostic level, I recommend that you spend a session or two with a clinical psychologist -- WITHOUT your niece present. Of course, he will not be able to render a formal diagnosis but he is far more likely to speak candidly and say "it sounds like she may suffer from ...."

Finally, you should know that the low-functioning BPDers are so miserable that they are commonly told the name of their illness -- and may be relieved to know what it is. The vast majority of BPDers, however, are high functioning -- as your niece likely is. The nature of the disorder itself makes these high functioning BPDers too ashamed of admitting to a flaw in their personalities. And they certainly do not want to hear that they have the emotional development of a four year old. Because they hate themselves, the last thing they want to hear about is one more thing to add to the long list of things they hate about themselves. 

On top of that, the disorder is usually invisible to them because -- even though they suffer from a "thought disorder" -- they've been thinking in that distorted, reactive manner since early childhood -- and thus the high functioning BPDers have difficulty seeing that they have the disorder. 

Hence, although I have had the privilege of communicating with nearly a hundred high functioning BPDers online, I have never met one in my personal life. I doubt if as many as one in a hundred HF BPDers are sufficiently self aware to acknowledge having the disorder and to stay in therapy. Indeed, therapist Shari Schreiber says you have a better chance flying to the moon strapped to a banana than ever seeing a HF BPDer stay in therapy long enough to make a difference.

4Sure, I say all this not to discourage you but, rather, so you know what the young lady is up against. A year from now, I don't want you beating yourself up over your intense feeling of "having failed her" when she fails to improve -- as is likely. I say this as a man who spent a small fortune taking his exW to six different psychologists for weekly sessions over a 15 year period -- all to no avail. 

We caregivers do not handle such failure well. Although we know intellectually that it is impossible for us to fix her -- only she can decide to do that -- we nonetheless consider it anathema to walk away from a sick loved one. It therefore is difficult for us to extract ourselves from a toxic relationship in which we have unwittingly become the "enablers" -- which is what you've already seen in her parents. So please keep reminding yourself not to have unreasonable expectations.


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## meganjo (Jan 29, 2011)

don't make any conclusions like she is having BPD. first speak to her and find out what is bothering her.. may be some issues relating to her relationship with her friends or may be with other family members..


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