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Dr John B
Dr John B, Psychologist
Category: Mental Health
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Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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My 22 year old daughter has struggled with anxiety and depression

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My 22 year old daughter has struggled with anxiety and depression for most of her life. She has a tendency to become obsessive with certain things as well and has told me that even as a little girl she would get up in the night to check that all taps were off and all doors locked. At the moment she has periods where she gets her hair style and/or colour changed several times in a row, keeps talking about what she 'needs' to get done to it next and is never satisfied just to leave it alone.

This year has been a constant yo yo of episodes of her cutting herself and being admitted to hospital. After the third such incident, she was finally persuaded to see a psychiatrist and has been seeing him for several months now. He has prescribed Zoloft and she takes 100 micrograms daily, which she has purportedly stuck with.

Last Sunday, the day after her twin sister left to take a job out of town as a tv journalist, Adrienne fell into a deep depression, unable to get out of bed and alternately crying and sleeping. She kept saying that she wanted to die because everything for her is just so hard and than she is simply too tired to try anymore. She has had quite a few of this sort of episode and it has resulted in her quitting or losing jobs, failing or barely getting by at university (she is a nursing student).

I took her to my house (she and her twin moved out together a year and a half ago) and she stayed a couple of nights, still feeling terrible. She went back home on Tuesday and slept at her place even though I wanted her to stay here with me. Wednesday morning I got a text from her "Mum it's weird but I feel totally normal today". It is now Thursday and she is still feeling "like a normal person". She even told me that she has lot of things to get done and wants to do them before "it happens again". Clearly she must be on the wrong medication if she can fluctuate so severely in such a short time frame!



Depression runs in the family and both her sisters are on antideprssants and are high acheiver. They have never had the fluctuations that Adrienne has, at least not anywhere near the frequency and Zoloft has worked well for them.

There was a high degree of dysfunction in my marriage to their father and we separated when the girls were in early high school. I was horribly depressed at that time and really just putting one foot in front of the other for a long time. It couldn't have been easy for the girls and I hate that I wasn't much of a parent during that period. The girl's father is an anaesthetist but has not helped me in any way, in fact quite the opposite, since the split. Although I know at some level he loves his daughters, he has at times been shockingly cruel and destructive towards them. When it comes to Adrienne's mental health he insists that she 'just needs to get on with it and stop feeling sorry for herself'.
He himself is quite manic and also has depression, but of course denies that he has any issues. The girls figured out a long long time ago that he is interested only in success stories when it comes to them. He has always been antagonistic and harsh towards Adrienne, distinctly favouring her twin over her. Hard to believe but even at the ages of five and six, he would draw comparisons between the twins and treated Adrienne as though she was unloved by him and barely even tolerated. I was afraid of him but I did try to point this out, but he would bully me to the point where I had to give up rather than cause' world war three.' To this day I am ashamed of how I let the bastard emotionally abuse his own kids, but all that I can do now is step up to the plate and offer my unconditional love and support. That doesn't seem to be enough, though and I am scared that Adrienne will have to struggle on, until one day she will decide it is too much and end her life.

My main query is what condition do you believe is causing these terrible mood swings and whether there are medications to stabilize them? Thanks
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr John B replied 2 years ago.

Hi,

 

I'm very sorry to hear of the situation. It is impossible to diagnose someone via JustAnswer but based on your description I would seriously consider the possibility of Borderline Personality Disorder (BPD). BPD is often mistaken for a mood disorder due to the frequent mood swings but the variation is too quick (days rather than weeks) and the instability tends not to respond to antidepressant medication. Self harming is a hallmark of BPD and we often see it develop in people who have experienced a difficult/traumatic relationship with a parent. Multiple hospital admissions due to crisis is also a hallmark of BPD.

 

I would suggest that you ask her current Psychiatrist if he/she has considered BPD and if so why this diagnosis has been discounted. If you don't get a satisfactory answer (either way) then I would strongly encourage her o get a assessment done by a clinician who is experienced in working with BPD.


I'll place a description of BPD here for you to look through. Keep in mind that every feature does not need to be present/occurring.


The main feature of borderline personality disorder (BPD) is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive. This disorder occurs in most by early adulthood. The unstable pattern of interacting with others has persisted for years and is usually closely related to the person's self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person's emotions and feelings. Relationships and the person's emotion may often be characterized as being shallow.

 

A person with this disorder will also often exhibit impulsive behaviors and
have a majority of the following symptoms:



Frantic efforts to avoid real or imagined abandonment


A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation


Identity disturbance, such as a significant and persistent unstable self-image or sense of self


Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)


Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior


Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)


Chronic feelings of emptiness


Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)


Transient, stress-related paranoid thoughts or severe dissociative symptoms


Key Features in Detail


Frantic efforts to avoid real or imagined abandonment


The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.

Unstable and intense relationships


People with borderline personality disorder may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.


Identity disturbance


There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.


As medications tend not to have much effect on BPD the treatment generally regarded as the best approach to BPD is Dialectical Behavior Therapy (DBT). DBT is a system of therapy developed specifically to treat persons with borderline personality disorder. DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD.

 

DBT is usually offered by Clinical Psychologists (although not exclusively) and you can contact The Australian Psychological Society for assistance with finding an appropriately trained Psychologist. Take a look at the APS locator service here - you can use this to find a Psychologist in your area and there is a phone number you can contact if you want a referral arranged for you. Also, take a look at an article published by the American Psychology Association here. It's an interview with a senior Psychologist and covers some of the things you should consider when you looking for a Psychologist. You should also be aware that Medicare subsidizes sessions with a Psychologist in many circumstances, so you may be able to get some help at little to no cost to yourself.


There are a number of books that can assist people to learn Dialectical skills at home and to generally manage typical Borderline behaviors. If you are interested in doing some further reading I can recommend both this book here and this book here .


I hope this has been of some help. Please let me know if you have further questions or wold like me to clarify any part of my answer.

Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience: PhD in Clinical Psychology, registered clinical psychologist.
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