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Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience:  Psychiatrist
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I have a nephew who had two different diagnosis, the first 1

Resolved Question:

I have a nephew who had two different diagnosis, the first 1 personailty discorder and then diagnosed as bipolar...different doctors have said that he is neither. He has extreme anger issues where he is destructive. He is 26 years old and his mom seems to enable him. What is the best solutions to help this matter.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr_Anderson replied 5 years ago.
Dr_Anderson :

Greetings, and thank you for your question. You have hit upon one of the quandaries of our field in your nephew's story! Efforts have been made over the years to try and standardize things so diagnoses remain consistent based upon what a person is going through. But, because we don't have imaging studies or lab tests to say for sure, we are left to decide what is going on based upon our observation, the report of the patient, and the reports of friends/loved ones. The training of the clinician can also make a difference. For example, if a person trains at a place where bipolar is stressed, they may be more likely to diagnose it over something else. The same bias is true for a clinician trained where personality disorders were stressed. With that preamble in mind, I think the best solution is thus:

Dr_Anderson :

(1) Get him in with a psychiatrist who is willing to do a comprehensive evaluation on him. 15 or 30 minutes is not enough time, in my personal opinion, to do that.

Dr_Anderson :

(2) No matter what the diagnosis ends up being, have him continue with that same person. As that psychiatrist sees him over time, his impression of what is going on will change or be reaffirmed. But this can only happen if he is seen consistently by the same person. I have found that when I saw a person and thought they had condition A, as they continued to come back to see me I actually found out they had condition B. This can only happen as you get to know a person.

Dr_Anderson :

(3) The doctor should be willing to have an open dialogue with your nephew. Also, it is helpful, if your nephew agrees, for you and other loved ones to be allowed to provide input into your observations on how/what he is doing.

Dr_Anderson :

Hope this helps get you started! Please let me know if you have other questions and if I may of further service!

Dr_Anderson :


Dr_Anderson :

Dr. Anderson

Customer: replied 5 years ago.
What about my sister enabling him, does this help or does it make it worse. I know she feels that if she isn't there for him that if anything happens to him then she will never forgive herself. Right now I feel he is somewhat holding her hostage.
Expert:  Dr_Anderson replied 5 years ago.
In most cases, enabling does not help the person being enabled. In which ways does she enable him? If, for example, she makes excuses for his behavior but does not hold him accountable for it, this does not help him to grow or learn accountability. If she is acquiescing in an effort to keep the peace, it is a kind of enabling, but it is also an effort on her part to keep from engaging in yet another fight where she will end up feeling worse, hurt, frustrated, etc.
Regarding the feelings of guilt she has (because truly that is what you are describing - guilt over something that has not even happened, but she is paying the price for it now), it is also enabling because as long as she continues to feel that way, she is more or less adopting responsibility for his actions upon herself. He, of course, needs to take the responsibility for his own actions, but as long as someone else is paying the price, there is no reason or stimulus for him to change.
Counseling for her is important - the telephone version is not ideal, but if it is all she can do, at least it is something. One focus of counseling for her is to learn not to let her guilt rule her actions, which from what you describe is what is going on.
Customer: replied 5 years ago.

One last question, her husband is not supportive of her son. He is causing more stress in her life and will not go for councelling. He just thinks he is lazy and has given her a untimatin that if he does not leave the house by July 1st, then he is leaving her. At this time she cannot kick her son out because of his illness. What should she do.

Expert:  Dr_Anderson replied 5 years ago.
This is a tough situation to be in. Since she is held hostage by her son, it is logical to conclude she is also being held hostage to her husband. She is caught in the proverbial middle.
The simple solution is to call his bluff. One thing that therapy can help your sister do is learn to set healthy boundaries. She is being pushed into making a decision: "It's either him or me." Well, setting boundaries means she puts the choice right back on them: "That is your decision, not mine." Easier said than done! Certainly it sounds like her husband is also frustrated with your nephew, but threatening to walk out is not the way to show love and support for your spouse - it is not putting her first.
What should she do? Stand her ground. If he decides to leave, it is his decision, not hers, and she ought not to feel guilt for it (but she will).
I'm sorry you all are going through such a tough time!
Customer: replied 5 years ago.
Sorry one more question. She and her husband were suppose to come to the island this weekend to visit me. However her son put his fist through his bedroom door and therefore she feels that she cannot leave him. My goodness he is 26 years old, should she be treating him like a child.
Expert:  Dr_Anderson replied 5 years ago.
I agree with you, she should not be treating him like a child. He is responsible for his actions. This door-meet-fist episode is one more way he can assert control over her - even over her vacation.
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