Seeking advice - dealing with 17-year old sister

[Altra, BSN, RN]

Hello all,

I'll try to keep this as brief as possible. I thought I might ask advice from the pros, because I'm not sure what else to do at this point. I'm extremely worried about my younger sister, J (there's an almost 20 years difference in our ages). She has a history of cutting herself, has repeatedly threatened suicide, expresses an interest in masochism, and exhibits mood swings and manipulative behavior that are starting to make me wonder about borderline personality disorder. Yes, I know, that's not an appropriate diagnosis for a teenager, but ...

She is self-focused to the extreme. If I, or anyone, talk to her about herself she listens with an intensity that is almost uncomfortable *until* something is said that she doesn't want to hear, at which point she becomes agitated, sometimes to the point where she is not very coherent. She has told all of us elaborate, detailed lies, and recently talked to me at length about how she considers lying and even hurting the feelings of others perfectly justifiable as a means for getting what she wants/needs. Yesterday she told mom calmly and matter-of-factly that she doesn't love her, and has no intention of trying to make their relationship better.

Our parents divorced last year after 37 years of marriage, but this is not the source of J's problems (although it certainly doesn't help). She has demonstrated problems with coping since she was about 13. Near the end of 8th grade she received a 5-day suspension for responding to a boy who verbally teased her - she said, "If I had a gun, I'd shoot you." Truly, I don't think she meant anything by it, but in the post-Columbine atmosphere she was immediately branded a potential threat, by other kids and parents. By high school she had adopted Gothic makeup and jewelry, which I'm not making a value judgement on, but it moved her far out of the mainstream of her small, conservative private school. After my parents divorce she and both of my parents were all in agreement that she would live with mom, and she campaigned long and hard for mom to move to a house within the school district where her boyfriend (at the time) lived. That eventually came to pass, so she's now attending this other high school. That is, when she chooses to go to school. She frequently complains of various ailments to avoid having to go to school. About 10 days ago she was suspended from school for a day for a verbal attack, complete with liberal use of the F word, on a teacher. She is also failing her math class. However, she insists that school is "fine."

This is not the best time in my parent's lives, however, they are both loving and supportive with J. Her response is to constantly bug my dad for "stuff" - cool gadgets, expensive entrees at restaurants, etc. and to continually push my mother's buttons.

About 4 months ago my mother enrolled J (with her agreement) in a counseling program for teens at risk. Because of the documented incidents at school, the program is free. Her only diagnosis is depression, and she's been prescribed Zoloft 75mg. I have met J's counselor (an MSN psych nurse) and she seems to feel that J and my mother have to come to some joint agreement about limits and what's acceptable and what's not. I'm sure that's appropriate, but my sister's behavior, and even her thought processes, seem to me to be getting worse, not better. She has complained for months about her menstrual periods and said that they worsen her mood considerably. So when my mother makes arrangements for her to see a GYN, and possibly get a scrip for birth control to help regulate things, J refuses the bc. ?????

I'm sorry for the rambling, I'm just kinda worn out. I love each member of my family very much, but sometimes I feel like all of their upheaval, especially my sister's, is more than I can handle. Thanks for listening.

~Leigh

[LilgirlRN, ADN, RN]

I feel for you. It's hard to know what to do in this kind of situation and you are limited by what teenager will allow you to do even though it would be in their best interest. I am not really sure what advice to give you, perhaps there is none to be given except to tell you to take care fo yourself. It's very hard not to be dragged into the drama of a teenager's life especially when you care so much. At times I am sure that it seems you care more for her than she does herself. As far as the BC pills are concerned, maybe she thinks they will make her fat, maybe she is already on them and just doesn't want you to know? I wish I cold give you the answer... if I could I'd be a millionaire. Just think of all the people you went to high school with who were just like your sister who are now quote, unquote normal people. She is going to counseling and taking her medication, hope for the best. Keep us posted. :) Wendy

[sanakruz, ADN]

Rule out substance abuse.

[maureeno]

whether she has a developmental problem

[real bad case of teenager]

or a drug problem or a personality problem

or even the start of a major mental disorder

the counselor seems right to suggest limits

you say your parents are loving and supportive...

do they give in to unreasonable demands?

watch for signs of mania

[athomas91]

i am sorry to hear of this difficult situation and wish you all the best.....

however - i agree w/ the previous thread to r/o substance abuse

the behaviors such as cutting, manipulation lead me to agree w/ ther personality do - her suicide attempts - did she do something and tell someone right away??? if so - i completely agree w/ one of the personality do's not being able to specify one because i do not know all of her behaviors... there are some great meds out there that help w/ depression/anxiety/bipolar and curb these personality traits - problem is - you cannot force her to take them.... until she sees the problem

hope all goes well for your family in the near future.

[TitaniaSidhe]

ditto to the substance abuse & perhaps you should look into or read up on conduct disorder. Just a thought...in any event best wishes to you in this situation. I have a 13yr. old step daughter with ADHD- it is real tough & exhausting.

[Altra, BSN, RN]

Thank you all for your kind words and forthright suggestions.

I did make one error in my post - my sister's Zoloft dosage was 150mg, but this was increased to 200mg this week when she met with the psychiatrist.

Substance abuse was my first thought also, but my sister denies using any drug and the drug screen when she entered the teens-at-risk program turned up nothing, so it would seem she's telling the truth about that.

I took her to her appt. this week because my mom had to work - it was just a short session because she was also seeing the psychiatrist, but the nurse went through a depression questionnaire with her. When asked, my sister stated that she feels good about herself most of the time, and she wishes that her mom & I understood that. Someone who inflicts harm on herself and can't cope with everyday stresses does not feel good about herself, IMO. Somehow this statement frightens me for her even more than some of her more dramatic episodes - I wonder if she even knows what it feels like to "feel good."

Thank you all again,

Leigh

[Will Benson]

Hi MLOS

I'm sorry to hear about your sister's troubles. What you are describing sounds like the DSM IV definition of an oppositional defiant disorder (O.D.D.). Having never met your sister, I couldn't say for sure (Only a fool makes a diagnosis without ever seeing the patient). She has problems with losing her temper, argues with adults, defies or refuses to comply with rules, blames others for her mistakes, is angry, resentful, spiteful, vindictive, etc. (Sound Familiar?) If this is truly the case, it may be more than "depression". O.D.D. can be a precursor to Conduct Disorder, which is more serious, and the patient can get into trouble with the law. Once the patient becomes an adult, the diagnosis may change to Antisocial Personality Disorder.

Now that I've scared you with this information, the counseling and antidepressant medication are the treatments of choice for this. If the counselor does, indeed agree with this, it would be prudent on your part to see how therapy is going. If your sister's behavior becomes more serious (ie physical cruelty to people or animals, deliberate destruction of property, theft, truancy, running away, etc), the counseling may not be working. Many teenagers respond well to counseling and antidepressants. O.D.D. is very common in families in which there are serious marital problems. Your parent's divorce is still recent (about a year). Some grief counseling might be in order, too. As maureeno suggested, depression might olny be one end of the spectrum. Many counselors will test for depression, but neglect to test for mania. There is the possibility of Bipolar disorder. If this is the case, antidepressants may not work and MAY actually bring on a manic episode. Keep us posted with how thing go.

[BarbPick]

L.

Sent you a PM.

It is wonderful to be able to get support on here, I appreciated it the other day

Barbara

[Sweetberry]

Hey,

Ok, my suggestions/advice come from both personal experience and friends' experiences (I'm 19 now, so this is pretty recent for me)... Your sister sounds similar to two people I knew, and myself...

* Check into a possible eating disorder... That could be causing the depression, the cutting, the suicide threats, and the reluctancy to take BC (aka not wanting to get fat).

* She could possibly have a personality disorder, like you said. If she is not hiding her scars and making numerous suicide attempts, simply for attention, and doing various other attention seeking activities, this may be something to look into.

* Check again randomly if she's using drugs. The lows would cause depression and make her want to cut and attempt suicide, and also cause the outburts.

Ultimately, take care of yourself first. And give your mom a hug. It sounds like she's got a handful. Take care.

[Josie K]

I'm all too familiar with this anti-social behaviour pattern described, being involved with the Youth Justice system.

Sounds like conduct disorder - with caution.

Within this category we find a number of teenage girls with a history of hormonal imbalance, and where there is self harm a high percentage had experienced sexual abuse.