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Baaku · 06:58 AM

Good morning Karen,

This will be brief but I hope to get some info to you nonetheless. Medication noncompliance is classic for patients with Bipolar Disorder, and the problem with this is that minus the meds, the condition worsens over the years until one develops what's called the "kindling effect" which is a condition in which the illness becomes self perpetuating and may even worsen to rapid cycling, to ultra-rapid, to ultradian cycling when left untreated over the years. We see this also in seizure disorders. For a good and easy read, you can look here:"Kindling" effect.

Secondly, while you can't control her or her behavior, I second the idea of managing your home by keeping her out if her behavior destroys family life. In this case, we recommend to families that they set up 3-5 basic house rules or boundaries (NO CURSING OR THREATS, NO DRUGS IN THE HOUSE, NO STEALING, NO COMING HOME HIGH, RESPECT OTHERS PROPERTY, ETC.) that can be done jointly with her so as to get her buy in. If she breaks one of the house rules, she has to leave for 2-4 days-- this becomes your behavioral contract and if aplied consistently with absolutely no emotion, fanfare, agitation, etc., it becomes an effective tool for teaching her how to respec the home. This will reduce much of the stress and actually may change the course of your relationship with her. Once she is on meds, if she gets on them, social skills training would be very useful. Overall, her treatment, as Blackpup wisely suggests, would be very different than that of someone with Borderline Personality Disorder, although there would be some similarities, such as learning mindfulness and acceptance.

I know this will be most painful for you and my heart goes out to you, but it may be what saves your relationship and your family as a whole. The roles must be enforced by you strictly since they teach responsible behavior and self regulation, which are requisites for learning to live with others and taking self responsibility.

With respect to whether or not she has BPD or Bipolar, while it never hurts to get a 2nd opinion (I always recommend this for some conditions) as implied by Blackpup, they're very distinct conditions. I do evals every day and these are 2 conditions that can be easily isolated by most descent clinicians, much more so than some of the personality disorders.

Sorry this is so short, please write back if you have any questions or need more info. Good luck to you Karen.

With great compassion,
David