Mania without signs of depression

My 22 year old stepdaughter is spiraling out of control. She was "diagnosed" at about 7 years of age as being ADHD. While she certainly has an attention deficit and is hyperactive beyond description, a psychiatrist now suggests that she was never ADHD, but is bipoloar with "satellite issues." Because she is an adult, we have no information other than what she has told us about this new diagnosis. She will not take meds. She is violent and out of control. She lives in a constant state of motion, constantly looking for drama and even fights, is promiscuous, and has extreme grandiose ideas about herself. She can't keep a job, constantly getting fired or quits and runs when she realizes she's about to be fired. She runs with rough, dangerous people until they run her off, often times after roughing her up in order to get rid of her. When "weaker" personalities try to distance themselves from her, she roughs them up, either physically or psychologically. She steals and pawns friends' and family's possessions, make false police reports about breakins at her home. She has strange habits such as hiding underwear under her mattress, cutting up people's clothing, and keeping used tampons under her mattress and in bedroom and bathroom drawers and in piles of trash in her bedroom (sorry, but this is especially disturbing). Her bedsheets are often covered with bloody handprints. In general, while she does keep herself relatively clean, her living conditions are beyond nasty. When I married her dad a year and a half ago, she got on the roof of the house where we had the wedding reception - with no explanation other than she "was just messing with us." Her dad reports that when she was a child the the mothers of neighborhood children would come to him demanding that he keep her away from their children. She once beat a little girl in the face with a gold club. I've seen NO signs of depression as I know them. No loss of appetite, she's never quiet. She dresses in terribly suggestive, inappropriate clothing and seems very obsessed with piercing and tattooing herself. She is currently on the run from the police (minor theft) and has left the state with a 17 year old in tow (could be very serious legal problems). She is voilent, provoking and out of control most all of the time. Do these types of bevior really fit the mold for any type of bipolar disorder? I'm concerned that one visit with a psychiatrist (whose advice she ignores) was not enough to make a good diagnosis. We see no common signs of depression, but instead a constant, high energy, destructive mania. I'm new to this family and trying to learn how to deal with this. Any input would be appreciated.

Bipolar I can be diagnosed with only 1 manic episode and no depression...to read the DSM criteria yourself, go to the Disorder page (see the menu bar above) and look up Bipolar. I think most pdocs would dx her bipolar in about 30 seconds, to tell you the truth. I say this because I have been in support groups with many people who exhibit similar symptoms to one degree or another. This poor girl definitely needs psychiatric care, probably in a hospital, and intense support afterward.

The upside is, I have seen people who have had a similar life course get things together with medication, therapy and support.

Good luck.

DJ

Thanks for the reply, Davey. I've read the info you suggested. This is all very new to me and I feel pretty helpless in the whole thing. Right now, my biggest fear is a selfish one. I'm very worried that my stepdaughter (together with her minor boyfriend and her newly acquired pitbull dog) is heading across several states toward our home. She's just been thrown out by her mother within 36 hours of her arrival there in this "fight or flight" rampage she's on. She's been thrown out of no less than 5 homes and her own apartment within the last 5 - 6 months and has been fired from at least 2 jobs that we know about in that same amount of time. The last time she stayed in our home, I woke up several times at night to find her standing at the foot of my bed or just inside the bedroom door. She also cut a doll to shreds - the one blonde haired doll out of a set of 6 (all the other dolls are dark brunettes). I am the only blonde in the house and she's been very clear in establishing her hatred for me (just for marrying her dad). A friend of mine who is a pastoral counselor/therapist has warned that he sees indications of impending physical violence aimed specifically at me. She's bigger and stronger than I am and I suppose, in all honesty, I'm very afraid of her. We live in a small town where doors are never locked, but now, knowing that she's supposedly driving this direction, we're both finding ourselves locking doors and watching for her surprise arrival (it fits her m.o.). Do you agree that her behavior is building toward a possible attack on me? (we've never had significant direct problems - she just acknowledges that she doesn't want me in her dad's life) How do I deal with this if it happens? Considering her past actions in this house, is it realistically safe to even allow her into the house? It's hard to stay focused on trying to help her when you're worried about protecting yourself and the others in the house. The list of previous damage to the house and other attacks (similar to the doll issue above) is long and would take pages to describe. We're truly not worrying about this without reason. Do you think we should be prepared to call for police assistance (kills us both to even think about that)? Or are we going to be expected to wait until she actually hurts herself or someone else? We're not sure she's ever going to get serious psychiatric help without being forced. Any advice on how to deal with the likely confrontation that is barreling our way?

That is a really hard question...the thought of calling the police on someone you love or is dear to someone you love is one of the hardest things you can do--I had to do it once, though I didn't have time to think about it.

I think you should absolutely be ready to call the police. I agree that it's the only way she is going to get the help she needs. You and your husband must be in total agreement on this. I am afraid that if the time comes you won't have time to argue about it.

Do you have a plan for what you would do if the worst happens? Do you know where you would take her if she had to have, or decided to get help? Do you know a psychiatrist or psychologist you can call on? It may not hurt to call the emergency room at the nearest hospital and find out what would happen if she had to go there.

I can't really make a judgement about the potential for violence, but I don't blame you for being frightened. I think you guys need to set some serious ground rules before she stays...you should not have to live in fear in your own home. Possible rules could be that boyfriend and go elsewhere, she gets help beginning now...stay out of my room. I know we worry about our kids, and we should, but your safety must come first.

I think that the best thing to do is to start with a talk that is calm, loving and assertive--she must understand what the deal is. And if she cannot handle that, then the consequences must be swift and firm. Hopefully that will result in her getting the help she needs. Also, perhaps he can persuade her to accompany him to a DBSA or NAMI support group (DBSAllince.org or nami.org). I have seen this work several times in encouraging the child to get treatment.

I am really sorry that you find yourself in this position, it is extremely hard. While you and your husband must be firm in doing what must be done, know that your stepdaughter would not be like this if she could help it, and it feels even worse on her side of the fence.

I wish you well, let me know how things work out.

~Hugs~
DJ

Not that it is not possible,but the several incidents/behaviours mentioned,sound more like several disorders,not just bipolar,and some things mentioned do not sound like bipolar.
If possible,see if you can get a different pdoc's opinion/evaluation. Several meds may be needed,not just mood stabilizers,but maybe even anti-psychotics too.
This definately is not going to be cured or stabilized by some natural/holistics/herbs to name a few,real professional help is needed.
I seriously feel she needs help,and needs it asap.
I wish you luck with this.

Thanks for the responses. It's good to have found a forum to discuss this and to learn more about what we're probably dealing with. My husband and I will be able to talk about this openly enough to come up with a plan if / when his daughter does show up here and there is an emergency. The first thing that I will have to insist on is that she cannot move into our home, not even for a night. I simply cannot live in the constant stress and fear of that again, especially with her building intensity. I'm not sure how far she will have to go before my poor husband sees that there is a serious problem. He still wants to believe that there's nothing wrong with her, maintaining that her ADHD is responsible for her behavior. I've read everything I could get my hands on ADHD and while she might have that disorder, it just cannot be responsible for what we're seeing. Seeing him struggle to maintain his denial of all of this makes me sad. It's a hard thing to watch. Thanks again for the input and the support. I'm glad I found this website.

Knowing what I know,growing up in a home,with the family torn,worn,devastated,by my brother's episodes due to Bipolar-I,was a nightmare for him,as well as our family.
Some manic episodes were mild,others escalated to violence,in which things got really nasty (early 1960's)and he'd be hospitilized.
I can't blame you at all for not wanting her at your home,you are not being mean either,if that's what some ever say to you.
Sounds like your husband really needs to talk with a therapist and address his denial. My dad at first couldn't accept that my brother had this disorder,he grew up in a time that things like this just didn't happen in his family.
The era where people told the depressed to "just snap out of it",you probably have heard that.
Besides the mania,my brother would get depressive episodes,very typical of Bipolar disorder.
That's where the elders,had that mindset,"you got to snap out of it",etc.
Well,yeah,a depressed person would if they could,duh.
It took years but with the help of a good pdoc and Lithium (other older meds didn't work)he has lived a fairly good life,is married and even requires less Lithium compared to his teens and early 20's,he's going on 60, 12/24.
Definately try to get your husband to talk with a therapist,to address his denial,and coping skills.
He needs to accept this is not all ADHD.
Lots of luck with this,and always feel free to drop in here.
DE

I also would recommend calling the police dept. beforehand & see what they have to say about handling the situation. They will then be on the alert if you need to call them in an emergency. They would probably take her to a hospital (even without her consent) if she is a danger to herself or others. I had to call the police about my mother when I was a teenager. She had bipolar I & was very violent towards my brother & then at other times suicidal.

Please continue to try to get your husband to understand that this is a MAJOR deal & it must be addressed.

My heart goes out to you as you face this ordeal.--Suzy

Thanks all. While I know I'm not intentionally being mean to deny her access to being in this house overnight, it does make me feel pretty rotten. Maternal instincts (I have two of my own) just don't support locking a child of any age out of your home. Even if it's not your child. I'll fully admit that I don't like this young woman very much, but I do care deeply for her. Does that even make sense? And who knows.....maybe I will learn that she is likeable if she will ever get treatment for this. Maybe I've never seen what's really inside of her? I want so much for her to get better - for her sake and for this family's sake. I've tried to take the approach with my husband that, if she was my daughter, I'd much rather learn that her behavior is caused by a disorder that can be treated and managed (and her life improved) than to think she is just being evil for the sake of being evil.

Thanks again.

Noone wants to keep a child out of the house, of course you feel rotten...has she arrived yet?

I would be inclined to give her (not the bf or dog) one chance, as I mentioned before, but your husband should lay out the ground rules very firmly first.

My thoughts are with you.

DJ

No, she hasn't arrived here yet.. The 17 yr old BF has been removed from the situation today, however, and put on a bus back across the country to where she picked him up. She's with her mother again now, but there is so much trouble there that the phone here rings off the hook. I don't know if BP runs in families or not, but the mother is in about the same shape as the daughter, with the added complication of alcohol and pain med abuse. You can probably imagine the calls we're getting. The only silver lining to the two of them being in the same house for the time being is that the chances are good that one will call the police on the other before it's all over with. Maybe that will force this to a head and we can start getting some help. The daughter has put the mother in the hospital before (baseball bat vs. ankle), so we can only pray that no one gets hurt this time. In the meantime, I'm wondering what kind of emotional problems the rest of us are going to have before this boils over. (I'm exagerating here, but not by much I don't want to subject everyone to the daily episodes of "As the World Turns," but that's certainly what it's turning into, isn't it?

i may be in the minority here, but i don't think she needs even one minute of a chance inside your home. any time you wake up and someone is standing at the foot of your bed, cuts up the blonde doll and does the dozens of other things she's doing, she sounds that it is only a matter of time til she harms one or both of you.

with her history of violence there is no way that you and your husband can lead her to the car and take her to treatment. that would be a very unsafe thing to try and do.

i go with the suggestion of calling the police and i would call them when she gets to your house. she can be arrested for trespassing and then when she starts acting out in the police car, she'll probably be taken to an ER and processed and sent to a mental health lockup for 72 hours. the police will be cooperative in protecting you. i worked in ER and saw this almost on a daily basis. and i know how my daughter fought when we took her to treatment. it ain't pretty. i had to take her down to subdue her and it doesn't sound like you could do that with your stepdaughter.

during the 72 hours, you and your husband will have time to make plans for her safety. and if need be, the police might even transport her to the treatment facility.i worked in a psych hospital and it wasn't unusual for a deputy sheriff or police officer to show up a patient that had to be subdued. she's definitely got a problem with anger and acting out and then there's probably several other DXs that she will have to deal with.

your safety is of the utmost importance. there's no way she isn't have some rational thoughts at times and knows exactly what she's doing. and she certainly could be planning something.

your family will be in my prayers tonight. best of luck to you, xoxoxo pat

Your thoughts and prayers are welcome, Pat. Thank you. I would never make any attempt at putting her in a car to go for help. I've seen her physical violence (toward others instead of just the house itself) once before and, espcially considering that she is bigger than me and much stronger (boot camp graduate, if that gives you any idea - the military was once the family's solution du jour), I would never cross her.

A few years ago, she woke up on a Saturday morning to find her dad tossing a ball with my son in the back yard. My son was about 15 at the time and she was probably 19. Nothing had happened beforehand. She had just gotten up. She walked out on the deck, yawning and stretching, saw the two of them, smirked, went back inside, thought about it for a few minutes and came back out. We had some remodeling work going on then and she walked straight to the scrap lumber pile, picked up a 4- 5 foot long 2 x 4, raised it over her head like a club and went straight for her dad. I yelled, he turned just in time and she stopped about 8 feet away from him. He calmly told her to put the wood down and walk away. She stood there, 2 x 4 raised over her head, for a minute or two, then launched it at him. He ducked out of the way (except for a scrape to the shoulder) and she charged. He ended up having to wrestle her to the ground and tried to hold her until she calmed down. She was laying on her stomach, and when she found that she couldn't get up, she just started banging her face into the ground until she finally bloodied her own nose. That traumatized the whole family that day. The rest of us couldn't believe what we were watching. When he let her up, she came screaming into the house, blood everywhere, vowing to call the police on her father. (she didn't call) Five minutes later, she walked back out on the porch, very calm, blood wiped off her face, and asked what was for breakfast - like nothing had ever happened. Had I been on the receiving end of that instead of her dad, she would have cracked my skull open, I'm sure. I asked her later what that was all about and she said that nobody had asked her to throw a baseball with them and she didn't appreciate being left out, as if that was a perfectly normal, reasonable explanation.

Her mother called last night and said that she was going to the area magistrate this morning to find out if an involuntary commitment is doable. I'm sure that they'll tell her that they can't do anything until there's proof that she's threatened to harm herself or someone else (or actually does it). That seems to be the answer I'm getting here in my area.

Yesterday, when my "step wife" discovered things missing (theft is a continual thing here), she decided to look through her daughter's car. Among a list of items found in the car were scores of used tampons (again). She says that her daughter is not keeping herself clean (never a problem when she lived here that I noticed) and that her habits (she didn't go into any more detail with me) are beyond nasty. She's locking her out of the house during her work hours, but her daughter is getting into the house any way and when she comes home, she finds her sneeking around the garage or hiding in the yard, always ending in scary sounding laughter that she's been 'caught' getting into the house during the day.

I just cannot understand why this has been allowed to go on for so long or why her father feels that she's just ADHD and hard headed. This behavior is not new, by any means. It's been escalating since she was 7 or 8 years old and has gotten unbearable in the last 3 or 4 years. I was shocked to hear straight from the step wife last night (we don't talk often) just how many children this girl hurt in her adolescent and teen years, and how many times her little brother has gotten caught in the cross fire of broken windows and the likes. I love my husband more than anything in the world, but how can he be so incredibly blind? He wants to believe that this is just a young woman who was never taught how to behave the right way. Sometimes, it's as if he thinks the answer is finishing school or something. It really is that ludicrous on most days. Maybe the distance of her being three states away (instead of back here again) makes turning a blind eye and a deaf ear easier. I just don't know.

As a step mother, I'm powerless in this situation. I've come to accept that over the melodrama of the last few weeks. Until she shows up here, I need to just accept that there's nothing I can do. Even then, I'm sure the trauma will have to get pretty intense before a positive step is finally taken. So......keep those thoughts and prayers coming.... for us all. And send the bulk of them my stepdaughter's way. She's the one who needs them most right now. This is far from over.

your husband needs intense prayers and positive vibes. i cannot understand how he would think all of her bizarre and seriously dangerous behavior is from ADHD..this is much deeper than that. her trying to slam him in the head and then him to take her down is bizarre enough. it's a wonder she didn't kill him. did that not sink in on him?

therapy is needed for the two of you. you to be truthful about what is happening to the family and a T to convince your hubby that this is indeed a very serious and dangerous situation.

my opinion is this child needs lockup for about two years. and then evaluated by a team of specialists. i know that sounds really intense, but her behavior is beyond intense. it is dangerous to so many people. she could decide at any moment to attack her mom. or her brother or a neighbor. getting away with this for so very long has empowered her bizarre and violent nature. this is where dad has really enabled all of this.

let her mom know that she cannot come to your home and her relay it to her daughter. even a letter from you to mom would be wise. then you have it on paper. then when she steps foot onto your driveway or lawn, call the law. immediately. and don't let her into the house. have everything battened down. good luck. keep us updated. xoxo pat

all the best to you,it sounds like a really hard and frightening thing to have to deal with,I agree with suzy about contacting the police so they know what to expect if the time comes that you need them,you are right in wanting to protect your family,and I really hope it all works out for you.luck.

An appointment has been made for my stepdaughter for an evaluation this coming Tuesday. She's still at her mother's, so let's all just pray that the two of them don't kill each other over the weekend. From the sounds of it over the phone, it's pretty wild down there almost constantly. Reportedly, she has agreed to keep the appointment, but has been emphatic in declaring she'll be evaluated but will not take any meds prescribed. Hopefully, they'll convince her that her life doesn't have to be like this. At any rate, news of the appointment is good news. If we can just get confirmation on the earlier diagnosis and some definition on the "satellite issues," we'll at least know more about what we're dealing with.

i am so very relieved.....we'll pray that things look up for her and the entire family. xoxox pat

My stepdaughter kept her appointment yesterday, and her mother reports that, all in all, it was a positive experience. I'm grateful that a step has been taken in the right direction, BUT.............I'm concerned now that I have more information. Please understand, this situation is developing about 600 or miles away from my husband and me, and the information coming from the other end is often sketchy and inconsistent.

Instead of a psychiatrist or a psychologist, my stepdaughter ended up seeing a therapist (who was also referred to in the conversation as a social worker). The report is that she will see this therapist once a week for a few more weeks and will then see an M.D. in about a month. The therapist is working in a free clinic, run by the state, in a small, remote town where her mother lives - and knows everybody. While I certainly do NOT want to take anything away from this type of facility and/or the good work that I'm sure many of them do, this smells of the mother's manipulation. She is well known, despite her own condition, for making happen whatever she wants to happen. Often, this results in a much bigger mess than the original problem.

From what I could understand, it seems that the primary focus is to get her back on the meds she used to take for ADHD. This is apparently after the mom's briefing of the therapist before the daughter's appointment. As you can see from the previous posts, it's just not likely that ADHD is what we're dealing with here. And one psychiatrist (about a year ago, in another state) has already determined that this is bipolar with "satellite issues." Lithium and something else (don't remember what it was) was prescribed then, but my stepdaughter refused to even fill the prescription, as I understand, and never took the first dose, declaring that she was NOT bipolar and that the doctor was crazy.

While it's been several years since my stepdaughter was on her meds for ADHD, the behavior I've described was well underway even then. It's more than obvious to me that those meds did nothing to help with this. (and granted, I'm new to this and am certainly no professional) We all know that, whether medical and/or psychiatric, we do, from time to time, get subjected to doctors who aren't paying attention and who miss the mark badly.

My questions for the masses today are these: If this type of care is the best we can make happen right now, are ADHD meds (previously on several different stimulants) going to help the symptoms of bipolar disorder? Please overlook my ignorance in all of this, but it seems to me that prescribing stimulants in error for out of control, and sometimes dangerous, mania is the equivalent of pouring fuel on an already raging fire. Am I wrong about this? Should I feel more comfortable than I'm feeling right now about this particular patient seeing a therapist in a free clinic instead of a psychiatrist? (please, if you're a therapist, don't be offended by my questions)

Again, while I feel like any step in the right direction is a good thing here, I'm just more than a little let down to learn the details of yesterday's appointment. I almost feel like this is the equivalent of seeing an eye doctor for a brain tumor. Maybe I'm over-reacting because of what we've lived through on the receiving end of some of this raging behavior?

As always, any input will be very welcomed.

Well, it's a start...

First, let me say this...treatment for bipolar disorder should include both a therapist and a psychiatrist. The psychiatrist to make a medical diagnosis if appropriate and to manage medications, the therapist to deal with psychological issues. Second, a licensed social worker can be an excellent therapist. Sure, we would rather them see Psy.D.'s. I can tell you that in my state, I have seen ads for therapists that would accept either Psy. D's or LSW's. While I don't think they are quite equivalent degrees, it's obvious that they are considered able to do the same work, at least in some places. Also I have personally been treated in three different "free" settings, and I have to say that the care is at least as good if not better than what I received when I had insurance. I think that these clinics probably have more experience when it comes to extremely troubled patients. By the time you get that bad, you've probably trashed your life and your other healthcare options, so I wouldn't worry too much about the quality of care at a free facility.

I guess I would rather that your stepdaughter be seen sooner by the MD (it is a psychiatrist, yes?), but perhaps the interim sessions will establish a trust between the her and the therapist, and hopefully your stepdaughter will be more willing to hear what the doctors say and take it to heart. I bet if she went to see a doctor tomorrow, she would balk at any sort of treatment; after a month of therapy, who knows?

Will ADHD drugs help her if she is bipolar? I'm out on a limb here, but from what I know of ADHD treatment, I do not think it would be helpful to a bipolar patient. Giving "upper" type drugs to someone who is manic is a bad idea, I think. That's the sort of thing time will tell. If she takes the ADHD treatment and gets better, then maybe she's not bipolar after all. If she gets worse, them maybe her therapist can help her see that.

All in all, I think there is a ray of hope here...at least she has made some sort of positive step to help herself, with some sort of support from her mom, and that should be encouraged. Keep your fingers crossed!

DJ

Thanks, DJ. And no, the MD is reportedly a general practitioner and not a psychiatrist. Hence my whole discomfort with all of these meds for psychiatric/behavorial disorders. He is reportedly the doc who made the inititial diagnosis of ADHD when she was about 7 or 8. He's a friend of the mom's, as I understand. And when the younger brother came along 9 years later, he was diagnosed as ADHD as well. That's not to say a doc who is a friend of the parent can't make an accurate diagnosis, but I'm not at all comfortable with a GP making these types of diagnoses and continuing the long-term dispensing of meds. Especially in this case, where the mom is a friend of the doc's and has significant problems of her own. I live in a small town too, and have docs for friends. I've been known to skip exams myself and be granted prescriptions with a phone call for things like strep, pulled muscles, etc. And don't forget, a psych. with no family connections has reportedly commented recently that she isn't/never has been ADHD. I say "reportedly" on much of this because these reports come thru my stepdaughter (and/or the mother). On a day-to-day basis, what she ends up telling us proves not to be true on most things. We never know what to believe when it comes from her. The lying is chronic, to say the least, on any subject from the weather to claims of non-existent pregnancies, to where she works (or doesn't) to whether she has a terminal illness this week. A few months before this last ordeal hit the fan, we got a call from her saying that a cat had nearly torn her nose off and that she was having to have major emergency surgery to put her face back together. Needless to say, none of that was true. Given her age, and without her consent, we have no access (that I'm aware of) under these circumstances to her records. I hope I'm just making a needless mountain out of a mole hill. Maternal instinct on overdrive, maybe. I just feel like we're flying blind on this. I guess time will tell.