A female behavioral health problem centered around self esteem and unhealthy relationships. What advice and resources can you offer to help?

@kevbo: Why does she fear for her sister’s safety at this point? What was said by the sister to give her that impression?

She is hysterical and unable to control her emotions at this point (gf’s words not mine). Luckily(?) she is flying (she’s a flight attendant) the next few days. Otherwise, she is pretty much home alone. Other circumstances include pressure from just having had a pay cut. Suicidal or not, though, the gf thinks it’s time to do something more substantial about this. Thanks again for whatever input you might have.

This one is difficult. It may sound terrible, but I was almost hoping that a direct threat to her safety was verbalized, because then your girlfriend would have good reason to call the sister’s local authorities. She would be brought to a hospital and psychiatrically analyzed. It sounds extremely harsh, and your girlfriend would probably catch a lot of crap from the sister about calling the police. But ultimately, the important thing would be that her safety was ensured because she was in safe hands. But this is a bit different. Maybe some type of formal intervention? Does your girlfriend know the sister’s friends (ones that are healthy influences)? Involve other family members? The sister’s obsession with men/sex/attention from men sexually will eventually destroy her, not completely unlike a substance abuse. I hope I’m making sense rather than sounding off-base.

doh, “your girlfriend would have reason…” sorry.

No, you’re absolutely on the right track. A challenge is that her circle of family and friends is small and not very reliable for something like this owing to their individual and collective dysfunctions. It’s more or less my gf, a brother who lives close to Denver but stays at arms length most of the time, a brother in Houston and her mom here in Albuquerque who tends to feed the drama beast. Other than that, she has one work friend and another friend in CA whose life is even more dysfunctional than hers. She also has the “man in her life.” That’s about it.

@kevbo: Yes, that can make it difficult. Do the other family members recognize her illness? Because that’s precisely what it is.

I think there would need to be some education on the problem and indoctrination on how to respond to it. So I would label that one of the steps. (Thanks to your input.) As she/we typically do, we’d been thinking along the lines of not involving “unreliable” family, but maybe it needs to go the other direction.

Absolutely. Everyone needs to be told and convinced that, hey, *** isn’t going to be so lucky one of these days. She could be beaten, raped, contract a disease, possibly terminal… and if she doesn’t get some serious counseling, possibly even inpatient treatment to deal with the reasons why she depends so heavily on men and sex for self esteem, then they can’t be depended upon to pick up the pieces for her anymore.

Sounds like this woman has Borderline Personality Disorder. The only thing that will really help her is a desire, therapy, and possibly medication. Its so hard to watch someone you love travel down this path; the feeling of uselessness can be overwhelming. For a disorder like this, a cognitive therapy (I recommend DBT) is the best approach. She needs to become aware of her emotions, her patterns, and her own culpability.

Taking poofs angle, authorities will not 5150 (CA term for a 72hr psych hold) a patient unless they actually state they are a danger to themselves or someone else unless, they physically do something to hurt themselves or someone else.

To determine a true suicide risk, ask this woman if she has a plan. If she is seriously thinking suicide she’ll most likely have a plan. If not, it could be she is crying out for help. Its a cliche, but sometimes someone does have to hit rock bottom before she/he realizes that her/his life much change.

Watch her, if possible, and do whatever you can to convince her she needs help.

@tinyfaery: That’s why I said I almost hoped she had threatened her safety, because then she could be held legally. it’s the same here in New Jersey.

@tinyfaery, DBT sounds like the perfect antidote based on the descriptors (“acute or long-standing difficulties with affect and impulse control, eating disorders, anger management problems, and self-destructive behavior” and “skill deficits in affect regulation, impulse control, assertiveness, and distress tolerance”). I mean I know it’s not like taking a pill, but I think it’s a good fit. Thank you.

This is a bit like alcoholism or another type of addiction, until she hits her own bottom she is not going to be ready for help.

@tinyfaery, do you know whether an “intervention” such as would be staged for someone with an addiction or eating disorder would be useful in a situation such as this?

removed by me. didn’t read something well enough before answering.

Yes, however, done incorrectly it could be worse than doing nothing at all. Those with BPD react impulsively and irrationally (reaction is disproportionate to stimuli). If she feels she’s being attacked or blamed, there is no predicting what she’ll do. I’d recommend either finding a professional interventionist, or just doing all you can to convince her to seek some help. You must go about it in a manner that does not accuse or place judgment; it must come solely from a place of care for her well-being and safety.

Thank you tinyfaery… I totally forgot to point out that there would need to be a professional interventionist involved. Duh for me :(

Thank you both. I still welcome more input from you or anyone else.

First, let me say how sorry I am that your girlfriend, and by extension you, are having to go through this. It is painful and stressful. The havoc an out-of-control adult sibling can wreck in the entire family is one I know very well.

I think you have had some good counsel from people with experience in dealing with this type of person. I would only add that you need to remind yourselves that, in the end, we cannot change or save someone else no matter how much we want to.

This may not be the time, but your girlfriend needs to think about the possibility of cutting her sister off if her sister refuses to take seriously the need for professional help that is real and not superficial.

To do that, sister will need to recognize that she needs it. Some never do. That is the time you have to think about saving yourself.

Please take care, both of you.

I don’t believe that BPD is especially amenable to treatment other than a very
structured “holding” involving therapist available at all times day or night, lots of group work, therapist having a heroic supervisory structure herself, and quite a lot of money. The chaotic nature of the
unloved infantile interior self demands a kind of reparenting which is almost impossible to obtain unless you live in Seattle (where you can find Marcia Linehan and her forces for good).
You could contact Marcia L’s lab at the Uof W and see if there’s a strong program in Denver, but the fact that the subject is out of town probably about half the time makes it unlikely that she can take advantage of such a structure even if she believed she needed it. I think, frankly, that your gf might need some help cutting herself loose. Hideous pain.
So sorry. You all are hurting and you all need support. I refer you, kev, back to all the good resources already at your disposal for remembering and practicing all available spiritual traditions’ versions of detachment with love. Heart with you, bro.

There are many qualified, effective DBT therapists. And even Marsha herself will say that her therapy can be used outside of a residential setting. I will admit that 24hr care is ideal, but in most cases this is not possible. What good is any therapy if it is unavailable to the vast majority of people? If you want to tell me where you are kevbo, I can look up some resources for you.

As far as “cutting her off”, that is so easy to say when you have never been in such a situation. This is her sister, she loves her, and is terrified for her sisters well-being. How would she feel if she ignored her sisters pain, and something horrible happened? What then? When it comes to family, “tough love” can be a slippery slope. It often causes more pain to the ones without the problem, than it does to the one with the problem. And in a lot of cases, is very ineffective.

I see young adults all the time who’s families have extracted themselves from my client’s lives. Not once can I say this ever had a truly positive effect. In most cases, my clients ends up seeking “family” so badly, just someone to accept him/her, that they allow anyone to do anything them. It rarely does any good to shun someone in pain.

Reactions out of proportion are definitely a possibility. My mother has Borderline Personality Disorder, and once “overdosed” (on non-lethal pills) because we got in a little argument on the phone. When she was got out of the mental hospital, she “slit her wrists” (scratches on the back side of her wrists) so she’d get readmitted. Once I realized she was craving attention, and not actually suicidal, I took the attention away (maintained distance, didn’t visit her in the hospital, didn’t “reward” the behaviour.) She never did it again. However, you need to be very careful, whatever you do. It is very difficult to live with the drama and self-centeredness that comes with BPD and I wish you all the luck.

@tinyfairy I respectfully disagree. I am not saying that people do not bail on family members too early. I am sure that happens

It did not seem, however, from Kev’s description that that was the case here. To wit: “This trajectory has been going on for years, if not all her life, and my gf usually is the one to talk her off the ledge when things come to a head.”

Unless you have lived with someone like this, someone totally self-centered either by choice or by illness or by addiction, you have can have no idea of the pain they can cause in the lives around them. I would not quickly judge family members who have bailed after numerous attempts at help and rescue that have failed. Why, if the person won’t seek help, should they drown too?

Loving family members as kev describes his girlfriend need help making the decision to disengage. It is never made lightly, and it is always painful. Sometimes, it just less painful than staying in relationship with someone who refuses help.

Sorry you have to go through this, it must be very tough and hard to go through. I’ve been in situations similiar to this and it’s a really helpless feeling. One thing to throw into the mix that concerns me is her occupation. The primary reason for having flight attendants on board is safety, and it looks as if she not stabile enough to be in that kind of situation either. It’s a tough enough job these days without problems like she has. I wonder if there is anyone in the company that could actually help? It’s not exactly the best place for her to be at this time and perhaps a medical leave is in order.

Again, thank you all. This is lots of good help.

@tinyfaery, the sister lives in Denver. We live in Albuquerque.

@susan, I’ll try the Seattle contact.

Just some more background. My gf and her sister have disconnected in the past, but it has always been at the sister’s initiation. One time the sister claimed my gf “hung up on her” (more truthfully she hung up at the end of a conversation without saying goodbye) and the sister didn’t speak to her for a year or more. This was in the middle of an episode, so it was a catalyzing event, not the cause, but my point is that they have been dissociated from each other in the past.

@seesul, I see your point, but I honestly think that she’s quite functional in that role. It’s sort of the one anchor in her life, and aside from taking unscheduled time off from it, she takes her job seriously enough based how I hear her talk about it. I agree though that she should seek employee assistance options and will add that to the plan of attack. Thanks.

There is definitely evidence/output of the problem in the time and attention it sucks from our lives first for my gf to have to handle the sister’s problem and then for the gf to process her frustration in a conversation with me.

You can change your reactions to the dysfunction, and still help the ones you love. No need to completely disengage. I agree with the attention-seeking behavior theory, but that doesn’t preclude that she is in legitimate pain.

Also, I have lived with someone like this. Other family members have given up, I refuse. So what if my life is sometimes inconvenienced; I’d feel like a self-centered narcissist if I just left her to her own devices. This is an illness. Would you turn your back on your sister if she had cancer, and needed you there to wipe-up her puke, and hold her hand?

Also, I worked for 3 1/2 years with girls 12–18 who were diagnosed with BPD. Dozens and dozens of cases have lead me to determine that family involvement and counseling is the best scenario for everyone involved.

Yeah, kevbo, I thought about that, I was just considering her reaction in case of an emergency or a real jerk of a passenger. Sometimes I don’t know how they do the job they do. In the “olden days” there used to be help from the union or airline on stress related problems, but who knows these days. Just look into all of the options. Gad, I really feel for you.

@Kevbo: Is she serious enough about her job that she’s not enticing and picking up passengers? It sounds cruel but that’s sort of like throwing a food addict into a bakery…

@pook, she does that, too, but it never amounts to anything. Also, it’s not “hey, let’s get it on in the bathroom.” It’s more conversation and signals during the flight in the hopes that the man will pursue her. She definitely doesn’t chase new men (just the ones that have already had her and then decide to keep her at arms length).

Also, she will only consider “professional” men of a particular minority race, so that limits her field of vision.

@Kev: Okay, because loss of a job due to a one-night-stand? Potentially catastrophic.

@tinyfaery: I said that really badly. I didn’t mean cutting herself loose from her sister, I meant cutting herself loose from the intensity of the secondhand pain. Detaching with love.
Good correction.
I hadn’t actually thought of inpatient tx, but a program that offers a lot of structure to outpatients makes things more intense (and these folks like a lot of intensity); structure is very reassuring (as well as giving the person in pain enough to fight against – fighting that heals, eh?).

This is so sad, I’m sorry you’re dealing with it. I would say that getting her plugged in with just the right therapy would be the answer. Getting a professional diagnosis and then presenting it as family therapy in which as many of her siblings as you can get attend some sessions with her might both make her attend more than one session and give her family a chance to help her see the problem in a guided setting. It may also be beneficial for your girlfriend to start coming to terms with some of her own damage from this, too.

One more terrible thought: you can’t fix her and you can’t make her fix herself. Learning to back away might actually be better for everyone, her included.

@All, Thanks again for your insights and advice. We got a list of DBT providers in Denver via Marsha Linehan’s office. My gf’s sister managed to pull out of her nosedive and is still in agreement that she needs professional help, so that’s more hopeful than not. Also, now that she’s read up on BPD, my gf feels she is doing a better job reflecting her sister’s thoughts and behaviors in coversation. Thanks so much from both of us!

So happy to hear that, kevbo. Lurve to you both (but I can only give the points to you.)

Awesome kevbo. Glad to hear it!