Help and questions around DD Mental Health

[SlightlyJaded]

Not really sure where to start.

I think DD (17) might have BPD... or something. I don't know. She also thinks this is a possibility. She has struggled with excessive mood swings, anger, impulsive behaviour, self-harm and generally self-destructive behaviour, for a long time. Things that could potentially be put down to being a teenager, except that it is SO extreme for her. She cannot manage her moods - she is never on an even keel - either really low or really angry. She sabotages friendships, relationships and will spiral into a deep depression at the slightest thing - a friend criticizing her outfit for example, can result in her walking out of school and ranting and raging for hours and hours on end. Her reactions are completely disproportionate and she definitely has a level of anxiety about being left out of things which she describes as 'being abandoned'.

She is also quite dramatic and stubborn - so there is a tiny bit of me that is sceptical. I don't know where her personality ends, and a condition may or may not begin.

Her relationship with her dad is the most difficult for her to manage. He is from a culture where women and girls are expected to be more passive and mental health is 'not a thing'. And although he is not a complete arsehole and doesn't want her to be a doormat, he does not cope with the way her behaviour manifests at home AT ALL. She is verbally challenging all the time. She questions all his decisions and causes conflict because she cannot seem to moderate her words - even when she knows the outcome will cause drama that she then cannot cope with. She pushes him and pushes him - almost taunting him to acknowledge how out of control she is, so that can then challenge him on the fact that he 'doesn't believe mental health is a thing'. They go round and round in circles - often ending up screaming at each other - and it's completely destructive and devastating for both of them (and the rest of us).

I know she is doing it because she is desperate for him to be supportive to her and he just can't get past the fact that she is so rude and confrontational to him. And - as an aside -he does believe that MH issues are wishy-washy and mostly used as an excuse for bad behaviour.

I have taken her to a GP who agreed she probably does struggle with 'something' but because she is under 18 we are on a wait list as long as your arm for any kind of diagnoses or treatment. I arranged 10 counselling sessions for her but they were not helpful as the therapist was really geared towards working with far younger children and wasn't the right person for DD. We have private health through DH work, but unbelievably they are unable to offer anyone for face to face anything and DD doesn't feel that she could do online - she says she would not feel relaxed, connected, free to speak etc. All the things you need to feel to open up. I get this.

Her GP offered to start her on a low dose of Fluoxetine - but without any kind of diagnoses, we don't know if this is a good idea.

So I guess my questions are:

• What do you think about the Fluoxetine without a diagnosis?
• Has anyone got experience of DBT which is what was recommended? It is really expensive and I can't really afford it, but if it's what's needed....
• And how do you approach a situation where one parent refuses to consider that mental health might be a problem?

(I realise that DH sounds like a dick but he loves her very much and has been very forgiving of things that I thought he would kick off about - so he is trying but he can't believe what he doesn't believe...)

Thanks

HI. I should be working, so this will be brief.

1. Fluoxetine is actually the only anti-depressant that has any significant evidence that it works and that was in a trial with teenagers, so it might actually work with her. However, watch it because (1) it can increase suicide risk (2) teenagers brains are still developing and these pills have a significant impact on the brain. PERSONALLY I worry about giving such pills to people with developing minds, but that is MY view and I am NOT A DOCTOR (so make your own mind up).

2. I'm doing DBT at the moment. I get it free via IAPT (NHS) and I registered for free online. There was a long waiting list (several months), but I am there now. I can tell you more about it if you are interested. I don't know why its expensive as its not rocket science and is mostly common sense. It is helping a lot as did mindfulness meditation (which is part of DBT) which we are using with our daughter who is a similar age.

3. Show your husband the evidence. There is a lot of it. I just did a free course with my DW which was entitled Understanding Children and Young Adult's Mental Health via Lincoln College and I've now got a GCSE in it. It was a real eye opener for me as I had some elements of that "everyone just wants a label to blame" mentality at times.

I can be a bit of a dick myself, but I am trying (sometimes very trying) and I realise that a lot of my issues are due to my upbringing and the generation I grew up in. We need to understand that with the bloody horrible internet and social media, children have a far harder life than we used to. At least bullying used to stop at the school gates in the "old days", now it follows you on your phone. Your husband also needs to realise that. Times have changed. Your daughter needs his help and understanding. She doesn't sound like she is looking for an excuse, she is looking for help.

Plus... remind him that she's a teenager and that she has all sorts of hormones going through her and changes in her body that she is struggling with and that her brain is still forming and her prefrontal cortex (the bit that makes us make decisions and realise that our actions have outcomes) has still not properly connected with the rest of her brain and wont for another 4 years or so.

Finally, he also needs to be aware that female suicide rates in her age group have seen the largest increase since records began. I'm sure he would be devastated if she took her life and he needs to be aware that there is a risk there.

Hope that helps. I am not an expert at all.

@NomadicSoul Thank you for such an incredibly kind and informed post. I'm sorry to hear that you have struggled but appreciate you sharing your learning with me.

Much of your comments confirmed thoughts I had, but it's really helpful to hear it from someone else - and don't worry - I've noted that you've stressed your advice is not medical and is amateur based on your lived experience.

I am going to see if we can register DD for the IAPT NHS DBT you mentioned. In some ways, I think she would get a sense of relief just to be 'doing' something about it - feeling heard and validated is so important to her.

I have tried showing evidence to DH but he is stubborn about acknowledgement. It's all been written by wishy-washy people with too much time on their hands and not enough moral fibre 🙄But I'll keep plugging away.

Thank you again. In particular, it was helpful to hear about Fluoxetine as that's currently all that's on offer. I'll perhaps look into it with DD a bit more. Thank you again

You're very welcome. It is hard growing up in this day and age.

As for being wishy washy, I was beaten/brought up by a very old school military father and I in turn served in the military for a couple of decades. I was brought up very old school, but over time have grown up and realised that my beliefs were not accurate and not helpful. Hopefully your DH will too.

However, if not, registering for something like DBT would be great. I have had a long wait but knowing that I was in a waiting list helped (and I had access to CRISIS support while I waited). The course I am doing is emotional regulation and is basically DBT. It is 5 sessions with a lot of practical stuff in between.

Week 1: Mindfulness . How emotions, feelings, actions and thoughts are linked and how you can break the link. Square breathing (I prefer breathing at 4 second in breath and 6 second out breath). Non judgementalism (I'm terrible at this)

Week 2: Changing your body chemistry - Using cold water to calm yourself. Progressive muscle relaxation. Improving sleep. 20 minutes exercise a day

Week 3: How to prevent acting on Unwanted emotions - Stress. The stress bucket. STOP (Stop, Take a breath back, Observe, Proceed Mindfully)

Week 4: Check the Facts - Looking at emotions, thoughts and actions and how one triggers the other. Unhelpful Thinking Styles (mental filtering, jumping to conclusions, labelling, emotional reasoning, catastrophising, personalisation, magnification and minimisation, black and white thinking). Wise Mind,

Week 5: ABC Please - reducing vulnerability to emotion mind, accumulating positive emotions, (short term and long term). Mindfulness of pleasant events calendar. Gratitude Journal Prompts. Helpful Apps. Helpful Websites

These sessions in my case are 2 to 3 weeks apart to let you practice them and see how they help.

The helpful apps are basically mindfulness apps. Personally, I would recommend Smiling Mind (free and has a very good few introduction course), Balance (which is a new one and free for a year at the moment) and when you get a good handle on it Insight Timer which is all you will ever need (1,000's of free meditations but it can be overwhelming for new people). I've studied a lot with mindfulness (there are some great courses around including free ones with Future Learn (Monash University)) and have introduced it to my daughters to help them with some of the problems they experience. I would strongly recommend it. They are both finding it very useful. You can also look at online mindfulness based stress reduction courses (I did an 8 week one which I found terrific).

The above will help your daughter to become the grown up in the arguments and it will help her emotional wellbeing and mental resilience.

Aside from that there are lots of self help books out there that she can look at (I've bought my daughters a few) and there are lots of free courses out there and helpful websites like mind.org.uk and anxiety.org.uk

As for fluoxetine, you can look it up online. I took it in the past, but unfortunately for me the side effects were bad as I tend to be sensitive to pills.

I cannot thank you enough @NomadicSoul for such helpful and candid posts.

Yes - the legacy of being brought up the 'old fashioned way' is hard to reconcile with such a different landscape now. I recognise that it is difficult for DH to unlearn everything he has been taught about 'just getting on with it' and he wants DD to be resilient as he was always taught that this is the only acceptable way to be.

I don't know how far I can realistically expect him to shift so it's doubly important to me that I am doing everything I can to support DD. Your five point lesson in DBT is really helpful and I'd be interested in hearing your recommendations for any books or podcasts that might help whist we wait for something more concrete.

Your responses have honestly been more than I could have hoped for when I posted - MN at it's best.

Thank you again - and for your two decades of service!

I've only just registered with MumsNet if I'm being honest and that's because my anxiety is through the roof with "life stuff" at the moment and helping others helps me, so you're welcome.

Books I have got for my eldest daughter:

The Power of Now by Ekhart Tolle
Self Compassion by Kristin Neff (my eldest is tough on herself)
Atomic Habits by James Clear (my daughter loves this one)

Books I got for both of us:

Full Catastrophe Living by John Kabat-Zinn (the guy who for want of a better word "invented" mindfulness)
Mindfulness - Finding peace in a frantic world by Mark Williams and Dr Danny Pelman

Books I bought for myself to have more of a clue:
Calm Parents Happy Kids - The secret of stress free parenting. Dr Laura Markham
The Silent Guides by Prof Steve Peters
The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma By Bessel A. van der Kolk

For DBT, you could look at:

DBT for Dummies or CBT + EI + DBT Mastery Guide
Overcome Anxiety & Rewire Your Brain (With Cognitive Behavioral Therapy Made Simple, Dialectical Behavior Therapy and Emotional...Overcome Anxiety, Depression and Fear) by Jocelyn Meyer

For mindfulness, you could got to Tara Brach's website and sign up for her daily meditation course and that will take you through the different types of meditations and its free.

I dont really listen to podcast's I'm afraid, but can look into them if you want. There's a few good things on YouTube that I've looked at before.

Hope that helps.