Reader’s Question

My 16-year-old daughter has been diagnosed with Bipolar Disorder, Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD). She has been in intensive therapy for years. She’s verbally abusive and threatens physical abuse.

My daughter’s therapists and doctors are convinced she has a terrible home life. But the truth is that we are all hostage to her. I feel so depressed all the time. My husband and other children are suffering as well. We have spent so much time trying to help her, but things only get worse. I don’t know what to do anymore.

Our Clinical Psychologist’s Reply

Your situation sounds not only dire but complicated, and naturally there is no way an accurate assessment could be made from such a distance. However, there are some perspectives on your plight that you might want to take into consideration.

Psychiatry and applied clinical Psychology are not exact sciences. We still have a lot to learn about the mysteries and complexities of human behavior. And sometimes, it’s hard to diagnose a situation adequately. That’s because the official diagnostic labels are based on observable behaviors as opposed to inferred etiology, so anyone who displays the qualifying behaviors ends up with a particular diagnosis. That’s one reason it’s common for individuals to have more than one diagnosis.

Not only do our diagnostic schemes undergo constant revision, but also our knowledge about causal factors is constantly growing and changing. Whereas there was once a time when we thought that all mental illnesses were due to parenting deficiencies or childhood trauma, we have been learning that such assumptions are not always well-founded. Human behavior is more complex than that. There are genetic factors, constitutional factors, temperamental variables, neurological factors, developmental factors, biochemical variables, and a host of other factors about which we are just beginning to learn.

When someone in the family struggles with significant mental illness, as you so rightly point out, the whole family is affected. But it’s also important to remember that for full recovery to occur, the entire family must also be involved. That’s why it’s often a good idea for other members of the family who are suffering under the weight of their own emotional trauma to seek the support and counseling they might need to help ensure that they acquire and maintain the strength and resources the family needs to cope.