Any point in getting axis II diagnosis for nearly 18 year old?

Discussion in 'Substance Abuse' started by Cracklin'Rose, Aug 10, 2010.

  1. Hello everybody. I just found this amazing place and after reading through the posts, I'm hopeful someone can advise me on whether it would be worthwhile to have my stepdaughter difficult child assessed for a personality disorder. Here's the situation: she has been gone a week and is couch surfing, drinking, doing drugs, etc. Last night she was caught shoplifting and then let go with a citation. She will be 18 in 9 weeks and just got back from a 3 month + stay in a wilderness therapy program. On her return we placed her in an intensive outpatient dbt program, as well as AA and individual and family counseling. We have a family contract and a level system. Our other children can live with the rules, but our difficult child will not. She is not usually openly defiant, just incredibly devious.

    After seeing the striking difference in outcomes between our difficult child and our 15 year old easy child/difficult child upon completion of the same wilderness program, I started to investigate the possibility that our difficult child has something more serious than the ptsd and depression she was diagnosed with. She has many antisocial traits, including a long history of recklessness, stealing, fighting, truancy, drug and alcohol abuse, promiscuity, lying, and cruelty to animals. She has also been very cruel to her siblings, especially her younger sister. She cannot maintain relationships with her peers and shows little or no empathy toward others. She has no real interest in anyone but herself. Family therapy is a joke because she will not accept responsibility for her actions; she just rationalizes, deflects and justifies.

    Honestly, there is little we can do for her at this point, and we don't want her in our home a minute longer than necessary. She can't be trusted as she steals money from us as well as stealing our vehicles. Also, she has told me that when she lived with her mother and was angry with her she would spit on her plate and in her food. I shudder to think what she does here when she is angry. There is not a single rule that she will voluntarily follow as she seems to believe that rules shouldn't apply to her. Again, she isn't openly defiant, she just sneaks around and then brags to her siblings about it.

    The reason I'm considering making the effort to have her assessed for a personality disorder is that the treatment she has received so far (pt, dbt) has done absolutely nothing for her. From what I know, the most effective treatment for cd or aspd involves longterm cbt. From what I have observed of her therapy sessions, she enjoys the sympathy and loves to talk about herself, but is completely unwilling to accept responsibility for her own behavior. On the other hand, if she returns home at all, she will not be here for long. Once she turns 18 she will be on her own and responsible for getting herself to treatment so is there any point to getting another diagnosis now?

    It is inevitable that she will have further contact with the mental health care system in future, and also likely with the court system. Would a pd disagnosis help or hinder her? There is obviously a stigma around cd and aspd, which may explain the reluctance I have seen by mental health professionals to explore that possibility, but the treatment she is likely to receive without an accurate diagnosis is worthless and may even do more harm than good. I say this because she had a miserable childhood with her mother (also likely aspd or nd) and was raped by a neighbor of her mother's. She has only lived with us for a little over a year. When she is in any kind of trouble, she has learned to bring these things up and use them to elicit sympathy and excuse her own behavior.

    I know I probably sound callous, but believe me, I was incredibly sympathetic for many months. I apologized to her over and over for what had happened, even though we had been fighting to get custody of her for years, and she had always insisted she wanted to stay with her mother. I cried and felt sick when she told us some of the things that her mother had supposedly done. I say supposedly because we later found out from her stepfather (since divorced from her mother) that our difficult child would return home from visits with us with all kinds of fantastical stories about how we mistreated her and would say nasty things about us and make fun of us. This stepfather absolutely doted on her, even after his own parents refused to allow her in their home any more because they thought she was "the devil." No kidding.

    So anyhoo, thanks for letting me vent and please let me know what you think about whether I should bother trying to get an axis II diagnosis or not.
  2. slsh

    slsh member since 1999

    Hi Rose and welcome! Glad you found us.

    Big sigh.... I should warn you that my head is extremely flat from beating it against the brick wall that is my beloved difficult child, and therefore I'm a bit cynical and skeptical about the practicality of a *parent* trying to get appropriate diagnoses and/or treatment when you're talking about an uncooperative/noncompliant mid-to-late teen. In my world at least, the sad reality is that at this age the kid holds all the cards. We cannot force them to be compliant with treatment or diagnosis. When the kid is a master manipulator to boot... well, quite frankly, I question at least half the evaluations my kid has had in the last 10 years because he's been far more interested in pulling the professionals' chains than getting *real* help. And I guess, to me, that is the key, especially when you're dealing with- a PD. If the person with the PD isn't interested in treatment and in learning how to function more appropriately, I don't think any treatment will work. It's the old dragging the mule to the trough thing - you can do it, but you sure can't make 'em drink. My kid would die of thirst rather than "drink" from the trough of treatment.

    I will say that when I brought up the likely possibility of my own kid having some very distinct PD traits when he was 16 or so, I was told they simply do not diagnose a PD before they're an "adult". Not sure why, but... okay.

    You say treatment thus far hasn't done much for her and I have to ask, do you think it's because of the treatment or because of her lack of honest participation? It sounds like she has been offered many and varied types of treatment. Again, just in my experience with- my difficult child, it really boils down to is the kid willing to recognize there's a problem and do something about it. You can drag her to every professional you can find, but you cannot force her to do anything with it.

    As far as a PD diagnosis, or any diagnosis, helping or hindering her in future contacts with- mental health professionals or court systems, I honestly don't know. My gut says it's a wash - won't help in court system, might in the MH system *if* she's ever willing to honestly seek help.

    It's a shame, really - it sounds like your step-daughter really has been thru the ringer. It's incredibly frustrating to watch our kids struggle and know that there is the potential for help for them, but they are their own worst enemies. The adamant refusal to accept that they need help, the refusal (or inability, I'm not sure which is is anymore) to see how their choices impact others, the whole "I don't have to follow rules/it's not my fault/I know what I'm doing" mentality - it makes for a rocky time all around.

    Anyway - just my very cynical perspective. ;) Fortunately, there are a wide variety of opinions on the board and hopefully someone will be along shortly to give you a different one. Again - welcome and I'm glad you found us!
  3. Thanks Sue for the quick response. It's good to be among people who get it. I used to belong to a support group for parents of troubled teens when we lived in Washington state. Instead of "difficult child's" we called them "star children." The group was a fantastic resource. I think in going through this process and meeting many other parents along the way, the saddest realization I have had is that there are so few success stories. Mostly it seems to come down to surviving until they are 18 when you can ask them to leave, and then waiting it out until they come to their senses somehow. You are exactly right when you point out these kids will not change until they want to, period.

    Yes, I think you have hit the nail on the head here. I did talk to the case manager at the dbt program she was attending and we came to the conclusion that the only benefit from pursuing a diagnosis would be that the next time she came in contact with the mental health system they wouldn't be starting from scratch. Also, I think that if we do it now while her dad and I are still in the picture, we will be able to provide a lot of information about her childhood that she probably wouldn't share even if she remembered. Our next step is to try and get her to go back into inpatient treatment and while she is there I suppose we could work toward such a diagnosis. If she won't go to treatment then I guess that's the end of it.

    Thanks again.
  4. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I actually think DBT is the best, however NO therapy will help if she's not willing to work very hard. Just going isn't enough. I'm so sorry about this. I know how frustrating it must be.
  5. slsh

    slsh member since 1999

    I've been on this board for over 11 years now and have "watched" a lot of kids grow up. Two things really stand out to me. One, that "success" is relative - what we dreamed for our difficult children when they were little pretty much gets chucked out the window somewhere along the way (I guess to be honest, that's probably true for all of our kids, LOL). I expected thank you to graduate HS, go on to college, get a job, comply somewhat to basic social norms (his appearance right now is ... well, it's kind of a goth/demented Dr. Seuss look and provokes a lot of negative reaction in his community - sigh, his choice), and lead a fairly "normal" life based on my blue-collar Midwestern standards. A lot to expect of my difficult child, in hindsight. As he veered towards 18, our expectations/hopes changed. Now, we're just happy that he's alive and not in jail. I ache because he has made his life incredibly difficult, but somehow he's making it work for him... and it's his to do with as he pleases.

    The other thing is that it seems to take our difficult children a lot longer to "cook". It seems like a *lot* of difficult children don't really start to get it until their 20s, and some of them make some pretty goofy moves in the meantime. The goal is a law-abiding, productive adult. Anything more is window dressing.

    But this waiting for them to get it is nothing short of torture. ;)

    I certainly don't think it's unreasonable to try again to get your difficult child into treatment again and as tuned up as she will allow. Certainly not a bad idea to get her difficulties as well documented as possible for future reference.
  6. compassion

    compassion Member

    Hi, My daughter has borderline Axis II diagnosis, has since age 15,also has diagnosis of bipolar I and subatance abuser. I think it is very helpful for understanding and dealing with the realities. The book Stop Walking on Eggshells and The Essential Family guide to Borderline (BPD) are very helpful. Onliine support group from CABF, for dual diagnosis, it is now known as substance abusers. is a great support. Antipyscotic and mood stabilizer keeps her out of instiution at this point. Compassion
  7. 7jewels

    7jewels Guest

    Hi Rose,
    My difficult child is in similar situation to your stepdaughter but is 19 now and not the least interested in any more diagnoses. I don't know if axis II diagnosis would be helpful in future anyway. Sorry can't give you more advice but will definitely pray for you and your family. We are in turmoil about our difficult child as well; at present, almost total detachment is my self-preservation. When there are younger sibs involved, it's a whole different story! D.
  8. Thanks all for your kind responses. I've calmed down a lot over the last few days and kind of reconciled myself to thinking that the best course of action is just to find a safe place for her (i.e. treatment facility) for as long as she will stay. I just found a couple of good ones covered by our insurance. Here in CA she must consent but once the police pick her up we will give her the option of staying here in CA in treatment voluntarily or being sent to a locked facility in OR. Either way, after she is 18 she will be on her own if she wants to leave treatment. I will make sure to let whichever facility she ends up at know that she is a pro at "fake it 'til you make it" behavior. That way hopefully she will be in treatment until at least until 18, and if they manage to get through to her, maybe even transition to an adult program.

    Again, I really appreciate all the understanding and good advice from everyone. If you have any tips for working with dual diagnosis facilities and how we can make the best use of her time there, I would love to here from you. Also, just what experiences you have had with them if you want to share.

    Thanks again.
  9. JJJ

    JJJ Active Member

    I think you have gotten some great advice here. I just wanted to add some (((hugs))) cause our kids make it so darn hard.
  10. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I am borderline and bipolar and to tell the truth, I dont think that having the diagnosis's listed anywhere helps much in a court setting unless you are just out of your mind delusional. Most of the time psychiatrists will be called in to do a new evaluation anyway.

    I have to think that at this point in time your dtr isnt going to willingly embrace any new ideas of something else being wrong. It took me years to find out all that was wrong with me. I knew something wasnt completely normal but I just didnt know what. I dont think I would have been ready to hear all that when I was 18. My 24 yr old isnt much on believing his whole alphabet soup.