Heather,
kt has a tenuous grasp on her sense of self or permanency as well. I hated to take the route that I took for her to take her medications however in her skewed perception of reality, she needed to feel in control. Felt (still does to a lesser degree) the need to "parent" herself with dismal results.
And it can be traumatizing to shut down the world - however, it's worked. And I had the treatment team behind me - supporting this stance & this strategy (as a last resort). Now there is no argument.
I hope difficult child can find a way to feel a sense of worth again... She's at such a tough age then adding in difficult child issues - well ahhhhhh!