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How long can you stave off full on bipolar?


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How long can you stave off ending up in the hospital if you manage to sleep, but are cycling wildly? My 20 yr old daughter is horribly irritable; this is no normal kind of irritability. She has a strong, strong genetic tendency for bipolar but is currently in denial and thinks that people should not take pills for it or that it's not "real." I have seen the irritability for years off and on, but now she's gone downright abusive. She's cutting off everyone who cares about her and she drives any potential boyfriends away with her "bitchiness."

She struggles with depression and anxiety and has been off meds for that for over a year. But now it looks like hypomania big time....I think she cannot pay her rent this month due to spending, too.

What is likely to happen? How long can this go on? Indefinitely?

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She struggles with depression and anxiety and has been off meds for that for over a year. But now it looks like hypomania big time....I think she cannot pay her rent this month due to spending, too.

<{POST_SNAPBACK}>

I don't know if I can answer you about how long before hospitalization, but I have 2 thoughts/questions:

1) "She struggles with depression and anxiety and has been off meds for that for over a year." So she takes meds for that, but won't consider meds (or even the possibility of BP? Is she already seeing a pdoc for the depression/anxiety? If so, he may be already thinking of the possibility of BP. If she isn't seeing a pdoc is she just getting the meds through her doc? Either way, if you want to talk with her about it, I think the only thing you can do is lovingly point out that depression and anxiety can actually be symptoms of BP, and that there might be more effective meds available to her.

I know I sound like a broken record with this, but I really think this site is good re: the basics of BP: Mood swings without "manic" episodes: Bipolar II -- more than plain depression, but never delusional or psychotic. It focuses on BPII, but has a lot of information on the whole BP spectrum. Maybe print some of it out and give it to her. A good choice might be the list of 11 "Soft Signs" of Bipolarity, on the "Diagnosis" page. Short and to the point

You can't do more than that; it's up to her to read it

2) "But now it looks like hypomania big time....I think she cannot pay her rent this month due to spending, too." This may be a wake-up call for her. If not, she is only 20...it may take some time of losing apts., jobs, boyfriends, etc. for her to face the facts.

I take it, from what you've said, there's no way to reason with her and she is not very receptive to the topic. Unfortunately, there may not be a lot that you can do about it as her mom.

Maybe someone out there with actual experience in this area has some better input?

Take care,

revlow

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I don't know if my own experience over the last few months will help at all, but it may give you a perspective into BP onsent (sorry, no idea how/when you were diagnosed...if this is useless ignore me!), especially as I'm a similar age to your daughter.

I first plunged into depression when I was almost 18. It was like I woke up one day with the weight of the world on my shoulders. Everyone noticed- it was like instant personality change. Kept it hidden from my parents for about 2 months, school noticed immediately. They made me give up my beloved maths A level because I was 'stressed' and they thought I was doing too much (in the UK it's normal to take 3 A levels, so by dropping the maths I was back to 3, like everyone else). That pissed me off. Suprise suprise, dropping the maths fixed nothing. I knew it lol. Teachers at school tried to counsel me, I was sent to some awful nurse once a week who really didn't get 'it'.

Fastforward several months and I'm mildly suicidal. Suprisingly, the downward spiral stops, and in a way I flick out of it. Que days on end with barely any sleep, intense irritability, money spending (in that sort of lets dispose of several thousand pounds meant for university in a couple of months way), agitation, distancing myself from people, concentration totally going. Maybe like what your daughters going through, maybe not.

Couple of months later I'm depressed as hell again. Not long after that I'm suicidal. I go to the GP and ultimately am referred to the local crisis team. Put on anti depressants and I go very obviously hypomanic- pure euphoria, grandiose ideas- the works. I had every symptom. At this point I'd just turned 19. After that initial hypomania, I cycled a couple of times, briefly stabilised and was put on Tegretol and discharged.

That was a couple of months ago. Within a couple of days of my discharge, I began to cycle rapidly- a few days of the most bleak suicidal depression, a few days of intense hypomania. Each cycle, the high worsened, and within just a few weeks (and I mean literally 2 or 3 weeks) I was experiencing cycles between psychotic mania and severe depression. Of course I went back to the pdoc, started a different drug cocktail and things have improved. There's a long way to go but I'm heading in the right direction.

I'm sorry for the length of that, I just wondered if something there may resonate with you. I think what I was really trying to imply was that from when any hypomania-ish symptoms first emerged, it was a total of about 8 months before I was experiencing psychotic mania. From my first classic hypomania, it was several weeks. I believe if I hadn't seen the pdoc when I did, I would have been hospitalised very shortly (and bear in mind hospitalisation seems to be much rarer in the UK- it certainly is in my area).

I do believe ADs seriously accelerated the onset of my BP. I was only on them for 5 days, but it seems the damage was done. I don't know what happened when your daughter was on ADs- something to think about I guess. I can't help feeling that without them it'd have been a good few years before I started getting fully manic, but then again I'd had what I think was an irritable hypomania before, so maybe it'd have made no difference.

My last mania was terrifying. If I hadn't been able to end it with my drugs, I'd have admitted myself to hospital. I'd gone past euphoric and things got so fast I had no real idea what I was doing. That was the point where, if I'd been in denial, I'd have changed my mind fast.

Things vary for different people and all, but my illness progressed in a very short space of time. I guess it could all vary depending on which specific subset of BP she may be, too. 

God this is long. If you've read this far, well done. I'll shut up now. Best of luck with your daugher, I know how scared my mother is for me, and know it must be really worrying for you. Hope it works out.

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I have 2 thoughts/questions:

1) "She struggles with depression and anxiety and has been off meds for that for over a year." So she takes meds for that, but won't consider meds (or even the possibility of BP? Is she already seeing a pdoc for the depression/anxiety? If so, he may be already thinking of the possibility of BP. If she isn't seeing a pdoc

Hi Revlow!

Thanks for your input. She saw her pdoc and tdoc about a year ago. Since then, she's gotten on a "health" kick and thinks that taking ANY pills is bad. However, if her depression got bad enough, I think she would come to a point with that where she goes back on Zoloft. It's just that she does not understand the mania part, and *is determined* not to become Bipolar like her mom. I did send her two of the symptoms in an email:

1. Extreme irritability

2. Thinking nothing is wrong.

Which will no doubt make her angry at me.

I think what may end up being the "wake up call" is that she can't keep a guy she really likes, because she becomes "super bitch" around him. You are right, that was the phrase I was looking for...."wake up call."

Thanks, revlow, for the link, and for taking time to reply to me! :-0

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Fastforward several months and I'm mildly suicidal. Suprisingly, the downward spiral stops, and in a way I flick out of it. Que days on end with barely any sleep, intense irritability, money spending (in that sort of lets dispose of several thousand pounds meant for university in a couple of months way), agitation, distancing myself from people, concentration totally going. Maybe like what your daughters going through, maybe not.

Yes that sounds exactly like her. Except she did get 90 days of treatment at age 15 when she became depressed and suicidal. That treatment did her good for several years.

Couple of months later I'm depressed as hell again. Not long after that I'm suicidal. I go to the GP and ultimately am referred to the local crisis team. Put on anti depressants and I go very obviously hypomanic- pure euphoria, grandiose ideas- the works. I had every symptom. At this point I'd just turned 19. After that initial hypomania, I cycled a couple of times, briefly stabilised and was put on Tegretol and discharged.
She won't admit to these symptoms and it's going to take a whole heck of a lot for someone to convince her. One problem is her pdoc. He would not put her on a mood stabilizer at all! I faxed him letters repeatedly, telling him about how hypomanic she appeared to us. I even ending up filing a Board of Medical Examiners complaint against him for not treating her as a Bipolar. He got stubborn against me and continuned her on 2 anti-depressants, until she got on her "health" kick and never went back.

That was a couple of months ago. Within a couple of days of my discharge, I began to cycle rapidly- a few days of the most bleak suicidal depression, a few days of intense hypomania. Each cycle, the high worsened, and within just a few weeks (and I mean literally 2 or 3 weeks) I was experiencing cycles between psychotic mania and severe depression. Of course I went back to the pdoc, started a different drug cocktail and things have improved. There's a long way to go but I'm heading in the right direction.

I just wish she would recognize what she's doing. She told me last week, "Mom, I either sleep too much or not at all!" But I can't tell her anything or she gets mad. She's extremely rebellious, even at 20.

I'm sorry for the length of that, I just wondered if something there may resonate with you. I think what I was really trying to imply was that from when any hypomania-ish symptoms first emerged, it was a total of about 8 months before I was experiencing psychotic mania. From my first classic hypomania, it was several weeks. I believe if I hadn't seen the pdoc when I did, I would have been hospitalised very shortly (and bear in mind hospitalisation seems to be much rarer in the UK- it certainly is in my area).

Hospitalization is common here and that just may be her wake-up call. I just pray she never has to get psychotic. (I didn't get that way until I was 34!) But someone told me once that with bipolar, the DNA strands get shorter - or something - with each generation. I got bipolar younger than my mom, and I see my daughter getting it younger than me. There's bad genes on the other side, too. Do you have a lot of bipolar genes?

Thank you SO MUCH for giving me your experience. It really helps. I see now that she may have to end up in the hospital for her wake up call! I pray she doesn't hurt herself or get psychotic first.

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Mellow:

Yes that sounds exactly like her. Except she did get 90 days of treatment at age 15 when she became depressed and suicidal. That treatment did her good for several years.
I am doing a copy and paste here from that site. You really need to read the whole site, but this may contain some things she'll think about. Maybe. (Among the others that fit, notice #2 about age of onset for the first episode of major depression.)

-----------------------------------------------------------------------------------------------

"Soft Signs" of Bipolarity

Here are eleven more factors that have been associated with bipolar disorder.  They are best regarded as markers which suggest considering bipolar disorder as a possible explanation for symptoms:  suggestive of bipolarity, but not sufficient to establish it.  Whether the simultaneous presence of many of these items actually raises the likelihood of bipolar disorder has not been studied, though obviously that is intuitively appealing.

The list has been adapted from Ghaemi and colleagues; errors in translation to plain English are mine (the list was prepared for the patient version of this section).  In a separate publication the age of which (1983) gives you an idea of how long this seemingly radical notion has been around, one of the most august researchers on bipolar disorder has presented sensitivity and specificity data for several of these factors.

1. The patient has had four or more episodes of major depression. 

2. The first episode of major depression occurred before age 26 (71/68) (some experts say before age 20, a few before age 18; most likely, the younger you were at the first episode, the more it is that bipolar disorder, not "unipolar", was the basis for that episode).

3. A first-degree relative (mother/father, brother/sister, daughter/son) has a diagnosis of bipolar disorder (56/98); or individuals with mood symptoms in at least 3 generations (32/95)

4. When not depressed, mood and energy are a bit higher than average, all the time ("hyperthymic personality").

5. When depressed, symptoms are "atypical":  extremely low energy and activity; excessive sleep (e.g. more than 10 hours a day); mood is highly reactive to the actions and actions of others; and (the weakest such sign) appetite is more likely to be increased than decreased (59/88).  Some experts think that carbohydrate craving and night eating are variants of this appetite effect. 

6. Episodes of major depression are brief, e.g. less than 3 months.

7. The patient has had psychosis (loss of contact with reality) during an episode of depression. (42/85)

8. The patient has had post-partum onset of depression (58/84). 

9. The patient has had hypomania or mania while taking an antidepressant (remember, severe irritability, difficulty sleeping, and agitation may -- but do not always -- qualify for "hypomania"). (32/100)

10. The patient has had loss of response to an antidepressant (sometimes called "Prozac Poop-out"):  it worked well for a while then the depression symptoms came back, usually within a few months. 

11. Three or more antidepressants have been tried, and none worked.

-----------------------------------------------------------------------------------------------

Good luck!

revlow

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Have you ever considered that sometimes when people deny something and get very angry, it can be because deep down they know it's true? It's possible that maybe, on some level your daughter does appreciate that she could be BP, but just isn't ready to accept it yet? I can remember that I saw my continual highs and lows as a weakness on my part; I knew it was silly but I couldn't help feeling that way. I can remember one day when I was particularly depressed crying to my pdoc about how out of control I felt, and how I kept trying to pull myself together but couldn't. The way I am without medication- and even now, the continual break through symptoms, enough to remind me of how screwed I'd be without any meds- angers me so much. It can take a while of being ill, and missed opportunities because of being ill, to appreciate that you are BP, and you need medication.

It's also possible, with her being only 20, that she feels if she 'submits' to (ie accepts she could have) the BP beast, that she's setting herself up for another 60 or so years of hell. It sounds silly, but when you've literally got the whole of your life ahead of you, 'allowing' yourself to have a lifelong condition, with the potential for relapse is quite a hard thing to do. I know that if I wasn't so certain of what I want to do with my life, and got so close to it even when I was very ill, I'd be more tempted to be non med-complient, to try alternative routes, until I had to accept what was wrong with me.

As for BP genes in my family, it's a bit of a mystery to me! Both my parents are officially normals, though my father does get a little depressed/mood-swingy from time to time, enough to make me wonder if he could be a bit cyclothymic, he deals with it and doesn't require medical help. My paternal grandmother however spent her life ill and did get hospitalised on several occasions, suffering with depression, intense/inappropriate anger at EVERYONE (dysphoric mania perhaps?!!) and obvious psychotic episodes. No dx, but family tales of her behaviour make me think possible BP. There's certainly a lot of mental illness down that side of the family- my dad's cousin commited suicide and my cousin has had depression.

Perhaps the best thing you could do would be to provide relevant information on BP, tell her to read it if she feels like it and that you'll always be there for her. Hopefully when she's ready she'll come back to you for help. In the meantime, just ask her how she's feeling but support her and don't force the issue. Hopefully with a bit of time she'll realise what's happening to her before it gets too bad. Fingers crossed for you both.

(And if she'll see a pdoc, get her to a different one. The word *bubbles the chimp* springs to mind!!)

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Have you ever considered that sometimes when people deny something and get very angry, it can be because deep down they know it's true? It's possible that maybe, on some level your daughter does appreciate that she could be BP, but just isn't ready to accept it yet?

Boy that makes a lot of sense! But doesn't that describe DENIAL perfectly? I know from experience with other people in my life that you can't break through the denial with arguments. I really need to start going to Al-Anon again. It's good for so many things like this.

It's also possible, with her being only 20, that she feels if she 'submits' to (ie accepts she could have) the BP beast, that she's setting herself up for another 60 or so years of hell. It sounds silly, but when you've literally got the whole of your life ahead of you, 'allowing' yourself to have a lifelong condition, with the potential for relapse is quite a hard thing to do.

Makes a lot of sense - again! I'd love her to have as much time as possible before her "sentence" starts, but I am so afraid she's going to hurt herself and become a casualty of this disease before she gets her wake up call. There's Al-Anon screaming at me quietly again. "Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference." Today she was supposed to have New Years Day dinner over here. The time came and went, and she didn't show again. And yet last night she told me she had no money for food. What can you do.

Good point about the doctor. If I tell her he's bad, she will just rebell against that, so I've been telling her how great my *female* pdoc is. Hoping she'll go to her if she's ready for meds again. Thanks so much!

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Hey, I'm about the same age, 19, going onto 20 in a couple of months. And yeah, a year ago, I got told, by my GP, that I've got some mild depression and anxiety, here's some zoloft, enjoy. Before that, I didn't want any mental illness, because, well, I want to be a psychologist myself, and I'm real interested in neurology, and according to my small mind at the time, psychologists don't have mental illnesses. I wrote this in my livejournal:

I do not want to end up like Mel, my friend who I talked about earlier(I wrote about her having a depressive episode, and then having a dream where I "lost it" throwing myself out of a window, thinking 'It doesn't matter anymore. Nothing I do matters. It cannot get any worse') . Or my dad. I do not want to be like me in that dream. I refuse to have depression. I refuse to give into genetics. This is why I like the movie 'Gattaca' so much. It is about a man who is shunned by society, because he is not genetically engineered, and statistics show that he will have all these health problems. In the end, he over came all these problems. My mum has schizophrenia and my dad has bipolar. Both my parents are mentally ill, but are being treated by medication.

All I started writing about how my boyfriend's friends have been spreading stuff about me at their school, and how upset I was about it. Then I went into this self pity session, and then that bit in italics. I mean, how on earth can I refuse to have a disease? Back than, this was in august 2004, and I wasn't diagnosed with anything, and didn't see anyone.

How is your relationship with your daughter's father, because that might be a factor in her denial. My parents faught a lot, and my mum would often yell "manic depressive" at him as an insult. Then they separated. The other day, I was trying to talk to mum about how I sometimes felt like fighting with someone, but then my mum started getting angry, saying "that's what your father was like, I hate his type!". I'd think "I don't care what I've got, as long as it's not bipolar".

I also agree with whatsgoingon, maybe she gets angry because deep down, she knows it is a posibility. I do get pretty angry at mum, almost irrationally, when she says "yeah, and that's what your dad did". But it would only seem irrational to those who don't know what I'm thinking, or trying not to think. Like she might get angry if you compare her symptoms with yours or something.

Also, she might not have bipolar, other diseases have similiar symptoms. Such as anemia, thyroid problems, debieties, etc. Even PMT. I blamed a lot of things on PMT. When I went to the doctor, I thought it what okay to go, because I was complaining of problems related to something like anemia, rather than depresssion, which at the time was fine for me. A couple of months or so later, he thought I might have depression after some talking, and getting good blood test results. In the middle of the year, he asked about how my highs were, ofcourse I knew what he was on about, so I snapped at him about how the medication is working "sometimes". (Nice one, me. Heh.)

But guess who comes crawling back later. I cut a neuron into my leg, which scared my mum. She found out on the night just before she was going to do night shift at work. So, she said she couldn't go, and explained to a superviser what happened. She used to be a psych nurse, so it's not like mum blurted it out to everyone (like me, but this is crazyboards). She apparently told my mum that it sounds like I have bipolar (ofcourse, she knows a whole lot of stuff) and from that, I accepted the possibility. Mum took me to the doc, who gave me a referal to my pdoc. After two sessions, he thought there was nothing major wrong, but he was a bit worried about some stuff, so I gotta keep seeing him. Been there four times already. I may have it, I may not. Don't know. But I was more willing to I guess admit to something when it wasn't my mum comparing me to dad, or something. Has friends or something said something to your daughter?

Also, what about diabities? She could be having ups and downs from her sugar levels. Maybe because she's a health freak she might 'accept' that. Maybe she'd go to the doctors for a diabities test, and maybe your daughter might be more willing to say her symptoms if they were diabities symptoms, rather than bipolar symptoms. Maybe?

Even, you could (and probably have) talk about what's bothering her more, rather than slapping a label on her. And maybe even say "yeah, I get that too, and this is how I dealt with it". You almost seem convinced she is 100% bipolar ( I even ending up filing a Board of Medical Examiners complaint against him for not treating her as a Bipolar. ) , when she might not be (but probably is), and she might sort of feel it. Don't know your actual situation, sorry. Have you also tried talking to her, when she's more down I guess, about what would be so bad if she was diagnosed with bipolar, or why she gets angry when you mention it. (I can imagine it "yeah, well I don't have it, leave me alone!"). There may be an issue behind it, like for me, thinking mum wno't like me anymore because of it.

Good luck with it, and sorry if I made no sense.

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I think it basically comes down to having a wake-up call and agreeing to treatment, or cracking up and getting treated involuntarily. Eventually I said "nope, this IS a problem. And you know what it is, self... dammit." It wouldn't have much mattered if other people were convinced I were bipolar, even if one of them had been a mentally ill relative, even a parent. I had to put the pieces together for myself, motivated by experience, before I would believe it.

It sounds like you're trying to educate her on the true nature of bipolar, which could be helpful if she absorbs any of it. I hope she picks up on enough accurate information to act accordingly, if the shoe fits. It might be pertinent to mention that I went through my own extremist health kick at one point (all whole foods, for a time vegan, compulsive exercise, and yes I was dumb enough to drop my NSAIDs). It was this, or more accurately the fact that this didn't work to fix me, which played a big part in my accepting that the problem wasn't somehow external, whether environmental or dietary or purely psychological; it was inherent in my physiognomy, and it needed to be addressed.

I think this is a matter of having to let her go, as terrifying as that is, and waiting for her to make her own decisions. I know you want to protect her from the travail of life with undiagnosed and misdiagnosed mental illness, especially with preliminary evidence suggesting the protective, prophylactic effects of long-term pharmacotherapy, but you can't. There is only so much influence you have over your adult daughter. Use what you have, but try to recognize that her own health and treatment are her responsibility now. Any mistakes will be her own.

Maybe Shinkei is right, and her symptoms reflect something besides the dreaded bipolar diagnosis. If that does turn out to be the case, then the only thing that matters is effective treatment. If they are indicative of bipolar, though, do you think she might be encouraged to reveal the full scope of her symptoms to a doctor (preferably with some background in psychiatry, though not a psychiatrist) if she believed they were looking for a physical problem, not a mental one? I don't recommend you deliberately deceive her, but it might be a way to get her in closer proximity to an diagnosis and perhaps treatment.

We twentysomethings are a prickly bunch. I just hope your daughter stays safe, and healthy.

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a.jpg

All of you guys have really good points. I will answer them but right now I'm kinda freaking because I found this picture of my daughter on the 'net. I guess I'm lucky she has clothes on. :-) Not a good thing for a mom to find. Oh well at least you all know who I'm talking about. She's not shy, I guess.

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Maybe I'm missing something, MY. Before I read your post, I immediately thought..."Oh, what a beautiful photo! Is that her daughter?"

Please take no offense. Even after reading your post, I still don't see what's so horrible about this photo. She's a lovely girl and it's a pretty photo. Is there some context I'm missing? Was this on a porno site, or one for an "escort" service? Or what??? Obviously, there must be more to this.

revlow

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Maybe I'm missing something, MY. Before I read your post, I immediately thought..."Oh, what a beautiful photo! Is that her daughter?"

Please take no offense. Even after reading your post, I still don't see what's so horrible about this photo. She's a lovely girl and it's a pretty photo. Is there some context I'm missing? Was this on a porno site, or one for an "escort" service? Or what??? Obviously, there must be more to this.

revlow

<{POST_SNAPBACK}>

It's not horrible. It's just a tad too sexy for a mom to come across. It's on her website at www.myspace.com, which is mostly friends, but also trolling for guys. Nothing wrong with being sexy! It just gave me a shock. :-) Thanks for the compliment on her. I worry that she's being hyper-sexual, but I guess they all start young these days.

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mellow,

my son is on my space, and believe me, your daughter's picture is tastefully conservative for my-space pics. Sometimes it's best to cover your ears and sing, la-la-la-la.

greeny

<{POST_SNAPBACK}>

Oh thank you, thank you! I guess I'm lucky; it could have been distasteful. Still, she is really openly and overly sexual on that site and it embarrasses me. I don't want people to call my daughter a s---, you know.

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Mellow:

I say this with all kindness and good intentions: You are going to have to detach, with love, from your daughter and her problems. I suspect you already know this from one of your previous posts. You've gone to Al-Anon (so have I). That's the only thing you can do. Both for your own sanity and well-being, and to -- hopefully -- keep the doors of communication open for your daughter. She may not take advantage of those open doors just yet, but if she does want to, she'll needs to percieve that you are open. No amount of worrying, nagging, or whatever on your part is going to help right now, and in fact it could make matters a whole lot worse. But you do already know that, right?

I think your idea about getting to an Al-Anon meeting is a sound one.

Best wishes,

revlow

PS - Whether we like it or not, our sons and daughters are sexual beings and they are going to express this the way they want. And at age 20, that's her business. Not to say you don't have reason to be concerned about her hypomania expressing itself through hypersexuality, but there just isn't a whole lot you can do. Hopefully she is "playing safe", and hopefully too you had discussions on this topic in the past. At age 20, she is not going to listen.

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Mellow:

I say this with all kindness and good intentions: You are going to have to detach, with love, from your daughter and her problems. I suspect you already know this from one of your previous posts. You've gone to Al-Anon (so have I). That's the only thing you can do. Both for your own sanity and well-being, and to -- hopefully -- keep the doors of communication open for your daughter. She may not take advantage of those open doors just yet, but if she does want to, she'll needs to percieve that you are open. No amount of worrying, nagging, or whatever on your part is going to help right now, and in fact it could make matters a whole lot worse. But you do already know that, right?

Revlow, thank you, you are absolutely right!! She has told me yesterday in email in no uncertain terms about how I better not express my worry to her any more, or she will just withdraw more. You are right, I need to go to Al-Anon about this. (And about my brothers, my father, lots of people). I'm a terrible enabler, much to my detriment. So, all this I've posted is actually about ME and my problems rather than my daughter. I need to detach. Thank you again.

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