TW: suicide, self harm

Hi all. I have a 15 year old stepdaughter that has been “loosely” diagnosed with BPD. (Her psychiatrist said they can’t officially diagnose a minor, but she is being treated as a BPD patient.) She returned home a week ago from a 7 day psych hold for suicidal thoughts.

I need help and advice on how to deal with her. This is going to be very long, so fair warning. 

She has had significant traumas in her life, with the biggest being her mothers completed suicide when she was 1 year old. Due to her dad’s culture, his parents took her back to their home country, and cared for her for a few years. (I understand this is controversial by American standards, but this is a normal thing in their culture, so please be respectful.)

By the time she was 5, she was back in his care. Initially she struggled in school because she didn’t know English well, and was teased a little bit. (This is what she has said - her dad was never made aware of any struggles with her peers from her teachers or school admins.) She is a very quiet and shy person, and has very poor self esteem. 

I believe she acclimated quickly, and has never struggled academically. She is a bit of a “nerd”, but she has always had friends and understood social cues. 

She is now a moody teenager, but it’s not “normal” teenage behavior. Here are some of her current struggles:

- manipulation. She manipulates people constantly. It ranges from suicide threats, to sweet talking, to straight up lying. She lies often, and about everything; from brushing her teeth, to where she went with her friends. (I want to confirm that we take her suicide threats very seriously, and we do not label them as attention seeking.)
- self harm. She has recently started cutting/burning/and poking herself with sharp objects. 
- food issues. Since she was a toddler, she has been overweight. She’s currently about 50 pounds overweight. She is a binge eater, although recent developments have occurred where she is now restricting and binging, and she’s lost about 20 pounds since July. (People have been commenting about this in a positive manner, which only feeds her disordered eating.)
- hypochondriac. She believes she suffers from a variety of ailments, ranging from ADHD to arthritis. Something is always “wrong” with her. She has attempted to manipulate her psychiatrists to give her autism and ADHD diagnoses. 
- chronic victim hood. She finds it almost impossible to find any blame in her actions or relationships. Her dad and I are blamed for everything wrong in her life, even if we are just doing what her doctors have advised. She sees things very different than what is reality.
- unable to give or receive gestures of love. She will not say “I love you”, and she doesn’t show any signs of affection. If you hug her, she completely freezes up. She doesn’t ever go out of her way to do anything nice for anyone, or remember to honor people’s special days like birthdays or graduations. 
- she romanticizes her issues. She has told us that she doesn’t want to get better, because she likes the attention she gets from people for her issues. She often “brags” about her diagnoses to her friends. 
- she is very impulsive. She makes decisions without thinking of the consequences. She also sometimes says things that are inappropriate. 
- she refuses to communicate. Her dad and I do our best to keep things open, and we are pretty open minded people. (Neither one of us has issues maintaining relationships, and are well liked by our coworkers, family, and peers.) She believes we don’t understand her, and will not talk to us about most issues. 

I understand that we are dealing with a very serious situation, and I want to be sensitive, but also firm with her. I truly believe she feels like a victim, and that her dad and I are assholes that don’t understand her. We walk on eggshells around her, because she is very volatile. This has created an unhealthy dynamic where we avoid a lot of interaction with her, as it is often negative. 

What are some things that we can do, as her parents, to help navigate her through this? What specific things do I need to talk to a therapist about to understand her better? How do you wish your loved ones responded to you? Is there anything we can do to create better communication? How do we help her understand herself better? How do we create boundaries without making her feel like we are abandoning her? What boundaries should we have? Will things ever feel less awkward? 

(We have scheduled her for DBT group, that starts next week. She also sees an individual therapist once a week, and is under the care of a psychiatrist, so please no suggestions of: get her therapy.)