Q. Dear Dr.,

My younger sister has had problems since she was around 2 yrs. old. My Mom's first memory of her abnormal behavior was when she was visiting a friend and "Anne" was 2 and stole a pair of earrings and had placed them under her clothes in her dresser drawer. This not seem too unusual, but the next 28 yrs. Have had 100's if not 1000's of incidents where she has lied, stole, "conned" and created her own reality. She always blames others - the law, the post office, the bank. Every situation she has an unbelievable story as to how it came about. She seems to have a self-esteem or image problem that makes her want to "impress" other people. She tells people things like "I was to be a ballerina, but I broke my leg". She also has a problem with finances and has written many bad checks, been charged with returning merchandise under false pretences, (she took a blouse out of her employer's closet when she was a nanny and tried to return it to the store), Insurance fraud (she faked two different break-ins and once they found the "stolen" electronics in her attic), and tons of other "scams". The odd part of all this is she appears a normal, successful, and personable woman to those who don't "really" know her. She is on her third marriage, has never worked long (she is always on disability from companies she works 2 or 3 mos. for). She has always been promiscuous since very early teens. We've tried to get her help but even after admitting one time that she didn't know what made her do these things and she needed help, she prefers to ignore it and continues to deceive, con, and lie to all of us that love her. She has 2 beautiful little girls (6 and 4) that I really worry how this will affect them when they get older and "catch on." Also her new husband doesn't have a clue. She was almost 3 mos. pregnant when she told me the marriage was a mistake. She faked a fall to cover the abortion. Dr., she is so good at these lies she "conned" the Ford dealership out of a '99 Eddie Bauer Expedition! Of course they caught her, but they had already titled it in her name. Please help, her crimes and lies get bigger and bigger. We don't know what to do to help her stop. My nieces may grow up without a mom.

A. She could be both antisocial and borderline, but most of the behaviors you describe are fairly specific to the diagnosis of antisocial personality. The more standard borderline symptoms--dysphoria, impulsively, self-injury, mood swings, and rejection sensitivity were not part of your description. The same medications that help borderlines can help folks with antisocial personality. Emil Coccarro, MD has done a lot off work in this area. But there are problems.

My experience has been that if people believe there is a problem, change is easier to bring about. Since there seems to be little to no remorse in your sister, it is difficult to see how or why she would wish to change. This makes medication and therapy compliance very poor, and thus outcome very poor. I do not know how to tell you very much that can help. I would tell you to not bend your own value system to accommodate inappropriate behaviors in others. Stick to your guns, and perhaps your sister will come around. She clearly needs professional help, but this help will be of little value if she has no desire to change.