Q. Our eldest child has been diagnosed with depression, narcissism, BP spectrum, anxiety disorder - you name it. She hurts herself and others. She is academically and musically gifted, but constantly undermines herself, directly responsible for her own failures. She refuses participation in the family (both parents & 3 younger siblings) and defies even the most basic safety rules. She is completely unaware/uncaring of other peoples' feelings. Her attitude is one of belligerence and disrespect, and has been since she was very small. She lies effortlessly and needlessly. She exhibits fantastic, grandiose plans; for example, she plans to be a punk rock star, tells everyone she has a (nonexistent) band, and does not practice. Reality is superfluous.

We have tried everything we could think of, including several therapists. They have all told us that we have done all we can. My husband has given up. She has abused her brother and sisters, even with our best efforts to protect them and reassure her. Everyone in the family is frustrated and angry. She wants to get away from us.

We are sending her (at her request) to stay with her single, childless aunt, in hopes that she can find her way better there, with no siblings. Her aunt is more emotionally detached, and similar in personality to our daughter.

I believe that my father, grandmother, and sister have a version of BPD.

Our daughter is presently taking Paxil and Seroquel, which have helped her more violent outbursts, but seem to have had no effect on her basic attitude.

We love our child, but she has never exhibited any loving behavior in return. I am terrified for her. How can we help her?

A. I hate being the bearer of potentially bad tidings, but feel I must be. You cannot do a lot for your daughter is she lacks enough insight to change. She is wired to react a certain way, and probably cannot learn how see the world very much differently. If she wears a coat in the winter and eats when hungry, we know she learns. Everyone wants to be comfortable. Therefore, to do the same thing over and over again with painful consequences is not consistent with her learning model (or any other learning model).

You can support her good behaviors, and not make excuses for the bad ones. Be consistent and very concrete in your dealings with her. Most importantly, get her on enough of the correct medications. Paxil is probably okay, but she may do better on others in the same group. Therapy for BPD is like talking to diabetics or cancer patients to get rid of the disease. You fox what is physically wrong first, and then do therapy. She may come around if she is still young. Heck, even BPD adolescents act like adolescents. They just bring a more disparaging style with them.

Ultimately, you cannot sacrifice your other family members. Do what is right by your standards. Do not lower your standards or bend them inappropriately to placate your daughter. It will not work, and you will feel worse in the long run. The BPD is not your fault, nor you daughter's, so do not own any guilt over it. Do the best you can by living your life and helping your children (all your children) live by this standard where possible.