This is SO well written and insightful (clinical psychologist here) My wife's sister took a $1700 taxi ride from New York to South Carolina, where she showed up at her mother's (my mother in law's) doorstep on New Year's day in 2004, expecting to be welcomed with open arms (and have the taxi ride paid for).

She was diagnosed with bipolar at the time. After spending a few weeks with her, I realized she had borderline symptoms. Her uncle (head of the teen psychiatric unit at a major NY hospital) thought she had the full BPD dx, but I never thought she fit the full diagnosis. About 2 years later I was given the opportunity to talk to her therapist, who - I agreed fully with - said she had TRAITS of several personality disorders, including OCD, paranoid, BPD, histrionic, and 2 more.

Over the years, I realized none of the diagnoses really captured what was going on with her. she's a very bright, sensitive, artistic person, who in her rare moments of functioning is quite funny, engaging, warm and friendly. Otherwise, she has been on disability for 20 years, has never been able to hold down even a part time job, and has been a puzzle to all of her therapists.

I only realized in the last few years that the single thing that best encompasses her functioning is that she is stuck - not just at one place but at several ages.

I first realized this about 8 years ago, when I did psych evaluations successively on 3 VERY rebellious teenage girls. Their defensiveness and argumentiveness reminded me SO much of my sister in law - right down to the excuses she makes for her obviously problematic behavior.

So here's a summary ,which may interest you:

When she's very angry and defensive, she's about 13 years old.

Most of the time, when she's being bubbly and a bit hyper, she's about 8.

When she's very sad or very frightened, she's about 4 (her mother used to see her often as a frightened toddler, which was true part of the time but not always)

I've never seen diagnoses put this way, but it makes sense of her in a way nothing else does.

Thanks for an excellent article

(PS: You might enjoy this: She's very religious, and I found a good way to approach this with her was to remind her of how many times Jesus told us to be "as little children" - and to tell her - honestly, not lying - that at her best, she is like a Divine child.)