Diagnose my sister. What is going on?

[Anonymous]

Anonymous wrote:It sounds like she had underlying autism, OP.

I know people will excoriate me because they're tired of hearing about this particular neurodivergence, but my family is rife with it, my kids have been diagnosed, my husband is autistic, we've talked to psychologists and read so much on the subject... and she has a lot of typical red flags :

1. personal hygiene issues,
2. seeking socialization but not managing to have best friends or stable boyfriends,
3. and being let go from jobs.

It may look like depression, but I bet you anything that the underlying uatism is what's actually making her struggle. She needs to be evaluated and then to talk to a therapist who specializes in treating people with autism.

Now on top of that, perhaps there's weight gain and depression caused by hypo-thyroidism, for example. Hypothyroidism is very common, particularly in women. She needs complete bloodwork to check for all sorts of medical issues.

Yes, I agree. I have a 20 year old daughter with autism. She has an app on her phone with "rewards" for things like showering, brushing her teeth, etc.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes it can be, depression isn't a permanent 24/7/365 gloom. It's also concerning to have a loved one noting the long list of things you are doing "right or wrong". That relationship may have left her crippled in some way to deal with family doing checklist criticism. You seem hyper judgmental and you are not seeing her daily.

Not OP. This seems incorrect. I think OP cares about her sister. It's not like she is judging her. She is concerned for her sister who doesn't bathe, smells, can't keep a job and wants to date but isn't getting 2nd dates. OP asking for help in this case, to me, is her being caring. But I do agree that it is hard to help someone who doesn't want it.

I'm someone who is a lot like OP's sister, although more functional. I can pull it together for my job, but that pretty much uses all my spoons.

One thing that hurts is when the goalposts move. If I worked really hard to show up clean, wearing clean well fitting clothing, and someone judged me because my clothes were stretchy (they always are) and I didn't have mascara on (I never have) and my hair wasn't colored (it never has been except once with koolaid for a Halloween costume), then I wouldn't think "Oh, I'll learn how to put on mascara", I'd think WTF is the point?

I think that identifying a couple concrete things, which to me would be showering, and figuring out if there is a medical cause such as depression, thyroid, apnea, for the sleep, is a huge ask. And focusing on those, and not on all the other peieces, is appropriate.

I think this is a really good point about moving the goalposts. Very insightful from someone who knows what it's like.

+1, that's a really good insight.

I am someone who could have been OP's sister but who wound up married by 35 which changed my trajectory some. I am also older and in the last decade or more have acquired a variety of tools that help with the mental health stuff that can make it hard for me to do the basic self care work OP's sister is struggling with. CBT was really, really important for me. But so was just trying different stuff and figuring out what works for me (that app OP mentioned sounds like a step in this direction, I use a variety of lists and incentives to make myself do the stuff I need to do). There was no single silver bullet, but it was like a combo of:

- therapy (different therapy with different therapists, most are only good for one of two things, I needed to work with different people to find stuff that works)

- lots of self help books, including like productivity books or books on career and socializing, as well as therapeutic books on depression, anxiety, CBT, DBT, etc. I read a book on having confidence. I read a book on dealing with friendship breakups. I got in the habit of looking for resources whenever I was having a hard time. My google history involves lots of stuff like "what to do when you are too depressed to go to work" or "can I buy something right now for less than $50 that will make me feel less sad" or "do other people have icky feelings that come over them and just ruin everything." I still do this. It helps. The act of looking for something that helps, helps

- having hobbies and friends. Like I said, I got married and that changed the course of things (for better in some ways, but it's harder in other ways -- you just wind up with different challenges than when you are single). But even beyond that, you just have to have people to hang out with and things to do, little goals to work on, etc. Sounds like OP's sister is actually doing well on this front, I think that's a great sign even if some of the other stuff is hard right now. People with friends and hobbies tend to be forward-looking, being forward looking is a great antidote to depression.

[Anonymous]

Anonymous wrote:The friends might be imaginary.

I hate to say it but I was thinking this too. I cannot imagine someone in OP's sister's situation hosting dinner parties.

[Anonymous]

"She says she has chronic fatigue."

Has she been diagnosed with ME/CFS? If so, that's a real thing. Don't dismiss it. And if so, the only issue I see here is the BO. It's ok if she wants to look frumpy.

[Anonymous]

I have many family members with ADD (inattentive) ranging in age from 18 to 85 and showering is not a priority for them. Don’t know why. I’ve wondered if it’s a somatic thing.

[Anonymous]

Is she obsessed with Disney?

[Anonymous]

I am on page 1, but I have to say that I doubt it she is hanging out with anyone besides you. All this sounds a lot like my elderly dad. He sleeps a lot and is prone to stinking but perks up when family visits and doesn’t look depressed. However when he is alone he rarely hangs out.
I bet your sister’s days are comprised of sleeping and watching reels or some such. Her living space is most likely a dump too.
I can’t diagnose the mental condition but it’s definitely something along the mental health lines

[Anonymous]

When did it all start?

[Anonymous]

Anonymous wrote:

Anonymous wrote:The friends might be imaginary.

I hate to say it but I was thinking this too. I cannot imagine someone in OP's sister's situation hosting dinner parties.

Maybe or maybe not. I have a neighbor who matches this description except she seems fairly consistently employed (in a WFH job) and she definitely has friends and a social life, as I have met them. She is a little younger than OP's sister (late 20s, maybe right around 30), and I know that her parents are paying at least a portion of her rent even though I do think she makes enough money to pay it herself, as I have met and spoken to them as well (super nice people, they seem to have a healthy relationship with their daughter and the financial arrangement seems to be viewed as a way to ensure she can live more independently while also not having to budget too carefully which might be something she's not particularly good at.

She is active in a couple hobbies, seems to have around 10-15 consistent friends, 4 or 5 of whom come over fairly often. I do think she gets depressed at times and on more than one occasion one of her friends has stopped by to ask me if I've seen the neighbor out of the house recently or to express concern for her her. My sense is that the neighbor is very likable generally, has a good and supportive family, and has a number of friends from college/grad school who care about her, but that she struggles with mental health and executive functioning.

If my neighbor had a sister or had visited her family for the holidays, I'd even think perhaps OP was talking about her. But she's an only child and her parents stayed with her over the holidays instead of the opposite.

[Anonymous]

Anonymous wrote:I have many family members with ADD (inattentive) ranging in age from 18 to 85 and showering is not a priority for them. Don’t know why. I’ve wondered if it’s a somatic thing.

Please stop. I have inattentive ADD and my daughter has it as well. We both shower daily and it has never been an issue--maybe because it IS a priority.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have many family members with ADD (inattentive) ranging in age from 18 to 85 and showering is not a priority for them. Don’t know why. I’ve wondered if it’s a somatic thing.

Please stop. I have inattentive ADD and my daughter has it as well. We both shower daily and it has never been an issue--maybe because it IS a priority.

Ah...Nevermind, you were only describing your family members with inattentive ADD, not everyone with inattentive ADD. There is no delete on anonymous forums. Carry on...my apologies.

[Anonymous]

Anonymous wrote:Yes it can be, depression isn't a permanent 24/7/365 gloom. Its also concerning to have a loved one noting the long list of things you are doing "right or wrong". That relationship may have left her crippled in some way to deal with family doing checklist criticism. You seem hyper judgmental and you are not seeing her daily.

What is the matter with you? The woman has bad enough BO that even her sister doesn't want to be around it for long.
Anyone would want better for a beloved sibling who doesn't bathe, has BO, is overweight but wants to date and seems to have a lot to give.

[Anonymous]

It sounds like most of you have had fabulous experiences with doctors. Have you ever been significantly overweight and gone to the doctor? I wonder if she's been let down by the medical profession because I feel like she would just be told that all of her problems are due to her weight. She may be feeling that her situation is hopeless because of the things she's faced at a doctor. It sounds like she's trying to put her best foot forward when she's smiley and hanging out. I finally found a good doctor, I've lost a ton of weight (on a GLP-1), and the difference in treatment is astounding and quite frankly, very sad. OP, I think that you do care about your sister. I wonder if you've ever spoken about medical issues with her and gotten a feel for her success with medical care in general. Please don't feel you need to tell her she's overweight, she knows.

[Anonymous]

Anonymous wrote:It sounds like most of you have had fabulous experiences with doctors. Have you ever been significantly overweight and gone to the doctor? I wonder if she's been let down by the medical profession because I feel like she would just be told that all of her problems are due to her weight. She may be feeling that her situation is hopeless because of the things she's faced at a doctor. It sounds like she's trying to put her best foot forward when she's smiley and hanging out. I finally found a good doctor, I've lost a ton of weight (on a GLP-1), and the difference in treatment is astounding and quite frankly, very sad. OP, I think that you do care about your sister. I wonder if you've ever spoken about medical issues with her and gotten a feel for her success with medical care in general. Please don't feel you need to tell her she's overweight, she knows.

No, I haven't had fabulous experiences with doctors and if they discussed my weight with me, I'd know it was serious.
I would not want a doctor who, say, let me keep smoking despite the respiratory problems it was causing me because I might be too sensitive about quitting smoking.
My father had a doctor like that but that was because my father was too old and his lung cancer was beyond reversible.
If a doctor is telling you to change something, that doctor believes you have a fighting chance to improve your life. Because if they aren't advising you on the change, they are essentially giving up on you.

[Anonymous]

Mean sister syndrome