Need Help with an Unusual Problem

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I live with an elderly relative. She is almost ninety years old and is very sweet. She's in very good shape and has no dementia problems that I am aware of.

Here's the problem. I have reason to believe that she has self-defeating personality disorder.

Here's why:
1) She will always choose the most unpleasant option of something. For example, the least appetizing food item, the
smallest possible portion of food, the most physically demanding task, etc.
2) She refuses offers of help except in extreme situations.
3) Won't take a compliment.
4) Repeatedly ignores me telling her not to do something, and then is devastated when I get angry. For example, me
telling her not to clear the table (a demanding and potentially dangerous task), continuously ignoring me even though
she has clear memory of being told not to, and then gets weepy when I confront her about it.
5) Won't participate in fun activities. Sometimes she will, but she frequently will find an excuse not to.
6) Idealizes self-sacrifice and martyrdom.

Here are some co-occuring problems:
1) She is known to be a pathological liar
2) Relies on passive-aggressive behavior to get her way rather than communication
3) Is prone to depression
4) Seems to need to play a certain role in a dynamic (i.e., the martyr, the victim, the hero, etc.)

The problem I see most day-to-day is her persistent "helping". She refuses to let me help unless I force the issue,
which I usually do. She isn't physically able to do the tasks that she tries to perform. Yet she continues to do them
even though a) I can do them more efficiently, b) I can do them without hurting myself, c) I have repeatedly told her
not to try and do chores, and d) her behavior is sometimes actually dangerous to other people.

I'm at a loss. What should I do???

I don't feel like I'm grasping the whole situation, but given her age she would've grown up during the Great Depression (assuming she grew up in the USA). So, maybe that's part of it -- growing up with hardship and having to 'tough it out' might be a deeply ingrained mindset. I.e. taking small portions of food, and never asking for help.

I dunno if it would be a good idea or not, but maybe you could ask her about how it was growing up then. If she were in charge of younger brothers and sisters she might feel she sacrificed some of her life for them, but that it wasn't appreciated (the wanting to be a martyr thing). I'm totally guessing, of course -- I really have no idea.

That's pretty accurate. She grew up during the Great Depression. plus her dad died when she was fairly young. She always says, "I was my mother's right arm". She describes working all day doing chores to help her mom and younger siblings. She took great pride in it. She also grew up in a culture where martyrs and other such saints were given a lot of reverence. When she was younger (I'm guessing while she was still a kid) she wanted to be a Benedictine nun. Back then they engaged in a lot of self-injurous behaviors.

You are not going to change a 90 year old person. If she wants to make herself miserable, let her.

If she is doing something which you think might be dangerous to her, offer to do it for her, or just say "Here, I'll do that, I need you to (give her another task to do)" and start doing whatever it is she was trying to do.

You can't teach an old dog new tricks.

Self-defeating personality disorder? I'd never heard of such a thing. Just Googled it. Oh, there is no such thing, or at least it was never formally admitted to the DSM (although that doesn't necessarily mean anything, I know).

Or then again, playing the devil's advocate a bit and trying to put myself in her shoes and see things from her perspective, maybe here's the problem:

1) Her younger relative views her with suspicion and disdain and criticises the fact that she will always choose the most unpleasant option of something. For example, the least appetizing food item, the smallest possible portion of food, the most physically demanding task, etc.

From her perspective, it's possible that she sees younger generations as selfish, greedy, always out for what they can get, always grabbing the biggest portion of pie (whatever happened to good manners and sorting out your guests and making sure everyone else is okay first?). All these young folk, they have all the modern conveniences, so they shirk away from performing any tasks that are remotely physically demanding - in her day, few people had cars, people walked, there weren't vast aircraft hanger sized hypermarkets, people butchered their meat, kneaded dough and baked their bread, people laboured on farms and in vegetable plots, they didn't have automatic washing machines, they washed and wrung out clothes by hand.

2) She's almost ninety-years-old, she's relatively fit and healthy and in possession of her faculties, yet younger relatives are trying to infantilise her and take over performing tasks that she feels she's perfectly capable of carrying out, and that's quite humiliating and upsetting to have been an independent adult and now she's being treated like a child.

3) What is it with young folk in this day and age? They want complimenting and praising all the time and mollycoddling and cause a huge great fuss and hullaballoo over everything? In her day, people were modest and humble. People were more godly in those days, and they knew that pride and vanity were seen as sinful.

4) Again, nearly ninety-years-old, relatively fit and healthy, yet being infantilised. Years ago, she probably warned the small children in her family to take care and not to mess around with the knives on the table and not to try to carry the heavy dishes or the fragile glassware, and now 'the tables are turned' if you'll excuse the pun. And it's humiliating being treated like a small child. And it compounds the humiliation to be told off like a child, and it's upsetting when that happens.

5) She's an independent-minded adult who has her own interests and likes and dislikes and won't be cajoled into participating in 'fun activities' that she doesn't like or doesn't feel in the mood for. And when she gets berated for not participating, that takes the fun associations away from that passtime and makes her feel reluctant to participate in future. The more of an issue is being made of it, the less fun it seems, the more she doesn't want to do it, the more of a problem that is, the less fun it seems... etc etc etc

6) She's of a generation which did make great sacrifices. She's lived through two world wars and the Vietnam war eras. She's undoubtedly known people of great courage and strength of character who've made great personal sacrifices, sometimes perhaps the ultimate sacrifice. And over those years, the women often fulfilled a traditional homemaker role, it was seen to be their job - to sacrifice their dreams of a career and greater independence, they were brought up to concentrate on looking after a husband and raising children. From her perspective, she probably sees today's generation as far too selfish, incapable of loving or caring for anyone other than themselves, unwilling to assume any hardship themselves if it will help or improve the situation for others. That younger people can't be less self-serving, can't be more altruistic and care for others is possibly a great disappointment to her.

As to the co-occurring 'problems':

1) She is known to be a pathological liar - perhaps ties in with self-sacrifice - "Oh, of course I've had enough to eat, I don't want any more, go on, you have that last piece of pie." Perhaps lies about struggling to carry out tasks, because she's so infantilised and belittled in other regards that she's desperately clinging on to what little independence and autonomy she has left.

2) Perhaps relies on passive-aggressive behavior to get her way rather than communication - because when she tries to communicate, when she takes a small amount of food and says it's enough, she's challenged and criticised, because when she tries to communicate that she can perform a task and doesn't need any help, she's challenged and criticised, because when she tries to communicate anything at all, it's like talking to a brick wall, because no one listens to her and acknowledges her point of view and capabilities.

3) I'm really not surprised she's prone to depression with this kind of 'care' being given and this kind of 'concern' being expressed.

4) Seems to need to play a certain role in a dynamic (i.e., the martyr, the victim, the hero, etc.) because at that advanced age she's probably quite set in her ways. Have you never heard the phrase 'you can't teach an old dog new tricks'? And why should she change her personality and her opinions to suit your convenience?

Stop being so bullying and domineering. Stop pathologising and being critical of behaviours that are quite normal for people of her generation. Stop pathologising and being critical of character traits that were and are perceived to be quite commendable among people of her generation, such as self-restraint, self-sacrifice, modesty and humility, independence, willingness to persevere and work hard.

I'm sure you're not, because you're expressing a lot of concern and you seem to provide a lot of care in practical terms, but you're coming across like a bit of a domineering bully who's failing to empathise and appreciate her perspective.

Perhaps what might be a good idea would be to consult with a geriatrician and/or old age social worker and/or old occupational therapist/physiotherapist? It might be a good idea to have a formal assessment made and get an expert opinion as to what tasks this elderly relative is capable of carrying out - and then to come up with a formal care plan that sets out when intervention might be necessary, and set out what tasks she can still safely carry out - like perhaps not clearing heavy dishes from the table, but helping to carry smaller items, condiments, tablecloths and table mats and napkins, or suggesting alternative tasks she can do instead, so that she can still feel useful. Again, you're failing to account for the fact that most women of her generation will have spent almost their entire lives in servitude, that's how many women see themselves and their role. You might think it's demeaning, and perhaps she shouldn't have that kind of self-sacrificing attitude and be such a martyr, but that's who and what she is and your undermining her identity and taking away her independence and sense of being 'useful' and making a contribution.

And as for the communication problem and what you see as her passive aggressive behaviour... you're failing to see that when she's tried to communicate with you, you've ignored or overridden her wishes and opinions and failed to acknowledge her capabilities and rubbished her attempt to contribute towards household activities. Don't underestimate that she's probably very grateful for the assistance and care you do provide and just wants to 'do her bit' to express her gratitude and thanks, but any gesture she makes in that regard, you criticise and upset her and reduce her to tears.

So talk to her! Sit down and have a conversation and ask her what she feels capable of doing, ask her what she wants help with. Have a discussion. If you think she's not capable or its unsafe for her to do something like clearing the table, explain your concerns and ask if it's possible to negotiate, to come to an agreement whereby you come up with an alternative, something she can do instead, to help maintain her independence and enable her to make a valuable contribution and to feel appreciated (instead of a troublesome burden) so that she can maintain some dignity instead of being infantilised and treated like a child.

You say there's no dementia problems you're aware of, so she's still in possession of her faculties, so treat her as such, instead of infantilising her treat her with dignity and respect as a fellow adult.

i think you've pretty much hit the nail on the head EnglishLulu. it's very possible ChrisVulcan is simply mistaking her being courteous for "self-sacrifice". back then nobody really took more then they needed. it's especially important to note how she was raised and how her life was when she was young. Essentially, when she was young, she WAS the "man of the house". As for the choosing the least appetizing food... maybe she happens to love that particular item. definitely time to sit down and have a long chat with her, who knows.. you may learn what makes her tick, and she'll become less prone to the depression you speak of when you gain a better understanding of each other.

nobody appreciates being being treated like an invalid, no matter how old they are, especially since she seems perfectly able to take care of herself. believe me.. if she needs help, no matter how humiliating it may be for her, i'm sure she'll ask for it. if you have a suspicion that she's not up to a certain task, graciously offer assistance. if she refuses, then, bow out and accept it. It just goes with the whole "respect thy elders" rule she likely grew up with.

Also, I just wanted to add some more comments about food and diet.

If she's always taking small portions and what you think isn't the nicest food, it's possible that there might be a problem with her diet.

Your metabolism changes as you get older, and obviously, if you're not as active, you're not burning off so many calories, so you don't need to consume so many calories. So while you think her portions are too small - presumably compared to yours and other family members who are younger than her - they might provide sufficient calorific intake for her needs.

However, that's not the only consideration, it's important to eat a balanced diet, to have enough fresh fruit and vegetables. And also to ensure that the right amount of vitamins and minerals and consumed. Perhaps she might need some more calcium, or iron? And make sure she has enough fibre in her diet.

It might be a good idea to keep a food diary for a couple of weeks and then assess it, make a note of everything she eats at mealtimes and also how much she drinks and what she drinks.

If you have any particular concerns, then it might be a good idea to run the food diary by her doctor or a nutritionist or dietician check whether her diet is appropriate, whether there are certain foods you need to make she eats more of (diary products for calcium, oily fish for omega 3, spinach or meat for iron or whatever) or whether she might need some vitamin or mineral supplements. I've just remembered that when I worked as a receptionist years ago at an old folks home, I used to type up the drugs records, and while obviously a lot of them had different medical conditions, a lot of them seemed to be taking a non-prescription fibre supplement called fybogel http://www.chemistdirect.co.uk/fybogel_v_2401.html and they had prunes with their breakfast cereal.

It's possible that you might need to make some adjustments to her diet or add some supplements. Or it might be that she's not eating enough. But generally speaking, it's not really something to be alarmed about if an older person has smaller portions (unless they're ridiculously small and they're virtually not eating), because of the change in metabolism and lack of activity and need for fewer calories that I mentioned.

I didn't find out why it was never admitted to the DSM. The fact didn't bother me for the reason you pointed out. I think a lot of the DSM criteria is based on a fuzzy understanding of how mental disorders actually work.



Good point. Many people believe that SDPD is caused by the way the person was brought up.



Another excellent point. There's a reason I said "relatively good health". She is in better shape than most octogenarians, but she still has some mobility issues which make it unsafe to perform too many household tasks.

Random question: is mollycoddling a word?



This may be what motivates some of the lying. I don't say "pathological" lightly. She lies for reasons, like to protect people from an unpleasant reality, for example. But a lot of her lying occurs when the truth would actually be more pleasant, or would support her case better. In this case, the behavior seems more habitual or compulsive than motivated. I think that she actually can't control it.

As for the passive-aggressive stuff, it isn't the kind of situation where she has tried communicating directly and been unsuccessful. She has always been an indirect communicator. I mentioned the co-occuring stuff in order to give you a more complete picture of the situation. [/quote]



One of the problems I have with the psychiatric community is that it defines what is healthy according to what is considered "normal" or "abnormal". For instance, Japanese culture (although this is less true today) used to see suicide as being a noble thing, at least in some contexts. It doesn't make suicidal thoughts healthy.



Sound advice! One thing I'll argue with you about, though. I'm not being domineering or bullying. I'm being frustrated. Then again, she has a different definition of what encompasses rude behavior, so it may come off that way to her. The other thing is that she does tend to cry easily. Reducing her to tears is actually hard not to do. I'm still working on being gentler with her.

She sounds like someone who is sad to be losing her independence, that may be why she cries easily. It's a large part of her identity, being eroded by something as pitiless and inevitable as old age. She must feel that she's on the losing side of a battle against time, like a peninsula thrust out into the ocean. She feels more and more of her self being whittled away, till she's just an island, and then, not even that. No wonder she cries easily.

Perhaps the best way to help her with this is not to say, "don't do that," but "could you do this for us?" If she can't carry a tray with a pot of tea and cups on it, for fear of dropping it and spilling tea, shattering crockery, she could still help to lay out the tray and make the tea. Or she could butter the toast, or lay the table.

I had a great granny who was very like this, and through careful and kind consideration she was able to remain independent right up until she was ninety six, when she suddenly died. When she could no longer slice bread, she could still make the mixture and show the youngsters how to knead it. When she could no longer see to read, she could tell us a story. When I was a little girl, she used to sit by my bedside and tell me stories about "Maire Clochaderg" (Irish version of Little Red Riding Hood) and she would teach me little verses and prayers. That helped her come to terms with the fact that her grandson was reading to her... she returned the favour by looking after her grandson's child.

Apparently it's one of the most stressful and depressing times in a person's life, when they know for a fact that they're looking at the end of their life. Almost everyone they know has gone ahead of them, the young no longer understand them, they're increasingly feeble, and day by day death creeps nearer. Under those circumstances any reminder of their mortality, frailty, and increasing dependance rubs salt into a deep raw wound.

You need to tread very carefully, lovingly and gently around anyone in such a situation. After all, if we're lucky, that's where we're all headed.