Worried about a Sibling

By Kristina Randle, Ph.D., LCSW

I’m concerned about my little brother. He’s 17. In public, he comes across as thoughtful, well-spoken, well-read, and almost forcefully calm. But at home, we see a completely different side of him. He’s often irritable or hostile with little cause. His eating and sleep patterns are disturbed. I’ve seen him in very cynical moods where he would probably sleep for several days if our parents didn’t rouse him for meals and homework. During those times he complains that he isn’t creative, productive, or effective. (Jordan is an amateur writer, so I think this really bothers him.) I’ve also seen him in moods of very offbeat humor, excess talkativeness, attention seeking, and high energy. This is the mood where he watches his favorite horror movies, Monty Python comedies, and musicals, cleans the entire house obsessively, swears profusely, fights with the younger brothers, tells completely inappropriate jokes, and complains about poor concentration and memory.

I’ve seen this for a couple of years, and I’m starting to wonder if he isn’t bipolar. I don’t really know the difference between bipolar disorder and normal teenage boy behavior. And there are other factors involved. He is transgender (female-to-male). Our family is dysfunctional, deeply religious, and dangerously enmeshed. He tries to wear men’s clothing in public, but the family is socially pressuring him not to transition. He intends to start passing as male as soon as he begins college next year. He has a tense relationship with Mom. He wants a proper father-son relationship with Dad but is afraid to pursue one, and thus avoids Dad. He is under my thumb and the thumbs of a couple other adult sisters, which he loudly resents. Also, because of the way our family works, he ends up taking too much (in my opinion) responsibility for our younger siblings, some of whom have special needs.

So what is this? Am I seeing a stressed-out teenager, or something more? He has mentioned suicide a couple of times. He insists that he’s not serious, but I’m scared.

A. Your letter has provided a glimpse of what your brother is like. It’s clear that he’s struggling. What’s less clear is if his behavior is due to a mental illness or if he is responding to what you described as a dysfunctional family dynamic. You also said he is transgender, which adds another layer of complexity.

The fact that he vocalized suicidal thoughts is a concern. Being suicidal is abnormal. Other symptoms that are concerning include his talkativeness, his compulsion to clean, his inability to concentrate and relax, his poor memory, and his mood instability. I would concur with you that bipolar disorder is a possibility, but from my vantage point, it’s difficult to untangle what might be a mental illness, family chaos, and the challenge of being transgender.

I don’t know what your relationship is like with your brother or your family but if you feel comfortable, suggest that he see a mental health professional. A psychological evaluation would help to determine what’s wrong and if treatment is required. His symptoms shouldn’t be overlooked and they should be evaluated. Early treatment is critical in preventing the development of a mental illness. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Last reviewed: By John M. Grohol, Psy.D. on 30 Jun 2013

APA Reference
Randle, K. (2013). Worried about a Sibling. Psych Central. Retrieved on July 29, 2014, from http://psychcentral.com/ask-the-therapist/2013/06/30/worried-about-a-sibling/

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