It’s possible that she is psychotic. You mentioned that she has bipolar disorder and that may be a symptom of her disorder. You also mentioned that she has a long history of alcohol and pill abuse. The paranoia could be the aftereffects of the damage done to the brain via drug usage. Another possibility is that she is experiencing a physical health condition and the paranoia is a symptom of it. You also can’t rule out the possibility that she is currently using illicit drugs or alcohol. She has used in the past, and it’s possible that she could be using again. Finally, another thought is that this could be a side effect of her medication or she’s taking medications that are interfering with one another. She’s taking four different medications that could be interacting in a problematic way.
You should encourage her to consult a primary care physician and/or a psychiatrist. I’m not certain that she’d be willing to consult a mental health professional, but this would be the ideal. It’s important for her to consult a primary care physician in order to determine if there’s a physical health problem. The mental health professionals could address her psychological symptoms.
One thing you should try to avoid is arguing with her or trying to convince her that she is wrong. As you mentioned, she is adamant and strongly believes in these ideas. In all likelihood, nothing you would say will change her mind or convince her otherwise. In fact, it might even make the situation worse or convince her that you are part of a conspiracy to spy on her.
The best thing you can do is encourage her to seek professional help. If she’s unwilling, then you might want to reconsider her living in your home. By allowing her to continue living in your home, while refusing to seek help, you may be inadvertently reinforcing or supporting her delusional ideas. You might try giving her an ultimatum: allow her to continue living in your home on the condition that she seeks treatment. It could solve the problem. It puts pressure on her to seek treatment which she clearly needs. It might be what is necessary in order for her to get the help she needs.
Before making any decisions about how to deal with your sister, it would be advisable for you to consult, in person, a mental health professional. You might only need one or two sessions with a therapist to devise the best plan for approaching your sister. It’s not going to be easy because of her symptoms.
Undoubtably, this is going to be a challenge. She likely doesn’t trust you because of her symptoms which in turn makes you potentially suspect in her mind. Having the guidance of a mental health professional will help you to know what to do in this situation. Good luck and please take care.
Dr. Kristina Randle