Sister Self-Injures, Hears Voices, and Wets the Bed

Reader’s Question

My sister is 18, soon to be 19, and has had a problem with wetting the bed her whole life. She also likes to make up stories and cuts herself. Excuses for her behaviors are always blamed on voices inside her head and they will get mad if she talks about them. We have confronted her many times, and we try to be supportive but the more we try to help, the more she continues with her behavior. This is causing a great deal of conflict in my marriage and in the family. My husband and I agreed to let her stay with us if she worked on her problems and continued with school. No one else is willing to take her in and I’m at the end of my rope with this situation.

What can I do to help her?

Our Consulting Clinical Psychologist’s Reply

Your sister may have significant psychiatric issues based on your description. I doubt that a promise to “work on her problems” will be effective. In her situation, professional mental health treatment will be needed to bring her symptoms under control. I would recommend that you include a requirement for psychiatric treatment as part of the payment for room and board in your home. I would take the approach that:

• Bedwetting is a medical symptom that can be easily treated with medication, even in adults.
• Self-injury (cutting) is a clear psychiatric symptom.
• Reports of “voices” is a serious psychiatric symptom that becomes worse if not treateed.
• Treatment of these symptoms will not require hospitalization in most cases and can be easily done on an outpatient basis if she is not a danger to herself or others.

I would volunteer to accompany her to her appointments. If she agrees to see a psychiatrist, I’d also arrange ongoing counseling in the area. Your sister is gradually losing her social skills and will slowly slip away if we don’t use an aggressive approach.

In the home, you and your husband should develop a team strategy to address your sister’s behavior. It may require some “tough love” on your part as she is likely to be uncooperative or resistive.