How do I know if suicidal threats of a loved one are real? Tips?

Unfortunately she needs to be hospitalized, maybe rehab. The number of medications she is taking are also part of the problem. Find a different psychiatrist that prescribes less medications, or gradually adds them as needed.
Trying to take care of your daughter will not lead to a happy ending.

@malebreastcancer47 She has indicated that she is thinking about changing the psychiatrist she has been going to. I think that she's on too many drugs as well but can't ask about it w/o a fight. I can't say I haven't thought about hospitalization and if we end up in the ER again I will tell them I think she should - in the past I have told them I thought she'd be ok to go home. I didn't mention in my post- she quit drinking over 2 years ago. At first it was court ordered but after being sober for 3 months she continued by her own choice. So rehab isn't really a consideration. She has had so many diagnoses over the years I have no idea of what the problem is - lately its PMDD. I do think thats part of it - I have her period marked on my calendar so I can brace myself. She is on the pill for that. I also think she could have BPD - she had an abusive boyfriend in her HS. Thank you for your reply <3

And one thing we haven’t considered is social media vs going outside, breathing in fresh air, having a meaningful conversation with a person. Abuse will have long term effects.

The root issue started well before all the medications. Combination of anxiety, depression, abuse, low self confidence, low self esteem, lack of quality sleep, etc
Is there a family member that she can go live with in another state? Make new friends.
What you have to be careful with is, having your daughter labeled with disorders. Once she is labeled, the candy will keep coming vs fighting.

One thing she hasn’t done yet is runaway. She hasn’t lost her mind, yet. 🙂

All of that definitely applies. There isn't anyone she can go live with but we have a 2nd house on our property we are getting ready for her to live in. Its pretty much done and she's 1/2 moved in but anxious about completely moving out of the main house.
She does need to be getting a job & meeting people but hard w/o a license - hence my being her chauffer. She is trying to get the $$ together to get a lawyer for her license and I think it will ease our conflicts a little when she isn't solely reliant on me.
I will say this she has a great group of friends who have issues of their own and they support one another - Id hate to see what it would be like w/o them.
I don't think her anxiety will allow her to runaway but I can't say it hasn't crossed my mind a few times, lol Thank you again - it helps to vent.

@ldlauwers, that is a heavy burden to carry. As you try to be there for your daughter, you are exposed to blame and verbal abuse. She holds you on high alert with threats of self-harm or suicide. You would never forgive yourself if she were to start to self harm again and the guilt would be unimaginable if she were to attempt or be sucessful in suicide.

You're not alone. There are crisis lines and trained counsellors that can help YOU navigate these difficult waters. Crisis lines are not only for the person in danger, but also for the family and people supporting them. You can find different resources on our Crisis Helplines page here: https://connect.mayoclinic.org/blog/about-connect/tab/crisis-resources/

Here are a few things you should have at hand for when the need arises:
- 988 Crisis Line https://988lifeline.org/help-someone-else/
Call or text 988 if someone you know is struggling emotionally or having a hard time. You can be the difference in getting them the help they need. It’s important to take care of yourself when you are supporting someone through a difficult time, as this may bring up difficult emotions. If it does, please reach out for support yourself.

- NAMI https://www.nami.org/family-members-and-caregivers/
NAMI is the National Alliance on Mental Illness. There are many state and local chapters. They also have resources to help family and friends.

I'm not a therapist, so I won't give any advice except to say getting help for yourself is the first step to helping your daughter. With the guidance of a trained professional, you can discover ways to assert boundaries to not be the victim of abusive behavior and to know how you can respond to threats that keep both of you safe.

@colleenyoung Thank you so much for those spot on comments. I am in therapy and have been since her DUI. I went to one for a couple years who I really liked but felt maybe too much...like I wanted to be her friend. I had done what I could do with her and it was time to move on. I have been looking for a new one for almost a year and I think I've finally found one I like and feel is competent. I am about a month in with her and feeling very comfortable and heard.