Receiving the diagnosis of borderline personality disorder (BPD) can come as a relief – finally knowing what is wrong and that there may be some solutions. But even after diagnosis, many attendant conflicts remain. There are few medications that work for BPD, and certainly no “magic bullet.” The disorder is known to be so complicated that many professionals shy away from taking on clients with the diagnosis. This being the case, it is no wonder that family members and friends find their loved one’s symptoms – intense episodes of distress and anger, attempts at self-injury or repeated threats of suicide, and the extreme reactions to seemingly normal conditions – to be confusing and frustrating, if not impossible to bear.
If you are the child of someone with borderline, or you have committed to a relationship with someone with BPD, it can feel sometimes that you are stuck – no way out of frequently bad interactions. People with BPD seem to wear their emotional skin on the outside, and, much like small children who cannot yet regulate their emotions, they are frequently angry, shocked, overjoyed, astonished, hurt, outraged, and infuriated – all in the matter of a half-an-hour. Moods shift frequently, and several intense emotions and moods are likely to be expressed by your BPD loved one in the matter of only a few days.
[tc2 img=”//elementsbh4.wpengine.com/wp-content/uploads/2011/09/malibuvista.jpg” title=”Malibu Vista” url=”//elementsbh4.wpengine.com/treatment-centers/malibu-vista/”]Malibu Vista is a residential mental health treatment center designed for women suffering from depression, anxiety, personality disorders and other mental health issues. Unlike a hospital-based center, residents live in a private, home-like setting in Malibu, California, with breathtaking views of the Pacific Ocean. An integral part of treatment at Malibu Vista is building resilience so that clients can work through setbacks and ask for support, with the ultimate goal being a balanced, healthy life. Malibu Vista supports women’s recovery in a way that embraces their specific physiological, psychological and emotional needs. [/tc2]
Some BPD Therapies Useful for Everyone
Some of the therapies that help people with BPD may be useful for their family members and loved ones as well. There are therapies that teach people with BPD how to tolerate distress and how to calm and sooth themselves when confronted with peak emotions, rather than reacting to those emotions. Because the behaviors of people with BPD are frequently high volume, learning to turn down one’s own responses to these behaviors is a good start.
The good news is that your loved one is likely not a child; he or she can learn how to regulate her/his emotions, just as you can learn how to modify your feelings, reactions, and even your beliefs in order to change your communication with your loved one – to impact it in a more positive direction. While your BPD loved one works on distress tolerance and emotional reactivity (provided she or he has committed to getting treatment), there are some important things you can do to stay sane, and to try to maintain a healthy relationship.
Tips for Loved Ones of People With BPD
1. Recognize the truth in this statement: Feelings are not facts. Your BPD loved one likely has a range of intense emotions which compel him to say things that feel unkind, unfair and even cruel at times. Recognize your BPD loved one’s reality: he has a mental disorder. His extreme feelings are highly changeable, as you have seen over and over. They are so changeable because your loved one has BPD, and because they are feelings, not truths. Try your best to keep this in perspective no matter how emotionally volatile your BPD loved one may become.
2. Recognize your part in disputes. It is easy to point the finger at the one with the diagnosis, especially when that diagnosis revolves around interpersonal dysfunction, but it is important to recognize that demonizing a person with BPD is unhelpful and is likely adding to the creation of chaos in your relationship. Likewise, seeing your BPD loved one as a “victim” of an illness or disease is also unhelpful. No matter who we are, we must learn to be accountable for our behavior, and that includes people with BPD as well as those who have a relationship with them.
3. Have a self-check in place for the potential feelings of FOG – fear, obligation, and guilt – in response to your BPD loved one, and a plan for handling these ungrounded responses. Susan Forward, PhD, coined the acronym “FOG” for the emotions likely to arise in people who are repeatedly emotionally manipulated. These feelings are unhealthy and unproductive. Change your reality until you have no true cause to fear your loved one; recognize that because your BPD loved one is an adult, no matter her relationship to you, so you are in no way obligated to remain in her life; and understand that guilt serves no healthy purpose. It can be used as a form of subtle manipulation, but manipulation, from someone with BPD, is more a matter of desperation, not real forethought or planning. She is seeking desperately to ensure she will not be abandoned (even while doing things that push you away from her).
4. Recognize, always, the degree of reaction your BPD loved one is likely to have in response to perceived or imagined abandonment. Because this is the deepest fear of someone with BPD, be careful and wise with potentially abandoning or rejecting words or phrases. If you decide to warn your BPD loved one that you may no longer maintain contact with him for any reason, be certain that you: 1) absolutely mean it, 2) are not saying it out of anger or cruelty, 3) are prepared for the potential fallout. No amount of fallout should keep you from going no-contact if this is what you believe to be best for you, but always be aware of the extreme ways your BPD loved one is likely to react, and be prepared.
5. Encourage your BPD loved one to learn distress tolerance, mindfulness, and other ways of handling unwanted emotions by taking part in these therapies yourself. Treatments such as dialectical behavior therapy (DBT), or mentalization therapy are known to be effective for people with DBT, but they can be quite helpful for anyone who wishes to improve their states of mind and more deeply understand human interaction. Your willingness to participate may be an encouragement to your BPD loved one to seek and continue treatment, and it may be good for you as well.
BPD is called “the Good Prognosis Diagnosis” because although it is one of the more difficult mental health diagnoses to contend with, many people have a high chance of getting better or recovering entirely. If you believe in your loved one and choose to stick by him during treatment, you may see real rewards. Many, many people who once experienced pervasive difficulty in interpersonal relationships as a result of BPD are now healthy and fully functioning after treatment and a lot of self-work. Keeping an open mind, working on some of your own responses and reactions, and being honest with yourself about the realities of BPD may just bring you to a fuller sense of self and happiness in time.