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SUPPORTING SOMEONE WITH BORDERLINE PERSONALITY DISORDER

Accurate information.

Knowledge of the biological basis of BPD can help families reframe the behavior of their loved one in the light of current science and accept that evidence-based treatment works. Accurate information can dispel the stigma that colours attitudes toward people with BPD.

Understanding.

Understand that the person with BPD is doing the best they can and does not intend to harm others or himself (debatable, sometimes a person with BPD can also have other conditions such as depression.) Discourage viewing the person with BPD as “manipulative,” as the enemy, or as hopeless. Understanding can melt anger and cultivate compassion.

Acceptance.

Accept that the person with BPD has a disability and has special needs. Help the family accept their loved one as someone with a chronic illness. They may continue to be financially and emotionally dependent on the family and be vocationally impaired. BPD is a deficit or handicap that can be overcome. Help families to reconcile to the long-term course of BPD and accept that progress will be slow. There are no short-term solutions.

Compassion.

Do not assume that every family is a “dysfunctional family.” Emotions are contagious. Living with someone with BPD can make any family dysfunctional. Family members have been recipients of rages as well as abusive and irrational behaviors. They live in perpetual fear and feel manipulated. They often react by either protecting and rescuing or rejecting and avoiding. Reframe their points of view with compassion. Families are doing the best they can. They need support and acceptance. “Bad parents” are usually uninformed, not malevolent. They did the wrong things for the right reasons (the “allergic to milk syndrome”). Anyone can have a disturbed child. Keep reminding the family of the neurobiological dysregulations of BPD, and of the pain their loved one is coping with each day.

Collaboration for change.

Accept that families can help, can learn effective skills and become therapeutic partners. They can reinforce treatment. The IQ of a family member is not reduced if a loved one has BPD. Do not patronize or fragelize family members. Family members are generally well-educated, intelligent people who are highly motivated to help. Respect their commitment. When you provide them with effective skills to help their loved one, they can become therapeutic parent or partners. You can help them.

Stay in the present.

Do not focus on past painful experiences when the person with BPD cannot cope with aversive feelings and has no distress tolerance skills. Avoid shame-inducing memories. If you induce arousal and the patient cannot cope with the arousal, therapy becomes unacceptable, giving her additional pressure and stress and undermining cognitive control. This is a sure-fire way to get her to drop out of therapy.

Be nonjudgmental.

Respect that families are doing the best they can, in the moment, without any understanding of the underlying disorders or the ability to translate their loved one’s behaviors. Although they may have done the wrong thing in the past, it was probably for the right reasons. Their intention was not to hurt their loved one.

Corroborate allegations.

Try not to assume the worst, and corroborate allegations. Remember that your perception of an event or experience may be different from what actually happened.

Avoid boundaries, limits, contracts, and tough love.

These methods are not effective with people with BPD. Be sure that families understand that boundaries are generally viewed as punishment by the person with BPD. Be sure they understand how to change behavior by explaining reinforcement, punishment, shaping, and extinction so that they do not reinforce maladaptive behaviors.

Discourage “we.”

Encourage family members to nurture individual relationships with the person with BPD, not the united front of “we.” Although both parents can have the same goals for their loved one, they must express these goals in their own style, in one-on-one relationships. Focus on developing individual relationships and trust, not solving individual problems. This will discourage “splitting.”

shitborderlinesdo

May 4

A few tips if you know and love someone with BPD:

1) People with BPD are incredibly perceptive and can read most emotions, but one emotion they consistently misinterpret is anger. They tend to interpret neutrality as anger, so often they may assume you are angry when you are simply content or bored or some other neutral expression. If your borderline loved one asks if you are angry, try to be patient and remember they are hypersensitive to tone, body language, everything. When an emotion of yours can’t be pinpointed, they tend to assume it’s anger. “Are you mad at me?” may be something you hear incredibly often. Just answer the question and be patient. They don’t mean to sound like a broken record; they really do believe you’re mad at them!

2) When providing reassurance for a borderline loved one, be sure to use concrete examples. When they’re having an episode, saying, “You’re a good person” will feel like empty words to them. They may even assume you’re following a script. Even more likely, they will default to being afraid they’ve somehow manipulated you into saying nice things to them, so be sure to have examples to back up what you’re saying. Instead of “You’re a good person,” add on why you feel that way about them. “You were having a bad day last week, and you still dropped everything to support your friend when they needed you.” Instead of stopping at, “I really care about you and think you’re great,” be sure to add, “You’re an incredibly passionate person, and I find that inspiring. Yesterday, when you were working, you become really involved in the task and cared a lot about the end results, and the way you poured your passion into the task was really incredible.”

3) Express yourself often, and in a constructive way. If you aren’t upfront with your feelings, your borderline loved one may assume you hate them. Open communication is incredibly important. If you are upset with something they’ve done or said, be sure to bring it up in a constructive manner which helps both parties and encourages communication on both ends. (Actually, you should be doing this with non-borderline people too.) Compassion > hostility. It’s okay to be upset, but it’s no reason to lash out. Bring up your concerns as soon as possible and help build an environment where you can both talk about these things openly. A relationship where you feel you can’t talk about concerns isn’t a healthy one. That goes for all relationships, mental illness or no.

4) Also applies to all relationships, if your loved one is clearly distressed, sometimes it’s best to walk away and wait until everyone has calmed down. However, with a borderline loved one, it’s important to express what you are doing and why. Don’t just leave the room. Make it clear, “We’re both too emotional right now to deal with this. I suggest we take a break and come back to this in half an hour when we’re feeling calmer. Is that okay with you?”

5) Do not try “tough love.” It is grossly unhelpful and can actually trigger more severe symptoms and make them worse. “Tough love” is a surefire way to keep your loved one from recovering.

6) Because of how emotional they are, people with BPD can come across as self-centered. This usually isn’t true, and is in fact more often the opposite. People with BPD are constantly thinking of the needs of others, and often their emotional responses are because of anxiety they have about how they affect the people around them.

7) Do not invalidate the feelings of your borderline loved one. Recognize that even if these feelings are not fact, they are still valid and are hurting your loved one and are incredibly real to them. Do not tell them they are “crazy” or “delusional.” This will make them feel like they can’t open up to you. Instead, assure them their feelings are valid, and then work through those feelings. Instead of, “There’s no need for you to feel guilty,” try “I understand why you feel guilty, but remember you are not at fault for what happened.” Or let’s say your borderline loved one has accused you of being angry even though you are not, and they are upset. Instead of “You’re upset for no reason” try “You are rightfully upset, however I’m really not angry with you, so let’s try to help you feel better.”