Reviewed by: Dr. Rachael Grantham, Psy.D

Loving someone with Borderline Personality Disorder can be very challenging. Unlike those suffering from depression or anxiety who understand they are behaving or feeling different than the norm, those suffering from Borderline Personality Disorder (BDP) fail to recognize that their emotions and behaviors are not in line with social norms. They also have a hard time understanding why their changes in mood, intense emotional reactions, and irrational behavior are so difficult and taxing on those they love. Additionally, those suffering from BDP are more likely than the general population to be verbally, emotionally, psychologically, and physically abusive to others. Therefore, to say that loving someone with BDP is hard is an understatement, but with work from both parties, a successful loving relationship can be developed and maintained.

Loving and caring for a person diagnosed with BDP requires patience and clear boundaries. It requires strong conflict resolution skills, and the ability to build a sense of independence in your loved one. You must learn to deescalate situations before they get out of hand, and remain calm as much as possible when conflict arises. With the right tools and support it is possible to maintain a harmonious relationship and aid your loved one on their road to recovery.

Signs and symptoms

If you believe someone you love might be suffering from BDP, while only a doctor or trained mental health professional can give an official diagnosis, there are several behaviors and symptoms that you can be on the lookout for. According to research signs and symptoms of Borderline Personality Disorder include:

Causes and treatments

There is no straight answer as to what exactly causes BDP, like many mental illnesses research doesn’t point to just one cause. While researchers have gained a great deal of insight on BDP there are still many unanswered questions. BDP could be a hereditary genetic disorder, as well as a result of past trauma. Traumatic events that took place in childhood, such as sexual or physical abuse, neglect, separation from loved ones, or high stress and violent environments, have all been linked to BDP.

Psychotherapy, or talk therapy, can be very beneficial for those struggling with BDP. Research shows that through therapy individuals can learn more about their diagnosis and understand how it affects those around them. Talk therapy can give them the tools they need to reduce impulsive or irrational behaviors, maintain boundaries in relationships, manage overwhelming emotions, and improve day to day life.

Dialectical behavior therapy, also known as DBT, is a common type of psychotherapy used to treat BDP. According to resources DBT helps individuals change unhealthy behaviors by becoming more mindful about the emotions they are experiencing in the moment, thus allowing them to better control their reactions to those emotions. Psychodynamic partial hospital programs have proven effective treatments for out of control patients needing more daily structure and control.

There are no medications currently approved by the FDA to specifically treat BDP, but with help from a Medical Doctor or Psychiatrist proper medication along with therapy can reduce depression, anxiety, and impulsive aggression. These medications can include mood stabilizers and antidepressants.

Your home life

The home should be a place of peace and solace, an escape from the everyday stressors of life. This is especially true for those suffering from BDP. It is important to create a calm relaxed environment. It is also important to create a sense of normalcy, every conversation should not revolve around their disorder and its challenges. Instead discuss topics that interest them, give them the opportunity to talk about themselves apart from BDP. Their hobbies and interest should be encouraged. Discuss current events, upcoming family vacations, or just laugh over a funny joke. Take the spotlight off their disorder and encourage them to explore who they are as a person, what they like and don’t like, what makes them unique. The more your loved one can feel comfortable and accepted the closer they will come to recovery.

Effective communication during conflict

Living life with someone struggling with BDP is challenging and usually full of conflict, but learning to navigate and deescalate those conflicts can literally transform your relationship. If you can learn to identify when your loved one is agitated or becoming volatile and adjust your behavior accordingly conflict can be avoided or at the least minimized and controlled. It is very important to avoid discussing any important or emotional topics when the individual is at all distressed or agitated, keep the conversation light and positive, maybe suggest a change in scenery or engage in a productive activity they usually enjoy, like baking or going on a walk. This will give them a chance to recalibrate and gain control of their emotions.

When your loved one does become volatile, they may become aggressive and verbally insult you. The most natural response is to become defensive and match their behavior. This will only escalate the situation. You must remind yourself that they are suffering from BDP and struggle to maintain control of their emotions and actions. Try to stay calm and listen, do not argue with them or try to reason with them, and try not to take it personally. If the individual feels like they are being heard they are more likely to calm down and the conflict will deescalate.

If the conflict gets out of control, and escalates to a point where the individual is threatening you, it is best to avoid any continuation of the conversation, ensure the person is in a safe place and walk away.

Threats of self-harm – crisis intervention

If your loved one begins to threaten self-harm or show signs of self-harm it is very important that you address the situation quickly and effectively. Sometimes the threats of self-harm will be very clear, such as verbal threats, or physically hurting themselves; however, other warning signs may be less obvious but should still be taken seriously. Scratches on the skin, refusing to eat, and isolation can all be signs of self-harm. Identifying early signs can help to prevent a crisis from escalating and allow for the correct steps to be taken to get your loved one the help they need.

Keep the lines of communication open. Don’t be afraid to ask if your loved one is contemplating self-harm. With the lines of communication open you are allowing your loved one to safely talk and share with you about their emotions. All threats of suicide should be taken seriously, but that doesn’t mean you need to call 911 every time a threat is made. Putting together a crisis intervention plan can ensure you know what steps to take if signs of self-harm or suicide are being demonstrated.

It is helpful to allow your loved one to participate in developing their crisis intervention plan, this will allow them to feel involved and more in control of their life. Ask your loved one what they would feel most comfortable doing when they threaten injury or suicide. They may prefer to go directly into an emergency room, or they may want to first call their personal therapist, or possibly a suicide hotline. If you work together and find a plan that you are both comfortable with, the outcome will be more successful.

Strategies that can reduce conflict

The most effective way to deescalate conflict with an individual diagnosed with BDP is to listen to them, sometimes they just want to be heard. It doesn’t matter if you agree or disagree with what they are saying, by listening you are allowing them to feel in control and valued. Listening isn’t the same as agreeing, it is simply acknowledging their feelings and opinions. Encourage them to continue to share with you, ask open ended questions…“What happened today that caused you to feel this way?” or “Tell me how your day has been going?”

Repeating or summarizing their statements back to them is a great way for them to understand that you hear them and are acknowledging them. For example, if your loved one believes you want to leave them for another person because you don’t love them anymore, you could say “do you feel like I don’t love you” The desire to argue and point out the flaws and inaccuracy in their argument will be present, but remind yourself that restating is not agreeing. This type of communication is not about proving your point or about winning an argument. It is about helping your loved one through their emotional crisis or breakdown and deescalating conflict.

Self-Care: options for when you feel overwhelmed

It is clear that BDP does not just affect those diagnosed but those around them as well. Loving someone diagnosed with BDP can be very draining. You may feel very alone at times, it is important that you find support as well. Make time to spend with other friends and loved ones that understand what you’re going through. If there is no one close to you that you can confide in, than seek out resources such as support groups, mental health professionals, religious leaders or your medical doctor as they are all available to provide support. Don’t forget that you’re allowed to ask for help and investing in your own individual psychotherapy can be extremely beneficial for your self-care.

It is also very helpful for you to have other loved ones or family members of the individual diagnosed with BDP come along side you and help with their care. It is tough, if not impossible for any “one” person to feel like they are solely responsible for the care and well being of another. Bringing others in can not only provide literal distance between you and your loved one (go get coffee, go hike, go do nothing) but can provide psychological distance as responsibility gets shared among others who care.

Self-Care is vital to your own health. You must take time to do things you enjoy and invest in bettering yourself so you can be there for your loved one. Exercise, eating healthy, spending time with others and practicing mindfulness are all ways to make sure you are meeting your own needs.

Is this my forever, is there a chance for recovery from BPD

Recovery has a different meaning when it comes to BDP, just as recovery has different meanings in all mental health disorders. Recovery does not imply complete healing, or that the symptoms are all gone. It does not mean the elimination of regular psychotherapy or the need for medication. Recovery from BDP means you experience less of the extreme tantrums and outbursts. It means you experience more freedom in your relationship and your loved one gains more control over their emotions, actions, and daily life. It is possible for your situation to improve. Life does not have to feel like you are being held hostage because you are afraid to leave their side, worrying constantly if you will upset your loved one or if they will harm themselves if you don’t do everything 100% correctly. Life can be better than that. Recovery is possible, through Psychotherapy, family support, and medication therapy if needed, your loved one can experience a completely different life. Continue to encourage your loved one to take small and steady steps towards a fuller and more fulfilling life, not for you… but for them. Your continued support and encouragement can help them live the life they deserve.

References

  • Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder.The Lancet, 364(9432), 453-461. doi:10.1016/S0140-6736(04)16770-6
  • Mohan, R. (2002). Treatments for borderline personality disorder: Integrating evidence into practice.International Review of Psychiatry, 14(1), 42-51. doi:10.1080/09540260120114050
  • Borschmann, R., Henderson, C., Hogg, J., Phillips, R., & Moran, P. (2012). Crisis interventions for people with borderline personality disorder.Cochrane Database of Systematic Reviews, (6), CD009353. doi:10.1002/14651858.CD009353.pub2
  • Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training.Training and Education in Professional Psychology, 1(2), 105-115. doi:10.1037/1931-3918.1.2.105