Personality disorders are a unique category in the world of mental illness. While someone with depression or anxiety may feel that they are experiencing symptoms that are different from their normal state, people with personality disorders often fail to realize that their emotions and reactions depart from the typical human experience. People with borderline personality disorder (BPD) struggle to understand how wives, husbands, friends, and other family members experience their intense reactions, mood swings, and risky behavior.

Needless to say, if you have a loved one with BPD, life can be fraught with crises and conflict. You might feel like you’re being held hostage, worrying that your family member will injure themselves if you don’t appease them.  You may wonder whether you should let them borrow money again or answer the dozens of voicemails they left on your phone. Dealing with borderline personality disorder requires skills for deescalating crises and fostering independence in your loved one.  With the right tools and community strategies, it is possible to help your loved one towards recovery.

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Signs and Symptoms

Only a doctor or mental health professional can officially provide an official diagnosis of a personality disorder, but there are several key symptoms you can observe that might indicate a person has BPD. These include:

  • Intense fear of rejection, separation, or abandonment
  • Rapid changes between thinking someone is perfect to believing they are evil
  • Risky behaviors including unsafe sex, gambling, drug use, or accumulating credit card debt
  • Threats of suicide or self-harm
  • Difficulty empathizing with other people
  • Mood swings from euphoria to intense shame or self-criticism
  • Frequently losing one’s temper

Origins and Treatments

Like many other mental illnesses, researchers don’t fully understand the origins of the disorder.   Some studies suggest that there is a genetic component, meaning the disorder can be hereditary.  Hostile family environments, childhood abuse, and neglect, and separation from caregivers can also increase the risk. Some research indicates BPD can emerge when parts of the brain that help regulate emotions and aggressive impulses are not functioning well.

Psychotherapy, otherwise known as talk therapy, can be incredibly valuable for treating BPD.  In addition to learning about the signs and symptoms of the disorder, individuals can gain skills for managing difficult emotions, developing and maintaining relationships, reducing impulsive decision-making, and improving daily functioning.

The most common typed of psychotherapy used to treat BPD is known as dialectical behavior therapy, or DBT.  The therapy helps people change unhealthy patterns of behavior by becoming more mindful about the emotions and reactions they are experiencing at the moment.

To date, there are no drugs approved by the FDA that have been specifically created to treat personality disorders.  However, some people find that medications can help reduce anxiety or impulsivity in individuals. These might include antidepressants, mood stabilizers, and antipsychotic medications.

If an individual with BPD experiences intense symptoms, such as self-injury or physically harming others, they may be in need of inpatient treatment at a hospital or other residential program.

How should I structure the home environment?

People with BPD benefit from a home environment that is calm and relaxed.  All involved family members (including a boyfriend or girlfriend) should know not to discuss important issues when the individual is in crisis mode.  Stop to take a breath yourself when they do become emotionally reactive.  It’s also important to not center all discussions around the disorder and setbacks. Conversely, it’s important not to place too much emphasis or praise on progress, or an individual may begin to self-sabotage. People with BPD should have opportunities to talk about their interests and thoughts about the news, family events, and other leisure activities. Take the time to laugh at a funny joke or eat dinner together several times a week. The less an individual feels like his or her mental illness is under the spotlight, the more opportunity they have to explore other aspects of themselves.

How can I communicate effectively during a crisis?

When a loved one becomes reactive, they may become to insult you or make unfair accusations. The natural response is to become defensive and to match the level of reactivity. You have to remind yourself that an individual with BPD struggles to place themselves in a different person’s perspective. They struggle to gauge what is a minor issue and what is a full-blown catastrophe. They interpret your defensiveness as not being valued.

Instead, when they become reactive, take the time to listen without pointing out the flaws in their argument. Try not to take it personally.  If the person does point out something you could improve or have done wrong, acknowledge their point, apologize, and suggest a way you can improve on the matter in the future.  If the individual feels like they’re being heard, the crisis is less likely to escalate. However, if the conflict rises to the level where an individual is throwing a full-on tantrum or threatening you, it’s best to walk away and resume the conversation when they are calmer.

What if they threaten to hurt themselves?

A crisis is escalating if a person with BPD begins to threaten to harm themselves. Sometimes self-harm signs may be less overt, such as scratching the skin, eating less, coloring or shaving off hair, or isolating themselves from others. These actions represent the person’s inability to express their emotions verbally. Recognizing early signs can help prevent an emotional crisis from becoming more serious or requiring medical or psychiatric attention.

Be aware that you don’t put the idea into someone’s head by asking about self-harm or suicide. Instead, you invite the individual to talk about their emotions and allow yourself to gauge whether professional assistance is necessary.  All threats of suicide should be taken seriously. Even if the behavior is attention-seeking, it can result in serious harm or even death. However, that doesn’t mean you have to call 911 every time an individual speaks about hurting themselves. This sends the message that they have an enormous amount of power over all arguments. Instead, ask your family member what they would feel most comfortable doing when they threaten injury. They might want to speak with their therapist, call a hotline, or walk with you into an emergency room.  Allowing them some amount of agency in deescalating a crisis can help calm out of control emotions.

What other strategies can reduce conflict?

Listening and reflecting can be the most effective strategy in communicating with someone with BPD. Though you might disagree with every word that is spoken, listening is not the same as agreeing. It is simply acknowledging a person’s emotions and perspective. Ask open-ended questions that encourage them to share, such as “What happened today that caused you to feel this way?” or “Tell me about how your week is going.”

Statements of reflection and summarizing can also help an individual feel heard. For example, if your son shares that he thinks you value his sister more than him, you can say, “You feel that we don’t love you as much as your sister.” The temptation to argue and point out their bias will be present, but just remind yourself that reflecting is not agreeing. This type of communication is not about winning an argument or being right. It’s about helping your family member feel heard and de-escalating conflict.

What can I do when I feel overwhelmed?

Because a family member with BPD may not be able to provide the empathy and self-awareness necessary for a relationship, it’s vital to have other supports in your life. Carve out time to spend with friends and engage in leisure activities.  If you need to talk about the experience of living with someone with a  mental illness, support groups, mental health professionals, religious leaders, and your doctor can be excellent resources.  You also should consider how to involve other family members in the care and support of someone with BPD. No single person should be responsible for communicating calmly and responding to crisis situations. The more people who know effective strategies for responding to the individual, the less often crises will erupt.

Will they ever completely recover?

Unlike a physical illness, recovery has a different meaning when it comes to mental health. Recovery does not imply the total elimination of symptoms, the lack of need for medication or therapy, and functioning comparable to persons without the disorder. Recovery from Borderline personality disorder looks like fewer threats of self-harm, reduction of frequency of emotional outbursts, and a decrease in the intensity of reactivity. Relapse may occur, but crises will resolve quickly and you will feel more prepared to handle the situation. In turn, your loved one will feel encouraged to take small but steady steps towards a fuller and healthier life.

Last Updated: Nov 24, 2020