Borderline personality disorder (BPD) is a very complex disorder for many families. The symptoms, the chaos, the abuse, the rage, the fear, the feelings of abandonment, and the self-harm or suicidal thoughts all take families by surprise. Sadly, many sufferers struggle to explain their symptoms to others who may believe they are being manipulative, oppositional, problematic, or difficult. While some of these things may be true for some people, there are others with BPD who lack the interpersonal and social skills needed to perform in these ways and who are so emotionally distraught that common sense goes out the window.
Do you have a loved one suffering with BPD? How have you coped? Are you coping? This article will explore ways that families and friends can learn to cope with a loved one suffering from BPD.
Borderline personality disorder affects a great deal of our population but research is still lacking on the subject. Sadly, there is very little research about specific populations suffering from BPD such as adolescents and males. Believe it or not, men can also be diagnosed with BPD but are often diagnosed at a lesser rate than females. Males with BPD also exhibit different patterns of emotional dysregulation than women. For example, men with BPD often exhibit physically aggressive behaviors, become substance abusers, get into a lot of legal troubles, or engage in high risk behaviors such as driving a car really fast or engaging in road rage. Women tend to suffer more with the interpersonal and relational aspects of the illness and tends to suffer more from feelings of abandonment and loss. Although both genders struggle with many of the same symptoms, males struggle in a very different fashion. Diagnosis for males is often difficult and most are diagnosed with intermittent explosive disorder, substance abuse disorder, or referred to anger management classes or drug and alcohol services. In my experience as a therapist treating many teens who have not been correctly diagnosed with BPD, both my male and female clients suffer with BPD traits but have not been diagnosed because of the field’s reluctancy to identify teens as having BPD. Because of this, many of my clients end up being treatment for “secondary diagnoses” (such as depression or anxiety) and are prescribed medication for impulse control problems. sadly, many of my clients don’t benefit from this kind of “therapy” because the underlying problem, which is a very big emotional and relational deficit, is driving all of the primary symptoms such as poor boundaries, interpersonal difficulties, poor parent-child relationship, and physical and verbal aggression including cutting and suicidal thoughts. This is why the field of psychiatry and counseling have both ventured to perform more research about the adolescent population with BPD symptoms. The earlier we can treat the symptoms, the better the prognosis.
Despite diagnostic difficulties, many families struggle with the symptoms of BPD and have trouble understanding why their loved one’s emotional responses are disproportionate to the actual situation and why outbursts of anger and emotional intensity are triggered by minor things. This is because the individual with BPD struggles with regulating emotions, comprehension of reality when they feel abandoned, and logical reasoning when emotions get out of control. Some of my client’s families have reported that their 34 year old or 19 year old has outbursts like a toddler, even in public. The ability to recognize what is going on inside of the BPD sufferer is very, very difficult at times. I’ve seen many of my families speak to the sufferer as if they are talking to a child or toddler who is tantruming. I have also seen families try to reason, using logic, with the sufferer only to find out that their loved one interpreted their statements to mean they are unloved, embarrassing, and “crazy.” The sufferer’s ability to see the bigger picture is an uphill climb. The sufferer’s ability to hear love, compassion, and concern is also clouded by their intense emotions. Families often struggle with this and cannot comprehend why it’s so difficult to get through to their loved one.
As a therapist working with this population in teens, I would like to share with you what I have shared in my office with families like you. You want to be sure that you do these 7 things:
- Don’t react emotionally to irrational statements or behaviors: When your loved one is in a tornado where everyone’s statements feel like personal attacks, it’s best to keep your distance and allow your loved one to let off steam. Anything you say during this time will be misconstrued and confused or used against you. Statements such as “you don’t want me,” “you don’t love me,” or “I hate you” are all statements that come from someone who is emotionally out of control and almost seeking validation, through the argument or confrontation, for their internal feelings. If you react negatively, you validate their feelings and risk losing the person. You don’t want to lose them, you want to reach them. Silence is a positive tool during this time when used appropriately. Also, don’t be afraid to invalidate their feelings by challenging their inaccurate statements. If the person says “you don’t love me,” it’s okay to say, “where is the proof for this? Can you give me an example of this?” 10 times out of 10, they won’t be able to give you an example. I’ve had clients say “you are on my parents side” and I’ve used this statement and I’ve seen it trigger introspection and awareness.
- Be mindful of the intense emotional, behavioral, and cognitive dysregulation: In other words, don’t forget that the person struggles with intense episodes of emotion that almost mimics a whirlwind or tornado. The significant dysregulation can be severe and appear as if it is disrupting any progress, logical reasoning, or healing that appeared to be taking place. It’s best if families remind themselves that the illness is powerful and can be triggered at any time by anything, but that this doesn’t always mean that there isn’t progress being made. There will most certainly be ups and downs with this diagnosis. There are periods of calm and periods of chaos. You want to be sure not to become overly positive or overly pessimistic either. You want to remain balanced in your view of the illness. You want to remember that many people with BPD are capable people, but struggle with emotional, cognitive, and behavioral dysregulation. This might never go away.
- Don’t reinforce or encourage abusive behaviors: We all have a tendency to want to help those we love or care about when they are feeling emotionally out of control. We want to calm their fears and become the rescuer. When a sufferer with BPD becomes emotionally out of control due to feeling like a need is not being met, their behavior can feel manipulative and controlling if not abusive. Most people run to the rescue of the sufferer in hopes of stopping the storm before it gets started or reducing the intensity of the person’s rage. But this is like giving a baby a pacifier to calm them temporarily. For example, imagine your 16 year old daughter erupting in rage after you tell her she cannot go to a party with college age peers. She begins to scream, curse, and cry, calling you every name in the book. She might also try to triangulate you by calling her father and asking for his input. To calm the storm and gain control, you compromise by letting her know she can go but must take her brother with her. She agrees and stops berating you. You feel relieved but also manipulated. The next time a party occurs the same thing happens but you decide not to give in this time out of guilt for how you reacted in the past. Your daughter not only sneaks out but comes back home drunk. When I sat down with this mother in a family session some years ago, I explained that she had reinforced negative behavior that would now be difficult to undo. Don’t fall into this trap.
- Stay calm and regulate yourself: It’s really easy to fall into the emotional chaos of your loved one when they are out of control. It’s easy to feel just as emotional as they feel. I have called this vicarious emotional reaction. You are vicariously experiencing the other person’s emotions and react in the same level of intensity if not worse than the sufferer. You want to be mindful of your own emotions and constantly check in with yourself to see where you are. I do this with my teen BPD clients who are very emotional at times. I have to ask myself “where are you now?” “Are you getting angry?” “Are you calm?” If I am not calm, I have to take a pause and start over. The only way you can co-regulate the sufferer (help the sufferer control themselves) is by controlling yourself.
- Don’t be afraid to call someone for help: BPD symptoms can get so out of control that the police has to be called or neighbors end up calling the police. If arguments or disagreements are getting out of control, don’t be afraid to initiate a call to the police (as a last resort of course) or suggest a 302 or 201 (voluntary commitment to a hospital). This is one of the most difficult decisions for families to make. Calling the police increases the risk that your loved one will act out and be charged with disorderly conduct, taken to the hospital on a 302, or become even more enraged by you for suggesting a 201. For many of my client’s, I suggest calling a crisis line first or someone in the family or close to the family that can gain some control. A fresh perspective can be helpful.
- Don’t feel guilty for feeling confused about the illness: BPD is an enigma for many families and friends including researchers and therapists. Understanding it can take years of experience and study. I’ve seen my fair share of parents who struggle with their lack of knowledge and even after reading almost everything they can on BPD, they still feel guilty for not knowing something. It is impossible to learn about every single aspect of BPD. The most important things for you to remember are the basics: what the disorder is, what it looks like, and remembering that there are treatments that can help. Don’t burden yourself with unnecessary information or guilt for not knowing. Learn and keep learning.
- Learn how to use a chain-analysis and share with your loved one: A chain analysis is basically a technique for looking at triggers, responses to triggers, and consequences of the responses. For example, the situation with the daughter who wanted to go to a party with her college age peers had a beginning, middle, and end to it. If the mother were to do a chain analysis, she would see that the daughter wanted to go to the party and mom said no (beginning), she became enraged when she couldn’t go (middle), and attempted to manipulate the situation by triangulating her parents and ultimately getting her way (consequence). A chain analysis can help you look at the situation objectively (or fairly) and help your loved one see themselves better. I encourage you to use this technique when your loved one begins to berate you, guilt-trip you, or say you are not fair. A chain-analysis promotes open communication and honesty. It also helps you help your loved one identify when their behaviors lead to negative consequences. Sneaking out of the house and going to a party against mothers wishes (beginning), led to her engaging in negative behaviors with peers too old for her (middle), and getting drunk which could result in legal charges, rape, or other troubles (consequences).
There are many ways that parents and families including friends can help someone with BPD symptoms. I constantly remind my clients and their families to do their own research, educate themselves, and become self-motivated learners. Nothing is more powerful than knowledge. Understanding the illness can lead to greater ways of coping with it.