February 23, 2020

Don’t Ask “How to Handle Someone with BPD”

by | Feb 23, 2020 | Personality Disorders

“How to Handle Someone Living with Borderline Personality Disorder”

Nearly two thousand people a month conduct an online search for “how to handle someone with borderline personality disorder.”

When learning how to best support someone living with borderline personality disorder, it’s important to understand the stigma surrounding this disorder. Even using the word handle instead of, say, care for, demonstrates how some people view those living with this disorder.

Don’t focus on how to handle someone. Instead, focus on how to care for them, how to support them, how to empathize with them, while still caring for yourself and setting up healthy boundaries.

With that in mind, several strategies can help increase awareness, strengthen connection, and improve relational satisfaction.

Let’s dive in.

Understanding Borderline Personality Disorder

Most research indicates that borderline personality disorder (BPD) impacts 1.6% of the US population. Borderline personality disorder is a pervasive and complex condition, and it can be challenging or even detrimental to the relationships shared between loved ones. 

Borderline personality disorder is a mental health condition characterized by frequent, ongoing patterns of intense moods, erratic behavior, and poor self-image. Other common symptoms associated with borderline personality disorder include:

  • Intense and frequent mood swings
  • Frequent changing of interests, hobbies, and employment
  • Viewing things in extremes (i.e., someone is “perfect” or “terrible”)
  • Desperate fears of real or perceived abandonment
  • A history of intense and often unstable relationships with others
  • Impulsive and reckless behavior (unsafe sex, substance use, binge eating, compulsive shopping)
  • Self-injurious and suicidal behaviors
  • Distorted and unbalanced perception of self
  • Persistent feelings of emptiness or loneliness
  • An uncontrollable rage that seems to occur at a moment’s notice
  • Inability or disinterest in trusting others
  • Experiencing dissociation (being detached or cut off from reality)

Like all mental health conditions, borderline personality disorder exists on a spectrum. Individuals with more severe cases might exhibit all or most of the symptoms. Others might just have a few symptoms, and they may be able to function at higher levels.

What Causes Borderline Personality Disorder?

It’s impossible to pinpoint a single cause for borderline personality disorder. Instead, most research suggests that a variety of factors may increase one’s risk of developing this illness.

That said, most people who have borderline personality disorder report serious histories of trauma in their pasts. Types of trauma often include:

  • Abandonment by a caretaker during childhood or adolescence
  • Severe disruption in the family-of-origin
  • Poor communication and expectations in the family
  • Physical, emotional, or sexual abuse

Being female is also a risk factor. Up to 75% of diagnosed borderline personality disorder cases are female. However, some mental health professionals argue that it’s unclear if women are more disposed to this condition, or if the medical community has gender biases that increase the chances for diagnosing.

Furthermore, many people with borderline personality disorder have been previously misdiagnosed with bipolar disorder. While individuals can have both conditions, misdiagnosis is a common phenomenon. Both conditions share many symptoms like impulsivity, mood swings, and irritability. However, medication and psychotherapy can often stabilize the majority of bipolar symptoms. On the other hand, there are no FDA-approved medications intended to treat borderline personality disorder. 

What Is Typical Borderline Personality Disorder Treatment?

Personality disorders have reputations for being difficult to treat. That’s because these conditions are rooted in rigid and unhealthy thought patterns and behaviors. Many people struggle with daily living, as the psychological disturbances are integrated into every part of the individual’s functioning. 

Seeking Treatment

Effective treatment can be challenging. Many people with personality disorders are known as being “change-resistant.” They’ve often spent their entire lives in a survival stance. This stance often emerges due to trauma. From an early age, these people have adopted the belief that others cannot be trusted and that they’re essentially on their own. 

That said, people with borderline personality disorder may seek treatment for a variety of reasons including:

Many times, these people do not know about their personality disorder. They just know they are in dire distress, and they need support. Sometimes, they are referred or mandated to treatment after a significant event, like an arrest or suicide attempt.

Dialectical Behavior Therapy

Dr. Marsha Linehan developed dialectical behavior therapy (DBT) in the 1980s after her own battles with severe mental health. Today, DBT is evidence-based, and it is often touted as the gold standard for treating borderline personality disorder

DBT integrates the Buddhist concept of dialectics, which refers to the integration of opposites. This means that therapists support clients to transition away from extreme thinking into a more balanced approach. The behavioral component of DBT includes strategies like goal-setting, problem-solving, and skills rooted in interpersonal effectiveness.

True DBT includes a combination of individual and group therapy in addition to 24-hour phone coaching support. Individual therapy includes learning skills related to distress tolerance, emotional regulation, core mindfulness, and interpersonal effectiveness. Group therapy entails the integration of these skills via social interactions and peer support. Phone coaching provides a sense of emergency support. The therapist serves as a coach facilitating and encouraging the usage of DBT skills in real-life scenarios.

That said, many mental health professionals blend components of DBT into their practice. Likewise, many clients benefit from learning these principles, even if they don’t adhere to the “true” model. 

Exploring The Challenges Loved Ones Face

Loving someone with borderline personality disorder can feel confusing, exhaustive, and frustrating. It’s not abnormal for people to feel like they’re riding on a wild roller coaster with no end in sight. These relationships often feel chaotic and tumultuous. Even when things seem “good,” there tends to be a sense of anxiety in waiting for the next catastrophe to strike.

Loved ones often report feeling alone and angry in their struggles. They may not understand why the individual continues to cause distress. They may bargain, plead, or beg for change. When change does occur, they often try to remain optimistic- only to feel dejected when the same cycle ensues again.

Loved ones also tend to experience financial, physical, and emotional consequences. For example, they may lend money or sacrifice their time helping the other person. They might offer to give them a job or babysit their children. They might even offer to help find a therapist or psychiatrist and pay for treatment.

It’s no surprise that loved ones often feel resentful, as if they’ve received the short end of the relationship stick. That said, setting boundaries can be a difficult endeavor.

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Learning About The Condition

Like with all mental illness, knowledge is power. Learning about the condition and its causes, challenges, and treatments places loved ones in an advantageous position. Rather than feeling lost or angry at the individual, they have a starting point for understanding the situation.

Take the time to learn about borderline personality disorder through reputable sources like the National Alliance on Mental Illness (NAMI). Read books. Ask questions. Even when people do not identify having the condition, loved ones can support themselves by having this awareness.

Seeking Support

Many loved ones feel tired and overwhelmed in their relationships. They often feel like they’re giving and giving and giving- without any real sense of reciprocity. That’s why seeking support is so vital.

Loved ones may benefit from their own personal psychotherapy. Therapy can help with:

  • Receiving education about borderline personality disorder
  • Identifying and setting boundaries
  • Recognizing triggers 
  • Decreasing codependency
  • Implementing self-care and self-compassion
  • Implementing healthier coping skills for managing stress 

Many mental health agencies, nonprofit organizations, and hospitals also offer support groups for loved ones. These groups can be invaluable for members who feel alone or lost in their struggles. Members can provide and receive feedback about how to support their loved ones while also taking care of themselves.

Finally, loved ones should also stay connected with their friends, family, and other sources of support. While many people tend to isolate or withdraw when life becomes stressful, this strategy only tends to perpetuate greater feelings of loneliness, despair, and anger.

Validating The Feelings

People with borderline personality disorder often feel sensitive and reactive to the world around them. They tend to live their lives seemingly “on guard.” This can be frustrating for loved ones. Feelings may seem inappropriate, irrational, or overly dramatic. It’s easy to dismiss or discount them altogether.

Loved ones should learn how to provide validation without enabling. Validation is simple, but it can be profound. Examples of this technique include:

  • I can understand why you feel angry at your boss.
  • It must be hard to feel so alone right now.
  • I understand you’re sad. I feel sad knowing you’re going through such a rough time.

Practice listening with compassion and empathy. Although this may feel difficult, it helps foster a sense of safety and understanding.

Promote Personal Accountability

Loved ones often assume the responsibility for taking care of the person with borderline personality disorder. These motives are not malicious or selfish. They often come from a place of genuine concern. Maybe the loved one feels the person cannot adequately take care of themselves. Perhaps they have ample evidence pointing to the dire consequences associated with past mistakes.

While the desire to rescue is normal, it’s rarely effective. That’s because it tends to encourage enabling behavior. The person with borderline personality disorder doesn’t actually experience the full magnitude of their choices. Likewise, if they know someone will always bail them out, they have a natural protection from life consequences.

Loved ones should pause before stepping in to intervene or rescue. While this may be hard, it’s often the best step towards helping others recognize the need to be accountable for their lives.  

Pay Attention To Crisis Issues

While threats or actions related to self-harm or suicide may feel repetitive, loved ones should still take these issues seriously. Although it may feel manipulative, many people can and do follow through with their intentions.

However, loved ones can change and simplify their reactions. Rather than probing or exploring the emotions or trying to reason, it’s easiest to remain calm and firm. Call 911 or the National Suicide Prevention Hotline (1-800-273-8255). Consider contacting the loved one’s doctor or therapist. 

It is never a loved one’s job to protect or prevent a crisis from happening. However, a loved one can offer support, guidance, and resources during this vulnerable time. 

Set and Implement Boundaries

Boundaries refer to the limits a person sets for other people. Boundaries can be physical, emotional, and financial. They aim to protect and preserve someone’s integrity and comfort. Without boundaries, relationships tend to become messy, unstructured, and one-sided.

At first, boundaries can feel punitive and shaming. Many loved ones have spent years trying to understand, adapt, and contort to another person’s needs. They may worry that stopping that behavior may cause the person to spiral or hate them. 

However, boundaries encourage personal accountability. They also foster growth, strengthen communication, and cultivate a sense of mutual respect. There are many different kinds of boundaries, but some examples include refusing to:

  • Condone disrespectful language or insults in your home
  • Provide ongoing financial support
  • Condone substance use in your home
  • Provide bailouts from jail or other legal matters
  • Lie, make excuses, or cover up particular behaviors
  • Change your routine or schedule
  • Let the person live with you

Boundaries can also be more covert. For example, you may decide that you no longer wish to share intimate details of your life because you’ve experienced your loved one “using it against you.” You may decide that you want to limit the time you spend with them altogether.

Boundaries are only as effective as the ability to implement them. Stating boundaries- without following through- only creates more opportunity for potential manipulation and conflict.

Encourage Treatment

Loved ones can and should applaud all efforts towards treatment and recovery. This includes helping find treatment and participating in therapies, if possible. Moreover, they should understand that treatment is not always a linear process. It’s reasonable to anticipate setbacks, relapses, and struggles.

Treatment for borderline personality disorder is often long-term and intensive. Unfortunately, clients can drop out. They may become upset with their therapists. They may believe “nothing is working.” They may also think that they’ve “become fixed.” 

Aim to remain neutral should these issues occur. Anticipate the resistance. While a loved one cannot force someone into treatment, they can consider setting healthy boundaries surrounding the importance of seeking help. They can also provide ongoing and routine encouragement.

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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