Page entirely devoted to Non's. =>  Are you a Non-BPD? (Click link for assessment if you are a person dealing with a Borderline, and if you have the traits of a "Non-BPD").

As this site has been under continuous revision and expansion, it has become evident to me that I needed to insert a page for the Non-BPD's.  Many people who have gone to this site are not Borderlines.  For every person diagnosed with BPD, there are 5-15 people on the average who interact closely with that person.  It is these people (the Non-BPD's) who need to know where they can turn for support.  This page is for you.  YOU are a very important contributor:  1) for maintaining your own sanity   2) helping to diffuse a Borderline "Moment".  Also, you need to know why they are so resistant to help from others.
 

DBT for the Family

DBT for the Family

DBT for the Family

DBT for the Family

DBT for the Family





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Family DBT     5-25-11  by Simone Hoermann, Ph.D.
 

Dialectical Behavior Therapy (DBT) has been applied not only for adults with personality disorders, but has more recently also been modified for the treatment of adolescents, couples, or people dealing with eating disorders or substance use issues. DBT has also been used to help family members of people with personality disorders and other mental illnesses. Dr. Elizabeth Wade, the clinical psychologist I mentioned in last week’s blog, facilitates a DBT group for family members and concerned significant others of patients who may be people who are suffering from a personality disorder, or bipolar disorders, depression, anxiety, substance use, and eating disorders. “The DBT family group is not confined to only family members of those with personality disorders, but is open to families and significant others of clients with a variety of different issues, “ says Dr. Wade.

Family DBT is set up similar to a regular DBT skills training group and covers interpersonal effectiveness skills, emotions regulation skills, and distress tolerance skills. This means that the family members learn the same skills as their loved one who is attending DBT groups.

The basis of all these skills is mindfulness, the idea that it is important to raise one’s awareness of one’s own thoughts, feelings, and behaviors and how they play out with their family member who is in treatment. Mindfulness practice can be helpful for dealing with the concerned family member’s own emotions, since anxiety, anger, or regret can build up in families and impact people’s ability to participate in a satisfying life.

The group meets once a week for an hour and fifteen minutes. It is an ongoing group, which means that new members can join at any time. A lot of family members like to go through multiple rounds of learning the skills. It takes about 6 months to complete a full round of skills, though family members are welcome to stay longer. Group participants practice their skills in the group and are assigned a small amount of homework, which they bring back to the group for fine-tuning and trouble-shooting, much like a workshop.

Participants in the DBT family group reinforce each other in using effective behaviors, and the group can include as many members of one family as possible, since they can all affect the family system. The family member’s participation is often valued by the person in treatment as a sign that the family cares, a sign that they are interested and working towards supporting their recovery.

Over the course of the group sessions, family members share their experiences and support each other, giving suggestions and offering up resources. It can be helpful for family members to see how other people are dealing with similar issues. Often, there is a lot of shame in the family, so that frequently is a liberating experience to get a sense that one is not the only family dealing with these problems.

The family members of the patient don’t necessarily have to be in treatment themselves, but it certainly can be helpful if they are. What is important for the participation in the group is that the patient is in treatment, and that the family member is willing to listen to others and to participate in the group by speaking about their personal experiences as they relate to the skills. In the course of the group, participants learn some skills for effective communication and some crisis management skills, and they also are encouraged to learn how to take care of their own emotional needs. Often, the group provides a sense of relief that while another family member is going through difficulties, there is something that a concerned other can do, and that it is acceptable, even important, to take care of one’s own needs and concerns in order to be able to support a loved one.

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by Randi Kreger & Kim Williams-Justesen  "Love & Loathing"  

This book is for people in romantic relationships in which one of the  partners has BPD. Discussion of how to survive the romantic emotional roller coaster ride, how it affects children and how to decide what  to do; legal experts explain how to deal with the legal issues often involved  in divorce, such as child custody battles, false accusations, and restraining  orders.  Should you need to legally leave the BPD you are married to, this booklet is about protecting your mental health and your Legal Rights.

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• A Non’s Bill of Rights
• Take care of Yourself    (10-24-09)
• Boundaries: What are They and Why Do I Need Them
• Modalities
• Setting Appropriate and Effective Boundaries
• Determining if you have Healthy Boundaries
• Stress and Anger Management
• Boundaries and Privacy
• Grief and Loss
• Introduction to the Healing Affirmation
• A Non’s Healing Affirmation
• "I am a Non"
• Triggers
• The Price of Keeping the Silence
  
  (7-8-10)

• According to Harriet P. Lefley, Ph.D, a technique called the "three R's"--Recognizing, Resisting, and Reconstructing—-may help you support the BP (a person either diagnosed with BPD or is undiagnosed but has BPD traits) in your life while paving the way for you to set your own limits. Her suggestions are based on her experiences with lower-functioning offspring.
  
  She explains the technique in a chapter of a new clinically-based book about BPD, "Understanding and Treating Borderline Personality Disorder" (American Psychiatric Press, 2005).
  
  The three R's stand for:
  
  *RECOGNIZE that the BP (person with BPD or BPD traits) lives in a world of distorted mirrors. Parents and their BP children have vastly different perceptions of reality. You may, she says, feel harassed, accused or threatened. But your borderline family member feels that he or she is the victim of your perceived inability to recognize and honor their pressing needs.
  
  *RESIST getting drawn into their swirling emotionality triggered by your refusal to give into inappropriate demands. When the BP acts out outrageously, she says, it's natural to want to fight back. But it's the wrong move. If you can keep your cool—maintain your boundaries and refuse to be provoked into anger, criticism, and rejection—you can help the BP calm themselves down. This creates a win-win situation.
  
  *RECONSTRUCT the relationship, in part by learning how to deal with verbal abuse, forming your own support system (see below), and appreciating that your rights must also be respected.

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• The Geographic Solution
• Oxygen - The Airline Safety Metaphor
• Being in the Doghouse
• Emotional Detachment
• Detachment
• Stress and Anger Management

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• Couples Counselling
• The Well-Formed Outcome
• To a Non-BPD in Crisis
• When is Enough Enough in a Relationship?

• Child Refusing Treatment?   12-2-11
  How to Help the Borderline    8-23-11
• A Warm Bath for the BPD's brain - Oxytocin  
  (12-1-09)
• More Discussion on Oxytocin     12-22-09
  Recovery from BPD, What are the chances?
• Medication for BPD
• Rages and dealing with them  11-26-09

What to Do When Your Child Refuses Borderline Personality Disorder Treatment    by Clearview Treatment on Dec 01, 2011 in Family & Friends, Treatment & Therapy

Whether your child is just into their 20s or well into adulthood, you may find you’re having difficulty getting them to enter Borderline Personality Disorder (BPD) treatment. Your child may be in denial about their diagnosis or simply unwilling to get BPD treatment. But you know it will help. So what do you do?

Here are a few ways to swing their decision the other way if they are not relenting.

Educate Your Child about BPD
You may come off as pushy, but continue to make efforts to educate your child about Borderline Personality Disorder and its treatment. It is imperative for them to understand the nature of the psychiatric disorder that they are diagnosed with. Knowledge of the problem and the fact that it is surmountable may spur your child’s desire to get better.

Validate Their Feelings
Since an individual with Borderline Personality Disorder suffers from symptoms such as unpredictable mood swings, compulsive behaviors, and unstable relationships, they are quite likely to feel misunderstood. This can lead to people with BPD feeling lonely, unheard, and unaccepted. One of the first steps toward getting your child to say yes to BPD treatment is to try to be empathetic toward their feelings and actions. Tell them you understand why they behave certain ways at times. If your child feels you understand them, they are more likely to listen to your advice on getting BPD treatment.

Explain the Benefits of BPD Treatment
Perhaps your child does not trust treatment or understand how it could actually help them. Take them to a therapist or BPD treatment center that can better explain how treatment will work to improve their BPD symptoms. If possible, make arrangements for them to meet people in BPD support groups who can explain how treatment helped them recover from BPD. Such steps could go a long way in changing your child’s perspective on not getting BPD treatment.

Show Tough Love
When all else fails, it might be the time to practice some disciplinary measures. For example, if your daughter has refused BPD treatment for a number of months, deny her financial help. This may seem like manipulation or sound contradictory to providing validation, but sometimes it’s just essential to show some tough love. The key here is to be balanced. Be understanding, but warn them that they will not be allowed every comfort until they decide to enter BPD treatment.

Promise Some Perks
Perhaps your child has been longing to take piano lessons? You could entice them into entering Borderline Personality Disorder treatment by promising to buy them a piano once they complete treatment. Or maybe they want their own apartment? Tell them you’ll help with rent if they opt for BPD treatment and sincerely adhere to it through the entire course.

As a parent, it’s very important for you to not give up, even if your child continues to be disinterested in Borderline Personality Disorder treatment. BPD treatment will improve their BPD symptoms and give them the tools needed to live a more functional life.

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Healing the Shame that Binds You       by John Bradshaw

Shame is at the root of BPD and many other mental concerns. Chapters include The Faces of Shame, the Sources of Toxic Shame, Liberating Your Lost Inner Child, On Loving Yourself, Integrating Your Disowned Parts, Confronting and Changing Your Inner Voices, and Dealing with Toxic Shame in Relationships. A classic.

"I have been told that the work of George Vallient, MD is quite illuminating about BPD and much more positive than the 'lay press' presents. I haven't yet read his works but from what I have heard I still recommend perusing his works."

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Boundaries: When to Say Yes, How to Say No to Take Control of Your Life               by Henry Cloud

Persons that benefit from this book include pushovers who have allowed people to pick on them their whole lives and parents who have a hard time disciplining children. Schoolteachers, pastors, and students benefit from this book as well.

On a deeper level, Boundaries has actually helped those struggling from the affect of childhood abuse. For instance, young women who grew up not being able to say no to a man who asks for sex can now say so.

Better yet, she can so so without worrying if he is ever going to talk to her again. Additionally, friends can set limits with other overly-needy friends by using the content of some of the chapters in Boundaries,  which comes with a corresponding workbook by the same title.

This book has been used in counseling sessions, as well as in group workshops. Moreover, people have purchased a copy and have read it in the privacy of their own home.  Anyone can benefit from this book.

Topics Covered in Boundaries: When to Say Yes, When to Say No to Take Control of Your Life, include the following:

1. How to effectively communicate without making excuses or feeling guilty about it.
2. How to enforce your boundaries when they are being challenged. How to end or 
    limit unhealthy relationships.
3. When to say yes or no.
4. How to discipline a child who is not behaving. Prevent from  being overworked.
5. How to discipline a child who is not behaving properly.
6. How to prevent from being further overworked. Boundaries series is considered
    thought of as one of the most practical boundary-setting guides of the 20th and  
    21st century.

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A Warm Bath for the Brain  by Linda Graham

Understanding Oxytocin's role in therapeutic change

Q: The couples I see often are in such a state of emotional arousal that they can't calm down enough to do the work of therapy. What can I do to reduce their agitation and help them become more emotionally open, to me and to each other?

A: I know exactly what you mean. Take a recent session of mine. Lisa started yelling at her husband, Andy: "You never talk to me anymore! I'm sick and tired of you never saying anything! You're a brick wall!" He sat frozen on the couch, staring at his hands.
When clients are emotionally worked up, caught in fight-flight-freeze mode, all their hard-earned skills in empathic listening and responsible (and responsive) speaking go out the window. Nothing therapeutic is going to happen until they feel calm enough and safe enough to reengage with each other.

So I quickly asked them to do what I knew would calm Lisa down and re-engage Andy in less than a minute.

"Stop! Breathe. B-r-e-a-t-h-e. Place your hand on your heart. Breathe any calm you can muster right down into your heart center."

They did, because they've done this before with me, and they knew it works. "Let yourself relax into that calm. Now remember any moment you can of safety, trust, love with each other, any moment at all. Get the sense of that memory in your body. Feel the love and the trust in your body. Settle into it. Relax and breathe."

In less than a minute, Lisa felt calm enough and Andy felt safe enough to reengage in the work they knew they need to do to rebuild the trust, connection, and intimacy that'll save their marriage.

What happened inside their brains that allowed them to recalibrate so quickly? How can they make it happen again whenever they feel overwhelmed, to give their relationships a chance to heal?

What happened was that Oxytocin flooded through their brains. Oxytocin is a naturally occurring hormone, which stimulates feelings of bonding and trust and reduces fear and anxiety by reversing the stress response. Just one of many neurochemicals that neuroscientists now know are potent catalysts of psycho-physiological change, Oxytocin is extremely relevant for us therapists: it is the neurochemical basis of the sense of safety and trust that allows clients to become open to therapeutic change.

Produced in the hypothalamus, deep in the midbrain, Oxytocin is released naturally into the bloodstream through warmth, touch, and movement. Orgasm and breastfeeding generate Oxytocin. It also floods our brains and bodies when we're in close proximity to someone by whom we feel deeply loved and cherished. Even evoking memories of people close and dear to us will spark its release.

Do clients need to know how the release of Oxytocin calms and soothes them to benefit from its effects? Maybe not. But I've learned that clients love the sense of mastery and agency that comes from knowing not only how the Oxytocin response works, but how they can stimulate it within themselves.

Andy reported in the next session that just two days before, Lisa was in a high state of agitation when she was running late getting their recalcitrant 4-year-old son to preschool. He was afraid that saying anything would make matters worse, so he stood in the doorway where Lisa could see him with his hand on his heart. Lisa caught herself, stopped, met his gaze, and put her hand on her heart, too. He took one step toward her; she took three steps toward him. They melted into a 20-second, full-body, "tend and befriend" Oxytocin-releasing hug, and then calmly got their son to school, on time, without further upset.

Lack of warmth and touch in clients' earliest attachment relationships can derail the full maturation of Oxytocin receptors in the brain. A deficiency in this "molecule of motherly love" makes it much harder for them to "feel" the love and trust available to them in other relationships, later in life.

Our "re-parenting" of clients—allowing them to experience us as reliably secure attachment figures or helping couples experience each other as secure attachment figures—contributes to rebuilding those receptors in the brain, even after years of depression and loneliness. Many times, I explicitly evoked Andy's previous experience of me, and of Lisa, to stimulate feelings of the safety and bonding that were available to him, saying things like:

"I'm feeling touched as I hear you talk about your fears of speaking up with Lisa. I'm so moved that you would share that with me, with us."

"That was quite a lot of sadness you let yourself feel just now. What's it like to feel so much sadness and share those feelings with me? With us?"

"What do you see in Lisa's eyes as you share your sadness with her? What do you see in her eyes as she feels what you feel?"

Scientists are discovering that helping clients shift their neurochemical responses from the fight-or-flight response of cortisol to the calm-and-connect response of Oxytocin primes the brain to alter the ways neural networks process emotions, thoughts, memories, and feelings. According to Sue Carter of the Chicago Psychiatric Institute, a single exposure to Oxytocin can make a lifelong change in the brain. Therapy offers enough sustained exposure to Oxytocin that clients can rewire large segments of implicit relationship "rules."

In other words, by strengthening our clients' conscious ability to stimulate the release of this hormone, we can begin to rewire the deep encoding of habitual, often unconscious, patterns of response to relational distress. The more we do this with them, the more permanent the changes become.

Linda Graham, M.F.T., is in full-time private practice in San Francisco and Corte Madera, California, specializing in relationship counseling for individuals and couples. She offers consultation and trainings nationwide on the integration of relational psychology, mindfulness, and neuroscience. She publishes a monthly e-newsletter on Healing and Awakening into Aliveness and Wholeness, archived on www.lindagraham-mft.com, and is writing a book to be entitled Growing Up and Waking Up: the Emergence of the Whole Self. Contact: lindagraham2@earthlink.net  This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Tell us what you think about this article by e-mail at letters@psychnetworker.org  This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine section.

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Borderline Personality Disorder Demystified:  An Essential Guide to Understanding and Living With BPD       by Robert Friedel M.D.

Demystified is primarily directed to diagnosed borderline patients seeking information and support. There is a chapter for family members in which he cites material from Stop Walking on Eggshells (1998, New Harbinger). He writes, “Stop Walking on Eggshells seems to strike a responsive chord in people [whose BP loved one] lacks insight into their problems and refuses to seek professional help.” The inclusion of material for family members of undiagnosed BPD's not in treatment is encouraging.

The book’s advice for Non-BPs includes a) learn more about the disorder, b) be supportive, c) join an appropriate support group, and d) try to convince the BP to go into treatment, but accept that you can’t make them do so. Friedel’s own sister had BPD, so his understanding comes from first-hand experience. He also writes, “Remember that it’s the responsibility of the person with BPD to take charge of his or her behavior.”

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When Words Hurt:  How to Keep Criticism from Undermining Your Self-Esteem    by Mary Lynne Heldmann

Understand how and why criticism undermines your self esteem Take control of your responses to criticism Listen to and think objectively about criticism Deal with childish responses to criticism Balance your feelings with rational thinking Build self-esteem in the midst of a verbal attack Give criticism tactfully yourself. "A self-liberation guide for victims of verbal abuse...a wealth of ideas for protecting oneself from attack without counterattacking."

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 The Verbally Abusive Relationship     by Patricia Evans

The book that introduced the term "verbally abusive relationship" to the world!

“A groundbreaking book...” Newsweek

“This is the first time I have read a book about myself. It is so clearly defined—I believe this book has saved my life.” —J.M., Danville, New Hampshire

“I have highlighted practically the whole book...I recommended it to my youngest daughter just an hour ago. Wish I’d been able to read it 36 years ago!” —M.M., Sedelia, Missouri

“No one has ever explained this tragedy as you have.” —A.W., Denver Colorado

“Thank you for writing (this book) for me and the thousands of women everywhere who suffer in abusive relationship.” —B.L., Clayton, California

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Stop Walking On Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder  by Paul Mason & Randi Kreger

Do you feel that anything you do or say will be twisted against you? Are you being accused of things you never did or said? Do you try to avoid horrible, confusing arguments by concealing your thoughts and feelings? Are you at the end of your rope?

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Why Are Borderlines So Resistant to Help?   by A.J. Mahari     (8-5-09)

P.U.V.A.S.  from the book "Love & Loathing" by Kreger/Williams-Justeson

This technique can be used to respond to a Borderline who is projecting, accusing, being overly blaming or critical, or who is making unreasonable demands.  The Borderline will often get angrier because he is not feeling heard.  So he becomes more insistent and louder. 

P= Pay attention
U=Understand fully
V=Validate the BP's emotions  => these are for the BPD's needs

A=Assert with "My Reality statement"
S=Shift responsibility for the BP's feelings and actions back to the BP=>
                                                    A and S address the Non-BPD's needs

Pay Attention when it is your turn to listen, really listen.  Don't think about what you are going to say.  Do NOT become defensive and tune out the BPD, even if they are accusing you of things you never did or said.  This accomplishes helping you validate the BP's feelings, and it will assist you in detecting emotions that may lie beneath the surface.

Understand fully:  Make sure you gently challenge any vague generalizations you don't understand.  Don't defend yourself.

Validate the BP's emotions  The BP's feelings may not make sense in your world, but they certainly make sense in their world.  Very important:  do not judge, deny them, trivialize them, or discuss whether you think they are "justified".  Do not ask condescending; the BP may get enraged if you do not sound like you are taking their concerns seriously.

Assert yourself with "My Reality Statements"   Some reality statements will reflect your opinions, and that's okay. This is where some negotiating could come in to resolve the upset.

Shift responsibility for the BP's feelings/actions back to the BP  Let them know that you support them, but only they can make themselves better.  This is hard.  Leaning new behaviors is difficult.  Don't expect miracles.   Don't take the BP's reactions or your discomfort as failure.

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The Non-BPD Mantra                                                       (8-22-09)

Memorize and Repeat as Necessary: I am a Non. I value MY well being , my emotional health, enough to make choices that allow me to move towards health , wellness and better relationships... if that includes the person with the disorder in my life... good... if not... it’s worth the price ... I am worth the price.

I am a Non... it is NOT my fault that the person in my life with the disorder is sick... I did not CAUSE the disorder , I cannot CONTROL it, nor can I CURE it... It IS my responsibility to care for myself , to work on my health, and keep myself and children safe. 
                   Copyright (c) 1996-2003 Turtle Island Center Family Services [1996] Incorporated

Being in a relationship or married to a mate who has Borderline Personality Disorder (BPD) will be very trying for all involved. The periods of emotional roller coasters that will be experienced throughout your relationship can only make you stronger or break you.

Dealing with the emotional ups and downs of a mate with BPD is tiring, and is often termed as a sort of Jekyll and Hyde type behavior. One minute the two of you equally share your adorations for the other in which your mate is totally into you. Suddenly, without warning or provocation you become like prey fighting off an angry animal wanting to devour your very soul. The same person that had recently confessed you to be the best thing in his/her world now seems to feel you are lower than scum.

Ones suffering with BPD exhibits extreme and intense mood swings, along with horrific rages. These dumfounding rages can leave a mate or family member in a state of shock and confusion because they some out of nowhere. As a mate of a BPD spouse, you must learn to live in the moment, because you never know what the next will bring. My undiagnosed BPD spouse and I go through extended periods when our marriage is in a euphoric state. The attention and love that is showered upon me during these periods is all any woman could ask for. Communication and interaction is present, togetherness along with give and take on both sides is shown. The funny thing about this is, it does not matter how often you travel down this euphoric road, hopes of this behavior continuing will lurk deep within the back of your mind. Each time a drastic mood swing rears it's ugly head I am totally caught off guard, even now. When he is in mood swing mode, nothing I do or say is ever right. My every word is scrutinized carefully just to ensure proper English and meaning is conveyed, otherwise it will be corrected accompanied by a condescending chuckle. The very intelligence of the most brilliant of spouses will disappear in the eyes of a mate that has a BPD. DO NOT BELIEVE IT.

You as the spouse must be strong enough to separate the illness from the person, if you plan to stay in the relationship work on your own self-worth. Ultimately, you must be completely clear about who you are, what you stand for and how much you are prepared to handle. The illness will not just disappear one day; you must be clear on this fact, even though it can be managed, it is still up to the individual to want to seek help. Until that time comes, you will have to be the stronger of the two by having total confidence in yourself and education to help you cope. Remember knowledge is power.

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Essay on "One-Way Ticket to Kansas"    (by Author of this Site)
I have read this book in its entirety.  It is easy to read and understand this perspective from a Non-BPD, who lived with a Borderline wife.  And she was "The Wife from Hell".  I gained new empathy about what my significant other was going through when I was going through a Borderline episode....the FOG:  Fear, Obligation and Guilt of living with me and the episodes/scenarios that could erupt.  He experienced his daily life as if our home was an old mine-field in Viet Nam, and that he could be blown to bits by bombs buried and forgotten from my childhood.  He read the book before I did.  I also see how he could benefit from some of the suggestions made in the book on how he could take better care of himself.  I do not need fixing.  My DBT-Specialist therapist has that responsibility.  He needs to fix or repair his own recovery program, and be comfortable within his own skin. 


Back to Books Section

In Part 1 of our interview, Shari Manning, Ph.D, a licensed professional counselor in private practice who specializes in treating BPD, shares these effective strategies and helps readers gain a deeper understanding of the disorder.   Specifically, she reveals the many myths and facts behind BPD, how the disorder manifests and what mistakes loved ones make when trying to help.   Manning also is Chief Executive Officer of the Treatment Implementation Collaborative, LLC, and author of the recently published book Loving Someone with Borderline Personality Disorder. (It’s a must-read!)  

Q: What are the most common myths about borderline personality disorder (BPD) and how it manifests? 

•People with BPD are manipulative. We have found that it is not effective to be judgmental of clients or each other. If you think you are being manipulated, you will be defensive in your responses to the person whom you think is manipulating you. You will act to protect yourself and not out of wisdom. Besides, as we tell our clients, the problem is that people with BPD are not artful at manipulating. Really skillfully manipulative people get what they want from others without them knowing they are being manipulated. People with BPD get caught.  

•People with BPD do not really want to die when they attempt suicide. Depending on the research, and the severity of the disorder 8 to 11 percent of people with BPD die by suicide. Their lives are agony and they often want to escape the pain of their lives. Sometimes they do so by trying to completely end the pain with suicide; other times, they get temporary relief with other behaviors, e.g. cutting, burning, substance abuse, binging/purging, shoplifting.

•People with BPD are stalkers (like the character from Fatal Attraction). People with BPD often don’t have interpersonal skills. Their learning history has been one of losing relationships, often because of their extreme behaviors. There have been several studies done and it appears that four to 15 percent of stalkers were diagnosed with BPD. It is important to remember that some percent of stalkers may meet criteria for BPD but stalking is not a characteristic of BPD. Very few people with BPD become stalkers.

•People with BPD just don’t want to change (or they would do so). I have never met a person with BPD who wanted to be emotionally and behaviorally out of control. If there were a magic wand that “cured” BPD, I am certain all of my clients would have me wave it at them. The problem is that change is really hard for all of us and doubly (maybe triply) hard for people who are emotionally sensitive. Think of a behavior that you wanted to change (quitting smoking, exercising, dieting). Think of all of the times you failed. Did you fail because you didn’t really want to change or because you failed?

•People with BPD are uncaring and only think of themselves. In my experience (and I don’t really have studies to back this up), people with BPD are extremely caring. They get a reputation for only thinking of themselves when they get distressed and engage in behaviors that cause harm to their relationships (overcalling, over-texting, showing up when not invited). In the heat of the crisis, people with BPD are often so physiologically/emotionally aroused, that they cannot be mindful to others. However, they feel an extreme amount of guilt and shame about the effects of their behavior on others.

•BPD develops from childhood sexual abuse. Not all people who have suffered childhood sexual abuse develop BPD and not all people with BPD suffered childhood sexual abuse. Depending on the study, 28% to 40% of people with BPD had sexual abuse in their childhood. We used to think that the incidence was higher but as the diagnostic criteria for BPD have been more effectively used, we are finding that the incidence is lower than we initially believed.

•BPD develops from poor parenting. As I said above, some people with BPD are sexually or physically abused as children. Some people with BPD had distant or invalidating families. However, some people came from completely “normal” families. People with BPD are born with an innate, biological sensitivity to emotions, e.g. they have quick to fire, strong, reactive emotions. Children who are emotionally sensitive take special parenting. Sometimes, the parents of the person who develops BPD just aren’t as emotional and cannot teach their child how to regulate intense emotions. We tell clients that they are like swans born into a family full of ducks. The duck parents only know how to teach the swan how to be a duck.

Q: What mistakes do you see loved ones make when trying to deal with someone with BPD?  

Family members often try to encourage their loved one but inadvertently invalidate them and increase their emotional arousal. For example: the person with BPD says, “I am a terrible person” after seeing hospital bills from a suicide attempt. The family member responds, “No, you’re not a bad person.” The contradiction makes the person with BPD more distressed.  

Instead, try acknowledging the feelings/thoughts behind the statement then moving into something else. Say instead, “I know that you feel badly about how you acted and that makes you think you are a bad person.”

Another error is that family members give the person with BPD more care and attention when they are in crisis and then withdraw when they are not. This may inadvertently reinforce the crisis behavior and punish non-crisis behavior.  

Q: In your book, you discuss the importance of gaining a deeper understanding of how BPD manifests so loved ones know what to expect and don’t feel so lost. You also note that Dr. Marsha Linehan, the founder of dialectical-behavior therapy, classified the disorder into five areas of dysregulation. Can you briefly describe these categories? 

•Emotional dysregulation—extreme emotional responses, especially with shame, sadness and anger.

•Behavioral dysregulation—impulsive behaviors like suicide, self-harm, alcohol/drugs, binging/purging, gambling, shoplifting, etc.

•Interpersonal dysregulation—relationships that are chaotic, fearfulness of losing relationships coupled with extreme behaviors to keep the relationship

•Self-dysregulation—not knowing who a person is, what their role is, being unclear on values, goals, sexuality

•Cognitive dysregulation—problems with attentional control, dissociation, sometimes even brief episodes of paranoia

Q: You say that BPD, at its core, is an emotional problem. Why are people with BPD so much more emotional than others? 

Our emotional sensitivity is something that is hardwired into us. Some people are more emotional than others. People with BPD are usually among the most emotionally sensitive people. Anyone who is emotionally sensitive must have skills to regulate those intense emotions. Skills are learned not hardwired.  

Margarita Tartakovsky, M.S. is an Associate Editor at Psych Central and blogs regularly about eating and self-image issues on her own blog, Weightless.  APA Reference    Tartakovsky, M. (2011). How to Help a Loved One with Borderline Personality Disorder, Part 1. Psych Central. Retrieved on August 23, 2011, from http://psychcentral.com/lib/2011/how-to-help-a-loved-one-with-borderline-personality-disorder-part-1/
 

How to Help a Loved One with Borderline Personality Disorder, Part 2
By Margarita Tartakovsky, M.S.  

When your loved one has borderline personality disorder (BPD), you might feel like you’re already overextending yourself but to no avail. You may feel “directionless, because all you can ever seem to do is react,” writes Shari Manning, Ph.D, a licensed professional counselor in private practice who specializes in treating BPD, in her excellent book Loving Someone with Borderline Personality Disorder.  

“You go from one extreme to the other, from trying to make sure nothing upsets the person you love to trying to get away from the person at all costs. You may feel like you’re caught in a riptide, unsure when the behaviors that upset you are going to stop and where you’re going to be dropped off at the end.” 

However, you can take steps to become “unlost,” as Manning puts it, and improve your relationship.  

In Part 2 of our interview, Manning reveals how to help defuse your loved one’s intense emotions, how to handle a crisis, what to do if your loved one refuses treatment and much more. Manning also is Chief Executive Officer of the Treatment Implementation Collaborative, LLC, which offers consultations, training and supervision in Dialectical Behavior Therapy (DBT).

Q: You suggest using a technique called validation to help defuse a loved one’s intense emotions. What is validation, and how is it different from simply agreeing with what someone says?  

Validation is a way of acknowledging some small piece of what the person says as understandable, sensible, “valid.” An important piece of validation that people miss is that we don’t validate the invalid. For example, if your loved one is 5’7,” weighs 80 pounds and says “I’m fat,” you wouldn’t validate that by saying, “Yes, you are fat.” That would be validating the invalid.  

You can validate some part of what she is saying by saying “I know you feel fat (or bloated, or full)”, whatever is appropriate to the context of what she is saying. Try to find some small kernel of validity. Remember that tone and manner can be invalidating when words are validating. “I know you FEEL fat” can be invalidating because it communicates that the feeling is wrong.  

Q: In your book, you talk about an emotional whirlpool where a person with BPD is triggered by some event that’s unpleasant or scary for them. Then they struggle with a torrent of emotions, which can lead to impulsive behavior. Loved ones can feel especially helpless in these moments. What can loved ones do?  

The first thing that loved ones should do is regulate their own emotions. It is so difficult to watch someone you love who is in agony and behaviorally out of control. Loved ones can become fearful, angry, judgmental, guilty, a whole gamut of emotions and thoughts. When family members regulate their own emotions, they are better able to think about how to help their loved one.  

Q: What’s the difference between self-harm and suicidal behavior?  

Suicidal behavior is behavior with the intention of being dead. Many people with BPD engage in behaviors that inflict physical harm that aren’t about killing themselves. Self-harm behaviors often function to bring down (relieve) painful, extreme emotions. People with BPD can have suicidal behaviors only, self-harm behaviors only or a combination of both.  

Q: What should you do if your loved one is suicidal?  

There are many reasons for suicidal behavior. Studies have shown that some people feel emotional relief by picturing themselves dying. Thinking, talking, planning suicide may work to relieve emotions, at least for a little while. Some people are planful about how they will kill themselves and meet all of the warning signs that are on suicide prevention websites.  

However, about 30 percent of suicide attempts are impulsive, meaning that the person thought about it for just a few minutes. One problem is that people with BPD often fall into the impulsive suicide attempts. So, it is important to remember that if your loved one says that she is going to commit suicide, you have to take it seriously.  

That being said, our responses to suicidal behavior can reinforce the behavior. If every time your loved one gets suicidal, you go get her, bring her to your house, feed her and tuck her into bed, you could be inadvertently reinforcing her behavior, especially if you don’t do the same thing when she is doing well.  

Figuring out the reinforcers for suicidal behavior is complicated work and the consequences for being wrong can be catastrophic. If you think you are reinforcing suicidal behavior, go talk to a behavioral or cognitive behavioral therapist. Create an alternative plan with your loved one that reinforces non-suicidal behavior. If your loved one is suicidal in the moment, here are a few steps to take with him: 

•It may sound strange, but the first thing to do is to tell him not to kill himself.

•Focus on tolerating the moment. Don’t drag up old issues.

•Ask what emotions your loved one is having.

•Validate his emotions and his experience.

•Ask how you can help (if you are willing to help).

•Communicate your faith in your loved one’s ability to get through the crisis.

•If you are ever in doubt, call a professional.

Q: BPD is highly treatable. But what can family or friends do if their loved one refuses to get treatment or there’s no professional in their area who treats people with BPD?  

Access to effective treatment for BPD remains an issue. Twenty years ago, clinicians considered BPD untreatable and it takes time to change perception, even when we have data that say that there are effective treatments. If there is no treatment available, start a grassroots campaign with the local community mental health center, NAMI (National Alliance for the Mentally Ill) Chapter or other advocacy groups. I have encouraged people to find a cognitive-behavioral therapist in their area if there is no one who specializes in treating BPD.  

If your loved one refuses to get treatment, the key is to support her and take care of yourself. Make sure you are regulating your emotions and communicating limits about what behaviors you can tolerate and which you can’t tolerate. Be supportive when possible but try not to reinforce out of control behaviors. Validate, validate, validate while encouraging your loved one to get treatment.  

Often people with BPD have had negative experiences in therapy. They have been fired by therapists, gotten worse, thought they were getting worse or were left with thoughts that they cannot be helped. Have honest, nonjudgmental conversations with your loved one about her reasons for refusing treatment and problemsolve if possible.  

Remember that changing behavior is often like water over rocks: gently, consistently and in a validating way, continue to encourage her to go to therapy while communicating your belief in your loved one’s ability to have a life worth living.  

Finally, find help for yourself. Many Dialectical Behavior Therapy programs have Friends and Family groups. Join a support program for family members of people with BPD. NEA-BPD and TARA and the Treatment Implementation Collaborative and others have distance programs for family members that provide support while teaching family members about BPD and how to help their loved one and themselves.  

Q: Anything else you’d like readers to know about BPD and what loved ones can do to help themselves and the person with BPD?  

At the end of the day, compassion is effective. If you are compassionate, you will try to help your loved one without judging or condemning him. If you are compassionate, you will care for your own physical and emotional health.  

When in doubt about what to do, I always ask myself what the most humane response is that I can have. Then, I do it.

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