How to Help a Loved One with Borderline Personality Disorder, Part 1
By Margarita Tartakovsky, M.S.
Borderline personality disorder (BPD) can seem like an enigma, even
to family and friends, who are often at a loss for how to help. Many
feel overwhelmed, exhausted and confused. Fortunately, there are
specific strategies you can use to support your loved one, improve
your relationship and feel better yourself.
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.
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.
Back to What You Can Do for Your BPD
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