It’s no secret that health insurance is expensive, and paying for mental health services can be outrageous as well. When you and your partner have a large pile of bills to pay, it can make a difficult decision to forgo mental health appointments and psychiatric medications appear–on the surface–to be easier.

No money = No care, no meds. Period. End of story. Right?

Unfortunately, you and your partner may have already discovered what happens when mental health treatment is stopped abruptly. Or if you are considering this possibility, you may be in for an unpleasant surprise.

The ramifications of not getting appropriate treatment go much further than just a depressed mood or anxious thoughts and feelings. It could result in an untimely death.

If you have a partner with borderline personality disorder (BPD), the phrase “walking on eggshells” likely defines your life. People with BPD struggle to regulate their emotions, even though the emotions they experience are the same as the rest of us.

The difference is in the intensity of how they feel those emotions. Marsha Linehan, PhD, the founder of dialectical behavioral therapy (DBT), compares those with BPD to third-degree burn victims: “Lacking emotional skin, they feel agony at the slightest touch or movement.” What might just be a small slight for you might mean off-the-charts upset for your partner.

In the DSM-IV-TR, four of the nine criteria required for a diagnosis of BPD have to do with how the person handles emotions. These include:

• frantic efforts to avoid real or perceived abandonment
• intense and quickly changing moods, including irritability and anxiety
• inappropriate anger or the inability to control anger
• chronic feelings of emptiness

What does this mean if your partner has BPD?

Sociopaths are all around us. When we hear that term, people like Jeffrey Dahmer, Ted Bundy, and Bernie Madoff come to mind, but reality is that most of us will encounter someone who is a sociopath during our lives. Some of us will get sucked into a relationship that is very hard to get out of and is very dangerous; others of us will escape unharmed, but potentially have interesting stories to tell about the insane things the sociopath talked us into doing.

At first, your partner may have seemed too good to be true. Sociopaths are fabulous at making people feel special, oozing charm, wit, humor, and (what appears to be) affection. Once they have reeled you in, though, some of the more noticeable features that will surface are manipulation, grandiosity, lack of emotions (including the ability to love), pathological lying, lack of remorse, and the need for stimulation. Sociopathic characteristics start before the age of 15, and does not seem to be influenced by upbringing, so if your partner is indeed a sociopath, chances are there is a history of these behaviors long before you came into the picture.

You are likely not their only partner, either.

Bringing up the topic of a partner’s mental illness with family and friends can feel tricky. In some cases, it might be obvious that there is something wrong, but many mental illnesses can’t be detected from the outside. However, that doesn’t mean you and your partner don’t need and deserve support from understanding family and friends.

Asking for that support can feel uncomfortable, though, given the stigma that still exists around mental illness, and cultural perceptions that we should keep personal problems to ourselves.

Jim’s drinking was clearly out of control…he had been up for over 24 hours, and the beer bottles lying around numbered over thirty. Yet he refuses to see a counselor, saying that he “doesn’t have a problem and doesn’t need help!”

Jane’s mother, Sally, age 76, can barely make her way through her own house because of the clutter and items she has accumulated. Jane is concerned for her mother’s safety, but Sally will not allow Jane to clean the house or throw anything away. The more Jane insists, the stronger Sally’s resistance. It’s gotten to the point where Sally has told Jane she is not welcome to visit anymore, and Jane cannot figure out how to help.

Josh has not been feeling like himself for a long time now: he lost his job six months ago and his girlfriend of two years broke up with him a few weeks ago. He’s finding himself sleeping through the day and staying up all night, gaming online and looking at porn. He knows he should be job hunting, but really, he doesn’t care anymore. He’s lost 20 pounds, and when he does see his friends, they are shocked at the changes. But when they ask questions, Josh blows them off and says, “I’m fine.”

All three of these people are great candidates for therapy, but none of them will go. Why?

The American Psychological Association released its annual Stress in America report earlier this month, and the findings were clear: those caring for people who are aging and/or chronically ill (including those having a mental illness) are under more stress than the average American. According to estimates from the National Alliance for Caregiving, 65.7 million Americans served as caregivers for an ill or disabled relative in the past year.

Not only that, caregivers reported that they are less successful in making changes that could improve their quality of life, such as eating well, exercising, managing stress, and getting enough sleep. If you read this blog regularly, you know that I often reinforce the importance of these strategies, but the results show this is still difficult to put into practice.

If you have a partner with borderline personality disorder (BPD), it’s likely that you have experienced times when your partner has said things that were extremely hurtful, maybe even cruel. A person does not have to have BPD (or any other mental disorder, for that matter) to know just how to push their partner’s buttons, but for the partners of those with BPD, the emotional outbursts tend to be more frequent and, ultimately, more harmful, both to you as the non-BPD partner and for your relationship as a whole.

“Emotional abuse” is any kind of behavior that is meant to control another person through the use of fear, humiliation, or physical assault. It can range from verbal attacks to more subtle forms of manipulation, intimidation, and the inability to be pleased, no matter what you do for them.

People who are emotionally abused have a slow erosion of self-esteem, self-confidence, and sense of self-worth. They begin to question their own thoughts and ability to judge a situation accurately, because their abuser is constantly telling them they are wrong. Eventually, the person being abused feels so worthless that they decide no one but the abuser would want to be in a relationship with them, so they stay. Their worst fear is being alone.

If this describes your relationship, you are not alone.

You may have told your partner during your time together that he or she is “one in a million,” but if they also have a mental illness, they are more like 1 in 5 Americans, according to a recent report from the Substance Abuse and Mental Health Services Administration (SAMSHA).

According to the report:

A new national report reveals that 45.9 million American adults aged 18 or older, or 20 percent of this age group, experienced mental illness in the past year. The rate of mental illness was more than twice as high among those aged 18 to 25 (29.9 percent) than among those aged 50 and older (14.3 percent). Adult women were also more likely than men to have experienced mental illness in the past year (23 percent versus 16.8 percent).

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health also shows that 11.4 million adults (5 percent of the adult population) suffered from serious mental illness in the past year. Serious mental illness is defined as one that resulted in serious functional impairment, which substantially interfered with or limited one or more major life activities.

As the well partner, what does this mean for you?

Last Friday’s post discussed how stigma is–unfortunately–still a major force in mental health.

Today, I want to share with you something you can do about it. Many positive things in the world have happened because someone has had a loved one go through a negative experience, and decided to instigate change. The National Alliance on Mental Illness (NAMI) has just the thing: Become a StigmaBuster!

Randi Kreger, coauthor of Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder, and the founder of BPDCentral.com, recently wrote a great post on her Psychology Today blog about how to leave a partner who has a personality disorder. Since this is a topic she is well-versed in, and I could not write about this topic any better than she has, I encourage those of you who are considering leaving your partner to go read it for advice.

Leaving a partner with a mental illness is a difficult decision, and can be a challenge to execute, as I had addressed in a two-part blog post earlier this fall. But if you have a partner with a personality disorder, there are extra layers of complexity, which Randi addresses beautifully in her post.