What is your first impression when you hear the term Borderline personality disorder (BPD)? For many people, the term is fraught with stigma and negative connotations as a result of years of unhealthy representations and lack of research. But with the advent of continuing research, new clinical findings, and an increase in psycho-education about the disorder, things are looking up in terms of understanding BPD better.
With more knowledge and understanding of how behaviors, attitudes, and perceptions work in the lives of those with BPD, you will be better able to control your own emotions, cope, and utilize your boundaries.
This article will explore ways that families and friends can learn to cope with a loved one how displays BPD traits.
BPD is a very complex disorder for many diagnosed with it. The symptoms, the chaos, the abusive tendencies, the rage, the fear of trusting others, 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 on purpose. In fact, research suggests that BPD creates a kind of “mis-perception” of self and others. BPD can be likened to a foggy lens that you may attempt to look out of. You seem “images” of things but cannot see the complete picture. Individuals with BPD often see only half of the picture through a foggy, emotionally-driven lens. That’s why proper management of emotions and thoughts as well as anger can seem impossible. You may also notice that the individual, when escalated, recalls a completely different story of an argument than you remember it to be.
It is important that I highlight that BPD, under great distress, can result in paranoia and some delusional forms of thinking. It is possible that someone who has the disorder begins to “recall” details that never happened at all. It is sad for me to say that because of this the disorder maintains its strong stigma and many people maintain an aversion to any sign of this BPD trait.
Gender and Borderline Personality
BPD affects a great deal of our population but research is still somewhat lacking on the subject. There is very little research about specific populations suffering from BPD such as adolescents and males. Men tend to be a group that BPD research is slowly beginning to study. Even in my local area there are limited opportunities for men with BPD-traits to be studied in clinical trials or teaching university studies. The majority population continues to be females. But after NFL player Brandon Marshall opened up about his diagnosis, researchers began to discuss male BPD more often. Still, however, we have limited videos, articles, research studies, etc. on the topic.
Thankfully, programs at Mclean Hospital (and similar places) offer research, studies, and education on both genders. it is important that we understand the different characteristics of BPD in females and males. Symptoms can look very different. Emotion dysregulation can also look different based on gender. For example, men with BPD often exhibit physically aggressive behaviors, become substance abusers, get into a lot of legal troubles, and engage in high risk behaviors such as driving a car really fast, threatening a violent suicide, or engaging in pushing legal or moral limits. Bipolar disorder can be a misdiagnosis for many males with BPD. 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.
Women tend to suffer more with the interpersonal and relational aspects of the illness and tend to struggle more with feelings of abandonment and loss. Although both genders struggle with many of the same symptoms, males struggle in a very different way.
Adolescents and borderline personality
In my experience of treating many teens who cannot (at this time) be diagnosed with BPD, both my male and female adolescent clients suffered with BPD traits that interfered with a great deal of their lives. Not only did they struggle with social relationships, honesty, and fear of being abandoned by friends and peers in school, but they also displayed behaviors that were very self-defeating. For example, adolescents with BPD may engage in back-biting, ostracizing peers, jealous or competitive behaviors, stealing and lying, substance use and abuse, or display an array of complicated relational patterns. It is true that most teens struggle with relationships as they are attempting to develop a more stable view of themselves. But most teens with BPD struggle with this process and may complicated every ounce of their interactions with other people.
Because today’s teens (as a result of a reluctance from the field of psychology to diagnose adolescents with personality disorders) “cannot” be diagnosed with BPD, many acquire a “primary” diagnosis of depression, anxiety, or bipolar disorder. This so-called primary diagnosis is then “treated” as the main problem when in fact the main problem is BPD. If this doesn’t make sense to you, join the club.
The earlier we can treat the symptoms, the better the prognosis.
Families and Borderline Personality
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. Families also question why outbursts of anger and emotional intensity are triggered by minor things. Trying to understand the “why” can take years, even after families develop a working knowledge of the diagnosis. “Things don’t make sense” is a common statement I hear when seeing a family who has an adolescent or adult child with undiagnosed BPD-traits. The main issue for someone diagnosed with BPD is regulating emotions, comprehension of reality, and logical reasoning when emotions get out of control. Some of my client’s families have reported that their 34 year old has unreasonable 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 who is tantruming. I have also seen families try to reason or use logi with the sufferer only to later find out that their loved one misinterpreted their statements. 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 intense emotions.
As a therapist who has taken on both adolescents and adults meeting criteria for borderline personality, I would like to share with you what I have shared in my office with families about the disorder. If you are dealing with someone who may have (or has been diagnosed with) BPD,you will 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 to manage and help someone with BPD symptoms. Next week we will discuss some of those ways. Nothing is more powerful than knowledge. Understanding the illness can lead to greater ways of coping with it.
As always, I wish you well
Please note this article was originally posted 4/8/2015 but has been updated to reflect comprehensiveness and accuracy.