Caring for a Family Member with Borderline Personality Disorder
Supporting and caring for someone with borderline personality disorder (BPD) requires patience, good communication skills, firm boundaries, and the willingness to learn more about this condition. Treatment can be effective in managing the symptoms of borderline personality disorder, but it takes time. Family members must be educated about BPD, about what it takes to treat it, and need to patiently support a loved one committed to getting better.
What it’s Like to Live with Borderline Personality Disorder
It is important for the loved ones of someone with BPD to understand more about this illness. Start your journey of supporting a family member by learning all you can about borderline personality disorder and BPD symptoms. This will help you be more patient and more compassionate when you see your loved one struggling. Without understanding what this illness is like, it can be difficult to empathize. From the outside it often seems as if this person is being manipulative, needy, irrational, and isn’t trying hard enough to get well. On the inside, it feels very different.
There are some misconceptions about BPD and people with this condition, so it helps to be aware of these misconceptions to better understand what sufferers are going through and how they feel. For instance, a person with BPD is not trying to be manipulative; they are scared of being left or abandoned. They are also not uncaring people. They do care about family and friends but find it difficult not to act selfishly when experiencing their own heightened emotions. They do want to change, but it is so hard.
Here are just a few examples of what it feels like to have BPD:
- Being extremely sensitive to what people say and do
- Having intense emotions that change rapidly, like being on a roller coaster
- Constantly fearing that loved ones will leave, even if this seems irrational
- Desperately needing reassurance
- Feeling broken and worthless
- Feeling intense rage, depression, anxiety, and fear, and being unable to control these feelings
- Being unable to figure out one’s own self or personality, feeling empty or like a nobody
Signs Someone May Be Struggling with BPD
What is borderline personality disorder? It is a type of personality disorder, meaning a mental health condition that causes a person to have thoughts, feelings, and to engage in behaviors that are negative and very difficult to change. Borderline personality disorder traits include intense emotions, changing moods, fear of abandonment, self-harm, unstable relationships, a lack of a stable self-image, paranoia, anger and aggression, and other symptoms that make living a normal life extremely challenging.
Here are some signs that the person you are worried about may have BPD:
- Your loved one changes moods rapidly, sometimes within minutes and from one extreme to another.
- You feel like you are always walking on eggshells trying not to set off an emotional reaction.
- Your loved one has intense periods of depression or anxiety.
- Everything is blamed on you, and you are criticized by your loved one for things that don’t make sense to you.
- Your loved one has tried to cut or burn his or her body, or has talked about suicide.
- You often feel like you are being manipulated by your loved one.
- Your loved one thinks you are amazing one minute and horrible the next, with no middle ground.
- Your loved one often changes things like jobs, activities, styles, hobbies, and other aspects that define his or her personality.
- You are often worried about the risky behaviors your loved one engages in.
Getting a Diagnosis for Borderline Personality Disorder
If you are worried about your loved one, and you recognize some of the borderline personality disorder symptoms in him or her, you need to get a professional diagnosis. This can be a difficult step because borderline personality traits are much easier to recognize from the outside. Someone with the condition may not think there is anything abnormal about how they think or act. It is so important to convince your loved one to see a doctor, a nurse, a therapist, or anyone who can help convince them that a diagnosis and treatment could help them feel better.
Borderline personality tests don’t exist specifically, but a detailed interview, medical exam, and psychiatric evaluation can help a mental health professional make an accurate diagnosis. There are several borderline personality disorder criteria, and if your loved one matches five or more of them, he or she will likely be diagnosed. While you can start with any medical professional, be sure your loved one’s diagnosis is ultimately made by or confirmed by a psychiatrist, who can guide you to a good therapist and prescribe any necessary medications.
Supporting and Managing BPD Treatment
Once your loved one has a diagnosis, they can begin to work on a treatment plan with their psychiatrist or other mental health professional. There is no borderline personality disorder medication, but your loved one may be prescribed a drug for depression, anxiety, or psychosis symptoms. Make sure your loved one takes it as prescribed and doesn’t miss doses. Make note of any side effects to report to the doctor.
A bigger part of treatment for BPD is a type of therapy called dialectical behavior therapy (DBT), which helps patients be more mindful and accepting of their emotions, negative thinking, and moods. It also helps them learn to actively change and control these emotions as well as negative behaviors. This type of therapy, and family psychoeducation, are proven by research to provide the best outcomes for BPD patients. Family psychoeducation is a program for teaching family members about BPD and how best to support the patient. Ask your doctor for recommendations for a program you can join.
With borderline personality disorder, relationships are one of the biggest challenges. From your end, learning how to communicate with your loved one can be a big help:
- Try to actively listen to your loved one. He or she needs to know you are listening and validating feelings. Listen and then respond to show that you heard and that you sympathize with them.
- Validate your loved one’s feelings, and don’t try to make him or her feel wrong or that you are winning an argument. It won’t help.
- Remember that the hurtful words should not be taken personally. Try to hear the emotions your loved one is expressing, not the mean words.
- Always communicate calmly, no matter how out of control your loved one gets. If you cannot remain calm, walk away until you can.
- Distract your loved one when emotions begin to escalate. Use music, television, an art project, exercise, or anything else as a distraction.
Also important in living in a BPD family is to set boundaries and enforce them. Not only will this make life easier at home, it will help your loved one learn how to better distinguish and respect boundaries with other people and in other settings, like work and school. Make the boundaries, and the consequences of stepping over them, very clear.
An example of a boundary you might set is that your loved one is not allowed to call you hateful names when having an emotional reaction or an argument. Maybe you let him or her yell if that helps, but name calling is off limits. Tell your loved one that verbal abuse like this will shut down the conversation and that you will walk away and shut the door. Boundaries should be firm, but reasonable. Don’t set your loved one up for failure.
Coping with Suicidal Behaviors and Self-Harm
Most patients with BPD don’t really want to die, but their intense emotions and feelings of guilt and shame can lead to self-harm and suicidal behaviors. These should not be taken lightly. Self-harm, like cutting and burning, are not typically suicidal but tend to help someone feel emotional relief. Talk to your loved one and his or her therapist about alternative and healthier ways to get that relief.
While you should take suicidal threats and behaviors seriously, your reaction may be reinforcing. Instead of coddling or giving attention and affection you wouldn’t normally give, be direct and unemotional. Tell your loved one not to do it, ask to hear what he or she is feeling, validate those emotions, and if ever in doubt of what he or she may do, call for help. Call 911 if necessary.
Care for the BPD Caregiver
When caring for or supporting a loved one with BPD it is important to take care of yourself as well. This is an emotionally unstable personality disorder, and living with and loving someone going through it can be exhausting. You will not be able to support your loved one effectively if you don’t also take care of you. Here are some important things to do for self-care:
- Find your own support. Your loved one needs support, but so do you. Reach out to friends and family and make sure they will listen to you and support you. A support group for family members of people with personality disorders can also be a big help.
- Take time for yourself. Caring for someone with BPD takes a lot of time, but you deserve to have a life too. Take time out to do what you like to do and take time away from your BPD loved one.
- Manage stress. Use stress-relief and coping strategies to manage and reduce the stress caused by this difficult relationship. Meditation, yoga, mindfulness practice, breathing exercises, and exercise can all help.
- Take care of your body. With so many other things that seem urgent, your physical health may end up as a lower priority. Don’t let this happen. Being in good physical health, with adequate sleep, exercise and good nutrition, will help you be better able to cope. It’s worth your time.
- Remember this is not your fault. It can be easy to fall into a trap of blame, guilt, and responsibility that is not your burden to bear. Always remember that you did not cause this illness and that you cannot control or fix it. You can only give support and love.
Living with borderline personality disorder is difficult for the patient and for loved ones. If you care about this person, support his or her treatment, learn to communicate effectively, set boundaries, and remember to care for yourself as well. Be patient and realize that treatment takes time to work. Continue to provide appropriate support, and your loved one will get better.