We live in a world where we are challenged to maintain our mental health everyday. It can be hard to know where we end and the next person begins, even if we are relatively balanced people. This is especially true in cases of mental illness. When someone has a distorted view of reality that causes him or her to see the world in unhealthy ways, it can be easy for that perception to negatively affect everyone that person touches. When someone we love has a skewed way of seeing the world, it can poison us if we are not careful.
Part of loving someone unconditionally is knowing when to support, when and how to safely merge, and when our presence is no longer beneficial in that person’s life. If someone we love is suffering from the intense distortion that is Borderline Personality Disorder, we may be able to offer invaluable help, or we may become part of the problem. The road to mental health for ourselves includes being able to discern the difference and act with both empathy and appropriate boundaries.
Borderline Personality Disorder In Theory
Before diving into how to work with BPD, it is helpful to understand it as much as possible. Borderline Personality Disorder (BPD) is a serious mental disorder that affects approximately 1.6 percent of adults in developed countries that do such psychological testing. It was originally thought to be an atypical (borderline) expression of other mental disorders, hence the name, but it has since been determined by mental health experts that BPD is a disease in its own right.
It is still a widely misunderstood disorder, and its far-ranging symptoms are easily mistaken for other conditions, making proper diagnosis and treatment especially challenging. Also, people with BPD are highly likely to have a co-occurring disorder such depression, anxiety, an eating disorder, or substance addiction. Physical illnesses often occur along with BPD, such as arthritis, chronic back pain, fibromyalgia, diabetes, high blood pressure, and obesity. This may be related to the high levels of inflammation common in both mental disorders and these physical illnesses, but the causation and correlation is uncertain.
The exact causes of BPD are still unknown. Most scientists agree that it is most likely caused by a combination of genetic, psychological, and environmental factors. The few studies that have been done so far indicate that BPD can be inherited, along with temperament and certain personality traits common in the disorder. These genetic factors are compounded or influenced by the environment in which a child is raised. Early childhood abuse or trauma, unhealthy family dynamics, an unstable home life, and stressful home and school environments significantly increase the likelihood of developing the disorder.
Symptoms of BPD may begin to appear as early as childhood, though usually become most apparent in adolescence and early adulthood. In order to be officially recognized as BPD, a person must have at least five of the following symptoms that endure over an extended period of time and in multiple situations:
- An unstable and distorted self-perception, where one does not perceive one’s self accurately in relation to the world and other people. Usually this sense of self will be disproportionately diminutive, where the person experiences relentless shame, self-judgment, lack of self-worth, low confidence, and even self-hatred.
- A lack of individual identity or a constantly shifting identity, which manifests as having no idea who one is unless another person is around for validation. This leads to poor or nonexistent boundaries, or radical and often frequent shifts in goals, plans, feelings, opinions, and vocational choices.
- Irrational fear of being alone, even for short, pre-determined periods of time.
- A fear of abandonment that causes extreme reactions, including panic attacks, depression, illogical dramatic behavior, and rage if a needed person leaves. These reactions can happen with even perceived abandonment.
- Suicidal thoughts and behaviors. Approximately 80 percent of people with BPD experience suicidal thoughts, and on average 7 percent commit suicide.
- Non-suicidal but still self-harming actions, such as cutting, burning, head banging, hair pulling, or otherwise mutilating one’s body; impulsive actions like risky sexual behavior, drug use, and gambling; and putting one’s self in physically and emotionally dangerous situations.
- Wild, erratic mood swings with no obvious triggers, that sometimes include large emotional outbursts that can last for a few days.
- Intense and erratic relationships with loved ones, characterized by exaggerated and dichotomous distorted perceptions – the other person is thought of as either a savior or a villain.
- Severe dissociation, being out of touch with reality, or feeling separate from one’s body.
- Chronically feeling empty or bored, and that life has no meaning or purpose.
- Rage that has no obvious cause and cannot be controlled, and antagonistic behavior.
- Awareness of the destructiveness of one’s emotions and behaviors, but feeling powerless to control them.
Just as it takes a combination of factors to cause BPD and symptoms to diagnose it, treatment of BPD is a multi-faceted, and not yet perfected, art of patience and experimentation. A lot of progress has been made and many lives have been saved with a variety of cognitive therapies, but no one treatment method has yet proven 100 percent effective in all cases.
Borderline Personality Disorder In Your Life
In the home environment, BPD can be confusing and frightening. If a loved one is suffering from this ailment, it can seem like he or she is purposely trying to hurt you one moment and cannot give you any room to breathe in the next. You may feel emotionally or even physically unsafe, and yet also be told that this person cannot live without you. Some partners of people with BPD have had their lives threatened one day, only to have their ill partners tell them they will commit suicide if they leave the relationship on the next day. The stress and fear this kind of instability and distortion creates in a home environment only feeds the disorder and can stimulate even more erratic and fear based behavior.
At first, BPD in a loved one can look like just anger with no real cause, neediness, or unthoughtful behavior. You might think that person is depressed, or anxious, or not really connected to what is happening with the rest of your family. It helps to keep track of your loved one’s words and actions for a while, especially when things seem contradictory or way out of proportion with reality. If you notice a pattern of multiple symptoms of BPD, it is crucial that you talk to that person about getting help from a doctor or mental health provider. If your loved one is exhibiting behavior or saying words that indicate he or she is in danger of committing suicide or engaging in self-harming behavior, speak with a doctor or call your local emergency number.
How to Help a Loved One With Borderline Personality Disorder
While it is never our work to fix our loved ones, there is a lot you can do to support your partner or family member’s healing. The first and perhaps most important step is to encourage your loved one to get professional help.
After that, it is very supportive to maintain a loving space in your home. Care for and protect yourself as needed, but do your best to be compassionate, kind, patient, and connected. Provide simple reassurance of your presence and love, when it feels authentic to do so. Positive mirroring can be very helpful, making it a point to compliment and support your loved one’s work, art, spirituality, and inner beauty, to help that person feel loved and appreciated. Encourage your loved one in the things that bring that person joy, including creative acts, cultivating balanced friendships, and physical movement. Create as much stability as possible in the home, with regular schedules and a high degree of consistency.
As for treatments, so far cognitive behavioral therapy and especially dialectical behavior therapy (DBT) have proven to be the most effective. One study showed that DBT reduced suicide attempts in female patients 50 percent, and reduced the need to use emergency room and inpatient services. Studies have shown that including family members in a person’s treatment can make it even more effective. DBT-family skills training (DBT-FST), is a way to support your loved one while also receiving some support that you may need by living with that person. Even if you do not go with DBT-FST, couple’s or family counseling is a great way to support both you and your challenged loved one.
It is important that you avoid co-dependency, a dangerous consequence of many mental disorders. Family members can unintentionally worsen a person’s condition by enabling, shaming, or receiving power from a person’s illness. Notice and transform any ways that you might be worsening the situation, or receiving subconscious, negatively oriented pleasure from your loved one’s challenges.
Modeling and providing a healthy lifestyle that includes plenty of exercise and other stress-relieving activities, mindfulness, and a nutritious diet that is high in omega-3 fatty acids. One study showed that supplementing with omega-3 fatty acids may help reduce symptoms of aggression and depression.
In any of these instances, it is only truly supportive if the person wants to be helped. If your loved one is willing to recognize that he or she is challenged and commits to doing the work necessary to heal, then your unconditional love and support will be invaluable. But if that person is not willing to admit that something is wrong, or refuses to seek help and do the work necessary to create a healthy relationship and a healthy life, then there may come a time when you need to care for yourself and leave the situation, or protect the rest of your family from that person.
BPD is a debilitating disorder that robs people of joy, perspective, and the ability to healthfully and realistically relate with other people. Its exact causes are unknown, and there is no one surefire way to treat it. But successful treatment options do exist, and a loving home environment is an important part of the recovery process. Research suggests that once treatment is successful, relapse is quite rare. That means if your loved one commits to receiving the appropriate care, with your support it is possible that he or she can find love again on the other side of begin lost, and live a meaningful and healthy life.