By: Kaitlin P. Ward, LCSW.
In 2008, the U.S. House of Representatives declared the month of May as Borderline Personality Disorder (BPD) awareness month. Nearly 6% of adults will meet diagnostic criteria for BPD at one point in their life. Unfortunately, BPD is one of the most stigmatized and misunderstood mental health diagnoses. Individuals living with BPD, as well as those with loved ones who have been diagnosed with BPD, need emotional support and empathy. This article will provide an overview of BPD symptoms, discuss BPD treatments, and provide tips for individuals who desire to support someone living with BPD.
The most salient features of BPD are patterns of intense, yet unstable interpersonal relationships and an inconsistent self-image. Underneath these areas of instability lie deep feelings of self-blame and self-hatred. These symptoms make it difficult for individuals with BPD to develop a stable relationship with themselves and others. However, BPD also involves other symptoms that hinder the development of healthy relationships.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BPD includes five or more of the following symptoms:
- Frantic efforts to avoid abandonment. According to the National Institute of Mental Health, examples of such efforts may include quickly initiating emotionally or physically intimate relationships or cutting off communication with someone in anticipation of abandonment. Research suggests that these efforts to avoid abandonment typically result in the loss of the very relationships that individuals with BPD were afraid of losing.
- A pattern of intense and unstable relationships. Relationships will suddenly shift from extreme closeness and adoration (idealization) to extreme resentment or aversion (devaluation). This shift in how individuals are viewed can be referred to as “splitting.”
- An unstable sense of self. This may manifest itself by a person’s opinions, goals, or behaviors frequently changing. Alternatively, a person may mirror the personality traits of others due to their struggle to maintain an independent identity.
- A pattern of impulsivity. Broadly, impulsive behaviors include actions that are taken without a proper level of planning and are inappropriate to the situation. Impulsive behaviors may include substance abuse, binge eating, overspending, reckless driving, constantly “starting anew,” and abrupt life changes or decisions.
- Recurrent suicidality. Research suggests that suicidal threats and crises are common among individuals with BPD, even among those who have never attempted suicide or engaged in self-harming behavior.
- Changing moods. Individuals with BPD can experience intense emotional episodes that last from a few hours to a few days. These mood swings may include general unhappiness, anxiety, irritability, and depression.
- Persistent feelings of emptiness. Emptiness typically involves a sense of feeling disconnected from oneself and others. These feelings may be experienced as aloneness, numbness, isolation, or meaninglessness.
- Inappropriate anger. The term “inappropriate” means that the level of anger is more intense than the situation warrants. Research suggests that such anger is typically triggered by a caregiver or loved one being perceived as abandoning or neglectful.
- Dissociation or paranoia when stressed. When feeling overwhelmed, individuals with BPD may feel as if they are outside of their body (dissociation). They may also feel paranoid, meaning that they do not trust other people’s intentions or feel conspired against.
BPD Diagnosis and Treatment
To be diagnosed with BPD, an individual needs to be evaluated by a licensed mental health professional, such as a psychologist, psychiatrist, clinical mental health counselor, or clinical social worker. Because BPD tends to strongly affect interpersonal relationships, the professional can benefit from receiving information about the client from family members, friends, and loved ones. Research suggests that individuals who are diagnosed with BPD are also more likely to be diagnosed with other mental health conditions, such as anxiety, depression, and eating disorders.
While there are numerous treatment options for BPD, research suggests that Dialectical Behavior Therapy (DBT) is one of the most effective forms of BPD treatment. Below are some areas of intervention that DBT therapists might focus on when treating BPD.
Emotional Vulnerability: Individuals with BPD tend to have high emotional vulnerability, meaning they are highly sensitive, experience emotions in a very strong way, and have difficultly returning their emotions to a manageable level. The therapist will help the client to gain an awareness of these emotional shifts and help them to experience difficult emotions without withdrawing from a situation.
Self-Invalidation: Individuals with BPD tend to mistrust their own perceptions and emotional states; therefore, they heavily rely on others. Some people with BPD state they feel the need to continually scan their environment for clues about how they should think, feel, and behave. This reliance on others tends to result in a poor sense of self, where the individual feels intense shame and self-hatred. The therapist can help the client work through their feelings of shame to develop a more consistent sense of self.
Unrelenting Crises: Studies have shown that individuals with BPD sometimes experience their lives as a series of “unrelenting crises.” The individual may feel they are constantly facing problems that need to be solved quickly. Unfortunately, these perceived crises tend to result in impulsive actions, which then create new crises. The therapist will help the client to tolerate difficult emotions in a perceived crisis, teach problem-solving skills that helps the client to slow down and avoid impulsive decision-making, and respond to problems with self-confidence.
Invalidating Environments: Research suggests that maladaptive patterns are created by a person’s BPD symptoms interacting with their environment. For example, individuals with BPD tend to receive the most emotional and material support when engaging in extreme dysfunctional behavior, which inadvertently reinforces that behavior. The therapist can help the client to find validating environments that are not dependent on emotional or behavioral dysregulation.
Supporting Someone Diagnosed with BPD
BPD symptoms are not just challenging for the person experiencing them. Family members and loved ones of individuals with BPD frequently report feeling overwhelmed, distressed, and helpless. Below are some ways to support individuals struggling with BPD.
Encourage and support therapeutic treatment: Encourage your loved one to seek out professional help. You can encourage this by dismantling the stigma associated with getting help—in other words, communicate that getting professional support is not a sign of weakness or failure, but is courageous and admirable. You can let them know that you desire to have a strong relationship with them and that getting help will allow you to grow closer together.
Seek out therapeutic treatment for yourself: Finding a therapist can help you process your own emotions and help you understand how to interact effectively with your loved one who has BPD symptoms. If you are feeling frustrated and overwhelmed by your loved one’s BPD symptoms, it will be difficult for you to respond to your loved one in a consistent and calm manner. A therapist will be able to help you regulate your own emotions so that you can provide a safe space for others.
Set and maintain healthy boundaries: Research suggests that extreme reactions tend to perpetuate extreme behaviors in a loved one with BPD. This means that responding to a crisis with too much support (financially, emotionally, or otherwise) or too little support will likely result in greater family dysfunction. Setting and enforcing limits along with defining acceptable behavior will help both of you to feel respected.
Use healthy communication tools: When your loved one with BPD is displaying emotional vulnerability, you can validate their emotions and help them feel heard. Remember: you don’t have to agree with what your loved one is saying to validate them. Try to identify what emotions your loved one is feeling, and validate how difficult it is to experience strong emotions. Instead of trying to argue or “fixing” the situation, simply give your loved one a safe space to talk about their feelings.
Remember to be gentle with yourself and your loved one. As you support yourself and your loved one with BPD treatment, you will learn how to break dysfunctional patterns, how to strengthen and maintain a healthy relationship, and how to connect and enjoy each other’s presence beyond the BPD symptoms.