Dealing with Borderline Personality Disorder in the Family

When there’s a family member diagnosed with Borderline Personality Disorder, BPD, it can be frustrating, difficult, chaotic and distressing for all concerned. Often, family members are at a total loss when first attempting to deal with their loved one with BPD. But it doesn’t have to be this way. There are some effective ways to help gain perspective and learn how to more effectively deal with BPD in the family.

The National Education Alliance for Borderline Personality Disorder (NEA-BPD) has some valuable information that can help family members get a better handle on what BPD is all about. The Web site is easy to follow and provides a clear and easily-understood overview of BPD. Much of the following is a restatement of some of the family guidelines offered on the site.

On Goal-Setting

The natural tendency is for families to encourage their loved one with BPD by saying that they’ve made great progress or telling them that they can do it. What isn’t well understood, however, is that the individual in recovery or returning home from treatment for BPD is fearful of change and of being abandoned by those he loves simply because he is showing progress. In the mind of the person with BPD, progress somehow equates with abandonment.

Here’s the logic behind the fear. The patient has been making great strides during treatment, taking on more responsibility and doing so successfully. While this is a positive outcome, there’s also a downside. The individual may leave day treatment and begin to work, and show other signs of becoming independent. Family members may feel that they can relax their support, concern and protectiveness, thinking, perhaps, that their work is done.

Then, when relapse occurs, family members are confused and conflicted. How could this happen when everything was going so well, they ask themselves? The answer is that the fears and anxieties in the individual with BPD increase as they more and more fear they’ll be abandoned. They may not consciously make a decision to relapse, but it often happens nevertheless. Thus, they may resort to their old coping methods, such as drinking, cutting or other self-harm, missing work, a suicide attempt, or bout of bingeing and purging.

How can family members deal with goal-setting and their loved one’s fears of abandonment? Experts recommend not showing too much excitement when the loved one with BPD makes progress. This does seem to be counter-intuitive, but tempering enthusiasm over the patient’s progress is actually the best thing family members can do. Instead, use messages along the lines of this: “You’ve worked hard and your progress shows real effort.  I’m pleased that you were able to do it but I’m concerned (worried) that this all might be too stressful for you.”

On Lowering Expectations

With the BPD patient and his or her family, setting too many goals or goals that are too much may be just that – too many and too much. Naturally, the parents and family members of the patient with BPD want to encourage goal-setting that takes into account the person’s strengths, talents, interests, intelligence and ambition. But it’s important to remember that the BPD patient has severe emotional difficulties, especially when setting about working toward goals.

Maybe the loved one with BPD wants to go back to school, and the parents are supportive of this goal as well. This is a big step, and it’s fraught with difficulties, perceived ones as well as unperceived ones. For one thing, the loved one can soon become overwhelmed by the magnitude of the reality of being out on his or her own (if he or she moved away to go to school, for example). But again, the BPD individual’s intolerance of aloneness, dyscontrol and black and white thinking are at odds with such independence – too much, too soon. The result of doing too much too soon is often relapsing — which may return the individual to such a repressed state as to require hospitalization.

How should families deal with their loved one with BPD making too big of changes too soon? Try to slow things down. Lower expectations and set goals in smaller, more manageable steps. Then, work on having the individual with BPD work on one goal at a time, one step at a time. If two goals, such as returning to school and living independently, are something that both the BPD patient and his or her family want, it’s best to work on only one of these at a time.

Keep a Cool, Calm Home Environment

It may be exceedingly difficult to do, but what the individual with BPD needs more than anything else is to live in a cool, calm home environment. This is where family members come in – and it’s not an easy task, by any means.

Since the loved one with BPD is emotionally handicapped, he or she is often unable to deal with or tolerate stress in relationships. Rejection, criticism and disagreements in the home can precipitate a relapse. Every day, the person with BPD is struggling with three handicaps: affect dyscontrol, black and white thinking and intolerance of aloneness.

How family members can help is to slow down when there’s a crisis instead of reacting with great emotion. Communicate in a calm manner and communicate when you are calm. Address any conflict in a cool, but direct, manner and avoid the use of any put-downs.

The Importance of Routines

When one individual in the family has BPD, there’s a great tendency to withdraw from normal activities, to sort of shut the family off from outside activities and friends. But, just the opposite is what’s recommended by experts.

To the extent possible, family members should stick to their routines. It’s important to maintain contact with friends and family and to have a good time. When people are relaxed after having a good time, it’s a lot easier to approach any problems and situations that need attending to at home.

Schedule Time to Chat

If the only time that family members talk is during conflict relative to a loved one’s BPD, that’s not conducive to a calm and cool home environment. It’s a set-up for conditioning. The person with BPD begins to fear family discussions, believing that it’s all about conflict and negativity. He or she experiences a lowered sense of self.

Remember that your loved one with BPD probably spends an inordinate amount of time going to various therapy sessions, doing things related to his or her recovery. As a result, your loved one is missing out on some opportunities to enjoy a number of talents and interests. Not only that, but he or she misses out on family bonding time, conversations about everyday life and movies and pets and special occasions that are the glue that makes family life so special.

How can family members step up casual discussions unrelated to the loved one’s BPD? One way is to schedule times to talk. This could be as simple as making it a rule that the family will eat dinner together four or five days a week and that during the meal, there are no discussions allowed about problems or conflicts of any kind. Try to intersperse conversations with humor whenever possible, as this lightens any tension that may be lingering.

Don’t worry. After a little while of “scheduling” talk time, it will no longer seem so difficult. It will become second-nature to you and other members of the family. And your loved one with BPD will be the better for it.

On Handling Crises

Part of the problem for people with BPD is that they have a great deal of anger. Often, they lash out in a fit of rage and say things that hurt their family members. Remember that people with BPD aren’t able to control their emotions like others without BPD. Experts recommend that family members listen to their loved ones with BPD but remain calm. Do not go on the defensive, even if what’s being said to you hurts. If you attempt to defend yourself, this just fuels the person with BPD’s rage. It’s much better to remain calm in order to give the situation time to defuse. Just listen, but don’t argue.

This does not, however, mean that you can afford to ignore self-destructive acts or threats by the person with BPD. Action does need to be taken to deal with such situations. While it’s important to respect the privacy of your loved one with BPD, it may be necessary for you to contact his or her therapist or call an ambulance for emergency medical assistance. Use your best judgment during dangerous circumstances but always keep in mind that your loved one’s safety comes first.

It’s also important that family members learn how to listen. The person with BPD needs to have his or her negative feelings heard. Never try to “make the bad feelings go away” by saying it isn’t true. Some of the best advice is to allow the situation to cool off by listening without arguing. Look interested and concerned and maybe ask a couple of clarifying questions such as, “How long have you felt this way?” or “What happened to trigger your feelings?” This shows that you’re listening but it doesn’t imply agreement. Another way is to make statements expressing what you believe you heard. This shows the person with BPD that you are listening but, again, it does not imply agreement.

By being able to be heard when voicing their negative emotions, it helps the person with BPD to feel less alone and afraid. If family members listen to their expression of feelings, the loved one with BPD is less likely to feel the need to act out on their feelings in order to get the message across.

How to Best Address Problems

There are three constants in addressing problems with the person with BPD. These include the following:

  • Always involve the family member in identifying what needs to be done
  • Ask whether the person can “do” what’s needed in the situation
  • Ask whether they want you to help them “do” what is needed

What’s important here is that when there’s a problem in the family, especially with the person with BPD, open discussion is necessary. Make sure everyone in the family is part of the discussion. Why? People who are asked to participate and offer their views on the solution feel more valued by it – and are more likely to do their part.

Of course, it’s also necessary to ask each person if they feel they are able to do the steps the planned solution calls for. By asking them this question, you are recognizing that the task may be difficult for them. This is in line with acknowledging how difficult it is to change.

Another point about addressing problems with the person who has BPD is to always act before stepping in to help. While you may be sorely tempted to just make things better by helping, if you don’t ask first, your help may be resented.

Set Appropriate Limits

It may seem impossible to family members dealing with a loved one with BPD, but it’s important to set appropriate limits. You need to let your loved one with BPD know in clear and certain terms what you expect. Everyone in the family – including the person with BPD – needs to know what is expected of them. But when dealing with the loved one with BPD, make statements about your expectations without any threats attached to them. For example, say to your loved one with BPD, “I want you to take a shower at least every other day.” This lets him or her know your expectation and puts the responsibility for the action on your loved one.

Don’t protect family members from the consequences of their actions. Even though people with BPD can engage in harmful, costly and destructive behaviors and it’s natural for family members to go to great lengths to give in to the person’s wishes, make the bad things go away, or ignore the consequences, this is not good for the person with BPD. First of all, the behavior is likely to persist, since there’s no accountability and the person has gotten a reward (gotten away with it). Second, other family members begin to feel resentment over what they’ve sacrificed – money, integrity, good will – in their efforts to protect their loved one with BPD. Tensions build up, even though the intent was to defuse them. Third, the loved one with BPD may start to display these behaviors outside the home, in places and at times where he or she could face greater harm or loss than at home. Setting limits and choices when your loved one with BPD is making unwise choices or engaging in destructive behavior is necessary. It’s also important to remember that while setting limits may be one of the most difficult things parents have to do, it’s not parents’ job to spare children with BPD these feelings but to teach them to live with such feelings as everyone has to do.

Never tolerate abusive treatment such as tantrums, threats, spitting or hitting. When this occurs, walk away and return later to discuss the issue when the air has cooled and both you and your loved one with BPD are calm. If the situation is a crisis, call an ambulance if you feel the circumstances warrant it. Safety should be your first concern, far outweighing any privacy concerns. And, if you don’t get proper medical attention for violent and out-of-control behavior on the part of your loved one with BPD, it will only lead to further escalation. Acting out is a cry for help that, if not heard, will get even louder.

Be extremely cautious about issuing ultimatums or making threats. Experts recommend that you only use them as an absolute last resort. And you need to be prepared to follow through on them if you do use them, but only go this route if professionals have h2ly advised that you utilize this option.

Being Patient and Seeking Support

Finally, dealing with a loved one with BPD is a long-term journey. In order to maintain your own sanity and that of other family members, enlist the support of groups that share in your situation of dealing with a loved one with BPD. Recognize that you need patience and understanding as well as a sense of humor, outside friends and activities, in order to keep yourself on an even keel in the days and months ahead.

Taking the time to enrich your spirituality may also help. You are never truly alone if you ask for assistance from your Higher Power, or the God as you may know Him. If you’re not religious, per se, try to ease your tensions and achieve balance by engaging in meditation or yoga or some other relaxing and healing activity.

On July 25th, 2011, posted in: Mental Health by Tags: ,