More and more, people are coming to talk to me about a spouse or a loved one who is suffering from a personality disorder, usually borderline personality disorder (BPD). If someone you love has been diagnosed with BPD, or if you suspect that they may be suffering from BPD, this page is for you!
I have tremendous sympathy for the people who live with BPD and for their family members. Family members typically describe feeling "crazy, out of control, manipulated, portrayed as the angel or the devil, constantly unstable, and never knowing what to expect." Living with these feelings destroys relationships, friendships, self esteem, joy and so much more.
Spouses pay a particularly high price for a relationship with a bordeline person; children of BPD also suffer profoundly. If you are a spouse or a child of someone with BPD, hang in there. We know a lot more about how to treat folks with BPD now and there are amazing treatments that WILL help.
The purpose of this post is to give help and resources to people who love and live with someone who has borderline personality disorder. Before I talk about that, I'd like to acknowledge two very important things....
The first is that people who have BPD suffer tremendously. They are not "evil, bad people" who want to hurt you; they are disabled and the world is a very painful place for them. We have to be sympathetic to their struggle; life is really very challenging for people with a personality disorder.
The second thing I'd like to acknowledge is that much of the content on this page comes from Dr. Gregory Lester, who is a personality disorder expert. I was very lucky to be trained personally by Dr. Lester and his contributions to my understanding of personality disorders are tremendous.
What is a personality disorder?
In our "normal" lives, we are able to be flexible when faced with a problem. We look at the problem, try to understand it, adapt to the environment, and try a variety of techniques to solve the problem. Healthy, "normal" people do this well: we are flexible and adaptable and solution-oriented. People with a personality disorder do not do this at all. PD people create drama instead of solving the problem. The purpose of the drama is to protect their ego, validate their identity, distract from their deficiencies, justify their misbehavior, and avoid a feeling of emptiness. This sounds harsh, but this is really what we believe is happening.
So, are PD people bad, defective monsters we should lock away somewhere? No, not necessarily. Some PD people are very dangerous and very unhealthy, but not all are. The very best thing we can do is to study people with personality disorders so that we can understand them and help them. It's also important for you to know that personality disorders are EXTREMELY common. We estimate that 1.6% of people in the general population have borderline personality disorder, some studies report that the prevalence is as high as 5.5%. We believe that 10% of people in therapy probably suffer from borderline PD, as many as 20% who are in a psychiatric treatment center have BPD.
What are the core characteristics of someone with borderline personality disorder?
- The fundamental pattern that BPD people have is a love-hate pattern: they love you one minute, hate you the next.
- They view others as either angels or devils, they feel the world is rejecting and hurtful.
- They view themselves as vulnerable and worthless.
- They deal with the world by emotionally justifying their misbehavior.
- You will see an ongoing pattern on instability in their lives: their moods are not stable, their relationships are not stable, their self-image is not stable.
- They lack the ability to be consistent and keep things in proportion.
- They always see things as black and white. There are no "gray areas" in their lives or in the problems they face.
How is borderline personality disorder diagnosed?
A diagnosis of a BPD should always be made by a trained clinician, therapist, or physician. I'm sharing the diagnostic criteria below because I would like you to be a look-out. If you see these behaviors in someone you love, please help them get help.
- Frantic, extreme efforts to avoid being abandoned. The abandonment can be real (i.e., you will divorce them) or imagined (i.e., they feel you're about to leave them).
- Unstable, intense interpersonal relationships that alternate between over-idealization (i.e., they think you're perfect) and devaluation (i.e., they think you're horrible).
- Identity disturbance (i.e., their view of themselves doesn't match reality).
- Impulsivity in two or more of the following areas: spending, sex, substance use, shoplifting, reckless driving, binge eating.
- Recurrent suicidal behavior (including gestures, threats, and attempts) and/or self-mutilation (cutting).
- Unstable moods. Dramatic shifts from typical mood to depressed, irritable or anxious. Mood rarely last more than a few hours, on occasion, moods last days.
- Chronic feelings of emptiness.
- Inappropriate, intense anger or rage.
- Stress-related, temporary paranoia (where they may have very bizarre ideas).
Someone needs to meet 5 out of these 9 characteristics to be diagnosed with Borderline Personality Disorder. The more of these characteristics they have, the harder their life is (and the higher their risk for self-harm).
How do borderlines typically behave?
- They are prone to exaggerating everything. Things that are slightly bad become horrors, a small injustice is an acute crisis.
- They frequently have verbal outbursts. They become rageful and extremely hurtful.
- They over-react to everything. There is no "gray area", things are perfect/good or the worst thing ever.
- They say things that are not true. We don't know if this is actual lying or if they're just trying to provoke a reaction.
- They also often have sleep disturbances, where they may be insomniacs, sleep too much, have terrible nightmares or other sleep problems.
How do most of us feel when we encounter someone with BPD?
Those of us without a personality disorder typically find borderlines to be:
- Unreasonable
- Hostile, while being dependent on us
- Intense
- Dramatic
- Threatening
- In chronic emotional pain
- Manipulative
- Black/White thinkers
- Rageful
- Spiteful
- Vicious, sharp-tongued
- Never apologizing
- Inconsistent, impulsive
- Overly moody and intense
- Thin-skinned
- Seeing people as angels or devils
- Intolerant of separation and intimacy
- Depressed
- Agitated
- Stormy or violent relationships
- Desperate to avoid abandonment
How do average people typically react to someone with borderline PD:
- Anger. We are angry and confused by their unstable and mean behavior.
- Fear. We don't know what they'll do next, what we'll see when we walk in the door, we are afraid of them.
- Placating. We constantly have to do things to pacify them, make peace or make them happy.
- Distancing. We want to keep our distance because they scare us and hurt us.
- Exasperation. We keep waiting for them to "get it" and they never do and we are frustrated by this!
- Sorry feelings. We feel sorry for them, they typically have few friends and many problems.
- Approval seeking. We keep thinking that if we're good enough to them, they'll see we're really on their side and they'll stop being nasty to us. Unfortunately, this never happens. We feel "damned if we do, damned if we don't" in our interactions with them.
- At first, we feel charmed by them and enamored with them. Over time, we feel angry, beaten down, and confused. We can't understand how "they don't get it."
What kind of drama do borderlines act out and why do they do it?
There are dozens of books on this and if you'd like to know more, please see the reading list at the end of this article.
In a nutshell, borderlines like to switch between three roles in their relationships: victim, persecutor, and hero.
Sometimes they are the victim, saying things like "I never get a fair deal!" or "I have been so mistreated!". They feel better by causing chaos, so they maintain chaos by switching into persecutor mode, saying things like "I'll get you for mistreating me!" By saying this, they put you into defensive mode and it gives them great power. This power soothes them.
To keep the power, they have to keep the drama going, so they do. It's truly very, very sad. Sometimes they go into hero (rescuer) mode, where they say things like, "Ugh, it will be us against those bad people who hurt you, I'll protect you!" We see this as them being loving and protective, but it's not really, it's another way to get power.
How do professionals treat and manage people with borderline personality disorder?
It's very important that you not try to fix or heal someone with BPD. To do so is hard, painful, and dangerous. You need to let a professional do this. In fact, helping these folks is so challenging that most therapists won't even try. Again, it's hard and dangerous.
There's a list of a few folks at the end of this article that do specialize in caring for people with PD and I encourage (ok, I insist!) you call them for help. While you can't fix them, you can manage them and learn effective ways to cope with them.
How to cope and set boundaries with a BPD person:
- Be consistent and firm with them. There should be clear limits, boundaries and consequences. For example, you can say, "Mom, when you go into rage mode, I am going to leave for an hour and then I will come back."
- When they behave appropriately, they get a reward. That reward can be that you will spend time with them. When they act badly, you go away. For example, "Honey, I will stay and work on this project with you as long as you stay calm and do not start threatening me."
- Do not give in to their bad behavior. When they are not getting what they want, their bad behavior will increase! Hang in there, it will get better, but you have to wait them out. Of course if you are ever in danger, call 911. Never put yourself in a dangerous situation.
- Validate the existence of their feelings, but not the accuracy of their feelings. For example, you might say, "I see you are so uncomfortable and so hurt." Don't go on to say, "Of course you are, those guys were jerks." This will only make their feelings more intense.
- Point out alternatives to their black and white thinking, show them the gray areas.
- Point out practical, immediate things they can do to change their mood, (i.e., go for a walk, take a bath).
- Model how to think logically, talk out loud about how you solve a problem.
- Most important: don't support their drama patterns. When they go into a pattern, stop, express a clear boundary, and leave if they are violating your boundary/rule/code of conduct.
The SET Method - from E. Johnston, LCSW
Following the support, empathy and truth (SET) method can also help.The SET method allows you to honestly address your loved one's demands, assertions or feelings, while still maintaining appropriate boundaries. Because each step builds on the last, it is important to do these steps in order.
Support
Support refers to an initial statement which indicates that you support the person with BPD. It is a statement that begins with "I" and demonstrates concern and a desire to help. It can be anything that establishes a foundation for the relationship or interaction: "I want to try to help you feel better," "I care about you" or "I am worried about how you are feeling."
Empathy
Empathy refers to communicating that you understand what the other individual is feeling and focuses on "you." It is not a conveyance of pity or sympathy, but instead a true awareness and validation of the feelings of the other person, such as, "I see you are angry, and I understand how you can get mad at me," or "How frustrating this must be for you."
It is important not to tell the BP how she is feeling, but instead, put her demonstrated feelings into words. The goal is to convey a clear understanding of the uncomfortable feelings she is having and that they are OK to have, reassuring her. Without a statement of empathy, she may feel that her feelings are not understood. It is important to use feeling words, as in the examples above.
Truth
Truth refers to a realistic and honest assessment of the situation and the other person's role in solving the problem. It is an objective statement that focuses on the "it", not on the subjective experience of the either you or her. She may seem to be asking or demanding something impossible, not taking an active role or responsibility in resolving the issue or even presenting you with a "no-win" situation. The truth statement is meant to clearly and honestly respond to her demand or behavior while placing responsibility where it belongs. Examples include,"This is what I can do…," "This is what will happen…" and "Remember when this happened before and how you felt so bad about it later."
It is important to use the support and empathy statements first so that she is better able to hear what you are saying, otherwise, the truth statement may be experienced as another rejection, creating even more, defensiveness or anger.
I sincerely hope this article has helped deepen your understanding of BPD. Here are some additional resources for more help and information...
Books:
Sometimes I Act Crazy: Living with Borderline Personality Disorder by Jerold J. Kreisman and Hal Straus
I Hate You--Don't Leave Me: Understanding the Borderline Personality by Jerold J. Kreisman and Hal Straus
Understanding and Treating Borderline Personality Disorder: A Guide for Professionals and Families by John G. Gunderson and Perry D. Hoffman
Fatal Flaws: Navigating Destructive Relationships with People with Disorders... by Stuart C. Yudofsky
Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder by Paul Mason MS and Randi Kreger
Personality Disorder Specialists in Southern California:
Michael H Foust, Ph.D.
540 Golden Circle Dr
Suite 211
Santa Ana, CA 92705
Phone: 714.834.9222
E-mail: michael@drfoust.net
Website: http://www.drfoust.net
Cynthia Skale, LCSW
24445 Hawthorne Blvd.
Suite 105
Torrance, CA 90505
Phone: 310.283.9027
E-mail: cynthiaskalelcsw@yahoo.com
Daniel A Kupper, Ph.D.
Borderline Personality Disorder Initiative, UCLA, Dept of Psychiatry
1917-1/2 Westwood Blvd.
Suite 2
Los Angeles, CA 90025
Phone: 310.441.5537
E-mail: daniel.kupper@roadrunner.com