The National Institute of Mental Health (NIMH) defines Borderline Personality Disorder as:
Borderline personality disorder (BPD) is a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image, and functioning. These experiences often result in impulsive actions and unstable relationships. A person with BPD may experience intense episodes of anger, depression, and anxiety that may last from only a few hours to days.(1)
As a spouse or family member of someone with BPD, not knowing how to react or respond to the emotional pain and seemingly abusive behavior between you and your loved one can feel hopeless and unbearable. This is why I advocate for mental health treatment that includes couples and family interventions whenever possible so that everyone involved is educated and on the same page. Often loved ones are left out of the healing process which makes getting better more complex and could take longer than necessary. In fact, there is evidence of improved treatment outcomes for BPD when loved ones are included in the treatment process. Because BPD causes an array of stormy relationship patterns, researchers like Dr. Alan Fruzzetti and Dr. Perry Hoffman have developed family-focused interventions based on their research as well as their significant professional expertise in counseling people with BPD and their loved ones. This program, The Family Connections Program(TM), is a format for effectively working with BPD and their loved ones. The nature of BPD tends to put the emotions of other family members on the backburner within the relationship. In my work with loved ones of those with BPD I begin with education of the disorder as well as skills to improve support as well as remind loved ones that their emotions need cared for as well.
#1 Become Educated About BPD. Many times individuals will come into therapy explaining they want to improve their relationship. After further discussion, it appears their partner may have an undiagnosed personality disorder. Behaviors such as mood swings, irritability, drug abuse, suicidal threats, inconsistency and low self esteem which appear to be wrecking the relationship. I encourage loved ones to begin reading resources like Stop Walking on Eggshells: Taking Your Life Back When Someone You Love Has Borderline Personality Disorder. This resource gives tons of examples of behaviors you can most likely relate to if your loved one actually has BPD.
#2 Identify BPD Behaviors. Once we have a basic understanding of BPD, it is important to begin identifying specific behaviors your partner engages in when they are not feeling well. This is because often, loved ones feel somehow responsible for the chaos and emotional pain that is in their home.
Together, we start to take a look at how BPD partners can unreasonably blame their loved one for their emotional pain or how they can use manipulation as a way to get what they want. It is important when living with someone with BPD that we can identify unhelpful emotional outbursts that can lead to sabotaging the relationship. During this stage, we just practice noticing, catching and identifying them either together if the partner is receiving treatment or just as a practice for loved ones. This makes it easier for loved ones to stop taking these behaviors personally or feeling responsible for their partner's emotional instability. All sessions remind loved ones that their BPD partner's emotional instability is not their fault.
#3 Provide Validation. Loved ones of those with BPD often describe feeling guilty for some things in the home. They also describe feeling as though their emotional wellbeing has been dismissed, neglected or abused. The third step in my work with loved ones of BPD is to validate their experience. This includes reminding them that (abusive behaviors aside) we are not responsible for the emotions of our loved ones. In this I mean, we have to allow all loved ones (BPD included) to have their emotional experiences. We must stop taking responsibility for how others feel.
You know what the airline stewardess says when we get ready to take off for a flight. She goes through a rant about how we need to put our own oxygen on first before we help a neighbor...well that's what we need to do with the loved who has BPD- first we must support ourselves emotionally.
The second part of validation begins after a loved one feels validated themselves, then we can begin learning to validate the emotions of our BPD partner. BPD is by nature extremely isolating and emotionally painful. More than anything, those with BPD want to feel connected, wanted and heard. In sessions we can learn to appropriately and compassionately support the emotional needs of our BPD partner.
#4 Set and Hold Boundaries. BPD is so emotionally painful that it can cause those experiencing it to fall into a pattern of sabotaging relationships through a pattern of over attachment and abandonment. This pendulum of emotional expression can be equally as painful on loved ones. Because of this, it is important to set clear boundaries for those with BPD. An example of this is to let the BPD loved one know when a behavior is unacceptable and to set consequences that make this clear, such as refraining from letting the BPD spend money irresponsibly or refusing to allow alcohol use in the home. Sometimes setting boundaries feel punitive, but in homes where someone has a personality disorder, maintaining strict, consistent boundaries can actually serve as a much needed support for their mental health and the health of supportive partners.
You Can Have a Healthy Loving Relationship with BPD
The most important thing to remember is that many people live happy, healthy lives with BPD. This included loving. supportive reciprocal relationships. There are so many resources out there to help you and your relationship thrive! Please touch base with me if you found this article helpful or need more information: firstname.lastname@example.org.
(1) National Institute of Mental Health. Borderline Personality Overview (2017) https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml