Understanding What Borderline Personality Disorder is/Isn’t
Borderline Personality Disorder (BPD) is a mental disorder characterized by extreme mood swings, trouble with interpersonal relationships, a tendency toward impulsivity, intense fear of abandonment, and an unstable self-image.
BPD is most common in females ages 18 to 27 years old and can diminish with age. The main feature is a pervasive pattern of instability of interpersonal relationships, self-image, marked by impulsivity.
BPD is not a multiple personality disorder, although at times it may seem that way as people with BPD tend to flip the script very quickly. One second, they may be happy and the next second there may be a huge emotional change.
Signs and Symptoms
For a confirmed diagnosis, seek out a medical doctor, psychotherapist, or psychologist. Though the following key factors are usually an indicator BPD is present in your partner:
- Intense fear of rejection, separation, or abandonment
- Rapid changes between thinking someone is perfect to believing they are evil
- Risky behaviors including unsafe sex, gambling, drug use, or accumulating credit card debt
- Polydrug use is often common in individuals with BPD as well as the use of sedatives, hypnotics, and alcohol as a means of self-medicating.
- Threats of suicide or self-harm
- Difficulty empathizing with other people
- Mood swings from euphoria to intense shame or self-criticism
- Frequently losing one’s temper
One of the most prominent features of people with BPD is instability. Their relationships with others are likely to be unstable. They will one day report how wonderful a person is and then the next day have expressions of extreme and intense anger, disapproval, condemnation and even hate towards that same person a week later. Then a month later the person with BPD is once again singing praises of that same person. These reactions can be unsettling for a partner, though remaining compassionate and understanding in your point of view can aid you in your communication with your partner with BPD.
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Where Does It Come From?
The development of BPD does not point to one clear cause but to many complex causes. Researchers believe the disorder to have genetic, biological, and environmental factors. Clinical theorists have suggested that disturbed attachments are central to (BPD) psychopathology and trend is early childhood trauma and/or neglect.
How Do I Respond? How Do I Help?
Progress for individuals with BPD can be slow. Be realistic in your expectations of your partner. Remembering individuals with BPD have often displayed maladaptive behaviors as means of survival.
A partner with BPD needs safety as an anchor as they always have massive fear of abandonment and rejection and often this is where it stems from. Most Individuals with BPD tend to be limited in their ability to receive, accept, or benefit from corrective feedback.
- Safety is Important for your partner!!!
- It is important to be understanding and patient and to know that while moods and feelings can be intense, they are not intended to be manipulative or destructive even if it may seem that way. Studies have shown that borderline personality disorder hinders a person’s ability to process negative emotions properly, and many turn this internally into anger and self-loathing.
- If your loved one suffers from BPD, it is important to realize that they will have an intense fear of being rejected and abandoned, so much so that if you’re five minutes late or tell them of an upcoming vacation, it may be a trigger for their anger and withdrawal. While it may seem counterintuitive, one of the best ways to communicate with someone suffering from BPD may be to acknowledge their feelings before the facts of the situation. BPD causes intense moods and mood swings, and sufferers have trouble regulating their emotions. By verifying their feelings first, you may be able to diffuse a possible volatile situation.
- It is also important to avoid giving in to a BPD person’s impulsive acts. While there are extreme lows associated with BPD, there are also extreme highs, and it can be easy to get sucked in. Be careful and understand these highs are also a symptom and can plummet to a low very quickly. Here are a few basic pointers for communicating with someone with borderline personality disorder in a healthy and productive way:
- Be patient.
- Be realistic.
- Try to separate facts from feelings.
- Validate feelings first.
- Listen actively and be sympathetic.
- Seek to distract when emotions rise.
- Do not allow yourself to be the product of the intense anger; attempt to diffuse it but sometimes you may have to walk away.
- Understand the symptoms and triggers.
- Offer constructive criticism.
- Help to set realistic goals.
- Keep schedules consistent.
- Encourage treatment.
- Attend therapy together.
Keep your word and be honest. It is easy to go along with a tangent or rage about how awful someone or something is, but it is important to offer honest feedback since they may not even realize how their behavior is affecting others
- In a crisis:
- Remember your loved one with BPD has difficulties with understanding a different person’s perspective. Take time to listen instead of reacting, try not to take it personally, acknowledge their point of view a suggest a way I which improvement can be made. If the escalation persists you may need to walk away.
- What if they threaten to hurt themselves?
- Self-harm is a common behavior. It can be less overt like skin scratching, or eating less, isolation or withdraw. It can be more serious such as threats of suicide. Talk to your partner about their emotions and allow yourself to assess the situation if professional assistance is necessary. All threats of suicide should be taken seriously even if it appears attention seeking. Calling 9-1-1 may not always be what they need. Ask your partner if they would like to speak to their therapist or call a hotline.
- How can I reduce conflict?
- Listening and reflecting is the most effective strategy. It doesn’t always mean you agree, but shows you are listening. Refrain from defensiveness and criticism, it always ends in a perpetuating argument.
It is vital to have your own support since you may not be able to be provided with empathy and the emotional support you would like from your partner with BPD when they are engaging in maladaptive behavior, cognitions, and emotions. Carve out time to be with friends, engage in your own mental health care with a professional, and tend to your self-care and hobbies.
Treatment
- Individual and Group Psychotherapy
- Dialectical Behavior Therapy (DBT) – Dialectical behavior therapy is an evidence-based psychotherapy that began with efforts to treat borderline personality disorder. There is evidence that DBT can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm, and substance abuse. Four key elements are focused on in DBT, and they are as follows:
- Mindfulness, which focuses on improving the ability to accept and be present within the moment
- Distress tolerance: this is geared towards increasing the tolerance for negative emotion, rather than trying to escape this
- Emotional regulation: a means and strategy used to manage and change the emotions that are super intense and creating a problem in a person’s life
- Interpersonal effectiveness: techniques that allow someone to communicate with others in a way that’s assertive, allows for self-respect to be maintained, and strengthen the relationship of a person
- Cognitive Behavior Therapy (CBT) – This type of therapy can help people with borderline personality disorder identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others, and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
- Family or Couples Therapy
- Dialectical Behavior Therapy (DBT) – Dialectical behavior therapy is an evidence-based psychotherapy that began with efforts to treat borderline personality disorder. There is evidence that DBT can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm, and substance abuse. Four key elements are focused on in DBT, and they are as follows:
- Psychotropic Medication
- Clinical Facility Based Treatment – There are different levels of care offered at treatment facilities for varying medical necessity. These levels of care are often covered by most insurance companies. Encourage your loved one to speak to professionals to gain a higher understanding and education on the levels of care and what appropriate facilitates would meet their personal needs, symptoms and/or diagnosis. Listed from most intense to least intense levels:
- Inpatient Hospitalization – this is the highest level of containment. Inpatient hospitalization may be done at a voluntary or involuntary basis and is for individuals who are in imminent danger to themselves or others, presenting a significant risk. The focus of treatment at this level is short-term stabilization and safety.
- Residential (RTC) – This program provides 24/7 monitoring in which the individual lives on site. This level of care is for individuals who are significantly impacted by their symptoms and display adaptive living skill deficits preventing them from accessing treatment from their home.
- Partial Hospitalization Program (PHP) or “Day Treatment” – This program provides care five days a week for six to eight hours per day. This level includes group and individual sessions with psychiatric care. Participation in the program does not include housing though some facilities may provide supportive housing with an out-of-pocket cost if needed.
- Intensive Outpatient Program (IOP) – IOP can be provided at three or five days a week for at least three hours a day. The program will focus on group sessions for the individual to gain skills to manage their symptoms. This level of care may include individual therapy and psychiatry for medication management.
- Outpatient (OP) – At this level, individuals are engaging in psychiatry and therapy and few times per month or once a week depending on their presentation and symptoms.
