Borderline personality disorder (BPD) involves emotional instability, interpersonal difficulties and impulsive, often self-destructive, behaviors. People with BPD experience intense emotions and often distrust themselves and others, making relationships difficult for all involved.
The underlying cause for BPD is believed to be an unstable or fractured sense of self. Most often, but not always, this is related to early childhood trauma or abandonment. Not all people who experience trauma in childhood develop BPD, suggesting that BPD, like most mental disorders, results from a combination of biological, psychological and social factors.
The nature of BPD makes relationships intense and stressful. The family and friends of a person diagnosed with BPD usually have questions about how best to help. Support systems can play an important role in helping a person with BPD manage and reduce troubling symptoms. The following 9 strategies can help you support a person with BPD.
1. Learn about BPD.
The first step for family, friends and other support people who want to offer meaningful help is to learn about BPD. It is more likely you will respond to difficult behaviors in a helpful manner when the underlying cause for the behavior is understood.
For instance, it is common with BPD for normal daily frustrations to become serious relationship conflicts. However, these conflicts can be reduced or avoided depending on the response from others. As an example, most people faced with a cancelled lunch date will take that in stride and simply adjust their schedule. However, for a person with BPD, a cancelled lunch is more likely interpreted as rejection or abandonment, triggering an intense emotional reaction. Instead of simply adjusting their plans and rescheduling, a person with BPD may respond with anger and upset, refusing further engagement or demanding immediate contact.
A helpful response would be to recognize this reaction as a misinterpretation based on fear and to convey your wish to connect. Focus on rescheduling the date, rather than reacting to the negative or inappropriate behavior.
2. Show confidence and respect.
There is a significant association between BPD and early life trauma. Early childhood trauma diminishes a person’s sense of safety and control regarding themselves, others and the world. It is important that support people approach the relationship in a way that promotes trust and respect, which can be helpful and healing to a person with BPD. Although you may feel you know what is best, provide the person with BPD the opportunity to make decisions for themselves. Convey your confidence in their abilities and ask how you can help.
3. Be trustworthy.
Many people with BPD have a history of attachment problems, which creates a sense of fear and mistrust. As a support person, it is important for you to be consistent and honest. As much as possible, do what you say you will do. It’s okay and usually necessary to set limits ahead of time. Try to focus on what you can offer in terms of time and resources.
4. Manage conflict with attachment.
Attachment is about caring over the long term and riding out good and bad times together. Conflicts and disagreements are difficult for people with BPD, as they interpret these as signals of uncaring or relationship termination, generating feelings of anger and shame.
Support people can provide perspective and help the person with BPD recognize conflict as part of a healthy relationship. When a support person stays engaged despite difficulties, there is a sense of acceptance and attachment that can heal and create meaningful change in BPD.
Support people can help by calling or visiting after a conflict. Focus on the person, not the behavior, and demonstrate understanding and forgiveness. You can reject the behavior and still accept the person. People with BPD need to know that you haven’t given up on them.
5. Encourage Professional Help.
Individual and group therapy has been shown to reduce some of the more difficult symptoms of BPD, including relationship conflict and self harm behaviors. Mental health professionals can also assess for other mental disorders requiring treatment, such as anxiety and depression. Support people can provide information and assist with arranging appointments, if needed. Knowing help is available can create hope for people with BPD.
6. Identify strengths.
BPD can be understood as a self-identity problem. People with BPD are unsure of themselves and how they are viewed by others. Every person has strengths and abilities. Support people can help by identifying positive characteristics and specific abilities they have noticed. It is important that you are honest and can give examples of instances where he or she demonstrated these qualities. Be sure to note positive attempts to cope and changes in behavior.
7. Have fun together.
Healthy relationships and attachments flourish when people experience positive emotions and feel good together. One of the most helpful and healing things a support person can do is to suggest a healthy activity that is mutually enjoyable, such as a walk in nature, gardening, attending a concert or watching a funny movie. These self soothing activities done together benefit both the person with BPD and the support person, while developing a healthy attachment.
8. Take suicide seriously.
People with BPD are more at risk for suicide than the general population. If a person talks about ending their life or makes suicide gestures, it is important to ask if they are serious about killing themselves. Let the person know that if you are concerned for their safety, you will act, because you care. If in doubt, seek help through the crisis phone line or mental health services available in your local area.
9. Be self-aware.
Know your own limits and when the relationship is creating stress. All relationships bring demands and involve give and take. Supporting someone with BPD is more demanding than most relationships. Be self aware and honest when you need time out. Frame this as your own self care and part of a healthy relationship – not a rejection or criticism. Your own self acceptance and self care is a powerful model for the person you are supporting.
With consistent and appropriate support, the impact of BPD on the individual and their family and friends can be reduced. Developing your capacity to respond in a helpful way is one of the most meaningful things you can do for someone struggling with BPD.
Trainer, Crisis & Trauma Resource Institute Inc
© Crisis and Trauma Resource Institute