When a loved one has Borderline Personality Disorder it can affect everyone: children, spouses, extended family, friends and coworkers.
What is Borderline Personality Disorder?
So what exactly is Borderline Personality Disorder and how do we know if our loved one is affected by it? The Diagnostic and Statistical Manual-5 (DSM5) defines Borderline Personality Disorder as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts.” (American Psychiatric Association, 2013). Individuals with Borderline Personality Disorder often have wildly unstable relationships and lives marked by sometimes dangerous and risky behavior. Recent research on prevalence rates in the United States indicates that 1.6% of the population of the United States, or roughly over 4 million people are affected by it. Women are diagnosed with it three times more often than men although the reasons remain unclear.
A diagnosis of Borderline Personality Disorder also come with an increased risk of suicidality with at least 70% of those diagnosed attempting suicide. Of these attempts, roughly 10% will be successful in their attempts. The rate of completed suicides among individuals with Borderline Personality Disorder is more than 50 times higher than that of the general population.
What are the signs of Borderline Personality Disorder?
According to the DSM5, when an individual exhibits five or more of the following symptoms consistently across time and a variety of environments they meet the diagnostic criteria for Borderline Personality Disorder:
1. Distressed efforts to keep away from true or imagined abandonment
Individuals with Borderline Personality Disorder have an intense fear of being alone and will go to great lengths to avoid being alone. Minor gaffes or misunderstandings may be viewed as perceived attempts at abandonment and cause them to become frantic and irrational. They will require constant reassurance from others and may have issues with trust in romantic or close relationships, often becoming jealous over perceived slights. This may translate into extreme clinginess to partners.
2. A form of unstable and extreme interpersonal relations described as alternating between extremes of devaluation and idealization
Often individuals with Borderline Personality Disorder have relationships that vacillate wildly between love and hate. They demonstrate instability in relationships and struggle to maintain healthy relationships. One day they will idealize you and you’re the best thing that ever happened to them-they cannot live without you. The next day they will devalue you and want nothing to do with you. They develop intense attachments to new people quickly and lack personal boundaries.
3. Identity disturbance: significantly and relentlessly unstable self-image
They may experience extreme highs and extreme lows that will lead them to believe they can do anything, even things that are literally impossible. This may lead them to exhibit manic behaviors followed by periods of extreme self-loathing.
4. Impulsive behavioral patterns in at least two aspects that are possibly self-damaging (e.g., substance abuse, sex, spending, binge eating, or reckless driving)
Their inability to reconcile their emotions with their physical experience causes individual with Borderline Personality Disorder to exhibit dangerous or risk-taking behaviors including but not limited to: shoplifting, gambling, thrill seeking behaviors, reckless spending, cutting, binging with food or alcohol, and sexual promiscuity. These thrill-seeking behaviors function to increase the production of dopamine in the brain causing heightened sense of pleasure and happiness. They also minimize their sense of emptiness.
5.Recurring suicidal patterns, threats, gestures, or self-harming behavior
They may threaten or actively attempt suicide. When upset they may exhibit self-harm behaviors such as cutting, branding or burning. They may wear clothing that is inconsistent with the season in order to hide signs of self-harm. It is important to take any suicidal ideation seriously and seek out professional help.
6. Affective instability because of a significant reactivity of mood (e.g., irritability, anxiety, or intense episodic dysphoria that typically lasts a few hours, rarely more than days)
Individuals with Borderline Personality Disorder may cycle between extreme highs and lows, negatively impacting their relationships and employment. They often have stormy and unstable relationships and may have difficulty maintaining a job.
7. Chronic empty feelings
They feel at times that they have nothing to offer and are at greater risk of falling into a deep depression. This depression can lead to self-harm behaviors (ie cutting) or even suicidal ideation.
8. In appropriate and intense anger or trouble controlling anger (e.g., always angry or often temperamental) and;
9. Short-lived stress-related paranoid thoughts or extreme dissociative symptoms
How do we support our loved ones with Borderline Personality Disorder?
Life with a loved one with Borderline Personality Disorder may feel like a ride on a roller coaster but there are things you can do to help them manage their symptoms and minimize the fallout.
Try and educate yourself on the signs and symptoms of Borderline Personality Disorder. Understanding why your loved one behaves the way they do and the underlying reasons can mitigate some of the frustrations and conflict that ensue.
Focus on responsibility
Just because your loved one has Borderline Personality Disorder it does not mean they cannot distinguish between right and wrong. Resist attempts to rescue them from natural consequences of their decisions. Allow them to experience these natural consequences. If they smash their car after a night of reckless driving, don’t but them a new car. If they max out their credit card, don’t pay their bill. Let them experience the consequences of their actions-this may incentivize them to change.
Take all suicidal ideation seriously
If your loved one hints at or expresses the intent to hurt or kill themselves take their words seriously. Get them help immediately. If may be a cry for help.
Be consistent and honest
Don’t feed into their behaviors unless you agree. Individuals with Borderline Personality Disorder usually lack insight into how their actions affects others. If their partner broke up with them and they attribute it to them being a “horrible human being” don’t agree with them if you know the breakup was due to your friend’s infidelity.
Know your limits. Recognize when you need to disengage or step away. Set clear boundaries and maintain them. Be aware of how you communicate and how it may affect your loved one and their vulnerabilities. Check for understanding.
Encourage them to seek professional help
Individuals with Borderline Personality Disorder may suffer from “Anosognosia” or “Abnegation ”. Abnegation is when we someone realizes the truth and it is so uncomfortable to process they just refuse to accept it-even when presented with evidence. Anosognosia is when an individual lacks awareness of their mental health status. Don’t tell them you think they have Borderline Personality Disorder, this may be perceived as stigmatizing and shaming. Meet them where they are and reinforce the difficulties they are experiencing, Help them recognize others areas you perceive as problematic. Express your agreement that their experiences are concerning, that no one is perfect and that everyone has room to improve.