Guidelines for Coping with Loved One with Borderline Personality Disorder

Adults Living With Mental Illness – Family to Family Series – Week 3 (NAMI)

A mood disorder is classified as an emotional state (or mood) that is altered and inconsistent with actual circumstances and that interferes with a person’s daily life. An individual will perceive their surroundings differently (more negatively) than others, especially in the home.

As mentioned in earlier posts, these reactions or moods, are not caused by having a bad day or being ticked off at something. They have a biological origin that displays itself as irrational feelings and behavior.

Today’s topic takes on a severe mood disorder that can cause extreme turmoil in a family.

Borderline Personality Disorder

BPD is a condition of intense emotional turmoil with persistent feelings of loneliness and the inability to be by oneself. Individuals have trouble controlling their rage and are extremely impulsive. They rush into and out of love relationships that are usually quite rocky and volatile. 75% of people with BPD are women. It is thought to have its origin in a neurological malfunction.

There is a strong pattern of instability in relationships, impulse control (over-spending, substance abuse, sex) and an intense fear of abandonment.

Parents and spouses of people dealing with BPD often suffer greatly themselves. They have to deal with mood swings and walk on eggshells to avoid an angry outburst. When the inevitable storm erupts, they take the brunt of the insults and accusations. After all they try to provide for their loved ones, they feel taken advantage of and used.

Advice for Coping

1. Go Slowly

Recovery and change take time and effort. One trap that family members fall into is being too excited and vocal about progress. Our loved one shows improvement and It appears they are taking a turn for the positive. We are so excited about these turns of events, that we rave and applaud their actions. This actually has the opposite of the intended effect.

Instead of making them feel better about themselves they start to grow anxious. “What if the improvement is only temporary? What if I can’t continue? They will be so disappointed in me.” The pressure mounts to please us and that pressure causes the one thing everyone is trying to avoid; a relapse.

Great progress can also bring on fears of abandonment, which are very strong with BPD. Once they succeed in overcoming their obstacles, we will move on to other things and leave them alone. If they believe we will not be around to help and support them, they begin to panic and the forward steps often stop.

It is important even when we are feeling encouraged by their progress, that we taper our enthusiasm and encourage them to go slow and steady in their recovery. Yes, we support and uplift them, but at a moderate and controlled level.

This concept was a real eye-opener for me. My daughter is not diagnosed with BPD, but there are definitely some recognizable traits there. After taking this lesson it occurred to me that some of her biggest setbacks came right after what I thought were her greatest triumphs. And I was right there leading the parade. I thought I was helping her, encouraging her and motivating her to keep moving forward. In fact, I was paralyzing her with fear that she would never live up to my expectations and she would then stop in her tracks and go back to square one. If I had only known of this phenomenon earlier, I wonder how far she could have actually gone in her recovery.

2. Keep Things Calm and Set Limits

Your loved one with BPD suffers greatly with their inability to handle stress in any relationship. They are super sensitive to perceived rejection, criticism or arguments. All efforts to maintain a calm and tranquil home will benefit everyone in the family.

Be prepared for extreme modes of thinking. A person with BPD has intense opinions. They view their experiences as either all good or all bad. If you are part of the ‘all good’, you are wonderful. If you happen to be part of the ‘all bad’, you are the villain. Try not to fall for the hysterics. It will be difficult and you will find yourself wanting to be rational and explain things in a reasonable way. But you have to remember you cannot reason with someone with a mental disorder, especially in a manic state.

When at all possible, keep family routines. Structure is good. It is also acceptable to set limits and have reasonable expectations. Be clear about those expectations. Be direct but not confrontational. Do not attach a threat or an ultimatum to your expectations. A threat will just be seen as a hostile act and most likely we would never go through with the ultimatum anyway so it is pointless to try it.

On a side note, however, it is acceptable and even advisable to allow your loved one to suffer the consequences of their actions. Do not rescue them or try to protect them from themselves. They need to learn the reality and impact of their decisions.

I personally have done this wrong for years. I have made it an art form of rescuing my daughter from almost every wrong turn she ever made. It has taught her almost no responsibility and has landed me in debt and distress. Take it from me, this one is IMPORTANT!

3. The Absolutes

Absolutely do not ever tolerate abusive behavior. Do not allow threats, physical violence or destruction of property. If a tantrum breaks out, walk away from the situation. You can return to deal with it when calm is restored. If your safety is being threatened, do not hesitate to call the police or ambulance. Be sure to ask for someone with Crisis Intervention Training. The goal here is not just punitive. A person who is out of control needs proper medical attention. Ignoring this type of behavior only encourages it to continue and escalate.

Absolutely do not tolerate illegal drug use. A close second is do not tolerate any substance abuse. Individuals with mental disorders are always looking to dull the pain and escape their emotional prison. It is understandable why so many turn to illegal drugs and even alcohol to ‘help’ them cope. The reality is these things will only make matters worse. Don’t be fooled by their pleas that they know better than the doctors and they have found what works for them. You have to draw a firm line in the sand with these issues for the safety of your loved one and the entire family.

Having a loved one living with a major mental disorder is heartbreaking. You want what is best for them and desire them to live a full and happy life. Unfortunately, that road is often very rocky and tumultuous. The good news is with information, knowledge, empathy and a strong support system, the family unit can learn to function and even thrive.

The key is never losing hope and never giving up on yourself or your loved one.

Be good to yourself. Be patient with yourself. You are doing the best you can.

Join me next time for a discussion on how the brain’s chemistry and the environment both effect mental illness. We will also learn about stages of recovery for your loved one.

Until then…

Hope With Abandon

Hope Out

PS. As a side note, panic disorder and OCD are also two lesser debilitating mood disorders. I have described them briefly below.

Panic Disorder

Panic Disorder strikes about 2% of Americans and half of the time presents before age 24 with twice as many women being affected than men. The symptoms of a panic attack mirror those of a heart attack and patients are almost always convinced that is exactly what is happening.

Pounding heart, trembling, sweating, nausea, dizziness, chills; these are all signs of a panic attack. The ‘disorder’ diagnosis is attached when they become recurrent and an individual avoids the situation related to the attacks. This is called becoming ‘phobic’. A person will refuse to leave their home, ride an elevator, go out in public, etc.

Obsessive-Compulsive Disorder

OCD is characterized by invasive thoughts and preoccupations that make no sense and typically revolve around a sense of harm. Fear of germs, control over objects, worrying about leaving something on, horrible impulses; etc. This is the obsessive part.

The compulsions are the behaviors that the person believes will eliminate the high anxiety caused by the thoughts. Repeatedly washing of hands or showering, ordering and rearranging items, repetitive checking and re-checking and even hoarding.

OCT sufferers are not delusional and many try to hide their symptoms. They simply can’t control their impulses. Again, the ‘disorder’ diagnosis occurs when these compulsions are so severe, they interfere with someone’s ability to function and interfere with social interactions.