For Loved Ones

People with borderline disorder have marked difficulties with relationships, especially with the people who are closest to them, such as families, partners and friends. Episodes of anger outbursts, moodiness, and unreasonable, impulsive, and erratic behaviors, which often appear unprovoked, can result in considerable harm to these important relationships. Attempts to engage in a discussion to work out reasonable solutions to problems frequently turn into highly emotional battles.

This usually results in responses from family, partners and friends that include anxiety and frustration, attempts to placate, and angry retorts when the limits of normal patience have been exceeded. Therefore, most loved ones of individuals with borderline disorder are quite relieved to learn that effective treatment is available for the disorder, and that there are ways they can help as well.

Two significant advances in the area of borderline disorder have been the recent research on the effectiveness of different educational and therapeutic experiences for families, and the development of consumer and family organizations focused on the disorder.

Ten Guidelines for Families, Partners and Friends

If you are a family member, partner or friend of someone with borderline disorder, you probably have developed feelings of anger and resentment towards them that conflict with your feelings of empathy and desire to help. The following are ten specific actions that you can take that will help the person with borderline disorder gain better control over her or his life, and help you in the process.

1. Learn About the Disorder

It is essential to understand that the person with borderline disorder is suffering from an illness that is as real as diabetes, heart disease, or hypertension. For most people, physical symptoms are easier to accept as indications of a disease than are behavioral symptoms. However, there is no reason to assume that a complex organ such as the brain is less susceptible to diseases that affect behavior than are other bodily organs that result in physical symptoms. Recently developed medical research studies demonstrate abnormal brain structure and function in patients with borderline disorder, thus confirming this conclusion.

It is also helpful to realize that persons with borderline disorder did not acquire the disorder through any actions of their own, nor do they enjoy having the disorder. Imagine what it must be like to feel that you are frequently at the mercy of forces within you, over which you seem to have little control, and that cause you extreme emotional pain and significant life problems.

Therefore, a critical first step in the process of helping them and you is to learn as much as you can about the symptoms and nature of borderline disorder, and the specific situational causes of acute episodes in the member of your family with the disorder.

2. Seek Professional Help

Facilitate the process of obtaining optimal help. It may be necessary that you do the initial work necessary to set up the first appointment. It may also be helpful if you agree to go. Some people with borderline disorder initially refuse to seek professional help. Provide them with a copy of my book and suggest they read the first two chapters. This may help them understand their potential problems well enough to agree to an initial appointment with a psychiatrist.

Other people with borderline disorder are steadfast in their refusal of help. This, of course, is a major problem. Dr. Perry Hoffman, the founding president of the National Education Alliance for Borderline Personality Disorder (NEA-BPD) offers this advice:

“The best way of approaching this problem from my perspective is for one to accept that you cannot get someone into treatment. Timing is important as to when someone might be “open” to hearing the idea. But the bottom line is to free families of feeling guilty, and to understand that they are not so powerful to effect that goal. Along that line, relatives need to get help and support for themselves as they watch their loved one in the throes of the illness.”

3. Support the Treatment Program

Once in treatment, encourage and support your loved one with borderline disorder to regularly attend therapy sessions, to take medicine as prescribed, to eat, exercise, and rest appropriately, and to engage in wholesome recreational activities. If alcohol or other drugs are a problem, strongly support their efforts to abstain completely from these substances, and encourage regular attendance in treatment programs or self-help groups, such as Alcoholics Anonymous. Remember, there is little hope of improvement of the symptoms of borderline disorder if alcohol and drugs are abused. It is very important that you remain persistent in your efforts to do everything possible to help reduce the risk of this behavior, and not enable it.

4. Respond Consistently to Problematic Behaviors

Develop a clear understanding (it may even be written) of the realistic consequences of recurring, problematic, destructive behaviors such as episodes of alcohol and drug abuse, physically self-damaging acts, and excessive spending and gambling. Also, agree beforehand on how best to respond to threats and acts of self-harm.

These and other problematic behaviors are often triggered by stressful events that need to be identified, and a clear plan developed for handling these events and situations more appropriately and effectively in the future. Such a plan is best developed with the help of the patient’s primary clinician.

Experience has shown that responding positively to appropriate behaviors is also very important in encouraging change to new and more successful ways of handling stressful situations. Doing so also reduces the incidence of inappropriate behaviors that then cause additional problems. Issuing spontaneous ultimatums should be avoided.

5. Attempt to Remain Calm

Reacting desperately or angrily when there is a flare up of symptoms will often add to the existing problem. Remain calm. Acknowledge that it must be difficult to experience the expressed feelings, even if they seem out of proportion to the situation. This does not mean that you agree with these feelings, or that you think that the actions resulting from them are justified. However, it is reassuring if you listen to them describe their feelings, the pain they are experiencing, and the difficulty they are having in dealing with this pain. Remember that you do not have to defend yourself if verbally attacked, or develop solutions to their problems. If they express thoughts of self-harm, remind them of the plan for dealing with this problem that has been worked out with their therapist.

Allow and encourage the person with borderline disorder to attempt to bring their response levels in line with the situation at hand. This may require that you give them a little time alone to collect themselves. Then it may be possible to more calmly and reasonably discuss the relevant issues.

In addition, do not be hesitant to express your feelings freely and openly, but with moderation. Recent research suggests that caring involvement with your loved one with borderline disorder is associated with better outcomes than a cool, disinterested approach. Stay involved.

6. Remain Positive and Optimistic

It is important to remain optimistic about the ultimate results of treatment, especially when the patient has a setback. The usual course of borderline disorder with optimal treatment is one of increasing periods of time when symptoms are absent or minimal, interrupted by episodes when the symptoms flare up. Over time, the specific causes of relapses can be identified, anticipated, then steps taken to develop alternative, more adaptive and effective responses. Occasional family meetings with the therapist may help clarify the causes of relapses and identify new ways of preventing them.

7. Participate in Educational Experiences About Borderline Disorder

It is very important that you learn as much as possible about borderline disorder and your role in the treatment process. Your participation in educational opportunities may benefit both you and your loved one with the disorder. When conducted by skilled and experienced people, such structured and informative experiences may involve both patients and family.

8. Join a Borderline Disorder Consumer and Family Support Organization

For information on such consumer organizations, contact the National Alliance on Mental Illness (NAMI) or the National Education Alliance for Borderline Personality Disorder (NEA-BPD). If such an organization exists in or near your community, seriously consider joining it. You will then have available to you a large amount of new information about borderline disorder, what you can do to help the member of your family with the disorder and yourself, and compassionate and understanding support in your efforts. If there is not a group in your area, consider starting one with other family members you have met. Also consider joining one of these national consumer organizations for borderline disorder.

9. Remember: the Person with Borderline Disorder Must Take Charge

Remember that it is primarily the responsibility of the person with borderline disorder to take charge of her or his behavior and life. Although difficult at times, it is important for you to provide the opportunity for your family member with borderline disorder to take reasonable risks in order to try new behaviors. It is also important that you help her or him to be accountable for the consequences of old, destructive behaviors.

Excessive dependency on family and friends is not helpful in the long run. Beware of the tendency of people with borderline disorder to act at the extremes. For example, the proper alternative to excessive dependency is not immediate, total independency. The more appropriate responses are to remain engaged and to gradually help move to a more balanced, mature relationship level of mutual interdependency.

10. Take Care of Yourself

If you take the time to meet your own needs, when your help is needed most, you will best be able to provide it. Remember that you cannot save your loved one with borderline disorder on your own.

If you are the parent, there is a natural tendency to focus much of your attention on the person with borderline disorder. However, make certain that you are not neglecting your other sons and daughters who may appear to be doing well. They have need of your time and attention too, even as they grow into adulthood. You will learn from educational experiences the extent of this potential problem and how best to deal with it.

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