Supporting a Loved One with BPD

Your loved one’s maladaptive reactions are rarely intentional and aren’t for “attention” or to be “dramatic”... their actions are trying to communicate their emotional sensitivity.

Maintaining firm boundaries with someone with BPD is helpful and necessary. They might have difficulty adapting to change or they might test limits by moments, but with time and consistency, it will become easier for them to engage with you in a healthier way.

People with BPD can have the tendency to misinterpret the messages they receive due to rejection sensitivity, which can lead to misunderstandings. People with BPD who have access to a stable support system can improve quicker ; research shows that it plays a crucial role in their recovery. They can become more regulated over time when in relation with people who are validating, warm, and consistent. On the contrary, interacting with people who are invalidating and chaotic will only escalate BPD “episodes”.

You can help them foster their independence by encouraging their autonomy. Focus on reinforcing their positive behaviors and acknowledging their strengths. Be patient and compassionate. Encourage them to seek professional help if their behaviour is negatively affecting their (or yours) well-being.

What is BPD?

BPD stands for Borderline Personality Disorder.

BPD is often linked to childhood abuse or neglect. According to the biosocial theory,  maladaptive behaviors stem from emotional dysregulation, which can be caused by biological sensitivity and experiences of invalidation throughout childhood. 

Symptoms include : 

• acute fear of abandonment and frantic efforts to avoid abandonment

• severe dysphoria (change in self-image and sense of identity)

• engaging in unsafe and impulsive behaviours (self-harm and suicidal gestures, eating disorders, substance abuse, reckless driving, spending etc.) 

• having unstable and intense relationships

• chronic feelings of emptiness

• perceiving others through idealization or devaluation (referred to as “splitting”)

• emotional dysregulation and rapid shift in mood

• dissociation or paranoid thoughts

• extreme anger or difficulty controlling anger

BPD is most common amongst women and its symptoms are often displayed as internalization (eg. mood disturbances) and comorbidity. Externalizing symptoms (eg. aggression and impulsivity) is mainly found in males with BPD. BPD is often misdiagnosed as bipolar disorder and vice versa.

Tips to help a loved one with BPD

1. Educate yourself from reliable sources.

2. Boundaries & Reassurance : Validate and acknowledge their emotions, even if you don’t agree. Communicate openly and honestly about your limits and your needs - do so with kindness.

   Eg. “I love you and I need you to talk to me in a calm voice.”

3. Avoid getting defensive when your loved one is in a state of dysregulation. Giving clarification and reassurance can be helpful in decreasing the intensity of their emotions.

   Eg. “I can see that my behaviour hurt you. You matter to me, my intention wasn’t to invalidate you.”

4. Avoid criticism or blame, and avoid making assumptions about their behaviours. Individuals with BPD act from a place of emotional pain & distress.

   Eg. “You’re being manipulative when you say that.”

5. Give them time and space to calm down & self-regulate. Discuss skills they can use ahead of time for when they are feeling in distress. Remind them of their resources and support system. Ask them about what they need at the moment.

   Eg. “Do you need a hug or would it be helpful to call a crisis line?”

Note : You can disagree with a behaviour and reframe that behaviour as a ‘cry for help’. You do not have to understand why they feel that way to acknowledge their experience. Validating someone’s feelings DOES NOT mean you accept their hurtful behaviours.

Treatment : Dialectical Behavioural Therapy

DBT was developed in 1993 by Marsha M. Linehan. Typically DBT treatment involves group and individual therapy, and in-between sessions coaching over the phone for a period of one year. This approach is based on the biosocial theory. DBT focuses on decreasing maladaptive behaviors while increasing adaptive ones. The skills are divided into four modules : mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

DBT skills are taught within the context of self validation. DBT's core philosophy is dialectical, which means balancing two opposites. In this theory, the paradoxical concept of acceptance and change is omnipresent. DBT focuses on how the individual perceive their internal experience (ie. sensations, thoughts, emotions, and memories).

Someone once told me that "The people who are hardest to love are the people who need it most."