For those of you living with a person who has boderline personality disorder (BPD), I want to direct your attention to the latest issue of Psychology Today, October 2013, and the article: "Kings and Queens of Chaos" by Elizabeth Svoboda. She cites Brian Palmer from the Mayo Clinic saying that research has now identified BPD as being the result of a neurobiological flaw that predisposes a person to have a highly reactive limbic (emotional) system coupled with a decreased capacity for cortical control (inability to regulate those emotions). Palmer suggests that this neurobiological flow is 55% inherited and that environmental factors can either increase or slightly decrease the person's likelihood to develop full-blown BPD. In addition, only one other mental illness has such a high biological predisposition and that is schizophrenia.
Why is this important? I get asked all the time by Caretaker clients whether their loved one who has BPD symptoms will get better if the Caretaker just does or says the right thing. They cite articles that suggest that people with BPD can get better. In her article, Svoboda says that there is evidence that with treatment the BPD can get better, primarily in reduced suicide attempts, reduced cutting, reduced psychiatric hospitalizations and reduced anger and depression. These are, obviously, important. The issue for most family members is more along the lines of "Will this person function emotionally, socially, and in a reciprocally positive way as a spouse or parent?"
Everyone is different, but these studies suggest that someone with BPD is very unlikely to ever consistently respond to emotional, intimate, stressful situations normally. It is highly likely that the BPD will always have to be supported financially (less than one-third can hold down a job), cared for emotionally, and treated with kid gloves in most or all emotionally laden situations, e.g. the kinds of situations that happen daily in most families and relationships. These factors need to be take into consideration when you are expecting the BPD family member to function in any kind of socially stressful situation.
Are there medications that help people with BPD? This article is consistent with the information I've read elsewhere, that at this time there are no effective medications that significantly help. Many people with BPD are diagnosed incorrectly and wind up on medication. One indication of a misdiagnosis may be that the medication, the therapy, all the tiptoeing and walking on eggshells that family members do, never make any significant change in the person.
This article corroborates what I have stated in my book, Stop Caretaking the Borderline or Narcissist, that you need to assume for practical, everyday purposes that the person with BPD will not get significantly better. For this reason it is so important for family members to give up trying to change, control, cajole, convince, threaten and demand that the person with BPD make changes. They just can't do what you are asking. This means that the family must come to terms with the fact that this person has a permanent, life-long emotional handicap and learn to function on that basis. This does not mean you should have no expectations of civility from the BPD person, but you will need to let go of your unrealistic fantasies that they will eventually be able to function normally in intimate family relationships.
What can you do with this information? Families can cope more effectively with their BPD family member if they remember:
- Borderline Personailty Disorder is a permanent, emotional handicap, and you cannot change that.
- The emotional reactivity and emotional control levels of the BPD are very similar t that of children between the ages of 18-24 months, and will not likely improve. Don't expect them to react like an adult.
- They will have good days and bad days, and you have no control over which today will be.
- The BPD functions best when things are predictable, routine and they know what to expect. They don't like sudden changes.
- When the BPD is emotionall activated they actually cannot think, hear or see normally. During those times they do not lay down memories. Don't expect them to remember what happened.
- Use the energy you used to expend on trying to change, convince or fix the BPD and put it into taking better care of yourself.
My next blog will focus on cognitive behavioral techniques you can use to help your household and yourself function more effectively with a BPD family member.