Following is a question from my Welcome to Oz family support group community, along with my response.

My wife acts very abusively toward me. On the one hand, you're saying I should hold her accountable for her actions. But on the other hand, she has a real mental disorder. So which one is it? Does she suffer from a disorder she didn't deserve, or should I hold her accountable for her hurtful behavior?

The answer is both. I'm going to explain this by asking you to imagine three different scenarios:

1. You, like me, are diagnosed with adult attention deficit disorder.

To manage my life, I need to take medication, to structure my office environment, and to develop strategies for managing my tendency to forget things, zone out, and over focus on things and lose track of time.

My husband gets frustrated when I forget to close the garage door because I get distracted when I enter the house. He expects me to write myself notes to take care of household things. If I'm really focused on something (like writing a blog post) he knows he has to say, "Can I talk to you?" to get my attention or I won't hear him. 

If I let my ADD take over, my books will not get written and my relationship with my husband will suffer--as will my finances.

It's not my fault that I have ADD. But it is my responsibility to manage it. It affects others; I don't live in a vacuum. People in my life give me some slack because they know I struggle. But I am an adult and they expect me to realize they have needs, too. I don't always succeed. But when I mess, up, I acknowledge the feelings of others and apologize.

2. Imagine your borderline/narcissistic wife has heart disease and her doctor says she must exercise and eat right.

But she doesn't. She eats fatty meat and no vegetables and takes the car to run an errand a block away. She may die early or become disabled. You argue with her to change. But she says she is fine; the real problem is the overly pessimistic doctors. Everyone dies of something, anyway, she says. Besides, since her family as a history of heart disease, a heart attack or stroke is inevitable. 

You're frustrated, angry, and worried. But you learn that fighting about her lifestyle or trying to control her just makes binge on fried food and chocolate. You can get mad and call her all kinds of names and make generalizations about how people with cardiac disorder don't take care of themselves. You might feel better for awhile, but your attitude is not productive or helpful, and you're making generalizations about people that aren't even true.

So what do you do: continue fighting, or accept she is in charge of her own body? Is it best to funnel your concern into things you can control, such as your own health, so that you, at least, will always be there for your children? Do you do your best at work because you need the health insurance? If you take care of you and give her space, she may decide on her own to take responsibility for her health.

My point: while physical and mental health are different, accepting responsibility for each is very similar. Also, making negative generalizations about others is neither helpful nor accurate. Many people with borderline personality disorder ask for help, and each person is unique.

3. Imagine that a son of yours marries someone who acts abusively

Would you want your son to be called names and be continually criticized and blamed? Can you imagine someone you love being raged at year after year? Would you want him to believe the abuse is all his fault, causing his self-esteem to collapse? Would you want your grandchild to use this marriage as a role model?

We all have needs. The most basic, according to psychologist Abraham Maslow, is the need for survival: food, shelter, and water. Once these basic needs have been met, the next needs are for safety and security.

As you progress up the pyramid, the need for love, friendship and intimacy become important. Further up the pyramid, the need for personal esteem and feelings of accomplishment take priority.

It is in our nature to long to feel safe and loved. People who have friends and a close community are happier and live longer. They tend to reach their full potential.

You can defer these needs, delay them, or refuse to do what you need to do to get them met. But they won't go away. Think about your life: it is all you have and it will not last forever. Each person must answer these questions for him or herself.

Stop Walking on Eggshells

When someone in your life has borderline or narcissistic personality disorder

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