Caring about someone with Borderline Personality Disorder (BPD) tosses you on a roller coaster ride from being loved and lauded to abandoned and bashed. Having BPD is no picnic, either. You may live in unbearable psychic pain much of the time. Your illness may distort your perceptions, causing antagonistic behavior and making the world feel like a perilous place. The pain and terror of abandonment and feeling unwanted may feel daunting.
For the partner, things will almost never be calm. Following a passionate and immediate beginning, a stormy relationship often emerges that includes accusations, anger, jealousy, bullying, control, and break-ups due to the person's insecurity.
Nothing is grey or gradual. For people with BPD, things are black and white. They have the quintessential Jekyll-and-Hyde personality. Fluctuating dramatically between idealizing and devaluing you, they may suddenly and sporadically shift throughout the day. You never know what or whom to expect.
People with BPD's intense, labile emotions elevate you when they’re in good spirits and crush you when they’re not. You’re a prince or a princess; a bastard or a bitch. If you’re on the outs with them, all their bad feelings get projected onto you. They can be vindictive and punish you with words, silence, or other tactics, which feel manipulative and can be very destructive to your self-esteem. Unlike bipolar disorder, their moods shift quickly and aren’t a departure from their normal self. What you see is their norm.
Their brains heighten the intensity and negativity of their perceptions and feelings. Their emotions, behavior, and unstable relationships, including work history, reflect a fragile, shame-based self-image, often marked by sudden shifts, sometimes to the extent that they feel nonexistent. It's all made worse when they’re alone; thus, they’re dependent on others. They may seek advice frequently, sometimes from several people on the same day, asking the same question.
They react to profound fears of abandonment with needy and clingy behavior and/or alternate with anger and fury that reflect their own skewed reality and self-image. They’re desperate to be loved and cared for, yet are hypervigilant for any real or imagined signs of rejection or abandonment should you, for example, be late, cancel an appointment, or talk to someone they see as competition. For them, trust is always an issue, often leading to distortions of reality and paranoia.
You’re seen as either for or against them and must take their side. Don’t dare to defend their enemy or try to justify or explain any slight they claim to have experienced. They may try to bait you into anger, then falsely accuse you of rejecting them. They may gaslight you to make you doubt reality and your sanity, even try to brainwash you. In their desperation for caring, they often behave in ways that feel like emotional manipulation and abuse. Cut-offs of friends and relatives who “betray” them is common.
Although they try to create an intimate, romantic merger that is very seductive to those unaware, they equally fear it, because they’re afraid of being dominated or swallowed up by too much intimacy. In a close relationship, they must walk a tightrope to balance the fear of being alone or of being too close. To do so, they manipulate and control with commands or indirect maneuvers, including flattery and seduction, to reel in their partner and use their anger and rejection to keep him or her at a safe distance. Whereas narcissists enjoy being understood, too much understanding frightens the borderline.
Because people with BPD are dependent, they find someone to merge with to help them. They seek a person who can provide stability and to balance their changeable emotions. Narcissists and people who act self-sufficient and in control of their feelings provide a perfect match. They’re easily seduced by the borderline’s extreme openness, charm, and vulnerability. In addition, the borderline’s passion and intense emotions are enlivening to non-BPDs, who find being alone depressing or “healthy” people boring. These partners vicariously come alive through the melodrama provided by the borderline.
The borderline may appear to be the more dependent underdog in the relationship, while his or her partner is the steady, needless, and caretaking top dog, but in fact, both are dependent on each other. It can be hard for either of them to leave. They each exercise control in different ways. Their partners are often codependent individuals who also yearn for love and fear abandonment. They already have low self-esteem and poor boundaries, so they placate, accommodate, and apologize when attacked in order to maintain the emotional connection in the relationship.
Partners become emotional caretakers. They do so sometimes to the point of self-sacrifice or enabling. In the process, partners give over more and more control to the borderline and further seal their low self-esteem and the couple’s dependency. Placating the borderline and giving them control does not make either partner feel more safe, but the opposite.
People with BPD need to feel loved and in control. They need boundaries. Setting a boundary can sometimes snap them out of their delusional thinking. Calling their bluff is also helpful. Both strategies require that their partner build their self-esteem, learn to be assertive, and derive outside emotional support. The relationship can see improvement when the partner takes steps to heal themselves and change their behavior.
Making the Diagnosis
Like all personality disorders, BPD exists on a continuum, from mild to severe. It affects women more than men and about two percent of the U.S. population. BPD is usually diagnosed in young adulthood when there has been a pattern of impulsivity and instability in relationships, self-image, and emotions. They may use alcohol, food, or drugs or other addiction to try to self-medicate their pain, but it only exacerbates it. To diagnose BPD, at least five of the following symptoms must be enduring and present in a variety of areas:
- Frantic efforts to avoid real or imagined abandonment.
- Unstable and intense personal relationships, marked by alternating idealization and devaluation.
- Persistently unstable sense of self.
- Risky, potentially self-damaging impulsivity in at least two areas (e.g., substance abuse, reckless behavior, sex, spending).
- Recurrent self-mutilation or suicidal threats or behavior. (This doesn’t qualify for Nos. 1 or 4.) Around 8 to 10 percent actually commit suicide.
- Mood swings (e.g. depressed, irritable, or anxious) mood, not lasting more than a few days.
- Chronic feelings of emptiness.
- Frequent, intense, inappropriate temper or anger.
- Transient, stress-related paranoid thoughts or severe dissociative symptoms.
Causes and Treatment
The cause of BPD is not clearly known, but often there has been neglect, abandonment, or abuse in childhood and possibly genetic factors. People who have a first-degree relative with BPD are five times more likely to develop BPD themselves. Research has shown brain changes in the ability to regulate emotions. Unlike narcissists who often avoid therapy, people with BPD usually welcome it; however, before recent treatment innovations, its effectiveness had been questioned, which led to stigmatization.
Today, BPD is no longer a life sentence. Studies have shown that some people recover on their own, some improve with weekly therapy, and some require hospitalization. Long-term treatment is required for maximum results, with symptom relief increasingly improving. A 10-year study showed substantial remission after 10 years. Use of medication and DBT, CBT, schema therapy and some other modalities have proven helpful.
Most individuals with BPD have another co-occurring diagnosis, such as addiction and/or depression. Acute symptoms diminish more readily than temperamental ones, such as anger, loneliness, and emptiness and abandonment/dependency issues.
People with BPD need structure, and a combination of knowing that they’re cared about plus boundaries that are communicated calmly and firmly.
©Darlene Lancer, LMFT 2013
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Mayo Clinic. Borderline personality disorder.
National Institute of Mental Health. Borderline Personality Disorder.