Borderline Personality Disorder (BPD)

Source: photo by D. Grande

People with Borderline Personality Disorder may be joyful at one moment and then terribly depressed in the next moment. Their mood shifts are sudden and unpredictable both to themselves and to those who live with them. Angry outbursts, threats of suicide, and impulsive behavior are all common occurrences with Borderline individuals (Kreger, 2008). It is a frightening disorder for those who suffer from it, as well as for those who live with them. Even mental health professionals will often think twice before agreeing to take on a Borderline person as a client because of the intensity of the emotional work that will have to be done and the frequency of challenging behaviors to be managed.

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is one of ten personality disorders identified and described by the American Psychiatric Association, along with more commonly recognized disorders such as Narcissistic Personality, Schizoid Personality, and Obsessive-Compulsive Personality. As with all of the personality disorders, the diagnosis is only used when there is a long term pattern of behavior which is outside of the norms and this pattern of behavior interferes with work/education or relationships or both. For BPD to be diagnosed, at least five of the following nine criteria must be present (Kreisman, 2010).

1. Frantic efforts to avoid real or imagined abandonment.

2. Unstable and intense interpersonal relationships.

3. Lack of a clear sense of identity.

4. Impulsive behavior which is potentially self-damaging, such as substance abuse, indiscriminate sex, shoplifting, reckless driving, binge-eating.

5. Recurrent suicidal threats or gestures, or self-mutilation.

6. Severe mood shifts and extreme reactivity to situational stressors.

7. Chronic feelings of emptiness.

8. Frequent, intense, and uncontrolled displays of anger.

9. Temporary feelings of unreality or paranoia.

Coping with Borderline behaviors

As you might imagine, or perhaps already know from experience, responding to some of the behaviors noted above requires very careful effort. It is critical to be supportive, but not overreactive. The goal is to provide reassurance of the borderline person’s self-worth but also to establish reasonable expectations of their behavior. Each response requires self-awareness (of your own emotional reactions) and self-control to avoid either an angry reaction or an overprotective one. For an excellent guide to how to respond to specific types of borderline behavior, I refer the reader to the classic book by Jerold Kreisman,  I Hate You – Don’t Leave Me (2010). You will find guidelines for coping with a range of problems including the Borderline person’s rage, mood swings, impulsiveness, and threats of suicide. For example, Kreisman warns that “threats of suicide should be taken seriously and met with prompt, predictable, realistic reactions, such as demanding that the borderline obtain professional help” (p. 128).

 Borderline behavior is usually complex and extremely challenging for everyone involved. It cannot be understood simply as an attempt to control or manipulate others, although this is certainly one aspect of the borderline person’s mindset. Individuals who suffer with this disorder experience intense distress related to their fears of abandonment, feeling misunderstood, and feeling helpless. The manipulative behavior comes from a true sense of despair, very unlike the cold and calculated manipulative behavior of the narcissist. Borderline individuals are often frightened by their lack of control over their own feelings, particularly their anger. The range of troublesome behaviors and feelings which they commonly experience cannot possibly be fully understood in the context of this one blog. My goal in this blog is to offer some guidelines for communicating in a way that will have both short-term and long-term benefits. In the short-term, the correct communication method will minimize the chances of difficult situations becoming even more difficult. In the longer term, it will maximize the chances that the borderline person accepts their responsibility for their own behaviors.

Using the SET method of communicating

In addition to learning how to cope with particular situations as mentioned above, it is extremely important to learn and practice a specific method of communicating with borderline individuals. The SET method involves statements of Support, followed by statements of Empathy, and lastly, stating the Truth of the situation.

Support: A statement of support usually begins with “I” and expresses concern, caring, and intent to be helpful. I will provide an example of how this might be done, drawing from work with one of my past therapy couples (names changed).  Patricia and John came to couples therapy with a complaint that John was neither attentive nor helpful enough at home. Outbursts of anger were occurring at least once per week, always with Patricia becoming suddenly enraged at John. In one incident, he made an extra effort to be helpful by making the family meal, washing the dishes and cleaning up the kitchen after a full day of work. Patricia was very happy and thanked him for this. Unexpectedly, she then received a phone call from her mother, who was upset and scolded Patricia for not having remembered her birthday. As soon as she got off the phone and joined John again, she was rageful and critical of John for not having walked the dog yet. He was shocked, having no clue as to what suddenly changed her attitude toward him. He might have made his first statement: “I am concerned about how you are feeling right now. “  This acknowledges her concern without anger or defensiveness.

Empathy: A statement of understanding of the other’s feelings. For example, John might say to Patricia:  “You were happy a moment ago and now sound very angry. You must be feeling very upset.” This should not be about the speaker’s feelings but rather an attempt to express an understanding of the borderline person’s distress.

Truth:  A statement which acknowledges the problem and addresses the practical issue of what can be done to solve it. This should be done without blaming or defensiveness. A matter of fact tone is most helpful here, as in: “Here’s what I am aware of…. The dog has not yet had his walk. The consequence of the problem is …one of us needs to take him out soon. Here’s what I can do…I am tired and need a few minutes of rest. What can you do?  This last part involves the borderline person in the solution and avoids the reinforcement of her helpless behavior.

 Each of these statements is critical to the response for every crisis situation, such as self-destructive behavior, an important decision-making moment, or an outburst of sudden anger in response to a minor stressor. The “Truth” statement must be clearly expressed each time. Without the statement of Truth (or realistic problem-solving) the borderline person will continue to have unrealistic expectations of others. Merely being supportive and empathic and then fixing the problem without the cooperation of the borderline reinforces the thought that others are responsible for her feelings or concerns.  

If you are in a significant relationship with a person who has Borderline Personality Disorder, you are already aware of how difficult it is to communicate with them in an effective way. Maybe you are so often frustrated in your efforts to be helpful that you end up shouting back during the angry outbursts, resorting to angry criticism, or avoiding them as much as possible. You knew that these reactions have not been helpful but you did not know what else to do. I encourage you to practice the SET response to the best of your ability. Seek professional help for yourself and others in the same household so that you may learn together and then support each other in practicing this method of communicating. The reality is that this is a very complex and challenging personality type. You did not cause the borderline person to act as they do, but there is something you can do about it for your own well-being as well as theirs.

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