Battling Borderline Personality Disorder
Your teenage daughter suffers from depression. She has tried to commit suicide more than once. She gets upset over minor instances. She could have borderline personality disorder.
Borderline personality disorder (BPD) is a mental health condition that involves poor self-image, a feeling of emptiness and great difficulty in being alone. People with BPD have intense moods and unstable relationships. They can be impulsive and have unsafe sex, drive dangerously, eat too much, drink too much and squander money. The vast majority being women.
Unfortunately, people with BPD are more likely than others to harm themselves. In fact, they are more likely than average to attempt or commit suicide.
No one knows what causes BPD. Most doctors think that it, as with many psychiatric illnesses, is a combination of genes and life experience. A person is born with a genetic vulnerability to develop the condition if he or she has certain life experiences. In particular, many teens and adults with BPD have experienced some form of abuse in childhood, including verbal, physical or sexual abuse, as well as being separated from one or both parents.
A doctor will diagnose BPD when a person has had many of the following symptoms. The symptoms must be severe and be present for a long time:
§ Unstable, intense and difficult relationships;
§ Poor self-image;
§ Self-destructive, impulsive behavior;
§ Suicidal threats or attempts;
§ Self-mutilation;
§ Extreme mood reactions including intense, inappropriate anger;
§ Feeling empty or alone;
§ Fear of abandonment;
§ Short-lived distortions of perception or belief (for example, a person may assume a friend or family member hates them).
These symptoms often lead to intense neediness, trouble with observing limits and boundaries and frantic efforts to control the behavior of others. Although the quest for love, compassion and approval can be relentless, the opposite is often accomplished as the unpredictability and often confusing behavior of people with BPD can put an enormous strain on their relationships or even drive people away from them.
A pervasive pattern of unstable relationships, characterized by alternating between closeness and distance, as well as by extremes of idealization and devaluation, is therefore fairly common.
Many experts believe the manipulative or aggressive behavior of a person with BPD is not intentional or malicious, but rather used impulsively and largely unconsciously in order to escape from the intense emotions of fear, desperation, loneliness or emptiness.
Stressful life events may further contribute to these emotions and behaviors. BPD frequently occurs simultaneously with other disorders (i.e. depression, bipolar disorder, schizophrenia), which can make an accurate diagnosis very difficult.
Some high-functioning people with BPD are very well capable of living a normal life and may, in spite of experiencing some difficulties in managing their personal relationships, be very achieved and successful in their work situation. On the other side of the spectrum are those who live from one crisis into another and are totally controlled by the disorder.
With care of loved ones, as well as the right medication and therapy, symptoms can be alleviated over time and more effective functioning may be developed.
What can you do to help someone with BPD without exhausting yourself or having to tip-toe around him or her? Here are some suggestions:
§ Take the behavior less personally since it’s not about you, but rather about the intense and confusing emotions of the person with BPD.
§ Become aware of certain triggers, such as perceived abandonment or criticism, and try to be a bit more sensitive around these issues.
§ Don’t respond to random blaming attacks and manipulation by denying, counterattacking or defending yourself. Instead communicate your position clearly, stay focused on one thing at a time, listen carefully, validate some of his/her feelings, diffuse by possibly agreeing with part of the statement or by using gentle humor.
§ Try to walk a very fine line between providing support and reassurance on the one hand, and setting personal limits and boundaries on the other hand. Remember that setting limits is not selfish, but necessary, both for your own sanity and to act as a good role model for the person with BPD, who often lacks internal stability. Be consistent and stand up for yourself in a gentle and respectful way. If you let unacceptable behavior go unnoticed, you might reinforce it.
§ Seek support and positive connections elsewhere. You may need a lot of love and validation yourself, especially when you are blamed frequently, so have a reality check with others once in a while. Look for support groups near you.
Experts have treated BPD patients with dialectal behavior therapy (DBT) with some success. With DBT, patients can learn how to regulate their emotions, handle frustration, communicate more effectively and learn how to be more mindful of their relationships with themselves and others. Critical to the therapy is helping the patient feel accepted and validated.
Medications are also frequently beneficial. These include antidepressants (such as Prozac, Zoloft, Paxil, Nardil and others), mood stabilizers (Tegretol, Depakote, etc.) and tranquilizers (Risperdal, Zyprexa, among others).
Living with BPD can be exhausting and frustrating, but if you have the right tools and take care of yourself, it is manageable. It helps that the diagnosis is more widely understood by the medical community and these patients are no longer stereotyped as difficult and unmanageable.
