“My husband is a wonderful, loving man, very kind to me and gentle with our children,” Elena* told me. “But every so often he loses his temper, and when that happens, it seems anything I say, or anything the children do, makes things worse. If we’re understanding and calm, he feels like we’re belittling him and putting him down. If we defend our position to him, he says we’re not valuing his experience. He never physically hurts any of us, and I know he loves us all very much. I’m sure that his rage is bad for the children, but they love him. My family thinks I should leave him, but I don’t think that would be good for any of us.”

Sam* described his younger sister as “a terror.”

“She’s been this way her whole life. I love her, but she has my parents tied up in knots. They spoil her because if they don’t give her what she wants, she makes their lives miserable. She screams at them, tells them they’re terrible parents, and threatens to commit suicide if they don’t do what she wants. The problem is, when she’s OK, she’s great. Fun to be with, smart, even thoughtful. But she can be manipulative and mean, too. She’s usually better with me than she is with my parents because she knows I won’t cave into her demands. But it’s really hard for me, because I know she’s hurting my parents. Sometimes I feel like telling my parents just to stop having a relationship with her at all.”

Arjun* said his mother controlled the whole family with her rage. “She can blow up in a nano-second,” he said, “destroying everyone in her path. And half the time—no, more than half—we don’t know what got her so upset. But if we try to ask her rationally about what has made her so mad, she just gets worse. We’ve learned to scurry around and try to appease her and wait for the cloud to pass over. And then she will be extra loving for a while. But my sister and I are tired of this. My sister thinks she’s toxic and is thinking of cutting her relationship. Which makes me very sad, because my mother would be broken-hearted.”

While I often take into account the reports of family and friends when making a diagnosis, no accurate diagnosis can be made on the basis of this kind of second-hand information alone. But these behaviors are all consistent with a possible diagnosis of Borderline Personality Disorder (BPD).

BPD has a number of symptoms and variations, the National Institutes of Mental Health (NIMH) says (click on the link if you’d like more details): “Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior.”

Symptoms of this disorder are often described in the negative, for example including impulsiveness, inability to tolerate separation, aggression, mood swings, negative self-image, and suicidality. But there is another quality displayed by many borderline individuals that is often left out of the diagnostic picture: individuals with borderline personality disorders can also love intensely, although somewhat erratically and egocentrically.

There are many theories about how an individual develops borderline personality order, ranging from biology to neurology to childhood trauma (often including traumatic loss, neglect, or abandonment) to family disorders to what my mother used to call “just plain orneriness.” But whatever has caused your loved one to be this way, the important thing to remember is that if they love you and you love them, as long as you remain aware of the potential ups and downs and other difficulties, there is a possibility of a rich, meaningful, and satisfying relationship.

One of the difficulties for many people who love someone with a BPD diagnosis is that when things are good, they want to believe that things won’t get bad again. As Arjun put it in terms of his mother, “If she can be so wonderful sometimes, she should be able to be that way all the time, shouldn’t she?”

The reality is that none of us stay in the same mood or maintain the same set of feelings all the time; but people with BPD tend to have more dramatic fluctuations than people without. In fact, because of the mood swings from happiness to depression, BPD is sometimes diagnosed as a mood disorder. Unfortunately, while some medications for mood disorders can be useful for BPD, they can’t cure the disorder.

So what can you do to make your own life tolerable while loving someone with BPD? Here are five suggestions that can help:

1. Recognize is that these disorders don’t go away. Your loved one will be dealing with the related symptoms and issues throughout life—and so will you if you choose to be with them. Acknowledging this possibility will save you from frustration and painful disappointment over the years.

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2. Encourage your loved one to get help. Dialectical Behavioral Therapy (DBT) is a form of cognitive behavioral therapy that was developed to help people with BPD develop some understanding control of their behaviors. Some medications used for depression, anxiety, and mood swings can also help. A professional who is familiar with these disorders can help you and your loved one find the best possible combination of therapies to make their and your lives more comfortable and meaningful.

3. Don’t take it personally when your loved one exhibits symptomatic behavior. Although they may accuse you of being the cause of their pain and their problematic behavior, it is the disorder, not you, who has caused it.

4. Get support from outside your relationship. Your own friends and family, work, exercise, volunteer work, almost any activity, and any person that helps you maintain your own self-esteem are invaluable in aiding your relationship. Professional help can also be useful. The National Education Alliance for Borderline Personality Disorder is an excellent resource, offering support groups and guidelines for families as well as useful information about the disorder for families and loved ones.

5. Most important of all, however, is to remember that as much as you love this person, you cannot change them. They are who they are, and that is not your fault—or your responsibility. That isn’t to say that someone with BPD cannot change. Therapy with a professional who specializes in BPD can address different aspects of their behavior, help them manage the intense feelings, and work with them on their fear of separation and abandonment. If they are willing—and able—to do the work, they can make important changes in how they deal with the world. You cannot do this for them.

If they are able to do the work, and if you are both able to manage the intensity of their emotions, the sometimes confusing impulses, and the level of their fear of separation, you can have a loving relationship with a sibling, a parent, a friend, or a lover with BPD.

*Names and identifying info changed to protect privacy.

Copyright @fdbarth2021.



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