For partners and families who love someone with borderline personality disorder, life can be an uneasy balancing act. Without diagnosis and treatment, it can be very difficult to understand why your loved one behaves the way they do. Sometimes they act like they hate you, other times as though you are the most wonderful person in their life. For husbands, wives, and children, these reactions can be highly distressing–and damaging. Fortunately, there is help for families who have a loved one with BPD. Dialectical Behavior Therapy is an empirically-proven, evidence-based treatment specifically developed for BPD that has shown high rates of effectiveness for clients and their families. With treatment and willingness, it is certainly possible for a client to recover and for the entire family to halt the “roller coaster” of BPD.
The Roller Coaster Ride
As many families and partners know, it isn’t just their loved one who suffers intense ups and downs. The whole family is along for the ride, struggling to understand how they got on it and how to make it stop. Everyone wants to get off, but no one knows how. And the more family members try to help, the more resistant their loved one becomes. “I don’t deserve help” or “Just leave me, I’m no good for you” are common faulty cognitions fueling these ups and downs. Because they don’t know how to change, they come to believe they never will. But there is an explanation for this.
It’s hard for a BPD client to understand their own emotions or where they stem from when they are so intense. Happiness is experienced as joy, anger as rage, and sadness as despair, among many others. These disproportionate reactions are often baffling for the people around them, and the cognitive distortions underlying the behavior harder to identify. The more confusing the behavior becomes, the more frightening it is. “Why is the person I love acting this way?” is a common question, and it isn’t one a person with BPD can answer until they’ve learned the skills to identify their own emotions and reactions.
Anger, Vengeance, and Betrayal
For many families, one of the most troubling aspects of BPD is intense anger. It is frequent for clients to experience splitting, or black-and-white thinking. In this form of thought, the person with BPD cannot think of both positive and negative qualities as a whole, which reflects in how they think about themselves and others. Things are either all good or all bad. People are loved or hated–and your family member’s feelings about this may change within seconds. An innocuous phrase or tone of voice can set off an enraged reaction where your family member may feel as though you’ve betrayed them, that you’re “just like all the others” or unworthy of speaking to.
Splitting acts as a faulty defense mechanism, and it only creates more distance between you and the person you’re trying to help. But so long as they hold onto that line of thinking, there’s no way to communicate. And waiting for your loved one to change their mind is not healthy for anyone in the situation, especially when perceived hurts turn into a cycle of “deepest cut wins.” It’s common for people with BPD to have come from circumstances where being vulnerable was something highly dangerous. In these instances, perceived wrongs are often met with punishments. Whether it comes in the form of accusations or icy silence, the faulty thinking that fuels these angry reactions only deepens the hurt and pain felt by everyone. No one understands where it’s coming from or why, and it further alienates each member of the family. Attempts to fix the problem or placate anger often result in deepening conflict. Anger and helplessness become a dominant mood within the household, and without intervention, the continuing cycle looks like it will never change.
The good news is that it certainly can. There are only two requirements for your loved one: willingness to accept help, and a desire to change.
DBT is hard work, but immensely rewarding, too. The four core modules of mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance teach clients to step back from their emotions (emotional mind) and examine where they are coming from and why before they take action. With interpersonal effectiveness, the client will learn how to communicate their needs and feelings in a healthy way, as well as how to respect boundaries. What they learn will carry over to the rest of the family. Provided everyone is willing to learn and compromise with each other, it is more than possible that the family can and will heal. It will take time and a lot of practice, but by reinforcing the skills you and your loved one learn through DBT will help the family as a whole.
This isn’t to say that DBT is an easy transition. Concepts such as doing things one-mindfully, both-and thinking, and radical acceptance can be difficult to master. Figuring out appropriate boundaries is also an important process the family must work on together. It is possible that the family will resist these changes as they are new, uncomfortable, and difficult to trust. Old patterns may be unhealthy, but to get rid of them, families must acknowledge that they no longer have a place in the home.
Is it true that a person with BPD will never change? Absolutely not. If they are willing to learn new behaviors and get rid of faulty cognitions, they’re ready for change. No validation can be found in false beliefs, and that is one of the first steps for the family. BPD is a disorder separate from the person who has it. One the client comes to realize that they are capable of regulating their emotions, having peaceful relationships, soothing their own distress, and staying in the present, they are capable of validating themselves. The ups and downs of the roller coaster are no longer necessary, and you and your loved one are free to move on and live your lives to their full potential.