Borderline personality symptoms in relationships

How to Make It Work

People with borderline personality disorder (BPD) often have rocky relationships, both romantic and platonic. Romantic relationships present a unique set of challenges for people with BPD and for their partners.

Symptoms of BPD can cause constant changes in emotions.

For example, a person with BPD may be affectionate and doting, but within a few hours, their emotional state may switch. They may feel smothered or overwhelmed. This can lead them to push away the partner they had just been drawing closer.

With treatment and continual support from family and partners, people with BPD can have successful relationships. Read on to find out how it’s possible and what you can do if you or your partner has BPD.

Borderline personality disorder (BPD) is a condition that affects the way a person processes everyday emotions and reactions.

People with BPD are often impulsive and emotionally unstable. They may have intense episodes of anger, anxiety, and depression. These episodes can last several hours and be followed by a more stable period.

These episodes could also last several days and negatively affect the person’s work, relationships, or physical health. Some people with BPD are prone to self-injury, accidents, and fights. Suicide is also more common among people with BPD.

Another way to understand how a person with BPD experiences life is to realize they have a more difficult time returning to an emotional baseline.

When something exciting or positive happens, they may experience greater joy for longer. But the opposite is also true: If something bad happens, they may have trouble bouncing back.

For friends, family members, and potential partners of someone with BPD, these emotional peaks and valleys may seem chaotic, which can lead to intense, conflict-filled relationships.

A romantic relationship with someone with BPD can be, in a word, stormy. It’s not uncommon to experience a great deal of turmoil and dysfunction.

However, people with BPD can be exceptionally caring, compassionate, and affectionate. In fact, some people find this level of devotion from a partner pleasant. A person with BPD may also be very physical and eager to spend a lot of time with their partner.

At the same time, people with BPD are sensitive to abandonment or rejection. Many are hyperfocused on perceived signs that a romantic partner isn’t happy or may leave them.

When a person with BPD senses a shift in their partner’s feelings, whether real or imagined, they may immediately withdraw. They can become angry and hurt over something a person without BPD would not react to. They can even become obsessive.

These emotional switchbacks can be difficult to handle. Sometimes they can lead to uncomfortable public scenes. The impulsive behavior of a person with BPD may put that person or their partner at risk, too.

However, the stability of a partner may have a positive effect on the emotional sensitivities people with BPD experience. It may require a great deal of work from both partners, but long-term relationships and marriages are possible for people with BPD.

The most common BPD behaviors and symptoms could be detrimental to any relationship. If you have been diagnosed with the condition, you likely know this already. People with BPD are more likely to have many romantic relationships, which are often short-lived.

This could be because you purposefully broke off the relationship for fear your partner might do it first. It could also be because your partner wasn’t comfortable facing so much difficulty.

It’s important to know that you can have a healthy relationship despite your personality disorder. Treatment, along with a strong support network, can help you find stability in your emotional state and in your relationships.

Treatment won’t cure BPD, but these options can help you learn to cope with the symptoms and react in ways that aren’t as harmful to you or your partner.

treatment for bpd
The most common treatments for BPD include:
Therapy. Dialectical behavioral therapy is commonly used with people who have BPD. A therapist will help you learn to respond to emotional situations with reason and proper judgment. This will reduce the dichotomous thinking (the belief that everything is black and white) that so many people with BPD have.
Medication. There is no medication that can treat BPD, but antidepressants, antianxiety drugs, and antipsychotics may help treat some of the symptoms.
Hospitalization. If you begin showing signs of self-harm or suicidal ideation, a doctor may hospitalize you for observation and intensive therapy.

If you or your partner has BPD, you can find ways to cope with the cycles of emotions that the condition causes. This can help you build a stronger, more resilient connection.

ways to improve bpd relationships
Learn about BPD. Part of caring for a partner with BPD is understanding what they’re experiencing. Understanding the level of emotional disorder they experience can help you respond in a way that protects both of you from additional chaos.

Seek professional help. Therapy can help people with BPD learn to better process emotions and events that upset them. Partners of people with BPD can also benefit from therapy. A professional can help a partner understand how to react, understand, and be supportive.
Offer emotional support. Someone with BPD may feel very isolated because of their past. Offer your partner understanding and patience. It is possible for them to learn and have better behaviors.

People with BPD are good and compassionate, and they can have healthy relationships. It takes work, and lifelong challenges will remain.

Therapists and doctors can work with you or your partner to develop a treatment plan. These healthcare providers can help you address the BPD symptoms that are most damaging to you and to your relationship.

Symptoms, Causes, and How to Cope

Our personalities are defined by the way we think, feel, and behave. They’re also shaped by our experiences, environment, and inherited traits. Our personalities are a big part of what make us different from the people around us.

Personality disorders are mental health conditions that cause you to think, feel, and behave differently than most people. When untreated, they can cause distress or problems in the lives of people who have them.

One very common personality disorder is called borderline personality disorder (BPD). It’s characterized by:

self-image issues
difficulty managing emotions and behavior
unstable relationships

One key behavior shared by many with BPD is known as “splitting countertransference,” or simply “splitting.”

Keep reading to learn more about splitting in BPD and how to cope with it.

To split something means to divide it. Those with BPD tend to characterize themselves, other people, and situations in black and white. In other words, they may suddenly characterize people, objects, beliefs, or situations as either all good or all bad.

They may do this even though they know the world is complex, and good and bad can exist together in one.

Those with BPD often seek outside validation without considering their own emotions about themselves, others, objects, beliefs, and situations. This can make them more prone to splitting, as they attempt to shield themselves from anxiety caused by potential abandonment, loss of trust, and betrayal.

People with BPD often experience intense fears of abandonment and instability. To cope with these fears, they might use splitting as a defense mechanism. This means they might cleanly separate positive and negative feelings about:

themselves
objects
beliefs
other people
situations

Splitting often occurs cyclically and very suddenly. A person with BPD can see the world in its complexity. But they often change their feelings from good to bad rather frequently.

A splitting episode can last for days, weeks, months, or even years before shifting.

What might trigger a splitting episode?

A split is typically triggered by an event that causes a person with BPD to take extreme emotional viewpoints. These events may be relatively ordinary, such as having to travel on a business trip or getting in an argument with someone.

Often, triggering events involve minor separations from someone they feel close to and sparks fear of abandonment.

You can identify splitting most commonly through the language of a person with BPD. They’ll often use extreme words in their characterizations of self, others, objects, beliefs, and situations, such as:

“never” and “always”
“none” and “all”
“bad” and “good”

Here are a couple of examples:

Example 1

You’ve been feeling good about yourself, generally. You’re out on a road trip one day and make a wrong turn that gets you temporarily lost. Suddenly, any good feelings you have about yourself disappear, and you get very down on yourself.

You may say negative things to yourself or others, such as “I’m such an idiot, I always get lost” or “I’m so worthless, I can’t do anything right.”

Of course, making a wrong turn when driving doesn’t mean a person is worthless. But a person with BPD can split their perception to avoid the anxiety of others perceiving them as worthless if they do the job first.

Example 2

You have a mentor you deeply admire. They’ve helped you professionally and personally, and you begin to idealize them. They must be without flaw if they’re so successful in their professional and personal lives. You want to be like them, and you tell them so.

Then one day your mentor undergoes turmoil in their marriage. You view this as a sign of weakness. Suddenly, you view your mentor as a complete fraud and failure.

You want nothing to do with them. You completely separate yourself and your work from them and look for a new mentor elsewhere.

Such splitting can leave the person being hurt, annoyed, and confused by the sudden shift in your perception.

Splitting is an unconscious attempt to safeguard ego and prevent anxiety. Splitting often leads to extreme — and sometimes destructive — behavior and personal turmoil in relationships. Splitting often confuses those who are trying to help people with BPD.

Splitting is an unconscious attempt to safeguard ego and prevent anxiety.

Those with BPD often report having intense and unstable relationships. A person who’s a friend one day may be perceived as an enemy the next. Some relationship traits of a person with BPD include:

difficulty trusting others

irrationally fearing others’ intentions
quickly cutting off communication with someone they think might end up abandoning them
rapidly changing feelings about a person, from intense closeness and love (idealization) to intense dislike and anger (devaluation)
rapidly initiating physically and/or emotionally intimate relationships

Splitting is a defense mechanism commonly developed by people who have experienced early life traumas, such as abuse and abandonment.

Long-term treatment involves development of coping mechanisms that improve your perspective of the events happening in your life. Reducing anxiety can also help.

If you need help dealing with a splitting episode in the moment, here’s what you can do:

Calm your breathing. A surge of anxiety often accompanies splitting episodes. Taking long, deep breaths can help calm you and prevent your extreme feelings from taking over.
Focus on all your senses. Grounding yourself in what’s happening around you at a given moment can be a good way to distract yourself from extreme feelings and help you better put into perspective what’s happening around you. What can you smell, taste, touch, hear, and see in a moment?
Reach out. If you find yourself splitting, consider reaching out to your mental healthcare professional. They may be able to calm you and help ease the split while it’s happening.

It’s not easy to help a person with BPD who experiences splitting. You may feel at the mercy of their symptoms. If you feel capable enough to help, here are some tips:

Learn as much as you can about BPD. It’s easy to get offended by the up-and-down behavior of someone with BPD. But the more you know about the condition and how it can affect behavior, the more understanding you’ll have about your loved one’s behavior.
Know your loved one’s triggers. Often, the same events over and over again are a BPD trigger. Knowing your loved one’s triggers, alerting them, and helping them avoid or cope with those triggers may prevent a splitting cycle.
Understand your own limits. If you feel unequipped to help your loved one cope with their BPD splitting episodes, be honest. Tell them when they should seek professional help. Here’s how to access therapy for every budget.

BPD is a mental health disorder characterized by extremes in the way a person thinks, feels, and acts. Many people with BPD form extreme characterizations about themselves, others, objects, beliefs, and situations during episodes called splitting.

Situations associated with anxiety often trigger splitting episodes. While it may be difficult at times, coping with splitting symptoms is possible.

Getting professional help can best prepare you to cope with your BPD and splitting cycles.

Borderline Personality Disorder, Symptoms, Causes, Diagnosis, Treatment

Borderline Personality Disorder (abbreviated as BPD ) is increasingly common among children today. The pathogenesis of this type of psychopathy is usually accompanied by a complex of unfavorable factors.

It is quite difficult to recognize this type of disease in everyday life. Often, it is confused with narcissism or simply the bad character of the individual, since the behavior of the "border guards" can be characterized by an extreme degree of unpredictability and hysteria, as well as a tendency to manipulation. For example, they confess their love to a partner, and after a couple of hours they leave “forever”, they can sincerely sympathize with someone, and then hit. It is also very common for patients of this type to constantly violate the boundaries of other people, shifting their problems onto them, and avoiding responsibility. Consider the symptoms of borderline in more detail.

Symptoms of borderline personality disorder (BPD)

The main symptomatic difference of this type of disorder is prolonged abnormal behavior of the patient .

While in many other psychopathy periods of instability alternate with remission, in the case of BPD the patient behaves destructively over a long period of time. In the field of psychological anomalies are such manifestations as:

aggressive behavior leading to problems in relationships,
unstable emotional background and inadequate self-image,
high anxiety,
total fear of loneliness and permanent feeling of boredom,
dichotomous thinking and changeable mood, dividing the world only into "black and white" (today I love, but tomorrow I hate).

Also among the main symptoms can be noted: sociopathy and fear of society associated with low self-esteem and, as a result, separation anxiety (it is experienced by a person when separated from home or loved ones). Patients often exhibit reckless irresponsible "risky" behavior, the extreme form of which may be self-harm or suicide attempt.

Types of spontaneous actions that accompany mental borderline personality disorders

Due to difficulties in self-identification, lack of one's own opinion and a tendency to polarity, spontaneous destructive actions are characteristic of BPD sufferers.

Panic fear of loneliness and lack of an inner core pushes them into contact with sociopathic personalities who are characterized by destructive behavior: gambling, theft, vandalism, promiscuous relationships, drug addiction. This also includes self-harm, which was mentioned above.

One of the reasons for this uncontrolled behavior is the problem with holding the inner impulse. The level of impulsivity is so high that a person is not able to control it.

Besherednichenko Andrey Nikolaevich

Chief physician of the Korsakov Medical Center network, psychiatrist-narcologist

Experience for more than 11 years

Consultation

Records for reception

Emotional unstable personality disorder in the ICD of the 10th review of the 10th review of the 10th review of the 10th review personality disorder is defined as "Emotionally unstable personality disorder (F60.3)". In the clinical community on the territory of the Russian Federation, this name is used quite often and is used due to the fact that the main symptom, as described above, manifests itself in the form of an emotionally unstable mental state of a person.

BPD pathogenesis

In the pathogenesis of the disease lies an incorrectly or incompletely formed intrapersonal self-awareness, in other words, “self-identification”. Border guards hardly realize how they relate to the main areas of life. They have problems with the concept of their opinions, interests, hobbies, and their character as well. Hence the more common definition of the disorder - "borderline". In this aspect, it means maneuvering on the verge between psychopathy and a stable state. The word "borderline" in a particular case means a precarious state between the norm and deviation, as if a person lives on the verge between "mental illness" (psychosis) and "mental health". That is why, the slang name for patients of this type is “borderliners” (from the English expression “border line”, which literally translates as “border”).

In classical psychiatry, borderline personality disorder is also classified as a type of ego syntonic disorder. Ego syntonicity implies that the patient does not assess his condition as painful, is not critical of him and calmly accepts deviations in behavior, not believing that they harm him in any way. Moreover, the patient, as it were, “defends” his symptom, preventing his own cure due to the difficulty in identifying his own “I”.

Causes of BPD

The underlying causes of BPD are currently not clearly defined, however, like most other disorders, BPD is caused by a group of factors.

Hereditary (genetic determinism), physiological (disturbances in the brain) and social factors (low stress resistance and psychological traumatic factor).

Unfavorable social environment

According to statistics, groups of people exposed to an unfavorable social environment, for example, in the family, are more susceptible to the disease. These include:

difficult childhood,
abuse,
tyranny,
physical or emotional domestic violence,
early loss of parents.

It is worth noting that "borderliness" occurs 3 times more often among women than among men.

Post-traumatic stress disorder (PTSD) , as a variation of an unfavorable social factor, can act not only as a cause, but also as a concomitant individual disease that is in a pathogenetic relationship with the diagnosis in question.

Childhood chronic emotional trauma can contribute to the development of BPD, but in rare cases it is the only cause. Personal qualities that are responsible for the ability to cope with a stressful situation in this aspect also play a big role. It is also worth noting here that, according to statistics, an injury received in childhood (especially before the age of 10) can lead to a subsequent disorder much more likely than an injury received at an older age. Also, scientists note that situations not associated with direct violence, such as natural disasters or catastrophes, are less likely to lead to the development of post-traumatic syndrome.

Physiology

Another group of factors considers a possible cause of the development of the disease - a disruption in the functioning of neural brain connections, namely the destruction of the functioning of the frontal limbic neurons

Heredity

diagnosis. It is quite difficult to achieve clear indicators in this vein, however, according to European studies, BPD is located in 3rd place out of 10 in terms of the genetic determinant among personality disorders. It is logical to note that deviations in the work of certain parts of the brain can be inherited and lead to a number of psychological problems, the development of which is aggravated by the social factor. Most studies show that most often borderlineness is transmitted from the mother.

Borderline state of the psyche in psychiatry and the severity of personality disorders

In clinical psychiatry, three levels of mental disorder are traditionally distinguished:

Neurotic . These include neuroses of a different nature, implying reversible temporary conditions that can be treated.
Psychopathic level . In its plane lie personality disorders, which include anomalies in the nature of various pathogenesis or painful changes in its features, with which nothing can be done, since they relate to the personality structure of the individual.
Finally, the deepest lesion of the psyche manifests itself at the psychotic level . This includes such manifestations as delirium, hallucinations, twilight consciousness.

Modern psychoanalysis distinguishes 4 levels of deviations. Between the state of psychosis and neurosis, it is conditionally located just “ borderline level”, also called borderline state . A borderline state can mean both the disorder itself and the designation of the level of mental damage.

How to reliably identify borderline personality disorder (BPD)

Borderline personality disorder is extremely difficult to diagnose and differentiate, as it has a high level of comorbidity, in other words, it is combined with a large number of concomitant disorders. For example, panic anxiety, eating disorders, bipolar affective disorder, attention deficit disorder, sociopathy, and so on. In connection with the above, the patient has to undergo a long diagnostic process and special tests.

Borderline personality disorder BPD test

One of the fairly popular tools for detecting the presence of psychopathy are tests, which are, in fact, a personality questionnaire. Used in modern clinical psychology, a test for screening for the bright signs of BPD was developed in 2012 by a group of scientists. In their work, the authors relied on the basic criteria for differentiating borderline disorder.

The questionnaire edited by them is a fairly effective tool for diagnostic verification and confirmation of symptoms. It is used both in psychiatric and general clinical, and in other practices that are not directly related to medicine.

The test itself consists of 20 questions and asks the subject to answer only yes or no. For each answer, the system counts a certain number of points. The probability of diagnosing BPD appears if the respondent scored more than 25 points.

Treatment of borderline personality disorder (BPD)

Cherednichenko Andrey Nikolaevich

Head physician of the network of medical centers "Korsakov", psychiatrist-narcologist

Experience over 11 years

Consultation

Appointment

Like most other mental disorders, borderline disorder is not treated at home and requires complex occupational therapy, including both medication (taking antidepressants and antipsychotics) and psychotherapy. And only a psychiatrist, often in tandem with a clinical psychologist, can competently develop an effective course of treatment.

The drug course is developed in accordance with the individual characteristics of the patient's body and includes the following drug groups:

Selective inhibitors of are aimed at preventing depressive episodes and reducing anxiety/panic/borderlines.
Mood stabilizers .
One of the most popular remedies is Lamotrigine. It is also used to neutralize depression, mood lability and impulsivity.
Atypical antipsychotics .
Now the 2nd generation of drugs of this cluster has already been developed, which have proven themselves well in neutralizing the symptoms of the cognitive sphere, such as: aggression, distortion of perception of reality, paranoia, dichotomy of thinking and disorganization.

As for the group of benzodiazepines and stimulants, they are used in modern therapy extremely rarely due to the high risk of dependence and, accordingly, overdose.

Thus, the main task of drug therapy in borderline personality disorder is to reduce the severity of symptoms and alleviate the general condition of the patient.

It is worth noting that BPD is the most difficult to treat due to the patient's ego syntony, which we discussed above. It is the patient with BPD who is the most difficult to respond to any therapy due to the rigidity of the psyche and the clear conviction that everything is generally normal with them.

However, when it comes to Selective Inhibitors, Dialectical Behavioral Therapy (DBT), one of the varieties of Cognitive Behavioral Therapy (CBT), is considered the most effective method in the modern clinical community. As part of the treatment, the patient is taught to look at the problem from different points of view and evaluate the causal relationship in different ways. Due to satisfaction with their symptoms and rigidity, "border guards" are difficult to treat, so the psychotherapeutic process can be lengthy.

Most often, relatives suffer the most from relationships with patients with BPD, so another parameter that the specialist works on is the patient's socialization and adaptation, aimed at developing basic life skills and developing an adequate behavior for the situation. In psychiatry, this type of technique is called STEPPS (System Training Emotional Predictability & Problem Solution) and in translation means Systematic Training in Emotional Predictability and Problem Solving.

One of the well-established methods are meditation techniques aimed at teaching a person to control their emotions and the ability to relax.

Another effective method when working with a psychotraumatic factor is the gelstat technique, during which the patient returns to a stressful situation and looks at it from the other side, rebuilding the scenario or acting it out again. The task of a specialist in this aspect is to remove the negative emotional charge from the memory.

Borderline personality disorder: symptoms, treatment, communication tips

What is it
Test
Symptoms
Causes and risk factors
Is it being treated
How to communicate with a person with BPD
Expert commentary

What is borderline personality disorder

Borderline personality disorder (BPD) inevitably affects how a person thinks and feels, how he interacts with others [1]. The diagnosis is recorded in the ICD-10 and is considered a subspecies of an emotionally unstable personality disorder. The disorder manifests itself in problems with self-esteem, the management of emotions and behavior, high anxiety and desocialization, and leads to unstable relationships with others. With borderline personality disorder, a person experiences a fear of being alone or abandoned. Misplaced anger, impulsiveness, frequent mood swings can alienate potential partners.

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Deviations are usually recorded in young people and may worsen with age. However, many patients diagnosed with BPD are able to live a full life, having worked through the main problems.

Borderline Personality Disorder Test

Some of the symptoms may point directly to BPD, but only the attending physician will give exact information. If you suspect you have a disorder, answer a few questions:

Do you have a fear of being alone that makes you act inappropriately? For example, constantly call a partner, try to be always near him.
Have you ever had to change your mind in relation to your partner, move from love to hate for no particular reason?
Have you ever felt that you do not have a clear idea of yourself, that you are not sure of your self-esteem?
Have you committed impulsive dangerous acts? For example, have you taken drugs, spent large sums of money recklessly, or had unprotected sex?
Have you harmed yourself, threatened suicide in the presence of loved ones?
Do you experience severe mood swings, from anxiety and irritability to days of depression and apathy?
Do you find it difficult to control your anger?
When you find yourself in a stressful situation, do you feel as if you are disconnected from reality and your own body, do not control your thoughts and behavior?

If you answered "yes" to more questions, it makes sense to talk to a therapist. Symptoms do not always point to borderline personality disorder and may be due to other health problems. Only a specialist can make a correct diagnosis and give competent advice.

Symptoms of borderline personality disorder

BPD affects how a person relates to himself and others, how he behaves in society. Signs and symptoms vary, there may be several, or just a couple from the list [2]:

Strong fear of being abandoned. A person is ready to go to extreme measures to avoid the real or imagined withdrawal or rejection of a partner.
Tendency to unstable relationships. For example, a person idealizes a partner, but at some point suddenly decides that the latter is cruel and unfair.
Rapid changes in self-identification and self-esteem. Goals and values switch disproportionately to the circumstances - abruptly and for no particular reason. A person tends to consider himself bad, he needs impulses from the outside in order to feel alive and needed.
Stress related paranoia. Loss of contact with reality lasting from several minutes to several hours.
Impulsive behavior, risk taking. Gambling, reckless driving, unsafe sex, alcohol abuse, overeating, drugs.
Sabotage of success. Sudden unreasonable rejection of positive relationships, good work.
Self-mutilation, suicidal tendencies. Often occur in response to separation anxiety or partner rejection.
Sudden mood swings lasting from several hours to several days. Bright, hypertrophied emotions: happiness, anxiety, shame and irritability.
Constant feeling of emptiness, lack of interest in what is happening.
Aggression - strong anger, cruel sarcastic remarks to interlocutors, fights.

Causes and risk factors

As with other mental health problems, the causes of borderline personality disorder are not fully understood. In addition to circumstances such as childhood abuse or neglect, borderline personality disorder may be associated with the following factors.

Genetics. Studies involving twins and their relatives suggest that BPD may be inherited and be part of a mental health complex [3].
Anomalies of the brain. Several studies have confirmed changes in certain parts of the brain involved in the regulation of emotions, especially impulsivity and aggression [4]. Patients with BPD may have malfunctions in the regulation of chemicals, such as the production of serotonin, which affects mood.

Is there a cure for borderline personality disorder

BPD is difficult to treat. But with the help of modern, evidence-based therapies, people with the disorder can be helped to manage their symptoms and improve their quality of life. It is good if the treatment is carried out by a licensed doctor who specializes in this disease. Sometimes the patient will need to interact not only with a psychiatrist, but also with a social worker who will help to adapt in the absence of loved ones.

The doctor usually conducts an interview and discusses the person's symptoms. Then there is a thorough medical examination and testing, which allows you to exclude other diseases. Comorbid disorders can make BPD difficult to diagnose and treat, especially if their symptoms overlap. For example, a person may show signs of depression, bipolar disorder, anxiety, substance use problems, or eating disorders. If a patient with borderline personality disorder does not receive proper treatment, they are more likely to develop chronic illnesses. And not only mentally, but also physically - patients with BPD tend to make choices in favor of an unhealthy lifestyle and self-harm.

Psychotherapy is the first line of treatment for a person with BPD. It can take place both individually and in a group. The second option helps the patient to interact with other people and express himself in society. Most often, the doctor uses one of two therapy options, or combines them:

Dialectical Behavioral Therapy (DBT). It uses the concepts of awareness and acceptance of the current situation and emotional state. DBT also teaches skills to control and reduce self-destructive behavior.
Cognitive behavioral therapy (CBT). This type of assistance allows you to identify and change the core beliefs that underlie inaccurate acceptance of yourself and others, as well as problems associated with communication.

Because their benefits are unclear, medications are not commonly used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat certain symptoms, such as controlling mood swings and depression. The psychotherapist should specialize in borderline personality disorder, that is, receive additional education in this area.

How to communicate with a person with BPD

People with BPD are often very suspicious and vulnerable. They need support, and it is important for them to realize that they have someone to turn to in case of exacerbations. Eliza Gordezki, a writer, artist and queer feminist with BPD, has developed a manual for interacting with people who have been diagnosed with BPD [5]. Here are the main recommendations.

Tell loved ones that you will take care of them.

People with BPD tend to think that if they don't hear this confirmation, then they are indifferent to those around them. Suitable phrases:

"Just writing to you to tell you I care about you."
"I wanted you to know that I'm thinking of you right now."
"I really like having you in my life and I wanted to make sure you knew that."

Take an interest in well-being and affairs

For people with BPD, this is a vicious circle: they are afraid of being rejected, so they do not share their experiences in order to eliminate the risks of negative reactions from others. Asking how you are doing is a good strategy for making contact.

“Hi, how are you?”
“I saw you posted a sad post on Facebook. I wanted to make sure you were okay."

Soften bad news with support and sympathy

When you tell your loved one some unpleasant information, try to remind him that he is important to you and that you will support him in any case. A person with BPD needs to be aware that his feelings are taken into account and not perceived as something feigned.

"It's not easy for me to support you in this crisis, but I need to know what to do to make it easier for you to deal with it."

Match words

Marsha Linehan, who developed the Dialectical Behavior Model (one of the most common treatments for people with BPD), uses specific vocabulary in her manuals [6]. Rather than characterize a person or their actions with judgmental words, she prefers adjectives such as "efficient, skillful, and wise" (or the reverse, "inefficient, inept, and unwise"). These words separate a person from his behavior, they name qualities that can be changed. If someone is being violent, negative, or insulting, you can say something like:

“I can see you're upset. I understand why you are upset, but these actions are very inefficient and will not bring you the desired results. Let's think together how we can achieve greater sense and achieve the desired prospects.

Compare this phrase with those that many people are used to using in similar situations: “It's not normal if you react like that!”, “It's impossible to communicate with you, there is too much drama”, “Why are you overreacting? You are always so sensitive!”

Be attentive to triggers

The only way to determine what is bothering a loved one is to ask and observe. Among people with BPD, two triggers are common (eng. trigger - a reason, a trigger; in psychology - an irritant that causes a certain reaction) - to be thrown and to be rejected. Simple situations that most people are used to can cause a strong negative reaction with borderline personality disorder. For example, if you reschedule a meeting or began to devote more time to other things, did not respond to a message for a long time, or forgot to call. Of course, changing plans is normal, but when communicating with a person with BPD, it is worth taking a little time to explain your actions to him:

“I remember that we planned to meet on Friday and have dinner together, and I'm sorry, but I have to cancel this meeting. I was assigned to make an urgent report, and I will be at work all evening. It will be great if, along with the cancellation of plans, you offer a quick alternative: “But I really want to spend time with you! Maybe we can meet on Saturday for lunch?

Repeat and confirm

People with BPD need to be reminded of your positive attitude. Frequent reinforcement and support is an important part of their well-being and confidence in the world. Be patient and focus on good moments, convince your loved one if he breaks into negative emotions, even if it seems to you that they are unreasonable. For example, your friend is upset that they don't reply to a message. At this point, he may seriously believe that the interlocutor hates him. Inform that this is not the case, most likely, the person is just busy, he will definitely write or call as soon as he has time.

What works well for one person may not work for another, so it's always best to talk to your loved ones and ask what they need.

Expert comment

Andrey Yudin, psychologist, Gestalt therapist, co-founder of Stemning Gestalt Center

It is not always possible to build relationships with a person with BPD [7]. But if it's not a destructive abusive relationship and it's important for you to keep the relationship going, you need to put in a lot of effort. First of all, set boundaries - when you can come or call, whether you can shout. Sometimes it can take years to rebuild, especially when it comes to older relatives. It will take a lot of labor and therapeutic support.

Borderline personality disorder is one of the three basic personality disorders in modern psychotherapy, the other two being schizoid and narcissistic. BPD is the most well studied and isolated, it is in the public eye due to its clinical manifestations. The disorder is included in the ICD-10, but the difficulty lies in the lack of uniform criteria for the diagnosis. There are three obvious signs of borderline personality disorder:

The person does not take care of himself. For example, he does not visit doctors, while experiencing guilt and shame for his choice. This factor applies to both hygiene and personal relationships.
Approach speed. People with BPD tend to quickly make contacts and just as quickly become disillusioned with new acquaintances, friends, and romantic relationships.
Extreme fear of rejection. If a person is afraid of being abandoned, being rejected by relatives, friends or partners, then this is a clear sign of BPD.

With BPD, there is a clear lack of self-activation - urging oneself to some kind of action. At the same time, it is difficult for a person to explain to himself why he cannot do this. Trying to rouse himself to action, he begins to worry. Borderline personality disorder begins in childhood, between 16 and 24 months. It is often the result of severe abuse, physical, emotional or sexual abuse, or a parent's negative response to a child's need for emotional closeness. In the case of premature separation, a mental structure is formed from two separate parts, which normally should be integrated into each other, but in BPD these are two separate modules.

BPD is often associated with drug addiction. Suffering, feelings of frustration, dissatisfaction encourage a person to chemically regulate his emotional state. This is alcohol, and drugs, and self-damaging behavior, and not only in relation to the body. For example, a person can spend all the money on payday.

With regard to BPD during adolescence, for this stage of human development, many of the "symptoms" are actually normal behavior. Severe emotional experiences, dulling the sense of self-preservation, experiments with substances and partners. But from the age of 16-18, when the transitional stage has been passed, the persistence of these signs may be a reason to contact a specialist.

Those close to people with BPD face, first of all, their emotional instability. The biggest difficulty is the chaotic influence on the lives of others. If a person with a narcissistic disorder extends his suspiciousness to the assessments of others, then with BPD people tend to have a different focus - love / not love, rejection / acceptance. A person may try to return the location of the partner or play ahead of the curve - break off the relationship, if he assumes that he may be abandoned. People with BPD may become abusers because of the unbearable emotional experiences they are trying to change in this way.

In the professional field, BPD can be suspected, for example, in rock stars. Moreover, the presence of such a feature for people in this profession will even be a plus. There will be a lot of life and pain in their work, it is very sincere and can be healing for other people.

If you encounter a person with BPD at work—a boss, a colleague, a subordinate—they are likely to have fairly loose boundaries because they find it difficult to set and maintain them. This may be a person who perfidiously treats other people's borders or, conversely, distances himself and avoids communication. People with BPD are very successful. Such bosses have reactive behavior, chaos in the department, and many will be uncomfortable. But there are qualities in BPD that are good for management: empathy, intuition, even being aggressive can be an asset for career advancement.

The diagnosis and treatment of borderline personality disorder requires a specific set of skills that are not taught in psychology departments, at least not in basic education programs. Most psychologists do not have such qualifications; a maximum of 10% of practicing specialists have it. Therefore, educational work is especially important so that people can find the understanding and support that are so needed. The peculiarity of therapy for BPD will be directed to the very two modules of consciousness (patterns) of the patient. A person with BPD may go to the doctor from their positive childhood pattern and talk about how well the treatment is working. He does this because he is used to being held in relationships in this way, he has learned that he must give positive emotional nourishment "so as not to be abandoned." The therapist must frustrate this pattern, help to go beyond it.

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