Help someone borderline personality disorder
Helping Someone with Borderline Personality Disorder
personality disorders
Have a loved one who's been diagnosed with BPD? While you can’t force them to seek treatment, you can take steps to improve communication, set healthy boundaries, and stabilize your relationship.
BPD and relationships
People with borderline personality disorder (BPD) tend to have major difficulties with relationships, especially with those closest to them. Their wild mood swings, angry outbursts, chronic abandonment fears, and impulsive and irrational behaviors can leave loved ones feeling helpless, abused, and off balance. Partners and family members of people with BPD often describe the relationship as an emotional roller coaster with no end in sight. You may feel like you're at the mercy of your loved one's BPD symptoms—trapped unless you leave the relationship or the person takes steps to get treatment. But you have more power than you think.
You can change the relationship by managing your own reactions, establishing firm limits, and improving communication between you and your loved one. There's no magic cure but with the right treatment and support, many people with BPD can and do get better and their relationships can become more stable and rewarding. In fact, patients with the most support and stability at home tend to show improvements sooner than those whose relationships are more chaotic and insecure.
Whether it's your partner, parent, child, sibling, friend, or other loved one with BPD, you can improve both the relationship and your own quality of life, even if the person with BPD isn't ready to acknowledge the problem or seek treatment.
Learning all you can
If your loved one has borderline personality disorder, it's important to recognize that he or she is suffering. The destructive and hurtful behaviors are a reaction to deep emotional pain. In other words, they're not about you. When your loved one does or says something hurtful towards you, understand that the behavior is motivated by the desire to stop the pain they are experiencing; it's rarely deliberate.
Learning about BPD won't automatically solve your relationship problems, but it will help you understand what you're dealing with and handle difficulties in more constructive ways.
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Recognizing the signs and symptoms of borderline personality disorder is not always easy. BPD is rarely diagnosed on its own, but often in conjunction with co-occurring disorders such as depression, bipolar disorder, anxiety, an eating disorder, or substance abuse. Your family member or loved one with BPD may be extremely sensitive, so small things can often trigger intense reactions.
Once upset, borderline people are often unable to think straight or calm themselves in a healthy way. They may say hurtful things or act out in dangerous or inappropriate ways. This emotional volatility can cause turmoil in their relationships and stress for family members, partners, and friends.
Many people in a close relationship with someone who suffers from BPD often know that there’s something wrong with their loved one, but have no idea what it is or if there is even a name for it. Learning a diagnosis of borderline personality disorder can come as a source of both relief and hope.
Does your loved one have borderline personality disorder?
In your relationship:
- Do you feel like you have to tiptoe around your loved one, watching every little thing you say or do for fear of setting them off? Do you often hide what you think or feel in order to avoid fights and hurt feelings?
- Does your loved one shift almost instantaneously between emotional extremes? For example, are they calm one moment, raging the next, then suddenly despondent? Are these rapid mood swings unpredictable and seemingly irrational?
- Does your loved one tend to view you as all good or bad, with no middle ground? For example, either you're “perfect,” and the only one they can count on, or you're “selfish” and “unfeeling” and never truly loved them.
- Do you feel like you can't win: that anything you say or do will be twisted and used against you? Does it feel as if your loved one's expectations are constantly changing, so you're never sure how to keep the peace?
- Is everything always your fault? Do you feel constantly criticized and blamed for things that don't even make sense? Does the person accuse you of doing and saying things you never did? Do you feel misunderstood whenever you try to explain or reassure your partner?
- Do you feel manipulated by fear, guilt, or outrageous behavior? Does your loved one make threats, fly into violent rages, make dramatic declarations, or do dangerous things when they think you're unhappy or may leave?
If you answer “yes” to most of these questions, your partner or family member might have borderline personality disorder.
[Read: Borderline Personality Disorder Test]
To help someone with BPD, first take care of yourself
When a family member or partner has borderline personality disorder, it's all too easy to get caught up in heroic efforts to please and appease him or her.
You may find yourself putting most of your energy into the person with BPD at the expense of your own emotional needs. But this is a recipe for resentment, depression, burnout, and even physical illness.
You can't help someone else or enjoy sustainable, satisfying relationships when you're run down and overwhelmed by stress. As in the event of an in-flight emergency, you must “put on your own oxygen mask first.”
Avoid the temptation to isolate. Make it a priority to stay in touch with family and friends who make you feel good. You need the support of people who will listen to you, make you feel cared for, and offer reality checks when needed.
You're allowed (and encouraged) to have a life! Give yourself permission to have a life outside of your relationship with the person with BPD. It's not selfish to carve out time for yourself to relax and have fun. In fact, when you return to your BPD relationship, you'll both benefit from your improved perspective.
Join a support group for BPD family members. Meeting with others who understand what you're going through can go a long way. If you can't find an in-person support group in your area, you may want to consider joining an online BPD community.
Don't neglect your physical health. Eating healthfully, exercising, and getting quality sleep can easily fall by the wayside when you're caught up in relationship drama. Try to avoid this pitfall. When you're healthy and well rested, you're better able to handle stress and control your own emotions and behaviors.
Learn to manage stress. Getting anxious or upset in response to problem behavior will only increase your loved one's anger or agitation. By practicing with sensory input, you can learn to relieve stress as it's happening and stay calm and relaxed when the pressure builds.
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Remember the 3 C's rule
Many friends or family members often feel guilty and blame themselves for the destructive behavior of the borderline person.
You may question what you did to make the person so angry, think you somehow deserve the abuse, or feel responsible for any failure or relapse in treatment.
But it's important to remember that you're not responsible for another person. The person with BPD is responsible for their own actions and behaviors.
The 3 C's are:
- I didn't cause it.
- I can't cure it.
- I can't control it.
Source: Out of the Fog
Communicating with someone who has BPD
Communication is a key part of any relationship but communicating with a borderline person can be especially challenging. People in a close relationship with a borderline adult often liken talking with their loved one to arguing with a small child. People with BPD have trouble reading body language or understanding the nonverbal content of a conversation. They may say things that are cruel, unfair, or irrational. Their fear of abandonment can cause them to overreact to any perceived slight, no matter how small, and their aggression can result in impulsive fits of rage, verbal abuse, or even violence.
The problem for people with BPD is that the disorder distorts both the messages they hear and those they try to express. BPD expert and author, Randi Kreger, likens it to “having ‘aural dyslexia,' in which they hear words and sentences backwards, inside out, sideways, and devoid of context.”
Listening to your loved one and acknowledging their feelings is one of the best ways to help someone with BPD calm down. When you appreciate how a borderline person hears you and adjust how you communicate with them, you can help diffuse the attacks and rages and build a stronger, closer relationship.
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Communication tips
It's important to recognize when it's safe to start a conversation.
If your loved one is raging, verbally abusive, or making physical threats, now is not the time to talk. Better to calmly postpone the conversation by saying something like, “Let's talk later when we're both calm. I want to give you my full attention but that's too hard for me to do right now.”
When things are calmer:
Listen actively and be sympathetic. Avoid distractions such as the TV, computer, or cell phone. Try not to interrupt or redirect the conversation to your concerns. Set aside your judgment, withhold blame and criticism, and show your interest in what's being said by nodding occasionally or making small verbal comments like “yes” or “uh huh.” You don't have to agree with what the person is saying to make it clear that you're listening and sympathetic.
Focus on the emotions, not the words. The feelings of the person with BPD communicate much more than what the words he or she is using. People with BPD need validation and acknowledgement of the pain they're struggling with.
Listen to the emotion your loved one is trying to communicate without getting bogged down in attempting to reconcile the words being used.
Try to make the person with BPD feel heard. Don't point out how you feel that they're wrong, try to win the argument, or invalidate their feelings, even when what they're saying is totally irrational.
Do your best to stay calm, even when the person with BPD is acting out. Avoid getting defensive in the face of accusations and criticisms, no matter how unfair you feel they are. Defending yourself will only make your loved one angrier. Walk away if you need to give yourself time and space to cool down.
Seek to distract your loved one when emotions rise. Anything that draws your loved one's attention can work, but distraction is most effective when the activity is also soothing. Try exercising, sipping hot tea, listening to music, grooming a pet, painting, gardening, or completing household chores.
Talk about things other than the disorder. You and your loved one's lives aren't solely defined by the disorder, so make the time to explore and discuss other interests. Discussions about light subjects can help to diffuse the conflict between you and may encourage your loved one to discover new interests or resume old hobbies.
Don't ignore self-destructive behaviors and suicidal threats
If you believe your loved one is at an immediate risk for suicide Do NOT leave the person alone. Call your loved one's therapist or:
- In the U.S., dial 911 or call the National Suicide Prevention Lifeline at 1-800-273-TALK.
- In other countries, call your country's emergency services number or visit IASP to find a suicide prevention helpline.
Setting healthy boundaries with a borderline loved one
One of the most effective ways to help a loved one with BPD gain control over their behavior is to set and enforce healthy limits or boundaries.
Setting limits can help your loved one better handle the demands of the outside world, where schools, work, and the legal system, for example, all set and enforce strict limits on what constitutes acceptable behavior.
Establishing boundaries in your relationship can replace the chaos and instability of your current situation with an important sense of structure and provide you with more choices about how to react when confronted by negative behavior. When both parties honor the boundaries, you'll be able to build a sense of trust and respect between you, which are key ingredients for any meaningful relationship.
Setting boundaries is not a magic fix for a relationship, though. In fact, things may initially get worse before they get better. The person with BPD fears rejection and is sensitive to any perceived slight. This means that if you've never set boundaries in your relationship before, your loved one is likely to react badly when you start. If you back down in the face of your loved one's rage or abuse, you'll only be reinforcing their negative behavior and the cycle will continue.
But, remaining firm and standing by your decisions can be empowering to you, benefit your loved one, and ultimately transform your relationship.
How to set and reinforce healthy boundaries
Talk to your loved one about boundaries at a time when you're both calm, not in the heat of an argument. Decide what behavior you will and will not tolerate from the person and make those expectations clear. For example, you may tell your loved one, “If you can't talk to me without screaming abuse at me, I will walk out.”
Do…
- Calmly reassure the person with BPD when setting limits. Say something like, “I love you and I want our relationship to work, but I can't handle the stress caused by your behavior. I need you to make this change for me.”
- Make sure everyone in the family agrees on the boundaries—and how to enforce the consequences if they're ignored.
- Think of setting boundaries as a process rather than a single event. Instead of hitting your loved one with a long list of boundaries all at once, introduce them gradually, one or two at a time.
Don't…
- Make threats and ultimatums that you can't carry out. As is human nature, your loved one will inevitably test the limits you set. If you relent and don't enforce the consequences, your loved one will know the boundary is meaningless and the negative behavior will continue. Ultimatums are a last resort (and again, you must be prepared to follow through).
- Tolerate abusive behavior. No one should have to put up with verbal abuse or physical violence. Just because your loved one's behavior is the result of a personality disorder, it doesn't make the behavior any less real or any less damaging to you or other family members.
- Enable the person with BPD by protecting them from the consequences of their actions. If your loved one won't respect your boundaries and continues to make you feel unsafe, then you may need to leave. It doesn't mean you don't love them, but your self-care should always take priority.
Supporting your loved one's BPD treatment
Borderline personality disorder is highly treatable, yet it's common for people with BPD to avoid treatment or deny that they have a problem.
Even if this is the case with your loved one, you can still offer support, improve communication, and set boundaries while continuing to encourage your friend or family member to seek professional help.
While medication options are limited, the guidance of a qualified therapist can make a huge difference to your loved one's recovery. BPD therapies, such as Dialectical Behavior Therapy (DBT) and schema-focused therapy, can help your loved one work through their relationship and trust issues and explore new coping techniques. In therapy, they can learn how to calm the emotional storm and self-soothe in healthy ways.
How to support treatment
If your loved one won't acknowledge that they have a problem with BPD, you may want to consider couple's therapy. Here, the focus is on the relationship and promoting better communication, rather than on your loved one's disorder. Your partner may more readily agree to this and eventually consider pursuing BPD therapy in the future.
Encourage your loved one to explore healthy ways of handling stress and emotions by practicing mindfulness and employing relaxation techniques such as yoga, deep breathing, or meditation. Sensory-based stimulation can also help them to relieve stress in the moment. Again, you can participate in any of these therapies with your loved one, which can strengthen your bond and may encourage them to pursue other avenues of treatment as well.
By developing an ability to tolerate distress, your loved one can learn how to press pause when the urge to act out or behave impulsively strikes. HelpGuide's free Emotional Intelligence Toolkit offers a step-by-step, self-guided program to teach your loved one how to ride the “wild horse” of overwhelming feelings while staying calm and focused.
Setting goals for BPD recovery: Go slowly
When supporting your loved one's recovery, it's important to be patient and set realistic goals. Change can and does happen but, as with reversing any kind of behavior pattern, it takes time.
- Take baby steps rather than aiming for huge, unattainable goals that set you and your loved one up for failure and discouragement. By lowering expectations and setting small goals to be achieved step by step, you and your loved one have a greater chance of success.
- Supporting your loved one's recovery can be both extremely challenging and rewarding. You need to take care of yourself, but the process can help you grow as an individual and strengthen the relationship between you.
Authors: Melinda Smith, M.A, Lawrence Robinson, and Jeanne Segal, Ph.D.
- References
Personality Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association.
https://doi.org/10.1176/appi.books.9780890425787.x18_Personality_DisordersChoi-Kain, Lois W., Ellen F. Finch, Sara R. Masland, James A. Jenkins, and Brandon T. Unruh. “What Works in the Treatment of Borderline Personality Disorder.” Current Behavioral Neuroscience Reports 4, no. 1 (March 1, 2017): 21–30. https://doi.org/10.1007/s40473-017-0103-z
Stoffers-Winterling, Jutta M., Birgit A. Völlm, Gerta Rücker, Antje Timmer, Nick Huband, and Klaus Lieb. “Psychological Therapies for People with Borderline Personality Disorder.” Cochrane Database of Systematic Reviews, no. 8 (2012). https://doi.org/10.1002/14651858.CD005652.pub2
Kulacaoglu, Filiz, and Samet Kose. “Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe.” Brain Sciences 8, no. 11 (November 18, 2018): 201. https://doi.org/10.3390/brainsci8110201
Bozzatello, Paola, Silvio Bellino, Marco Bosia, and Paola Rocca. “Early Detection and Outcome in Borderline Personality Disorder.
” Frontiers in Psychiatry 10 (2019): 710. https://doi.org/10.3389/fpsyt.2019.00710Ripoll, Luis H. “Psychopharmacologic Treatment of Borderline Personality Disorder.” Dialogues in Clinical Neuroscience 15, no. 2 (June 2013): 213–24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811092/
Ng, Fiona Y. Y., Marianne E. Bourke, and Brin F. S. Grenyer. “Recovery from Borderline Personality Disorder: A Systematic Review of the Perspectives of Consumers, Clinicians, Family and Carers.” PLOS ONE 11, no. 8 (August 9, 2016): e0160515. https://doi.org/10.1371/journal.pone.0160515
Sutherland, Ruth, John Baker, and Sharon Prince. “Support, Interventions and Outcomes for Families/Carers of People with Borderline Personality Disorder: A Systematic Review.” Personality and Mental Health 14, no. 2 (2020): 199–214. https://doi.org/10.1002/pmh.1473
Angstman, Kurt, and Norman H. Rasmussen. “Personality Disorders: Review and Clinical Application in Daily Practice.
” American Family Physician 84, no. 11 (December 1, 2011): 1253–60. https://www.aafp.org/afp/2011/1201/p1253.html
Borderline Personality Disorder – Overview of symptoms, causes, and treatment. (National Institute of Mental Health)
Borderline Personality Disorder (BPD) –Explains borderline personality disorder (BPD) including possible causes, how you can access treatment and support, and tips for helping yourself. (Mind)
What is Dialectical Behavior Therapy (DBT)? – A comprehensive article with ten shot videos. (Behavioral Tech)
Last updated: November 15, 2022
Supporting Someone with Borderline Personality Disorder
JUN. 23, 2017
By Luna Greenstein
“The things I struggle with the most are the feelings of abandonment, feeling like people are always mad at me, the self-hatred and self-harm.” says Katie, who lives with Borderline Personality Disorder (BPD). You might notice these symptoms are all related to relationships—with others and herself.
This is not a coincidence.
Intense relationships, fraught with conflict, are the hallmark of BPD. And while it’s difficult for someone with BPD to develop, manage and keep meaningful relationships, it’s essential for them to have support and encouragement for recovery.
So, for those helping a loved one manage their BPD: Yes, their symptoms will most likely affect you and your relationship won’t always be easy. However, it’s important to keep in mind that BPD is not an easy mental illness to experience either. Your stable, reassuring presence in the life of someone experiencing BPD can help them get better. Here are some suggestions on how to further provide effective support, straight from people who live with BPD.
Encourage and Understand Treatment
BPD is not an easy condition to treat, but it is treatable. There are specific options designed for this condition, such as Dialectical Behavior Therapy (DBT). Help your loved one enter and/or stay in treatment.
Once they are in treatment, learn the language of that program and use it to offer support in times of need. For example: Learn the basics of the four skills of DBT—mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation—and how you can help your loved one practice them.
Show You Appreciate Your Loved One
Someone with BPD may go out of their way to do things for you and make you happy because they want to receive love and affirmation in return. Relationships can become turbulent when a person with BPD feels unappreciated: “If we don’t get the recognition we think we deserve, then we’ll start to feel like we hate [the people we love], because they didn’t give you that feeling that you had helped them or did what they wanted,” says Katie. You can combat this by showing your loved one you appreciate them and the things they do to make you happy. Individuals living with BPD are often looking for honest validation and love—so if you feel it, be open about it.
Be Prepared for Mixed Messages
A person with BPD can go from loving and adoring you (idealization) to being furious and “hating” you (devaluation) in a matter of hours. Even when they do “hate” you, they will still carry an overwhelming fear that you will abandon them. “My relationships were very volatile…I was terrified people wouldn’t listen to me, or understand me, or that they would just leave me,” says Robert about his onset of BPD.
When these fears arise, be ready to offer comfort with a meaningful reassurance: “I understand that your feelings are overwhelming right now; I understand that you feel afraid that I will leave you. But I won’t. We will get through this and I support you.”
Be Responsive
When a person with BPD is trying to reach out or contact you, it’s helpful to be as responsive as possible. If a friend or loved one doesn’t respond, a person with BPD can feel rejected and internalize that as something being “wrong” with them. As Katie describes it, “Everybody needs to be there for you and everybody needs to love you.
And if they don’t, then you start blaming them, but you also start hating yourself. You start thinking, ‘What did I do to keep them from liking me?’”
This can lead to self-hatred and destructive behaviors. It’s very difficult for a person with BPD to handle conflict or rejection because they blame and punish themselves. This is one of the reasons why self-harm is often associated with BPD; 75% of people with BPD will cut, burn, bruise, bite or hurt themselves in some way. This is not to say it’s your fault if a person self-harms, but being responsive and kind can make all the difference.
Understand It’s Not Their Fault
BPD is known to add immense stress to relationships. It can be challenging—even impossible—for a person to manage their symptoms in a way that doesn’t affect the people close to them. So when symptoms do flare, remember that they don’t have control—literally. This condition is defined by its lack of regulation, or control, over emotions, thoughts and behavior.
You wouldn’t blame a loved one for having cancer symptoms that might spill into everyday life, so don’t blame someone for having a mental illness with active symptoms.
Laura Greenstein is communications coordinator at NAMI.
We’re always accepting submissions to the NAMI Blog! We feature the latest research, stories of recovery, ways to end stigma and strategies for living well with mental illness. Most importantly: We feature your voices.
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Help for people with borderline personality disorder //Psychological newspaper
Psychologists and psychotherapists are often approached by people who, in the process of psychodiagnostics and initial interviews, have borderline personality disorder or "emotionally unstable personality disorder" according to ICD-10. What are its signs? How is life for people with page personality disorder? What do experts think about healing? What self-help techniques can people with BPD use in difficult situations? I will talk about this in the article.
Borderline personality disorder (BPD) is a group of personality disorders characterized by self-injurious behavior and difficulties in interpersonal relationships. Some people characterize BPD as "the apocalypse."
I highlight such signs of BPD as: constant anxiety, people with BPD may be anxious because of the crises that accompany their lives, changing events. Often there is an alarming suspiciousness in connection with the state of health. Anxiety leads to psychosomatic illnesses, which reinforces the "vicious circle" - going to the doctors. Anxiety is associated with fear in the lives of people with BPD. A lot of things can scare them, these are new relationships, and intimacy, and parting, and other situations. Numerous spheres of life of people with BPD are “saturated” with fear, as in children aged 3-5 years, who are prone to various fears and anxieties. Especially fear and suspicion can increase in situations of stress. People with BPD have low self-esteem.
It is as if a constant critic, distinguished by self-criticism, “sits” inside, and self-doubt and doubts are born from this.
It is worth noting that it is difficult for people with BPD to answer the question: “who am I?”, “What do I want?”, The so-called diffuse identity manifests itself, where there are no strong goals, values and beliefs. When there is a series of events associated with parting with a loved one, with failures in work or in the sphere of relationships with others, which is typical for people with BPD due to emotional instability, emotional or mental pain arises - it resembles an uncomfortable feeling inside, close to despair. People with BPD may have problems controlling their emotions, which manifests itself in uncontrollable anger and anger, chronic conflicts with others. It is very difficult for them to be in a relationship with one partner for a long time, therefore, changes often occur in relationships, even some chaos, the search for more and more new partners.
People with BPD tend to change jobs frequently. The work book is literally teeming with notes about various organizations in which I had to work. As a result, they may face certain difficulties in finding employment in the future. The litmus test for BPD in people's behavior is self-harm and suicide. At the same time, self-harm can manifest itself in different ways, from suicidal attempts to masochistic tendencies in behavior, when people with BPD want the other person to scold, offend, hurt. For some people with BPD, various kinds of addictions are characteristic, for example, alcoholism, drug addiction, gambling, Internet addiction. People with BPD are characterized by unreasonable spending of money, risky driving, and promiscuity. Often, after traumatic events, there may be problems with sleep, nightmares, obsessive thoughts about unpleasant situations, memories that disturb and do not allow you to live in peace. In general, the signs of BPD are characterized by polymorphism, and behavioral patterns - by a variety of manifestations.
You can describe borderline personality disorder with the word: INSTABILITY, where:
N - hate. People with BPD are characterized by a feeling of hatred as a long, intense, negative feeling, reflecting disgust, hostility, rejection of someone.
E - Yeralash. Characterized by disorder, confusion, confusion. Chaotic interpersonal, incl. intimate relationships, lack of structure.
C - Self harm. Among people with BPD, there are suicide attempts, cutting, poisoning, self-harm with the help of other people in interpersonal relationships, self-infliction of pain.
T - Spending. Unreasonable spending of money on unnecessary purchases, unreasonable expenditure of effort.
A - Ambivalence. Opposite feelings in a short amount of time. For example, love and hate.
B - Pain. Characterized by mental pain with repeated unsuccessful attempts, for example, in building interpersonal relationships, employment, etc.
I - Idealization. The tendency to idealize other people and depreciate them after a short period of time.
L - Lie. People with BPD are prone to deceit, lies, embellishment of reality.
N - Troubles. People with BPD often find themselves in conflict situations, quarrels, unfriendly relationships.
Oh - emptiness. People with BPD often feel empty inside, lack of interest.
S - Boredom. A feeling of boredom, a decrease in activity, a lack of prolonged interest in any activity, the world around and other people are characteristic.
T - Branding, branding. They often brand themselves. After hospitalization in a hospital, they feel the stigma of the mentally ill, acutely experience such a state, and isolate themselves.
INSTABILITY characterizes the lives of people with BPD, these are interpersonal relationships, and situations related to employment, and mood, and behavior in general.
Expert opinions on borderline personality disorder
Anton Yezhov, PhD in Psychiatry. Institute of Neurology, Psychiatry and Narcology of the Academy of Sciences of Ukraine, Kharkiv, full member of the Russian Psychotherapeutic Association, certified and accredited by the Moscow Gestalt Institute (according to the standards of the European Association of Gestalt Therapists).
- Anton Vladimirovich, what is borderline personality disorder?
- In ICD-10: F60.3 it is “Emotionally labile personality disorder. Impulsive and borderline type. With borderline character disorder ( BPD), patients generally test reality, however, during diagnosis, there may be a slight distortion in the description of events occurring with the patient, as a result of a poorly developed ability for reflection, mentalization, the impact of strong affects and primitive defenses on cognitive processes. In some cases, there may be quasi-psychotic episodes in the form of short paranoid reactions, usually provoked by any dual and uncertain situation, as well as episodes of dissociation. But, as a rule, all these phenomena do not develop into stable delusional and hallucinatory symptoms. Patients with PPH also have a rather high suicidal risk, but the main motive is most often a demonstrative protest, jealousy, a desire to “punish” a partner and make him feel guilty.
In PPH, rage, hatred, resentment dominate in suicidal behavior. Auto-aggressive actions are usually performed impulsively, at the peak of affect, often in a demonstrative style.
- How can BPD be corrected?
- In the therapy of CPH, the pathogenetic is long-term psychotherapy focused on the client-therapeutic relationship - this is the main type of treatment! Pharmacotherapy acts as a maintenance therapy. Drugs in the treatment of BPH include selective serotonin reuptake inhibitors, low dose antipsychotics, and mood stabilizers. The general approach in the pharmacotherapy of BPH is to reduce the unnecessary use of medications (!), medicating the target symptoms with an understanding of pharmacodynamics.
Irina Mlodik, Ph.D. in Psychology, psychologist, Gestalt therapist, existential psychotherapist, author of books and articles on child and adult practical psychology, author's training courses.
- Irina Yurievna, please tell me, is it possible to recover from borderline personality disorder?
- About the treatment: it's hard to say.
I do not have a psychiatric, not a medical position on this matter. I believe that in each of us there can be a borderline arranged and borderline functioning part. In that sense, there's no cure for the way you're made. One can only reduce the consequences of border effects. Including and mainly with the help of high-quality and long-term, for example, humanistically oriented or analytical psychotherapy. Long-term and regular therapy creates a special type of relationship with the therapist, which allows, being in high-quality and constant contact: to live through many difficult and not processed by the psyche affects from childhood, to create and maintain with the help of therapeutic contact an important, permanent, uninterrupted connection with the therapist (which there was almost certainly no person with BPD), who becomes an important “adult” in the life of a “border guard” who can be relied upon. Subsequently, from relying on the connection and the figure of the therapist, inside and the person with BPD, other relationships grow both inside themselves (to their internal objects) and outside, they have the opportunity to maintain closeness not only with the therapist, but also with other people and build with them a long-term relationship.
Affects become rarer, not so amplitude, endurable. There is an opportunity to know one’s own painful places better, take care of oneself more, be less exposed to destructive relationships and processes, better understand one’s reactions, features and manifestations, learn to treat oneself like this in the world of people, sometimes explaining to them one’s own characteristics and properties.
Advice for People with BPD to Use in a Crisis
Calming an emotional storm
Stop fighting, avoiding, repressing, or denying what you are feeling. Give yourself permission to feel, this will take away the power of feelings over you. Try to simply experience your feelings without judgment or criticism.
Awareness
Let go of the past and the future, focus solely on the present moment. Mindfulness techniques can be very effective in this regard.
• Start by observing your emotions, step back and just observe them.
• Watch them come and go (it can help to think of them as waves that come and go).
• Focus on physical sensations that are accompanied by emotions.
• Tell yourself that you accept your emotions, accept what you feel right now.
• Remind yourself that just because you feel something doesn't mean it's real.
Do something to change your bad feelings
You will need to experiment to find out what works best for you. What can help when you are angry or have very strong feelings, when you are depressed, etc.
Some ideas for working on yourself
Tactile sensations . Try running your hand in cold or hot (but not scalding) water; hold a piece of ice in your hand; grab the edge of the piece of furniture as hard as you can. If you're feeling anxious and need to calm down, try taking a hot bath or shower; cover yourself with a blanket or cuddle with a pet.
Taste . If you feel empty or bored inside, try putting strong flavored sweets or mints in your mouth, slowly eating something with an intense taste, such as something salty.
If you want to calm down, try something calming like hot tea or soup.
Smell . Light a candle, smell the flowers, try aromatherapy, spritz on your favorite perfume, or smell something that smells good in the kitchen. You may find you respond best to strong odors such as citrus, spices, etc.
Landmark . Focus on an image that grabs your attention. It could be something in your immediate environment (a great view, a beautiful flower, the location of a building, a favorite painting or photo) or something you imagine.
Sound . Try listening to loud music or a bell or whistle when you need a boost. To calm down, play soothing music or listen to soothing sounds of nature such as the wind, birds, or the ocean. The sound of a car can help a lot if you can't hear something more real.
Need to reduce emotional vulnerability
You are more likely to experience negative emotions when you are stressed. That is why it is very important to take care of your physical and mental well-being.
Take care of yourself :
- Avoid drugs.
- Eat a balanced, nutritious diet.
- Sleep well and rest.
- Practice self-help skills regularly.
- Minimize stressful situations.
- Practice relaxation techniques.
Basic methods of psychotherapy for BPD
- Dialectical Behavioral Therapy (DBT).
- Schematic (schematic) therapy.
- Psychotherapy based on mentalization (MBT).
- Transference-Focused Psychotherapy (TFP) is a psychotherapy focused on the analysis of transference.
Borderline personality disorder is not a sentence. Change is possible if there is a desire to change and improve the quality of life. I hope this article has helped you better understand the structure and manifestations of BPD, as well as approaches to psychotherapeutic treatment and self-help methods in a difficult situation.
How to live with borderline personality disorder
Daria Batyrshina
lives with BPD
Author profile
I could not get a correct diagnosis for several years, and then it completely changed my life.
To describe borderline personality disorder, or BPD, psychologist Marsha Linehan's well-known statement is perfect: “These people simply don't have 'emotional skin'. Even the slightest touch or movement can cause the most severe suffering.”
Sharing my path to a correct diagnosis, symptoms, and tips for dealing with people with BPD.
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Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.
What is borderline personality disorder
Borderline personality disorder is characterized by permanent changes in mood, self-image and behavior. This can lead to problems in relationships with other people and impulsive actions of all kinds.
BPD - Mayo Clinic
BPD - National Institute of Mental Health, USA
In the International Classification of Diseases 10th Revision, or ICD-10, there is in fact no diagnosis of "borderline personality disorder", there is an emotionally unstable personality disorder, which two types: borderline and impulsive.
In ICD-11, this is already a separate diagnosis, which is called borderline personality disorder.
The disorder has several main features.
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Self-injurious and risky behavior. For example, a person may injure themselves or use psychoactive substances - borderline disorder increases the risk of developing various addictions.
Black and white thinking: it seems to a person that there can only be good and bad, there are no halftones.
Criteria for diagnosing BPD - Medscape
Problems with self-esteem. People with this disorder are overly sensitive to the opinions of others, enter into dependent relationships, have a strong fear of being alone, and may take desperate actions to keep a loved one or get their attention.
The manifestations of borderline personality disorder are similar to those of adolescence: outbursts of anger, mood swings, aloofness, so this diagnosis is made after 18 years.
What are the symptoms of borderline personality disorder
Alexey Pribytkov
psychotherapist, psychiatrist, Ph.D. It happened.
For example, the partner did not respond to the message. Why borderline personality disorder develops
Why borderline personality disorder develops is not exactly known.
NHS
Biological factors. There is evidence that the development of personality disorders, including BPD, may depend on genetic factors.
BPD may also be associated with changes in some parts of the brain responsible for controlling emotions. Its development can be affected by disturbances in the functioning of the system of neurotransmitters - compounds with the help of which brain neurons communicate with each other, in particular serotonin.
Social factors. For example, unstable relationships with significant adults, lack of love in childhood, neglect by parents, loss of a loved one.
Emotional or physical abuse, as well as intense fear experienced in childhood, greatly increase the risk of any psychological problems. In this case, BPD can be combined with another diagnosis - post-traumatic stress disorder, or PTSD. It is manifested by constant frightening memories of a traumatic event and increased anxiety. The more unstable the environment around and the more traumatized the child, the more likely it is to get PTSD.
How I treated depression and anxiety for several years
I first saw a doctor almost eight years ago. I had an eating disorder - it often accompanies BPD, but I didn't know about it yet.
My gastroenterologist at some point realized that my constant pain in the abdomen was most likely not related to physical problems, but to mental ones. My mother took me to a government clinic, where I came across incompetent doctors.
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The psychiatrist said that I have anorexia, I look terrible and I won't be able to find a partner because "men don't throw bones." Then I realized that it was not worth waiting for help from him.
I coped with eating disorders myself, having lived through all the stages from anorexia to bulimia and compulsive overeating in two years. After solving the problem with food, depression came. Here, I couldn't manage on my own.
My days were similar to each other: constant fatigue, apathy, I didn’t have enough strength even to eat and brush my teeth, and there was only fog in my head and no thoughts. My circle of contacts narrowed greatly, because those around me saw only aggression or received no answers at all. So several years passed, then I realized that I needed help.
On the Profi-ru website, I found a psychologist who lived next to me. Then I did not yet know how psychiatrists differ from psychologists and psychotherapists, so I did not receive the necessary help.
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How to choose a psychotherapist
Psychologists usually do not work with mental disorders, besides, in the sessions I just told what was bothering me, there was no other support. Sometimes I couldn't find words and we just kept silent.
I went to the specialist for about a month and paid 1300 R for each meeting. In total, we held nine meetings. The only thing I got was the fog left my head. Despite my condition and the fact that the psychologist could not do anything about it, she persuaded me to stay in therapy. She said that it helps, although I did not feel any relief.
11,700 Р
I spent on a psychologist who did not help me
As a result, I did not want to spend more money on myself and lost confidence in doctors. Then I learned that in Moscow you can get free psychological help at the Moscow Service for Psychological Assistance to the Population.
Moscow Service for Psychological Assistance to the Population
I had to wait for an appointment, but I had nowhere to hurry. About six months later, I was able to get to a psychologist. I told her what worries me - at that time they were symptoms of depression and apathy. She immediately said that I should talk to a psychotherapist, and I made an appointment with another specialist in the same clinic.
The psychotherapist referred me to a psychiatrist, suggesting several doctors she trusts. She said that I most likely had depression and needed medication. Psychiatrists are not accepted at MSPPN, so I went to a private clinic, where I had to pay 4000 R for an appointment.
The amount of free help in the ISPP is limited, but enough to get you started. Source: MSPPN A psychiatrist at a private clinic diagnosed me with depression, prescribed an antidepressant and a tranquilizer. I was lucky that my doctor saw not only in a private clinic, but also in a state one, so I went to all subsequent appointments for free.
The second time I managed to find the right medicines. We fixed the changes not only with the help of conversations. The psychiatric clinic had a simulator on a computer, where the patient was asked to pass several tests: attentiveness, reaction speed, the ability to distinguish faces, and much more. I took tests at intervals of about once a month.
This testing is not necessarily and does not always reflect the effectiveness of the treatment, but I liked that the results got better every time. At that time, about 1,500 R per month was spent on medicines.
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During the same period, I tried cognitive behavioral therapy. In a year I started and quit three times, nothing worked out for me. The mood diary was empty, because I do not distinguish between emotions, the diary of situations that concern me and their analysis, too. I did not understand why this or that situation became important to me.
In total, I had five meetings with a psychotherapist, the cost of one was 3000 R.
At that time, the doctor and I did not yet know that I had more than just depression with panic attacks and anxiety, so we did not follow my emotions and feelings much, which is important in BPD.
At some point, I abruptly stopped taking the prescribed pills and coped with the withdrawal syndrome for another week. I refused the pills, because it seemed that I could manage without them, besides, they helped for a short time, then everything started all over again.
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A month or two after the withdrawal, I felt fine and even started to exercise. Then anxiety and depression symptoms returned, I suffered for a few more months and went to a new doctor.
Over the next year and a half or two, I changed three doctors in one private clinic, I was prescribed different types of medicines in different combinations and dosages.
Primary appointments cost 4000-5000 R, repeated - 2400 R. I went to psychiatrists once a month to control my condition. I bought medicines either generics or original ones, they spent about 2000-3000 R per month.
The pills made me feel better for a short time, about a month. During this period, I was already diagnosed with "emotional personality disorder", but they did not tell me about it. I later found out from the medical record, which I requested before changing the clinic.
At the same time, I also turned to Gestalt therapy for help - this is one of the areas of psychotherapy aimed at developing self-awareness. For me, the sessions were an opportunity to cry, acknowledge problems, and receive support. For three months, I called a psychologist every two weeks. One session cost 2000 R.
107,100 R
I spent on specialists before I got the correct diagnosis
I spent 177,100 R on treatment before the correct diagnosis was made
| Expenses | |
|---|---|
| Drugs in the last two years of treatment | 55 000 R |
| Regular visits to psychiatrists | 50 400 R |
| Medicines in the first year of treatment | 15 000 R |
| Cognitive behavioral therapy, 5 sessions | 15 000 R |
| Three initial appointments with the following psychiatrists | 14 000 R |
| Gestalt therapy sessions, 6 sessions | 12 000 R |
| Psychologist sessions with "Profi-ru" | 11 700 Р |
| First psychiatrist appointment | 4000 P |
Medicines in the last two years of treatment
55 000 R
Regular visit to psychiatrists
50 400 R
Medicines in the first year of treatment
9000 000 RCognitive-behavioral therapy, 5 sessions
15 000 R
Three primary appointments with the following psychiatrists
14,000 R
Gestalt therapy sessions, 6 sessions
12,000 R
Psychologist sessions with Profi-ru
R 11,7000002 Appointment of the first psychiatrist
4000 Р
How borderline personality disorder is diagnosed
Alexey Pribytkov
psychotherapist, psychiatrist, candidate of medical sciences
There are no specific studies in psychiatry that would help to make a diagnosis.
In the first place is always the clinical picture, that is, manifestations of mental disorders.
There is an interesting story with borderline personality disorder in Russia. We still use the International Classification of Diseases of the 10th revision, where in fact there is no such diagnosis, which means that for a long time it was out of sight of psychiatrists. But the absence of a diagnosis in the classification does not mean the absence of violations, because more than 30 years have passed since the adoption of the ICD-10 - it was adopted by WHO in 1990 - and the understanding of mental disorders during this period has noticeably changed.
Now many modern doctors are guided by other criteria when making a diagnosis. They are most clearly formulated in the American classification of psychiatric disorders DSM-5. Similar criteria are used in ICD-11, which is adopted by WHO and should come into force in Russia in 2024.
The above are nine criteria that are specific to BPD.
The task of the psychiatrist is to identify them during a conversation with the patient. The basis for the diagnosis of "borderline personality disorder" is the presence of at least five of the nine criteria.
How I was correctly diagnosed and treated
After many unsuccessful attempts at treatment, I decided to change doctors again and went to a new psychiatrist at another clinic. The first appointment there cost 7,000 R, and repeated appointments cost 6,000 R.
The drug treatment was corrected for me. And with the final diagnosis, they rushed between bipolar affective disorder, or BAD, and borderline personality disorder.
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How much does it cost to treat bipolar affective disorder
They are similar in symptoms. BAD also occurs with alternating periods of depression and high spirits, but they are usually long and can last several months.
In BPD, periods of different moods change over several hours, less often over several days, that is, the mood is constantly unstable.
Moreover, these two disorders can occur simultaneously in one person.
As a result, the psychiatrist diagnosed me with borderline personality disorder. Now, once every one and a half to two months, I go to him to monitor the condition.
Since that time, I began to go to schema therapy - this is a therapy focused on making a person change their behavior patterns. I go to a psychotherapist every week, one session costs 6000 R. I feel that it helps me.
BPD - MSD Handbook
My maladaptive patterns of behavior that my therapist and I identified at our first meeting. In the lower left corner are the schemes to be achieved It is difficult to treat BPD. My doctors never know in what condition I will come to them and whether I will come at all. Meetings are held online from time to time. I am often late, I call specialists from different places: it can be a park or my workplace, a stop on the street or someone else's apartment, a noisy highway or a food court. Sometimes I don't want to see my doctor because it seems that he is wrong about everything.
Sometimes I felt disgusted and decided that I needed another doctor: I abruptly go from idealizing a person to hating him. For this reason, many doctors refuse patients with borderline disorder. In addition, people with BPD tend to discount their own problems, so many may not seek help for a long time.
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Over the years, I have developed several rules for choosing a doctor for myself:
- At the reception, they listen to me attentively.
- Everything that I consider important is important to a doctor. He should not wave his hand and say that there is no point in talking about something.
- The doctor speaks honestly about the diagnosis, does not hide anything, describes the treatment regimens.
- I am informed about the drug I will be taking. They explain exactly how it works, why it was prescribed, what side effects.
- If I don't like something, I change doctors.
Unfortunately, there are no rules that help fight mood swings. I try to turn to the facts at such moments and tell the doctors how I feel. Psychiatrists, as a rule, treat the frequent change of doctor normally. I have never faced condemnation.
One of the latest treatment regimens My prescriptions for drugs, there are a lot of them due to different dosagesHow borderline personality disorder is treated
Alexey Pribytkov
psychotherapist, psychiatrist, PhD
The main method of treating borderline personality disorder is psychotherapy. It is necessary to achieve a stable result. Medications only alleviate some of the symptoms of the disorder.
Dialectical Behavioral Therapy, or DBT, has the most evidence of effectiveness in treating BPD. Other directions can be applied: schema therapy, transference focused therapy - TFP.
However, medications are also prescribed for most BPD patients.
Three groups of drugs are usually used:
- Mood stabilizers, or mood stabilizers, are drugs that smooth out emotional fluctuations and help maintain an even mood.
- Antidepressants - they help to reduce the severity of emotional instability. BPD often accompanies depressive and anxiety disorders, obsessive-compulsive disorder - antidepressants are also used to treat them.
- Antipsychotics, or second-generation antipsychotics, are prescribed in low doses to correct impulsivity and aggression.
The choice of treatment regimen depends on the individual patient's symptoms. Drug therapy usually lasts at least a year, more often several years.
How do I deal with borderline personality disorder
Insomnia. I have suffered from sleep problems since I was a child. I tried everything: from hot milk at night to being very tired during the day.
Unfortunately, I do not have a universal solution to this problem.
I only save myself with pills: psychiatrists prescribed tranquilizers for sleep, now I have an antidepressant with a strong sedative effect - or I just don’t sleep.
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Anxiety and panic attacks. It often overtakes unexpectedly and at the most calm moments. Just talking to a friend, I can start twitching my leg, nervously breaking my nails, scratching my skin with my nails, or sticking to my phone. This is also manifested by a rapid heartbeat, trembling in the body, a desire to move, and strong fear.
To get rid of this feeling, I knit, switch to TV series, listen to meditation practices, start moving more, turn to metaphorical associative cards or Tarot. Metaphorical associative cards are cards with pictures that you can interpret based on your experience.
I use cards when my anxiety is about the future. I am extremely afraid of uncertainty, and this is a chance to decide at least a little, albeit somewhat irrational.
Feeling alone and abandoned. Feels like an unfilled hole in the chest. At such moments, I am sure that I have no one to turn to, no one will help. The feeling that I am alone in the whole world.
Saves background noise such as a movie or TV series. I also have three cats that periodically ask for attention, and I am no longer alone. During periods when I feel very lonely, my friends help, who, if they cannot come, then at least call or write.
Sometimes, in order to feel that I am not alone, I look for meetings with different men. I tend to dive into the person who gives me attention, as if I'm trying to close the inner "hole". If I don’t get enough attention, then I show aggression, and subsequently I change the “victim”. I'm trying to deal with this with the help of psychotherapy.
Mood swings, anger and aggression. In an hour I can experience a huge range of emotions, it is very tiring.
Moreover, anything can become a trigger: an incorrect statement on the part of the interlocutor, just an action that seemed wrong to me, or an opinion that is the opposite of mine. I can be aggressive even to banal questions about my well-being.
I try to warn people about the peculiarities of my behavior, I leave the dialogue if I feel that I am jumping into aggression, I try to distract myself. My psychotherapist advises to live through aggression and give it a way out: tear a sheet of paper, go in for sports, beat a pillow, shout.
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Changes in interests, hobbies and desires. I don't have one hobby, they are constantly changing. I can't say what my favorite movie or music is. Because today I like one thing, and tomorrow I'm already interested in absolutely polar things. I never know in advance what awaits me the next day.
Suicidal thoughts and destructive behavior. For the first time I thought about suicide at the age of 14. Then these thoughts haunted me throughout my life. Somehow I lived with a gas leak in my apartment for several months, knowing full well about it. I drown my negative emotions in alcohol. I used to cut myself, but then I replaced this ritual with getting tattoos on my body.
Such thoughts are difficult to deal with. Medication, mindfulness and constant support from a psychotherapist help a little. I also sometimes go outside in the cold or take a shower: it's sobering.
Unstable self-esteem. I need a permanent evaluation from the outside. I doubt whether I am doing the right job, whether I look right if I do not receive feedback from people. Every mistake is a tragedy for me, but from praise I can feel capable of anything. I can spend weeks thinking that I did some wrong action, although it did not suffer consequences.
To cope with this, I try to compliment myself, remind myself what I'm doing and why, and look at the results of my work.
This does not always work, but here you need to take small steps and learn to focus on your feelings, and not just on others.
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Communication difficulties. I'm thrown from love to hate. I often conflict and change because of this place of work. In no relationship have I lasted more than a few months, and communication with friends is reduced to a couple of meetings a year. If I feel that I may be rejected or denied something, then I do it first to avoid emotions.
Everything that happens is always a disaster: vivid emotions, strong feelings of guilt. If I feel like I'm getting less attention, I'm hysterical. I immediately feel abandoned and abandoned. Considering my peculiarities of behavior, I always try to warn friends and relatives about my condition and tell how not to run into even more negativity.
How to better communicate with people who have borderline disorder
As with many people with BPD, the SET-UP method works well for me.
There is about him in the book “I hate you, just don’t leave me. Borderline Personalities and How to Understand Them by Kreisman and Strauss.
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SET stands for support, empathy, truth - support, sympathy, truth.
It is important that none of the parts can be thrown out of this triangle of communication, otherwise a person with BPD will go into conflict or completely stop communication:
- Support should be expressed in the form of concern in the first person: “I worry about how you you feel." The main thing is to express your own feelings and sensations.
- Sympathy: "You must be feeling upset." It is important to validate the feelings of the person with BPD. Don't try to show pity or talk about how you feel the same way. Most likely, this is not the case. And the phrase "I know how bad you feel" will only cause ridicule and anger.
- Truth: you need to rely on the facts about the situation and not go into accusation.
For example: “You quit, you have enough money for a couple of months. I can help by preparing your resume, and you will look for a new job.”
UP is understanding, perseverance, or understanding and perseverance. These are goals that both participants must achieve.
A person with BPD must become aware of the causes of his actions and their consequences. Understand that he influences his life and can change it. He needs perseverance in order not to give up treatment, because any changes are difficult.
For those close to a person with BPD, understanding is the recognition of a person's feelings and emotions. That is, the acceptance that negative statements and aggression are behavioral features. They need perseverance in order to continue communicating with a person with borderline disorder, not to stop reminding him of his readiness to help, to sober him up and help him find the true cause of events, rely on facts, and not let him focus only on emotions.
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Communication with a person with BPD is always stressful, so people around need to take more care of themselves. It will take a lot of patience and strength to withstand sudden mood swings and maintain relationships.
The main thing is to understand that it is not your fault and you cannot influence BPD. However, if you remain in a stable state and support a person with a disorder, he will eventually cease to see his relatives as a potential threat, which means that there will be fewer outbreaks of aggression.
There is a resource center "Borderline Personality Disorder" in Russia. It is designed for Muscovites, but on the site you can find personal stories of people with BPD, literature on the topic and features of this disorder.
How much does it cost to treat borderline personality disorder? The psychotherapist told me that we would manage in a year.
I need to visit a psychotherapist every week, an appointment costs 6,000 R. In addition, every one and a half to two months I visit a psychiatrist, whose appointment also costs 6,000 R.
/prl/
How much does borderline personality disorder treatment cost? Since I have severe depressive episodes, I need to take pills for a long time: from the moment my condition becomes stable on the background of psychotherapy, it is another 6-12 months.
Drugs now cost about 2000 R per month. I often change pills, so the cost is approximate.
Drug treatment can remove symptoms that interfere with a normal life, and with the help of a course of psychotherapy, it will be possible to go into remission and significantly improve the quality of life. Relapses are extremely rare and are associated with affective states.
I spend 372,000 R per year for the treatment of borderline disorder
| Treatment | Expenses |
|---|---|
| Weekly psychotherapist visit | 312 000 R |
| Psychiatrist visit every 2 months | 36,000 R |
| Medicines | 24 000 R |
Visit of a psychotherapist every week
312 000 R
Visit a psychiatrist once every 2 months
36 000 000 0005
Medications
24 000 R
Is it possible to cure a border personality disorder
Aleksey Profitkov
0005
psychotherapist, psychiatrist, MD
We cannot completely eliminate the symptoms of borderline personality disorder.
