How to help someone with a personality disorder
Helping Someone with Borderline Personality Disorder
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.
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.
Do you struggle to clearly express how you're feeling inside?
Differences arise in any relationship, whether at home or at work. But there is a way out of seemingly unresolvable conflicts where everyone leaves with a sense of fulfillment and with their self-respect intact. This is the path of Nonviolent Communication from Sounds True.
GET ACCESS TO THIS FREE TRAINING NOW
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.”
- 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.
- 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.
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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
How to Help a Friend With A Personality Disorder (8 Simple Tips)
Living with a personality disorder can be difficult, but having the support of loved ones can be beneficial. These 8 steps can empower you to help someone with a personality disorder.
Someone with a personality disorder may have a difficult time coping with their condition. Personality disorders affect the way a person thinks about themselves and other people, how they respond emotionally, how they relate to other people and how they control their behaviors.
Personality disorders are challenging to treat, but there are effective treatments available. These conditions require professional treatment and ongoing support. There are ten types of personality disorders, each with different symptoms and each requiring specific treatment interventions.
Regardless of which personality disorder a loved one has, learning how to help a friend with a personality disorder can make a world of difference for the person with the condition. Here are specific actions you can take to show support and help someone manage a personality disorder.
1. Avoid focusing all conversations around their personality disorder.
Remember that not every aspect of a person’s life relates to their personality disorder. Instead of focusing on how a person is progressing in treatment, and compliment their other positive attributes and accomplishments. Continuing normal activities and conversations can promote a feeling of stability.
2. If an emotional crisis occurs, do not escalate the situation.
Simply remaining calm and avoiding arguing can help to diffuse a tense situation. If a loved one becomes verbally aggressive, do not take offense and avoid responding defensively. Suggest talking a problem over when tempers have cooled off rather than engaging in an argument.
Knowing how to act in a crisis can be helpful. When a loved one is feeling well, create a crisis plan to address what actions should be taken in an emotional crisis. Include information on preferred providers and treatments.
3. Maintain clear boundaries and expectations.
Many personality disorders influence the way a person connects with others and how they experience relationships. Set clear personal boundaries and expectations and enforce them. Someone with a personality disorder can benefit from having relationships with people who are consistent and rational.
4. Avoid being judgmental.
Avoid judgmental statements like, “You’re just overreacting.” While some personality disorders, such as borderline personality disorder, are characterized by difficulty regulating emotions and reactions, it is important for a person to have their feelings validated.
Most people with personality disorders deeply desire being understood. Acknowledging and validating their feelings can be beneficial. Personality disorders are surrounded by societal stigma, which may discourage someone from speaking up about their condition. It is important to provide a safe, non-judgmental environment for someone to share. Do not jump to conclusions about how a person thinks or feels, but instead try to understand their perspective. Ask questions, if necessary, to deepen understanding.
5. Be patient.
A personality disorder is a severe condition and setbacks are likely to occur during the course of treatment. Do not set unrealistic expectations or voice disappointment when setbacks occur. Criticizing someone when progress is slow or a setback occurs can cause further roadblocks to recovery.
6. Be present.
Simply being present and offering support to a loved one with a personality disorder can make a difference. Often people with personality disorders experience social isolation. Having a supportive person can help to alleviate feelings of isolation. To consistently be present in a loved one’s life, be reliable and trustworthy. The simple act of listening when a loved one wants to talk can increase feelings of support. Consistency helps provide a sense of security.
7. Research specific personality disorders and common symptoms.
Personality disorders are often misunderstood. Learn about the disorder, including symptoms and how a personality disorder impacts someone’s life. Understanding the obstacles a person with a personality disorder faces can increase empathy.
8. Avoid over-generalizing.
While all personality disorders influence how a person experiences the world around them, they are all different from one another. Understanding the specific personality disorder a loved one faces can help prevent over-generalizations. Be sure to understand what their specific symptoms are and do not assume that symptoms of other personality disorders are present.
Helping a Friend or Family Member Find Treatment for a Personality Disorder
It is common for people with certain personality disorders to seek treatment initially, but then drop out suddenly. One common attribute of all personalities disorders is the fact that improvement is unlikely without professional treatment. When a loved one’s willingness to engage wanes, continue to encourage ongoing treatment.
It may be helpful to recognize small improvements and initial successes to increase motivation to continue with treatment. For example, recognizing the effort put into attending an initial appointment can make it easier to attend the second appointment. If may also be helpful to provide support and assistance in scheduling and keeping appointments. While someone cannot be forced to continue therapy, reminding them of their appointments can increase the likelihood that they continue treatment.
If you or a loved one has a personality disorder, treatment is available. The Recovery Village provides effective treatment for substance use and co-occurring disorders, such as personality disorders. Speak with a representative today to learn more about treatment options.
Editor – Camille Renzoni
Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more
Medically Reviewed By – Denise-Marie Griswold, LCAS
Denise-Marie Griswold is a Licensed Clinical Addictions Specialist. She earned her Master's Degree in Substance Abuse and Clinical Counseling from East Carolina University in 2014. Read more
Dingfelder, S. F. “Treatment for the ‘untreatable.’” American Psychological Association, Published March 2004. Accessed February 23, 2019.
Mind.org.uk “Personality Disorders.” (n.d.) Accessed February 23, 2019.
Psychiatry.org “What are Personality Disorders?” American Psychiatric Association, Published November 2018. Accessed February 23, 2019.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.
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.
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.
Help for a loved one with a mental disorder
There is a lot of talk these days about the rise in the number of mental disorders in society, but many people have very vague ideas about this very vague concept. Despite the fact that now psychiatrists are doing everything possible to inform the population as best as possible about stress, depression, anxiety, neuroses, more severe mental disorders, there is very little literature written by experts for the average layman, and on the Internet there is an abundance of information written either difficult language, or simply illiterate. All this ultimately leads to the fact that such information is not only contrary to reality, but also harmful.
It is impossible to sort everything out in one article and give clear instructions on the relationship between the patient and his relatives, but it is possible to bring to a holistic picture the idea of this complex group of diseases (the terms "disease" and "disorder" from a medical point of view are largely close, but not identical*). Therefore, my task is to acquaint the reader with this complex problem, primarily related to relationships and assistance to those suffering from severe mental illnesses.
* It is desirable to know the most basic terms, then it will be easier for the doctor to help both the patient himself and his relatives. In addition, you should not use terms that are not well known to you, it is better to describe the situation or condition as you understand it.
So, mental (or mental, because psyche - translated from Greek means the soul ) disorders - are painful conditions of a person with psychopathological (i.e., with mental disorders) and behavioral (i.e., they do not always appear, for example, in case of neurosis, when a person by an effort of will keeps himself within the limits of cultural society up to a certain point) manifestations due to the influence of biological, psychological, social and other factors.
Let's not confuse with psychosis (or psychotic) disorders, which are characterized by gross and contradictory environmental disorders of thinking, perception and behavior (delusions, in a medical, not philistine view; hallucinations; psychomotor agitation; suicidal behavior, etc. ).
It is important to note that the problem of mental disorders is interdisciplinary and even interdepartmental, social. Rehabilitation is needed, not just treatment.
As for the diagnosis. Diagnosis - definition and recognition, an indication of the disease. In medicine, and especially in psychiatry, diagnosis does not always mean treatment in strict accordance with the diagnosis. Diagnosis is often a statistical category needed to understand, roughly speaking, how the condition of one patient is similar to another.
I am sometimes puzzled by the desire of a person to look at the records of a doctor. After all, a special interpretation, justification of the diagnosis, terminology can not only frighten and offend an unprepared person, but cause unreasonable distrust of a specialist and, even worse, aggravate disturbed mental balance, upset not only the patient, but also relatives.
It is much more important to trust each other (the doctor, the patient, his relatives), to ask questions of interest. It is on trust that the desired result is achieved - a cure or a stable remission, if the disorder is chronic.
I will not decipher concepts and terms much in this article. Let's talk about the topic corresponding to the title. We will talk about such diseases as schizophrenia, dementia, severe depression, drug addiction (alcoholism, drug addiction), etc. I will try to give basic, a kind of "universal" recommendations.
1 situation: a relative (both a 16-year-old child and an old grandfather, in the past or present a researcher) became “somehow not like that”, began to withdraw, get annoyed for no apparent reason, although “he had never been aggressive before ', to talk, to talk to oneself.
Usually, such behavior is first perceived as a joke, then surprise, then a discussion with a sick person begins, which can lead to serious conflicts and distrust. If you suspect that a person close to you has a mental disorder (we do not take emergency situations, for example, in case of severe aggression, the police and medical workers are already intervening here), you cannot argue.
It is also desirable not to support the painful delusions of a person, to try to be patient and caring, to persuade a loved one to seek medical help. Unfortunately, in our society, when it comes to psychiatry, in most cases it causes a smile, fear, surprise, but not sympathy and a desire to help a sick person, especially if it refers to a relative. Only later, when a sick person can feel and even understand that the help of a psychiatrist is for his benefit, will he himself reach out to her.
At the initial stage, it is worth trying to persuade a person to calm down, assess his degree of adequacy (if he used to trust you, but now he doesn’t groundlessly, whether he understands you or is completely in his experiences, etc.), to understand whether there are threats to him and surrounding.
It is impossible to forcibly help a person (involuntary hospitalization in a psychiatric hospital is carried out only by a court decision), but everything possible must be done: to involve relatives who will correctly understand and support people who are authoritative for the patient, consult a doctor.
Situation 2: patients were brought to a psychiatrist. There can be 2 ways here. The doctor will help to understand the situation, make a diagnosis, prescribe treatment, give recommendations. Everything here is very individual. But it may also be that the doctor gives a recommendation, but not only the patient (due to inadequacy), but also a relative does not want to follow it.
I can give an example. A mother brings her 20-year-old daughter to a psychotherapist. The daughter has painful sensations in her body: the bones, according to her, “go back and forth, fall through and hurt.” All specialists were examined, all studies were carried out, including MRI, no diseases were found, the symptoms do not correspond to the alleged physical pathology.
A mental illness was diagnosed, drugs were prescribed, and after a couple of months there was a significant improvement. The patient stops taking the medicine, after a while she comes to the doctor with her mother, complains about the deterioration, assures that the medicines do not help, refuses help, runs out of the office, rushes about, says that she does not want to live. Hospitalization is proposed, since adequate dosages of drugs can only be prescribed in a hospital, in response - a categorical refusal.
With difficulty he manages to calm down, persuade him to give an injection, agrees to resume taking medications. The doctor suggests that the mother call a psychiatric team to resolve the issue of hospitalization, in connection with the suicidal risk, to which he receives the answer: “Well, she will kill herself, then this is her fate, I will not put her in a psychiatric hospital.” On receipt released home. The mother calls the next day, the daughter gets a little better, then disappears for six months. Another call to the doctor's personal phone: the daughter lies in bed, does not want to get up, complains about "movements in the body of some creatures" that cause severe pain.
Recommendations were given, the patient was finally hospitalized in a psychiatric hospital with schizophrenia. She was discharged with improvement, criticism of her condition appeared, adequate therapy was selected.
Bottom line: fortunately, this story ended happily, but the patient suffered for several months, while the mother believed in the need for hospitalization; I had to prescribe heavier drugs, the treatment was delayed.
There is nothing wrong if the patient refuses this doctor (for example, the patient has included the doctor in his delusional system) or the doctor himself understands that he will not be able to provide adequate assistance. Then it is necessary to attract colleagues, send them to a hospital, together with relatives, think over options for assistance and choose the best one. It happens that the patient returns after treatment, apologizes for his behavior, because he did not understand the pain and inadequacy at that time.
You should not change specialists (sometimes people come to me with dozens of recommendations from different doctors of the same specialty, which is puzzling). Well, 2-3 opinions is understandable, but more than 10!? The most common reason is that medications do not immediately help, side effects.
Some patients soon stop taking their medications, and many diseases are chronic and require many months or even years of maintenance therapy. A natural deterioration sets in, the new doctor does not yet know the specifics of the course of the disorder in this patient, experiments with treatment begin, a new selection of medicines begins, resistance to treatment is formed, and previously effective drugs cease to work.
And one more thing: it is desirable, at the initial visit to the doctor, to bring, if not all, then the main examinations, extracts, and tests. A psychiatrist is a doctor like everyone else, and the more information about the patient, the easier it is to understand the diagnosis. For example, if a person has a pathology of the thyroid gland, it is advisable to bring the last tests for hormones, since when the hormonal background changes, the state of mind also changes (irritability, sleep disturbances, mood swings, etc.).
In some cases, antidepressants are not only not needed, but can be harmful, it may be worth limiting yourself to the appointments of an endocrinologist and psychotherapy. Elderly people with diabetes can confuse events and even behave inappropriately with an increase in blood glucose, here prescribed antipsychotics are also not always necessary.
3 situation: the patient has been examined for a long time, the diagnosis is known, but the disease is progressing. Relatives begin to "look for a miracle": consult the patient with leading specialists, go to the main scientific centers, someone is looking for help abroad.
I have had a number of cases where patients have returned from the US, Europe, Israel, etc. with complaints that the prescription of drugs selected in Russia was refused, or that the treatment was simply ineffective, worsened. Here I would advise you to find a specialist you trust and coordinate your actions with him. Only together can we help sick people provide adequate assistance and, if not cured, then improve the quality of life as much as possible.
4 situation: terminally ill patient in the final stage. There is an opinion, or rather another myth, that one does not die from mental illness, however, mental illness is the same as somatic (i.e. body diseases), only the brain is sick, regardless there is a visible focus there (for example, as a result of a craniocerebral injury to the damaged part of the brain) or not. For example, severe progressive dementia, the final stage of alcoholism with multiple organ disorders, the terminal stage in malignant forms of schizophrenia, and others. Here it is necessary to decide individually, depending on the specific case.
“If a person cannot be cured, this does not mean that he cannot be helped.”
If you are destined to die, it is easier to do this among loving relatives on your bed, even if a person does not understand anything and does not recognize anyone. But he FEELS the attitude towards him. How a small child feels the caress of his mother, smiles or cries when his mother is gone. You will say - there is no comparison, children are our future, and here is a dying person who does not understand anything. Yes, this is true, but we must understand that any of us can, God forbid, be in the place of this person ...
Well, a few words about help for those who care for the sick. It is difficult to give specific recommendations here, only one thing is clear: you cannot take the position of either a rescuer or a victim, you just need to fulfill your human duty to the best of your ability and ability. Don't forget yourself.
Any person who lives with a sick person, and even more so caring for him, experiences enormous personal and emotional stress. Therefore, you should think about how you will cope with the disease in the future. By understanding your own emotions properly, you will be able to deal more effectively with both the patient's problems and your own problems. You may have to experience emotions such as grief, shame, anger, embarrassment, loneliness and others.
For some people who care for the sick, the family is the best helper, for others it brings only grief. It is important not to reject the help of other family members if they have enough time, and not to try to bear the sometimes difficult burden of caring for the sick alone.
If family members upset you with their unwillingness to help, or criticize your work because of the lack of information about this disorder, you can form a family council to discuss care problems. In particular, make a decision to involve an employee, at least for the period of time necessary for your rest and recuperation, and, if necessary, treatment.
And the last. Don't keep problems to yourself. Feeling that your emotions are a natural reaction in your position, it will be easier for you to cope with your problems. Don't reject the help and support of others, even if you feel like you're making it difficult. Even psychotherapists themselves (seemingly knowing how to minimize stress as much as possible) often have their own psychotherapist, and it is bad for the doctor who neglects the help of his colleagues.