The worst mental health killer you probably know nothing about (part 4)

This four-part series looks at a serious mental illness that is seriously neglected and heavily stigmatized.

In the first article (part 1) of this series, I told the story of my friend’s recent suicide attempts following a history of self-harm and volatile mood swings, and our belief that he has borderline personality disorder (BPD). In the second article (part 2) I discussed the diagnosis, causes, and treatment of BPD. The third article (part 3) exposes how BPD is a seriously neglected and highly stigmatized mental illness, including by mental health practitioners.

This final article (part 4) of the series provides information on how to effectively support a partner, family member, or friend with BPD.

Expect to experience an emotional roller-coaster ride

As a partner, family member, or friend of someone with BPD, you can expect a roller-coaster ride that at times will be very distressing, frightening, and frustrating:

Dealing with borderline behaviour can be frustrating for everyone in contact with the borderline personality because  … their explosions of anger, rapid mood swings, suspiciousness, impulsive actions, unpredictable outbursts, self-destructive actions, and inconsistent communications are understandably upsetting to all around them.¹

Some of the most difficult aspects to cope with are the black and white thinking, the rage and anger, the no-win situations, and the paranoid thoughts.

Black and white thinking: one moment they’ll like you, the next moment hate you

The world of a borderline, like that of a child, is split into heroes and villains. A child emotionally, the borderline cannot tolerate human inconsistencies and ambiguities. he cannot reconcile another’s good and bad qualities into a constant, coherent understanding of that person. At any particular moment, one is either “good” or “evil”; there is no in-between, no gray area. Nuances and shadings are grasped with great difficulty, if at all. Lovers and mates, mothers and fathers, siblings, friends, and psychotherapists may be idolized one day, totally devalued and dismissed the next.²

Frequent displays of intense rage and anger

Borderline rage is often terrifying in its unpredictability and intensity. It may be sparked by relatively insignificant events and explode without warning. It may be directed at previosly valued people. The threat of violence frequently accompanies this anger. All these features make borderline rage much different from typical anger.³

No-win situations

Borderline confusion often results in contradictory messages to others. Frequently, the borderline will communicate one position with words, but express a contradictory message with behaviour. Although the borderline may not consciously be aware of this dilemma, he frequently places a friend o relation in a no-win situation in which the other person is condemned no matter which way he goes.⁴

Transient, stress-related paranoid thoughts or symptoms of severe dissociation

The most common psychotic experiences for the borderline involve feelings of unreality and paranoid delusions. unreality feelings involve dissociation from usual perceptions. the individual or those around her feel unreal. Some borderlines experience a kind of internal splitting, in which they feel different aspects of their personality emerge in different situations. Distorted perceptions can involve any of the five senses.⁵

How to support someone with BPD

As hard as they are to cope with, you can’t take any of these challenging BPD behaviours to heart, and you can’t react against them. People with BPD have a great need for constancy and consistency in their world. If you are to provide them with effective support, you will need to try to provide and facilitate this constancy and consistency, becoming a rock and an anchor in their sea of torment.

Reacting back against the behaviours of the person with BPD is almost guaranteed to make things much worse. This is because the emotional state of someone with BPD can be likened to an emotional third-degree burn or emotional hemophilia:

People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.⁶

A borderline suffers a kind of “emotional hemophilia”; she lacks the clotting mechanism needed to moderate her spurts of feeling. Prick the delicate “skin” of a borderline and she will emotionally bleed to death.⁷

Don’t tell them to “just get over it”, but do expect them to take responsibility

Always try to remember that the person is not their BPD. Under the BPD is a person just like you, who is suffering from an illness:

It is important to remember that BPD is an illness, not a wilful attempt to get attention. The borderline lacks the boots, much less the bootstraps, with which to pull himself up. It is useless to get angry or to cajole and plead with the borderline to change; without help and motivation he cannot easily modify his behaviour. However, this does not imply that the borderline is helpless and should not be responsible for his conduct. Actually, the opposite is true. He must accept, without being excused or protected, the real consequences of his actions, even though initially he may be powerless to alter them. In this way, BPD is no different from any other handicap.⁸

Encourage and assist them to receive treatment

The responsibilities of someone with BPD include seeking treatment, if it is available in their area or region. You can encourage them to take up treatment, and to stick with it once they have commenced.

The resources below can help with this. As well as providing good information to assist your understanding of BPD, they include the inspiring stories of people who have successfully overcome BPD through psychotherapy.

Use the SET communication method

The best approach to take when communicating with a person with BPD is to use the SET method.

SET stands for support, empathy, and truth:

• Support. Support refers to an initial statement which indicates that you support the person with BPD. It is a statement that begins with “I” and demonstrates concern and a desire to help. It can be anything that establishes a foundation for the relationship or interaction: “I want to try to help you feel better,” “I care about you” or “I am worried about how you are feeling.” The support statement is meant to reassure the other person that the relationship is a safe one and that their needs matter even during this difficult moment.

• Empathy. Empathy refers to communicating that you understand what the other individual is feeling and focuses on “you.” It is not a conveyance of pity or sympathy, but instead a true awareness and validation of the feelings of the other person, such as, “I see you are angry, and I understand how you can get mad at me,” or “How frustrating this must be for you.” Without a statement of empathy, they may feel that their feelings are not understood. It is important to use feeling words.

• Truth. Truth refers to a realistic and honest assessment of the situation and the other person’s role in solving the problem. It is an objective statement that focuses on the “it”, not on the subjective experience of the either you or them. They may seem to be asking or demanding something impossible, not taking an active role or responsibility in resolving the issue or even presenting you with a “no-win” situation. The truth statement is meant to clearly and honestly respond to their demand or behavior while placing responsibility where it belongs. Examples include,”This is what I can do…,” “This is what will happen…” and “Remember when this happened before and how you felt so bad about it later.”

More detailed information on the SET method can be found in the book I hate you—Don’t leave me: Understanding the borderline personality.

Take talk of suicide seriously

As discussed in the second article (part 2) of this series, around 10% of people with BPD will commit suicide at some point⁹, and people with BPD commit suicide more often¹⁰ than the general population.

Because of this, any talk of suicide by a person with BPD must be taken absolutely seriously. If counseling or other suicide prevention support services are available in your area, engage with them immediately. If such services are not available in your area (which is the situation we face), use the SET method to talk with the person about their suicidal thoughts. Remind the person that suicide is NEVER the answer. If you are unable to bring about a change of mood or thinking or have any doubts about what the person might do then liaise with other relatives or friends to set up 24-hour monitoring of the person. If a suicide attempt occurs or appears to be imminent then rush the person to hospital. Someone needs to stay with them at all times until they are out of danger.

Understand why self-harm occurs

Another common frightening behaviour of people with BPD is self-harm. Contrary to popular belief, people with BPD typically don’t engage in self-harm as attention-seeking behaviour. Rather, they do it as a physical release of their intense emotional pain, and because of this they will often feel great and immediate mental relief as a result of self-harm.

If self-harm occurs, be empathetic rather than critical or judgemental, and continue to encourage the person with BPD to seek treatment because psychotherapy can provide them with much better ways of dealing with their emotional anguish. Assist the person to seek medical treatment for their injuries because their emotional state is likely to hinder them in initiating this action themselves.

Lobby for better BPD support

As was discussed in the third article (part 3) of this series, BPD is a seriously neglected and heavily stigmatized mental illness. You can help to address this by lobbying politicians and other key decision-makers to take action on providing better support and increased funding for BPD research and management.

Recommended resources

The more informed you are about BPD, the better that you will be able to help your partner, family member, or friend. The following resources are strongly recommended.

Books

There are a range of BPD books available, but two of the most well-known and recommended are:

• I hate you—Don’t leave me: Understanding the borderline personality

• Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder

Examples of people living well with BPD

As discussed in part 2 of this article series, people with BPD can be successfully treated. The Resources to Recover website lists ten examples of celebrities and other high-profile people who have been able to achieve notable success while living well with BPD.

They include:

• American National Football League (NFL) player Brandon Marshall, who revealed that he has BPD in an emotional media conference.

• World-renowned Australian skateboarder Tas Pappas.

• World-famous author Susanna Kaysen, who wrote the memoir Girl, Interrupted about her 18-month hospital stay during which she was diagnosed with borderline personality disorder. Girl, Interrupted has since been made into a movie.

• American psychologist Marsha M. Linehan, who is famous for developing the dialectical behavior therapy (DBT) treatment for BPD (see part 2 of this series). In 2011, Linehan revealed her own struggle with BPD.

Videos

Video sharing websites include a growing number of videos addressing BPD and suicide, including documentaries, presentations, and the personal stories of people with BPD. The following is a selection of some of the most well-known and helpful videos, which include the inspiring stories of people who have successfully overcome BPD through psychotherapy.

Understanding BPD and the significant potential for recovery

Guidance for parents

Michi Mavros’ personal journey of living with BPD

For further videos in the series visit Michi’s YouTube Channel.

The cultural taboos of suicide and mental illness

Suicidal Behavior in BPD

Header image source: Mic445 on Flickr, CC BY 2.0.

References: