Supporting Someone with Borderline Personality Disorder

“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.