The National Institute of Mental Health defines Borderline Personality Disorder, or BPD, as a mental illness that involves unstable moods, self-image, and behavior for an ongoing period of time. BPD affects an estimated 1.6% to possibly as high as 5.9% of the general population and approximately 75% of those diagnosed are females (Diagnostic and Statistical Manual of Mental Disorders). This mental illness directly targets a person’s ability to form and nurture relationships. Someone who suffers from BPD is likely to sabotage their own relationships with insecurities and create tension between themselves and the parties involved. This raises the question, can people with BPD maintain healthy relationships? Granted, relationships with anyone who has a mental illness are always going to take more work; however, with the right support system, medications, and professional help it is still possible to love and be loved with BPD.
Before we question how individuals with BPD love and can be loved, we must first question why it is they feel they can’t be loved in the first place. As with all mental illnesses, we start the researching journey with the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-V, which is essentially the bible of the psychiatric profession. It is never recommended that you self-diagnose, as reading symptoms may cause you to start having them when they were not present beforehand. However, if you want to check on your symptoms and then bring the disorder up to a professional, the DSM is the best place to do so. In the DSM-V, the diagnostic criteria for BPD is listed as follows:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following:
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, instability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms (American Psychiatric Association 663).
When you take a step back to look at the symptoms of BPD, some of the symptoms sound a lot like common issues in modern relationships (e.g., trying to avoid abandonment, unsafe behaviors such as excessive spending or substance abuse, consistent mood swings, anger issues). Many people who are diagnosed with BPD simply believed they just had bad luck with relationships, when in reality they just weren’t aware of their own psyche’s plan to sabotage all interpersonal relationships.
Getting diagnosed is the easiest part of dealing with a mental illness, the search for a cure and coping mechanisms is the hard part. If you were recently diagnosed with BPD, you may be thinking, “well, now what?” Luckily, knowing is half the battle when it comes to mental disorders. Dr. Kristalyn Slaters-Pedneault stated in her article, “Is There a Cure for Borderline Personality Disorder?”, that we may be in luck. Although there is no official cure for BPD, there are many different medication options as well as different therapy options available to patients. Mood stabilizers, anti-depressants, or supplements such as Saint John’s Wort can be used to help alleviate symptoms. However, there is not a cure-all pill, as no mental illness is truly black and white. Each person experiences a mental illness differently and that is why we have psychologists and psychiatrists to help find what works best for you. In the DSM-V it states you only have to have six of the nine symptoms listed, meaning there are some people with BPD who do not experience anger and disassociation, but there is also people who experience anger and dissociation as well as impulsive behavior. This is what makes mental illnesses so complex. There are ways to alleviate symptoms, such as anti-depressants or mood stabilizers, but the human brain cannot be re-wired to a neuro-typical state unfortunately. However, it is said that many individuals will see a decrease in symptoms in their 40s (BPD OVERVIEW).
As an individual is diagnosed with BPD, the family and friends are diagnosed as well, in a way. Coping with a personality disorder can be extremely difficult as they are considered unchangeable. When looking at mental illnesses, the easiest way to understand how they work, is to imagine a room full of different types of furniture. Psychiatric disorders, such as depression, anxiety, obsessive compulsive, etc.; would be considered the furniture. We have the ability to move furniture and rearrange how we please. The same is for psychiatric disorders, we are able to medicate and manipulate the neurotransmitters and ultimately the end goal is to no longer have the disorder. Personality disorders, however; would be considered the walls and fireplace in a room. It is a part of the structure of the home, you can’t just tear it down and make it go away. Personality disorders cannot be cured, but we can alleviate some of the symptoms. Just try and put yourself in the shoes of someone who was diagnosed with an incurable disease. Say you were diagnosed with terminal cancer, the doctors can offer you treatment to help prolong your life and ease the pain, but ultimately it is not going away. A mentally ill brain might process its diagnosis in a similar way. That brings us to the question of, “what can I do to help support my loved one?’ Dr. John G. Gunderson and Dr. Cynthia Berkowitz wrote a piece titled “Family Guidelines”, published by The New England Personality Disorder Association, laying out some goals and guidelines for the friends and family of BPD individuals:
Goals: GO SLOWLY
1. Remember that change is difficult to achieve and fraught with fears. Be cautious about suggesting that “great” progress has been made or giving “You can do it” reassurances. Progress evokes fears of abandonment. When signs of progress appear, family members can reduce the risk of relapse by not showing too much excitement about the progress and by cautioning the individual to move slowly.
2. Lower your expectations. Set realistic goals that are attainable. Solve big problems in small steps. Work on one thing at a time. “Big”, long-term goals lead to discouragement and failure. Although the person with BPD may have many obvious strengths such as intelligence, ambition, good looks, and artistic talent, she nonetheless is handicapped by severe emotional vulnerabilities as she sets about making use of those talents.
Family Guidelines
3. Keep things cool and calm. Appreciation is normal. Tone it down. Disagreement is normal. Tone it down, too. This guideline is a reminder of the central message of our educational program: The person with BPD is handicapped in his ability to tolerate stress in relationships (i.e., rejection, criticism, disagreements) and can, therefore, benefit from a cool, calm home environment
4. Maintain family routines as much as possible. Stay in touch with family and friends. There’s more to life than problems, so don’t give up the good times. Often, when a member of the family has a severe mental illness, everyone in the family can become isolated as a result. The handling of the problems can absorb much time and energy. People often stay away from friends to hide a problem they feel as stigmatizing and shameful. The result of this isolation can be only anger and tension. Everyone needs friends, parties, and vacations to relax and unwind. By making a point of having good times, everyone can cool down and approach life’s problems with improved perspective.
5. Find time to talk. Chats about light or neutral matters are helpful. Schedule times for this if you need to. Too often, when family members are in conflict with one another or are burdened by the management of severe emotional problems, they forget to take time out to talk about matters other than illness. Such discussions are valuable for many reasons. The person with BPD often devotes all her time and energy to her illness by going to multiple therapies each week, by attending day treatment, etc. The result is that she misses opportunities to explore and utilize the variety of talents and interests she has. (FAMILY GUIDELINES)
I know this list seems like a lot, but you would be surprised how much these small changes in behavior can greatly affect the mental health of your family. The key to being a helping hand is to be sensitive to the heightened emotional state that BPD individuals are constantly stuck in. As this disorder does manifest usually in the young adult years, it is easy to just brush past their flare ups as stress or simply “growing up”. This is not the case and it is vital to remember that.
Romantic relationships are the most difficult type of relationship for someone with BPD to maintain. It is not impossible, but it is definitely a challenge. If you start dating someone with BPD, there are a few things you’ll need to know. As the main symptom of BPD is unstable mood, you will come to expect your partner having crises very often. Fear of abandonment fuels many of these crises and acknowledging that is the first step. Your partner may accuse you of cheating, they may participate in self-destructing behaviors, they may even threaten to commit suicide. These threats and actions are not to be taken lightly, what you see as an exaggeration they see as a monumental issue. It is important to listen to your partner and talk through these episodes. A person who suffers from BPD will try to sabotage their own relationships in the mindset of, I’ll hurt them before they can hurt me. You will need to acknowledge their pain and consistently work with them to alleviate it. Consistency is one of the best ways to show your partner you love them and aren’t going to leave them.
If you are struggling with BPD, it is important to look at your actions and try to become aware of your borderline tendencies. Do you notice yourself lashing out based on certain triggers? Do you find yourself jumping to conclusions without talking to your partner first? Do you tend to do impulsive things when you are upset? Knowing what your own personal relationship with BPD is, can make it much easier to form healthy relationships. Once you have identified your tendencies, you can have an open line of communication with your partner that will make things easier for both parties. Dr. Beth Allan wrote in her piece titled, “This is What it’s Like to Date Someone with Borderline Personality Disorder” that, “paranoia is a common symptom among people with BPD, and this can blow not replying to a text, because your phone was on silent, into your partner thinking you have been hit by a bus/run away with the circus/are having an affair with your boss, in under 30 minutes” (Allan). It is your responsibility to establish your limits with your partner. By setting a verbal boundary, you are more likely to avoid a triggering engagement. If your partner is aware of your fear of abandonment, they will be more likely to shoot you a text before disappearing for a while. Dr. Allan actually suffers from BPD herself and when she faces the insecurities that eat at the mind she had this to say:
“In my somewhat limited but quite eventful 26 years of experience, as a person with BPD, the way to make it work with [a] person is always communication. If you communicate clearly and honestly then you get rid of that fear of the unknown, the fear that you’ll disappear, and the fear they have of not being good enough” (Allan)
Dr. Allan brings up a very important point here. Fear is such a huge part of BPD, so it makes it that much more important for you to communicate your needs with your partner. You must let down your walls for the sake of a healthy relationship, healthy mindset, and healthy lifestyle. On the opposite side of the spectrum, however, you may also run into falling “in love” too quickly. This, ironically, feeds into the symptom of fearing abandonment. You may find it hard to find someone who you click with, and when you do, you fall hard and fast. The feeling of a fresh relationship is fiery and addictive. You want to spend as much time as possible with them and feel like without them you would rather die. This is not love however, and it will be difficult to convince yourself of that. You may care for the person, but you can’t allow yourself to become emotionally dependent. This is arguably the greatest struggle for someone with BPD. It all goes back to knowing yourself and your tendencies.
Putting all negatives aside, anyone who is willing to put in the work to have a functioning relationship can most definitely do so. It may be argued that people with BPD are just too much to deal with. You can come across many posts detailing failed relationships on the internet and the following article was exactly that. Winston Smith wrote a piece titled “Don’t Date Girls With Borderline Personality Disorder” documenting an encounter he had with a mentally ill woman, experiencing the worst parts of BPD. He went head to head with an emotionally unstable woman who got angry after he denied her unprotected sex, took everything he said the wrong way, had an episode about the details of their date being undecided, and then proceeding to call him back five minutes later begging for forgiveness. These incidences are very common with BPD women, as it seems that BPD amplifies normal female insecurities. He compared the hyper-masculinity of the autistic brain to the hyper-femininity of the BPD brain. This is a theory that has most definitely been brought up in the psychology community, and it may actually hold some merit. Where Mr. Smith begins to lose his credibility is when he warns men to save texts confirming consent for sexual intimacy. Understandably, no one wants to be accused of rape, but it is not fair to BPD women to completely discredit their rape accusations. Consent can be revoked at any time, and the fact that Mr. Smith doesn’t see it that way is concerning. Honestly, his argument seems to better reflect fragile masculinity rather than a BPD problem. To put the cherry on top of this biased piece, he finishes his statement by saying, “Ultimately no matter how attractive she is, dealing with this type of crazy is not worth it. Do not hesitate to kick these women to the curb if they exhibit this behavior. You’ve been warned” (Smith). Looking at it from a professional standpoint, this argument is far from credible. Going back to what Dr. Allan had to say in her piece:
When people pull away for any reason, that part of our illness goes into overdrive and this is where the disorder may get its bad name. The fear of being abandoned is almost always, even if only subconsciously, the driving force of our ‘crazy’ behavior in relationships. To understand why our reactions can be so adverse, our partner needs to understand that because of our illness, we think differently in some ways to others (Allan).
It is just a fact of life that some people just can’t find a way to make it work. Not to say that Mr. Smith is a bad guy, it just takes a special kind of person to love someone with a mental illness, just as it takes a special kind of person to treat people with mental illnesses.
Love comes in many forms, and it is truly an active commitment. Mental illnesses cannot keep you from finding love. Although someone suffering from BPD may have to work harder towards having a nurturing, healthy relationship it is completely possible. Case studies have proven that with therapy and medication a person with a psychological disorder CAN function in society. It is the responsibility of those diagnosed with BPD to alert their friends and family of their boundaries and concerns. Communication keeps everything flowing smoothly, and yes, sometimes you will still have episodes. You also may still have failed relationships and end up falling hard and fast. All you can do is accept that this is your truth, and this is you. Become at peace with yourself and the rest will follow suit.