Strategies for Supporting Loved Ones with Borderline Personality Disorder

Living with borderline personality disorder (BPD) can be challenging, as symptoms can impact family dynamics and relationships. However, the support of family and friends is so important to help reduce the impact of BPD on the individual and their family and friends. 

The National Institute for Health and Care Excellence (NICE) puts the prevalence of BPD in the UK as between 0.7% and 2% in the general population which is currently almost 68 million people; approximately between 1 in 200 and 3 in 200 people who have the disorder. It is believed to affect men and women equally; however, it is a disorder predominantly diagnosed in women (75%). This high figure may be accounted for in the fact that women are more likely than men to seek treatment. 

For family and friends to be able to give support to a loved one who may be experiencing BPD, it is necessary that they gain an awareness of the disorder so that they can recognise behaviours and offer the appropriate helpful response. The impact of BPD on the individual and their family and friends can be reduced when friends and family members respond in a helpful way.

In this article we will examine borderline personality disorder (BPD), its symptoms, and the challenges that individuals with BPD may face, together with strategies to help support your loved one who is experiencing BPD.

Understanding Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is a mental health condition that affects the way people feel about themselves and about others. It is characterised by instability in mood, behaviour, self-image and relationships, and is a complex condition that affects how individuals perceive themselves, others and the world around them. It is called borderline because doctors previously believed that it was on the border between two different disorders, neurosis and psychosis, terms that are no longer used in mental health.

People with BPD come from many different backgrounds, but most will have experienced some kind of trauma or neglect as children. Although the causes of BPD are unclear, it appears to result from a combination of genetic and environmental factors.

The symptoms of a personality disorder may range from mild to severe and usually emerge in adolescence, persisting into adulthood. Experiences of living with BPD are unique to each person and an individual will only need to experience five of the following symptoms to be diagnosed with BPD. Symptoms can include:

• A strong fear of abandonment. This includes going to extreme measures so the individual is not separated or rejected, even if these fears are imagined.
• Long-lasting feelings of emptiness and abandonment, leading to feelings of intense anxiety and anger.
• A pattern of unstable, intense relationships, such as believing someone is perfect one moment and then suddenly believing the person doesn’t care enough or is cruel.
• Feelings that others are smothering, controlling or crowding them, which also provokes intense fear and anger.
• Impulsive and risky behaviour, such as gambling, dangerous driving, unsafe sex, spending sprees, shoplifting, extreme sports, binge eating, destruction of property, drug misuse, or sabotaging success by suddenly leaving a good job or finishing a positive relationship.
• Quick changes in how they perceive themselves. This includes shifting goals and values, as well as seeing themselves as bad or as if they don’t exist.
• Wide mood swings that last from a few hours to a few days. These mood swings can include periods of being very happy, irritable or anxious, or feeling shame. Some people feel better in the morning and some in the evening, the pattern varies; however, they are usually unpredictable.
• Inappropriate, strong anger, such as losing their temper often, being sarcastic or bitter, or physically fighting and difficulty controlling emotions and anger.
• Periods of stress-related paranoia and loss of contact with reality. These periods can last from a few minutes to a few hours.
• Threats or thoughts of suicide or self-injury, often in response to fears of separation or rejection.
• It is common for people with BPD to feel suicidal with despair, and then feel reasonably positive a few hours later.
• Brief episodes of strange experiences such as hearing voices outside their head for minutes at a time. These may often feel like instructions to harm themselves or others and they may or may not be certain whether these are real.
• Prolonged episodes of abnormal experiences where they might experience both hallucinations and distressing beliefs that no one can talk them out of, such as believing their family or friends are secretly trying to kill them.

Common triggers for someone with BPD include anything that may result in perceived rejection, criticism or abandonment and can include:

• Anything they might interpret as a sign of rejection or abandonment. For example, unexpected delays in text message responses, not being invited to an event, or cancelled plans. Impulsive behaviours are a way for the person with BPD to cope with their fear. Such behaviour might include repeatedly calling or texting someone or engaging in self-destructive behaviours.
• Criticism, even if well-intentioned, has the ability to trigger a person with BPD emotionally. If they perceive criticism, such as feeling as if someone is judging them, disapproving of them, or rejecting their ideas, it can feel like a personal attack on their character and lead to feelings of shame, guilt, anger or sadness.
• Feeling as if their emotions or experiences are being dismissed or invalidated can be triggering for someone with BPD, especially if they feel misunderstood or not heard.
• Unintentional slights, actions or comments that might seem harmless or small to people without BPD, might spark fears of abandonment, separation, severe anxiety or anger in someone with BPD.

There is no medication to treat borderline personality disorder (BPD). However, the symptoms are sometimes controlled by medication in a crisis, but this isn’t helpful as a long-term treatment. BPD is treatable through therapies and interventions such as:

• Dialectical behavioural therapy (DBT) – this helps the individual to learn new ways to deal with distress, rather than harmful ways that they may be using to help them to cope, such as self-harm or substance abuse.
• Cognitive analytical therapy (CAT) – this helps an individual to understand problems they have in relationships, and to change patterns of unhelpful behaviour. This may be useful if they often switch between liking and disliking people who are close to them.
• Mentalisation-based therapy (MBT) – this aims to challenge an individual’s perceptions about what other people are thinking or feeling. Mentalising helps the person to understand other people’s behaviour and their reaction to it.
• Mindfulness – this can help someone to manage their emotions by focusing on the present.

The understanding, compassion and support of family and friends is also significant in treating BPD. It is important for loved ones to approach the individual with BPD with empathy, understanding and patience in order to support them. This is why gaining an awareness of the condition and the symptoms that the individual may be experiencing is essential. 

Open Communication

For individuals with BPD, emotions can shift from being calm and peaceful to being disturbed, agitated and angry in an instant, making communication and relationships challenging. This constant emotional turmoil can make it difficult for the individual, and it is important that those supporting them recognise these constant fluctuations in emotions when communicating. Understanding how to communicate effectively with someone with BPD can help improve your relationship with them. 

Patience, thoughtfulness and understanding are key qualities that are important to display in communications with someone who has BPD. It is also important to recognise how a person with BPD thinks. They are prone to split thinking, seeing the world as either all-good or all-bad. This will mean that at any given time, you are either all-supportive or never-supportive, there will rarely be any in between. Much of the time it may feel like walking on eggshells around the person with BPD. However, living in a world where they feel something so intensely can be terrifying for the person, so it is important that you don’t challenge these emotions. Validation of their feelings is vital to connecting with them.

Validation is acknowledgement that what a person is feeling or thinking is okay, without any judgement, even if you disagree with them. Feeling validated is important for everyone, but is of great importance for people with BPD. The key to validation is finding some small grain of truth in what the person is saying. You need to understand that they believe their reality even if, to you, it is not logical. It is important for the person to realise that what they are feeling is not wrong. 

When they speak to you, it is important to be engaged. Being present and really listening to the person is the ultimate validation. Being distracted or not fully present during the conversation can make the person feel as if you are not interested in what they have to say. It is important to give the person speaking your full attention and demonstrate that you are fully engaged in the conversation.

Respond empathetically, accurately summarising what you understand the person to be saying and feeling, avoiding sarcasm and exaggeration, and without bias, for example “I sense that you are really very angry about …….”, “It sounds like you are feeling really sad about this”. Try to help them separate facts and emotions. For example, their anger at someone they believe to have wronged them doesn’t prove the person intended to hurt them.

Often a person with BPD is all over the place during a conversation, but urging them to get to the point quickly can be counterproductive. Avoid interrupting or cutting off their sentences; wait your turn to speak, be patient, ask questions, and clarify comments as needed. Ask open-ended questions. These are questions that require more than a yes or no answer. They encourage a person to talk more and to share their thoughts and feelings, for example “How did that make you feel?” “What happened next?” Consider what the other person is feeling and try putting yourself in their position while you listen.

If and when there are gaps in the conversation, it can be tempting to jump in and fill a silence with an offer of advice, a solution or your own experience. However, it is important to remember that making space for silence gives the person the chance to consider if there is anything else that they want to share. 

Knowledge about the common traits, triggers and challenges associated with BPD allows you to approach conversations with empathy, understanding, and a more informed awareness of the unique aspects of BPD. Below are listed a variety of resources that you can access to increase your knowledge of the condition. 

Educating Yourself

As has previously been mentioned, it is important that anyone wanting to provide support to loved ones experiencing BPD equips themselves with information about the condition. There are a number of organisations that offer advice, support and useful resources that can provide information for friends and families supporting a person diagnosed with BPD. Below are details of some of these:

• Borderline Support UK is a non-profit organisation which is volunteer-run and led by people who are living with, or affected by, borderline personality disorder. They have created a wide collection of downloadable worksheets, colouring books and e-books, all in PDF format. These cover a wide range of topics including anxiety, depression, DBT, CBT, mindfulness and much more. They also provide free peer support groups, signposting, training and information services.
• Samaritans – if you are worried about someone else having suicidal thoughts you can contact a Samaritan 24/7 for free on 116 123.
• NHS’s information on BPD www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview.
• Mind – provides a comprehensive downloadable resource explaining BPD.
• Rethink Mental Illness – provides advice and information for supporting someone with a mental illness.
• Mental Health UK – delivers both national and local services that enable and empower people to understand and manage their mental health in a person-centred and empathetic way.
• BPD World – provides information and support to people affected by personality disorders. It has an online support forum.
• Talking about BPD is a blogsite hosted by Rosie Cappuccino, blogger and author living with BPD.
• National Suicide Prevention Helpline – a national helpline offering a supportive listening service to anyone throughout the UK with thoughts of suicide or thoughts of self-harm.
• CALM (Campaign Against Living Miserably) – is leading a movement against suicide. They offer accredited confidential, anonymous and free support, information and signposting to people anywhere in the UK through their helpline and webchat service.
• Borderline Arts – is a charity that uses the arts to raise awareness of borderline personality disorder.
• Mary Frances Trust – supporting people with BPD in the Surrey area.
• Young Minds – young person’s mental health charity.
• Turning Point – works with people who have problems with drug and alcohol use, mental health and learning disabilities.
• Mental Health First Aid (MHFA) England – provides mental health training and resources.
• CPD Borderline Personality Disorder Awareness course.

A multitude of books have been written on the subject of BPD, offering insights, strategies and personal narratives to those affected by the disorder. Here is a selection:

• I Hate You, Don’t Leave Me: Understanding the Borderline Personality by Jerold J. Kreisman and Hal Straus
• Loving Someone with Borderline Personality Disorder by Shari Y. Manning
• The Buddha and the Borderline: My Recovery from Borderline Personality Disorder Through Dialectical Behaviour Therapy, Buddhism, and Online Dating by Kiera Van Gelder
• Beyond Borderline: True Stories of Recovery by Perry D. Hoffman and John G. Gunderson
• Lost in the Mirror: An Inside Look at Borderline Personality Disorder by Richard A. Moskovitz
• Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder by Paul T. Mason and Randi Kreger
• The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD by Alex L. Chapman, Kim L. Gratz and Perry D. Hoffman
• Mindfulness for Borderline Personality Disorder by Blaise Aguirre and Gillian Galen
• Get Me Out of Here by Rachel Reiland
• Coping with BPD by Blaise Aguirre and Gillian Galen
• Helping Teens Who Cut by Michael Hollander
• Other books on the topic of BPD can be found at, for example:

A multitude of books have been written on the subject of BPD, offering insights, strategies and personal narratives to those affected by the disorder. Here is a selection:

Waterstones

Amazon

WHSmith

Setting Boundaries

Healthy boundaries are essential for your own self-care when you are supporting someone with BPD. By setting clear boundaries you can provide structure and predictability, helping reduce the fear of abandonment and rejection. Be kind but honest about the fact that you have to set some boundaries to take care of yourself, at the same time reassuring the person that you want your friendship/relationship to continue. 

Be specific, so that they understand the behaviours that you won’t tolerate, such as throwing objects or violence. Don’t let yourself be the focus of their anger. If you can defuse their emotion, do so. But in some instances, you may simply have to walk away. Whilst these boundaries may be unintentionally challenged at times, make sure that you carry out the pre-determined consequence, which may include walking away from the situation. 

Saying no to someone with borderline personality disorder can be a delicate process. If said in the wrong way, it can make them feel rejected and trigger an emotional episode. Navigating these situations without feeling guilty or causing harm can be challenging, but don’t allow them to push boundaries with manipulation, emotions or control. When a person with BPD has clear boundaries and knows the consequences of not keeping to them, they can better regulate their emotions and behaviour, potentially producing more stable relationships. Boundaries can also prevent the person with BPD from becoming overly dependent on others. 

Encouraging Treatment

As we have seen, borderline personality disorder is a complex condition that can make a person feel uncomfortable in their own skin, and they can display behaviours that are both challenging for themselves, and also for those around them. It is essential to recognise the symptoms and triggers of BPD, and for that person to seek professional help if they are struggling. Often a person with BPD will need encouragement to seek a diagnosis and professional help; however, you need to first ask yourself if you are the best person to do the convincing. In order for your encouragement to be effective you will need to have a close relationship with the person built on trust. Nobody likes being told what to do, and they won’t be receptive to you especially if you are not a trusted and close family member, friend or partner. Once you decide to go ahead to start the conversation, plan your case and remember to stay calm and to approach the subject with empathy.

There is no point in having the conversation if you are unable to help, so you need to be available to support them and to be able to offer resources and help with finding a professional therapist. Often the first port of call is their own GP. It can help if you can get the person to start to keep a record of their symptoms, feelings and behaviours. This can help them and their GP to understand what difficulties they are facing. You can also help by writing down lists of questions that the person you are supporting might want to ask their doctor, as it helps to be prepared for this appointment. The GP will not be able to make a formal diagnosis but will refer the person to a mental health professional who can. 

When you start the conversation make sure that you pick somewhere where you cannot be interrupted, somewhere safe and comfortable, and a time when they are feeling well. It is best to start the conversation by emphasising the importance of your relationship with the person. Express how their behaviours make you concerned about their wellbeing, and describe examples that you have noticed that have raised your concerns, but avoid blaming or using words such as always or never. Describe how the behaviours appear to affect the person and those around them. Doing this helps to let the person know that the issue is bigger than them.

Remind them about their positive qualities, and explain how getting professional support can help to alleviate the BPD symptoms that they experience. Empathise that you know it may not be easy, but that you want to support them in taking this step. You could offer to help with finding a professional, to go along with them to the first appointment, or ask what else you can do to support, as this may present you with options you never realised. It may be helpful to point out that a mental health professional will be able to identify the specific help needed in areas in their life that they find difficult; for example, any support needed in returning to or finding work, any psychological treatment or talking therapies needed, coping strategies that they could use and how to manage their day-to-day life, relationships and work. Hearing that there are positives to be gained from seeking professional support may encourage the person to take that step.

You do need to be aware, however, that there is a chance it can go wrong and your offer to help may be unwanted. That’s OK as long as they know you are there to help when they need it. Be prepared for the person to be upset and angry. Remember that any hurtful words should not be taken personally. Try to hear the emotions that the person is expressing, not the harsh words. Give them room to think, signpost them to information, and continue the conversation another day. Let them know that you have been thinking of them and their difficulties; however, it is up to them how they want to proceed.

Crisis Management

When a crisis is less severe, sometimes helping to distract someone from difficult feelings can be really useful. Try suggesting activities or tasks, such as watching a film or going for a walk, or you could start something yourself and let them know that they are welcome to join in when they feel ready.

Understanding their triggers could help you avoid difficult situations, and feel more prepared when they have strong reactions to certain things. 

Depending on the intensity of the situation and behaviours displayed, remain calm and objective so that you can assess the situation clearly and respond appropriately. Use open questioning, active listening and your undivided attention to find out what the problem is and acknowledge the emotions of the person. Keep communication open to allow the individual to calm down and gain trust with you, avoiding negative language; it is essential to approach the situation with empathy. Being non-judgemental allows people to feel safe, which has a calming effect on their behaviour.

Sometimes it may be necessary for someone who is displaying challenging behaviours to have some personal space until they have calmed down sufficiently. It could make matters worse when you try to intervene too quickly or forcefully. Ask them if they would rather be left alone rather than just leave them as this may add to their feelings of abandonment.  

During real or perceived periods of more severe crisis, people with BPD are more at risk for self-harm and/or suicide than the general population. If a person talks about ending their life or makes suicide gestures, it is important to ask if they are serious about killing themselves. Let the person know that if you are concerned for their safety, you will act because you care. If in doubt, seek help through a crisis phone line such as calling 999, or contacting mental health services available in your local area.

Self-Care for Caregivers

Taking care of yourself is one of the most important things that you can do in order to be able to give support to others. Don’t wait until you are completely overwhelmed. Learn what your own warning signs are and take steps to minimise sources of stress where possible. Here are some suggestions:

• Find something active that you enjoy. That might be walking, dancing, gardening, or playing with a pet. Even short periods of exercise can be beneficial.
• Prioritise quality sleep. Aim to get seven to nine hours of sleep each night. Develop a relaxing bedtime routine to make it easier to fall asleep. Try to go to sleep and get up at the same time each day.
• Work on having a well-balanced diet that includes a variety of healthy foods and drink plenty of water every day.
• Make time to relax. Put aside time each week to do something that you enjoy such as watching a favourite TV show, reading, or working on a hobby.
• Experiment with relaxation techniques such as meditation, tai chi or yoga to help relieve stress.
• Be kind to yourself.
• In many cases, one person takes on most of the everyday responsibilities of supporting someone with BPD. Ask others to help when you need it and if someone offers to help, practise saying, “Thanks for asking. Here’s what you can do.”
• Join an online or in-person support group; these are people who will know what you are going through and may have suggestions or advice.

Remember their condition is not your fault. It can be easy to fall into a trap of blame, guilt and responsibility that is not your burden to bear. Always remember that you did not cause this illness and that you cannot control or fix it. You can only give support and love.

Support Groups and Resources

As mentioned above, joining an online or in-person support group can put you in touch with other people who are going through similar experiences, and who may have gems of wisdom that they can share.

• Borderline Support UK CIC has Partners, Parents and Carers support groups that meet virtually once a month.
• Carers UK is a charity that provides expert information, advice and support for unpaid carers in the UK. They provide practical and emotional support, advice on a range of topics including benefits, and can advise on a carer’s assessment.
• Rethink Mental Illness has a directory of support groups right across the UK, some of which are specifically for carers.
• Turn2Us is a charity which helps people find and apply for benefits, grants and other support.
• Action for Carers has multiple Hubs, located right across Surrey. These are drop-in locations for Surrey’s unpaid carers to visit for advice and support.
• Mind’s Infoline can help you find services that can support you.
• BPD World offers a list of support groups across the UK for carers and those suffering mental health issues.

Patience and Empathy

For those living with borderline personality disorder it can often feel like walking on a tightrope, balancing between intense emotions and the constant search for stability. It is essential to recognise that those living with BPD often experience feelings intensely and may find it challenging to regulate these emotions. Having understanding, patience, empathy and compassion are key to supporting someone as they participate in therapy in order to recover from the condition. 

People with BPD can be good at pushing buttons, and for those supporting them it is their responsibility to be responsive and not reactive and this requires lots of patience. A big part of treatment for BPD is a type of therapy called dialectical behaviour therapy (DBT), which helps the person to be more mindful and accepting of their emotions, negative thinking and moods. It also helps them learn to actively change and control these emotions as well as negative behaviours. However, there may be plateaus and setbacks along the way, and your support will be invaluable, particularly at these times. 

Although progress can be slow, if they can begin to work on a borderline personality disorder treatment plan with their mental health professional and have consistent support in place to ensure that they keep to the plan, then progress can be made.

Although the condition is serious, the borderline personality disorder prognosis is better than many assume. What experts know for sure is that the BPD prognosis is much better for people in mental health treatment than the prognosis for untreated BPD. Follow-up studies of people with BPD receiving treatment found a borderline personality disorder treatment success rate of about 50% over a 10-year period. BPD takes time to improve, but treatment does work.

Celebrating Progress

For anyone embarking on the journey towards mental health and wellbeing, every stride forward, no matter how small, is a triumph worthy of celebration and it is essential to acknowledge and applaud the progress made along the way. Celebrating progress serves as a powerful motivator. Recognising achievements, whether big or small, can encourage individuals to continue working towards their mental health goals. It reinforces the idea that their efforts are making a difference and that positive change is possible.

The challenges of living with BPD can often take a toll on the person’s self-esteem and confidence. By acknowledging and celebrating progress in recovery, you can help the person to build a more positive self-image, fostering a sense of accomplishment and self-worth.

Progress in therapy, whether through breakthrough insights, improved coping mechanisms, or better communication with a therapist, is a significant milestone. Celebrating these moments encourages continued engagement in the therapeutic process.

Openly celebrating mental health achievements creates a supportive environment. Encouraging the person to share their successes in, for example, support groups helps to reduce stigma, encourages open communication, and fosters a sense of community among individuals facing similar challenges.

Encouraging the person to keep a progress diary, regularly recording thoughts, feelings and notable achievements provides a tangible record of growth and achievement, and serves as a reminder of the journey.

Celebrating progress in mental health is an integral part of the healing journey. It fosters a positive mindset, motivates continued effort, and creates a culture of support.

Final Thoughts

As we have said before, living with borderline personality disorder is difficult for the person themselves and for partners, family and friends. You will show that you care about the person, helping them to feel understood and less alone in their difficulties if you support their treatment, learn to communicate effectively with empathy and patience, set boundaries, and remember to take care of yourself as well. Although treatment takes time to work, the prognosis is good.