Roller Coaster Relationship

If you have a partner with borderline personality disorder (BPD), your relationship may look something like this:

• Yesterday, in the eyes of your partner, you could do no wrong. Today, everything you do is wrong.
• Ten minutes ago, your partner was smiling and happy. Now, they are screaming at the top of their lungs about a perceived snarky comment from you, which was not meant in the way it was interpreted, and household objects are being thrown. You hastily leave to go to work.
• By the end of today, you will get 15 text messages, eight phone calls, and 10 emails from your partner that ask if you still love them, and threatening suicide if you end the relationship.

According to the National Institute for Mental Health, two percent of Americans are diagnosed with BPD, which equates to about six million people, although some estimates are as high as six percent, or eighteen million people. Women are more frequently given the diagnosis, but that may be because they present for psychiatric services more often than men, or because of provider bias, with men being diagnosed with antisocial personality disorder instead of BPD.

Obviously, having a relationship with someone who experiences BPD is a challenge. At the beginning of your relationship, there may have been a honeymoon period where you were idealized by your partner. But now you may be experiencing the darker side of BPD: fears of abandonment, impulsive behaviors (gambling, unsafe sex, spending sprees, binge eating, drug use), emotional instability, and suicidal gestures or attempts.

What does the partner of someone with BPD do?

Helping your partner find the right treatment is crucial. Convincing them to first try treatment, and then stick with it, however, is a whole other issue. BPD clients are frequently considered the “toughest to treat” by mental health professionals because of the instability they present. Remember, what happens in the “real world” also happens in therapy offices: the same patterns your partner with BPD does at home happen with the therapist, too.

But there is hope. Dialectical behavioral therapy (DBT) is considered the most effective treatment for BPD. There are a ton of resources online about DBT, including the blog Dialectical Behavior Therapy Understood here on PsychCentral, so I invite you to check them out to learn more. There are other treatments that are beginning to receive more attention as well, such as mentalization-based therapy (MBT), transference-focused psychotherapy (TFP), schema therapy (ST), and cognitive behavioral therapy (CBT) tailored specifically to BPD.

Next, finding a therapist to help you is vitally important as well.Even if your partner is in treatment, the instability and uncertainty around their mood and behavior will not resolve overnight. Treatment for BPD is a long process, and if you and your partner are going to get to the other side with your relationship intact, you are going to need professional support.
It is important for you to learn about DBT as well so that you can participate in your partner’s recovery. One way to do this is through DBT Family Skills training.

As for day-to-day ways to support your partner during the recovery process, some tips include:

• Do not ignore your partner’s threats to harm themselves. After a while, family and friends can become desensitized to the threats of the person with BPD. However, it is common, especially when someone is in treatment, for things to actually get worse before they get better. Statistically, around 9-10% of people with BPD complete suicide, and it is often by accident. Don’t take chances: call 911 or bring your partner to the emergency room if they are threatening suicide. Let the mental health professionals decide the level of actual threat.
• Learn how to validate your partner’s experience. One of the theories behind DBT is that the person with BPD grew up in an invalidating environment, which means they were consistently told that their feelings were bad or wrong, or may have even been physically punished for showing emotion, even if their reaction to the situation was perfectly appropriate.
• Use good communication skills to set boundaries with your partner. Another hallmark of the experience of people who have BPD is that their lives have always been unstable. Having boundaries in place in their adult relationship, and especially having those boundaries remain in place when tested, helps to provide your partner with a safe environment that they know will not fail them.
• Take care of yourself. I say this in practically every post: if you are not caring for yourself, you are not in a position to help your partner get better.

Kate Thieda

PsychCentral.com