I am guessing you are here because you are exhausted. And perhaps also scared, and so very sad. But hanging on to a little bit of hope...

You are a mom or a dad, a sibling or a spouse, or an adult child of someone who is so frequently " out of control" - either with anger or with sadness; this person in your life experiences a lot of emotional dysregulation, you see that they suffer greatly, and you do too. You want to help and be there for them, and you don't know how. Most of what they do makes little sense to you. It feels like most attempts to help, or connect, result in worst crises, although sometimes you do feel you are being helpful. You are given lots of advice, and you know friends and family mean well yet don't really get what it's like. And all along, there is that voice inside that tells you there IS something you can do.

Well, there is. More good news: it's not that hard, although it takes determination and desire to change. It will not resolve all, but it will take you and your relative a long way towards an improved family life.

Borderline Personality Disorder [BPD]

First, let's discuss what might be going on. This severe emotional dysregulation might be the sign of Borderline Personality Disorder, at different levels of severity. But let's be clear: that label does not need to be given for there to be much pain and dysfunction. In fact, often the wrong label is given. The DSM IV "rules" are that the BPD diagnosis is given to people who meet five or more of the following nine criteria (or symptoms):

  1. Frantic efforts to avoid real or imagined abandonment.
  2. 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, 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.
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger.
  9. Transient, stress, related paranoid ideation or severe dissociative symptoms.

As you see, people with BPD will often have unstable interpersonal relationships, self-image and emotions. They are also usually very impulsive.Yet life can be quite hard for anyone who has just two or three criteria.

So why is there a diagnosis?

Well, it makes it easier to characterize people when we speak of treatment. We know that some therapies or medications work quite well for some specific combination of symptoms, and it's easier to call that by a name than listing all the symptoms one by one. Also, diagnoses are given because insurance companies demand it. If there is a diagnosis, then there is a reimbursement code and they know that there is a specific treatment that is given that hopefully addresses the illness.

This BPD diagnosis (or symptoms)? Well, it is also good news. There are treatment options that work very well, and there are things you can do even if your relative refuses treatment for now. Currently, the most researched and effective treatment is called DBT (Dialectical Behavior Therapy.) Medication is not so effective for BPD in general, although medication can be used to treat other parallel (co-morbid) illnesses or to take the edge off some severe symptoms.

So now, what can you do?

A great place to explore is the NEA-BPD website. It is at BorderlinePersonalityDisorder.com. You will find a lot of terrific resources there: videos, recordings of webinars, important information about the illness, about DBT and about other promising treatments. I strongly recommend that you sign up for NEA-BPD's virtually free class for family members, Family Connections. The wait list for this class can be quite long, but it is the most effective way of learning how to help your relative. And if you need help now, or if you have taken the class already and need help in implementing the skills, then by all means, send me an email so we can connect and set up a time to talk.

If appropriate, we will make an appointment to talk for a 1/2 hour at no charge. We will discuss your immediate needs and goals, and we will decide together what a helpful course of action might be.

What you are going through is incredibly hard. I wish you well, I wish you peace, I wish you hope.

Marie-Paule de Valdivia, LMSW, MBA, CPC
Telephone: 646.771.8321 || mp@FamiliesOnTheLine.com