Caring about someone with borderline personality disorder (BPD) tosses you on a roller coaster ride from being loved and lauded to abandoned and bashed. Having BPD is no picnic, either. You live in unbearable psychic pain most of the time, and in severe cases, on the border between reality and psychosis. Your illness distorts your perceptions, causing antagonistic behavior and making the world a perilous place. The pain and terror of abandonment and feeling unwanted can be so great that suicide feels like a better choice.

If you like drama, excitement, and intensity, enjoy the ride, because things will never be calm. Following a passionate beginning, expect a stormy relationship that includes accusations and anger, jealousy, bullying, control, and breakups due to the insecurity of the person with BPD.

Nothing is gray or gradual. For people with BPD, things are black and white. They have the quintessential Jekyll and Hyde personality. They fluctuate dramatically between idealizing and devaluing you and may suddenly and sporadically shift throughout the day. You never know what or whom to expect.

Their intense, labile emotions elevate you when they’re in good spirits and crush you when they’re not. You’re a prince or a jerk, a princess or a witch. If you’re on the outs with them, all their bad feelings get projected onto you. They can be vindictive and punish you with words, silence, or other manipulations, which can be very destructive to your self-esteem. Unlike bipolar disorder, their moods shift quickly and aren’t a departure from their normal self. What you see is their norm.

Their emotions, behavior, and unstable relationships, including work history, reflect a fragile, shame-based self-image. This is often marked by sudden shifts, sometimes to the extent that they feel nonexistent. It is made worse when they’re alone. Thus, they’re dependent on others and may frequently seek advice from several people about the same question on the same day. They’re desperate to be loved and cared for, yet are hypervigilant for any real or imagined signs of rejection or abandonment. It is common for them to cut off relatives or friends who “betray” them.

For them, trust is always an issue, often leading to distortions of reality and paranoia. You’re seen as either for or against them and must take their side. Don’t dare to defend their enemy or try to justify or explain any slight they claim to have experienced. They may try to bait you into anger, then falsely accuse you of rejecting them, make you doubt reality and your sanity, or even brainwash you as emotional manipulation. It is not unusual for them to cut off friends and relatives who they feel have betrayed them.

They react to their profound fears of abandonment with needy and clingy behavior or anger and fury that reflect their own skewed reality and self-image. On the other hand, they equally fear the romantic merger they try to create, because they’re afraid of being dominated or swallowed up by too much intimacy. In a close relationship, they must walk a tightrope to balance the fear of being alone or of being too close. To do so, they try to control with commands or manipulation, including flattery and seduction. Whereas narcissists enjoy being understood, too much understanding frightens the borderline.

Generally, borderlines are codependent, and find another codependent to merge with and to help them. They seek someone to provide stability and balance their changeable emotions. A codependent or narcissist who acts self-sufficient and controls his or her feelings can provide a perfect match. The borderline’s partner vicariously comes alive through the melodrama provided by BPD.

The person with BPD may appear to be the underdog in the relationship, while his or her partner is the steady, needless and caretaking top dog. In fact, both are codependent and it’s hard for either of them to leave. They each exercise control in different ways.

The non-BPD may do it through caretaking. A codependent who also yearns for love and fears abandonment can become the perfect caretaker for someone with BPD (whom they sense won’t leave). The codependent is easily seduced and carried away by romance and the person with BPD’s extreme openness and vulnerability. Passion and intense emotions are enlivening to the person without BPD, who finds being alone depressing or experiences healthy people as boring.

Codependents already have low self-esteem and poor boundaries, so they placate, accommodate, and apologize when attacked in order to maintain the emotional connection in the relationship. In the process, they give over more and more control to the borderline and further seal their low self-esteem and the couple’s codependency.

Borderlines need boundaries. Setting a boundary can sometimes snap them out of their delusional thinking. Calling their bluff also is helpful. Both strategies require that you build his or her self-esteem, learn to be assertive, and derive outside emotional support. Giving in to them and giving them control does not make them feel more safe, but the opposite. See also my blog on manipulation.

BPD affects women more than men and about two percent of the U.S. population. BPD usually is diagnosed in young adulthood when there has been a pattern of impulsivity and instability in relationships, self-image, and emotions. They may use alcohol, food, or drugs or other addiction to try to self-medicate their pain, but it only exacerbates it.

Like all personality disorders, BPD exists on a continuum, from mild to severe. To diagnose BPD, at least five of the following symptoms must be enduring and present in a variety of areas:

Frantic efforts to avoid real or imagined abandonment. Unstable and intense personal relationships, marked by alternating idealization and devaluation. Persistently unstable sense of self. Risky, potentially self-damaging impulsivity in at least two areas (e.g., substance abuse, reckless behavior, sex, spending) Recurrent self-mutilation or suicidal threats or behavior. (This doesn’t qualify for nos. 1 or 4.) Around eight to 10 percent actually commit suicide. Mood swings (e.g. depressed, irritable, or anxious) mood, not lasting more than a few days. Chronic feelings of emptiness. Frequent, intense, inappropriate temper or anger. Transient, stress-related paranoid thoughts or severe dissociative symptoms.

The cause of BPD is not clearly known, but often there has been neglect, abandonment, or abuse in childhood and possibly genetic factors. People who have a first-degree relative with BPD are five times more likely to develop BPD themselves. Research has shown brain changes in the ability to regulate emotions. For more, read here and here.

Unlike narcissists, who often avoid therapy, borderlines usually welcome it; however, before recent treatment innovations, its effectiveness had been questioned. Use of medication and DBT, CBT, and some other modalities have proven helpful. Borderlines need structure, and a combination of knowing that they’re cared about and firm boundaries communicated calmly.

Today, BPD is no longer a life sentence. Studies have shown that some people recover on their own, some improve with weekly therapy, and some require hospitalization. Long-term treatment is required for maximum results, with symptom relief increasingly improving. A 10-year study showed substantial remission after 10 years.

Use of medication and DBT, CBT, schema therapy and some other modalities have proven helpful. Most individuals with BPD have another co-occurring diagnosis, such as addiction or depression. Acute symptoms diminish more readily than temperamental ones, such as anger, loneliness, and emptiness and abandonment or dependency issues.

Borderlines need structure, and a combination of knowing that they’re cared about plus boundaries that are communicated calmly and firmly. For partners, it’s also important to seek therapy in order to raise your self-esteem, learn to be assertive, and set boundaries. See my blog on “How to Spot Manipulation” and my books and e-workbooks for helpful exercises.

©Darlene Lancer, LMFT

Loving Someone with Borderline Personality Disorder