Borderline personality disorder (BPD) can seem like an enigma, even to family and friends, who are often at a loss for how to help. Many feel overwhelmed, exhausted and confused.

Fortunately, there are specific strategies you can use to support your loved one, improve your relationship and feel better yourself.

In Part 1 of our interview, Shari Manning, Ph.D, a licensed professional counselor in private practice who specializes in treating BPD, shares these effective strategies and helps readers gain a deeper understanding of the disorder.

Specifically, she reveals the many myths and facts behind BPD, how the disorder manifests and what mistakes loved ones make when trying to help.

Manning also is Chief Executive Officer of the Treatment Implementation Collaborative, LLC, and author of the recently published book Loving Someone with Borderline Personality Disorder. (It’s a must-read!)

Q: What are the most common myths about borderline personality disorder (BPD) and how it manifests?

People with BPD are manipulative. We have found that it is not effective to be judgmental of clients or each other. If you think you are being manipulated, you will be defensive in your responses to the person whom you think is manipulating you. You will act to protect yourself and not out of wisdom. Besides, as we tell our clients, the problem is that people with BPD are not artful at manipulating. Really skillfully manipulative people get what they want from others without them knowing they are being manipulated. People with BPD get caught.

We have found that it is not effective to be judgmental of clients or each other. If you think you are being manipulated, you will be defensive in your responses to the person whom you think is manipulating you. You will act to protect yourself and not out of wisdom. Besides, as we tell our clients, the problem is that people with BPD are not artful at manipulating. Really skillfully manipulative people get what they want from others without them knowing they are being manipulated. People with BPD get caught. People with BPD do not really want to die when they attempt suicide. Depending on the research, and the severity of the disorder 8 to 11 percent of people with BPD die by suicide. Their lives are agony and they often want to escape the pain of their lives. Sometimes they do so by trying to completely end the pain with suicide; other times, they get temporary relief with other behaviors, e.g. cutting, burning, substance abuse, binging/purging, shoplifting.

Depending on the research, and the severity of the disorder 8 to 11 percent of people with BPD die by suicide. Their lives are agony and they often want to escape the pain of their lives. Sometimes they do so by trying to completely end the pain with suicide; other times, they get temporary relief with other behaviors, e.g. cutting, burning, substance abuse, binging/purging, shoplifting. People with BPD are stalkers (like the character from Fatal Attraction). People with BPD often don’t have interpersonal skills. Their learning history has been one of losing relationships, often because of their extreme behaviors. There have been several studies done and it appears that four to 15 percent of stalkers were diagnosed with BPD. It is important to remember that some percent of stalkers may meet criteria for BPD but stalking is not a characteristic of BPD. Very few people with BPD become stalkers.

People with BPD often don’t have interpersonal skills. Their learning history has been one of losing relationships, often because of their extreme behaviors. There have been several studies done and it appears that four to 15 percent of stalkers were diagnosed with BPD. It is important to remember that some percent of stalkers may meet criteria for BPD but stalking is not a characteristic of BPD. Very few people with BPD become stalkers. People with BPD just don’t want to change (or they would do so). I have never met a person with BPD who wanted to be emotionally and behaviorally out of control. If there were a magic wand that “cured” BPD, I am certain all of my clients would have me wave it at them. The problem is that change is really hard for all of us and doubly (maybe triply) hard for people who are emotionally sensitive. Think of a behavior that you wanted to change (quitting smoking, exercising, dieting). Think of all of the times you failed. Did you fail because you didn’t really want to change or because you failed?

I have never met a person with BPD who wanted to be emotionally and behaviorally out of control. If there were a magic wand that “cured” BPD, I am certain all of my clients would have me wave it at them. The problem is that change is really hard for all of us and doubly (maybe triply) hard for people who are emotionally sensitive. Think of a behavior that you wanted to change (quitting smoking, exercising, dieting). Think of all of the times you failed. Did you fail because you didn’t really want to change or because you failed? People with BPD are uncaring and only think of themselves. In my experience (and I don’t really have studies to back this up), people with BPD are extremely caring. They get a reputation for only thinking of themselves when they get distressed and engage in behaviors that cause harm to their relationships (overcalling, over-texting, showing up when not invited). In the heat of the crisis, people with BPD are often so physiologically/emotionally aroused, that they cannot be mindful to others. However, they feel an extreme amount of guilt and shame about the effects of their behavior on others.

In my experience (and I don’t really have studies to back this up), people with BPD are extremely caring. They get a reputation for only thinking of themselves when they get distressed and engage in behaviors that cause harm to their relationships (overcalling, over-texting, showing up when not invited). In the heat of the crisis, people with BPD are often so physiologically/emotionally aroused, that they cannot be mindful to others. However, they feel an extreme amount of guilt and shame about the effects of their behavior on others. BPD develops from childhood sexual abuse. Not all people who have suffered childhood sexual abuse develop BPD and not all people with BPD suffered childhood sexual abuse. Depending on the study, 28% to 40% of people with BPD had sexual abuse in their childhood. We used to think that the incidence was higher but as the diagnostic criteria for BPD have been more effectively used, we are finding that the incidence is lower than we initially believed.

Not all people who have suffered childhood sexual abuse develop BPD and not all people with BPD suffered childhood sexual abuse. Depending on the study, 28% to 40% of people with BPD had sexual abuse in their childhood. We used to think that the incidence was higher but as the diagnostic criteria for BPD have been more effectively used, we are finding that the incidence is lower than we initially believed. BPD develops from poor parenting. As I said above, some people with borderline personality disorder are sexually or physically abused as children. Some people with BPD had distant or invalidating families. However, some people came from completely “normal” families. People with BPD are born with an innate, biological sensitivity to emotions, e.g. they have quick to fire, strong, reactive emotions. Children who are emotionally sensitive take special parenting. Sometimes, the parents of the person who develops BPD just aren’t as emotional and cannot teach their child how to regulate intense emotions. We tell clients that they are like swans born into a family full of ducks. The duck parents only know how to teach the swan how to be a duck.

Q: What mistakes do you see loved ones make when trying to deal with someone with BPD?

Family members often try to encourage their loved one but inadvertently invalidate them and increase their emotional arousal. For example: the person with BPD says, “I am a terrible person” after seeing hospital bills from a suicide attempt. The family member responds, “No, you’re not a bad person.” The contradiction makes the person with borderline personality disorder more distressed.

Instead, try acknowledging the feelings/thoughts behind the statement then moving into something else. Say instead, “I know that you feel badly about how you acted and that makes you think you are a bad person.”

Another error is that family members give the person with BPD more care and attention when they are in crisis and then withdraw when they are not. This may inadvertently reinforce the crisis behavior and punish non-crisis behavior.

Q: In your book, you discuss the importance of gaining a deeper understanding of how BPD manifests so loved ones know what to expect and don’t feel so lost. You also note that Dr. Marsha Linehan, the founder of dialectical-behavior therapy, classified the disorder into five areas of dysregulation. Can you briefly describe these categories?

Emotional dysregulation — extreme emotional responses, especially with shame, sadness and anger.

— extreme emotional responses, especially with shame, sadness and anger. Behavioral dysregulation — impulsive behaviors like suicide, self-harm, alcohol/drugs, binging/purging, gambling, shoplifting, etc.

— impulsive behaviors like suicide, self-harm, alcohol/drugs, binging/purging, gambling, shoplifting, etc. Interpersonal dysregulation — relationships that are chaotic, fearfulness of losing relationships coupled with extreme behaviors to keep the relationship

— relationships that are chaotic, fearfulness of losing relationships coupled with extreme behaviors to keep the relationship Self-dysregulation — not knowing who a person is, what their role is, being unclear on values, goals, sexuality

— not knowing who a person is, what their role is, being unclear on values, goals, sexuality Cognitive dysregulation — problems with attentional control, dissociation, sometimes even brief episodes of paranoia

Q: You say that BPD, at its core, is an emotional problem. Why are people with BPD so much more emotional than others?

Our emotional sensitivity is something that is hardwired into us. Some people are more emotional than others. People with BPD are usually among the most emotionally sensitive people. Anyone who is emotionally sensitive must have skills to regulate those intense emotions. Skills are learned not hardwired.

In Part 2 of How to Help a Loved One with Borderline Personality Disorder, Manning discusses how to help defuse your loved one’s intense emotions, how to handle a crisis, what to do if your loved one refuses treatment and much more.

How to Help a Loved One with Borderline Personality Disorder, Part 1