BPD within the Family System

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“When you travel to another country, it’s important to know the local customs. When you’re interacting with someone with BPD, it’s crucial to understand that their unconscious assumptions may be very different from yours.”

~ Paul T. Mason, Author of “Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a severe mental health issue that impacts not only the sufferer but also everyone they have relationships with, including romantic partners, friends, and family.[1]

What is Borderline Personality Disorder?

BPD is estimated to directly affect 1.6% in the general population.[2] It is typified by the sufferer’s being hypersensitive to rejection and, as a result, experiencing interpersonal strife, having trouble controlling one’s behavior, and struggling to maintain a realistic self-image.

Emotional dysregulation is one of the most common traits of the disorder and is characterized by two key threads: increased emotional sensitivity and affective intensity or emotional vulnerability.

Those who have BPD appear to experience emotions far more powerfully than someone without the condition. It is noted that common intense feelings include a disparate fear of abandonment and feelings of loneliness, isolation, sadness, hopelessness, and emptiness.  

BPD sufferers may engage in negative defense mechanisms to escape the emotional discomfort they are subject to. These can include:[3]

  • Idealization – holding oneself or another in unrealistically high esteem
  • Devaluation – viewing oneself or someone else as unforgivably “bad”
  • Splitting – viewing the world in purely black and white terms where everyone is either “good” or “bad”

It is frequently assumed that those with BPD lack empathy, as they seem to struggle with interpreting or managing other people’s feelings and emotions. However, rather than lacking empathy for others, people with BPD find nuance difficult to process. They tend to see the word in absolutes, without grey areas. This can cause the individual to feel dissociated from those around them or to feel emotionally exhausted and overwhelmed by the challenges they experience within interpersonal relationships.[4]

BPD and Young People

BPD takes a toll on all areas of a child’s life and functioning. The instability that this disorder causes affects their self-awareness, mood, body-image, self-esteem, behavior, and relationships.

Research demonstrates that teenagers with BPD are more likely to engage in the following behaviors:

  • Running away from home
  • Truancy
  • Self-injurious behaviors
  • Suicidal ideation
  • Substance use
  • Sexual promiscuity
  • Emotional outbursts, including anger and rage
  • Aggressive behavior

This group is also more likely to have volatile friendships, to bully or be bullied, to experience legal trouble, or to require welfare services.

BPD and the Family System

Borderline Personality Disorder impacts the entire family system and presents issues that are far beyond the parenting dilemmas most parents face. As a child with BPD emerges into adolescence and young adulthood, the family will often struggle with unchartered territory and require professional therapeutic support.

The ordinary pressures of adolescence can leave parents feeling exhausted and inadequate at times. However, this struggle is vastly accentuated when a child has BPD. It is common for conventional parenting techniques to fail, for shame and resentment to emerge, and for conflict to occur among the child, parents, siblings, and extended family members. Family Time can grow to resemble a battlefield with a perpetual cycle of circular conversations, promises, arguments, and chaos. These conflicts can intensify over time and end in crisis.

Those with BPD are particularly sensitive to feelings of abandonment and rejection, and these fears can manifest in various ways, including when other people state their own reasonable needs. Reactionary, impulsive, or aggressive behaviors, including threats of self-harm or suicidal gestures/attempts, are, unfortunately, common.  Family members frequently witness these behaviors and are called upon to intervene or even save the individual.

Sadly, suicidal gestures all too often result in intentional or accidental death among this group, and these situations cause immense distress to the entire family system. It is not uncommon for family members to seek therapeutic support of their own in order to cope with the distressing situations they must manage at home. In fact, there are higher levels of psychopathology in the families of patients with BPD than with other mental health conditions.[5]

Siblings may have to take on the role of caregiver; parents may lose sources of pleasure such as hobbies due to the upheaval at home; marriages may end in divorce; and extended family may feel the strain and distance themselves.

Tips for Living with Someone who has BPD

It can be tempting for families to want to “save” or “fix” the person who is struggling with BPD. However, this can lead to co-dependency, guilt, resentment, and a need to control. BPD is a highly complex mental health condition which requires clinical treatment. However, if you have a family member with BPD, there are certain actions you can take to alleviate the situation:

  • The first step is to acknowledge that BPD is a mental health condition that will not resolve on its own.
  • The behaviors of someone with BPD can be upsetting, but it is important to not take it personally; their actions are symptomatic of their condition.
  • If someone with BPD is experiencing strong emotions, it is important to try and remain calm, as reacting strongly can exacerbate the situation.
  • Showing care and support in a steady, equanimous way will help the person with BPD realize they are not going to be abandoned or rejected.
  • Use boundaries to ensure that you take care of your own needs before you try and help them with theirs.

Treatment

Intensive treatment programs offer the most hope for significant, sustainable change. However, the stress of coping with a loved one’s BPD symptoms can become intensified by the difficulties of managing their treatment program.[6] Family members can feel immense responsibility to notice changes in their loved one’s mood, to spot self-injurious behavior, and observe whether they have stopped taking medications as prescribed or following self-care routines.

It is essential to enlist the help of an expert clinician who specializes in BPD treatment for the entire family.  BPD affects the entire family system, and each family member must be offered the support, attention, and care they deserve.

These patterns of communication can most successfully be addressed in a safe environment outside of the home to ensure that all family members, including siblings, can fully heal.

If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.


Sources:

[1] Borderline Personality Disorder. National Institute of Mental Health. Revised December 2017.

[2] Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2020 Nov 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/

[3] Kramer, U., de Roten, Y., Perry, J. C., & Despland, J.-N. (2013). Beyond splitting: Observer-rated defense mechanisms in borderline personality disorder. Psychoanalytic Psychology, 30(1), 3–15.

[4] Katsakou, Christina et al. “Recovery in Borderline Personality Disorder (BPD): a qualitative study of service users’ perspectives.” PloS one vol. 7,5 (2012): e36517. doi:10.1371/journal.pone.0036517

[5] Sansone, Randy A, and Lori A Sansone. “The families of borderline patients: the psychological environment revisited.” Psychiatry (Edgmont (Pa. : Township)) vol. 6,2 (2009): 19-24.

[6] Kay ML, Poggenpoel M, Myburgh CP, Downing C. Experiences of family members who have a relative diagnosed with borderline personality disorder. Curationis. 2018;41(1):e1-e9. doi:10.4102/curationis.v41i1.1892

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