One of the most common questions I get from people when I give talks on Borderline Personality Disorder (BPD) and Dialectical Behaviour Therapy (DBT) is the question of how to support someone with BPD? So many individuals, couples, and families are struggling with how to love, care for, and support someone in the midst of what often feels like total chaos and painful experiences.
Shari Y. Manning, former President and CEO of Behavioral Tech and Behavioral Tech Research, the research organizations founded by Marsha Linehan to provide training in BPD, wrote a book on just this, titled “Loving Someone with Borderline Personality Disorder” and in it she focuses on how to keep the out of control emotions from destroying relationships between individuals with BPD and their families and other supports. She highlights the difficulty of balancing compassion for the person, while still wanting to help them find ways to change their behaviour and managing their emotions.
I’ll admit that it’s not easy to help someone struggling with BPD. It may seem that they are manipulative, egocentric, and focused on their own needs exclusively. The reality is that it’s not actually too far from the truth. The key to supporting someone with BPD without losing our own sanity, in my mind, is in our approach and how we frame what we’re observing. This is where Dialectical Behaviour Therapy (DBT) skills come in handy for us as well.
Interpersonal Effectiveness and Manipulation
Let’s talk for a minute about the idea that people with BPD are manipulative. It’s common to hear, both amongst clients with BPD, support systems, and yes, even professionals. I remember years ago that I used to get very angry when I heard this because I felt very compassionate toward clients with the borderline personality disorder and their need for help. Then it dawned on me – that is, they are being manipulative. And so are we.
See, manipulation is nothing new in relationships. We do it all the time – in fact, as I said to my intern John this week in supervision, we’re all in relationships to get what we need from the other person. None of us would be in relationships if this weren’t true. The difference is, we do it in a mutually beneficial way that serves everyone involved. The fact remains, however, that we’re all trying to get what we need from others, we just have more ability to do so effectively. This is what interpersonal effectiveness skills in DBT do for clients and for members of support systems; they teach us how to get what we need from others in an effective way.
Why Individuals with BPD Behave the Way That They Do
I remember back many years ago when I began working with individuals with developmental disabilities, we often repeated the phrase with staff and caregivers, “All behaviour is communication.” This is a very important concept and applies just as much to kids and adults alike, as well as individuals with BPD. When we can’t use words to communicate, we use actions. Further, when we see the often extreme behaviours of individuals with BPD, it’s important we remember what is happening to them at that moment, and how it got that way.
Personal history
We’ve learned from research that individuals with BPD have reasons for interacting with the world in the way they do, just as we all do! Linehan’s theory from 1993 is the most substantiated, and it suggests that BPD can be the result of the interaction between biological and psychosocial factors, including adverse childhood experiences. One of the predominant factors is invalidating developmental contexts where emotional expression is invalidated in childhood. Further research suggests that between 30%-90% of individuals have experienced abuse and neglect in their lifetime. This has a significant impact on the developing brain.
Brain Function
What we also know from brain science, and certainly I’ve observed this in my clinical work, is that individuals who have histories of abuse, neglect, invalidating emotional environments, and other traumas, have brains that are more sensitive to danger. The limbic system is designed to keep us safe and also regulate our emotions. At its’ best, it keeps us safe when we’re in danger, and regulates our emotions to keep us at an even keel. At its’ worst, it’s being triggered in situations that aren’t dangerous and causing us to react in ways that would make sense if we’re in danger but make no sense when we’re not. It’s also important to remember that when this system is acutely active, it shuts down our frontal cortex, which is where our rational thought mechanisms are housed. So, when we’re in danger, as I often say to clients, we can’t think to save our lives. This is the brain state that individuals with BPD are in when they react in extreme ways. Their brains are in full-blown fight or flight mode and simply reacting, trying to do anything they can to be safe. Most often, they turn to their closest relationships.
Relationships as Safety
Ever heard the idea that we hurt the ones we love the most? This is often the case with individuals with BPD when they react in extreme ways. But why is this? Many people with BPD have a very externalized locus of control, meaning, they don’t believe they can contain their own emotions, especially when they’re overwhelmed. You know what? They’re right. When they’re in fight or flight the mechanisms in their brain responsible for regulating emotions and behaviour are not rational, and are just reacting and they can’t contain it. This is simply a more extreme version of what happens to all of us. So then, what’s the difference?
I believe the difference is the level of fear experienced in these moments. The idea of not being able to contain extreme emotions would be, I imagine, quite terrifying. Coupled with the fear of being left by the people they are closest to, the proverbial pot boils over and they have to do something extreme to get attention. I often hear, “Oh they’re just attention-seeking,” to which I reply with an emphatic, “Yes, of course, they are!”
Remember the idea that all behaviour is communication? When people with BPD are at this heightened state they are unable to communicate effectively and are doing their darndest to communicate their pain and fear to us, asking us to help them contain it. What may look to us like someone simply showing out of control behaviour, I believe, is a desperate attempt at seeking safety and containment.
Can you imagine what it would be like to be in this position? Having BPD, feeling so unsafe and so in pain that you have to go to such extreme lengths to try to get help? I can’t. The idea of being there is far too terrifying to me. Quite frankly, I don’t want to know what it feels like to be in that place, but it gives me a great deal of compassion for those who are.
What Do We Do To Help?
One of the best ways to be supportive is to help those struggling with BPD to get the help they need. Dialectical Behaviour Therapy (DBT), on an individual basis as well as in skills groups, is very effective in helping those with BPD manage their symptoms. With the right help, individuals with BPD can learn the skills they need to manage their emotions and relationships and ultimately, have a life worth living! This was Marsha Linehan’s goal in developing DBT, to help those struggling with suicidal thoughts have a life worth living. We’re proud to say that our DBT programs have been effective at doing just that for our clients, and we’d love to help even more people this way.
We have often been asked if we run groups for family members and other supports who are trying to help someone with BPD. Unfortunately, we don’t at the moment but it’s on our radar. We are looking into doing exactly this in the future. What we can do, however, is teach DBT skills on an individual or family basis for those supporting someone with BPD. We have a number of counsellors available for this, and you can talk to Doug, Share, or Kelly about this if it would be helpful.
Education is also very important as once we understand what is happening, it gets less scary. There are many books that can be very helpful. Here are a few ideas to get you started:
Stop Walking on Eggshells by Paul Mason
Loving Someone with Borderline Personality Disorder by Shari Y. Manning
DBT Made Simple: A Step-by-Step Guide to Dialectical Behavior Therapy by Sheri Van Dijk
Finally, self-care is absolutely paramount to your survival for yourself and the person struggling with BPD. As the airlines often remind us, we need to put our mask on before we can help anyone else! If we don’t take care of ourselves, we will flip our lids and react in much the same way as those we’re trying to help.
I hope this has been helpful – if our team can be of any help to you as you support someone with BPD please feel free to give us a shout. Our Dialectical Behaviour Therapy program is comprehensive, and we would love to teach you the skills needed to be a solid support, for yourself and your loved ones with BPD!