Being Close To Someone Working With Borderline Personality Disorder Challenges

Borderline personality disorder (BPD) can significantly affect a person’s mental health and social life, and some people may not be aware they are living with the disorder. Those close to people experiencing this condition may also experience challenges. These people may include friends, family members, colleagues, and mental health professionals who focus on working with borderline personality disorder cases. 

To understand the impacts of BPD on one’s broader social community, it may be helpful to explore the challenges people may face, the causes of BPD, and how to find support as a loved one or social connection of someone with BPD. 

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Causes of borderline personality disorder 

According to the National Alliance on Mental Illness (NAMI) California chapter, there are approximately 3.5 million adults living with borderline personality disorder in the United States. While researchers aren’t certain what exactly causes borderline personality disorder or other personality disorders, they tend to believe that there is a combination of factors that contribute to the disorder. Genetic, environmental, and social factors may contribute to the development of BPD. 

Aside from the above risk factors, some researchers believe that people living with BPD may have functional and structural changes in regions of the brain that contribute to emotion regulation and control of impulses. However, they aren’t certain whether these changes cause the disorder or whether they result from the disorder. Regardless of the cause, individuals with this disorder are not at fault. They may not know that they are living with BPD or any comorbid conditions. 

Symptoms of borderline personality disorder

In some cases, the term borderline is used casually in modern culture to describe certain behaviors or traits. However, only a licensed mental health professional can diagnose borderline personality disorder or other mental disorders. 

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person must meet at least five of the following nine criteria to be diagnosed with borderline personality disorder: 

1. Frantic efforts to avoid real or imagined abandonment (Note: This criterion does not include suicidal or self-mutilating behavior covered in Criterion 5)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbances, including markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging, such as spending, sex, substance use, reckless driving, and binge eating—Not including suicidal or self-mutilating behavior covered in Criterion 5)
5. Recurrent suicidal behavior, gestures, and threats or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood, such as intense episodic dysphoria, irritability, or anxiety lasting over a few hours and only rarely more than a few days
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger, such as frequent displays of temper, constant anger, or recurrent physical fights
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

The DSM-5 notes that borderline personality disorder is typically characterized by a persistent pattern that starts in early adulthood and exists across various contexts. Thus, if a person in your life exhibits some of these traits in isolated circumstances, this doesn’t necessarily mean they have a disorder. 

The symptoms of BPD are typically present independent of substance use. For this reason, if you are close to someone who may have a substance use disorder, you might keep this in mind before assuming they have BPD or another personality disorder. In some cases, symptoms of autism spectrum disorder (ASD) in adult women and complex post-traumatic stress disorder (C-PTSD) can be similar to those seen in people with BPD. Misdiagnosis may occur if these symptoms are not adequately examined. 

Clinicians often take care when diagnosing borderline personality disorder (BPD), as some of the signs and symptoms can be similar to those of other personality disorders and mental health conditions. For example, both BPD and separation anxiety disorder tend to cause fear of abandonment. However, individuals living with separation anxiety disorder may not have problems related to identity, impulsivity, and interpersonal skills, which tend to be common in people with BPD. 

The potential challenges of interacting with someone living with borderline personality disorder 

If you have a friend or family member living with borderline personality disorder, you may experience ups and downs in your relationship. At times, they may seem close. In other moments, they may distance themselves for no apparent reason. For example, if a friend or loved one is a few minutes late for an appointment, an individual living with BPD may react with anger and change their opinion about the person. This response may be related to a fear of abandonment, which can lead to behaviors that attract attention. In some cases, people with BPD may self-harm. This behavior can put intense pressure on loved ones, who may fear the potential consequences if they don’t respond appropriately or quickly. 

These relationship challenges can be difficult for friends, loved ones, and co-workers of people living with BPD. These individuals may not understand that the person is living with a personality disorder. Even those who do know the person has BPD may not know how to navigate mood swings and angry outbursts. They may experience doubts about how to support the person while also maintaining boundaries that protect their own mental health.

Romantic relationships for those who are dating someone with BPD may also be confusing. A person living with BPD might idealize a person immediately after meeting them and make demands on their time. They may also immediately discuss intimate details of their life. However, they may change their opinion about the person if they believe the person does not care enough about them. In some cases, a person with BPD may abruptly end relationships if they fear abandonment. 

The challenges of BPD for therapists

Mental health professionals who have clients with borderline personality disorder (BPD) can also experience unique challenges. Given the fear of abandonment often present in BPD, therapists may witness anger or frustration when they announce the end of a therapy session, even though this ending involves a normal, time-limited separation. Therapists may also worry about a client living with BPD, especially if there is a danger of self-harm. They may wonder if they’ve done everything possible to ensure their client’s safety after a session.

According to research published by Forbes, people with BPD often have a “favorite person”—someone they idealize and depend on for emotional support. This person can sometimes be a therapist. This dynamic may create challenges for therapists as they strive to help the person with emotion dysregulation challenges while maintaining healthy boundaries. Mental health professionals may benefit from speaking to a therapist themselves to explore strategies for working effectively with people who experience BPD while considering their own best interests.

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Getting help as a person close to someone living with BPD

If someone in your life is living with borderline personality disorder (BPD), It may be difficult to know how to manage some of the relational challenges that often arise with this disorder. In these cases, it may help to speak with a licensed therapist who understands BPD and the ways it can affect friends, family, colleagues, and therapists in the person’s life. 

If you are so close to the person that it is not easy to step away to attend traditional in-person therapy, you might consider online therapy through a platform like BetterHelp. With online therapy, you can communicate with a therapist through phone, videoconferencing, or live chat from anywhere with an internet connection. You can also contact your therapist anytime through in-app messaging, and they’ll respond once they are available. This feature may be beneficial if you experience relationship challenges between therapy sessions. 

Research shows that online therapy can be as effective as in-person therapy. One study published in 2020 found that digital cognitive-behavioral therapy (CBT) was effective in reducing stress and anxiety, which may be common among people who are striving to help a person living with borderline personality disorder. An online therapist may also be able to provide tailored advice for handling emotional challenges as a person who cares for someone with BPD.