This is a topic that, although I have no professional experience or qualifications with, I have quite a bit of personal experience to speak to. I do not have borderline personality disorder (BPD) myself, but I have had many friends and family members with it, and was involved with (and married to) a woman with BPD for many years.

I’d been meaning to write something about this for a while. I suppose I didn’t find just the right “spark” until this past weekend, when a friend linked an article on BPDFamily. I’d never heard of this site before, but they claim to be the most-visited borderline-related site online. More’s the pity, if so, because it seems that the purpose of this site is not to advocate for people with BPD or to offer therapeutic solutions to BPD sufferers, but rather to alarm loved ones and stigmatize people with borderline.

I’m never sure how familiar most people are with this disorder, so I’ll provide a quick (though hardly exhaustive) description. The hallmarks of BPD are unstable personal relationships, emotional volatility, distorted self-image, impulsive (sometimes dangerous) behaviors, threats of suicide, dishonesty, constant feelings of emptiness or boredom, outbursts of rage, and dissociative episodes. If these symptoms sound vague, that’s because they are. Meeting one or more of these symptoms doesn’t mean (or someone you know) has BPD. Only a mental health professional can make that determination for sure. (Insert lengthy qualification about the current limitations of mental health care, access problems that impact many, and poorly-qualified practitioners who misdiagnose and/or mistreat their patients. I may write about those problems in the future.)

BPD sufferers often find limited treatment options because their disorder is poorly understood and often thought untreatable. Many therapists refuse to treat BPD patients as they are considered fundamentally dishonest, manipulative, and uninterested in improving their condition. But this must be viewed in context of a cultural environment and medical system in which BPD develops mainly as a response to severe traumas during important developmental stages. A person with BPD does not lie or manipulate for fun–it is done as a defense mechanism, to protect against potential harm and abuse. It damages one’s relationships because distorted thoughts present false threats to which a BPD sufferer reacts.

Imagine you are accustomed to having people mistreat and abuse you. This happens over and over, throughout your life. You have a difficult time trusting anyone. You meet someone new, who is very kind and attentive and generous. It feels amazing–for a while. But soon, certain thoughts creep in. _What is this person trying to get from me? What do they want? They’re going to hurt me. I just know it. They’re going to be just like all the others. Once they really get to know me, they’ll hate me like everyone else.__ They say they care about me but they have to be lying. Nobody ever really cares. And they didn’t answer when I texted them yesterday. They must have been telling their friends what a pathetic idiot I am. I’m so stupid. I should have known I couldn’t be happy._

These thoughts don’t have to be in any way true. What matters is that they are very real to a person with BPD. What comes next, then, is acting on those thoughts. This is where sudden outbursts of anger, accusations of dishonesty, and other behaviors typically described as “manipulation” come in. I dislike having it described as “manipulation,” though, because the word suggests an intent to deceive and control, when it is really an attempt at self-defense in a situation that feels hopeless to the BPD sufferer. If you are on the receiving end of this, it can seem deranged, even hateful. You may be attacked, verbally or physically, out of the blue. You may be commanded to produce an explanation for things you didn’t even do, which may leave you flustered and confused. Your inability to offer up any satisfying response to the accusations will only be proof of your guilt. This leaves everyone hurt and unhappy, and although there may be some making-up later, trust has been undermined–perhaps permanently.

This cycle of relatively calm periods punctuated by sudden, acrimonious outbursts can persist for months or years. To someone who has never been in such a situation, an obvious question arises: why would anyone stay? Everyone will have different reasons, but they often boil down to relationships that have become codependent. For my part, I hated the idea of leaving behind someone who was clearly in pain and who had alienated nearly everyone else in her life. There was also the sense that she needed me, and I needed to feel needed. So, although it was a dysfunctional relationship, it was locked into a cycle that was unlikely to break by itself (and indeed, only broke when I moved across the country).

I mentioned the BPDFamily article earlier because its approach to the topic of relationships with BPD individuals is all wrong. It places all the agency with the BPD sufferer, drawing her (always “her” in the examples in the link) as a manipulative, lying monster who throws herself into perilous situations merely for the thrill of forcing her partner to rescue her. The partner is shown as a blameless cipher in all this, the innocent victim of a walking disaster machine from whom they cannot escape. No one is responsible for their own abuse, of course, but when it comes to describing a relationship between two adults, making both parties to strawmen is not conducive to reaching any kind of understanding.

As for treatment: BPD is treatable. Not curable, but treatable. In the past, cognitive behavioral therapy (CBT) was recommended. More recently, dialectical behavioral therapy (DBT) and schema therapy are seeing success in treating this disorder. What all of these therapies have in common is training the BPD patient to identify and regulate their thought patterns, learning to target the severe cognitive distortions that lead to dangerous and disruptive behaviors. None of them are a panacea and different treatments work for different people–and there may be some for whom none of these treatments work at all. There’s also a tendency to blame BPD sufferers when they don’t seek or follow through treatment, but again, this is essentially victim-blaming. One of the hardest things to deal with, if you have a person with BPD in your life, is to stick it out and support and encourage them through seeking help, and potentially seeing them fail again and again. They may eventually succeed–or they may not. It can be a very difficult disorder to overcome. Empathy and compassion are necessities. But each person must also look out for their own well-being, and that extends to cutting a person with BPD out of your own life. If you find yourself in such a situation, it’s a decision that only you can make.

Speaking only to my own experiences, it took a long separation, run-ins with the law, and a brutal custody and divorce case for my ex-wife to finally realize how badly she needed help. Though we are no longer romantically involved, we get along better now than we ever did in the past. I used to have severe panic responses every time she called me, before I even answered the phone, because I never knew if it was going to be a normal conversation or yet another round of random accusations and threats. (I later learned that such anxiety associated with a ringing phone is a common form of post-traumatic stress disorder.) Although ringing phones still cause me some amount of anxiety, my reaction is much more subdued now, in large part because I no longer fear that she’s going to terrorize me over the phone. Her improvement really has been remarkable, and it gives me hope for other people who live with borderline personality disorder.

Treatments for BPD are evolving all the time, and there are more options today than existed even a few years ago. It’s also true that there remain significant barriers to treatment–insurers who won’t pay, for instance, and finding suitable therapists willing to treat. Evidence-based therapies have seen dramatic successes in recent years, though, and hopefully that means the stigma surrounding BPD and its treatment will diminish with time.

There is a lot of self-directed material out there for people with BPD, too, and I will link a few (not BPDFamily!):

  * [DBT Self Help](http://www.dbtselfhelp.com/) -- A site for people who have been utilized or are interested in DBT.
  * [GET.gg](http://www.get.gg/) -- CBT resources.
  * [Schema Therapy](http://schematherapy.com/) -- A website focused on schema therapy, with materials for practitioners and patients.

Please feel free to share additional resources in the comments, as well as any of your own thoughts.