Friday, September 23, 2016

Borderline Personality Disorder Part 2: Help Me, Help You

Now you are well versed in the symptoms of Borderline Personality Disorder (BPD) and one of the theories of its origin in a person.  So now let’s discuss treatment, and how people can support a loved one, while at the same time, keeping safe.  
There are a number of treatment modalities being used with BPD.  I’m not going to try to put together an exhaustive list.  These will be the most common ones, and ones with which I am the most familiar.  I am not comfortable writing about treatment methods with which I have no experience.  I don’t think it’s fair to my readers.  As with anything on IOI, I encourage you to use this as a starting point.  Do your own research too.  Ask questions.  Think critically about what you find out, and know that IOI is here.  I can learn from you too!
Cognitive Behavioral Therapy (CBT) - While CBT is not directly targeted at Borderline Personality Disorder, the next type of treatment is a derivative of CBT, so I want you to have a frame of reference.  Cognitive Behavioral Therapy basically does what it says on the box: it teaches the person to change how they think, which then changes how they behave.  The effect is then a change in how the person feels; lather, rinse, repeat. 
Dialectical Behavioral Therapy (DBT) - This is a therapeutic method created in the late 1980s by psychologist Dr. Marsha Linehan.  What I like about it is that it takes a person’s strengths and builds on them.  This is something I was taught to do early on in my professional training.  It has components of CBT which help a person to shift from the all or nothing, black and white thinking that is characteristic of Borderline Personality disorder.  DBT teaches people to deal with the surges of emotion they feel. It is a multi-faceted treatment approach which uses individual therapy, group therapy, consultation for the therapist, and phone coaching.  DBT consists of four modules, each of which teach different skills.  These are mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.  The goal of DBT is for a person to learn to manage emotions by recognizing, accepting, and experiencing them.  
Medication - While medication will not cure Borderline Personality Disorder, it can help with conditions which often accompany it.  These include Depression, and Post-Traumatic Stress Disorder (PTSD). Treating symptoms of these may make it easier for the person to get more out of other types of treatment such as DBT.  Medication will not take these disorders away.  But if the person is not feeling distressed by the symptoms, they will be better able to focus on skills learned in DBT, and therefore, be better equipped to use them. 
Hospitalization - Hospitalization is sometimes necessary for a person with Borderline Personality Disorder.  It is common for a person with BPD to also have Depression. The person may require inpatient treatment for suicidality.  
So now let’s talk about when someone close to you has Borderline Personality Disorder.  First and foremost: YOU ARE NOT OBLIGATED TO CARE FOR SOMEONE AT THE EXPENSE OF YOUR OWN WELLBEING.  You MUST take care of yourself first.  If your relationship with someone, not just someone with BPD is causing you distress, you need to attend to that.  It is really important to know that you are not the cause of what’s happening.  Like we’ve talked about before, if you feel you have some responsibility, own up to it.  But you are not obligated to take on more than your share to appease someone else.  
You can honor someone’s feelings without taking their side.  Even if I disagree with someone one hundred percent, I can still acknowledge their experience and their pain.  Remember Maslow?  Right above our physical needs sits our need for love and belonging.  Now imagine still having that need without ever really being able to trust that you are loved?  We can start helping someone just by letting them know they are being heard.  If you’re not sure, ask!  “I want to make sure I’m hearing you right.  It sounds like you’re really sad about how your boss talked to you yesterday.”  You’re not taking the person’s side, you’re not taking the boss’s side.  If they agree, you can say that you understand how they could feel that way.  It can be really tempting to take sides to make the person feel better in the moment, but this is tricky.  This opens you up to be the bad guy when the boss apologizes tomorrow.  
Try not to directly argue.  The all-or-nothing thinking is hard.  It’s hard to see someone we love feel worthless.  When something bad happens in the person’s life, they may make absolute statements like, “everybody hates me!” I know my first reaction would be to say, “I don’t hate you!  I love you!” This can actually make things worse.  The person may feel the need to defend their awfulness to you, which reinforces it in their own mind.  Instead try, “I understand how you could feel that way, given what happened.  I’m so sorry you’re hurting like this.” 
Something else that can happen is that someone may give the person with BPD attention while they are in crisis, and then drop off when everything is okay.  This is understandable.  It also reinforces to the person with BPD that they need to be in crisis to get attention.  It can feel like you need a break when things are going well for them.  Understandable!  But if it feels healthy and safe for you, grab coffee together.  Give a phone call or a text.  Whatever feels right for your relationship and your well-being.
You may need to access your own mental health support, especially if the person is immediate family.  In fact, if this is the case, I really suggest you do.  You are going to need your own support system.  This is a hard thing to watch someone else go through, and a person with BPD is likely to be a hardcore practitioner of “misery loves company!”  Remember, always put your own oxygen mask on first.
This is by no means an exhaustive description of methods of treatment for Borderline Personality Disorder, nor for how to relate to someone who has it.  There are great resources online, as well as books and community groups.  You’re always welcome to ask questions here on IOI as well.  No matter your interest in this topic, thank you for being here.
Be well.

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