How Can I Help My Friend?

Reader’s Question

I am a second-year psychology student from Australia and I have some questions about a friend of mine.

For over four years now, she has had issues with self-harm and depression-like symptoms. She had a very destructive relationship when she was 16, after which she became impulsive and unstable. She would have episodes where she would explode in anger and abuse, including being violent to her friends when we tried to help her. She would disappear from home and show up the next day with no explanation. Most of the time, these episodes happened when she was under the influence of alcohol.

Her relationship with her parents has been really bad; she says she hates her dad, and she treats her mum with no respect. I think they have tried to get her to see someone for help, but she is stubborn, and refuses to do anything like that. We have tried to sit her down and confront her, but it just makes her angry; she won’t listen to anyone.

Recently, she had been improving, being more sensible about everything, and even saying that she wanted to move on. She found a new boyfriend, and seemed to be very happy with him. But recently they broke up, and after about a year of being pretty good she had another episode. She was out with two of my friends, having a great time, when suddenly she had an outburst, and physically and verbally abused them. She ran away, saying she would rather be left in the town and get raped, than leave with them. They tried to get her into the car to go home, but again, she ran away, and eventually they gave up. They contacted her mum, but none of us have heard from her or her parents since then. So at this stage we don’t even know if she is okay. We are only 19 and we have no idea what to do next.

She seems to have a pattern related to breaking up with a boyfriend. We have researched it, and have narrowed it down to some sort of borderline personality disorder, or even intermittent explosive disorder. It would be encouraging to know if we are on the right track. Any help you can provide would be greatly appreciated, especially suggestions about what to do.

Psychologist’s Reply

Q: Without meeting with your friend I would obviously not be able to diagnose her. Additionally, based on your description of her, it is a complex situation and would require some careful consideration by a mental health professional before a diagnosis or intervention plan could be made.

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Personality disorders are loosely defined as a particular pattern of thinking and behaving that is fairly consistent over time and situations. Patterns can be seen in adolescence, but someone must be at least 18 before an official diagnosis of any personality disorder can be given. The reason for this is that there are many situations that can cause symptoms or behaviors that could be mistaken for a personality disorder. It is only the persistence across time and situations that points to the idea that something is characterological. Borderline Personality Disorder typically involves a pattern of instability in relationships, feelings, and self-concept. Some of the behaviors your friend has demonstrated are consistent with this, such as her intense anger/difficulty controlling anger, impulsive behavior, self-harm, emotional ups and downs that happen fast, and her tendency to react quickly and extremely to others. BPD usually includes an unstable sense of self, a feeling of emptiness, and a sensitivity to feeling abandoned by others. Relationships that are intense, and come and go quickly, are also common.

You mentioned that your friend has a conflictual relationship with her parents. It is impossible to say whether the conflict with her parents has followed from her behavior or whether her feelings and behavior are a result of a difficult home life. Also, if alcohol has been involved in these incidents, it would be important to tease apart whether alcohol misuse is in part causing problems. Finally, with someone who came to me with these patterns of feelings and behaviors, I would explore whether there had been any traumatic experiences in childhood or adolescence, and whether there were acute or chronic stressors that are occurring. Again, it is important to carefully consider adjustment problems, alcohol and substance use, and clinical disorders (e.g., depression, anxiety, PTSD) as probable causes for feelings and behaviors before diagnosing someone with a personality disorder.

You asked what you could do to help. It appears that you and your friends care for this woman a great deal, as you have continued to be there for her despite being the recipient of some intense anger. Some additional thoughts: First and foremost, you are likely already expressing empathy for the pain she must be in. This is probably the most helpful thing you can do. Second, encouraging her to seek help in a gentle, supportive way might help her take the step to contact a mental health professional. Finally, when safety is involved and you feel as if you are in over your head, contacting emergency personnel or a public officer might be the best way to keep her from endangering herself or others. For example, if a friend is threatening to harm him or herself or others, a call to a parent, emergency professionals, or the police might be in order. Although it might feel as if a choice like this would put the friendship at risk, safety should be the priority.

Ideally, a friend is someone with whom there is a two-way, mutually enjoyable relationship over time. Of course there will be times when one friend needs another more or less. If you are studying psychology, you might be someone who wants to enter a helping profession. Many who find themselves drawn to psychology find themselves frequently in the role of helper or listener with friends. This can feel natural, comfortable, and rewarding. However, if you find that you are feeling tired, resentful, or angry in this or other friendships, it might be useful to consider what role you want to take. You might decide that you need to take a break from the friendship, or get a bit of distance, if caring for this friend becomes too taxing. In some cases, taking a step back might be the only way that the friendship can continue. In the end, taking care of your own mental health is as important as helping others.