Helping a Family Member With Borderline Personality Disorder

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Reader’s Question

I have a family member who has BPD. What are the best therapy and/or medication options for borderline personality disorder, and does a ‘cure’ exist?

Psychologist’s Reply

Borderline Personality Disorder is a complex, long-standing pattern of interpersonal and emotional difficulties that affects approximately 1.6% of the population (cited by the National Institute of Mental Health). Friends and relatives of individuals with BPD often notice that these individuals show rapidly shifting emotions and a pattern of swinging from one extreme to another.

Because it is a long-standing pattern, it is difficult to treat, and often requires long-term individual and/or structured group counseling. Some medications (such as those that treat anxiety or depression, or mood stabilizers that are typically prescribed for bipolar disorder) may be helpful for some individuals, depending on the presenting BPD symptoms, but there are no medications to treat BPD specifically. It can be an unpredictable and frustrating illness and typically requires therapeutic support when stress and symptoms increase. Trying to support a family member with BPD can be very draining as well. You may have experienced some of these typical BPD behaviors that are described on APA’s website:

Individuals with the disorder often seek help, yet they also tend to drop out of therapy. While they’re quick to open up, they’re even quicker at shutting down. And while they crave approval, a small provocation can result in abusive or violent behavior toward those trying to help.

While there is not a ‘cure’ for BPD, two therapies have demonstrated success in decreasing some of the harmful symptoms of BPD: Dialectical Behavior Therapy (DBT) and Cognitive Therapy. Dialectical Behavior Therapy, developed by Marsha M. Linehan, PhD, focuses on helping individuals with BPD learn skills to tolerate and regulate difficult emotions. Many behavioral health centers offer structured DBT groups for individuals with BPD, along with individual therapy. When compared to traditional (non-DBT) psychotherapy sessions, research shows that individuals in DBT therapy were significantly more likely to stay in therapy — one of the most difficult obstacles to treatment. Cognitive Therapy, in contrast, focuses on challenging and changing distorted thoughts that can lead to the distressing emotions. Individuals with BPD who were able to complete a course of cognitive therapy also showed significant improvement in regulating emotions.

Often, the best way to help a friend or relative with BPD is to set clear and consistent boundaries with them: express care and concern about your family member’s distress while also setting clear time limits and sticking to them. Listening to the distress of someone with BPD for hours on end is not helpful for them, and may actually increase their distress because they have difficulty damming the flood of emotions. Many individuals with BPD have learned that being in distress keeps others close to them, but it tends to turn quickly when they are flooded and need to distance themselves immediately. Letting your family member know when you plan to see them, how long you plan to stay with them, and when you plan to return (and sticking to your plans) is the best way to remain supportive. Encouraging them to stick with therapy (even when it gets difficult) can also help. Having a professional support system in place is important — especially when indviduals with BPD start to talk about hurting themselves. I encourage you and everyone in your family to take those threats seriously and to have an action plan in place. It can be as simple as calling a suicide crisis hotline, or discussing which hospital you would take your family member to.

It can be difficult and frustrating to have a friend or relative with BPD. When coping with the roller-coaster ride, many have found support from the book Stop Walking On Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder [Amazon-US | Amazon-UK] , by Paul T. Mason and Randi Kreger. You might also read Dr George Simon’s BPD article on the Psychology, Philosophy and Real Life blog.

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