Someone close with borderline personality disorder: understanding and helping

1. Before you begin

You were in a meeting, and you replied to your daughter's message an hour late. In the meantime, she had sent you eleven. The first simply asked you to call her back. The fifth said that nobody cared about her anyway. The last said that you could forget about her and that it would be simpler for everyone. You called her; she did not pick up. You spent the evening with your phone in your hand. The next morning she called you, affectionate and funny, as if nothing had happened.

And there you are, relieved, angry and exhausted all at once, with a question you dare not ask anyone: is she doing it on purpose?

In your family, it may be a partner, a brother or a mother. The scene changes; the feeling of walking on eggshells comes back for almost everyone close to a person with this disorder.

Three things, straight away.

What you are seeing is not manipulation: it is pain that has not yet learned to express itself any other way. People with borderline personality disorder feel emotions faster, more strongly and for longer than most people, especially in the relationships that matter to them. The floods of messages, the break-ups announced and then regretted, and the acts against themselves serve first and foremost to bring down a tension that has become unbearable. Understanding them in this way does not oblige you to accept everything, but it changes the way you respond to them.

This disorder improves, and often a great deal. The large studies that followed people for ten and sixteen years show that most of them eventually stop having the disorder, and that full relapses remain a minority. Several psychotherapies have demonstrated their effectiveness. The reputation of an incurable illness that clings to this diagnosis is false.

You can help a great deal, provided you do not forget yourself. Your role is not to treat. It is to acknowledge what your loved one feels without approving of everything they do, to hold clear limits, to know how to react when their safety is at stake, and to stay on your own feet. All of this can be learned.

2. What borderline personality disorder is

A name that causes confusion

"Borderline" means "on the boundary", "at the limit". The word comes from an idea that has since been abandoned: it was once thought that these people stood on the frontier between two large families of mental disorders. The idea has gone; the name has stayed. In French, the disorder is also called "personnalité limite", literally a "limit personality". The International Classification of Diseases, the reference list that the World Health Organization publishes for doctors all over the world, allows in its eleventh revision for the specifier "borderline" to be added to a personality disorder when the picture matches the one this guide describes.

What "personality disorder" means

The word "personality" is frightening, because it seems to refer to the person's character, for ever. It means something else. Doctors speak of a personality disorder when ways of feeling, reacting and relating to others have been in place for a long time, often since adolescence, and cause significant suffering to the person and often to those around them. Part of these ways of reacting was learned, and what has been learned can change: the follow-up studies in section 5 show this clearly for this disorder.

What people with the disorder experience

Nobody shows all of the manifestations that follow: what counts is how many of them build up, and how long they last.

Emotions, first of all, rise very quickly, reach an intensity that most people rarely experience, and take a long time to come back down. A trivial remark can trigger, within seconds, an immense shame or anger that will last for hours.

In relationships, next, the fear of being abandoned sits at the centre: a silence, a delay or a change of tone can be experienced as the sign that one is about to be left, and trigger desperate efforts to prevent it. The same person may seem perfect one day and unforgivable the next.

Self-image wavers too: many people with the disorder say that they do not know who they are or what they are worth, and they live with a feeling of emptiness that nothing seems to fill.

Impulsivity also drives them to act quickly to bring down a tension, in ways that do harm: spending without counting, drinking or taking drugs, driving dangerously, eating without being able to stop. In many people there is also self-harm, meaning acts by which a person hurts themselves deliberately without seeking to die, as well as suicidal behaviour. Sections 11 and 12 are devoted to these.

Finally, under intense stress, some people go through short moments of mistrust, with the impression that others wish them harm, or of dissociation, that is, the sensation of being cut off from oneself or from the world, as if behind a pane of glass. These moments pass when the tension falls.

What you see, and what is going on inside

When your loved one reacts in a way that seems out of all proportion to you, the emotion really does rise higher in them, and they have not learned to bring it back down. When they admire you one day and heap reproaches on you the next, it is often because the capacity to see shades of grey collapses under a very strong emotion; people then become entirely good or entirely bad. When your brother spends his salary in a single evening, he is most often trying to put out an emotion, not to defy you.

These readings are not an excuse. They are an explanation, and an explanation makes it possible to respond to what is really going on.

What it is not

It is not bipolar disorder, even though the two are often confused. Bipolar disorder comes in episodes: for days or weeks, mood stays very high, with little need for sleep, or very low, and then returns to its usual state. In borderline personality disorder, the swings tend to last a few hours and are triggered by events, often in relationships. The two can coexist, and it is for the doctor to decide. This guide is one of a series of three guides for families and friends, built in the same way: if bipolar disorder or schizophrenia affects your loved one or another member of your family, Someone close with bipolar disorder: understanding and supporting and Someone close with schizophrenia: understanding and supporting explain each of these disorders and what you can do day to day.

Nor is it a diagnosis you can make yourself on the strength of a video. Other disorders resemble it, such as post-traumatic stress disorder, which refers to the lasting after-effects of a terrifying event, or attention deficit disorder, which combines distractibility and impulsivity from childhood onwards. Only a professional can tell them apart.

Who is affected

Surveys of the general population put its frequency at around one person in a hundred, and much higher among people receiving psychiatric care. A large American survey found no difference between men and women, contrary to the image of a female disorder. The manifestations generally appear in adolescence or early adulthood, often together with depression, anxiety, alcohol or drug use, or an eating disorder, all of which can also be treated.

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