Borderline Personality Disorder – Moving Beyond the Label

Borderline personality disorder, borderline, BPD – whatever the chosen label, the mere mention of it causes a definite reaction among most people.

Those diagnosed often experience a sense of powerlessness, confusion, anger, or refusal to accept. After all, how are you supposed to react when your personality is being called into question? How do you change your personality?

Family members who want to maintain a relationship with someone diagnosed with BPD often struggle to understand and manage the character traits and accompanying behaviours associated with the label.

Therapists describe this diagnosis (and the individuals living with it) as “challenging,” “exhausting,” “impossible”: they schedule many a case consultation around trying to figure out what to try. This, of course, assumes that the helper hasn’t already been fired by the client or that the helper hasn’t tried to offload them.

It all sounds like bad news no matter what role you play in the equation – but it doesn’t have to be.

Living with BPD requires a healthy indifference to the label, and it requires patience.

• Give the diagnosis the acknowledgement it needs while also striving for healthy indifference toward the label. It’s no different than any other label: lazy, smart, kind, tolerant. Its importance, however, becomes not what it is but rather what you do or don’t do with it. Recognize that the diagnosis serves to highlight character traits and behaviours that cause personal discomfort, create conflict in relationships, and make it difficult to maintain healthy boundaries. This awareness allows a framework for meaningful change to occur and is a reminder that certain behaviours challenge the label while others support it. In the context of BPD, remain focused on fostering new patterns of behaviour that are in conflict with the diagnosis. With time, commitment, and an increased tolerance for the discomfort that long-term change requires, you will make progress.

Being a family member, friend, or loved one of someone living with BPD requires boundaries and patience.

• It’s important to be aware that you don’t have to love the traits and behaviours that are typical of BPD. You need boundaries. Accepting responsibility for drama when it’s not yours; apologizing profusely after being convinced you’ve done something wrong; feeling guilty for saying no; being a perpetual saviour; or watching healthy relationships fall apart around you as a result of protecting, supporting, or enabling your loved one – these are all indicators that your boundaries need work. State clear expectations to your loved one regarding what behaviours you will and won’t accept and what you will and won’t do to offer support. With the okay of your loved one, stay in contact with therapeutic helpers to monitor progress, and continue to foster and maintain healthy relationships with others.

Being a therapeutic helper to someone living with BPD requires critical self-reflection and empathy.

• Figuring out what it is about this diagnosis that makes working with it so challenging, exhausting or impossible to you personally is essential. For some clinicians, it is the time commitment, the unpredictability, or the intensity of the client’s emotions. For others, it is the increased boundary setting that is required, the slow progress, or the impact of vicarious trauma when working through the traumatic histories that often partner with a BPD diagnosis. What part of this population or this diagnosis is most difficult for you? After you’ve figured it out, address it through clinical growth, and then reconnect to your empathy. We’re working with a population whose personalities are problematic – to them, to their families, to their relationships, and ironically to the therapeutic process in general. Reminding ourselves that we actually have it easy in comparison to the person living with BPD can help us build tolerance and maintain momentum.

Borderline Personality Disorder – we all need to move beyond the label.

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