Personality disorders have a series of peculiarities that can contribute to the appearance of conflicts within social relationships, being the Borderline Personality Disorder (BPD) one of the most commonly associated with it.

Due to daily frictions (some of them important) it is frequent that interest arises about how to help a person with TLP , in order to alleviate the own discomfort or that of the affected relative/friend.

In this article, we will investigate the specific characteristics of this alteration in the very structure of the personality, since this knowledge is essential for understanding how a person with BPD feels and acts.

Borderline Personality Disorder (BPD)

The TLP is a clinical entity included in cluster B of personality disorders ; along with the antisocial, histrionic and narcissistic. Like the rest of those mentioned in the list, its core orbits around the difficulty of regulating emotions and behaviours. People who suffer from it often feel overwhelmed by their emotional life, which leads to considerable instability in their relationships with others and with themselves (their inner experience).

These are people who have difficulty controlling their impulses, which leads them to commit thoughtless acts that they may regret, feeling guilty and ashamed. They also often think that others do not really care about their lives and may abandon the relationship that binds them, a belief that ends up precipitating desperate acts to regain the love and companionship they fear losing.

The mechanisms through which they evaluate others are conditioned, like their own emotional experience, by instability and unpredictability. They tend to resort to the extremes of idealization and devaluation , ignoring the varied spectrum of gray shades that may exist between one and the other. For this reason they tend to react with intense anger, becoming an emotional response that occasionally lasts for days.

The instability that characterizes the judgments they make about others also extends to the way they perceive themselves, making evident a constant fluctuation in self-image and identity. All this can be accentuated when, in addition, dissociative symptoms such as depersonalization (feeling of inner emptiness that translates into the vivid sensation of being an automaton or a kind of hollow shell) concur on the same stage.

In addition to the above, which alludes to a deep experience of suffering, those suffering from the disorder tend to frequently resort to threats or coercion in an unconscionable attempt to take control of the external circumstances that cause them pain. The content of these threats may involve the production of harm to themselves, or the intensification of a harmful behavioural pattern in which they had previously been involved (substance consumption, risky sexuality, etc.).

All these circumstances, together with others such as self-harm or verbal aggression (insults, provocations, sarcasm, etc.), foster a context of extreme relational tension. Although nowadays there are empirically validated treatments to address this mental health problem (such as Linehan’s dialectical behavior therapy), which should be prioritized with respect to the rest of the approaches, it is also essential for those close to us to learn about how to help a person with BPD .

Why does it happen?

Many studies have been conducted to determine the causes of this personality disorder, although currently we only know of risk factors that contribute to its appearance in a given individual. Most of these studies consider circumstances that occurred during the childhood years, since this is the period in which the foundations for its full clinical expression (in adulthood) begin to take shape.

One of the most important risk factors is the presence of psychopathology in the parents , including mood disorders and BPD itself. Also, low warmth and explicit rejection of children by their parents has been consistently associated with a higher likelihood of suffering from it, as well as inconsistent care. Hostility and high negative emotional expression (from parent to child) also play a role.

The experience of long-term traumatic situations, generally in the form of childhood abuse (physical, emotional, verbal and sexual), is one of the risk factors on which there is currently the greatest consensus in the scientific community. These long-term stresses may also be associated with the presence of dissociative symptoms of BPD.

Basic attachment styles have also been studied by researchers , based on empirical evidence that insecure attachments (especially anxious ones) contribute decisively to the formation of the disorder in adolescence and adult life. Finally, basic dimensions of personality structure, such as neuroticism, impulsivity, and experiential avoidance, may be part of the premorbid profile of those with BPD.

How to help a person with TLP

Here are some suggestions that can help you deal with the daily frictions that come with living with someone who has this important mental health problem. Putting all these tips into practice can be an effort at first, and they do not substitute for psychological or pharmacological treatment. Its purpose lies solely in facilitating the moments of greatest difficulty .

1. Validates your emotional experience

People with TLP often feel that they are not understood by others, and that they are the target of constant criticism for their thinking or feeling. It is necessary to remember that people with BPD may experience very intense and long-lasting emotions when they perceive that they are the subject of an offense.

It is therefore important to learn to validate the experience as it is related, showing support and listening ; in a context of acceptance, honesty and avoidance of judgment.

2. Offer support

In a situation of emotional overload, make the person with TLP aware of your willingness to take the time to listen to what he or she has to say.

The use of shouting, or other negative communication strategies (both verbal and non-verbal), can result in the abrupt interruption of an opportunity for connection and the consequent increase in difficult attachments. The rupture of the channels of emotional expression ends in a distancing of the two parties that may take time to resolve.

3. Communicate your needs and allow it to express itself

It conveys to the person that you understand how he or she is feeling, directing the focus of attention to the emotional experience rather than accentuating the supposed relevance of the situation that preceded it.

If you find it difficult to connect with her speech, encourage her to keep digging into it with an explicit purpose of understanding it. Speak clearly about what you do not consider tolerable at this very moment , such as insults or disrespect, establishing a pattern for contact.

4. Get involved in treatment guidelines

Many of the treatment guidelines offered to patients with BPD directly involve the family. Take an interest in what happens in the context of the intervention, respecting the limits of confidentiality and avoiding attitudes of a paternalistic nature. Show commitment to the improvement project on which you have embarked , contributing to the changes that must necessarily be articulated in the daily life of the person suffering from this disorder.

5. Shows understanding of worsening symptoms

Many people with TLPs learn to manage their own difficulties and to lead a completely normal life. However, it is very likely that at certain times (periods of intense stress, occasional relational conflicts, etc.) the symptoms will become more pronounced.

It shows understanding and communicates hope that the emotion you are experiencing will eventually be resolved , as it may have been at other times in the past.

6. Learn strategies to regulate your own emotions

It is undeniable that living with a person with LPD can mean suffering for the whole family, because from a systemic perspective, the family is a mechanism in which all the gears are relevant for its optimal functioning.

Learning specific techniques to control autonomous activation , such as diaphragmatic breathing or Jacobson’s progressive muscle relaxation (always guided by a specialist), can help to make difficult moments more bearable.

7. Seek professional help

If the situation you are experiencing with your family member generates a stress response in you that you find difficult to manage (distress), it is important that you are able to take a break and seek professional help.

Long-standing stress can cause a decline in our adaptation mechanisms (even physiological), leading to exhaustion that increases the risk of many mental health problems (such as major depression or various anxiety disorders, among others).

What to Avoid

There are a number of situations to avoid when we want to help a person with TLP. The first is to develop overprotective or condescending behavior and to maintain the belief that by our actions we will be able to solve all their problems. An important part of improvement is learning how to regulate affect, and to do this, a person with TLP must take on his or her day-to-day life with maximum autonomy.

It’s also necessary to make an effort not to personalize the harsh words the person with TLP may utter during a moment of anger , since he or she is dealing not only with the conflict you both are in, but also with the symptoms of his or her disorder.

Bibliographic references:

  • Stepp, S.D., Lazarus, S.A. and Byrd, A.L. (2016). A Systematic Review of Risk Factors Prospectively Associated with Borderline Personality Disorder: Taking Stock and Moving Forward. Personality Disorders, 7(4), 316-323.
  • Stone, M.H. (2019). Borderline Personality Disorder: Clinical Guidelines for Treatment. Psycodynamic Psychiatry, 47(1), 5-26.