People with borderline personality disorder (BPD) can be intensely caring, warm, smart, and funnybut their behavior often drives away those closest to them. If you're struggling in a tumultuous relationship with someone with BPD, this is the book for you. Dr. Shari Manning helps you understand why your spouse, family member, or friend has such out-of-control emotionsand how to change the way you can respond. Learn to use simple yet powerful strategies that can defuse crises, establish better boundaries, and radically transform your relationship. Empathic, hopeful, and science based, this is the first book for family and friends grounded in dialectical behavior therapy (DBT), the most effective treatment for BPD.
|Publisher:||Guilford Publications, Inc.|
|Product dimensions:||6.00(w) x 8.90(h) x 0.80(d)|
About the Author
Shari Y. Manning, PhD, is a clinician in private practice and the former President/CEO of Behavioral Tech and Behavioral Tech Research, the organizations founded by Marsha M. Linehan to provide training in DBT. Dr. Manning has focused on the treatment of people with BPD since 1993. She lives in Columbia, South Carolina.
Read an Excerpt
Loving Someone with Borderline Personality Disorder
How to Keep Out-of-Control Emotions from Destroying your Relationship
By Shari Y. Manning
The Guilford PressCopyright © 2011 The Guilford Press
All rights reserved.
"Why Do I Feel So Lost in This Relationship?"
Someone I know recently fulfilled a life goal: he married a wonderful woman. About 2 months later, though, things began to change. The woman he had married asked him for a significant sum of money to start a business. He told her he didn't have that kind of money and was completely unprepared for the emotional reaction he got. She first became really angry and berated him for not loving her enough. She picked up a paperweight and threatened to throw it at him. Then she became despondent and said she didn't deserve to live. Finally, she drank a bottle of wine and burned herself several times on the arm with a cigarette.
That one evening became a turning point in their relationship. The wife quit her job. She vacillated between not speaking with my friend for hours and spending hours telling him what a bad person he was. She often drank two bottles of wine in an evening. She went into great detail about how worthless she was. My friend tried to get his wife help, but she mostly refused. After he had to leave the house several times because his wife was out of control, friends and family began to tell him to leave her. The problem with leaving his wife, however, was that she was not always despondent, drunk, and enraged. There were moments when my friend saw the woman he had fallen in love with, a woman who was smart, witty, caring, and exciting. He wanted to be with that woman.
Meanwhile, the psychiatrist who had seen his wife a couple of times told my friend that his wife met the criteria for borderline personality disorder (BPD). He was very discouraging. In fact he told him that there was no help for his wife and that he should just get out of the relationship before things got worse. My friend is still with his wife, but he's often exhausted and stressed out and seems less and less like the outgoing, optimistic person I've known.
HOW BORDERLINE BEHAVIOR CAN MAKE YOU LOSE YOUR BALANCE
My friend, whose name is Brad, describes himself these days as feeling generally lost. A man with the enviable knack for knowing just the right thing to say or do in virtually any situation, he now says that everything he does with regard to his wife, whose name is Sadie, seems to be wrong. Brad no longer trusts his social instincts, and friends have started to notice that he often retreats into a corner at gatherings where he'd usually be at the epicenter. After the fateful conversation where he told his new wife that he couldn't give her thousands of dollars, he agonized all night over whether he was in fact being stingy and had underestimated what he could afford to do without. It was only the first of many sleepless nights spent second-guessing simple decisions that seemed so benign at the time but got such an accusatory reaction from Sadie. Surely he must have done something offensive if his wife was that upset, he told himself. So he would rehash the incident again and again, looking for an explanation but never able to find a credible middle ground between the idea that he was the terrible person Sadie had called him and the idea that she was. He wasn't quite sure who he was anymore, and he certainly didn't know who Sadie was.
Brad's confusion was compounded by the fact that sometimes Sadie was everything he'd ever wanted in a wife. Once, after hearing the discouragement in his voice when she called him at work and asked how his day was going, she surprised him by having a candlelit dinner all ready when he got home and a DVD of an obscure old movie he'd mentioned months ago that he'd always wanted to see. When his mother was recovering from surgery and he was caught up in the busiest time of year at his job, Sadie had doted on his mother so Brad didn't have to worry about how she was managing on her own. Two of his friends kept asking him when they could all get together for dinner again because the last time they'd gone out Sadie had had everyone in convulsions as she told one hilarious story after the next. Sometimes Brad felt like he was living with two different women, and he wondered whether he was simply losing his mind.
Of course he wasn't. The fact is that there are so many reasons we love people with BPD. Most are kind and generous of spirit. One time I had surgery, and after returning to run a group with eight women who had BPD diagnoses, I casually remarked that my husband was not doing such a good job of cooking for me while I was recovering. The next week, every woman in the group brought me some kind of casserole.
When someone acts so caring, you can easily question whether your anger at the aggressive, frightening behavior that you see at other times is justifiable, as Brad did. Maybe, you might think, you're not a very good or worthy judge of human character at all. Or you get over involved. In training therapists, I have often found that therapists who treat BPD can lose their way simply because their clients are so kind and such brilliant listeners that the therapists feel like the clients are taking care of them instead of the other way around. Then they feel an irresistible urge to repay the clients in kind and end up extending themselves in inappropriate ways. For example, I knew of a therapist at one point who loaned a great deal of money to a client. I once met another one who called her client when she, the therapist, was in emotional distress. A third I know of ended up adopting the daughter of a client. All of these behaviors are considered questionable or unethical in our profession, and I know the therapists did not set out to be unethical. Somehow the behaviors typical of someone with BPD made them lose their way.
You've probably had the same types of experiences. Family members and loved ones often find themselves trying to rescue people with BPD. After a particularly wonderful period with Sadie, Brad suddenly found himself writing a check for her poorly defined new business even though he was going to have to withdraw funds from his retirement account to cover it. Months into their marriage, Brad found out that Sadie's older sister had bailed her out of financial disasters for years, despite repeated vows never to help her again. Sadie's mother was under strict doctor's orders to find a way to reduce the stress that was draining her but could not bring herself to let the phone ring when she knew it was Sadie calling in the middle of the night, even when it was the third or fourth time in an hour, as it often was. People who love someone with BPD often give money, time, support, and so much of their concern that they become fatigued. Sometimes they reach the point where the relationship feels intolerable. Many, many people with BPD have lost most or all of the people in their lives. Or their social and family circle seems to be fitted with one big revolving door by which people exit and then return, over and over.
Maybe you're familiar with this scenario: You're in a room with your loved one who has BPD. You're having a great time, and it seems pretty clear that your loved one is too. There's a lot of laughter and sharing and mutual understanding. Your loved one—let's say it's your brother—goes home, and you're left with the glow of good will. Then all of a sudden, hours later, you get a phone call. It's your brother, and he's spewing out a list of all the things that you said and did that hurt him terribly. You're completely thrown. Were you two even in the same room together? Did you imagine the whole encounter? Were you that blind to the fact that your brother was upset at the time? No wonder you feel lost. You may also feel angry, defensive, confused, and guilty. So you react from your own emotions. Maybe you yell and hang up. Maybe you just withdraw, telling your brother you need a little time and distance.
This only makes things worse. Now you're getting multiple telephone calls from your brother, some with cursing and threats, some with tears and bewilderment, and many, many hang-ups. You withdraw more.
The next thing you find out is that your brother is in the psychiatric hospital following an overdose. He was trying to kill himself because he was so upset by your nonresponsiveness. You feel so guilty that you swear to your brother that you will never abandon him again.
But, of course that turns out to be an impossible promise to keep, because a few weeks later you are "hurting" your brother again ... and he is calling again.
Like Brad, you begin to feel like everything you do is wrong. Now you're constantly worried that your brother may kill himself the next time you upset him. And you start to feel a lot of resentment. You stay in the relationship, feeling like a yo-yo, bouncing back and forth between despair that your relationship is out of control and hope that things can be better. Many people who love someone with BPD feel like they're constantly losing their balance.
This sequence of events befalls almost everyone who is intimately involved with a person with BPD. It happens to therapists, family members, and friends. The relationships are terminated and begin again and are terminated again.
When you're closely involved with someone who has BPD, you may feel directionless, because all you can ever seem to do is react. You go from one extreme to the other, from trying to make sure nothing upsets the person you love to trying to get away from the person at all costs. You may feel like you're caught in a riptide, unsure when the behaviors that upset you are going to stop and where you're going to be dropped off at the end.
At the same time, the relationship may be so intense that you can't find yourself in it at all. I probably don't have to tell you that relationships with those who have BPD are not typically characterized by quiet, easy companionship. Instead there's likely lots of high-intensity behavior that demands attention, accusations that cry out for an immediate defense, pleas that bring out the Lone Ranger in the least heroic of us.
I probably also don't have to tell you that the person with BPD has emotions that are like tornadoes. They can appear out of nowhere, gather strength, and wreak destruction. The emotional states of people with BPD change rapidly, and it's hard for the rest of us to keep up with them. It's emotion that's at the heart of the chaos. Because people with BPD often have no control over their emotions, they also seem to have very little control over their behavior. As you'll learn in this book, much of what they do—the impulsive decisions, the anger outbursts, the about-faces—is aimed at trying to deal with out-of-control, overwhelming emotion. The fact that you are either directly on the receiving end or on the cleanup crew has led many authors to say you have to protect yourself in relationships with emotionally sensitive people. They are accused of being full of rage (which sometimes they are), unpredictable (which they usually are), and volatile (which they definitely are). So, yes, it may very well make sense to protect yourself. But while you're doing so, it's also important to know that the extreme emotions and their accompanying behaviors are not usually a deliberate attempt to lose relationships, cause problems, or ruin anyone's life.
Understanding where these extreme emotions and their accompanying behaviors come from is a better antidote than simply protecting yourself. Lacking the knowledge that can reveal a better alternative often means that ending the relationship seems like the only solution. This book, therefore, is going to educate you about the nature of the behaviors that make up the diagnosis of BPD. Getting educated is the only way to have a relationship in which everyone can achieve better balance.
WHAT DOES BORDERLINE PERSONALITY DISORDER MEAN?
This is a difficult question to answer. Most people have an inkling of what depression means, or even something like schizophrenia. But what does borderline signify, and what's a personality disorder ? Let's dispense with borderline just to get it out of the way. Borderline was a term created in the early 20th century, meant to indicate that this disorder fell in between two major classes of psychiatric diagnoses, neuroses and psychoses. That's all I'm going to say about it, because it's really irrelevant to your understanding of your loved one, though it does give you a hint at how tricky this disorder is to get a handle on and to diagnose. As to personality disorder, what you need to know about this term is that it means your loved one exhibits a chronic pattern of behaviors that are based in his or her personality, which means essentially that they affect everything: moods, actions, and relationships. You can probably see this pretty plainly for yourself.
To get into a little more detail, if you were to consult the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; the manual that psychiatrists and other mental health professionals use as a guide for diagnosing BPD and other disorders), you would see nine diagnostic criteria listed. They range from suicidal and self-harm behaviors to psychotic behaviors to behaviors intended to avoid abandonment. These criteria are often cumbersome and difficult to pinpoint. Many mental health professionals have found it challenging to diagnose the disorder using these criteria, because they are so wide-ranging and because the disorder can manifest itself in such diverse ways. Maybe your loved one is dramatic, impulsive, and emotional, the profile that's pretty common and that I've been alluding to so far in this chapter. But your loved one could also qualify for the disorder if she often seems emotionless or numb (more on this a little later in the chapter). Some people with BPD function brilliantly as parents and friends but can't keep a job; others abuse alcohol and/or drugs and can't function normally in any domain of life. Unfortunately, I don't think the DSM criteria make it easy to see that these people all suffer from the same underlying problem.
I also think that the wording in the DSM makes BPD sound untreatable and fuels despondence in people with the diagnosis. The psychiatrist who diagnosed Sadie and only made Brad feel worse is a good case in point.
Dr. Marsha M. Linehan, originator of dialectical behavior therapy (DBT), the type of treatment I use to help people with BPD, thought that there had to be a better way to capture and identify what was going on in this disorder. So she reclassified the diagnosis into five areas of dysregulation. That is, she identified five different ways that people with BPD are unable to regulate themselves—their behavior, their emotions, their thoughts—the way other people do. Dividing the diagnostic "symptoms" into these subgroups of behaviors makes the behaviors of your loved one, and a lot of others with the disorder who may look vastly different on the surface, understandable and, even more important, treatable.
Being familiar with these subgroups can also make it a lot easier to understand why you feel so lost in your relationship. It may help you understand why you're having such a hard time deciding what you can do to improve your relationship while still being interested in preserving it. As you read about the five areas described below, ask yourself whether you see these problems in the person you love. I'm not asking you to undertake an amateur diagnosis, and I'm definitely not asking you to judge. Just look at the behaviors. The key is to try to keep some distance and observe the behaviors as if you were watching television. As difficult as it may be not to get embroiled in rehashing painful events, try not to jump into interpreting or blaming your loved one for the behaviors that seem to fit into these subgroups. Instead, just try to start noticing patterns. This is a first step toward regaining your balance and becoming "unlost."
Extra-Sensitive and Highly Reactive Emotions
Jill wakes up every morning and says to herself, "I am not going to overreact today." She goes downstairs to fix breakfast for her children and soon realizes they are not getting ready for school quickly enough, so she finds herself becoming irritated. At the school, she stops in to talk with one of the kids' teachers. The teacher says that her daughter is struggling in reading class. Jill feels very sad about her daughter and then begins to believe it is all her fault. Her shame and guilt build to the point that she needs to do something to feel better. She stops at the local department store and buys clothes that are on sale. When she gets home and realizes how much money she has spent, she is mortified. She begins to call herself names: "idiot, worthless." Jill turns on the TV and finds herself sobbing during a talk show. Finally, she pulls out a bottle of vodka. Just one glass will help make her feel better ...
As Jill exemplifies, people who suffer from emotional dysregulation are really at the mercy of their highly tuned emotional system all the time. I know, you undoubtedly feel like you're at its mercy too. Believe me, it's not pleasant for either of you. Emotional dysregulation can feel like drinking a cup of boiling coffee that everyone else insists is just lukewarm. Where you might feel a twinge of irritation, an emotionally dysregulated person feels instant rage. Where you feel a flush of attraction to someone, the person with BPD may feel irresistible desire. Something that makes you feel slightly embarrassed might send the emotionally dysregulated person scurrying off to cut herself repeatedly or drink a fifth of bourbon to obliterate the feeling of overwhelming shame.
Excerpted from Loving Someone with Borderline Personality Disorder by Shari Y. Manning. Copyright © 2011 The Guilford Press. Excerpted by permission of The Guilford Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Foreword, Marsha M. Linehan
I. Understanding Your Loved One and Your Relationship
1. “Why Do I Feel So Lost in This Relationship?”
2. What Makes Someone So Emotional?
3. The Hidden Power of Validation
4. Five Steps to Balanced Responses and Better Outcomes
II. The Many Faces of Borderline Personality Disorder
5. "I Can't Stand Feeling Like This!"
6. "It Was All My Fault"
7. "You Have to Fix This for Me!"
8. "Things Are Awful . . . but Don't Worry; I'm Handling It"
9. "Why Do Terrible Things Keep Happening to Me?"
10. "Nothing's Wrong—I'm Fine"
III. Dealing with Crisis and Getting Help
11. Handling Your Own Difficult Emotions
12. Understanding Self-Harm/Suicide and Making Decisions about Hospitalization
13. Getting Treatment and SupportResources
Loved ones facing the challenges of BPD; mental health professionals and students.