The Essential Family Guide to Borderline Personality Disorder

by Randi Kreger

  • Blaise Aguirre, MD: chapter 11 (Power Tool 5: Reinforce the Right Behavior)

  Other professionals whom I interviewed or whose work inspired me include Byron Bloemer, PhD; Annette Boehm; Andrea Corn, PsyD; Carolyn DeRoo; William Eddy, attorney, mediator, and clinical social worker; Kathryn Jane Gardner, PhD; Mary Gay, PhD, LPC; Jan Hargrave; and James Holifield, LCSW.

  Also Patricia A. Judd, PhD; Anne Katherine, MA, CEDS; Janet Klosko, PhD; L. Allison Langlois, PsyD; Daniel Mattila, MDiv, LCSW; Bennett Pologe, PhD; Karen Pryor; Rachel Reiland; Kimberlee Roth; Kwan Soo, MD; and Amy Sutherland. The founding mothers of the fundamental premise of all three of my books have been Harriet Lerner, PhD, and her book The Dance of Anger, and Susan Forward, PhD, and her book Emotional Blackmail.

  I would also like to thank two singer-songwriters for the use of their lyrics: John Forster (“Codependent With You,” Chapter 8) and Carrie Newcomer (“Closer to Home,” Conclusion). I found Carrie’s lyric about going “to the edge of my blindness, and then a little more ways” to be a perfect definition for a leap of faith.

  All writers have something we must deal with called “real life,” which occurs in those brief moments when we’re not stewing about the book, researching the book, writing the book, rewriting the book, or incessantly talking about the book until everyone around us becomes thoroughly sick of hearing about it. My husband, Robert, has kept me fed these past three years (twelve years, if you count the first two books) and seen to things like changing the oil in my car while I had my nose in a book, was staring at my computer, or looking blankly at nothing while my mind was churning out the solutions in the second half of this book. He is the one who avidly scans the Internet and sends me new book reviews, articles, and the URLs of Web sites he thinks I might be interested in.

  Lisa Radtke, the manager of my Welcome to Oz (WTO) online family community, took over after the death of a dearly beloved volunteer and has, for the past several years, kept the WTO community a safe, sacred place for all 16,000 members in fifteen Listserv “neighborhoods.” Assisting Lisa is another longtime volunteer, Rita Closson, MA, who scans the list and sounds the alert when something needs attention. Rita missed her true calling as a stand-up comedian.

  In 2007, computer programming whiz kid Robert Bauer tried to help me keep my technically challenged message board on www.bpdcentral.com in one piece. When it became apparent that, like the Titanic, it was sinking fast and all I could do was rearrange deck chairs, he gave the message board new life at his “Facing the Facts” board at www.bpdfamily.com. He has been generous with his time and expertise in all sorts of matters.

  Also in 2007, Leslie Steis assisted me by setting up interviews and doing research. I learned a great deal from her about the challenges facing grandparents, who are so often villainized and prevented from spending time with their beloved grandchildren.

  Finally, I would like to recognize Edith Cracchiolo, a good friend whom I sorely miss. She and I worked together on the WTO community for ten years. For several of them, she dedicated more than eight hours a day to assisting people on the WTO, especially her beloved adult children. In 2005, she traded in her earthly guardian angel wings for real ones up in heaven. How I wish she were here so I could give her this book. She would have taken it in both hands, looked up at me with a grin, and exclaimed, “Yes!”

  The author gratefully acknowledges the following sources:

  Kay and Doug’s story, Chapter 1, reprinted with permission from Hope for Parents: Helping Your Borderline Son or Daughter Without Sacrificing Your Family or Yourself by K. Winkler and R. Kreger (Milwaukee, WI: Eggshells Press, 2000). Richard and Laurie’s story, Chapter 1, reprinted with permission from Love and Loathing: Protecting Your Mental Health and Legal Rights When Your Partner Has Borderline Personality Disorder by R. Kreger and K. Williams-Justesen (Milwaukee, WI: Eggshells Press, 2000). All material from A. J. Mahari’s Web site articles reprinted with permission of the author. Material from June People’s radio interview reprinted with permission of The Infinite Mind produced by LCMedia, Inc., ©1999. Material on schema therapy reprinted with permission of Jeffrey E. Young from www.schematherapy.com—this material also appears in Schema Therapy: A Practitioner’s Guide by Jeffrey E. Young, Janet S. Klosko, and Marjorie E. Weishaar (New York: Guilford Press, 2003). Material on medications for mental health conditions, Chapter 5, taken from www.drjoecarever.com, “The Chemical Imbalance in Mental Health Problems,” by Joseph Carver, PhD, reprinted with permission. Medication chart, Chapter 5, taken from www.bpddemystified.com, reprinted with permission of Robert O. Friedel, MD. E-mail from Rachel Reiland, Chapter 6, reprinted with permission of Rachel Reiland. Material on the Stockholm Syndrome, Chapter 8, taken from www.drjoecarver.com, “Love and Stockholm Syndrome: The Mystery of Loving an Abuser,” by Joseph Carver, PhD, reprinted with permission. Material from www.aboutpsychotherapy.com reprinted with permission of Bennett Pologe, PhD. Material from the National Association of Cognitive-Behavioral Therapists Web site (www.nacbt.org) reprinted with permission. “Codependent With You” music and lyrics by John Forster, Chapter 8, ©1991 Limousine Music Co. (ASCAP), all rights reserved, reprinted with permission. Chart on boundaries, Chapter 10, reprinted with permission of Donna Bellafiore, www.drbalternatives.com, © by Simmonds Publications. “To the edge of my blindness, and then a little more ways,” lyric adapted with permission on Conclusion, from Closer to Home, lyrics by Carrie Newcomer.

  About This Book

  The information in this book reflects the best of three types of research: an exhaustive, three-year survey of the latest scientific studies related to borderline personality disorder (BPD), interviews with more than two dozen top mental health clinicians and researchers, and the collective experiences of thousands of people affected in one way or another by BPD. All these individuals are members of the Welcome to Oz Online Family Community located at bpdcentral.com or the Facing the Facts message board at www.bpdfamily.com.

  Welcome to Oz, or WTO, has provided an online home for more than 65,000 family members since it started in 1996. It functions much like a real-life support group, except that members communicate via e-mail instead of face-to-face. Current membership stands at 16,000, with members gathering by type of relationship (parents, siblings, stepparents) or similarities in their situations (partners who want to stay in the relationships versus those who have decided to separate). Facing the Facts—with 7,000 members—offers the same support. There, members post their thoughts on an online message board.

  In part 1 of this book, you’ll learn exactly how BPD impairs an individual’s thoughts and feelings, which in turn triggers behaviors such as raging, perceived manipulation, suicide threats, and excessive blame and criticism. Since the bane of every family member is finding effective professional help, chapter 6 provides hard and soft qualities to look for in a clinician and seven questions that separate neophyte BPD providers from those with the necessary experience.

  Then, armed with new insight about how your borderline family member experiences the world, you’ll be introduced to five powerful tools that will help you organize your thinking, learn specific skills, and focus on what you need to do to avoid becoming overwhelmed. They will help you become more confident and clear about who you are, and they will show you steps to take to improve the quality of your life.

  Many self-help books are written so readers can skip from chapter to chapter as needed. This book isn’t one of them. The chapters in The Essential Family Guide to Borderline Personality Disorder are like Russian dolls—you open a big doll, and inside there’s a smaller doll, and inside that a smaller one, and so on. Many of the concepts and terms used are unique to this book. So, start at the beginning and read straight through. The one exception is the chapter on finding a therapist.

  If you feel trapped, this book will teach you how to get unstuck. If you feel burdened, you’ll learn how to ask for help from others. If your self-esteem is in the pits, you’ll learn how to climb up, step by step.
And perhaps most important, you’ll come to realize that you have a right to your own feelings and your own beliefs, and the right to pursue your own goals.

  Psychiatrist Milton Erickson said, “There are so many things you know. It’s just that you haven’t always known that you know them.” After you’re done reading this book, you’ll know.

  Terms You Need to Know

  To keep it simple, we use the following terms throughout this book.

  “Borderline” and “BP”

  Because the diagnosis of borderline personality disorder (BPD) has been so stigmatized, it’s much more acceptable to say, “He’s bipolar” or “She’s a diabetic” than to say, “He’s borderline.” In effect, there is a double standard. Just the word borderline conjures up such negative stereotypes that many people avoid the term altogether or use a substitute.

  One popular alternative is consumer, as in consumer of the mental health system. However, a large percentage of people with BPD are not in the mental health system. They are in as much denial of their illness as an active, untreated alcoholic. They not only don’t seek treatment, but also forcefully repel any suggestion to do so.

  People with BPD are finding their own solution. Just as people who are gay or lesbian have adopted the word queer as their own, individuals with BPD use the term borderline or BP for short. This book will follow their lead.

  “Family Member” and “Non-BP”

  A similar problem surrounds the term family member. Like the term consumer, family member is limited. The effects of BPD are far-reaching: in addition to the immediate family, the disorder impacts the lives of extended relatives, co-workers, friends, in-laws, stepparents, those who emotionally support family members, and even therapists. For this reason, the term non-BP refers to anyone who is in a situation in which the behavior of a BP affects him or her.

  Non-BPs may have their own mental health issues, too, from depression to a personality disorder. In fact, it’s common for some non-BPs to have either BPD or narcissistic personality disorder (NPD). You’ll read more about narcissism on pages 46–47. Stop Walking on Eggshells has an appendix called “Tips for Non-BPs Who Have BPD.”

  The terms BP and non-BP are not a philosophy meant to divide loved ones and family members into separate camps. They’re just shorthand, like saying “scuba gear” instead of “self-contained underwater breathing apparatus.”

  • Part 1 •

  THE ABCs OF BPD

  Chapter 1

  Welcome to Oz

  Be true to yourself despite being misunderstood.

  It is painful but not fatal.

  • I Ching •

  Do you feel as though you’re walking on eggshells around someone important in your life? Does this phrase immediately strike not just a chord but a whole piano concerto? If so, someone in your life may have either borderline personality disorder (BPD) or borderline traits.

  Take a look at the following questions. If you answer “yes” to most of them, your loved one might have BPD:

  • Does she see you in one of two modes: either a hateful person who never loved her or a source of blessed, unconditional love?

  • Does he continually put you in no-win situations? When you try to explain that his position is the opposite of what he said earlier, does it bring on more criticism?

  • Is everything always your fault? Are you the target of constant criticism?

  • Are there times when everything seems normal and you’re on her good side—even idealized—but then for no obvious reason everything falls apart?

  • When he’s angry, does it degrade into a take-no-prisoners, vicious attack that leaves you reeling?

  • Does she use fear, obligation, and guilt to get her way? Do you feel so manipulated that you don’t trust her anymore?

  • Are you starting to doubt your own sense of reality? Has constant exposure to his skewed sensibility, combined with isolation from family and friends, made you feel like Dorothy confounded in the strange Land of Oz?

  What Is Borderline Personality Disorder?

  Borderline personality disorder is a serious mental illness that causes those who have it to see people and situations as all good or all bad; to feel empty and without an identity; and to have extreme, blink-of-an-eye mood swings. People with BPD act impulsively; their self-loathing and extreme fear of abandonment can cause them to lash out at others with baseless criticism and blame. Some practice self-harm or see no other option than suicide as a way to end their pain.

  People with borderline personality disorder experience the world much differently than most people. For reasons we don’t entirely understand, the disorder distorts critical thought processes, resulting in emotions and actions that are out of the norm.

  If we could look inside the heads of people with BPD to see the way they think, we’d find out they live in a world of extremes. To them, people and situations are all good or all bad, with nothing in between. They don’t just admire or respect someone—they elevate that person to an impossible standard and then knock him down when he inevitably disappoints them. They see themselves this way, too, so that one small misstep leads them to think, I am a worthless person.

  If you could snap your fingers and, by magic, experience what a BP feels, you would be overwhelmed by self-loathing, an intense fear of being abandoned, and a relentless sense of emptiness. Irritability and depression would be there, too, a steady drumbeat blocking out feelings of joy and even simple satisfaction. “BPD is a cancer that eats away at my body, mind, and soul,” says one woman with the illness.

  It’s easy enough to observe how BPs act. Actions, unlike thoughts and feelings, are obvious. They’re what make people with BPD so hard to live with. BPs behave impulsively, not thinking things through. Some deliberately hurt themselves—they make themselves bleed or they attempt suicide. They may spend too much money, engage in dangerous sex, abuse drugs or alcohol, drive recklessly, shoplift, or eat in a disordered way.

  People with BPD repeatedly pull people toward them—often desperately—and then brusquely shove them away through bitter criticism, unappeasable rages, and fits of irrational blaming. They elevate people onto a lofty pedestal and then push them off. Some BPs put people into no-win situations and make absurd accusations.

  What’s difficult for loved ones to understand isn’t the what of borderline behaviors, but the why.

  What Is It Like to Have BPD?

  Helen is a twenty-two-year-old borderline woman who just transferred from a small community college to a large university, miles away from friends and family. Other people see her as talented and bright, though a little standoffish. She sees herself as defective and keeps to herself because people terrify her.

  To assuage the loneliness, she sometimes sleeps with men she doesn’t know very well just to feel their bare skin on hers. She is a binge eater now; in high school she was anorexic. She keeps a journal, from which the following entry is taken (spelling and grammar are preserved).

  I want to be dependent sometimes, i want to be taken care of i want to be loved no matter what i want complete understanding from everyone (at all times, no less, ho ho ho). i wants someone who makes love to me, to love me, to understand how I FEEL besides this journal, I want to really touch someone and I want them to touch me. I don’t know where to go, I doubt myself so much I don’t respect myself i don’t have confidence I can do whatever. I WANT TO BE LIKE A NORMAL PERSON I WANT TRUE LOVE, i feel insecure and tired.

  I AM AFRAID OF MYSELF AND MY FEELINGS I AM AFRAID, HORRIFIED THAT OTHER PEOPLE WILL HURT ME, I CAN’T ACCEPT MYSELF I DON’T FEEL INCONTROL OF MY BEHAVIOR I CAN’T CONTROL MY EATING. I think if I let it all out I could scream and cry and rage and fear and disappointment, anger, hurt. I feel like a little girl. i want someone to come along to take control and enfold me and tell me I will be ok. I feel tired of living sometimes. I want to help myself and my room is so messy I can’t stand it . . . I feel like I alternate be feeling so dead inside and feeling so m
uch such rage I would rather be dead! Why do I feel so self-conscious around my roommate? She tells me my feelings are too intense, I’m too spacey, I take everything as criticism. Why do I feel so angry when someone tells me to open up and share my feelings? Why do I let them manipulate me? I am so very hungry . . . I am me my name is Helen Helen Helen Helen Helen Helen Helen

  What Is It Like to Care about Someone with BPD?

  Loving someone with BPD is a full-time job. Family members describe it as living on an emotional roller coaster or walking on eggshells. They feel alternately pursued and rejected, as if they’re constantly being tested for something, but unsure of what it could be. Over time, people who are close to someone with BPD become so accustomed to living with abusive behavior they start to think it’s normal. Family members frequently experience feelings of guilt, shame, depression, exhaustion, isolation, and helplessness.

  People affected by the behaviors of someone with BPD come in two categories: “chosen” and “unchosen.” In the chosen category are partners and friends. The unchosen category encompasses parents, siblings, in-laws, stepparents—both blood family and those who find themselves in this situation because of their relationship with someone else, for example, a wife whose husband’s father turns out to have BPD.

  If you have someone in your life with BPD, you may

  • be angry a great deal of the time at yourself, your loved one, fate, and the healthcare system

  • be drained of emotional energy; your inner resources tested to the limit

  • grieve for the loss of your dreams of the happy child, loving partner, close sibling, or loving parent

  • fear for your physical safety

  • question your own self-worth and your ability to be a good parent, partner, relative, or friend

  • experience strain in other family relationships

  • experience financial difficulties

  • constantly walk a tightrope, balancing your needs and the needs of the rest of your family against those of your BP