The Challenges of Unstable Interpersonal Relationships and BPD

Borderline Personality Disorder Can Make Relationships More Difficult

mature couple arguing
What are the challenges of unstable interpersonal relationships with BPD and how is this managed?. Denkou Images/Cultura/Getty Images

Does borderline personality disorder affect relationships between family members, friends, or other people in the community? How could BPD specifically create troubles, and what can be done to resolve these problems?

Interpersonal Relationships in People with Borderline Personality Disorder (BPD)

Many people with borderline personality disorder (BPD) have intense and unstable relationships with others.

Their relationships tend to fluctuate between being all good or all bad and they can be unable to experience contradictory feelings when relating to the world or others. This black and white thinking, or splitting, can spill over into all relationships including those at school or work with peers, professors and instructors, managers and supervisors.

Idealization and Devaluation Cycles in Relationships with BPD

If you have BPD, you may initially idealize a person or situation, throwing yourself into a relationship fully and without reservation. However, soon something may occur that conflicts with this idealized view, such as a harsh comment from a supervisor, a poor grade on a paper or a fight with your partner. This can cause you to switch from an idealized view to one of devaluation. You may think that there is suddenly nothing good about the person or situation and there never was.

A heightened sensitivity to rejection (abandonment sensitivity) may trigger your devaluing reaction.

This sensitivity can cause you to overreact to real or perceived rejections. The feeling of rejection is overpowering and consuming and can feel very real, regardless of whether it was truly meant or unintended.

In response to devaluation, you may erupt in anger, quit the related task, become aggressive or just give up.

It is possible that the person, relationship or task will again be seen as ideal, but it is also possible that the negative view will remain constant or that the damage that occurred will be irreversible. Friendships can be destroyed, jobs quit or classes dropped. It can be a debilitating experience with significant consequences. 

Treating Borderline Personality Disorder and Managing Relationships

Borderline personality disorder can have a significant impact on your relationships. Even with your family members, you may be sensitive to rejection, changes in plans or feelings of being slighted. These distortions in thinking can make you feel isolated, lonely and helpless. 

In the past few years, significant progress has been made in understanding and treating BPD, both from a psychotherapy standpoint and through the use of medications.

Therapy - There are many treatment options that have been proven to be effective. Specific therapies that have shown promise in helping with the relational aspects of BPD include:

  • Dialectal behavior therapy (DBT) - DBT, sometimes called "talk therapy" is a form of cognitive behavioral therapy. It looks at cognition, or thought, and relates this to behavior, or actions. There are now other forms of therapy available which address relationship concerns with BPD, but DBT is one of the therapies that was first found most effective for BPD. There are four primary skills taught in DBT, with one being interpersonal effectiveness skills designed to help people successfully state their needs in a relationship and manage conflict.
  • Mentalization therapy (MBT) - MBT is a therapy that focuses on looking at your feelings, thoughts, and hopes, in order to see how they may be connected to your behaviors. MBT is a form of psychodynamic therapy which focuses on present situations rather than prior events and uses your relationship with the therapist to work through issues. Using specific examples or settings, MBT helps you to analyze both your feelings and the feelings and thoughts of others in a specific situation. For example, if a friend of yours gets angry and leaves your home, you would address what feelings she had which may have prompted her behavior of leaving rather than focus on the behavior of leaving.

In some cases, inpatient treatment may be necessary.

Medications - While there are currently no medications approved to treat BPD, medication is sometimes prescribed by doctors to help manage BPD symptoms and improve your interpersonal relationships. Some studies have shown that certain medications approved for other mental disorders are effective in controlling symptoms like anger, impulsivity, depression and feelings of isolation. Results can vary greatly and it is unlikely that medication will completely eliminate these feelings; you can most likely expect modest results. 

While medication may be a useful tool for managing your symptoms while undergoing therapy, many of the medications used have significant side effects. Before taking any pills, talk to your doctor and your therapist about potential side effects and if the advantages of medications outweigh the drawbacks. For some people, the risk is not worth the modest improvements in symptoms. 

Bottom Line on Managing Relationships with Borderline Personality Disorder

Regardless if you take medication or not, therapy is essential for improving your relationships with others and managing your other symptoms. Talk to your doctor about your specific needs and concerns to come up with a strategy to meet your unique needs.

Take the time to learn about some of the most common issues faced by people with BPD in their relationships. Romantic relationships with BPD in particular, tend to be chaotic and intense and it is important that both you and your partner understand some of these issues and how to address them before they become apparent.

If you are living with someone with borderline personality disorder, it can be helpful to learn some of the ways in which a diagnosis of BPD affects the whole family.

While learning about BPD either in yourself or a loved one can leave you feeling depressed, learning to understand the common issues and seeking out therapy can make a tremendous difference. Family therapy, in particular, can make a huge difference not just for someone living with BPD, but for the whole family.

Sources:

Dammann, G., Riemenschneider, A., Walter, M. et al. Impact of Interpersonal Problems in Borderline Personality Disorder Inpatients on Treatment Outcome and Psychopathology. Psychopathology. 2016. 49(3):172-80.

Edel, M., Raaff, V., Dimaggio, G., Buchheim, A., and M. Brune. Exploring the Effectiveness of Combined Mentalization-Based Group Therapy and Dialectical Behaviour Therapy for Inpatients with Borderline Personality Disorder. British Journal of Clinical Psychology. 2016 Nov 29. (Epub ahead of print).

Jeung, H., and S. Herpetz. Impairments of Interpersonal Functioning: Empathy and Intimacy in Borderline Personality Disorder. Psychopathology. 2014. 47(4):220-34.

Lazarus, S., Cheavens, J., Festa, F., and M. Zachary Rosenthal. Interpersonal Functioning in Borderline Personality Disorder: A Systematic Review of Behavioral and Laboratory-Based Assessments. Clinical Psychology Review. 2014. 34(3):193-205.

Continue Reading