1. My loved one won’t seek help but their behaviour has a strong impact on the entire family, what can I do?

As a family member or partner you might feel powerless witnessing your loved one’s distress, anger, and difficulty in maintaining relationships and achieving goals. You might also feel exhausted and frustrated by their demands, and possibly even scared by their behaviour.

Your loved one might have found destructive ways to cope with their distress, such as substance abuse, impulsive behaviour, suicidal ideation, angry outbursts, venting, or avoidance. While these coping strategies may provide fast relief, they can be harmful to them and to their family. Seeking appropriate help, such as Dialectical Behavioural Therapy (DBT), could help to gradually let go of these coping strategies and replace them with a new set of skills. Letting go of self-destructive behaviours can feel overwhelming, with the stigma attached to a BPD diagnosis adding another challenge; so the journey toward treatment and change may take a while.

This does not mean you should accept out-of-control behaviour in your home. With adequate guidance, you and your family can learn to navigate these situations and maintain your wellbeing, even if your loved one is struggling and won’t seek help for the time being.

2. As a parent, I support my child with BPD as best as I can, but what about their siblings? They often witness overwhelming situations and can be caught in the middle of conflicts.

As a parent, you may have focused your time and energy on your loved one with BPD who experiences high levels of distress, trying to prevent self-destructive behaviours and keep the family safe. Siblings are impacted by a family member with BPD, and might experience a range of emotions: anxiety, confusion, resentment, and hurt; they may feel unheard and overwhelmed themselves. They might also want to protect and support you by being responsible and supportive.

What can you do? Ask them how they feel, what they think about the situation, and what would be helpful to them. Could they benefit from support for themselves, either through therapy or support groups? Once a month, AMI-Quebec offers a support group for young carers who care for loved ones and/or care about loved ones (age 18-30); they are considered young carers, even if they don’t perceive themselves as such. They may find it helpful to share their experiences with other young carers.

3. Setting limits to my loved one with BPD has been a real challenge. It is not working out! How do I do this without giving an ultimatum?

When demands for your time and energy become overwhelming, or when out of control behaviours and conflicts are disrupting family life, it does feel as if the only thing left to do is to give an ultimatum. Unfortunately, this rarely works! If at all possible, the first step would be to explore what might be driving your loved one’s behaviour. What could be the feelings underneath their actions and words? What is their perception of the current situation? Could you negotiate and meet in the middle? Could you present your loved one with a few options? A person with BPD may perceive boundaries as rejection, so setting limits can be challenging and stressful for the family. But it is necessary and can be done. More information about setting direct but careful limits can be found here: borderlinepersonalitydisorder.org/family-connections/family-guidelines.

4. How can I determine what can or can’t be asked of my loved one? Should I let them deal alone with the consequence of their choices?

Your loved one may be very intelligent and full of potential. And yet you see them having difficulty moving forward in life. Any new challenge or transition (like a new job or relationship) might be very challenging for someone with BPD. Living daily with high sensitivity and reactivity and not having the skills to cope can make it very hard to function in the world. Until your loved one has integrated some essential skills such as emotion regulation and interpersonal effectiveness, they will struggle.

As a family member, support may be a fine line: you might have to adjust your expectations to meet them where they are, and you might have to offer some guidance at times; you also want to let them face some challenges. Reaching small goals will increase their sense of agency, empowerment and autonomy. Dealing with the consequences of their choices and actions can be a powerful learning experience for someone with BPD.

5. My loved one creates dangerous or complex situations for themselves and I feel I have to save them, is that a good idea?

Our first impulse is to jump in and do what needs to be done so that the situation does not deteriorate (fill out forms, make calls for them, find them a new job, give them money for rent, etc). It makes sense that you want to help, but you might want to explore if this is really helping them move forward. Has their situation improved or does the same cycle occur every few months or so? Inadvertently, despite your good intentions, by jumping in every time your loved one is faced with a difficulty, you may deprive them of the opportunity to learn to do things on their own and to reach out to organizations or mental health professionals who could bring them closer to treatment and change.

6-My loved one isolates, is angry at me, won’t talk to me. How can I maintain some type of connection with them?

This is a difficult experience. You care, you wish to know your loved one is okay. You miss them, but you might sometimes resent them too; it hurts so much. When someone lives with BPD, sustaining relationships is challenging, especially with people who are closest to them, like family members or partners. Your loved one, therefore, might find it easier to keep some distance. Feeling shame for not being good enough or not meeting expectations may prevent a person with BPD from keeping a healthy connection. Try to respect your loved one’s abilities and boundaries when it comes to interactions, and find simple ways to let them know how much you care and how important they are to you.

If your loved one lives with you, it can be more complex. You might need someone to help you navigate challenging situations. AMI-Quebec offers free counseling to caregivers; contact us if you require help.

7-My loved one self-harms and has suicidal thoughts. I am scared; what can I do?

As strange as it may sound, self-harm is often used as a way to avoid attempting suicide. Your loved one with BPD might self-harm as a strategy to numb emotional pain. A majority of individuals who injure themselves do not feel suicidal while engaging in self-injury. Although very alarming, self-injury usually does not result in suicide. However, research has shown that self-harm may be associated with a higher possibility of suicide attempts.

Both self-harm and suicidal thoughts are a cause for concern. They are often a sign that your loved one is struggling with intense emotional pain. Don’t be afraid to ask your loved one how they feel and listen to what they say (without offering an immediate solution), so they feel heard and understood.

If your loved one is seeing a therapist, encourage them to share their experiences honestly and openly as soon as they can.

If a situation escalates and you are at a loss, do not hesitate to call the Suicide Action hotline or your local crisis center: amiquebec.org/crisis.

8-My loved one keeps bringing up the past and say I am the reason they are not doing well today, what should I say?

This is difficult to hear and may bring up mixed feelings: anger, guilt, confusion, self-doubt, and resentment. You did so much to support and help them, how can they say this to you? Especially if you feel their version of events is very different from yours.

Validation could be helpful. Validation is a key concept in Dialectical Behaviour Therapy (DBT) and is aimed at recognizing how someone is feeling without necessarily agreeing with what they say.

For example, your loved one might say: you have always cared more for my siblings than for me. Validation would be saying, for example: it must feel terrible for you to think that I care more about your siblings…Once your loved one feels heard, it can be an opportunity to explore the feeling underneath their belief; do they feel like they don’t matter? Do they feel like they don’t meet your expectations? A person with BPD often struggles to identify their feelings, so this type of conversation might increase your loved one’s awareness; it could also help to build trust and improve your relationship. For more information on BPD and validation:
amiquebec.org/bpd4fam.

9-My child is a teen. They have been drinking, wishing to quit school, are engaging in self harm, are very angry, and won’t talk to me. Could this be Borderline Personality Disorder? What can I do?

If you are the parent of a teen who is struggling to regulate their emotions or has been diagnosed with BPD, you are welcome to attend our groups and workshops. If you would like guidance as to how to navigate the system in order to get support for yourself and your teen, do reach out to us.

For more information about teens and BPD, read our article BPD and Teens: What Parents Want to Know: amiquebec.org/BPDteens.

10-I feel exhausted, frustrated, helpless and not sure I can continue this way! I want to support my loved one but I am burned out; what should I do?

Since it might take a while before your loved one’s condition improves, it is essential that you take care of yourself while you support them. While staying connected to your loved one is important, respecting your own limitations is important too. Take breaks, engage in activities that bring you pleasure, see friends, take time to enjoy your hobbies. Connecting with other people who share similar challenges can also be a great source of comfort. At AMI, we offer workshops, support groups, counseling and a Caregiver Group for family members.

– Sylvie Bouchard, BPD Programs for Family Members at AMI-Quebec

From Share&Care Winter 2023 and Spring 2023