I Hate You: What it’s like to have a loved one with Borderline Personality Disorder

Guest Post by Mary Chistine

One hopes to never hear your child say that to you but many times they do.

“Mom, I think I know what’s wrong with Jennie!” My younger daughter, Bella, usually called me on her way home from nursing school to pass some of the time.  She’d been doing a week of clinicals at the state mental hospital.  One of the patients there had been diagnosed with BPD. This young woman had been exhibiting the same type of behavior as her sister. The most notable of which is explosive anger, even over what seems to be small things, and can escalate to a full blown melt down. I had never heard of BPD.  Intrigued, I started what turned out to be months of research on this mental disorder beginning with finding out what it is and how one is diagnosed with BPD.

What does Borderline Personality Disorder mean?

Historically, the term “borderline” has been the subject of much debate. BPD used to be considered on the “borderline” between psychosis and neurosis. The name stuck, even though it doesn’t describe the condition very well and, in fact, may be more harmful than helpful. 

Current ideas about the condition focus on ongoing patterns of difficulty with self-regulation (the ability to soothe oneself in times of stress) and trouble with emotions, thinking, behaviors, relationships and self-image. Some people refer to BPD as “Emotion Disregulation.”

What are the criteria for diagnosing BPD?

The National Education Alliance for Borderline Personality Disorder. Founded in 2001, this organization is one of the best resources for learning about BPD. They define it as

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Fear of abandonment
2. Unstable or changing relationships
3. Unstable self-image; struggles with identity or sense of self
4. Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating).
5. Suicidal behavior or self-injury
6. Varied or random mood swings
7. Constant feelings of worthlessness or sadness
8. Problems with anger, including frequent loss of temper or physical fights
9. Stress-related paranoia or loss of contact with reality

Jennie checked the boxes of at least six of the above. Numbers 3 and 7 are possibilities but I can only speculate without being inside of her mind. Notice they say the symptoms manifest in early adulthood. Probably because some of the behavior listed is impossible until you hit the mid-teens. However, NEABPD publishes lectures and testimony from people who have been through their program. Parents who saw the explosive anger throughout childhood, and people with BPD, say they dealt with the mood swings and inability to control their anger as children.

Jennie had been a relatively easy baby. She seemed happy and hit all the milestones normal babies pass on their way to toddlerhood. But at about 18 months I began wondering if she was a changeling. “It’s just the “terrible twos” coming on a little early.” my pediatrician said. I don’t want to give the impression it went from all good to all bad. There were days when things went well and days where I wondered if I was going to make it through the day at all. One day, a 5-minute time out took hours because she refused to stay in the chair. “You should have spanked her!” some will say. Don’t worry, I tried everything. “You have a strong-willed child.” the pediatric nurse told me. She recommended a book, The Strong-Willed Child. I read the book, none of what was suggested worked.

For most kids, the terrible twos fade away and usually, about age 5 the tantrums are not a regular thing anymore. Not for Jennie. Now, I worked part-time and while she never seemed to get over being dropped off and having separation anxiety, she did calm down and function normally so that the teachers (or babysitter) did not complain that it was a regular problem with tantrums. Nope, she saved those for when she was home.

But odd things would set her off. Things that most kids could brush off more easily.

One of those odd things I distinctly remember was her problem with sock seams. Mornings could be a nightmare sometimes as she pulled off her socks and threw them down, crying in frustration. Weird huh? When one of the NEABPD lecturers (a parent of a Borderline child who had been through their program and was now teaching) told the story of sock problems her child had, a lot of people in attendance raised their hands. Borderlines experience frustration in a completely different way than normal people and unable to deal with it, the tantrums ensue.

But they also tend to be highly intelligent and creative. Jennie loved art and could draw things at a very young age that I’ve never been able to draw. She scored high in language arts and reading. She loved to read and would read by flashlight when she was supposed to be asleep. She created elaborate imaginative games and would play with her younger sister for hours. It’s common for them to love animals, mainly because animals seem to calm rather than cause distress.

By the time she turned 13 she was beginning to show signs of getting worse. A divorce did not help things. A highly recommended family counselor misdiagnosed her as oppositional defiant. BPD was only identified in the 80’s and misdiagnoses were common.  While therapists now are familiar with it, many will not treat it.

BPD is notoriously hard to treat and co-morbidities such as narcissism and bi-polar can also manifest in a percentage of Borderlines making it even more challenging to treat. Some honest psychiatrists note that some of their patients who say they are trans have BPD. No one knows how many people have BPD but the estimate of 5% of the population could be on the low side. Women are more likely to be diagnosed than men. Possibly because men with this disorder can end up in jail and are never diagnosed.

Some of the reasons why many therapists will not treat people with BPD are:

• Noncompliance with treatment: People diagnosed with BPD become very reactive and often demonstrate an extreme resistance to change. This is because individuals with personality disorders often do not see themselves as a problem but instead view everyone else as being the cause of their difficulties. When these individuals have co-occurring substance use disorders, this increases the chances for noncompliance.
• Self-destructive tendencies: BPD patients are often self-destructive and have issues with self-injurious behaviors and suicidality. Because the treatment process attempts to correct dysfunctional behaviors, individuals with BPD must first see the need to change (which means they must accept deficiencies within themselves), which fosters even further issues with self-degradation, suicidality, etc. This often complicates the treatment process.
• Relationship issues: People with BPD have relationship issues with nearly everyone in their lives, and significant relationship issues will often develop with therapists as a result of the therapeutic process of change. The patient may first idolize the therapist and then later totally demonized them (splitting) or may attempt to manipulate different therapists against each other in order to manipulate the overall treatment. Professionals who treat people diagnosed with BPD must be aware of these potentialities and even expect them to occur. Unstable personal relationships within treatment itself as well as outside treatment contribute to the difficulty of helping these individuals adjust.

Jennie is notorious for blaming her problems on others and uses manipulation to get her way. On the other hand, she will sometimes admit her bad choices are the cause of her current predicament.

Of course, I wondered what causes this insidious mental disorder.

Research on the causes and risk factors for BPD is still in its early stages. However, scientists generally agree that genetic and environmental influences are likely to be involved.

Certain events during childhood may also play a role in the development of the disorder, such as those involving emotional, physical and sexual abuse. Loss, neglect and bullying may also contribute. The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk.

Brain scans comparing normal and BPD brains show there is a noted difference. This same study shows a genetic tendency, as well. Jennie’s paternal aunt has very similar symptoms.

Childhood trauma such as abandonment, which can be real or perceived often contributes to the onset. I think back to her separation anxiety and wonder. If I had known, there are a lot of things I would have done different.

What does BPD look like over a lifetime?

BPD presents across the lifespan and may be thought of in stages:¹³

1. Premorbid stage (starts in childhood)
2. Subclinical stage (early adolescence)
3. First full BPD episode (middle or late adolescence)
4. Remission and relapse (from middle to late adulthood)

Not everyone with BPD follows this pattern. Other trajectories are possible.

Remission and relapse. Jennie seemed to go into somewhat of a remission around age 21. She gave birth to her son at 22, worked several jobs as a server over the next 15 years. One lasting 5 years and then bouncing from restaurant to restaurant over the next 10. Some people with BPD can function to the point where they graduate from college and are able to have a career, those are considered to be “high-functioning” as they turn all of their pain inward instead of having the explosive outbursts of anger. Nevertheless, it takes a heavy toll on them.

In order to keep this from turning into a book, I will leave out details of the tumultuous teens and the toll it took on the family to keep her from being evicted after her son was born. This effort kept him living in the same duplex and around school friends he met who lived nearby, giving him a fairly stable life until he was 15.

Another failed relationship with a guy who she said was bi-polar sent her back into full blown BPD and unable to keep her job, she was evicted and lost custody of her son.

These are all things I can look back on and know now what the underlying cause of all of this drama was. It was spring of 2019 when Bella, in her last semester of nursing school, called me with what she thought was Jennie’s problem.

I never know where she is. She has been homeless except for a short 6-month period last year. She has bounced from man to man, always someone who probably has their own mental health issues. There was a DUI in 2017, a suspended driver’s license, driving without a license, more driving offenses. Jail several times, missed court appearances and skipped bail.

Is there hope for her? I never give up praying but I’m also realistic. Every year that goes by it looks more and more grim.

On the positive side, her son, despite what he’s been through, has done well. Moving a half-continent away to live with his dad was tough. He graduates from high school this year and plans on moving back here where he considers it to be home. He sees his childhood friends every time he comes back to visit.

Is there hope for others with BPD? That is why I wrote this essay. The population is thought to be at 5% of people with BPD, and possibly higher. That is at least 1 in 20.

If you know someone like that there is hope. Even if they won’t get help, NEABPD has a 12-week course that teaches the families of loved ones with BPD to learn how to interact with them. Learning how to deal with them in a positive way helps diffuse the anger before it becomes explosive. There are resources to help you find a nearby therapist if they are ready to get help.

When I do hear from Jennie, I don’t start in on her about what a failure she is. She already knows that and acknowledges it from time to time. There is no point, and it’s counterproductive. Either she will cut off contact completely, or she starts screaming at me and I must disconnect the call. I want to stay in contact. Maybe she will decide she is ready to get help at some point. I hope so, otherwise the outlook for her is grim.

What will happen to all the mentally ill homeless people when the country finally collapses? We might be surprised. They have an amazing ability to survive under circumstances that would kill normal people.

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