Wednesday, February 22, 2012

Borderline Personality Disorder: Getting Help


People with Borderline Personality Disorder (BPD) have lives fraught with emotional upheaval and frequent crises. Often their work life is inconsistent. They change jobs frequently due to being fired or because of personal dissatisfaction. Relationships usually are strained. They frequently put others into no-win situations. Friends and family become burnt-out with the constant demands, radical emotional swings, self-centeredness, and impulsivity. Risky and self-destruction behaviors are the norm.

Friends and family members usually recognize their loved ones need professional help, before individuals with BPD see the need. Like people who have Narcissistic Personality Disorder, people with BPD rarely admit their need for help. Instead, they tend to blame their problems on to external circumstances or other people.

Randi Kreger in her book, The Essential Family Guide to Borderline Personality Disorder, identifies six stages family members or friends of BPD go through in the process of trying to motivate their loved one to get the necessary help. (Please note that the labels of the stages are mine.)

Stage 1—Denial: Individuals with BPD don’t see their need for help, but rather blame their family members or friends for the problems. They see others’ efforts to help them as controlling and abusive.

Stage 2—Threats: When a crisis arises, friends and family will use threats to push their loved ones with BPD to get help. They may say, “I will leave you” or “I will stop supporting you,” hoping such threats will motivate their loved ones to seek treatment.

Stage 3—Reluctant or Anxious Compliance: The threats often frighten sufferers of BPD enough that they apprehensively seek treatment. Unfortunately professional help usually isn’t useful since those with BPD are not motivated to change, but are only trying to secure the threatened relationship.

Stage 4—Relapse: Once the threatened relationship seems to return to normal, those with BPD lose interest in therapy and find some reason to drop out.

Stage 5—Reluctant Acceptance: Eventually family members and friends realize that coerced treatment is rarely effective and reluctantly accept that only their loved ones with BPD can decide to get help. This often takes several failed attempts to push those with BPD into treatment.

Stage 6—Disillusionment: Family members and friends of those with BPD come to realize that any effort to change their loved ones is only adding more conflict to their already troubled relationship. This revelation causes friends and family to become discouraged, depressed, angry, and disillusioned.

As outlined in Kreger’s six stages, it can be difficult to motivate those with BPD to seek treatment.  These individuals get into significant trouble before they are ready to accept help. This may mean several suicide attempts, psychiatric hospitalizations, legal trouble, personal bankruptcy, being fired from another job, or experiencing another relationship break-up (such as a divorce) before they recognize their need for professional treatment. Real change is only possible when those who are in trouble recognize their own need for help. No one can threaten, cajole, or coerce another into changing.

The next article will address the current treatments available to help those with BPD.

For more information on this topic, please also see:

            (Hazeldon, 2008)

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