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Borderline Personality Disorder: An Information Guide for Families Centre for Addiction
and Mental Health

Self-care

From: Borderline personality disorder: An information guide for families. (© 2009 CAMH)

On this page:

Caring for yourself when a family member has BPD

Helping children understand and cope with BPD

Caring for yourself when a family member has BPD

I am learning to refocus on my own needs and taking better care of myself.
— a client’s parent

Borderline personality disorder can be as devastating for partners, parents, children and others close to a person with BPD, as it is for the person himself or herself. As a family member, you may have had many years of trying to cope with the intense anger, suicide attempts, self-injury or other impulsive behaviours that are part of BPD. As a result, you may feel weighed down by the burden of your family member’s illness. Depression, anxiety, grief and isolation are some feelings you may have experienced.

Even though care and support of your affected family member may seem to be all you can manage, making time to care for your own needs is a priority. Self-care can reduce stress and give you more energy and patience to support a family member with BPD. Self-care can involve seeking support from a community agency that provides family counselling services, joining a mutual-aid group, signing up for an exercise class, or reconnecting with family and friends.

Some services for people with BPD offer facilitated family programs on either an individual family basis or as part of a support group for family members. These programs provide information about the issues related to BPD, new communication and coping skills and most important, support from others in the same situation. Groups may be facilitated by a health care professional or by a trained family member. Your community may also have self-help groups for family members. Additionally, some family members may also benefit from individual counselling sessions as well as the family group support.

Acknowledging and Addressing Grief

Grief is a normal response to loss, whether the loss is the death of a child or loss of a child because of a serious and chronic illness. Grieving may be accompanied by feelings of anxiety about how one will cope, guilt about whether the family has in some way contributed to the onset of BPD, anger about what has happened and a feeling of helplessness to change things.

Both the individual with BPD and his or her family may grieve the perceived losses that result from a serious mental illness such as lost expectations and potential. Some feelings of loss may include loss of their child’s role in the family and society, academic and professional expectations and healthy relationships for their child.

Parents also experience internal losses such as loss of self-esteem and feelings of competence as a parent, loss of dreams for a child, loss of hope and security, loss of faith, loss of a normal family life. Grief may not be recognized and validated by others such as other family members, friends, or health professionals, but it is important that family members find ways of working through their grief so they can move forward to accept their child’s illness and its implications for the future (MacGregor, 1994).

Limit-Setting

Families will often go to great lengths to protect their affected family member from the consequences of her or his behaviour. However, if a person does not experience the consequences of his or her problem behaviour, it is likely to persist. At the same time, family members can become angry that they are continually picking up the pieces. Experiencing the consequences of one’s behaviour can sometimes be the first step toward change.

Setting limits on problem behaviour can reduce family conflict and provide a more secure and predictable environment for everyone in the family. There are three important steps identified by Gunderson and Berkowitz when solving a family member’s problems:

  • involve the family member in identifying what needs to be done
  • ask whether the person can “do” what’s needed in the solution
  • ask whether they want you to help them “do” what’s needed.

Limit-setting involves an understanding of how a problem behaviour develops and is maintained, and how desired behaviours can be increased and undesirable behaviours decreased. For example, you may want to increase the frequency of your affected family member talking to you without getting angry. Verbal praise, listening to what they are saying or some other positive reinforcing response can increase the frequency of this behaviour.

Negative reinforcement such as not listening or leaving the room when your family member is angry or shouting can decrease the frequency of this behaviour.

Some undesirable behaviours are maintained because they are inadvertently positively reinforced. Some people label this “enabling” because the person is enabled to continue their problem behaviour while someone else deals with the consequences or picks up the pieces. An example might be providing excuses to your family member’s therapist when they miss an appointment, rather than having the person phone himself or herself and explain.

Stress Management

Having a family member with BPD can seem overwhelming, especially if that family member is living at home and requires help in managing their activities of daily living and some aspects of their treatment regimen. People experience stress in different ways. We may experience physical symptoms such as headaches, difficulty sleeping, stomach upsets, weight gain or loss. We may experience emotional symptoms such as moodiness, restlessness, feeling overwhelmed or depressed. We may experience cognitive symptoms such as memory problems, racing thoughts, chronic worrying or fearfulness. We may experience behavioural symptoms such as eating less or eating more, using substances to relax, overreacting to situations or isolating ourselves socially.

People pay a high price in terms of their emotional and physical health when they live with chronic stress, so it is important to look at ways to reduce stress. There are many resources, both print materials and on the web, that provide advice on strategies for stress reduction. These include improving one’s diet, building in regular exercise, learning relaxation exercises, building in enjoyable activities (e.g., having a massage, engaging in a hobby), changing the stressful situation (for example, setting limits for your family member’s behaviour), obtaining support from others (for example, involving other family members or friends), joining a support group, and drawing on sources of spiritual support.

In developing a self-care plan to reduce your level of stress, it is important to keep your plan realistic and doable. Small changes will make you feel better and have more chance of success than big changes that run the risk of being unsuccessful and thereby further contributing to your stress. Your plan should also be concrete and identify what needs to happen for the plan to be successful. For example, you decide to go to an exercise class once a week; in order for this to be successful you may need to have another family member cook a meal or enlist a friend to go with you for mutual support.

Helping children understand and cope with BPD

Children can be affected when a family member has BPD. To protect their children, parents may say nothing. They may try to continue with family routines as if nothing were wrong. This strategy may work in the short term but not in the long term. Children can feel confused and worried about their family member’s behaviour when they are not given the opportunity to talk about it. Children are sensitive and intuitive. They quickly notice when someone in the family has changed, particularly a parent. If the family doesn’t talk about the problem, children will draw their own, often wrong, conclusions.

Young children, especially those in preschool or early grades, often see the world as revolving around themselves. If something happens, they think they caused it. For example, a child may accidentally break something valuable. The next morning, the parent may seem very depressed. The child may then think that breaking the object caused the parent’s depression.

Older children, particularly if they have a sibling with BPD, may worry about developing mental health problems, substance use problems or both. They may worry about the stress and strain that their parents are enduring, and may take on the burden of trying to make up for what their parents have lost in their other child.

At the same time, brothers or sisters sometimes resent the time that parents spend with their sibling. They may become angry to the point of acting out or distancing themselves from family or friends. Siblings may also experience anger, hostility or verbal or physical aggression from their brother or sister. These behaviours can evoke shock, dismay, fear and a sense of abandonment and rejection. Sometimes, children may feel like they have lost their best friend. They may feel guilty that they have a better life than their brother or sister.

How much should I tell the children?

Children need to have things explained. Give them as much information as they can understand, and that is appropriate to their age.

It is helpful to tell children three main points:

The family member has a problem called borderline personality disorder. The family member behaves this way because he or she is sick. The illness may have symptoms that can cause the person’s mood or behaviour to change in unpredictable ways.

The child did not cause the problems. Children need reassurance that they did not make the parent or family member sad, angry or unhappy. They need to be told that their behaviour did not cause the person’s emotions or behaviour. Children think in concrete terms. If a parent or family member is sad or angry, children can easily feel they did something to cause this, and then feel guilty.

It is not the child’s responsibility to make the affected person well. Children need to know that the adults in the family, and other people, such as doctors, are working to help the person. It is the adults’ job to look after the person with the problem.

Children need the well parent(s) and other trusted adults to shield them from the effects of the person’s symptoms. It is hard for children to see their parents distressed or emotional. Talking with someone who understands the situation can help sort out the child’s feelings (Skinner et. al., 2004; O’Grady & Skinner, 2007).

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