You mean how to predict? I don’t know. The woman I’m talking about wasn’t very old, and already she had a history of extreme behavior. It started young. She could be very charming, but could also freak out at a moment’s notice, so no one was ever really safe-feeling around her. When you first meet someone and they are unstable, it’s easy to see. It’s when it’s a change from previous behavior that it gets harder.
Just FYI (since I didn’t see it mentioned in other postings), there is a therapy that can be useful for people with BPD.
It’s called dialectical behavioral therapy, and it was started by Marsha Linehan. It’s essentially Zen without the spiritual trappings. The aim of DBT (also called “diabolical behavioral therapy” or “death by therapy” by some) is to help the person learn to manage the waves of feelings/emotions that flood them.
For the average to above average intelligence, motivated individual (wherever the motivation comes from), it can be a very useful therapy. It’s a long hard slog, though, and some people take longer to internalize skill sets that others.
As to the violence? It depends. People with BPD can present very differently. I have met “dependent” borderline patients who do well in a structured setting, but collapse back in the outside world. I have met “rageful” borderline patients whose primary task seems to be making you feel as helpless and inadequate as they feel by showering you with seething anger 24/7. And, I have met “violent” borderline patients who go from one to ten on the mood swing scale - and ten is accompanied by throwing chairs and such.
It’s a tough situation to deal with - and I work in one of those structured settings. Boundaries really become more for your mental well-being than for the person with this condition.
I know this is an old thread, but I wanted to point out this memoir of living with a spouse with BPD that I’ve just discovered: Borderlands (warning: PDF). It really made me see clearly how the partner of someone like this gets sucked in and so readily blames him or herself.
A dear friend is early in the process of divorcing his wife, who seems to be borderline. She has a lot of the traits: terrified of abandonment, almost entirely without long-term relationships outside her family, guilty of reckless overspending and substance abuse, intense episodic dysphoria, irritability, difficulty controlling anger, violent. Unfortunately for him, they have 2 kids, so him walking away is not an option. He’s in for a long battle – the stories he’s been reading on a messageboard for partners of people with BPD are not pretty. I was going to post about this divorce, and may still. But I highly recommend Borderlands.
Talking with friends and family in the mental health business, BPD basically = “just plain psycho”. They also tell that is the one thing you don’t want to see someone diagnosed with because it is extremely resistant to any sort of treatment.
I was talking about this with my (half)SIL last week when she was here visiting. She is a clinical psychologist and her mother had BPD. From what I hear about her mother, she was an incredible piece of work by all accounts. She did massive amounts of drugs, had serial affairs and everything else. She divorced my FIL and hooked up with her psychiatrist. She killed herself by drinking Drano a couple of years later. She destroyed a few generations of family singlehandedly and no one really mourns her loss.
My SIL took on a couple of BPD people as patients and then decided that she couldn’t help them and didn’t want to try anymore. She only speaks of them in the negative and won’t take on any more.
What a professional can do, that’s harder to do when the person is in your family or is one of your friends:
- Set appropriate boundaries.
A. Maintain said boundaries.
B. Have a conversation with the person about these boundaries
A. that’s not emotionally laden due to the closeness of the relationship.
B. that’s not emotionally laden due to past experience with the person. - Help the person evaluate crises
A. from a position of curiosity and empowerment.
B. with reference to the question, “Is the crisis inside of me, someone else’s, or mutual?”
C. without humiliating the person,
i. which may mean talking about humiliation.
ii. which may require cognitive-behavioral skills to decrease the intolerable affect.
iv. without diminishing the emotional impact that the crisis has on the person.
D. without losing the stimulus for the crisis in the crisis itself
i. (for example, getting focused on a self-harmful behavior to the exclusion of the emotion and events that made the self-harm seem inevitable,
ii. (or becoming enraged with the person for engaging in this strategy again). - Help the person be accountable for their part of relational crises
A. by helping them notice and articulate alternative explanations for the sequence of events.
B. by providing judicious interpersonal feedback about how the person is behaving in relation to oneself, in the moment and without unexamined anger at the person. - Help the person practice better communication, trust, and mutual responsibility for relationships by practicing in the therapy relationship.
- Help the person learn
A. attention and mindfulness (this is part of the DBT part).
B. and cognitive-behavioral skills for managing intolerable affect (may also be DBT). - Provide assessment and referral for ancillary services, such as
A. Drug abuse treatment and abstinence or harm reduction support.
B. Sexual abuse or trauma treatment and support.
C. Anger management and other skills.
D. Medication evaluation.
E. Physical relaxation training.
F. Art or other expressive therapies. - Not escalate the inevitable conflicts that will arise in the therapy relationship, as in others.
- Not get swayed, confused or hurt by the person’s statements that
A. you are perfect.
B. you are perfectly betraying and horrible. - Routinely engage in self-evaluation to understand more about what the person is experiencing, and evoking, in the therapy relationship
A. rather than “firing” the person.
B. rather than feeling bad about oneself, or guilty, such that one is
i. also angry.
ii. also scared.
iii. guilty and humiliated in turn. - Maintain compassion for the person and hope about the person’s future.
I’m not suggesting that family and friends can’t do this, too, but that some of it’s easier when there’s some emotional distance and clear boundaries. It’s much harder when you’re living with the person or interacting with them a lot.
You might look at *I Hate You; Don’t Leave Me, The Divided Self, Trauma and Recovery, * and/or Women Who Hurt Themselves
Typical disclaimer: This is general information and is not intended as specific advice, nor does a professional relationship exists between us.
Shoshana, psychologist.