Borderline Personality Disorder: A Guide for Families

July 2019

By Susan Todoroff

While looking for library books on borderline personality disorder (BPD) I saw the choices were scarce. Before going online to look for more, I decided to check out “The Essential Family Guide to Borderline Personality Disorder” by Randi Kreger. The book helps family members understand and communicate better with their loved ones who live with BPD, and it offers advice on treating those struggling to overcome their symptoms.

BPD is a mental illness characterized by intense mood swings, impulsive behavior and extreme reactions, resulting in tumultuous relationships and risky behavior such as self-harm, eating disorders and suicide attempts. People with BPD often feel uncontrollable anger at minor slights, may act impulsively and experience self-loathing and extreme fear of abandonment. The paradox is that they often lash out at those they love the most, inflicting verbal abuse and making communication very difficult with those they most fear losing. Loved ones often feel as though they are being verbally abused and “walking on eggshells.”

The first step to understanding any mental disorder is empathy, and Kreger does a good job of helping readers put themselves in their loved ones’ shoes to understand the intense emotions someone with BPD experiences. She stresses that loved ones must realize that BPD deeply impairs thoughts and feelings, triggering behaviors such as rage, perceived manipulation and excessive blame and criticism, and loved ones must not take these behaviors personally.

Kreger also touches on finding the best treatments, including medications and different types of therapy. She walks the reader through which medications may help BPD patients, and she explains different types of therapy proven to help, such as dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) and a few others, with helpful descriptions of each. Kreger even gives a step-by-step guide on how to find a therapist and what questions to ask. Of course your loved one must first agree to medication and therapy, and Kreger has a section on that as well.

The second half of the book focuses on how loved ones of people with BPD can learn communication skills to make relationships with those with BPD easier. Loved ones, whether parents, spouses or children of a BPD parent, often feel like they are on an emotional roller coaster, leading to their own internal turmoil and feeling overwhelmed.

Kreger introduces “power tools” to help loved ones feel less stressed and more confident in their relationships with those with BPD. These power tools include self-care, setting limits, communicating to be heard and reinforcing loving behavior, and Kreger digs deep into each one. She uses anecdotes and acronyms such as FOG (fear, obligation and guilt) and DEAR (describe, express, assert and reinforce) to get her points across. She also talks about what not to say while in the throes of a conversation. Things not to say (such as comments that minimize feelings, deny perceptions, or suggest how your loved one should feel) are good reminders, as they are typical “go-to’s” for many of us.

The “rules” for communicating effectively with someone with BPD can seem exhausting and overwhelming. But as with any self-help book, if the reader uses only a few techniques that especially resonate, it may make communication with your loved one easier and more effective. Perhaps the most helpful aspect of the book is the revelation of Kreger’s self-developed website. Started in 1996, it specifically addresses BPD in different relationships such as living with a BPD parent, spouse or child. There is up-to-date information, a message board, blogs, support groups and a wealth of information on BPD.

Once I realized that Kreger’s book was written in 2008, I looked online for more current material on the subject. A website listing nine of the newest books on BPD can be accessed by clicking here.

While Kreger’s book only touches on it, the good news according to more current data and websites is that BPD can be controlled and even overcome. While it’s usually diagnosed during adolescence, the majority of those afflicted overcome most of their symptoms as they mature into adulthood. According to the aforementioned site, by middle age, over 80% of people in a study of BPD no longer met most of the criteria, and 50% had no symptoms at all. This is hopeful information, as most people with BPD are intelligent, productive, loving individuals who experience heightened emotions and an inability to appropriately act on them. With self-awareness, maturity, a desire to improve and loving support, many people with BPD can live a full, rich life.


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