Walking on Eggshells at Home – Borderline Personality Disorder
What to do when your talking to your teenager feels like a minefield
Borderline Personality Disorder (BPD) presents challenges far beyond the usual parenting dilemmas. During the teenage years and early adulthood, many parents experience unchartered territories.
For families who are also challenged by the complexities of a highly sensitive, or emotionally unstable teenager experiencing the unpredictable dynamics of Borderline Personality Disorder, can quickly run into a parenting nightmare.
The pressures of adolescence can leave parents feeling inadequate, ashamed and in some cases feeling exhausted beyond repair.
Parenting Challenges in Borderline Personality Disorder
BPD impacts the entire family system.
The usual parenting (and previously successful) techniques fail. The family system suffers as a result, with conflict emerging between both parents and their child, siblings and the extended family.
Parents with younger teenagers may have sought professional help.
Professionals may describe the young person as emotionally unstable or experiencing a high degree of emotional sensitivity.
Parents may hear Mental health professionals describe their child as demonstrating ‘traits of BPD’, without their child meeting the criteria for a formal diagnosis. Parents frequently approach mental health professionals when their behaviours have become too difficult to manage at home or school.
Parents often report episodes of running away, non-attendance at school or college, self-harm, increasing alcohol or drug use, multiple sexual partners, online sexual activity, excessive anger or rage, breaking property, the involvement of the police or social services and violence at home.
Friendship circles can often be volatile, with bullying, being bullied, changes of school and a lack of insight into the damage caused.
Parents can see that BPD affects almost all areas of their child’s functioning. Mood, behaviours, relationships, self-awareness, perception and body image can be adversely affected by the instability experienced.
The first step for parents in managing the challenges is to accept that the behaviours are there and will no go away on their own.
This is a challenge in itself.
Family meetings, promises, consequences, privileges lost and gained and resulting disappointment when the unwelcome behaviours return. Parents are often used to a high degree of conflict in the home and may have experienced something similar in their childhood.
It can be difficult for parents to decide upon or remember what ‘normal’ feels like. Family time has become a battlefield.
For many families, the circular conversations, arguments, promises and chaos will feel familiar. It becomes the normal interaction in the family. The cycles decrease in duration, intensify and all too often end in crisis.
The breaking point, fast approaching the family begin to live in fear of the next outburst, the next cutting, burning, bingeing or suicide attempt.
A young person with BPD has an intense set of needs. They often express a desire to monopolize the family attention, creating highly emotional situations to feel that they are noticed, needed and attended to.
A family often responds by avoiding these ‘needs’ in an attempt to avoid the anticipated unpleasant results.
This intensifies the ‘needs’ in the teenager; which is then fuelled by the urgency of the need being met.
The feeling of being ‘unloved’ or ‘unloveable’ is incredibly powerful for them. The needs, however, can feel insatiable for parents. The combination almost ensures disappointment, feelings of failure and rejection for all.
Parents may experience some or all of the following:
- The young person may attempt to guilt, blame or reject the parents. The parents feel bad about being a parent. Worthless, useless and lose of parenting confidence.
- The young person may withhold physical affection, hugs, smiles and previous family affection rituals.
- Experience ‘black and white’ thinking or ‘all or nothing’ behaviours. Many parents describe their teenager or young adult as extreme in many aspects of daily life.
- Parents may feel unable or ill-equipped to help as their children describe self-loathing, body disgust, and demonstrate low levels of self-care.
- The young person may drop the usage of the words’ Mum and Dad’; choosing to use their first names or unpleasant or belittling ‘nicknames’. The parents feel disempowered and rejected from the role of caregiver.
- The young person may become physically abusive, financially abusive, violent or destroy personal or valuable items.
- Family events and social situations may become difficult. The young person may behave differently or engage in destructive behaviour in the extended family, causing conflict and concern.
- The young person may frequently change friends. Sometimes, there is a change of identity; clothes, character, speech, interests, accents or behaviour that coincides with a friendship change.
- Siblings may become involved in disputes or tension in the home. There can be increased competition with siblings for the parents’ attention and affection. Sometimes this can translate into a competitive preoccupation with the siblings’ character, body shape, academic achievement or social circle.
This can lead to conflict as the sibling becomes the source of ‘blame’. Siblings may become withdrawn, lose confidence, describe feeling sad or scared. They may fear the future and sometimes move away from the family home.
- The young person has little interest in developing independence. The push-pull of requesting independence while demanding dependence can be confusing for all. There is often a reluctance to take responsibility for their actions or accept their part in the family dynamic.
- Families may experience a ‘divide and rule’. The family may feel split as the young person attempts to play one parent or sibling against another.
Teenagers and Young adults with emotional instability or those formally diagnosed with Borderline Personality Disorder experience difficulty in seeing the world through the eyes of those around them.
BPD can sometimes appear as a lack of ability to empathize with others.
As the young person experiences such high internal needs, any acknowledgement of the needs of others would detract from their own intense feelings.
This is often felt like a type of rejection, and the feeling of being injured reappears.
Any perceived rejection or abandonment can be met by impulsive reactions, sometimes with prior warning and at other times behaviours will escalate to self-destructive acts in silence.
Frequently, threats of non-suicidal self-injury (self-harm) or suicidal gestures or attempts will follow a perceived sense of rejection or abandonment. Parents describe finding notes, journals, evidence of items used to self-harm, medications or other items left behind. Parents describe feeling distressed.
This reinforces the feelings of failure in the important role of parenting.
Parents should always take threats of self-harm or suicide seriously.
Young people may try to make light or brush off these serious events. It is important to seek emergency medical attention immediately.
Do not allow the young person to sleep off intoxication or delay medical advice in any event.
There are many successful treatment options for families who feel they have reached a breaking point. The tough decision of reaching out for help in a residential setting is never easier.
Parents are worried that a period in treatment or ‘being sent away’ will reinforce the feelings of abandonment or not caring from the family. ‘Will he/she hate us?’
Is a question that we frequently hear shortly following admission to a residential treatment program.
The answer is clear, as parents, you are not leaving or abandoning your child. You are reaching out for solutions.
Far from ‘sending them away ‘, you are extending the treatment family to bring them closer. You are making parenting decisions that are empowering and secure, building a bridge back to normal family living.
There is no cure for BPD. We have heard this many times too.
In some ways, this is true. There is no magic wand. No pill will change things overnight.
There is, however, evidence-based psychotherapeutic treatments, including D.B.T, CBT-e, EFFT and IFS that can help to significantly reduce the intensity in which traits and symptoms of BPD are experienced. Finding a psychiatrist that is experienced in Adolescent and Young Adult BPD is also essential for wellbeing.
Many pharmacological treatments are available to assist with the most prominent symptoms for each young person.
The role of the family is a central part of treatment programs, specializing in Borderline Personality Disorder.
New parenting approaches, including empowerment and the formulation of great family boundaries, are essential to long term remission.
Intensive family therapy throughout the treatment episode ensures that contact is maintained and encouraged. At the same time, distance allows healing for all family members. Honest communication that was perceived to be too risky in the home setting can at last begin. Patterns of communication can be addressed to ensure that all family members, including siblings, can feel the benefits of the therapeutic setting.
Working with families is where the most significant sustainable change can take place.
Planning for the future and seeing dreams come true, is after all or of the greatest rewards in working with young people.
We would like to share the following resources and recommended reading lists for families:
I Hate You – Don’t Leave Me: Understanding the Borderline Personality Disorder. Jerold J Kreisman
Hard to Love: Understanding and Overcoming Male Borderline Personality Disorder. Joseph Nowinski
Beyond Borderline. True Stories of Recovery from Borderline Personality Disorder. John G Gunderson. M.D Perry D Hoffman. PhD
Coping with BPD. Blaise Aguirre.
Fiona Yassin is the Clinical Director of The Wave Clinic in Kuala Lumpur. A Fellow of ACPPH and Accredited Clinical Supervisor.
Fiona has spent many years working with young people and families facing the challenges of Borderline Personality Disorder and Eating Disorders, utilizing the evidence-based D.B.T approach to treatment.