Borderline personality disorder: how to deal with a crisis

People with borderline personality disorder often experience crises throughout their lives. What is behind them and how can we act?

Borderline personality disorder (BPD) involves a pattern of instability in interpersonal relationships, self-image, and emotions which, in most cases, could be considered destructive. It is a disorder in which the person experiences different crises throughout their life in response to some stressor or biological factor.

BPD crises are experienced as a tsunami tremendously difficult to control. Impulsivity, the fear of helplessness or abandonment and, sometimes, the need to harm oneself make their way without the person being able to do anything to remedy it. However, these crises can be better managed with a number of factors. Let’s take a closer look.

BPD crisis and its consequences

These cascades of intense feelings, emotional overflow, have very negative consequences for the person. They take different forms depending on who has them, so they can range from intense feelings of anxiety to self-harm. Many times, Once the crisis is over, feelings of shame and guilt appear in the personnot feeling identified with her usual self.

On the other hand, when the patient lives in an environment that is not involved with his disorder or does not know it, he receives care that can worsen his condition. For example, a family member may not have the resources to help you and may be more likely to judge you, restrict your daily activities, or invalidate your feelings.

Evidently, The pain for the family member who suffers from the disorder is enormous. Not only because crises can even harbor verbal or physical attacks, but because they know that, deep down, it is the patient with BPD who is suffering the most.

BPD crises decrease in intensity as the years go by, but we cannot forget that we are talking about something chronic that is worth learning to manage.

What the environment can do in a BPD crisis

BPD affects about 2% of the population and the number of diagnoses has increased in recent years. This is a difficult condition to manage, since attacks often lead to uncontrolled crying, angry outbursts, self-harm, and suicidal ideation. In fact, it is one of the disorders with the highest prevalence of suicide.

Thus, although people with BPD receive care from community health teams, it is essential that those closest to them know how to react and help at crucial moments. Let’s look at some resources.

Emotional validation and BPD crisis

If we ask several patients with borderline personality disorder what they need when they are in the middle of a crisis, It is very likely that they will answer that the only thing they demand is affection, understanding and, ultimately, love.. It’s easy to feel invalidated by others when crisis behavior is so intense.

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When crises arise, the person feels tremendously empty, as if some emotional piece is missing. And based on this sensation, he goes out in search of that “piece”, although he does not do it in the most appropriate way. Instead of demanding love and affection with words, she does so through demands and criticism tinged with anger, instability, or constant dysphoria.

The environment usually reacts with attention and understanding during the appearance of the first crises. However, the results are fruitless, since the intensity of the patient’s discomfort is too much to assimilate this care.. Therefore, over time conflicts appear and loved ones end up moving away. This, for the person with BPD, only confirms the terrible fear they feel of abandonment.

Therefore, in the presence of a BPD crisis, The most sensible and advisable thing is for family members or partners to provide support without judging. Below, we delve into this aspect.

Some strategies for managing BPD crises

Most people who suffer from borderline personality disorder They have grown up in environments where their emotions have not been validated, which is known as disabling environments. This, together with a certain biological predisposition to suffer from the disorder, contributes to its development.

Although we cannot control the biological part, we cannot say the same about the environmental part.

As we said, In the middle of a BPD crisis, the person needs company without judgment, unconditional acceptance and validation of their emotions. This, paradoxically, will cause the emotional intensity to decrease and the crises to be of shorter duration.

Thus, there are some strategies that we as family members can practice to reduce the intensity of BPD crises. Let’s go see them.

1. Be available as support

Those who suffer from BPD need to have a list of contacts who they can turn to in crises. They have to be people with whom they feel safe, that they know that they will respond if necessary and that they will know how to react to their needs at that moment. So, take care of becoming that safe haven where they can go.

2. Unconditional acceptance

Although it may seem difficult from the outside, the truth is that a person with BPD requires unconditional acceptance from others. This implies that The person next to you internalizes the presence of this disorder and assumes that crises will arise from time to time.

3. Provide affection

It is difficult for a person who witnesses a BPD crisis to provide affection. However, without this affection, understanding and patience you will only walk towards the deterioration of the relationship. There is no point in reproaching the actions carried out during the crisis, losing one’s temper or acting with the same intensity.

If we do not contribute to defusing the BPD crisis, the situation can escalate and become a serious problem.

4. Help you defuse your pathology

A person with BPD has difficulty recognizing themselves during a crisis. Over time, the natural tendency is to identify with those very negative moments, assuming that one is an aggressive, overly intense or self-destructive person. Therefore, it is essential to help her separate her identity from the disorder.

This support for separating crises from their real personality will make the person feel more whole and supported. At the same time, it reduces subsequent feelings of guilt, since it generates an awareness that one does not agree with what the BPD symptoms manifest.

5. Keep yourself safe

Crises not only endanger the emotional well-being of the BPD patient and those close to them. There are other serious behaviors, such as aggression or self-harm, that compromise the individual’s own physical safety.

If, as a person close to the patient, you suspect that attempts at self-harm or suicide could occur, protocols must be put in place to prevent this. Urging him not to consume any type of substance or put sharp objects out of his reach are examples of this.

In this line, it is positive have non-self-harming alternatives to which to redirect to the person at this moment. Furthermore, although dialogue can be extremely complicated during crises, it is necessary to remind him that he was able to overcome similar situations before and that soon he will be able to see everything differently: the crisis is limited.

6. Don’t overprotect him

Giving affection to someone is not synonymous with overprotecting them. It is one thing to validate emotions and tolerate disorder and another to make it dependent. It is positive to encourage the person to maintain their daily routines, their autonomy and responsibility. Thus, crises are tolerated and understood, but the patient’s life must continue as usual.

7. Have professional help

Your family member, friend or partner with BPD is not the only one who can benefit from psychological therapy. Accompaniment in this type of disorders is not solved only with patience and love: Critical and delicate moments must be managed and a very great emotional burden must be endured.

Strategies for the patient with BPD

For its part, also It is important that the person suffering from BPD develop resources that allow them to protect themselves in these moments of crisis. In this regard, the AMAI TLP Foundation suggests that the patient implement the following protective factors:

Avoid isolating yourself in moments of crisis.Communicate the feelings and thoughts you experience to family, friends or trusted people.Get away from any situation that is harmful.Avoid the consumption of alcohol, drugs or other toxic substances.Identify the risk signs or signs that usually trigger these crises.Connect with other people, participate in group, leisure or volunteer activities. Keep in mind that crises are temporary.Have a list of non-suicidal alternatives on hand. To do this, you can write down five things you can do if the crisis appears again.Discard all potentially dangerous objects.Have a list of things that you should not forget, such as reasons for living, aspects that served as containment at other times or overcoming previous problems.Have a list of trusted contacts on hand to whom you can turn in those moments. Have a list of telephone numbers of local organizations or institutions that offer specialized intervention in times of crisis and that work 24 hours a day.

Final thoughts

To conclude, we highlight that BPD crises are not easy to manage, neither for the patient nor for the family. The emotional intensity reaches such high levels that all we want is to get away from it. The patient tries to regulate himself by harming himself and the environment, distancing himself.

Perhaps we could consider the strategy in reverse. Instead of running away from the emotional turmoil of the BPD patient, we could begin to embrace it. Even if it is not born to us, even if at that moment we want to avoid it at all costs. We might be surprised at how hugs often deactivate demons and make the person come back to themselves.