At first, Stephanie was diagnosed with bipolar disorder, but when she found another doctor who took the time to complete a thorough evaluation, she learned the true culprit was borderline personality disorder (BPD), which she was diagnosed with six months later.
The Challenges of Having a Partner or Spouse Diagnosed With BPD
Borderline personality disorder (BPD) is a mental illness that can cause affected individuals to have a negative self-image, make risky or impulsive choices, engage in self-harming behaviors, and have intense emotions and mood swings. Also, BPD, which is likely caused by a mix of environmental factors, brain activity, and genetics, can lead people to have trouble empathizing with others’ feelings and fear that they will be abandoned by their loved ones. (1) It goes without saying that these symptoms can create a perfect storm for a tumultuous relationship that in some cases may prove destructive. In September 2018, SNL comedian Pete Davidson, who has been open about his struggles with BPD, said he had been concerned his diagnosis would prevent him from having a healthy relationship before getting together with then-fiancée Ariana Grande. “I was [afraid it could ruin relationships] until I met her,” he said, according to People. “I just think we are supposed to be together.” But in October 2018, TMZ broke the news that Davidson and Grande called off their engagement and broke up. As of that month, the pair hadn’t confirmed the cause of their split. But the truth is “it is challenging to be in a relationship with somebody who has BPD because one of the hallmarks is this fear of real or fantasy abandonment,” says Gail Saltz, MD, clinical associate professor of psychiatry at the NewYork Presbyterian Hospital Weill-Cornell School of Medicine in New York City. That fear of abandonment can lead people with BPD to mistrust their partner. A study published in the journal Personality Disorders: Theory, Research, and Treatment found that after talking to their spouses about personal fears and possible reasons their relationship might end, women with BPD experienced a lower perception of trustworthiness in their spouse compared with women without BPD. (2) For the person with BPD to manage the demands, closeness, and vulnerability of the relationship with his or her partner, “they have to work harder than other people at allowing themselves to choose to trust that person,” says Elizabeth Ochoa, PhD, chief psychologist at Mount Sinai Beth Israel in New York City. The instability and unpredictability of the relationship itself can cause the partner without BPD to have trust issues as well. For Stephanie, fear of abandonment was a familiar feeling from childhood. When she was a teenager, she says, her parents divorced, moved away, and left her and her brother on their own. With Jerome, Stephanie says those fears would also surface. “I always felt if he was going to go out, he would do something or find somebody better,” Stephanie says. Unfortunately, that fear was realized when, while Stephanie was pregnant with one of their children, Jerome had an extramarital affair, further exacerbating her abandonment and trust issues. “I’m still dealing with it,” she says. Dr. Saltz explains that people with BPD perceive emotion even in the absence of facial expressions. “That is their interpretation because that is what their brain is telling them,” Saltz says, “and that disconnect can of course make it hard for them to connect to and understand and feel safe with their partner.” BPD can also cause extreme mood swings. “There can be this wonderful intensity, which may be delightful at the time with your partner, but it can quickly become unstable,” Saltz says. One minute the person with BPD may idealize their partner and feel very close to him or her and the next, the person with BPD can get angry and put down his or her partner whether the partner did something wrong or failed to do something desired. “I had no clue when I would get angry. It would just come on all of a sudden,” Stephanie says. “If he left a dish on the counter, I would go off.” Jerome says Stephanie’s extreme mood swings were challenging because he couldn’t anticipate what would cause her to get angry and trigger an argument, or how to prevent these episodes. “At the surface, we’re fighting over something that was kind of immaterial to the bigger picture of what was going on, and that kind of created a lot of noise,” he says. Surrency and other experts say that despite the challenges BPD can bring to a relationship, communication skills and self-care are important for both partners. Here are some other tips for partners dealing with BPD: Seek out information. Learning as much as possible about BPD can increase empathy in a partnership. If you’re the partner affected by BPD, educating yourself about the disorder can help give an explanation for your feelings and behaviors and help ease your shame. Education can help the spouse without BPD understand that it’s an illness, not a choice. “When the person is responding out of fear, shame, or lack of self-worth, [the spouse can understand] this is not the whole person, this is a moment in time that will pass,” Dr. Ochoa says. Get help. Seeking support from a mental health counselor or therapist — separately or as a couple — can help people affected by BPD gain insight, communicate more effectively, resolve conflict, and strengthen their relationships. Because someone with BPD can also experience other conditions, such as anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, depression, eating disorders, and substance abuse, it’s important for both partners to keep their provider informed about changes in mood and behavior, Surrency says. Practice healthy communication. When you communicate, don’t say anything that could make the person with BPD feel slighted or uncared for. Actively listen and do your best to respond in a positive way. “Always do it in love as opposed to attacking or putting the person down,” Surrency says. Ask open-ended questions. If you’re a partner to someone with the disorder, it’s important to speak objectively and keep in mind that BPD can cause people to misconstrue what others say to them. Asking open-ended questions can also help them feel that they’re being heard, such as “I think….” “You may need to use your words in places where you would assume that your facial expression or the nuance in the room would make it clear,” Saltz says. “You may really need to spell it out.” Talk only when your partner is calm. A severe episode of BPD is not the time to tackle potentially sensitive topics, like the cleanliness of your living room or your family budget. Doing so may lead your partner with BPD to make irrational decisions. He or she is also more likely to be defensive, pull away, or turn to self-harming behaviors when their symptoms are uncontrolled. Offer support. Partners should provide the person with BPD understanding and emotional support and encourage and support their treatment. “I think it’s important for the partner to tell the person that they are there, that they understand it’s hard, and they want to help them in any way they can whether or not it’s rejected,” Ochoa says. Avoid labeling or blaming. It’s important to be careful not to blame everything the person with BPD says or does on their mental illness because “then it starts to become sort of an insult or a put-down,” Saltz says. Take threats seriously. Threats of self-harm or suicide should never become a form of blackmail in the relationship, but they must be taken seriously regardless of whether you believe the person plans to follow through. Call your spouse’s therapist, the National Suicide Prevention Hotline (1-800-273-8255), or 911. This isn’t only to protect them. “You also have to maintain your own sanity and safety,” Saltz says. Prioritize self-care. Likewise, being in a relationship with someone who has BPD can feel all-consuming, but it’s important to seek out your own support system and have a healthy outlet to deal with stress. Make healthy eating, fitness, and sleep a priority, and carve out time for friends, a hobby or enjoyable activities. Although a glass of wine for example, can help you relax, be aware that you can get drawn into substance abuse if your partner is abusing too, Saltz says. Know that you can live a normal life with BPD. People with BPD often have risk-taking behaviors, such as overspending, drug use, reckless driving, or self-harm due to a lack of inhibition. Although these behaviors can be dangerous, and potentially life-threatening, many people with BPD are high-functioning individuals. “There are definitely different degrees of severity of BPD,” Saltz says. Therapy and learning more effective ways to communicate has also helped her marriage. When Stephanie is struggling, for example, she’ll tell Jerome, “Today is an off day,” which helps him understand and not take things personally, but still offer support, even if it’s a simple hug. Instead of letting an argument escalate, they’re able to neutralize a disagreement before it gets out of control. “Going down that path and going blow for blow isn’t going to get us anywhere,” Jerome says.
