Navigating Family Relationships When a Loved One Has Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious mental health disorder that affects how a person sees themselves and others. Their unstable sense of self, intense fear of abandonment, erratic mood swings, impulsive behaviors, and unpredictable, intense emotional reactions can make it difficult for them to maintain healthy relationships, even (or maybe especially) with the people that matter most to them. People with BPD suffer from emotional dysregulation that makes it difficult for them to manage their own extreme emotional responses, and they may turn to unhealthy behaviors like violence, self-harm, or substance abuse to attempt to cope with emotional pain.

In the context of family relationships, the struggles of somebody with BPD have a negative impact on everybody in the family. Often family members describe their experience with a child or parent with BPD as feeling like they’re walking on eggshells, unsure of when they will unwittingly provoke an outburst, or a rollercoaster, in which moments of happiness and hope for improvement are rapidly replaced with anxiety and fear as their loved one lapses into destructive behavior again.


Borderline Personality Family Dynamics

When one family member has BPD, the overall experience is one of instability. One moment they may be loving, the next, lashing out. A child may be skipping school, or their self-destructive behavior may escalate to a suicide attempt. A parent with BPD may be overly attached and controlling or demonstrate affection inconsistently. Ongoing unpredictability skews how the family interacts with one another.

Stress and worry are constant, as family members fear for their loved one’s well-being. Guilt is another common feeling—parents may feel responsible for their child’s mental health and behavior, or children may feel that they somehow caused a parent’s mental illness. They may also feel exhausted or helpless when previous attempts to set healthy boundaries or provide support haven’t worked.

To complicate the issue, a family history of BPD or early disruption of family life are both risk factors for developing BPD. If you have BPD, you may not be the only one in your family struggling with their mental health, and parents may have unconsciously passed on patterns of toxic family relations. Improving family relationships often requires getting help for everyone, not just the family member with borderline personality disorder.


Starting with Self-Care

Therapy is the main form of treatment for BPD, helping you understand the disorder, improve your response to someone with BPD, learn to manage uncomfortable emotions and your response to their impulsiveness, as well as,  improve your relationships. Dialectical behavior therapy (DBT), a form of treatment developed by clinical psychologist Marsha Linehan, is considered one of the most effective types of therapy for BPD and those who are in the circle of someone with BPD.

DBT focuses on improving life skills through:

  • Distress tolerance: Learning how to tolerate negative emotions so that you don’t react impulsively or self-destructively.
  • Emotional regulation: Learning to recognize and handle emotions to improve control over thoughts, behaviors, and feelings.
  • Mindfulness: Learning to be focused on the present as well as nonjudgmental of yourself and others.
  • Interpersonal effectiveness: Learning skills to better handle relationships, such as how to communicate more effectively, how to advocate for yourself and set healthy boundaries, how to build relationships, and how to end relationships that aren’t healthy.

By cultivating acceptance and balance, patients are able to validate the emotions they’re experiencing while addressing and changing problematic behaviors.

Therapy can help you understand your triggers and put effective coping mechanisms in place before you need them. This might mean things as simple as stopping to use a breathing exercise or listen to music to ground yourself before negative emotions spiral out of control. It may mean knowing when to step away from a situation and giving yourself time to collect your thoughts and calm down. With these kinds of tools, you’ll be better equipped to work on your relationships with your family in a healthy, productive way.


Developing Better Relationships

When a family has been coping with borderline personality disorder, it’s likely that the person with BPD isn’t the only one who will need to learn healthier ways to interact. Family therapy can be extremely helpful in preventing parents and kids from slipping back into patterns that may be unintentionally triggering or enabling negative behaviors. The guidance of a mental health professional can also help a family learn how to better support your recovery, enabling them to replace feelings of helplessness and frustration with the rewarding sense of being able to help you make progress toward your goals. Families may also want to join a support group to connect with others who share their experience.


Finding Help

If BPD has upended your family, positive change is possible. Therapy can be instrumental in helping give you and your loved ones the tools to build the healthy relationships you want. To get connected with a therapist who can help with either online or in-person sessions, contact the SF Stress & Anxiety Center here. We’ll schedule a free initial phone consultation with one of our compassionate Care Coordinators to match you with the right therapist for your needs.


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Managing Stress and Anxiety When You Have ADHD

For somebody who has been diagnosed with ADHD (attention deficit hyperactivity disorder), stress and anxiety may be constant unwanted “bonus” problems that seem difficult, if not impossible, to separate from the disorder itself. While the symptoms of ADHD can look different in adults and children, the inattention, impulsivity, and restlessness/hyperactivity that characterize it tend to make even simple tasks at home, school, or work harder to complete. Daily life can become an ongoing source of uncertainty, worry, and stress—in fact, anxiety disorders are one of the most frequent comorbid diagnoses among adults with ADHD.

Of course, the relationship between ADHD and anxiety isn’t necessarily that simple. It can be a bit of a chicken-and-egg problem to figure out whether ADHD is the cause of anxiety or if they are issues that exist side by side. Either way, learning to cope with stress and anxiety when you have ADHD can help make treatment for both conditions more effective.


ADHD vs. Anxiety

ADHD and anxiety can have similar symptoms, especially ADHD-inattentive type (what was once known as ADD or attention deficit disorder). For example, being unable to focus or having trouble concentrating, experiencing sleep problems, or being restless or irritable can be symptoms of either anxiety or ADHD. The key difference is what underlies the symptoms. For someone suffering primarily from anxiety, distraction is caused by overwhelming fearful thoughts that make it difficult to concentrate, while someone with ADHD is easily distracted even in situations when they’re calm.

Unfortunately, determining the source of troubling symptoms might not be that straightforward, because people with ADHD are also likely to feel anxious about problems brought on by their struggles with their mental health condition. ADHD can negatively affect nearly every aspect of daily life, and someone coping with it can be highly aware of how they’re failing to live up to their own expectations but still have trouble changing their behavior. Missing important deadlines or meetings at work; being unable to prioritize important tasks; missing instructions because you couldn’t focus on a conversation; feeling guilty because an impulsive outburst offended someone you care about—these common situations that can arise from ADHD also produce anxiety.

The overlap in ADHD and anxiety symptoms can be the source of misdiagnosis or delayed diagnosis. It’s important for a mental health professional to carefully screen symptoms to rule out an anxiety disorder when diagnosing ADHD, and vice versa. Having an accurate diagnosis is the first step toward effective treatment.


Can ADHD Get Worse with Stress?

If you’ve been under stress and thought it made your ADHD even harder to deal with, you’re not imagining it. Your body’s physical response to stressors exacerbates classic symptoms of ADHD. Stress hormones are designed to activate a fight-or-flight response that, among other things, routes blood away from the prefrontal cortex, the part of the brain that governs executive function and which is already affected by ADHD. The stress response weakens working memory, mental flexibility, impulse control, coping skills, and the ability to sustain concentration. Worse, chronic stress can cause biochemical changes to the brain that make it harder for it to function correctly. It’s entirely possible to end up in a vicious cycle where stress exacerbates ADHD, leading to more stress. However, it is possible to break that pattern with the proper assessment and treatment.


Getting the Help You Need for ADHD, Anxiety, and Stress

The best treatment for ADHD and anxiety may vary somewhat by individual, especially if the anxiety they’re experiencing is primarily due to their ADHD. You’ll get better results if you know exactly what you’re dealing with, so if you don’t have a confirmed diagnosis already or think it might not be accurate, we encourage you to seek out assessment and testing to get a clearer picture.

In general, ADHD is treated with a combination of medication (either stimulant or nonstimulant), therapy, and behavioral tools. A comprehensive approach is essential for success—therapy is not a substitute for medication, and medication can’t replace therapy. Medications help balance levels of important neurotransmitters to improve the symptoms of ADHD. Therapy can assist in identifying negative thoughts and behavior patterns and help patients change them so they’re better able to function and manage their ADHD symptoms. Dealing with ADHD head-on, coming to understand that daily difficulties with it are not character flaws but the effect of a disorder with a neurological basis, and learning better coping strategies can all go a long way toward relieving ADHD-related anxiety as well as improving the overall diagnosis.


In addition, lifestyle changes can help you better deal with stress and anxiety when you have ADHD. Setting a regular schedule that incorporates breaks and exercise helps, as does maintaining a healthy diet, reducing the use of alcohol and/or caffeine, and quitting smoking. Learning relaxation techniques such as breathing exercises can help provide tools to mitigate feelings of stress before they become overwhelming. These changes will work best when you can be consistent; consider phasing them in gradually so they become habits that are easy to follow rather than an abrupt shift.


If you’re struggling with ADHD and anxiety, or suspect you might be, the SF Stress & Anxiety Center can help. Our experienced therapists use evidence-based methods to help you overcome the challenges you face and learn strategies that allow you to improve your quality of life. For your convenience, we offer both in-person and online sessions. Schedule your free initial phone consultation with one of our compassionate Care Coordinators to be matched with the right therapist for you.