How to Handle Borderline Personality Disorder in Relationships

Borderline personality disorder (BPD) is one of the 10 personality disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A core feature of this disorder is instability in interpersonal relationships. This can lead to significant challenges in the relationship, both for the individual living with this condition and for their partner.

If you or your partner has symptoms of BPD, it's important that you seek professional help in navigating your relationship with each other.

What Is Borderline Personality Disorder?

BPD is typically diagnosed during adolescence or early 20s. People who have this condition often experience instability in their mood and how they see themselves and the world.

Common symptoms of BPD include:

• Fear of abandonment and difficulty trusting
• Patterns of intense unstable relationships
• Unstable self-image and sense of self
• Recurring thoughts of suicide and threats of self-harm
• Self-harming behaviors
• Intense and varying moods
• Suspicions of others and fear of their intentions
• The feeling of emptiness or sadness
• Intense anger and problems controlling anger
• Feelings of dissociation from self and disconnected from the world around

The frequency, severity, and how long each symptom lasts varies based on the individual and any other conditions they have.

It’s common for people with BPD to also have other psychiatric disorders, and the most common are:

• Anxiety disorders
• Depressive disorders
• Post-traumatic stress disorder

Effects on Relationships

Research suggests that the attachment style of people with BPD can commonly create difficulties in relationships.

Some issues include:

• Fear of abandonment: This can lead to either becoming overly attached in an attempt to prevent their partner from leaving, or they could choose to leave first before their partner has the chance to leave. 
• Difficulty connecting: Communication and connecting are challenged by the shifting views of their identity and place in the world. This can lead to difficulty connecting with one’s partner and may make the relationship chaotic, feeling like a rollercoaster with many highs and lows.
• Mood swings: People with BPD experience instability and reactivity in their mood and tend to view things as all good or all bad. Hostile actions, verbal aggression, and physical aggression may be present.
• Distrust: People with BPD tend to be distrusting and suspicious of others. This can cause them to question the intentions of their romantic partner and distrust their behaviors.

One study compared the relationships of couples where one partner had BPD with relationships where neither partner had BPD. They found that the partner who had BPD had a more negative perception of the relationship than their partner, demonstrating that BPD symptoms impacted happiness and trust in romantic relationships.

Diagnosing and Treating BPD

Diagnosis of BPD is done through an interview and assessment by a trained mental health professional. Assessments of the criteria for BPD diagnosis are used, and other mental health conditions that have similar symptoms are ruled out.

Psychotherapy is the primary treatment for BPD. It provides tools and coping mechanisms to help identify and manage thoughts, feelings, and behaviors. The goals of psychotherapy are to help learn to manage emotions, reduce impulsive actions, improve awareness in relationships, and understand the disorder.

There are no medications that specifically treat borderline personality disorder. In some cases, medications are recommended to help with co-morbid conditions, such as anxiety and depression.

Supporting a Partner With BPD

If you have a partner who is living with BPD, there are many challenges that can occur, but there are ways you can help support your partner who has BPD and take care of yourself.

These include:

• Educating yourself: Learn as much as you can about BPD. Understanding the mental health condition can increase compassion and ease some of the difficulty.
• Seeking help for yourself: Get help from a trained mental health professional.
• Practicing clear communication: BPD can cause people to jump to conclusions and misunderstand others' meanings. Clearly communicating, and expressing fears to each other can help.
• Knowing how to spot symptoms: Save important conversations for when the person living with BPD is calm.
• Asking your partner how you can help them: Knowing how to support them when they are experiencing symptoms will help.
• Build your own self-care routine: It can be stressful supporting someone with a mental health condition, so building your own social support systems and coping techniques is important.

Prognosis

It takes work and can present ongoing challenges, but BPD can be managed and often improves. People who are living with BPD can be very compassionate to others and can have positive relationships.

A Word From Verywell

Because of the nature of BPD, it has an impact on relationships. Following a treatment plan and consistently working on communication can help with managing the effects that BPD has on relationships.