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Professor Barbara Oakley's Evil Genes provides a terrific “big picture” overview of those who carry traits similar to borderline personality disorder. What Barb didn't tell you, however, was that when she first began to look for information related to her sister, she stumbled across my Stop Walking on Eggshells. “That's what started the boulder rolling,” she told me.

Many who have read Evil Genes have asked Dr. Oakley what they should do if they are dealing with a troubled person in their life who they suspect has some—or many—of the symptoms of borderline personality disorder. As it turns out, my most recent book, The Essential Family Guide to BPD: New Tools and Techniques to Stop Walking on Eggshells, deals with precisely that topic. That's why Barb asked me to write this afterword.

As you know, many of those who have symptoms of borderline personality disorder remain undiagnosed. Some of these people can function at prominent levels—as doctors, ministers, business leaders, or other highly respected individuals. If you suspect someone you care about or work with has some or many of the traits of borderline personality disorder, you may be left feeling helpless and hopeless. However, you do have the power to improve your situation whether or not the borderline-like person (“BP”) you know chooses to change.

Your feelings are normal, and you are not alone.

The following are common emotions among those who affiliate with BPs (called non-BPs here for short):

If “your” BP is a family member, don't tell him you think he has BPD or try to force therapy upon him.

If you do, as Dr. Oakley pointed out earlier in Evil Genes, you can be sure your family member will become furious and say that you're the one who has borderline personality disorder—especially if you and your BP have been playing the “blame game.” Even if the diagnosis was coming from a doctor, it would be meaningless unless your BP wanted help. Making major changes is tough even when people want to make them.

The question people ask most often is, “How do I make my family member go to a therapist?” The answer is, “you can't.” You may be able to threaten the person into going, but all you get is a warm body, not an engaged or open mind. Rather than focus on what your family member thinks, which you can't control, focus on his behavior toward you, and think about what you will and will not accept.

Recognize the common triggers of shame and fear of abandonment.

Whether your BP is in your family, or simply someone you must work with, you can create more predictability in your life by identifying triggers (sensitive areas) that lead to borderline defense mechanisms. The most common ones are shame and fear of abandonment.

Everyone fears abandonment to some extent. However, BPs react to real or imagined threats. And they have a good imagination. In a family situation, normal things such as spending time with your own friends or working long hours can trigger an over-the-top expression of fear that cannot be easily assuaged because it originates from within the BP.

People with borderline personality disorder feel innately bad, worthless, defective, or toxic at the very core of their being—not for something they have done, but simply for being. This makes them sensitive to rejection. They anxiously await it, see it when it isn't there, and overreact to it whether it's there or not. This is why small slights—or perceived small slights—can cause major messes.

Leave if your family member rages or becomes violent.

Don't listen to family members berate and call you names. At that point in time, they can't see your point of view or think through the effects of their interactions with others. It's not that they won't—it's that they can't, not without having had the proper treatment. Remember—their emotional toolkit is missing some key components.

Verbal abuse harms you: ongoing, repeated verbal assaults can be every bit as emotionally devastating as physical battering—especially when it is meted out by an intimate or by someone in a position of authority.

If your family member loses control, you can:

Think through your options and make concrete plans ahead of time. Then discuss your plan with the BP before these situations occur so that you have a shared understanding of what will happen. Assure your family member that if you leave, you will be back. Let your BP make her own choices, and give the gift of allowing her to take responsibility for the outcome of her decisions.

Use phrases like:

Become an advocate for your borderline child.

If you believe your minor child has BPD, run to your nearest bookstore and purchase a copy of Borderline Personality Disorder in Adolescents (Fair Winds Press, 2007) by Blaise Aguirre, MD.

You will hear over and over again that a person can only receive a diagnosis of BPD after the age of eighteen. This is an old and entrenched way of thinking. Today, experienced clinicians believe it's crucial to address borderline-like behavior as soon as possible. The longer the disorder goes untreated, the more entrenched it can become.

Learn and practice the five core skills that will empower you to improve your own life.

Borderline personality disorder is multifaceted and borderline-like behaviors can be wildly unpredictable. Those with BP family members, or who are dealing with a BP in their work life, need more than information: they need skills training, emotional support, and often their own therapist to help them determine what is and isn't “normal.”

My book The Essential Family Guide to Borderline Personality Disorder (Hazelden, 2008) identifies five major tools family members need to organize their thinking, learn specific skills, and focus on what they need to do instead of becoming overwhelmed. If you are dealing with a BP in your work life, you will also find these tools to be useful.

Here, I'll briefly go over the first three: take care of yourself, uncover what keeps you feeling stuck, and communicate to be heard. (The fourth and fifth have to do with setting limits and reinforcing the right behavior. These are too complicated to discuss given the amount of space available.)

TOOL 1: TAKE CARE OF YOURSELF

Non-BPs tend to become isolated. Don't let this happen to you. Reach out to others. Don't let yourself be embarrassed into isolation or pushed into it by threats, implied or outright.

Depend on friends to give you reality checks. Non-BPs almost always lose sight of what is normal. Join a support group, whether online or in real life (see links at BPDCentral.com). Get enough sleep and live a healthy lifestyle.

TOOL 2: UNCOVER WHAT KEEPS YOU FEELING STUCK

Most often, you don't recognize situations that have the ability to make you feel trapped and stuck until you're deeply involved and unable to tell what is “normal” anymore. These feelings of helplessness and lack of control can cause just as much suffering as the presence of the personality disorder itself.

Feelings of fear—for example, fear of conflict, fear of being alone, fear of financial problems, and fear of losing the relationship—make some people feel trapped. Susan Jeffers, the author of Feel the Fear and Do It Anyway, says that all we need to do to diminish fear is to develop more trust in our ability to handle whatever comes our way.

Sometimes survival is dependent upon giving up the myths of the ideal parent, sister, or other family member, and accepting reality, no matter how much we wish it were otherwise. We may cherish our feelings of loyalty and carry a strong sense of obligation, but sometimes those feelings can mislead us into doing things that are ultimately harmful for both ourselves and our loved one.

Take a close look at your beliefs and decide which ones are based on myths and which ones are based on reality. This consists of asking questions such as: What do I do because of a sense of obligation? What feelings rise up when I ask myself that question? Which of my obligations feel good to me? Which ones do not?

Guilt drives parents to lose their sense of judgment and go to ridiculous lengths to assuage their guilt. Society says that parents who have a child who isn't functioning well are not up-to-snuff. Acknowledge your guilt, but formulate a plan to overcome it so it doesn't act as a barrier.

Rescuers love their family member and want to help. So they “help,” often by doing things they don't want to do or by giving up things they don't want to give up. When things don't improve (or get even worse), they “help” some more—even though they resent it and think it's unfair. Rescuers do things for people that the people could do for themselves, which encourages their dependence.

TOOL 3: COMMUNICATE TO BE HEARD

The first rule of communication is knowing when not to attempt it. When someone with symptoms of borderline personality disorder has intense feelings, the emotional centers of his brain “hijack” the logical centers. Asking your family member to process factual information is like asking a baby to drive a car. It's not that he doesn't want to, it's that he can't.

If you're feeling criticized or blamed—especially when it's quite undeserved—the natural response is to defend yourself. But this only makes things worse because the message the borderline receives is, “Your feelings are wrong.” While no one wants to be told their emotions are baseless, borderline individuals have an especially intense, negative reaction to having their feelings “invalidated” (meaning rejected, denied, ignored, mocked, judged, or diminished).

To avoid doubling his anger at and pain of being told he's incorrect about his own feelings, you need to separate your BP's distorted thinking from the intense, overwhelming feelings, and then empathically acknowledge those emotions to your family member without necessarily agreeing with the thoughts that link the two.

So how do you do that? Through a technique called “empathic acknowledging”—a blend of empathy, active listening skills, and acknowledging.

EMPATHY

Empathy is emotionally putting yourself in someone else's place to the point when you can vicariously experience her thoughts and feelings.

Metaphorically, people who express sympathy are like people who drive by the scene of an accident, slow down, give an encouraging expression to the driver of the banged-up car, then speed up and go along their merry way. On the other hand, people who express empathy pull over, get out of their car, clasp the shoulder of the driver, and say, “Oh wow, I bet this is the last thing you needed to happen right now.”

ACTIVE LISTENING

Active listening means suspending your judgments and opinions, and pushing everything out of your mind except your family member—you're about to enter her world. Focus on what she's feeling as well as saying, with her words, tone of voice, facial expressions, and body language.

Listen with 100 percent of your attention without interrupting, asking questions, offering solutions, or thinking about what you're going to say next. This says, “You and what you say are so important that I'm giving you my undivided time and attention. I am willing to listen to you with an open mind.”

ACKNOWLEDGING (VERBAL AND NONVERBAL)

Verbally, use encouragers such as “oh,” “hmm,” and “really?” Reflect their feelings (“That sounds frustrating”). Show involvement (“I'm happy for you”). Punctuate intense emotions (“Oh no!”).

Your most powerful communication tool is your face and body, not your mouth. Research shows that people convey just 7 percent of their attitudes and beliefs through their actual words. The other 93 percent comes from our tone of voice (38 percent) and our facial expressions (55 percent).

Make your eyes soft and steady, showing interest. Have a relaxed facial expression (no tightening or scrunching up) with a neutral expression or genuine half-smile. Relax your body (whether seated or standing) and have your arms loose by your sides. Don't stare, glare, look away, grimace, frown, or scowl.

Asking validating questions is another form of acknowledgment. Ask specific, clarifying questions in a way that shows genuine interest and is not provoking. BPs frequently make general, black-and-white comments like “You're selfish.” Ask your BP just what she means by these vague words. What exactly did you do that showed selfishness? How often did you do it? What makes your family member think you don't care about her?

You might say, “I really want to understand you, but I'm having trouble appreciating the depth of your feelings about this. Can you try explaining this in another way? I care, I just need to understand better.”

DEFUSE AGGRESSION

Use noncombative statements that help you to reach your goal and inject some reality into the situation. Examples include:

Manage the conversation:

Create a climate of cooperation:

Respond to unwarranted criticism or abusive statements:

DON'T MAKE YOUR HAPPINESS CONTINGENT ON YOUR FAMILY MEMBER'S DEGREE OF RECOVERY.

Recovered BP A. J. Mahari advises family members to let go of their desire to control their borderline family member's recovery. “This is their journey, not yours,” she says. “You can support them, but it can't be your life plan.”

Some non-BPs have embraced detaching with love, a concept promoted by Al-Anon, an organization for people whose lives are affected by someone who abuses alcohol. “Detachment” is neither kind nor unkind. It doesn't imply judgment or condemnation. It is simply a way that encourages each person in a relationship to make his or her own decisions and live with the consequences of those decisions.

Strive to make sure you're neither used nor abused. Avoid manipulating situations to help the BP avoid looking at his own behavior. Neither create a crisis nor prevent one if it is in the natural course of events.

Evil Genes may have opened your eyes to a whole ’nother side of human behavior. Although it may seem that a BP you know is consciously choosing his or her troubling behavior, try to remember that if your brain were similarly wired, you would in all probability be acting the same way. Join us at www.BPDCentral.com if you need friends and support as you retool your life in light of your new knowledge.

Randi Kreger
www.BPDCentral.com
Coauthor of Stop Walking on Eggshells and
author of Stop Walking on Eggshells Workbook and
The Essential Family Guide to BPD

Portions of this afterword are from The Essential Family Guide to BPD: New Tools and Techniques to Stop Walking on Eggshells, by Randi Kreger (Hazelden Publishing, 2008).