PDF Summary:Loving Someone with Borderline Personality Disorder, by Shari Y. Manning

Loving someone with Borderline Personality Disorder can feel overwhelming and isolating. The emotional turbulence, impulsive behaviors, and recurring crises can leave you exhausted and unsure how to help. In Loving Someone with Borderline Personality Disorder, Shari Y. Manning explains the core mechanisms behind BPD, including emotional and behavioral dysregulation, the role of shame and invalidation, and the serious risks of self-harm and suicide that often accompany the condition.

Manning offers practical guidance for supporting your loved one while maintaining your own well-being. You'll learn techniques for productive communication, including how to validate emotions, set healthy boundaries, and use a five-step framework for managing difficult situations. She also emphasizes the importance of self-compassion and resilience for caregivers, along with resources and support networks available to families navigating BPD.

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(Shortform note: Some scholars and advocates disagree with Manning’s explanation of self-harm and suicidal behaviors. In Critical Suicidology, Jennifer White and Ian Marsh argue that self-harm and suicidal behaviors are responses to social, economic, and political conditions. They argue that the current understanding of suicide and self-harm is too focused on individual pathology and doesn’t consider the broader context in which people live. They believe that self-harm and suicidal behaviors are often responses to structural violence, such as colonization, racism, gendered and sexual oppression, poverty, and the insecurity produced by neoliberal forms of governance.)

Individuals with borderline personality disorder are often seen as engaging in suicidal or self-harming actions to seek attention. They're misrepresented as pretending to attempt suicide for attention. However, self-harm is mainly used to manage emotions. Due to their increased emotional sensitivity, people with BPD need the relief that self-harm offers much more. They frequently lack the ability to engage in more effective ways of obtaining relief. At times, individuals may resort to actions that harm themselves or end their lives to stop distressing feelings from coming up entirely. They may engage in these behaviors to provoke a reaction from other people, though they're not always conscious of doing so. If they’re aware, they typically haven’t planned this to receive sympathy.

(Shortform note: E. David Klonsky, a psychologist who studies self-harm, explains that people who self-harm, including those with borderline personality disorder, often do so to escape unbearable internal states. He notes that when people are asked why they self-harm, they most often say it’s to manage their emotions. This is in contrast to the less common reason of trying to influence others. This suggests that self-harm is more about managing internal distress than seeking attention.)

Manning notes that while self-harm and suicidal behaviors are distinct, both are frequent in people with BPD. Approximately 60 to 80 percent of those who have BPD engage in some form of self-harm. It's crucial to understand that self-injury doesn't carry an intention of dying. However, around 75% of people with BPD attempt suicide during their lives, and unfortunately, 8-10% of them complete suicide. As a person fulfills more criteria for BPD, their suicide risk increases. Self-harming individuals have an increased suicide risk.

The Blurred Line Between Self-Injury and Suicidal Behavior

The distinction between self-injury and suicidal behavior is not always clear-cut. Matthew K. Nock, a leading researcher on self-injury, notes that people who deliberately harm their own bodies without an explicit plan to die often report that their intentions are complex and shifting, with thoughts about death or suicide present to varying degrees across different episodes. The same person may alternate over time between acts they describe as nonsuicidal and acts they describe as suicidal, and many so-called nonsuicidal self-injury episodes involve at least some wish to die, a desire to communicate suicidal distress, or a wish to test their capacity to carry out a future suicide attempt.

Responding to and Supporting Someone with BPD

Manning advises that when helping someone with BPD, you should seek support and resources for yourself. Remember that you're doing your best, and so is your partner. You can feel very alone when trying to help someone who has BPD, especially if they refuse to get treatment. Manning shares that many programs using DBT (Dialectical Behavior Therapy) offer “Friends and Families” groups that teach skills in managing emotions, tolerating distress, communicating effectively, and practicing mindfulness. These sessions don't need your relative to be in treatment.

(Shortform note: This advice may be difficult to apply if you live in a community where there are few, if any, mental-health professionals who understand BPD. In Stop Walking on Eggshells, the authors note that in these circumstances, you may have to rely on educating yourself and making decisions about boundaries and contact to protect your own well-being, even if that means limiting the amount of help you can realistically offer. Additionally, in some communities, there may be a stigma attached to seeking mental health support, making it unsafe for you to participate in support groups. In these cases, you may need to find alternative ways to cope, such as online resources or private counseling, if available.)

There are also advocacy and support organizations for families of people with Borderline Personality Disorder, such as TARA (Treatment and Research Advancements, National Association for Personality Disorder), the National Education Alliance for Borderline Personality Disorder (NEABPD), and the National Alliance for Mental Illness (NAMI). These organizations offer education and support to families. Should your loved one experience suicidal thoughts, the American Association of Suicidology (AAS) provides helplines and crisis worker certification. If you prefer not to join an organization, consider consulting a therapist with experience in BPD. Ensure the therapist is supportive and nonjudgmental toward your loved one. Check their credentials and approach to ensure they align with your needs. Manning also advises you to be cautious of incorrect information related to BPD and unlicensed treatment providers online. Consult with advocacy organizations or trusted mental health professionals to find reputable groups and treatment providers.

The Historical Context of Mental Health Resources

Manning’s emphasis on seeking out established organizations and licensed providers reflects the historical context of mental health care in the US. In the mid-20th century, deinstitutionalization policies led to the rapid closure of psychiatric hospitals without adequate community-based services to replace them. This left families to navigate a confusing landscape of experimental treatments, unregulated providers, and inconsistent quality of care. National organizations like NAMI and NEABPD emerged to advocate for better services, educate the public, and push for more coordinated, scientifically grounded approaches to mental health care. The field of suicidology developed in response to the need for specialized expertise in suicide prevention, recognizing that general mental health services often lacked the training and resources to address this critical issue. Manning’s advice to seek out these established resources reflects the hard-won lessons of a mental health system that has often failed to provide reliable, accountable care.

Now that we've discussed some resources you can turn to for support, we'll explore how you can effectively communicate with your loved one, support your own well-being, and build resilience.

Techniques for Productive Interaction

To interact effectively with someone who has BPD, Manning suggests using opposite action to regulate emotions. She explains that every emotion prompts a corresponding action, and taking opposite action can alter emotions. To reduce an emotion quickly, try some opposite action. Fear, anger, guilt, and sadness are the four most commonly felt emotions during interpersonal conflicts. For example, when you're angry, you feel compelled to attack. To lessen your anger, disengage. Leave, end the call, avoid texting or emailing, but do it softly, without having the final word or getting angry. Simply create space. Remaining engaged may keep your anger elevated or even intensify it.

(Shortform note: While disengaging from a conversation when you’re angry can help you regulate your emotions, it can also create problems in your relationship. In The Seven Principles for Making Marriage Work, John Gottman and Nan Silver explain that when one partner repeatedly copes with tension by emotionally or physically checking out, the other partner tends to feel abandoned, criticized, and overwhelmed. Over time, this pattern becomes a strong predictor of divorce. To avoid this, Gottman and Silver recommend that any break from a difficult conversation should be framed as a temporary self-soothing time-out, with reassurance and a clear agreement about when and how the discussion will be resumed.)

After disconnecting, make an effort to show kindness. Consider things from your loved one's perspective, feel empathy for them, and do something kind for them. Compassion hinders your capacity to stay angry. Anger often leads to rumination, which is problematic. Triggers for anger continue to arise, so compassion needs to be employed repeatedly to reduce it. In contrast, feeling sad causes a desire to withdraw and lose motivation. It results in inaction.

(Shortform note: While showing kindness and compassion is important, it can also lead to compassion fatigue, a state of emotional exhaustion that arises from caring for others in distress. In Compassion Fatigue, Charles R. Figley explains that compassion fatigue is the cost of caring for others in emotional pain. It occurs when those who help are repeatedly exposed to others’ suffering and respond with sustained empathy and a strong sense of responsibility, but lack sufficient opportunities for rest, support, and recovery.)

Using an opposing behavior activates and addresses the issue. It engages your physiology. Get active again. If you want to decrease sadness quickly, take a quick walk, swim, play tennis, or use an aerobic dance DVD. Over time, enlist your support network to engage in enjoyable activities that aren't connected to them. Research what resources are accessible for your partner, locate a group that offers support, and attend one of the family advocacy programs mentioned in the twelfth chapter and the book's appendix. Avoid becoming motionless and silent.

How Movement Improves Mood

Research shows that even a single bout of moderately intense aerobic movement can measurably improve low mood for many people. In Spark, John Ratey explains that movement triggers a cascade of neurotransmitter and growth-factor changes in the brain that can rapidly shift mood. For example, a quick walk can increase dopamine and serotonin levels, while also boosting brain-derived neurotrophic factor (BDNF), which supports neural plasticity. These neurochemical shifts can help break the cycle of rumination and low energy that often accompanies sadness.

Manning also recommends setting and expressing limits during interactions. Limits are adaptable and may vary depending on circumstances. They're centered on you, not your partner. Limits are important because they preserve your connection. Constantly changing your boundaries will lead to resentment. Failing to communicate your limits could eventually cause you to explode, ending the relationship.

Express your boundaries in advance. Explain truthfully your actions and reasoning. Soothe your loved one when you communicate a limit. When possible, propose something else. Validate how hard it is to have someone withdraw something.

When It’s Not Safe to Express Your Limits

Manning’s advice to express your limits in advance and to soothe your loved one when you withdraw something is intended to preserve your relationship. However, if your loved one has a history of stalking, physical violence, or coercive control, this advice could put you in danger. Announcing a new limit could trigger a violent response, and focusing on soothing your loved one could distract you from your own safety. In these situations, it’s safer to make changes to your behavior without announcing them in advance and to seek support from a domestic violence expert.

Let’s take a look at some core techniques for skillful reacting, as well as a five-step reaction framework for those close to you.

Core Techniques for Skillful Response

According to Manning, one core technique is to acknowledge the emotions and experiences of your loved one. Validation is the most effective way to help someone who is shutting down emotionally. It requires you to listen without attempting to find a solution, and you must speak sincerely. You aren't required to share the other person's opinion to validate them. You can validate the emotions they must be experiencing and how difficult those emotions are to feel. You can also generate hope that they'll make it through this crisis. If they are open to it, you can suggest ways to rebuild their life that honor what they've lost.

(Shortform note: Validation is effective because it signals to the other person that you understand them. When someone feels understood, they feel safe. This safety calms the brain’s threat response, which is what causes emotional shutdown. When the threat response is calmed, the brain can re-engage the circuits that regulate emotions.)

A Five-Step Framework for Managing Loved Ones

Manning suggests using a five-step response framework to improve how you engage with your loved one. The sequence is: 1) Manage your emotions. 2) Acknowledge their feelings. 3) Ask what they need from you. 4) Collaborate to find solutions. 5) Clarify your part and how you’ll follow up. This five-step approach helps you stay calm and productive when dealing with emotional outbursts. It provides a method of responding that doesn’t escalate the situation.

(Shortform note: While Manning’s five-step response framework can be helpful in many situations, it may not be effective in all cultural or family contexts. In The Culture Map, Erin Meyer explains that different cultures have varying communication styles, especially when it comes to handling conflict and emotional expression. In some cultures, direct confrontation or open discussion of feelings is seen as disrespectful or shameful. In these contexts, Manning’s approach of openly acknowledging emotions and collaborating on solutions might backfire, as it could be perceived as challenging authority or violating norms of emotional restraint.)

It also allows you to sidestep common mistakes like dismissing their feelings or offering unwanted advice. Here’s the process: - Step 1: Manage your feelings. Breathe deeply and tune into yourself. Identify your emotions. - Step 2: Validate your loved one’s feelings. Demonstrate that you comprehend and accept how they're feeling. - The third step is to inquire what they need from you. Find out if they'd like you to hear them out, offer guidance, or help address an issue. - Step 4: Collaborate on potential solutions. If they want help, work together to generate ideas and choose a plan. - Step 5: Clarify your part and how you’ll follow up. Find out what they need from you and ask them to update you on how things go.

The Origins of Empathy-Based Communication Frameworks

This five-step response framework is part of a broader tradition of structured, empathy-based communication methods. For example, Marshall Rosenberg’s Nonviolent Communication (NVC) model organizes conversations into four stages: observing what happened, identifying each person’s feelings, uncovering the underlying needs, and making clear requests. Like Manning’s approach, NVC emphasizes self-awareness, empathy, and collaborative problem-solving. Both frameworks aim to create space for each person’s experience while moving toward mutually satisfying outcomes. Manning’s sequence can be seen as a specific application of this broader lineage of needs-focused communication, tailored to the unique challenges of supporting someone with BPD.

Supporting Your Well-Being and Requesting Assistance

Caregiver Self-Regulation & Resilience

As a caregiver, Manning emphasizes the importance of practicing self-kindness and embracing yourself. Empathy involves a profound acceptance of people as they are right now. Self-compassion involves caring for both your physical and emotional well-being. Manning explains that having compassion enables you to empathize with the challenges of others. You can't accept another person and empathize with them if you don't empathize with yourself. Being in good physical health makes you more resilient and better able to regulate your feelings, even if your loved one is upset.

(Shortform note: Kristin Neff, a leading researcher on self-compassion, has found that self-compassionate people have lower levels of the stress hormone cortisol and higher levels of oxytocin, a hormone associated with feelings of trust and safety. This hormonal balance helps you stay calm and centered, even when your loved one is upset. Neff's research also shows that self-compassionate people are more likely to feel empathy and concern for others. This suggests that by caring for your own body and mind, you expand your capacity to accept and empathize with your loved one.)

To practice self-compassion, Manning suggests visualizing a version of yourself that is happy and open. Consider what you like about yourself. Say things aloud that show self-compassion and self-acceptance. Identify aspects of yourself that you can love, and repeat them frequently. Additionally, care for your body. Ensure you get adequate nutrition and rest, and limit caffeine, alcoholic drinks, and sugary foods. Step away from your job to refresh and restore your energy. Engage in activities that give you joy and a sense of empowerment.

Kristin Neff’s Self-Compassion Framework

Manning’s recommendations for self-compassion are similar to those of psychologist Kristin Neff, who has developed a framework for self-compassion based on her research. Neff’s framework includes three components: being kind to yourself, recognizing that your difficulties are part of the human experience, and holding your painful experiences in mindful awareness. Neff’s work has been influential in the field of psychology, and her framework has been used in a variety of settings, including therapy, education, and healthcare. Neff’s work is also connected to the Buddhist tradition of self-compassion, which emphasizes the importance of treating oneself with kindness and understanding.