How Borderline Personality Disorder Affects Relationships

Forming and maintaining close bonds can be extremely difficult for someone with borderline personality disorder (BPD), a mental illness that makes it difficult for someone to regulate their emotions. At the same time, navigating these relationships can be extremely hard on spouses, partners, friends, family members, and other loved ones.

"There is often a sense of frustration and helplessness on both sides of the equation," said Brandon Unruh, MD, medical director of the Harvard-affiliated McLean Hospital's Gunderson Residence, a program for women with severe personality disorders in Massachusetts. "It's important that we work with everyone involved to help them understand each other and understand this disease better." Learn more about the ways BPD can affect relationships and how to avoid these issues.

People With BPD Are Terrified of Rejection

"Almost everyone who suffers from this disease will have difficulty holding onto relationships," said Anna Miari, MD, associate professor of clinical psychiatry at Weill Cornell Medical College in New York City. "They are extra sensitive to rejection, and they perceive rejection even when it is not intended."

People with BPD are terrified of rejection or abandonment. So they may plunge headfirst into relationships or end them quickly.

"They pay a lot of attention to how people treat them, and they take other people's behavior very personally, as an attempt to control the environment around them," Dr. Miari said. "Their goal is to avoid feeling the state of emptiness or anger or despair they perceive if they feel rejected."

They Have Unrealistic Expectations

"People with BPD are looking to their relationships to be the answer to all of their interpersonal and emotional needs," Dr. Unruh said. They tend to look for "perfect" relationships, he added, and their expectations often don't match up with those of the average person.

"This naturally creates a lot of friction and frustration when their hopes don't match up with the expectations of others in this person's world," Dr. Unruh continued. This can lead to burnout, anger, confusion, and misunderstanding on the part of family members or partners.

"Some of the stigmas around this disease is that people with BPD are just manipulative or are just selfishly trying to get attention," Dr. Unruh said. "But we view this quite differently in the field: We understand that this is a symptom of the illness, and people are doing the best they can to get their emotional and relationship needs to be met."

There's No Such Thing as a 'Little' Argument

It's normal for couples to fight. But when one person in a relationship has BPD, a simple argument can trigger an emotional downward spiral because people with BPD may see it as evidence of abandonment or rejection, which is something people with BPD try to avoid.

Partners often learn that the hard way, said Dr. Miari, which leads them to feel like they can't discuss serious issues without experiencing major conflict. They may even be worried their partner will do harm to them—especially because people with BPD are often impulsive and angry.

That's why it's important for partners and loved ones to be involved with a patient's treatment⁠—they can learn how to react in certain situations. Loved ones can also encourage skills learned in treatment that can help patients regulate their emotions and respond appropriately.

Assisting a loved one with seeking treatment can help you both better understand your own needs as well. "You want to avoid being involved with someone with BPD who makes you feel completely responsible for their emotional state," said D. Bradford Reich, MD, assistant medical director of the Pavilion at McLean Hospital in Massachusetts. "Even though you want to be supportive, in the end, it's the patient who needs to be responsible for themselves."

They Can Go From Hot to Cold

"People with BPD have a tendency to view people, and themselves, in very black or white terms," Dr. Miari said. "They tend to idolize people in certain situations and then devalue them very quickly." That makes it hard for them to stick with not only romantic partners but also career choices and friend groups. "Living with a person who sees you one way one day and another way the next day is extremely difficult."

Something else that makes coping with these pendulum swings especially difficult for friends and loved ones: Patients with BPD often don't realize they are causing the problem.

"They perceive that the world is against them, that nothing works out for them because of external factors, that the world is unable to provide them with what they need," Dr. Miari said. "Even when they keep finding themselves in the same situation, they may not have the insight to realize that maybe something is wrong with them and that maybe therapy can help."

Therapy Can Be Helpful for Partners Too

Family involvement is an important part of treatment, but it's not always an easy thing to achieve. "Many people come alone to treatment," Dr. Unruh said. "Perhaps the family feels quite burned out and is unwilling to engage in the process."

If family members are interested and willing to learn more about BPD, Dr. Unruh said there are online resources like the McLean mental health webinars "to learn about what's going on with their loved one, in an empathetic way." This can be a good first step before trying to incorporate the partner or family member into family or couples therapy.

Bringing a partner or loved one into therapy with a BPD patient can also be helpful, said Dr. Miari, but only if the patient is comfortable with it. "Some patients are very protective of their alliance with their therapist, and they don't want another person there to threaten or undermine it," Dr. Miari said. "So one has to be careful about when and how you introduce the idea."

If patients and their loved ones are both willing, however, joint sessions can go a long way toward helping both sides understand each other and work toward a healthier relationship. "It can improve communication and reactions," Dr. Miari said, "and may help improve other relationships in the patient's life as well."

Seeking Treatment Can Help Save Relationships

Treatments for BPD, which include several different types of psychotherapy, are designed to help patients reframe their thinking and manage their emotions. This can make a big difference when it comes to how they interact with other people.

"Many people with BPD, after they've done the hard work of treatment, do report that they've been able to find satisfying vocations, meaningful social roles, and meaningful and rewarding interpersonal relationships," Dr. Unruh said.

Some BPD patients will still struggle with relationships, Dr. Unruh added, especially while going through stressful periods in their life. "But in those times, they can always come back to treatment for extra support," Dr. Unruh said.