How Can I Help a Loved One with Borderline Personality Disorder?

Article: Xavier Amador, PhD, Adjunct professor, Columbia University, Board of Directors of NAMI
Introduction: BPDFamily Staff (based on principles from an article by Richard O'Connor, PhD)
Video: Catherine Roach documentary
Video: Xavier Amador, PhD presentation
Sidebar: excerpts from Suite101 article by Randi Kreger

Introduction - Caring, loving and wanting to help are all natural feelings to have. It is one thing to care. It is another one thing to be "in love" with someone. It is quite another to try to help them "not be mentally ill".

Hard To Give - Trying to change the behavior and feelings of someone with a mental illness, or get them start a recovery program, no matter how well intended, is not "help". It crosses over healthy relationship boundaries and often leads you to unhealthy enmeshment in your loved one's life. If they enter therapy or alter behavior to please you, or out of fear that you will leave - this is not a motivation that leads to recovery. And frankly, this type of "help" is often born out of a need to control.

Hard to Receive - Often borderlines will see these efforts to help as threatening or condescending. Borderline's are known to have dysfunctional abilities to "cope" with life's challenges. The possibility of mental illness is a serious life challenges.

Pathological exhibits of splitting, projection, and introjection by borderlines are characteristic borderline defenses. At the same time, rationalization and denial can similarly be pathologic defenses. If someone can't cope with the information, you cannot easily overcome that.

Ultimately, change is a choice. Change can only take place when a person chooses it for him/herself. It cannot be imposed. We can only support them in their choices. And if we need something in our lives, or in any relationship to change, we, ourselves, must change. We cannot extend over their personal boundaries and expect them to change for us.

Treatment and Therapy is a Goal, Not a Given.

Report from the convention of the National Alliance for the Mentally Ill in Washington, D.C.

A growing body of evidence points to the fact that for many people with mental illness, have "lack of insight" of that illness. .

According to Dr. Xavier Amador, adjunct professor in Clinical Psychology at Columbia University in New York City "People will come up with illogical and even bizarre explanations for symptoms and life circumstances stemming from their illness, along with a compulsion to prove to others that they are not ill, despite negative consequences associated with doing so."

What is often thought to be immaturity, stubbornness, and defensiveness is a much more complex problem.

Amador and his colleagues found in a 1998 study that nearly 60 percent of a sample of 221 patients with schizophrenia did not believe they were ill.

Amador describes what it is like to work with someone who does not believe they are ill. One patient encountered by Amador was paralyzed on his left side and he had problems writing. When asked to draw a clock the patient thought he did fine, Amador recalled.

However, when Amador pointed out to the patient that the numbers were outside of the circle, the patient became upset. "The more I talked to him [about the drawing], the more flustered he got. . . . Then he got angry and pushed the paper away, saying 'it's not mine-it's not my drawing.' "

Amador finds the same reaction appears when he talks to people with severe mental illness. "Instead of being an ally, I end up being an adversary," he said.

Amador urged family members and mental health professionals to understand that collaboration with treatment by someone who has a severe mental illness is a goal, not a given.

Amador has written about getting people with serious mental illness to accept treatment in a book he coauthored with Anna-Lisa Johanson titled, I am Not Sick, I Don't Need Help: A Practical Guide for Families and Therapists, (2000 by Vida Press.)

It is important instead to develop a partnership with the patient around those things that can be agreed upon.

Amador said that family members and clinicians should first listen to the patient's fears.

Empathy with the patient's frustrations and even the patients delusional beliefs is also important, remarked Amador, who said that the phrase "I understand how you feel" can make a world of difference.

The most difficult thing for family members to do in building a trusting relationship, he said, is to restrict discussion only to the problems that the person with mental illness perceives as problems - not to try to convince them of others.

For more information on how to help someone wit a mental illness, please view this video. The author uses the example of Schizophrenia, but these principles apply to Borderline Personality as well.

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[Please allow 3-4 minutes for video to download]
[1 hour viewing time]

Dr. Xavier Amador is an adjunct professor in Clinical Psychology at Teacher’s College, Columbia University in New York City and is on the Board of Directors of the National Alliance for the Mentally Ill (NAMI). He is a clinical psychologist who treats adults, children, and adolescents in individual, couples and family therapy.

Previously, he was a professor in the Department of Psychiatry at Columbia University, College of Physicians & Surgeons; Director of Research at NAMI; and the Director of Psychology at the New York State Psychiatric Institute.

Dr. Amador's expert opinon is frequently sought by the news media. He has worked as an “NBC News Consultant” and “Today Show Contributor” and has also appeared regularly on numerous other programs: e.g., NBC's Today Show, Good Morning America, CBS This Morning, NBC Nightly News, CBS 60 Minutes, ABC Prime Time Live, CNN, NBC Dateline, Fox News Channel, Court TV, A&E Network, Discovery Channel, BBC, and PBS among others. He has been interviewed by the New York Times, USA Today, Reader’s Digest, the New Yorker, and other national print media. In addition to national media, he is frequently called upon for local TV, radio and newspaper interviews, both in the USA, and overseas.

He has published over 100 peer-reviewed scientific papers, and many other publications that include five books; among them: ‘I am Not Sick, I Don’t Need Help!’; When Someone You Love is Depressed: How to Help Without Losing Yourself; and Insight and Psychosis. His books and other publications have been translated into 18 languages and are frequently cited by scientists and policy-makers worldwide.

Soundtrack on Video: Low - A band from Duluth, Minnesota, formed in 1993. Featuring Alan Sparhawk on vocals and guitar and Mimi Parker on vocals and drums and Matt Livingston on bass and vocals..
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Note: Self injuring tendencies are not a requirement for diagnosis of Borderline Personality Disorder. Many BPD's are not this dysfunctional, but their inherent thought process is similar.

Rage, denial, and a torrent of criticism?

... I was only trying to help!

I do not recommend that you tell somone that you suspect that they have Borderline Personality Disorder. This is difficult advice. It seems logical that your friend or relative will benefit from the information as well.

The fantasy goes like this: "The person will be grateful to you and will rush into therapy to conquer their demons."

Unfortunately, this doesn't usually happen. Your loved one will probably respond with rage, denial, and a torrent of criticism.

When people say they want to "help" the BP, they usually mean they want to change the BP.

People can only change themselves...

Randi Kreger
Contributing Author, Suite 101

Excerpts from an article that first appeared on

Xavier Amador PhD
Original essay text

Richard O'Connor, PhD
Original essay text

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Updated: 04/11/14