I think it helps to keep in mind that BPD affects all relationships and that your sister's relationships are not your responsibility.

Having a family member with BPD influences family dynamics and sometimes the person with the disorder becomes the focus, with the other family members taking on the role of helping, or finding solutions for them. In this sense, the person's issues take over the whole family.

I recall a quote from a Dr. Phil episode. (yes, I know it's TV but he has some good advice). One family member had a disorder (not BPD but this can be with a number of issues) and the entire family was focused on her condition. Dr. Phil said to them. "You are all lost in the woods and looking to a disordered person to lead you out".

You care about your sister but as long as you are focusing on her and her moods and issues, you aren't in tune with your own goals and directions. Listening to her all day isn't your responsibility. It may feel like it is in context of the family dynamics but she's responsible for her own medical care and other responsibilities. It's good that you kept your mouth shut but the next step is to not be as available to her to vent her emotions. CC43's idea of time when you are available or not is a good suggestion.

My situation was a bit different as it was with my mother. For most of the time, I had no involvement in her medical care or decisions and she didn't want me to be involved.  At some point, many adult children do get involved in an elderly parent's care when it becomes apparent that help is needed, and so at that time, I had medical POA for her. My BPD mother had a wonderful doctor, but at times she'd get angry at him, seek out someone else, but it didn't last long. I think she knew he was a good doctor for her.

Why she would get angry was because, medical providers have boundaries- as they should have. BPD mother didn't like boundaries. This same dynamic happened with other providers and caregivers in her elder years. She might get angry at them for telling her to take her medicine, or eat her dinner when she didn't want to. But they were right- whatever boundaries they had were in her best interests.

Even though I had access to speak to her medical providers and could help make decisions for her- BPD mother still had her own free will. She was legally competent. So if she made a decision that may not have been in her best interest, it was a decision she could make.

Your sister is still legally competent and you are not her medical POA. Her medical decisions are entirely her business. Of course you care about her but - she's going to make her own decisions. Unless there was a situation where she truly needed help, you could decide to help if you wanted to. But for now, her medical care is her responsibility and it's up to her to learn to have a working relationship with a provider, if at all possible for her.

This was something I learned too.  I knew there were "crazy" and "abusive" people out there, but I didn't know that they were not always obvious and easy to spot.   And I knew from experience growing up and dating that some women were "clingy" and "controlling" and others were not, but I didn't think why some were like this, and the implications of what that would be like in a committed relationship.  I didn't understand that you can't let things you don't like slide; tolerance is good in society, but in a relationship, it's not.  If you're not being treated how you want to be treated, you've got to speak up and establish those boundaries, or otherwise you'll be treated as a doormat. 

There are bigger implications in all this I think humanity needs to grapple with. Like for example what happens when people like this get into positions of power, how to keep people like this out of positions of power, and how to keep them from passing these behaviors and traits to the next generation.  I feel like a lot of our problems go back to these issues writ large. 

But changing that is all beyond one person's ability... it's hard enough dealing with BPDers on an individual basis 

Indeed, I think zipping your lips or saying something nonjudgmental as Pook suggests, "Hope you find someone who works for you" is the way to go.  Look, if she wants to file a complaint, she can do that--people file complaints all the time.  Whether the complaint is baseless or not, it will be dealt with in the appropriate manner.  In medicine and other regulated industries, dealing with complaints is simply part of the business, and there's a well-defined process for it.

When I'm feeling charitable with people who are venting too much, I sometimes employ what I call the three strikes rule.  I'll say something like, "Let's please talk about something else now."  If she doesn't take the hint, I'll say something stronger:  "We're not getting anywhere, I need a break from talking about this."  And if she still continues, that's a third strike, and I'll say something like, "Gotta go now, talk to you later, bye."  In other words, when conversations get too heated, circular, one-way and  overwhelmingly negative, you give a warning and/or take a break, because you need to protect yourself from getting sucked in and ruining your mood.  I have a family member who seems to relish venting her negativity over seemingly insignificant and unsolvable things, and I've employed this tactic multiple times.  By now she knows that by my second warning, she has to shut up about it, or the call will end.  I try not to be mean about it, but I have my limits for listening to circular, repeated gripes with no solutions in sight.

If you want to keep the lines of communication open, but diminish potential for absorbing negativity, one thing you might try is to get on a "schedule" of communicating when it's convenient for you.  That might look like checking in during a drive home from work or the grocery.  That way, you're not "interrupted" by her toxicity as much, and you have a natural exit point:  "Gotta go put the groceries in the fridge/start dinner, talk to you later."  And if she's not available, you can leave a short message on voicemail, something like, "Just checking in, I'll try again next week."  If she calls back and it's not convenient for you, just let her go to voicemail and call back on your schedule.  Does that sound more doable?

I'm so sorry that you're in this position and a lot of folks here can relate.  I think you're doing the right thing though and you shouldn't try to solve problems for someone who's causing the problems to begin with.

I would say, "Hopefully you can find a better doctor for your situation," and leave it at that.  If they want to file complaints, so be it.  I certainly wouldn't be the one to help them though.

As for the "listening, affirming all day" part, do you live with this person?  If not, then you shouldn't put yourself in the center of their internal drama.  While you may not be mentally ill, these types of conversations over and over again certainly have an effect on our mental health.  It's better to put some distance between yourself and the "problems" that keep occurring.

Hi again,

Well I think you have a very good read of the situation, and you're doing great, though the situation is unsettling.  I noticed too that abuse of substances made my BPD stepdaughter's behavior much worse.  She was self-medicating, believing she'd numb herself from her issues, when in actuality she made herself more dysfunctional, more paranoid and more emotionally off-kilter.  After daily use of substances over an extended period, I noticed some deterioration in her verbal skills, too.

I like the idea of you keeping the lines of communication open, but not responding when your daughter is being abusive.  You're right, she doesn't want your advice, and she is blaming you.  When she's in a state, she can't process anything you have to say anyway.  It's all part of her victim attitude and blame-shifting.  And yes, she's channeling her out-of-control rage your way.  Maybe she's doing this because she needs a release, and she knows that nobody else in the world will tolerate it.  But if things continue to spiral, she might unleash her rage onto others, which means she'll probably end up friendless, jobless and maybe even homeless.  Maybe then she'll hit bottom, where her only option will be to get some professional help.  Now I'm not suggesting that you should tell your daughter that you suspect BPD or mental illness, because as you've seen, she'll take it the wrong way and also accuse you of being the sick one (that's projection, by the way).  But if she mentions getting therapy, I'd try to frame it in a supportive and non-accusatory way ("That's mature of you, taking care of yourself is important," or maybe, "Getting therapy to cope with trauma sounds like a good idea, it couldn't hurt," or maybe "Doctors are professionals, they help people feel better, that's their job."

I think you ARE being emotionally supportive, with this approach:  "I love her very much, but I cannot tolerate verbal abuse and threats on my livelihood."  You stick to that boundary, and maybe, eventually, your kid will figure out that, in order to have a closer relationship with you, she needs to be respectful.  The thing is, with BPD, her emotional intelligence is impaired, and she's a slow learner (in terms of learning how to self-soothe, how to process her emotions in a healthy way, and how to problem-solve and communicate more effectively).  DBT therapy is designed to improve these skills.

Look, I realized I had to make a shift with the emotional support I was providing to the pwBPD in my life.  At first, I had a tendency to try to fix things, to try to help her out (e.g. with a job search).  But she didn't really want the type of help I was providing; she just wanted my money, and to do whatever she wanted.  I thought, OK, she's an adult, if she wants my advice, she'll ask for it; any unsolicited advice I provide she'll take as insulting or condescending.  She wants to go her own way, and I'll support that from an emotional standpoint.  So when she declares her intentions--"I want to move to New York City" or "I want to volunteer in Gaza"--I'll say something like, "I can see why you'd like to do that."  And that's it.  The "old me" would have peppered her with questions, cautioned her about safety, high costs and long-term commitments.  The "old she" would expect me to help her find a place to live, buy plane tickets, co-sign a lease and help move her in.  But hey, she's in her late 20s, if she wants to move to NYC or Gaza(?!), she has to be the one to make it happen.  My guess is, if she really wants it, she'll take some steps forward, and if not, she'll decide to do something else, all by herself.  And that's OK.  In fact, it's better than OK, because she is the commander of her life, not me, not her dad, not anyone else.

It's such a balancing act and there's not a "perfect" answer here because every person is a little bit different.  But as a general rule, when you're receiving abuse, then back off. 

If they persist, make it solely about you (and your boundaries).  I can't do this right now...I need to calm down and clear my head...I don't want to argue and can't continue this conversation.  Make it 100% all about you.  For the words about her, it should be "I love you and..<then the 'you statement'>."

What you shouldn't say is, "I love you BUT you're being ridiculous right now."  In that instance, all they hear is "you're ridiculous".  The rest literally goes right out the window.  This happens because they're thinking emotionally and everything is super intense in the moment.  When they're in this kind of state, there's no logic involved and it will never be a productive conversation.

So you go with the tried and true <me statements> balanced out with <you statements> that show you care and they have your sympathies that they're having a bad day.

What if your "me statements" don't work?  That's when you go no contact (or very low contact), and it could be for a few hours, days, or weeks.  The timing is really determined by them because you'll remain limited contact until they can speak to you in a civil, respectful manner.  I'll usually give my BPD kid a few rude statements for free, but after that I start my "me statements" and begin pulling away.

Thank you for your words of wisdom and insights! I am not supporting her financially and I won’t. The only support I have been giving her is emotional support and that has backfired because she is now dysregulated and splitting and she blames me for everything wrong in her life. I told her to please get some help and she says I am the one who needs help. She doesn’t want to have a conversation. She wants to rage. She has been quiet for a week, but then reached out over text last night to once again blame me for her depression and lack of support. I love her very much, but I cannot tolerate verbal abuse and threats on my livelihood. I guess I just want to know if I should respond or be silent. I did not respond last night. I feel like anything I say sets her off because she’s in such a spiral. I also believe she is abusing substances, which is exacerbating her out of control rage. Any advice on the best way for me to move forward would be much appreciated.

I'm back, 2 days in a row. My family member has a few medical issues that need attending to but the problem is she doesn't have a regular General practitioner because she's written all the ones she's seen, off. I thought she'd finally found one but she now doesn't like him. She goes to them once and never goes back. Now she is wanting to make a formal complaint about 2 or 3 Medical professionals. She feels she's so upset that she can't go back. So there I am listening, affirming, all day. She's mulling over it all, big time. I can't say anything or else I'll be in the bad books too. It's so frustrating seeing all this when I know these Medical issues can be sorted out. But, she's an adult.. and I  had decided that zipping the lips was the best scenario.

My 35yr old has BPD, I think. She had my grandson 3 years ago. I was her person,helped her and took care of him. Than i wasn't. She split my family, no showed at Christmas and two days later slapped me with a restraining order claiming domestic violence.  She spent the next 9 months filing fraudulent restraining orders against me a d my husband to obtain housing vouchers. All of the restraining orders were thrown out. I have not seen her or my grandson for almost two years now. I'm heart broken, and struggling in ways I never thought possible. I did not mention the long 20 year history of suicide attempts,  rescuing her from different states which all came with some dramatic story. This last time was it for me, mentally I can't do it anymore.  Than my mother, my daughters enabler told me today that she planned to have my daughter around again and I would have to accept it. I feel like I will have to grieve my mother and move on because the wreckage is just to much. Not sure what to do but I like I'm going 10 steps back.

So I take it you don't have a custody order from the court, and have been winging it so far? 

I hope you've been documenting all this. 

One thing I did that worked out well in my favor was have the court designate a therapist, because I knew BPDxw would otherwise "shop around" until she found a therapist that she could control.  So what I did was have a good child psychologist my attorney knew vet a list of reputable therapists in our area - ones who were professional and would not be bullied by a parent.  Then we gave this list to BPDxw and let her choose.  That allowed her to feel "in control" enough to go along with it.

Now, sending our daughter to therapy had been her idea in the first place, but after a couple visits, once she saw that: 1) she could not bully the therapist, and 2) it would still cost her money/co-pays for visits, she sent me a message saying she thought therapy was a waste of time, and would not take her anymore.