I’m very certain my mom has BPD but she’s in denial. How do I help her?

[infinitelytired]

  My mom fits almost all of the characteristics of BPD except for the unstable sense of self and paranoid thoughts. Being around her is incredibly exhausting. We’ll be good for a couple weeks and then either myself or my siblings will do something to set her off and suddenly we’re the worst people on earth to her. This is usually accompanied by a disproportionate display of anger from my mom, verbal abuse, and then days of passive aggressiveness until she’s over it. Once she’s over it, we’re supposed to carry on like nothing happened. And then it’ll happen again. And again. And again.

We’re at our wits end. This endless cycle is utterly exhausting and multiple interventions have been futile because she believes that we are all the problem and that we need to change so that we don’t provoke her. But it’s impossible because we honestly have no idea what’s going to set her off on her next rampage.

I want her to get the help she needs and recognize that she exhibits behaviors consistent with BPD but this is hard because she’s so quick to point the finger at everything everyone else needs to change. I know that her insecurity is preventing her from taking an honest look at herself and her own actions, and that she’s hypersensitive to what everyone else is doing, but we’re just so tired. I’m not sure what else to do.

I guess my question is: what’s the best strategy for getting someone who’s in denial about anything being wrong with their behavior (she attributes these unhealthy behavior patterns as part of her personality. Normal, in other words, because she’s so used to dealing with things this way) to recognize that they have BPD and seek directed treatment so that we can all work together towards healing as a family?

[missing NC]

Hi infinitelytired,

I love your handle and can relate to it and the denial and fingerpointing aspects of your experience.  You are really wise to look at the situation as something to be solved together with your mom. 

There are three parts to her "upsets," and you have varying degrees of control or lack of control over each. These are the trigger, her intial reaction and your response to her intial reaction. 

I know from experience how easy it is for seemingly anything and everything to trigger a pwBPD.  So it's not realistic to think you can eliminate all triggers.  However, if you and your sibling brainstorm, you could probably generate a list of common triggers and come up with ways of reducing those topics and/or rapidly changing the subject.  You need to establish what was described to me as a "therapeutic" relationship with her which is highly filtered and does not feature the type of authenticity you enjoy in your other relationships.

The second aspect of an "upset" is her reaction.  This is not within your direct control.  I understand the desire to get a pwBPD to understand that he or she needs help, and I banged my head against that proverbial brick wall in the past.  You are no doubt familiar by now with their black and white/all good all bad thinking.  In your mom's mind, if you are telling her that she needs help, that means she is bad in some way. So if she is a pwBPD, that means - in her mind - that she is all bad, which is an overwhelmingly painful admission. There is a slight chance you'd have some luck getting her to see a therapist who specializes in DBT if you go together and position it as some form of family therapy. It doesn't sound like she is willing to entertain the idea of a full-blown treatment approach for herself.  There is now a podcast, Therapists in the Wild, that features two therapists applying DBT techniques to their own challenges. You and your siblings might find it of interest, but I'm not sure it would resonate with someone your mom's age. 

The last step in an "upset" is your response to her reaction.  Here is where you have the most control.  This is where the Survival Skillsthrough BPD Global and Family Connections training through NEABPD place the bulk of their emphasis.  It's also where S.E.T. (support, empathy, truth) in the reading on this site and E.A.R. (empathy, attention, respect) in Bill Eddy's writings come into play. They are variations on recognizing the need to validate your mom's feelings to decrease her emotional arousal.  I've looked at some of the research on how validation, if done skillfully, decreases emotional arousal in pwBPD and find it quite compelling.  The hard part is what they term in Survival Skills "zipping up your raincoat" or "putting on your PPE" as the pwBPD unloads their fury on you. 

It's fortunate that you are not alone within your family in dealing with your mom.   You'll also find a number of individuals on the board with many years of experience grappling with similar issues. 

[Methuen]

what’s the best strategy for getting someone who’s in denial about anything being wrong with their behavior to recognize that they have BPD and seek directed treatment so that we can all work together towards healing as a family?

My short answer is you probably can't.    Sounds like a great goal, and a win-win for everyone.  But if that worked for BPD, this site wouldn't have so many members.

Trying may escalate the problem, which it sounds like you already know.

Great response from NC already.  To that I would add that what has worked for me is three things:
- educating myself about BPD, and learning new relationship skills to navigate around the intense emotional roller coaster "feelings" (fear, anger, rage etc) of my uBPD mom.  (To be fair sometimes her feelings could be intensely positive too, but this is usually followed by a crash where she would dump her feelings on me)
- accepting that the only thing I could change (that I am in control of) is how I react to her.
- letting her make her own choices (even when I think they are bad ones), and learning herself from the consequences of her own choices.  This lets her have complete control, and means she doesn't feel invalidated by my disagreeing with her choices.  I may ask her validating questions, but I never give advice any more.  

I use SET, no JADEing, validating questions, boundaries, radical acceptance, and I'm now a believer in mindfulness and self-care. I also have less contact than I've ever had before (about 2X/week) , and it's currently working.  She's 84, very frail, and chooses to live independently rather than go into assisted living which she qualifies for.

I want her to get the help she needs and recognize that she exhibits behaviors consistent with BPD but this is hard because she’s so quick to point the finger at everything everyone else needs to change.

I can completely relate to the cycling you describe. My mom use to RAGE at me.  In my experience, if you try to rationalize and explain to pwBPD, it will go very badly, ie  if you try to change her ... well this might be a non-starter, and do more damage.   If you try to change yourself, it will go a lot better.