How Borderline Personality Disorder Affects Relationships

One hallmark of borderline personality disorder (BPD) is interpersonal hypersensitivity—which is a technical way of saying that many BPD patients have trouble being in healthy, secure, and mutually beneficial relationships with others. According to the Journal of Personality Disorder, BPD patients have “intense needs for closeness and attention,” but at the same time they also possess “equally intense fears of rejection or abandonment.”

That can make forming and maintaining close bonds—romantic, platonic, or professional—extremely difficult for someone with BPD. It can also be extremely hard on husbands, wives, friends, family members, and other loved ones.

“There is often a sense of frustration and helplessness on both sides of the equation,” Brandon Unruh, MD, assistant medical director at the Harvard-affiliated McLean Hospital’s Gunderson Residence, a program for women with severe personality disorders, tells Health. “It’s important that we work with everyone involved to help them understand each other, and understand this disease, better.” Here are some ways BPD can wreak havoc on relationships, and what patients and their loved ones can do to about it.

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

People with BPD may scrutinize every detail of a conversation or an interaction, and they believe they can pick up on very subtle emotional cues. “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,” says Dr. Miari. “Their goal is to avoid feeling the state of emptiness or anger or despair they perceive if they feel rejected.”

“People with BPD are looking to their relationships to be the answer to all of their interpersonal and emotional needs,” says Dr. Unruh. They tend to look for “perfect” relationships, he adds, and their expectations often don’t match up so much 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,” he continues. This can lead to burnout, anger, confusion, and misunderstanding on the part of family members or partners.

“Some of the stigma around this disease is that people with BPD are just manipulative or are just selfishly trying to get attention,” Dr. Unruh says. “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 met.”

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. Partners often learn that the hard way, says Dr. Miari, which leads them to feel like they’re walking on eggshells and can’t discuss serious issues without experiencing major conflict. They may even be worried their partner will harm themselves.

That’s why it’s important for partners and loved ones to be involved with a patient’s treatment, so they can learn how to react in certain situations. They 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,” D. Bradford Reich, MD, an attending psychiatrist at McLean Hospital in Belmont, Massachusetts, tells Health. “Even though you want to be supportive, in the end it’s the patient who needs to be responsible for themselves.”

“People with BPD have a tendency to view people, and themselves, in very black or white terms,” says Dr. Miari. “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,” she says.

There’s 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,” says Dr. Miari. “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.”

Family involvement is an important part of treatment, but it’s not always an easy thing to achieve. “Many people come alone to treatment,” says Dr. Unruh. “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 says there are reading materials and online resources they can turn to “to learn about what’s going on with their loved one, in an empathetic way.” This can be a good first step, he says, 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, says Mr. 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,” she says. “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,” says Dr. Miari, “and may help improve other relationships in the patient’s life as well.”

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,” says Dr. Unruh.

Some BPD patients will still struggle with relationships, he adds, especially while going through stressful periods in their life. “But in those times, they can always come back to treatment for extra support,” he says.