BPD

Borderline Personality Disorder & Cyclothymic Disorder
Borderline Personality Disorder Symptoms

A person who suffers from this disorder has labile interpersonal relationships characterized by instability. This pattern of interacting with others has persisted for years and is usually closely related to the person's self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) in a person's affect, or feelings. Relationships and the person's affect may often be characterized as being shallow. A person with this disorder may also exhibit impulsive behaviors and exhibit a majority of the following symptoms:

� frantic efforts to avoid real or imagined abandonment.
� a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
� identity disturbance: markedly and persistently unstable self-image or sense of self
� impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
� recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
� affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
� chronic feelings of emptiness
� inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
� transient, stress-related paranoid ideation or severe dissociative symptoms

Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

Cyclothymic Disorder Symptoms

For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year.
During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms above for more than 2 months at a time.
No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance. Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).
The symptoms in the first paragraph are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

What is Borderline Personality Disorder (BPD)?

A borderline writes:
"Being a borderline feels like eternal hell. Nothing less. Pain, anger, confusion, hurt, never knowing how I'm gonna feel from one minute to the next. Hurting because I hurt those who I love. Feeling misunderstood. Analyzing everything. Nothing gives me pleasure. Once in a great while I will get "too happy" and then anxious because of that. Then I self-medicate with alcohol. Then I physically hurt myself. Then I feel guilty because of that. Shame. Wanting to die but not being able to kill myself because I'd feel too much guilt for those I'd hurt, and then feeling angry about that so I cut myself or O.D. to make all the feelings go away. Stress!"
Therapists use a book called "Diagnostic and Statistical Manual" (DSM) to make mental health diagnoses. They've outlined nine traits that borderlines seem to have in common; the presence of five or more of them may indicate BPD.

However, please note the following:

� Everyone has all these traits to a certain extent. Especially teenagers. These traits must be long-standing (lasting years) and persistent. And they must be intense.

� Be very careful about diagnosing yourself or others. In fact, don't do it. Top researchers guide patients through several days of testing before they make a diagnosis. Don't make your own diagnosis on the basis of a WWW site or a book!

� Many people who have BPD also have other concerns, such as depression, eating disorders, substance abuse � even multiple personality disorder or attention deficit disorder. It can be difficult to isolate what is BPD and what might be something else. Again, you need to talk to a qualified professional.
DSM-IV Definition of BPD

1. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

2. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating
behavior covered in (5).

3. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."
Following is a definition of splitting from the book I Hate You, Don't Leave Me by Jerry Kreisman, M.D. From page 10:

The world of a BP, like that of a child, is split into heroes and villains. A child emotionally, the BP cannot tolerate human inconsistencies and ambiguities; he cannot reconcile anther is good and bad qualities into a constant coherent understanding of another person. At any particular moment, one is either Good or EVIL. There is no in-between; no gray area....people are idolized one day; totally devalued and dismissed the next.
Normal people are ambivalent and can experience two contradictory states atone time; BPs shift back and forth, entirely unaware of one feeling state while in the other.
When the idealized person finally disappoints (as we all do, sooner or later) the borderline must drastically restructure his one-dimensional conceptionalization. Either the idol is banished to the dungeon, or the borderline banishes himself in other to preserve the all-good image of the other person.
Splitting is intended to shield the BP from a barrage of contradictory feelings and images and from the anxiety of trying to reconcile those images. But splitting often achieves the opposite effect. The frays in the BP's personality become rips, and the sense of his own identity and the identity of others shifts even more dramatically and frequently.

4. Identity disturbance: markedly and persistently unstable self-image or sense of self.

5. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).

6. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

7. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

8. Chronic feelings of emptiness.

9. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

10. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality," whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"), or other, more disconnected actions. It is the opposite of "association" and involves the lack of association, usually of one's identity, with the rest of the world.
There is no "pure" BPD; it coexists with other illnesses. These are the most common. BPD may coexist with:

� Post traumatic stress disorder (PTST)

� Mood disorders

� Panic/anxiety disorders

� Substance abuse (54% of BPs also have a problem with substance abuse)

� Gender identity disorder

� Attention deficit disorder
�
Eating disorders

� Multiple personality disorder

� Obsessive-compulsive disorder
Statistics about BPD

BPs comprise:
� 2% of the general population

� 10% of all mental health outpatients

� 20% of psychiatric inpatients

� 75% of those diagnosed are women

� 75% have been physically or sexually abused

Causes and Treatment for BPD
Causes
� Impaired brain chemistry (treated with medications). The neurotransmitters dopamine, serotonin, acetylcholine, and norepinephrine may be involved.

� Early environmental influences (anything from long-term isolation for an early infectious disease to severe physical or sexual abuse).

� Triggers that bring on symptoms (such as divorce or adolescent traumas).
Treatment
When a person with BPD allows themselves to be treated (denial is often part of the disorder), treatment generally consists of:

� Medications, which are often successfully used to reduce depression, dampen emotional ups and downs, and put the brakes on excessive impulsivity. Antidepressants can help with depression, while mood stabilizers such as Depakote, Tegretol, or Lithium can help with mood swings. Selective Serotonin Re-uptake Inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil may help control impulsivity, as may Effexor, a related antidepressant. Tegretol may be helpful for controlling excessive anger and irritability.

� Therapy, especially cognitive-behavioral therapy. The major problems are finding a qualified therapist and getting the BP into therapy. Researcher Marsha Linehan�s cognitive-behavioral method of treatment, called Dialectical Behavior Therapy (DBT), has been shown in empirical research to help BPD patients experience less anger, less self-mutilation, and fewer inpatient psychiatric stays than patients who received other forms of treatment. For more on DBT. see http://faculty.washington.edu/linehan/

Statistics and Facts about BPD
BPD patients make up 20% of the inpatients in the mental health system and is the fastest growing population
BPD makes up 11% of the outpatients in the mental health system
BPD has a 10% suicide rate.
70% of the hundreds of people on family and friends (non-BP) support groups sought the help of therapists.
PD is cormobid (occurs along with) major depression, bipolar disorder, substance abuse, and eating disorders.
The Diagnostic and Statistical Manual 1V, published by the American Psychiatric Association, lists the incidence of BPD in the general population as 2%. This is 50% more common than Alzheimer's disease and nearly that of bipolar disorder and schizophrenia combined. However, the statistic of 2% cannot be accurate for the following reasons: clinicians are actively discouraged from putting BPD on a patient's chart because of the stigma and insurance denials and because most clinicians do not have the training to make a diagnosis.
The latest research findings indicate that many of the core traits of the severe personality disorders like BPD (e.g., impulsiveness and mood swings) appear to have neurobiogical underpinnings.
Although BPD has been shown to have neurobiogical underpinnings and an article about this appeared in a newsletter published by the National Alliance for the Mentally Ill (NAMI), NAMI has not included BPD in its advocacy efforts. (NAMI advocates for five brain disorders: schizophrenia, bipolar, mood disorder, obsessive compulsive disorder, and panic attacks.) As we said above, BPD is 50% more common than Alzheimer's disease and nearly that of bipolar disorder and schizophrenia combined

Brainwashing effects on non-BPs
A definition of non-BP
How 24 Million Non-BPs are "Brainwashed"
A definition of non-BP
The term �non-borderline� (non-BP) does not mean �person who doesn�t have BPD.� Rather, it is shorthand for �relative, partner, friend, or other individual who is affected by the behavior of someone with BPD.� Non-BPs can be in any type of relationship with someone who has BPD. Non-BPs we interviewed were married partners, unmarried partners, friends, children, parents, siblings, daughter-in-laws, aunts, cousins, and co-workers of people with BPD.

How 24 Million Non-BPs are "Brainwashed"
Some people who enter into relationships with borderlines feel brainwashed by the BP�s accusations and criticisms. The techniques of brainwashing are simple: isolate the victim, expose them to consistent messages, mix with sleep deprivation, add some form of abuse, get the person to doubt what they know and feel, keep them on their toes, wear them down, and stir well.
The following are some ways in which this happens.

� Continual blame and criticism: Family members have been raged at and castigated for such things as carrying a grocery bag the wrong way and having bedsheets that weighed too heavily on the BP�s toes. One son who "ate too fast" was not allowed to join the family at dinner for 15 years. The criticism often crosses the line into emotional or physical abuse.

� Splitting: BPs have a hard time seeing gray areas. To them, people and situations are all black or white, wonderful or evil. Dividing the world into good or evil makes it easier for BPs to understand. But it means that if you don't agree with everything the BP says, you are a horrible person who is against them.

� Extreme Projection: Lacking a clear sense of who they are and feeling empty and inherently defective, people with BPD feel lonely and in excruciating pain. So they may cope by denying their own unpleasant traits, behaviors, or feelings by attributing them (often in an accusing way) to someone else. For example, the borderline may say (with real meaning in parentheses):
o "You think I�m controlling? You�re the one who�s so controlling!" (I feel like I�m losing control right now and it scares me.)
o "Stop screaming at me!" (I am so angry that I need to scream at you right now.)
o "You never consider my needs. You�re always thinking about yourself." (My needs are so overwhelming to me that I can�t think about yours.)
o "If you had taken my calls at work, I wouldn�t have had to call you at three o�clock in the morning at home." (I need to talk with you so badly that I�ll do anything to reach you.)

� Narcissistic Demands: Paying attention to themselves and their own needs, often to the extreme. For this reason, BPs sometimes have a hard time when other people are the focus of attention, such as birthday parties. BPs may also have a hard time giving support when it is needed (such as a partner�s illness)

� Apparent Manipulation: People who are about someone with BPD often feel manipulated and lied to. This may be the result of BP's of trying to get what they want the only way they know how--through emotional blackmail. This usually is not purposeful. Rather, it is the result of the BP not being as skilled in relating to others. Non-BPs are often prone to the BP's use of fear, obligation and guilt and give the BP what they want.
Learning to take care of yourself
The following excerpt from the book The Emotionally Abused Woman: Overcoming Destructive Patterns and Reclaiming Yourself will explain how you can begin taking care of yourself . It may also help you figure out something that may keep you in an abusive relationship. The book is by Beverly Engel, MFCC. It was published in 1990 by Ballantine Books, is $10 soft cover, and is about 230 pages. Although the book is directed at women, it applies equally to both sexes:
If you are in an emotionally abusive relationship, you will need to learn how to take care of yourself. You will need to learn how to stop rescuing, to set your personal limits and boundaries, and how to be assertive.
One of the reasons you may have been so attractive to an emotionally abusive person is that it has been clear from the start that you could be manipulated into taking care of him, and furthermore, that his needs were more important than yours. One of the most important things you can do is to begin to put your own needs first.

If you learned as a child that your needs were unimportant, you may believe that taking care of yourself is a selfish act. But your highest responsibility is to yourself. When you take care of your own needs first, you will be able to be a genuinely caring, giving person, not a martyr. Although it will be uncomfortable at first, and you may be afraid that others won't like you unless you are giving to them, keep trying. [Note: the book then gives more specific information on how to begin this process.]
If you are going to begin setting and enforcing additional boundaries with someone who has BPD, we strongly advise learning all you can about the disorder, becoming educated about boundaries, and talking with a professional therapist. A borderline might feel threatened by new boundaries and might react in ways you cannot anticipate. We suggest you choose a therapist who understands BPD (see "Programs and Therapists" for guidelines.)

The following is from another section of the book:
Some types of people are attracted to people who are emotionally abusive. They complain, blame, and try to control. Yet they continue to allow others to hurt them. In reality, they are more comfortable complaining and feeling resentful than acknowledging how very hurt and angry they are. They push their thoughts and feelings out of awareness by focusing all their energy on other people. They stay busy so they won't have to think about things and face reality. They ignore problems and pretend they aren't happening. They pretend that things aren't as bad as they really are.
The irony is that as much as a "codependent" feels responsibility for others and takes care of others, she believes deep down that other people are responsible for her. She blames others for her unhappiness and problems, and feels that it's other people's fault that she's unhappy.
Another irony is that while she feels controlled by people and events, she herself is overly controlling. She is afraid of allowing other people to be who they are and of allowing events to happen naturally. An expert in knowing best how things should turn out and how people should behave, the codependent person tries to control others through threats, coercion, advice giving, helplessness, guilt, manipulation, or domination.
Are you codependent? Author Melody Beattie (Codependent No More) developed this list:

� Do you feel responsible for other people--their feelings, thoughts, actions, choices, wants, needs, well-being and destiny?

� Do you feel compelled to help people solve their problems or by trying to take care of their feelings?

� Do you find it easier to feel and express anger about injustices done to others than about injustices done to you?

� Do you feel safest and most comfortable when you are giving to others?

� Do you feel insecure and guilty when someone gives to you?

� Do you feel empty, bored and worthless if you don't have someone else to take care of, a problem to solve,
or a crisis to deal with?

� Are you often unable to stop talking, thinking and worrying about other people and their problems?

� Do you lose interest in your own life when you are in love?

� Do you stay in relationships that don't work and tolerate abuse in order to keep people loving you?

� Do you leave bad relationships only to form new ones that don't work, either?

If you answered "yes" to more than half these questions, you're probably codependent.

We're not suggesting that codependency is the only reason you may be in a chosen relationship with a borderline. There are many many others, including the fact that the BP has many good qualities that drew you to him or her in the first place!
Emotional/Verbal Abuse and BPD
Many non-borderlines are verbally or emotionally abused by the person who has BPD. Many (but not all) people who have BPD were also verbally abused at some time in their lives. Emotional abuse is insidious. It can be worse than physical abuse.
So what is it? Read the following excerpt from the book The Emotionally Abused Woman: Overcoming Destructive Patterns and Reclaiming Yourself. It's by Beverly Engel, MFCC. It's about 230 pages. Although the book is directed at women, it applies equally to both sexes.
Keep in mind that this book was written for women who are victims of domestic abuse, not for people in BPD situations. Although borderlines may act emotionally (and even physically) abusive, it's crucial to understand that they are not usually trying to harm you. Rather, they are acting out of intense pain, fear, and shame using primitive defenses they may have learned long ago. Moreover, borderlines feel as though they cannot control these reactions.

However � and here's an important point � for the non-borderline, the reactions to the abuse are the same. If, after reading this, you feel trapped in an emotionally abusive relationship, please get help. If a child in your home is experiencing this kind of abuse, please do all you can to protect them from its harmful effects.
Emotional abuse is any behavior that is designed to control another person through the use of fear, humiliation, and verbal or physical assaults. It can include verbal abuse and constant criticism to more subtle tactics like intimidation, manipulation, and refusal to ever be pleased.
Emotional abuse is like brainwashing in that it systematically wears away at the victim's self-confidence, sense of self-worth, trust in her perceptions, and self-concept. Whether it be by constant berating and belittling, by intimidation, or under the guise of "guidance" or teaching, the results are similar. Eventually, the recipient loses all sense of self and all remnants of personal value.
Emotional abuse cuts to the very core of a person, creating scars that may be longer-lasting than physical ones. With emotional abuse, the insults, insinuations, criticism and accusations slowly eat away at the victim's self-esteem until she is incapable of judging the situation realistically. She has become so beaten down emotionally that she blames herself for the abuse. Her self-esteem is so low that she clings to the abuser.
Emotional abuse victims can become so convinced that they are worthless that they believe that no one else could want them. They stay in abusive situations because they believe they have nowhere else to go. Their ultimate fear is being all alone.

Following are types of emotional abuse:

� DOMINATION: Someone wants to control your every action. They have to have their own way, and will resort to threats to get it. When you allow someone else to dominate you, you can lose respect for yourself.

� VERBAL ASSAULTS: berating, belittling, criticizing, name calling, screaming, threatening, excessive blaming, and using sarcasm and humiliation. Blowing your flaws out of proportion and making fun of you in front of others. Over time, this type of abuse erodes your sense of self confidence and self-worth.

� ABUSIVE EXPECTATIONS: The other person places unreasonable demands on you and wants you to put everything else aside to tend to their needs. It could be a demand for constant attention, frequent sex, or a requirement that you spend all your free time with the person. But no matter how much you give, it's never enough. You are subjected to constant criticism, and you are constantly berated because you don't fulfill all this person's needs.

� EMOTIONAL BLACKMAIL: The other person plays on your fear, guilt, compassion, values, or other "hot buttons" to get what they want. This could include threats to end the relationship, the "cold shoulder," or use other fear tactics to control you.

� UNPREDICTABLE RESPONSES: Drastic mood changes or sudden emotional outbursts (This is part of the definition of BPD). Whenever someone in your life reacts very differently at different times to the same behavior from you, tells you one thing one day and the opposite the next, or likes something you do one day and hates it the next, you are being abused with unpredictable responses.
This behavior is damaging because it puts you always on edge. You're always waiting for the other shoe to drop, and you can never know what's expected of you. You must remain hypervigilant, waiting for the other person's next outburst or change of mood.
An alcoholic or drug abuser is likely to act this way. Living with someone like this is tremendously demanding and anxiety provoking, causing the abused person to feel constantly frightened, unsettled and off balance.

� GASLIGHTING: The other person may deny that certain events occurred or that certain things were said. You know differently. The other person may deny your perceptions, memory and very sanity. (If a borderline has been disassociating, they may indeed remember reality differently than you do.)

� CONSTANT CHAOS: The other person may deliberately start arguments and be in constant conflict with others. The person may be "addicted to drama" since it creates excitement. (Many non-BPs also are addicted to drama.)

Causes and Treatment of BPD

(From Stop Walking on Eggshells, 1998, New Harbinger, Randi Kreger and Paul T Mason, MS)

According to John M. Oldham (1997), BPD, like many mental disorders, is caused by a combination of genetic influences and environmental circumstances. Yet many clinicians, and many of their patients, believe that BPD almost always stems from a childhood of physical or sexual abuse. So pervasive is this myth that one BPD treatment program diagnoses patients with BPD only if they come from abusive backgrounds.

Trying to diagnose BPD by the presence of childhood trauma flies in the face of current research. John D. Preston (1997) notes that 20-25 percent of borderline patients come from intact families without evidence of severe early stress or trauma. And, according to prominent BPD psychiatrist Kenneth R. Silk (1997), preliminary research suggests that BPD behavior may be influenced by neurotransmitter disturbances.

Neurotransmitters

Neurotransmitters carry the signals between all the nerve cells in the brain. According to Madeleine Nash (1997), they are "the most mind-bending chemicals nature has ever concocted." They underlie every thought and emotion, as well as memory and learning. About fifty different neurotransmitters have been discovered thus far.

The neurotransmitter dopamine involves thinking. Impulsivity and aggression are associated with serotonin, mood stability with acetylcholine, and sensitivity to the environment with norepine-phrine. People with BPD may have difficulties in all of these areas.

However, physicians cannot at this point simply prescribe medications to "correct" each of these neurotransmitters. Silk writes, "Neurotransmitters work in subtle ways and the level of one may directly or indirectly effect the level of another, and thus what is true in the lab does not translate directly into what is true, wise, or useful in a person."

Medications

Medications are often successfully used to help people with BPD by reducing depression, dampening their emotional ups and downs, and putting the brakes on excessive impulsivity. According to Larry J. Siever (1997) antidepressants can help with depression, while mood stabilizers such as Depakote, Tegretol, or Lithium can help with mood swings. Selective Serotonin Re-uptake Inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil may help control impulsivity, as may Effexor, a related antidepressant. Tegretol may be helpful for controlling excessive anger and irritability.

These medications must be carefully titrated; that is, the right dose must be found for each person so that it helps relieve distressing symptoms without causing troubling side effects.

How can I help the BP in my life?

This article was written by Randi Kreger, coauthor (with Paul Mason, MS), of "Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has BPD." Kreger is also co-author of the booklets Hope for Parents, Love and Loathing, and Walking on Eggshells.
Before you knew about BPD, you were probably very confused about the behavior of the person with BPD (BP) in your life. Now that you know it is a treatable disorder, it's understandable that you want to help that person and get them into the best treatment program available.

If the BP acknowledges that they need help and wants treatment, you can help them find the most knowledgeable, experienced treatment program available. You can also recommend books about BPD such as "Lost in the Mirror" or "The Angry Heart."

But if the BP in your life blames you for all the problems in the relationship; constantly criticizes you; or is physically, sexually or emotionally abusive, I recommend an entirely different tact.

First, I do not recommend that you tell them that you suspect that they have BPD. 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. Frequently, the possible borderline will accuse you of having BPD.

The complete opposite may also happen: the possibly borderline person may feel such shame and despair that they attempt to hurt themselves. Or, they may use the information to deny responsibility for their behavior--"I can't help myself; I'm borderline."

You cannot force someone to want to change their behavior. After all, they are not just 'behaviors' to the person suffering from the disorder-they are coping mechanisms they have used all their life. Generally, it's preferable that the person learn about BPD from a therapist--not from you.

When people say they want to "help" the BP, they usually mean they want to change the BP. This is impossible--people can only change themselves--but that doesn't stop people trying the same things for years and years. Following are some of the methods people use.

Although some of these methods may sound illogical, they're extremely common and part of human nature. Read these and be honest with yourself and ask yourself if you have been doing some or all of them. The purpose of the exercise is to make the unconscious patterns conscious decisions, not to berate you for faulty thinking. Ask yourself:

* Do you want to keep doing this? How has it affected you, the BP, and any kids?

* Has any of this actually worked in the long term? More than a day, a week?

* If no, why repeat the technique when it has not improved the situation?

* If yes, think hard: Was it really you who changed the BP, or did the BP make the decision (for whatever reason) to make a change themselves?

Here are the techniques:

* Explain all the logical reasons for the BP doing what you want/don't want.
Repeat.

* Explain all the emotional reasons for doing so. Repeat.

* Make threats for the hundredth time. Do not carry them out. Do it again.

* Pay no attention to your own life. Fixing the BP is what matters. Then you will be happy.

* Wait for a miracle to develop on its own without clinical intervention. You never know.

* Remind yourself that the BP you fell in love with is the real, true BP and that you can change this "alien person's" behavior if you discover the right formula.

* Ignore behavior you find totally unacceptable. A person like you would never have fallen in love with someone capable of this, so it can't really be happening.

* Keep changing yourself according to the BP's wants and needs until you make them happy. If they are unhappy, you must not have changed yourself in the right way. Try again. Repeat.

* Break up with the person. Come back when they tell you they will change. Break up with the person when the behavior this time. Break up with the person when the behavior starts again. Come back when they tell you they will really, really change this time. Repeat for the next several years.

* Try to convince them they really have a disorder. Argue endlessly about the fact that they think you're the sick one. Repeat this conversation in a variety of ways, places, and circumstances. See who can get the most people on their side. Repeat.

* Stop asking for anything in the relationship. Stop talking. Don't make comments or let the BP know what you think. This will avoid a variety of fights and work for you in the long term.

* Make sure everyone thinks you have a wonderful relationship and that everything is OK. If you say it enough times, it will be true. Besides, a bad relationship would make you look bad. If you ever do separate or divorce, this will also ensure no one will believe your partner could be capable of such things.

* Repeat this like a mantra: a bad relationship is better than none at all. To be by yourself shows you're a failure and would really make you intolerably unhappy. This thought is especially useful during BP raging.

* Whatever the BP does, escalate it. If they yell, you rage. If they push, you shove. If they hit, you smack. It feels good and they deserve it anyway.

* Remember, no one will ever love you as much as the BP. They have demonstrated their love repeatedly. And no matter what they do, they are not responsible for their behavior (after all, they have BPD) so no one will ever love them as much as you do or be able to change them and make them happy.

* When the BP calls you on the phone, rages, shows up at your door, or acts abusive when you're with them, remember you have no choice but to sit there and take it. Keep listening. Listen some more, no matter how it makes you feel. If it doesn't make sense, it will soon. Either that, or you will be able to rationally convince them of the truth. Besides, if you set a limit or left you'd only get into more trouble when they accuse you of "abandoning" them.

* Seek professional help from people who know less about BPD than you do. They are the professionals and should know. Do what they say even if your intuition tells you its the wrong thing.

* When your friends and family all tell you the same thing about how negatively they see the relationship and how worried they are, ignore them. They don't understand how wonderful the BP really is and how great the relationship can be. Don't try to remember the last time it really was like that.

* Never question the essential rule of the relationship: the BP's needs are more important than yours, or even those of your children. It is your responsibility to make things work and your fault if they don't.

* Remember: You're a victim and have no control. Somehow, things ended up this way. Why? An act of fate. God. Nature.

* You may try the techniques above. But don't make any real, threatening, scary changes or take real risks.

So now you know what doesn't work. What does? Simply put, look at BPD behavior as a method of coping that the BP has learned to use over a period of many years. At some point, they may have worked. If it continues to work, the person will continue the behavior. Your job is to stop letting the behavior work.

Yes, it is frustrating and heartbreaking to watch someone you love act in ways that hurt themselves and others. But no matter what you do, you can't control anyone else's behavior. Moreover, it's not your job--unless, of course, the person with BPD in your life is your minor child. Even then, you can only influence the child's behavior--not control it.

Your job is to know who you are, to act according to your own values and beliefs, and to communicate what you need and want to the people in your life. You can always encourage people to do what you want through subtle or blatant rewards and punishments. But it is still their decision how to act.

What motivates people with BPD to seek help? In general, people alter their behavior when they believe that the benefits of doing so outweigh the obstacles to change. People with BPD are the same as everyone else in this regard.

The specific catalysts for change, however, vary greatly. For some people, the unbearable emotional turmoil of living with BPD is worse than the fear of change. For others, it is realizing how their behavior is affecting their children. Some face their demons after losing someone important to them because of their behavior.

You, that important person, can change by acting like a "mirror" instead of a "sponge." It is common for the same person to react both ways-sometimes absorbing, sometimes reflecting.

Some non-BPs absorb their BP's projections and soak up their pain and rage (sponging). These non-BPs may be under the illusion that they are helping the borderline. But in fact, by not reflecting the BP's painful feelings back to their rightful owner (mirroring), they are rewarding them for using these defense mechanisms and making it more likely that the borderline will continue to use them in the future.

People who act like sponges say they feel like they are trying to fill a black hole of emptiness inside the BP. But no matter how much love, caring, and devotion they pour into the hole, it is never enough. So they blame themselves and work even more frantically to fill the hole.

At the same time, the BP feels the very real and terrifying pain of the aching cavity and urges the non-BP to work even harder and faster at filling the hole. The BP may castigate the non-BP for being lazy or indifferent to their terrible anguish. Or, the BP may tearfully beg the non-BP to do something-anything-to end their suffering.

But it's all a diversion to keep the BP and non-BP from addressing the real issue: The emptiness belongs to the person with BPD, and the only person who can fill it is the BP themselves.

Don't get caught up in the borderline's accusations, blaming, impossible demands, and criticism. Instead of soaking up the other person's pain, try to maintain your own sense of reality despite what the other person says. Reflect the pain back to its proper owner-the person with BPD.

Express confidence that the BP can learn to cope with their own feelings. It is important that you offer your support, while making it clear that the BP is ultimately the only person who can control their feelings and reactions. Show by your actions that you have a bottom line: there are limits to the type of behavior that you will and will not accept. Communicate these limits clearly and act on them consistently.

You may also need to take steps, if necessary, to protect yourself or your children--not because you are judging or labeling anyone else's behavior, but because you value yourself and your feelings.

These steps might include removing yourself or your children from an abusive situation, letting the BP take responsibility for their own actions, asserting your own feelings and wishes, disregarding name calling or provocative behavior, refusing to speak to an enraged person, declining to let anyone else's public behavior embarrass you, or simply saying no.

You must know your own bottom line for different types of situations. This will help you in all your relationships--not just the one with the BP. Remember, the only person you can change is yourself. Once you really realize this and stop taking responsibility for the BP's life, you will start to feel better.

(Note: more specific information on how to do all of this is available in the author's book