Appendix D.Guidelines for Families

The families of people with borderline personality disorder (BPD) can tell countless stories of instances in which their son or daughter went into crisis just as that person was beginning to function better or to take on more responsibility. The coupling of improvement with a relapse is confusing and frustrating but has a logic to it. When people make progress—by working, leaving day treatment, helping in the home, diminishing self-destructive behaviors, or living alone—they are becoming more independent. They run the risk that those around them who have been supportive, concerned, and protective will pull away, concluding that their work is done. The supplies of emotional and financial assistance may soon dry up, leaving these individuals to fend for themselves in the world. Thus, they fear abandonment. Their response to the fear is a relapse. They may not make a conscious decision to relapse, but fear and anxiety can drive them to use old coping methods. Missed days at work; self-mutilation; a suicide attempt; or a bout of overeating, purging, or drinking may be a sign that lets everyone around know that the individual remains in distress and needs their help. Such relapses may compel people around them to take responsibility for them through protective measures such as hospitalization. Once hospitalized, the individual has returned to his or her most regressed state in which he or she has no responsibilities while others take care of him or her.