Originally published at Psych Central

As a teenager, Melanie made a suicide attempt and was diagnosed as having bipolar disorder during her psychiatric inpatient stay. She was told the several different medications would help curb her tendencies towards high-risk behaviors, self-harming behaviors, and suicidality. It did not. Rather, the medications made her more angry and anxious, so she stopped taking them altogether much to the frustration of her parents.

In her twenties, she would go for months and even as long as a year without slipped into potentially dangerous acts. She would appear to be doing better, focusing on school or a job, and socializing with friends. But then without warning, she would crash and make another suicidal attempt. Desperate for help, her parents sent her to yet another facility. This one diagnosed her correctly with having Borderline Personality Disorder (BPD).

After working with a therapist who specializes in this disorder, Melanie began to do better. Her progress improved even further after her parents agreed to participate in therapy as well. The way they confronted her in the past was causing more harm than good to their relationship. But with the therapy, they were now on the same page. As a result, their family dynamic changed and they enjoyed each other’s company. Here are the ten tips her family implemented.

1. Understand the disorder. Sometimes thoroughly researching a disorder is not the best idea. This is true for BPD. Think of BPD as on a scale of one to ten. At the one level, a person displays minor traits of BPD; at a ten, they have full-blown BPD plus another personality disorder such as narcissism, histrionic, or anti-social. Each individual person has a different experience with BPD. Understanding the disorder means learning about how it impacts this specific individual not the population as a whole.
2. Encourage treatment. In the past, Melanie’s mother would make comments about the progress or lack thereof in Melanie’s therapy. Her mother had to learn to put aside the assumption that Melanie would be “fixed” and never have to deal with having BPD in the future. While therapy is extremely beneficial in reducing the effects of BPD, most do better when they have a therapist they can continually rely on for additional assistance. Temporary emotional flair-ups at not uncommon and should be addressed.
3. Be honest. Melanie had the ability to sense the strong emotions of her parents even when they went out of their way to disguise them. Nothing angered her more than her parents claiming they weren’t angry when she clearly felt they were. In the past, her parents thought that by minimizing their anger they could diffuse a situation but in reality, it only made matters worse. So they agreed to be honest with their feelings. This helped Melanie to feel like her parents were treating her with respect.
4. Be present. Likewise, Melanie was easily triggered when her parents would recount past traumas or predict future disasters. Learning to be mindful of living in the present moment was difficult at first but it dramatically improved their relationship. This simple step actually helped Melanie to think forward as her parents were no longer doing the predicting for her.
5. Recognize dissociation. When the tension in the house became too much for her, Melanie would dissociate. In the beginning, her parents would see the disconnect but would think that she was intentionally being defiant. Melanie was not, she was just looking for a means to escape because she felt trapped. After the family therapy, her parents would see the dissociation and instead of becoming angry, they showed compassion. This allowed Melanie the time she needed to reconnect.
6. Each is responsible for themselves. When things became difficult, Melanie would turn to her dad for help. In his desire to help and protect her, he would rescue her out of financial situations, pick her up in the middle of the night, and hire an attorney to reduce her legal charges. He was constantly fixing things for Melanie. This had to stop. Instead, Melanie was asked to do the majority of the work to resolve her own issues and could rely on her parents for only 10% of the effort. Strangely, this was harder for her dad to follow than it was for Melanie.
7. Speak to the fear. An essential ingredient of having BPD is an intense and pervasive fear of abandonment. It literally occupies their brain at all times and is at the heart of most emotional outbursts that seem to come from nowhere. Instead of trying to logically work through a matter when Melanie erupted, her parents got calm and spoke to her fear. A statement like, “You are not alone, we love you and won’t abandon you,” helped to temper her emotional reaction and stop the survival instincts that were activated.
8. Release negative anticipation. For a while, Melanie’s parents literally braced themselves every time their phone rang. They feared the worst possible outcome and were easily triggered by the smallest infraction. But this negative anticipation of a catastrophe exhausted them and depleted their energy. In addition, Melanie picked up on their apprehension and would react negatively. Her parents had to retrain their brains when the phone rang by saying, “Whatever this is, I can choose to help or walk away.”
9. Expect imperfection. Generally speaking, people who have BPD give up on being perfect sometime during their adolescence. This is one of the reasons for acting up during this time period because they are desperately trying to get those around them to see that they will never be perfect and don’t want to be. Unfortunately, most parents hold onto some hope that their child is only going through a phase and will act like everyone else one day. Once Melanie’s parents reset their expectation of imperfection rather than perfection, Melanie settled down.
10. Stop comparing. Hearing about the accomplishments of Melanie’s peers was hard for her parents. In the past, they would compare her behavior to her friends or their friend’s kids. When she was younger, they would say, “Why can’t you be more like Susie.” As Melanie got older, they stopped verbalizing the hurtful statement but still caught themselves thinking it. Purging this comparison made all the difference in their approach to Melanie and Melanie felt valued and appreciated.
11. Say good-bye to the dream. Every parent has dreams of who their child will become someday. Melanie’s parents knew she was sensitive and hoped she would go into a career in nursing. But the demands of the schooling were too much for her and caused the last crash. Rather, her parents had to stop trying to push her into a career that they wanted her to have instead of one the more properly utilized her unique gifting. Once they abandoned their dreams, Melanie felt free to explore her own.
12. See the benefits. Instead of looking at the diagnosis of BPD as a negative thing, Melanie’s parents had to learn to see the benefits of it. Melanie’s ability to sense the emotions of others, have a playful approach to life and embellish the dramatic side of things made her excellent at the theatre and working with kids. Children seemed to flock to Melanie and loved to connect with them. The stage was a perfect environment for Melanie to thrive and use her BPD gifting.

These twelve tips helped to transform their relationship from dysfunctional to healthy. Once their relationship stabilized, Melanie’s fear of abandonment lessened even further and her high-risk behaviors stopped.