When your loved one has Borderline Personality Disorder (BPD) you may find yourself haunted by fears of their possible suicide. The intensity of that fear can feel as if you are being held hostage—afraid to say no to a request or of accidentally saying the wrong thing and triggering an attempt. Additionally, friends and family cannot begin to understand the burden you carry because their days don’t include such potential for a devastating outcome.
Over time you may begin to experience a sense of isolation or of being less than others who don’t have the same struggles we deal with on a daily basis—even when you have regular contact with friends, family and co-workers.
As we well know, BPD is characterised by unstable emotions, impulsive behavior, an unstable sense of self, intense and unstable relationships, repeated sudden and rapid mood swings, self-harm and frequent suicidal thoughts and actions all of which set the stage for severe emotional distress.
Well documented research indicates that people with borderline personality disorder have the highest number of suicide attempts per year and also the highest number of completed suicides.
70% of people with BPD will attempt suicide at least once in their lifetime.
A number of studies show that 70 percent of people with BPD will attempt suicide at least once in their lifetime, while many will have multiple attempts. The death rates are estimated as high as 10%.
Some individuals, my clients included, report first thoughts of suicide as early as age 8. Our fear is not without reason!
Contributing factors unique to those with BPD
Impulsivity
Impulsivity is the tendency to act quickly without recognizing consequences. Suicidal ideation and suicide attempts are the most life threatening and dangerous consequences of impulsivity. Many attempts are not planned but happen spontaneously with the rapid onset of a negative mood state (anger, sadness, shame, guilt).
Suicidal thoughts and behaviors are frequently a reaction to the pain of the negative emotion. Following attempts, many will say their intent was NOT TO DIE, but to STOP FEELING an emotional state. When the amygdala (threat sensor) deep in the low mid-brain becomes too hot, the thinking brain snaps shut and goes off-line.
At this point, when emotional pain seems intolerable, and there is no ability to see a beginning, middle, or end, the risk of suicide as “solution” becomes real because the individual cannot recognize that an emotion will not last forever.
Every thought and action becomes emotionally driven, and thoughts of suicide and self-harm arise. In the pain of the moment, an intense action urge to avoid pain at all costs may trigger the suicidal or self-harm thought. This powerful combination can prompt an impulsive response such as swallowing a handful of pills.
Lack of access to treatment
Lack of access to proven treatment that focuses entirely on eliminating suicidal and self-harm thoughts and behaviors before moving on to other issues.
BPD is considered a chronic illness because it typically lasts for years, and there are no medications to directly treat this disorder. The medications prescribed are usually designed to treat depression and anxiety or to stabilize overall mood. Recovery is achieved step by step through therapy. It is difficult and takes time. The good news is that a motivated person in evidence based treatment can find themselves no longer meeting criteria for BPD in 2 years.
Unfortunately, many people do not have access to the specific therapies that have been proven to work such as Dialectical Behavior Therapy, (DBT) and Mentalization Based Therapy (MBT).
Mental health professionals may continue to be unaware of the newest treatment guidelines which encourage addressing BPD symptoms as early as age twelve. By the time a person with BPD is diagnosed they may have missed out on years of valuable treatment lengthening suffering, increasing potential for life threatening events and potentially extending the time needed to recover.
When pursuing treatment options, it’s important to look for a doctor and therapist who is familiar with BPD and understands your needs and the importance of building a treatment team to collaborate on how best to serve the client.
BPD going untreated related to lack of access to proper treatment predicts more dysfunctional responses to emotional pain.
Financial barriers may also interfere with obtaining evidence based care. More and more treatment providers are refusing to work with insurance companies due to unreasonable paperwork demands, low and slow payment or find themselves unable to get panelled by the insurance companies. This results in higher out-of-pocket costs for treatment and leaves the family without an adequate support network.
Stigma
Of the major mental illnesses, individuals with borderline personality disorder (BPD) are perhaps among the most stigmatized. Even among healthcare professionals, BPD is frequently misunderstood.
Common stereotypes include that BPD patients are dramatic, manipulative, and attention-seeking. These stereotypes can cause therapists to not take a person’s symptoms or fears seriously which can negatively impact treatment. A person with BPD has to tolerate this stigma in addition to the intense self-loathing that is symptomatic of the illness increasing the burden of suffering.
When opposite truths collide
Truth #1
Our clients and loved ones, when experiencing suicidality are in an unbearable amount of pain, to the point where it truly feels that the best option in response to that pain is to end their lives.It’s frightening to be faced with a suicidal person, especially when it’s someone we love.
Truth #2
Especially if our loved one or client has been in this state a number of times in the past, it can feel like our loved one is using these same words again and again in response to us doing something so benign as saying “no” to a request on purpose to get us to give them what they want. No wonder it can feel like they are attacking or manipulating us when they yell those words, “I might as well kill myself!”
Those words carry an implication that we are responsible for their current misery and any consequences related to it plus it can be aggravating to listen to their description of how they are feeling especially when it comes with rage, accusations, tears, insistence that we drop whatever we are doing, and/or an inability to see other perspectives on the situation that seem obvious to us.
In DBT we refer to this as a dialectical dilemma, meaning that the problem to be solved is that two opposing truths are occurring in the same moment. Typically this makes us extremely uncomfortable, triggering a powerful urge to do something to return to a state of balance, or wise mind.
While we CANNOT control how our loved one feels or what they do in the situation, we CAN control how we respond. And there are skills we can use to return to a wise mind state.
The problem is that two opposite truths are occurring in the same moment.
Effectively responding to suicidal threats is a skill of sorts. Here’s a bit of what has worked for me:
I pause, think STOP and imagine a big red stop sign.
Then observe, describe and tolerate my own anxiety on behalf of my loved one or client, plus their distress in that moment. This means that I remind myself—and accept—that I cannot control other people.
I also have to remember that I am only able to do the best I can on any particular day, and on some days there is little available to give. I am human. I may make a mistake. And despite my greatest efforts, the worst case scenario may play out.
My goal in this moment is to do what I can to help the individual stay safe until they have either calmed down or help arrives.
One thing that has often been helpful is to make myself available if they need my presence, stay with them (without talking), and when they are calm, ask them what they need to be different. I validate the intensity of the emotional pain of not having what they want in the moment. I avoid giving advice or trying to talk them out of their thinking.
In these moments we have to remember that every individual is the expert on themselves, and our ideas of what is helpful may not be what they need and can be misunderstood as our not understanding how hard the experience is for them.
Some needs I have heard many times are:
- some time to rest,
- a chance to vent and get things off their chest,
- an additional therapy appointment,
- some time to themselves, or
- a medication adjustment.
Depending on age, the person may be unable to identify what is needed and/ or may be unable/ unwilling to stay safe on their own. You may not be confident that you can keep them safe until they can see their therapist/ doctor. If any of these things are true, don’t hesitate to call 911.
I want to be very clear that we are not required to do anything we feel uncomfortable doing in such a situation. This is why we have emergency services.
I have also created a safety plan for myself and shared it with my loved one, emphasizing that the plan is for me—to help me feel more confident in a crisis situation. I ask them for suggestions as to what will be most helpful for me to do if they tell me they are suicidal. I tell them exactly what they can expect from me in response.
Depending on the age of the individual, the safety plan may look quite different; however, for everyone I make sure to clearly state that I want them to stay alive, and if for any reason I do not believe they are safe, I will call 911.
When the crisis is over, talk about the experience with someone who understands.
Lastly, when the crisis is over, I make it a point to talk about the experience with someone who understands what it’s like to be in that situation.
As people who love someone with BPD, our reality is markedly different from that of most of our peers. In order to remain in the relationship with those we care about deeply, we need support and understanding from those who truly understand what this life is about.
We must create safe spaces to meet and process our shared experience of this unwanted reality. Too often I see family members, support people and treatment providers worn down and traumatized by the stress that comes with constantly dreading a life shattering outcome over which they ultimately have little or even no control. The burden is too heavy to carry alone.
If you would like to join a community of people who understand what it’s like to love someone with BPD, I personally invite you to join me and my people over on Facebook.
If your family is in need of additional support, I am here to help.
This information is not a substitute for professional advice from a Medical Doctor, Psychiatrist, or Licensed Counselor. The information provided by www.coachlisabond.com does not constitute legal or professional advice nor is it intended to be.
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