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Imagine that the island stranding Tom Hanks in the film Castaway triggered a genetic predisposition to borderline personality disorder. The possibility of symptoms manifesting would be about as likely as his one way conversations with "Wilson" turning interactive. "It plays out within close relationships," says Social Worker Perry Hoffman. This leaves the patient in a consistent state of fearing abandonment, rage, distorted perceptions, self mutilation and suicidal behavior. But what of family members trying to navigate their loved ones and themselves through a disorder that turns lives upside down.
That's the question that prompted the Rye based psychiatrist to found Family Connections. "There was nothing out there for families. So we designed a 12-week program which provides the most current information, teaches coping skills and creates a network of people who otherwise would be isolated because of the disorder," said the President of the National Education Alliance for BPD.
Teach your parents well.
Matt and Ann of Westchester County can attest from both sides of the classroom. They have taken the course at New York Presbyterian in White Plains as parents of a child with Borderline. "My wife and I are class leaders, and we've been through everything these parents have been through,” said Matt.
Their journey reached a crossroad in 2007. A family member had long exhibited anger issues, instability in relationships, while developing a substance abuse problem. "We hit our limit in that we could no longer live that way,” said Matt.
In real terms, the couple informed the 18-year-old that he would no longer be unconditionally welcome at home. The loved one had to agree to medical intervention to address the substance abuse and the underlying Borderline issue.
That said, ultimatum does not define the scenario. "It's your choice," Matt conveyed the sentiment.
So by acknowledging the breaking point, families begin to feel liberated." You automatically start feeling better,” said Matt.
At the same time, since the child will or won't acquiesce, observation of this limit really isn't directed at them. "A lot of nuance and language," Matt said.
Dialectic Behavior Therapy to the Rescue
The general strategy is a treatment known as dialectic behavior therapy, and families are clued in through Family Connections. As anger is the prevalent emotion, staying calm is the best defense against a state of dis-regulation. "Borderlines take a very long time to come back down from anger,” Matt said, and meeting an outburst with equal force only makes it worse.
In turn, acquiring DBT skills allows the child to understand where their anger comes from. Pause then gives the family the chance to talk about the rage once things have calmed down.
On the parents end, a similar recognition allows parents to face confrontation calmly. "What I'm really feeling is sadness because you are afraid your child will not grow up into a normal life," Matt said. "Once you get to those types of primary emotions it's hard to become angry."
Dealing with perceptions—distorted or not—is also an important skill parents learn. "Validation is such a key and core skill," Matt said.
So if your adolescent or young adult child claims that no one in school likes him, what needs to be validated is that the emotion exists. Not hearing the concern or attempting to disprove the data is invalidating. At the same time, trying to understand where the emotion comes from should be the approach. “Then it becomes a matter of validating what can be validated,” Matt said.
Don’t fight back.
In the process, though, the conversation can put the parent on the defensive and staying targeted without fighting back is hopefully learned. "Ask questions, get more information on what triggered the feeling and then say I understand or maybe you are right," Matt implored.
This—without necessarily agreeing—again provides validation and a framework for ongoing conversation.
That said, money often becomes as issue and an immediate one. “Gently validate and hear their reasoning,” Matt said, "but step back and tell them you need time to think it over.”
Hopefully, the dis-regulation passes and eventually parents won't sound like a script. "It's a bit of an art form," Matt revealed, and rehearsing scenarios ahead of time gives parents the advantage.
The world is not a safe place.
On the other hand, the ends of friendships and relationships may not be avoidable. In this family’s case, their family member reacted horribly to one breakup, but luckily DBT skills gave him a fall back. "The pain didn't go away," said Matt. "But 70 days were spent learning stress tolerance skills, and those skills helped him.”
For parents, overcoming guilt is a key component because parents often think they triggered the onset of BPD. So the truth must be reinforced. "If the world and girlfriends, friends and parents were perfect, it would never happen. But they have a predisposition, and the world can be an invalidating place.”
As it stands, about three percent of the population is diagnosed with BPD, while many others are misdiagnosed or go undiagnosed. The Seriousness of the condition show that 10% will commit suicide. But treatment has 34 percent of patients recovering after two years and 90 percent after that, according to Hoffman. For the most part, she saID, "You get better, and you stay better."
The choice seems clear and hopefully more families recognize it.
The process of a coaching session also siphons out the toxic relationships that can hold dreams back. But one may still suffer at the hands of misdirection that can obscure due north for their life. “They haven’t decided what their main thing is,” she says. “I can help them decide what they really want and make their heart sing.” It creates a safe space to align our energetic vibration.