Family Guide

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What that individual wants most is to be heard. Of course, listening without arguing means getting hurt because it is very painful to recognize that someone you love could feel so wronged by you. Sometimes the accusations hurt because they seem to be so frankly false and unfair. Other times, they may hurt because they contain some kernel of truth. Remember that such anger is part of the problem for people with BPD. It may be that she was born with a very aggressive nature.

The anger may represent one side of her feelings which can rapidly reverse.

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See discussion of black and white thinking. Keeping these points in mind can help you to avoid taking the anger personally. Self-destructive acts or threats require attention.


Do not keep secrets about this. Talk about it openly with your family member and make sure professionals know. There are many ways in which the person with BPD and her family members may see trouble approaching.


Threats and hints of self-destructiveness may include a variety of provocative behaviors. The person may speak of wanting to kill herself. She may become isolative. She may superficially scratch herself.

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Some parents have noticed that their daughters shave their head and color their hair neon at times when they are in distress. More commonly, what will be evident is not eating or reckless behavior. Trouble may be anticipated when separations or vacations occur. When families see the signs of trouble they may be reluctant to address them. Other times, family members dread speaking directly about a problem because the discussion may be difficult. Problems are not created by asking questions. By addressing provocative behaviors and triggers in advance, family members can help to avert further trouble.

People with BPD often have difficulty talking about their feelings and instead tend to act on them in destructive ways. Privacy is, of course, a great concern when one is dealing with an adult. However, the competing value in these situations of impending danger is safety.

Most people would agree that safety comes first. At the same time, there may be a temptation to overreact in ways that give the person reinforcement for her behavior. People need to have their negative feelings heard. Using words to express fear, loneliness, inadequacy, anger, or needs is good.

When feelings are expressed openly, they can be painful to hear. A daughter may tell her parents that she feels abandoned or unloved by them. Listening is the best way to help an emotional person to cool off. People appreciate being heard and having their feelings acknowledged. This does not mean that you have to agree.

One method is to remain silent while looking interested and concerned. You may ask some questions to convey your interest. With these statements, you prove that you are actually hearing what the other person is saying. Do not rush to argue with your family member about her feelings or talk her out of her feelings. As we said above, such arguing can be fruitless and frustrating to the person who wants to be heard.

Remember, even when it may feel difficult to acknowledge feelings that you believe have no basis in reality, it pays to reward such expression. It is good for people, especially individuals with BPD, to put their feelings into words, no matter how much those feelings are based on distortions. If people find the verbal expression of their feelings to be rewarding, they are less likely to act out on feelings in destructive ways. Feelings of being lonely, different, and inadequate need to be heard.

By hearing them and demonstrating that you have heard them using the methods described above, you help the individual to feel a little less lonely and isolated. Such feelings are a common, everyday experience for people with BPD. Parents usually do not know and often do not want to believe that their daughter feels these ways. The feelings become a bit less painful once they are shared. Family members may be quick to try to talk someone out of such feelings by arguing and denying the feelings.

Such arguments are quite frustrating and disappointing to the person expressing the feelings. If the feelings are denied when they are expressed verbally, the individual may need to act on them in order to get her message across. Problems are best tackled through open discussion in the family. Everyone needs to be part of the discussion. People are most likely to do their part when they are asked for their participation and their views about the solution are respected. It is important to ask each family member whether he or she feels able to do the steps called for in the planned solution.

By asking, you show recognition of how difficult the task may be for the other person. This goes hand in hand with acknowledging the difficulty of changing. You may feel a powerful urge to step in and help another family member. Your help may be appreciated or may be an unwanted intrusion. By asking if your help is wanted before you step in, your assistance is much less likely to be resented.

Family members need to act in concert with one another. Parental inconsistencies fuel severe family conflicts.

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Develop strategies that everyone can stick to. Family members may have sharply contrasting views about how to handle any given problem behavior in their relative with BPD. The typical result is increasing tension and resentment between family members as well as lack of progress in overcoming the problem. An example will illustrate the point. A daughter frequently calls home asking for financial bail outs. She has developed a large credit card debt. She wants new clothing. She has been unable to save enough money to pay her rent. Despite her constant desire for funds, she is unable to take financial responsibility by holding down a job or living by a budget.

Her father expresses a stem attitude, refusing to provide the funds, and with each request and insisting that she take responsibility for working out the problem herself. The mother meanwhile softens easily with each request and gives her the funds she wants. The daughter will adhere to the plan only after both parents adhere to it. If you have financial responsibility, you have the right to address your concerns to the therapist or doctor. They may wonder whether the psychiatrist is aware of the side effects the patient is experiencing.

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Can the psychiatrist see how sedated or obese the individual has become? Is he or she subjecting the patient to danger by prescribing too many medications? When family members have such concerns, they often feel that they should not interfere, or are told by the patient not to interfere. They can play that role by contacting the doctor or therapist directly themselves to express their concerns. Set limits by stating the limits of your tolerance.

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  5. Let your expectations be known in clear, simple language. Everyone needs to know what is expected of them. Expectations need to be set forth in a clear manner. Too often, people assume that the members of their family should know their expectations automatically. It is often useful to give up such assumptions. The best way to express an expectation is to avoid attaching any threats. Often, in these situations, family members are tempted to enforce an expectation by attaching threats. The threat becomes an empty expression of hostility.

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    Of course, there may come a point at which family members feel compelled to give an ultimatum with the true intention to act on it. We will discuss this situation later. This can be downloaded for free http: The family-guide "translates" the full academic publication into a form that is more readily understandable to non-specialists and will enable families to have a clear guideline that they can use to discuss their care with their care providers. The treatment guidelines are based on medical management recommendations by a group of 82 international experts from 7 medical subspecialties: For further information about this initiative, please contact Diane Smith-Hoban: This guide is currently being translated into several different languages.

    Outcome measures About outcome measures Outcome measures research Registry of outcome measures NMR as an outcome measure Functional evaluation tools. Trial sites and patients Care and trial site registry Patient registries Feasibility studies Patient recruitment. Industry Service overview Trial sites Advisory boards Industry partners.

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