BPD Information for Family and Friends

• 1-6 percent of people meet diagnostic criteria for BPD sometime in their lives.
• Parents often report that they could tell something was wrong in the first year of their child’s life.
• People with BPD have some brain differences from people without BPD, eg different sizes and functioning of some brain structures, sluggish serotonin system, resulting in overactive “brain emotional petrol pedals” (amygdala), underactive “brain emotional brakes” (pre-frontal cortex) and sluggish “brain oil” (serotonin).
• Experts agree that it is likely that both biological and psychological factors are involved in causing BPD.
• Evidence of biological causal factors include five-fold increased rates of BPD in identical vs non-identical twins where one twin has BPD; five-fold increased rate of self harm where a particular gene is present.
• Evidence of psychological causal factors include higher rates of self-harm where childhood sexual abuse has occurred and higher rates of BPD where court-recognised childhood abuse has occurred.
• BPD can occur in caring families with neither the person with BPD nor parents to blame.
• Most people with BPD make substantial improvements over time, such that they no longer have BPD.
• There are now a range of treatments demonstrated in gold standard research to be effective, including high-quality generalist treatment.
• A range of family and friend interventions have also been shown to be effective in moderately rigorous research.
• Higher family member involvement with the person with BPD has been shown in general (statistically) to be predictive of better outcomes for the person with BPD.
• Validation has been shown to be a highly effective action that family and friends can take, helping to improve the quality of relationships.
• ‘Validation’ is when the other person knows that you “get it” – that is, you know where they are coming from.
• We can all practice and improve our validation skills.
• Research shows that, in general, it is much more effective to reward someone (eg praise) after they do a behaviour you like, than to punish or criticise them after they do a behaviour you do not like.
• Research shows that when rewarding someone, it is most effective to do so as soon as possible after the behaviour that you like.
• We need to wait till the behaviour that we want to encourage occurs and then reward the person as soon as possible thereafter.
• Sometimes the person with BPD does not like being praised (eg they feel pressure to perform), with praise actually inadvertently decreasing the likelihood of the behaviour occurring again. In these situations, a reward other than praise will need to be found.
• Research shows that the lives of family members of people with BPD are challenging and difficult, with high levels of stress and burden experienced.
• We hope that as family and friends you will take excellent care of yourselves. All humans are deserving of compassion and the right to strive towards a happy life.
• If you are choosing to support a family member or friend with BPD, it is our belief also that the more content you are, the better you will be able to support the person with BPD.

From Borderline Personality Disorder: An Evidence-based Guide for Generalist Mental Health Professionals
by Anthony W. Bateman, Roy Krawitz
Oxford University Press, 2013