How about that Super Bowl? By the way, I think you might have borderline personality disorder.

January 31, 2009 9:02 AM

How does one tell a friend that they might have borderline personality disorder?

I'm following this thread pretty closely, for personal reasons. I have a friend who, I've been pretty sure since I met her, has BPD. Before getting into the details, I just want to say: She's preposterously smart, driven, hilarious, and creative. She is not, as this link from the post would suggest, evil. And she definitely didn't cause the fall of Rome.

That said, she displays a range of borderline traits: wild mood swings, impulsiveness, self esteem issues, and most importantly, chronic abandonment issues that result in her testing, lashing out at, and emotionally exhausting those closest to her. Needless to say, it's interfering with her personal relationships, which it hurts to watch. As a result, she's now going through a divorce, after the better part of a decade of marriage.

She's currently being treated for anxiety, for which she takes Klonopin and attends talk therapy. On an ethical level (non-doctors, please feel free to reply), should I mention that she might want to ask her therapist about BPD, or seek dialectical behavioral therapy? If so, any recommendations on how to gently bring up the subject, without making her feel judged or abandoned?

Again, I really think she's great. It'd just be nice to see her get the help she needs, so she's not constantly stuck feeling alone in an emotional whirlwind. I figure it might also help her cope with the divorce, and either eventually reestablish rapport with her husband, or simply have better, future relationships, all around.

posted by anonymous to human relations (25 comments total)

It's not clear how long you've known her, but are you sure it's not the divorce that's causing her to feel this way, as opposed to the other way around?
posted by Airhen at 9:16 AM on January 31

If she's that smart she's already googling things and that will be one of them. Plus it's entirely possible she has bipolar 2 or something else besides borderline.

By all means have her investigate dialectical behavioural therapy-it's good for more than just borderline-but I'd hesitate to mention borderline unless you two are really, really REALLY good buds that talk about everything.
posted by St. Alia of the Bunnies at 9:16 AM on January 31

Don't. If she's in therapy and has BPD, the therapist will know better than you how to address it and treat her. If you think she might have BPD though, be mindful of your personal boundaries with her.
posted by dchrssyr at 9:28 AM on January 31 [7 favorites]

Yeah, unless she's got a spectacularly inept therapist, BPD will very quickly be diagnosed.

No need to get involved.
posted by tkolar at 9:38 AM on January 31

Were I you, I'd avoid diagnosing her. That isn't your job. If you want to have a discussion with her about certain things she does which hurt, alarm, confuse or worry you, that's one thing. Branding someone with a label like BPD, even in a constructive conversation meant to help them, is a good way to scare the crap out of a person who is already medicated for anxiety and who is already in a course of talk therapy. You also risk alienating her, invading her privacy, and insulting her, which you clearly have no desire to do.

If you want to have a discussion with her about your personal concerns, you're going to have to tread lightly. Base what you say to her on personal examples of things you have witnessed, felt or thought as a result of your own interactions with her, and stress that you want your personal relationship with her to improve and for her to be happy. Do not start throwing around diagnoses you have read about on the internet or in print; again, she is working with professionals, is medicated, and it is quite possible that her problems do not stem from a very serious personality disorder like BPD. If she doesn't want to discuss any of this with you, back off, set certain personal limits with her to avoid getting sucked too deeply into her personal drama, and leave the sorting out of her personality issues to her and her doctors.
posted by TryTheTilapia at 9:38 AM on January 31

On an ethical level (non-doctors, please feel free to reply), should I mention that she might want to ask her therapist about BPD

Wait. Which one of you is crazy? Because you're not qualified to suggest anything to your friend regarding her mental health. I mean, your basing your half-ass diagnosis on what strangers on the internet have been talking about.

Look, if your friend is getting treatment, that's good, and you should encourage her, but it's not your place to roll out your own diagnosis.

wild mood swings, impulsiveness, self esteem issues, and most importantly, chronic abandonment issues that result in her testing, lashing out at, and emotionally exhausting those closest to her

Here's a diagnosis for ya: your friend is an asshole. Look, she's getting help, but at the same time if she is displaying this sort of behavior treat it like you would if it were any other person: ask her what the hell her problem is. Tell her she's being a jerk. I think most people's bad behavior can be corrected by negative reinforcement... call her out when she shows her ass, at the very least you're going to polish down larger problems which she can then work on with her head shrinker.
posted by wfrgms at 9:46 AM on January 31

BPD is not easy to diagnose, and this suggestion from you is not likely to be helpful.
posted by hermitosis at 9:53 AM on January 31

You also may want to entertain the idea that even though she has told you she is in therapy and being treated for anxiety, she may not want to share a diagnosis like BPD with you. Anxiety and depression are far more socially acceptable mental illnesses than BPD. If she's already in treatment I would just stay out. You really have no idea what her doctor has diagnosed her with or even what she has. I wouldn't do more than encourage her to stick with the therapy and treatment plan she's been given (unless you have some indication that her doctor is incompetent, then I would encourage her to get a second opinion).
posted by whoaali at 9:54 AM on January 31 [1 favorite]

See also...
posted by hermitosis at 9:55 AM on January 31

I agree with the comments saying not to personally diagnose her with BPD or say "I think you might have BPD." However, I have occasionally suggested to a friend (who has already confided in me that she is seeing a therapist) something to the effect of "You keep lashing out at me, and I don't know how to deal with it, and you don't seem to know how to deal with it, and I wonder if it's something your therapist might be able to help with." I don't think there's anything wrong with pointing out the symptoms that are affecting you ("You are lashing out at me"/"Your mood swings are emotionally exhausting"/etc.), as long as you leave the actual diagnosis to her therapist.
posted by Meg_Murry at 10:01 AM on January 31 [3 favorites]

You don't. You say 'A, I know you're being treated for anxiety, and I'm concerned. You seem to have mood swings and it's getting pretty exhausting. Ultimately, your behavior is your responsibility. Can you ask your therapist about ways to better get some of these under control?'

Be patient, but remind her that she is an adult.
posted by kldickson at 10:42 AM on January 31

"How do you treat a patient with borderline personality disorder?"
"You refer them."

Borderline personality disorder is a condition with a LOT OF STIGMA. Saying "I think you have BPD" to anyone who's been around the mental health block can be like saying "I think you're incurable."

As others have said, anyone but the most inept therapist will diagnose BPD if it does, in fact exist. There are other conditions that mimic it, including atypical depression, and particularly PTSD. It's not your job to diagnose it.

By all means encourage her to bring up DBT with her therapist--perhaps as part of a conversation where you ask her what disciplines her therapist is trained in. But don't scare her or insult her by assuming you can diagnose her off the web.
posted by saveyoursanity at 11:17 AM on January 31 [1 favorite]

There's no good way to do it. Like TryTheTilapia said, you can bring up your concerns, but it's definitely not your place to diagnose her.

Also, have you considered that she already has been diagnosed with BPD but isn't telling you? As others have said, it has a tremendous amount of stigma associated with the disorder. Any discussion or diagnoses should be between her and her therapist, not you.
posted by christinetheslp at 11:54 AM on January 31

Seconding what Meg Murry and christinetheslp just mentioned. It would be reasonable to for you to say "Sometimes I feel like you are lashing out at me, and I don't know what to do" or whatever. This might well be followed by her eventually saying "I didn't want to ever have to tell anyone about this . . . I wanted to keep it hidden, and now I guess I can't even do that very well . . . but I [recently/a long time ago/suspect I should] have been diagnosed with BPD. etc."

Just treat her like a friend and, depending on how wary you are of these things, treat her like a friend who happens to have BPD. Also consider that you may be someone who's helping her by NOT mentioning it. Someone with a chronic illness needs to have a few friends who know all about it, and also some friends who "don't know"-- which helps him/her not feel like quite such a damaged person/permanently labeled/embodiment of an illness. I will tell you that it is comforting to feel "OK, well, I can still blend in with others . . . not EVERYone in the world knows about this . . . I can still relate normally to some people . . so maybe I'm not a lost cause."
posted by oldtimey at 1:03 PM on January 31

I wouldn't necessarily say "don't tell her", but if anything you should definitely delay your urge to do so until after her major divorce has more or less absolved. There is a good chance that the stress involved in that affair is more than enough to drive her over the edge, and cause her to display symptoms of a personality disorder when it may truthfully just be a passing state of temporary insanity. Catch my drift?
posted by tybeet at 1:04 PM on January 31

Personality disorders are quite rare and only a psychiatrist/psychologist with lots of experience is going to be able to spot one. Lots of more common disorders, including bipolar, could have symptoms like you describe. The overarching feature of personality disorders is impaired functioning in all areas of life and an unwillingness to modify behaviors to situations, over long periods of time, like years. Something that starts during divorce doesn't count, and honestly your friend doesn't sound all that extreme. Yes, sounds like she has some problems, but ONLY her therapist is going to be able to diagnose and treat.

For all intents and purposes, her diagnosis is irrelevant to you as a lay person and her friend. Help her identify when she's acting inappropriately by saying things like "that was hurtful," etc., and respond positively when she's behaving well. That's all you can or should do.
posted by slow graffiti at 1:16 PM on January 31 [2 favorites]

3rding Meg_Murray - just focus on your concern about her behavior affects your relationship with her. Ask her what you can do to help her when she is having trouble with mood swings, anger etc. If she says she doesn't know or doesn't want anything, tell her that you know she is in therapy and if there is anything you can do to help support the changes that she is working on for herself, please let you know. That keeps it between you and her.

She needs to have control over her relationship with the therapist - telling her what she should tell her therapist is not helpful and not likely to listened to. On the other hand, knowing that you are open to talking about it and to helping her, gives her option of asking for your support if and when it would be helpful to her.
posted by metahawk at 1:17 PM on January 31

As someone with chronic, complicated health problems (but not mental health ones), I'm constantly offered unsolicited and invariably inane diagnoses by concerned friends and colleagues. Internally I roll my eyes as outwardly they glaze over. My method of coping is to change the subject as soon as I can, but I continue to think, "Why does this apparently intelligent person believe that the article they read or story they heard from a neighbor holds the key to my illness, a key that has not occurred to myself or my team of doctors?" I end up categorizing the concerned person as socially inept, naive and liable to jump upon whatever faddish health info train that comes along.

That's not fair on my part, as I know these people mean well. However, I bet your friend's reaction to you would be similar, especially since she's already working with trained professionals to address her problems.

Certain kinds of ailments seem to give laypeople false confidence they have useful advice when they have none. Many, many variables factor into the treatment for any medical problem. I can guarantee you that the magazine article you read or the Dateline story you saw on the subject, or even a personal experience with a loved one, did not expose you to all of the variables that your friend and her health care providers consider as a matter of course.

I wholeheartedly agree that you should tell her when she's being an ass, but you really, really have no idea what the true scope of her health problems are, what treatments are available to address her unique set of problems, and it's none of your business unless she directly asks you for advice.
posted by vincele at 1:39 PM on January 31 [2 favorites]

Agree with everyone who says DON'T. I understand your instinct, because I have a friend who fits this description you've given perfectly. I am also a mental health professional. I would never suggest to her she might have BPD. If for no other reason than that it's horribly rude and would harm our friendship. I would discuss the problems she's having if she brings it up and encourage her in her treatment. She's seeing a professional, so that's taken care of. It's the therapist's responsibility to handle this, not you. If she expresses doubts in the efficacy of her therapy, I would suggest she seek a different therapist. Maybe talk about new types of therapy such as DBT. But that's it.

Especially if she actually has BPD, you don't want to get involved in her therapeutic process.
posted by threeturtles at 4:19 PM on January 31 [1 favorite]

Nthing.

Coming from a doctor, don't do this. If you're really close, feel free to bring up DBT, ask open-ended questions about her health (mental or otherwise), or if she's ever thought about alternative therapies/therapists.

But if you value your relationship, do NOT offer her your amateur diagnosis.
posted by drpynchon at 5:04 PM on January 31

You've heard from a doctor, now hear from someone who has BPD. It's not your business.

Also, don't assume anything about your friend or her behavior. I've had people assume that just because I have BPD, if they tell me something bad, I'll "go off" on them or scream or flame out or whatever. (A note: I did a lot of therapy and still see a psychiatrist, and I no longer meet at least 5 of the diagnostic criteria, so I could probably be considered recovering.)

I once asked someone here on the site to run the numbers for me. You have to have at least 5 of the 9 diagnostic criteria to qualify as BPD. You *can* meet any 5, 6, 7, 8, or all 9 criteria, and that works out to over 200 (IIRC) possible symptom combinations. Also, BPD can closely mimic bipolar disorder.

BTW, that article linked from the main Mefi thread is excellent.
posted by IndigoRain at 9:46 PM on January 31

If any of my friends ever suggest(ed) to me that I might have/suffer from Borderline Personality Disorder, that would be the end of the friendship. She has her own therapist, and it isn't you.

Friends don't diagnose friends.
posted by bilabial at 3:19 PM on February 1

One doesn't, unless one is the person's qualified therapist.
posted by balls at 4:38 PM on February 1

"the Dateline story you saw on the subject"

I know someone whose random symptoms got diagnosed because their mom recognized them on Mystery Diagnosis. I ain't saying everyone upthread isn't completely correct with their advice... just thought this was interesting.
posted by cranberrymonger at 9:45 AM on February 2

If you think she might have BPD though, be mindful of your personal boundaries with her.

So many good answers here, but this is really the main thing that you should do. Do not get involved with her treatment, but also do not get sucked into the crazy if she does have BPD. Not saying cut her out or don't support her, but also don't sacrafice yourself if it starts to become that way.

Also, I would like to echo what vincele said. It sucks really very much to be instructed on your health problems by laypeople, no matter how web-researched someone might think his or her opinion is. Especially--and this is 100% my personal bias--when the opnion invoves homeopathy.
posted by Pax at 11:55 AM on February 2 [1 favorite]