What relationships and self-care activities can help manage borderline personality disorder (BPD) symptoms?

Managing BPD Through Relationships and Self-Care

Building stable, trustworthy relationships is essential for managing BPD, but you must actively work on developing trust appraisal skills and emotional regulation within these relationships, as unstable trust perception—particularly during threatening situations—is a core mechanism driving interpersonal dysfunction in BPD. 1, 2

The Critical Role of Trust in BPD Relationships

Understanding Trust Impairments

• People with BPD experience unstable trustworthiness perception of their partners, especially after relationship-threatening situations, showing significantly diminished trust compared to healthy individuals even when baseline trust may be intact 2
• Trust impairments in BPD involve problems with both appraising others' trustworthiness and learning from trust-related experiences, which directly contributes to the unstable relationships that define the disorder 1
• The inability to maintain a stable image of a trustworthy partner during stressful moments is a key driver of relationship dysfunction in BPD, not just general emotional dysregulation 2

Who to Seek Out

• Yes, you should actively seek people you can trust, but more importantly, you need to work on your capacity to accurately perceive and maintain trust during difficult moments 1, 2
• Perceived tenderness in relationships serves as a protective factor against trust deterioration, suggesting you should prioritize relationships characterized by warmth and emotional safety 2
• Incorporating significant others into your BPD treatment represents a unique opportunity to maximize outcomes, as interventions targeting BPD within the context of close relationships show robust evidence for reducing BPD symptoms, significant other distress, and relationship distress simultaneously 3

Relationship-Based Interventions That Work

Family and Significant Other Involvement

• Disorder-specific interventions that incorporate significant others have the most robust evidence base for improving BPD symptoms, reducing distress in loved ones, and improving relationship quality all at once 3
• Family psychoeducation combined with skills training in communication and problem-solving represents an active treatment component with strong empirical support 4
• Education and family-facilitated engagement interventions can help significant others understand BPD and support your treatment, though these primarily target engagement rather than core symptoms 3

Skills to Develop Within Relationships

• Core skills you need to practice include emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness techniques—these are the foundational components of dialectical behavior therapy that directly address relationship dysfunction 4, 5
• Problem-solving therapy specifically aimed at improving your ability to cope with interpersonal stressors shows evidence for reducing suicidal ideation and behavior 4
• Communication and problem-solving skills training, particularly around managing conflict and expressing needs effectively, should be prioritized 4

Self-Care Activities Beyond Therapy

Crisis Management Strategies

• Develop a crisis response plan collaboratively with someone you trust that includes: clear identification of your warning signs (behavioral, cognitive, affective, or physical), self-management skills you can use independently to distract from stressors, identification of social supports you feel comfortable contacting, and a review of crisis resources 4
• This approach shows statistically significant reduction in suicide attempts compared to treatment as usual 4

Relapse Prevention Planning

• Identify potential triggers for symptom re-emergence (such as relationship breakdowns), recognize your personal warning signs of relapse (which symptoms typically return first), and create an action plan for tackling symptoms that re-emerge 4
• Identify sources of support you can access if symptoms worsen 4

Environmental Considerations

• Comprehensive assessment of family relationship dynamics, levels of conflict, cohesion, and expressed emotion is critical, as these factors contribute significantly to treatment outcomes 4
• Family environment characteristics should guide your decisions about which relationships to invest in and which may require boundaries 4

Important Caveats

• BPD is associated with high morbidity and mortality, including significant suicide risk, making professional treatment essential alongside relationship-based strategies 6
• While building trustworthy relationships is important, trust impairments in BPD stem from both developmental factors and current cognitive-emotional processes, meaning you cannot simply "choose better people"—you must also work on your trust appraisal and learning mechanisms 1
• Relationship distress in BPD is bidirectional: BPD symptoms promote relationship problems, and relationship problems maintain BPD symptoms, creating a cycle that requires active intervention 3
• Managing trust during the early stages of any therapeutic or close relationship is particularly important, as trust processes represent a central mechanism of change in BPD treatment 1