What are the practical steps to help a partner with Borderline Personality Disorder (BPD)?

Practical Steps to Help a Partner with Borderline Personality Disorder

The most effective way to help a partner with BPD is to participate in family psychoeducation combined with skills training in communication and problem-solving, which represents an active treatment component with strong empirical support. 1

Immediate Priority: Support Their Access to Evidence-Based Psychotherapy

• Encourage and facilitate your partner's engagement in Dialectical Behavior Therapy (DBT), which is the most effective treatment for BPD with moderate to large effects in reducing self-harm and improving functioning. 2, 3
• DBT typically involves 12-22 weekly sessions (though may extend to one year for severe presentations) and includes skills training for emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. 2, 3
• Use motivational interviewing techniques to enhance their treatment engagement by explaining that treatment aims to reduce distress and improve quality of life rather than focusing on personality "flaws." 2

Learn and Practice Core Skills Together

The four core DBT skills you should learn alongside your partner are emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness techniques. 1

• Communication and problem-solving skills training, particularly around managing conflict and expressing needs effectively, should be prioritized in your relationship. 1
• Practice these skills during calm moments, not during crises, to build a foundation for when emotions escalate. 2

Develop a Crisis Response Plan Collaboratively

Creating a crisis response plan together shows statistically significant reduction in suicide attempts. 1

The plan should include:

• Clear identification of warning signs specific to your partner (e.g., increased isolation, sleep changes, self-critical statements). 1
• Agreed-upon self-management skills your partner will use first. 1
• Your role as social support and when/how to intervene. 1
• Emergency contacts and resources (crisis lines, therapist contact, emergency services). 1

Understand Family Environment Factors That Impact Treatment

Comprehensive assessment of your relationship dynamics—levels of conflict, cohesion, and expressed emotion—is critical, as these factors contribute significantly to treatment outcomes. 1

• High-conflict relationships can lead to increased treatment drop-out and relapse. 4
• However, when high-conflict families engage in family-focused therapy, they demonstrate significantly reduced conflict, whereas low-conflict families show less change. 4
• Use this information to decide which relationship patterns to actively work on and which may require temporary boundaries. 1

What NOT to Do: Common Pitfalls

Avoid excessive familiarity, maintain regular structured interactions, set appropriate limits, and maintain awareness of your own emotional reactions. 5

• Do not enable health-sabotaging behaviors or participate in impulsive decision-making. 5
• Avoid "all-or-none" thinking yourself—recognize that your partner's extreme attitudes (idealization/devaluation of you) are symptoms, not reality. 6
• Never use benzodiazepines or substances together to manage acute crises, as these increase disinhibition in BPD. 2, 3

Seek Support for Yourself

Being a significant other to someone with BPD affects your own health, with high incidence of stress, fear, anxiety, depression, and family burden. 7

• Consider peer support groups not linked to a particular psychiatric treatment yet offering support in a structured way. 7
• A professional coordinator intended specifically for significant others can provide guidance. 7
• Your own support is not selfish—it's necessary for sustaining your ability to help. 7

Medication Context (What to Expect)

No medications consistently improve core BPD symptoms; medication should only target specific comorbid conditions like depression or anxiety. 2, 8

• If your partner is prescribed SSRIs (fluoxetine, sertraline) for comorbid depression or anxiety, maintain realistic expectations about their impact on core BPD symptoms. 2
• For acute crises, low-potency antipsychotics (quetiapine) or antihistamines (promethazine) are preferred over benzodiazepines. 2, 8
• Monitor medication adherence and consider Brief Motivational Intervention if adherence is poor. 2

Long-Term Perspective

Interventions that target BPD in the context of close relationships have the most robust evidence base for improving BPD pathology, significant other distress, and relationship distress simultaneously. 9

• Identify potential triggers for symptom re-emergence in your partner's life. 1
• Recognize personal warning signs of relapse (what symptoms re-emerge first, what you would notice). 1
• Create an action plan for tackling symptoms that re-emerge, including when to re-engage with professional support. 1