I am having real issues with my roommate, who I am desperately trying to be kind to and understand, but who is exhibiting ALL of the behaviors of NPD. It is very hard to deal with her and because of her symptoms she displays, she keeps people at bay, and so I am the only one around at the end of the day to pick up the pieces. She is constantly needing praise, is arrogant, haughty, has an ideal of what love is and should be, is a binge eater and is morbidly obese, and she honestly displays everything mentioned above according to the NPD symptoms. She has told me in the past that when she is upset or annoyed with someone, she will hold it in for months, perhaps years, and then finally lash out with unbridled fury toward people. This concerns me very much as I would be completely unaware of her true feelings toward me and I fear she could lash out at me if I were to annoy or bother her over the course of a few months/years. She lives two states away from her immediate family and has no connection to them except for by phone, etc.

Of course, I cannot ever be certain if she is actually NPD because she is only my roommate and it was suggested that it wouldn’t be wise to alert someone of this kind of disorder, but how would I handle this situation sensitively? Should I ask her to move out and suggest she seek help? Her personality is so abrasive, but in a passive way for the most part. She doesn’t understand social cues, non-verbal communication, etc. I am a teacher of students with disabilities and also work closely with those who are high functioning autistic, so I have some background in identifying those with high functioning autism, but I believe she is more borderline autistic and more NPD. She is truly pushing me away, but I feel a great deal of guilt and sadness when I think of asking her to move out. Will she lash out at me? Will she become suicidal? She really doesn’t have anyone to help her, except uncles or aunts and I know, for a fact, that she drives them all crazy. I am a very religious person and feel I can do her a service, but how? Should I talk to my pastor/minister and seek advice?

I have really been trying to pin down why my roommate is so “different” from other people, did some more digging past just “high functioning autism” and found this sight. I am at my wit’s end. Can someone please give me some frank, constructive advice? Should I ask her to move out before I say things I will regret that may harm her rather than do her good? HELP!!!!!

Rather than provide a blow-by-blow response to each of your points, I’d like to respond to the ones that I find most foggy and on which you and I differ. You said: “In order to help your family member, you have to help yourself first.” I agree with this assessment for the most part, although I believe that this can be done through skills acquisition and personal emotional skills. No need to talk about that anymore, since we agree on that point.

I believe there are 3 parties involved in the loved one/person with BPD relationship. These are: the loved one, the person with BPD and the relationship itself. The problem that I have with the use of boundaries and limits is two-fold… One is the over-emphasis of this tool. Too many people use only limits/boundaries in their relationship, not understanding that this tool is one EXCLUSIVELY for the loved one. It doesn’t help the relationship at all. In mentalization-based treatment, Bateman and Fonagy have posited 3 tools for when a person with BPD experiences a “failure to mentalize” (i.e. when the train starts to derail and the relationship is suffering). Those are: 1) Stop, Listen, Look; 2) Stop, Rewind, Explore and 3) Stop and Stand. The third one is the application of boundaries and it is to be used when the relationship goes completely off the tracks. The first two are tools to understand the point at which a relationship has started to derail and to get it back on the tracks so it can continue.

You see, my problem with the over-emphasis of boundaries and limits is that many people believe that those tools will actually help the relationship. This is not the case. In fact, if you use the third tool (Stop and Stand, the application of boundaries) the relationship will suffer. Why? Modern fMRI research on BPD (see “Dysfunction in the Neural Circuitry of Emotion Regulation–A Possible Prelude to Violence” Richard J. Davidson,* Katherine M. Putnam, Christine L. Larson and “Quieting the Affective Storm of Borderline Personality Disorder” notes from presentation of Marianne Goodman, M.D., Erin A. Hazlett, Ph.D., Antonia S. New, M.D., Harold W. Koenigsberg, M.D., and Larry Siever, M.D.) shows that the “resting state” of the brain’s of people with the disorder is not the same as those without the disorder. The resting state of a person with BPD is one of more pre-frontal cortex activation in those with BPD. The result of this brain state means that a person with BPD will be actively scanning the environment for potential threats (particularly emotional ones). When a threat actually occurs (or is perceived), the pre-frontal cortex goes “off-line” and the limbic system lights up. The effect of this is that the person with BPD will react reflexively and impulsively to threats; however, the decision-making process becomes inhibited. This reaction, in combination with the person with BPD’s preoccupation with attachment relationships, means that it is likely for the attachment person (particularly a parent or partner) to be a trigger of the reaction. So, the amygdala lights up and the “fight or flight” response begins. That in concert with the activation of the anterior cingulated cortex portions of the brain (which is the personalization part on the top of the limbic system) makes a person in this state (which I call emotional dysregulation in my book, although it might be better described elsewhere) feel that there’s a threat, the threat is to them and the ability to make a wise decision goes-off line. They react and usually react impulsively.

OK, so, why am I bothering with this? It is because boundaries (and even more so “detaching with love”) feel like a HUGE threat to the person with BPD. They can’t take tough love. While boundaries can make YOU feel better, they make the person with BPD feel decidedly worse. That dynamic, and the resultant impulsive BPD behavior, hurts the relationship. What family members don’t understand is that boundaries have this function. I have seen many, many people recommend boundaries as a tool for the relationship, rather than as a tool for you, as a family member, to keep your sanity.

I will give you an example from my life. I have a boundary for myself that I will not go outside the house with my wife if she has been over-medicating (something that she does, though not as much, from time-to-time). If she is over-medicated, I tell her, “No, I will not go out with you when you’re in this state.” For me, it is an effective tool, yet it inevitably causes RAGE in her. The reason is that she experiences it as a threat of rejection, which is painful for her, and impulsively strikes back at me. Partners of people with BPD need to understand that the application of their own personal boundaries will most likely trigger this reaction. I personally expect it and know that it is coming, yet I have this boundary (for me) and I am consistent about this boundary. And yes, I have communicated the boundary to her. Why does she “not observe it”? Because she doesn’t feel like it at the time. I say that not flippantly at all. Her emotions are engaged in such a way that she is not thinking about me or my boundary at all. She is experiencing the brain reaction I described above. The “not observing other people’s boundaries” is usually situational, yet the reaction to the application of boundaries is typically pain, shame and impulsive behavior.

So, when the family member applies boundaries to a person with BPD, they are expecting it to be effective in the relationship. Then, they are surprised when the natural BPD reaction occurs and feel that the person with BPD is trying to manipulate them into changing their mind about the boundary. It becomes characterized as “pushing limits”. However, that is NOT the case. I try to explain in my book and in my blog postings that the application of a boundary is solely to help YOU and that, when it is done, you should EXPECT rage, judgment, criticism and impulsive behavior from the person with BPD. It is based on the neurobiology of BPD. Boundaries should only be used for yourself and should be used sparingly – only in the most extreme cases of situations you don’t want to participate in. In my case I use that boundary when she’s in that state because I feel uncomfortable and experience emotional pain myself when we’re out and she’s over-medicated. Yet, when I apply that boundary, I expect fireworks.

The second problem with boundaries is that many, many people confuse boundaries with rules. This is not your fault at all, Randi. I think you have done a pretty good job of explaining that boundaries are tools for YOU, not to be applied to the other person. The problem I see (and perhaps this is why you said “the B word”) is that boundaries in the context of child-rearing really ARE rules. If I tell my son he has to go to bed at 9 PM, that’s a rule, not a boundary. Unfortunately, the word is commonly used in a variety of settings and is inaccurate in its application. The effect of the Internet amplifies this misunderstanding. That is why I talk so much about boundaries and try to clarify the differences between boundaries and rules. I guess that’s why you choose “limits” rather than boundaries in your new book. Maybe “guidelines for self” would be even better, as klunky as that is.

If a person DOES start issuing rules to a person with BPD (calling them boundaries, limits or anything else), then fur is going to fly again. I think you would agree with me that you can’t change the behavior of another person through rules. It is the threat of punishment which, if the person would like to avoid, enacts the behavior change. However, positive reinforcement works better than punishment threats, as you know. Plus, a person with BPD, because of the great shame that they feel on a daily basis, will take punishment threats seriously and to the heart. My experience is that people with BPD live in a kind of dread of punishment and will avoid blame at all costs specifically because if they have done something wrong, then they are ALL wrong as a person.

Finally, I’d like to address the use of DEAR in both of your books. Two things on that:
You left out the MAN part. In the case of DEAR MAN, the first portion DEAR is the “what” skill. The section one MAN is the “how” skill. Because you decided to drop the MAN part which is – Mindfully, Appear Confident, Negotiate – you are missing something essential to the skill. While the DEAR part provides a road-map for non-judgmental expression of your OWN feelings and desires, by dropping the MAN part, you are removing the give-and-take related to the relationship. If you’re not willing to negotiate and find a middle ground, then you’re providing a nice, non-judgmental way of saying “my way or the highway”.

Which leads me to my other point on DEAR. This skill (DEAR MAN) is probably the most “aggressive” of the skills within DBT. It is intended for a person with BPD, who may capitulate to other’s wishes because they don’t trust their own decisions and desires, to get what THEY want out of an interpersonal relationship. It is a tool entirely for the person using the tool – particularly when you remove the requirement to negotiate. So, if you apply that tool from DBT, and ONLY that tool, to the loved one, you’re again providing a one-way benefit that helps the loved one get what THEY wish, but doesn’t help the relationship at all. The DEAR MAN tool is intended to provide a non-blaming road-map to ask for what you wish, without it devolving into a shouting, demanding, raging mess. If there was any interpersonal effectiveness tool from DBT that I would place emphasis on it’s the GIVE FAST tool. That’s another discussion entirely. Yet, the DEAR MAN tool (like boundaries) is important for YOU, just not for the relationship.
I think that both of these instances, the tools are assumed by your readers to be beneficial to the relationship. I am saying neither helps the RELATIONSHIP, although both can help YOU. Unfortunately, if you apply only these tools, the person with BPD will experience emotional pain and be unable to make effective choices in the context of themselves or the relationship. It seems to me that both of these tools assume that the person with BPD is doing something “wrong” or nonsensical and neither encourages compassion, trust or empathy, which is the life-blood of an effective relationship, regardless of the disorder(s) involved. The choices and behaviors of a person with BPD make complete “sense” when a loved one understands the function of each. Usually the function is pain-avoidance. My book does include both boundaries and a DEAR-like tool (called “Inserting your feelings”), yet the main emphasis is on other inter-personal tools. The inter-personal tools that I emphasize are intended to cool the rages and to help the person get back to baseline from which they can make an effective decision about their behavior. And in the case of most loved ones, once the person with BPD begins to make more effective decisions and, therefore, behaves more effectively, the work is done. I don’t take this view… I believe the work has just started – because, for my daughter at least, I’d love to see her actually FEEL better, rather than just behave better. Many loved ones are so tied up in the person with BPD’s behavior they begin to believe that the disorder is just a case of the person behaving badly. You and I know otherwise. It is a real disorder and requires a lot of hard work on everyone’s part to help your loved ones with BPD and to build a trusting, loving and respectful relationship in both directions.

Take care,
Bon

Thanks for replying to my post. I plan on responding to your 3 comments, yet I’d like to do so on the other comment, because it better describes what I am expressing here.

Bon

Concerning validation, I used info in SWOE directly from Linehan. In the second edition, see p. 128 and 128, BPD-specific communication skills in which I cite Linehan, and p. 146 where I use the term validation.

In fact, if you compare Linehan’s communication skills to mine, I don’t believe you’ll see a lot of differences in either SWOE or The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells. I researched her well before I wrote either book.

Now, here I am just confused:

In SWOE I said, “If you want the BP to change, you have to be willing to make some changes yourself if the person does not observe your limits. (page 157)”

Nowhere in that do I say the BP is “violating” limits. In fact, I took the phrase “observing limits” directly from Linhan. I also used Linehan’s limi-setting technique DEAR: Describe, Express, Assert, Reinforce. This is directly from the Linhan text (1993A) and workbook (1993B).

I do think your material is much more “staying” focused in the promotion and the purpose. The promotion of SWOE was all about getting people to read it, as back in 1998 no one had ever heard of BPD.

It is incorrect to say that my goal was to get people to leave the relationship. My goal was to help them understand BPD and make changes that would improve their own life WHILE improving the relationship. Because when you do one, you do the other! You don’t HAVE to choose between you and your BP.

This is from my new book, The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells (2008, Hazelden Publishing). Since I wrote this a decade later, this more accurately states my belief about this:
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Keep these principles in mind as you read this book. These thoughts need to become a permanent part of your mind-set when dealing with someone with BPD.

*********TO HELP YOUR FAMILY MEMBER, YOU MUST HELP YOURSELF FIRST **************

Your intuition may tell you that it should be the other way around—that the health of your relationship is dependent on your family member’s willingness to get help, and your job is to ignore your own needs and concentrate on fixing the other person. Wrong.

People spend years trying to please their borderline family member by twisting themselves into a pretzel to avoid conflict. Even if it works, the price is high. Family members suffer from depression, isolation, helplessness, low self-esteem, sleep deprivation, and even physical illnesses (especially adult children of people with BPD).

Predictably, the relationship begins to degrade, which is exactly what family members are trying to avoid.

This means that paradoxically, the long-term health of your relationship partly depends upon your willingness to look after your own needs, such as taking time away, setting limits with love, and having a hearty life of your own separate from your borderline family member.

This curious paradox is many family members’ undoing. They may hear it but not believe it; they may have lost the ability to take care of themselves (or never had it to begin with), or they may be unwilling to accept that giving, giving, and giving some more is just not helping the situation.

…………………………………………..

As you said, “I got a LOT of validation out of SWOE when I first read it 3 years ago.” Validation is the very first step toward family members helping themselves, which is the first step to them helping their BPs.

As I said, your work speaks for itself and is very good. it’s quite likely that your readers will also read something of mine: people want anything that will help. People don’t have to choose between our books. You could just as easily stress the similaries between our approaches as what you see as our differences.

Randi Kreger
Randi @BPDCentral.com
Author, “The Essential Family Guide to Borderline Personality Disorder: New Tips and Tools to Stop Walking on Eggshells”
(Available at http://www.BPDCentral.com)

Randi Kreger
Randi @BPDCentral.com
Author, “The Essential Family Guide to Borderline Personality Disorder: New Tips and Tools to Stop Walking on Eggshells”
(Available at http://www.BPDCentral.com)

But first, some background.

I wrote SWOE (with Paul Mason) in 1996 and 1997, right when I was going through my own version of, “Wow, this is a disorder.” I had a lot of questions, like everyone. It’s hard to imagine now, but I cowrote SWOE when there were no web sites about BPD because almost no one was using the web.

In fact, there was no “yahoogroups” type of software at the time: we started by just pasting in people’s names (all 12 of us). So you have to imagine where we were when SWOE first came out. It was the second book out there just for laypeople, after I Hate You –Don’t Leave Me.

I cowrote SWOE during those first years, as we (me and the first 100 or so members of WTO) were going through those “wow” periods when we need to unburden ourselves, complain, and so forth: in fact, it’s called the “outer directed stage” and it’s the second stage we all go through after the “confusion” stage.

Paul and I made sure that SWOE was very gentle, and was very explicit about the pain people with BPD go through. Despite the subtitle and call outs referenced in the post above (which helped the book become a success and lead to many others like it) SWOE is so gentle to people with BPD, and so sensitive, that I’ve had several bad reviews from non-BPs on Amazon who thing we’re much too nice to BPs.

Here is a sample one star review:

…………………………………………………………………………………………….

“If you grew up with someone who has BPD, then you are already familiar with the content of this book: yes, Borderline behavior is abusive and crazy-making, but the poor Borderline, he/she can’t help it, so twist yourself into a pretzel in order not to trigger them or upset them in any way. Otherwise, they may retaliate in a vindictive, manipulative, or vengeful way. Really?

I read this book thinking it would at least give some support to the non-BPD in his/her efforts to maintain a sense of self and sanity in the face of Borderline behaviors. Instead, it asked Borderlines what they thought non-BPD’s should do in the face of the Borderlines inappropriate, inexplicable rages.

Be good now and don’t upset the Borderline, who can’t help it. The Borderline’s world is painful (as if everyone around the Borderline doesn’t routinely pay the price for that), so try to understand.”
…………………………………………………………………………………………….

Now back you the post above and what I see as info that is incorrect, although you may have your own opinion.

Quote: “SWOE CAN modify the BP’s behavior, but only through threats and punishment (which SWOE calls “boundaries”)”

Reality: Boundaries are not threats and punishments, and nowhere in SWOE do I say so. They are must-haves in ANY relationship. Boundaries are positive things that keep relationships from becoming enmeshed. People have trouble with this “B” word because it has bad connotations. (That’s why in “The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells I call them Limits with Love.”)

This is what I said about boundaries in SWOE, p. 112 second edition:

“Personal limits are not about controlling or changing other people’s behavior. In fact, they’re not about other people at all. They’re about you and what you need to do to take care of yourself…..” Then on page 120: I have a section called “How Limits Help the BP.”

Perhaps I am missing something, but please let me know if you see any threats or punishments relating to boundaries, or anything that might be interpreted as such, and I will certainly revise it.

Quote: “Yet people must realize that SWOE can’t be used to engender a trusting, loving relationship with someone with BPD.”

Reality: SWOE can’t make any relationship loving and trusting. That has to be done by the two people themselves using the skills in SWOE. When people say SWOE helps people learn what to do, they don’t mean “leave.” They are referring to skills used WITH their BP loved one. SWOE is full of the same kinds of skills used in other book, including those on DBT.

….From page 146: “Validate the BP’s emotions:…this combines the paraphrasing and reflective listening skills you learned in chapter 6.” From page 125: “…become a good listener…do not become defensive and tune the other person out, even if he or she is accusing you of things you never said or did.” I could go on and on here….

Here are some reviews from Amazon about the techniques used to better your relationship:

….In addition to clarifying what BPD is, they provide crucial survival techniques for those who wish to stay in relationship with the BP’s they love.

…The authors give the reader interesting and useable scripts, provocative personal comments that make the reader deeply reflect on the agony of the BP’s mental states and clearly details step-by-step what to do if you are the spouse, child or parent of a loved one with BPD

….As a BP…I learned how my behavior affects others around me. It made me more aware of what non-BPs are thinking and feeling and encouraged me in my desire to change my behaviors through cognitive efforts….They do not try to offer solutions but rather focus on different techniques that can be of great aid to non-BPs and Borderline Personalities alike.

….More important, it contains very useful information about what I can do to make our relationship less hellish. We have small children, so divorced or not, we in each other’s lives for a long time. …I had to acknowledge my own failure to set boundaries, which is crucial with dealing with this kind of problem.

…Here’s hoping that clinicians will be more willing “to hang in” with the borderline for the long-term after reading this book.

… it encourages a sympathetic and empathetic approach to dealing with behaviors, which, on the surface, may seem driven by anger or revenge. …The book then moves on to suggest very common-sense approaches to dealing with day-to-day problems one may encounter…
…………………………………….

I don’t have the time to keep quoting here, but I will end with this one:

….the claim that the book just encourages the “non”-BPD partner to dump the BPD partner is the most unfair of all. About two thirds of the book, from pp. 85-220, is about how to deal with BPD on a day-to-day basis. Ospawno (another reviewer) finds this advice “vague and ambiguous”, but frankly, I would like to see him do a better job. BPD is not easy to live with. On the message boards run by one of the authors you will see people trying to deal with the disorder, and you will sometimes see what Ospawno calls “vindictive folks spewing vitriolic hate against their ex”.

If he had any actual knowledge of what it’s like to live with BPD, he would understand that this is a pretty natural reaction in some cases. It’s not a consequence of reading this book, which is most of the time more kind to the borderline than I would be inclined to be myself. Rather, it’s a consequence of living with BPD, which Ospawno clearly knows nothing about. ”
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Of 189 reviews, it has 4.5 stars out of 5. Not all of them have left their BP. Clearly, some people find it very helpful.

Quote: “Yet, if the relationship is going to work properly, one of the first things that one must accept is that the behavior of the person with BPD is not about you.”

Reality: I say that in SWOE on about every page. In fact, that is the first thing people say after reading SWOE: “it’s not about me!”

Quote: “Only through positive reinforcement did (my wife) start to behave better. SWOE doesn’t teach positive reinforcement.

Reality. Actually, that’s right: as I said, I wrote SWOE in 1997 or so. Back then I didn’t have all the answers (I don’t know, but I know more). Step five (tool 5) in The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells is all about behavioral science.

You know, while people criticize SWOE, in the 15 years since I’ve written it I have yet to find one person to point out one specific page or point and disagree with it. What I find is that most people don’t like the idea of the book, or they don’t like what people make of the book, or they don’t like it that non-BPs get angry and blaming themselves after being the focus of a lot of anger and blame.

I don’t mind all the SWOE-bashing in this blog—I really don’t. But I think that criticism should be balanced, and I see a whole lot of overlap between what is in SWOE and what is in every other book about this topic—perhaps just worded differently, or not given as much thrust, or put in another context.

It’s time we stopped telling non-BPs that focusing on themselves is wrong. It’s not. It’s part of the process. It’s why I have three books, matching with the process that people themselves go through. For those who don’t remember the process, this is from SWOE:

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Predictable Stages: People who love someone with BPD seem to go through similar stages. The longer the relationship has lasted, the longer each stage seems to take. Although these are listed in the general order in which people go through them, most people move back and forth among different stages.

Confusion Stage. This generally occurs before a diagnosis of BPD is known. Non-BPs struggle to understand why borderlines sometimes behave in ways that seem to make no sense.

Outer-Directed Stage. In this stage, non-borderlines turn their attention toward the person with the disorder, urging them to seek professional help, attempting to get them to change, and trying their best not to trigger problematic behavior. Anger is an extremely common reaction, even though most non-BPs understand on an intellectual level that BPD is not the borderline’s fault.

Inner-Directed Stage. Eventually, non-BPs look inward and conduct an honest appraisal of themselves. It takes two people to have a relationship, and the goal for non-BPs in this stage is to better understand their role in making the relationship what it now is. The objective here is not self-recrimination, but insight and self-discovery.

Decision-Making Stage. Armed with knowledge and insight, non-BPs struggle to make decisions about the relationship. This stage can often take months or years. Non-BPs in this stage need to clearly understand their own values, beliefs, expectations, and assumptions.
Resolution Phase. In this final stage, non-BPs implement their decisions and live with them. Depending upon the type of relationship, some non-BPs may, over time, change their minds many times and try different alternatives.
………………………………………………………………………………………

SWOE is what it is. It was the first. It wasn’t meant to be the best, the only word on the topic, or whatever. It was my first step: since, I’ve written better. But without it, I doubt the other books written on the topic would be as good as they are–or even there in the first place.

Randi Kreger

Randi @BPDCentral.com
Author, “The Essential Family Guide to Borderline Personality Disorder: New Tips and Tools to Stop Walking on Eggshells”
(Available at http://www.BPDCentral.com)