How do I tell someone I think they have Borderline Personality Disorder?

BPD anyone?! – Winona Ryder and Angelina Jolie in “Girl, Interrupted”

This is one of the questions I get asked a LOT. It’s also a search term that leads people to my blog a lot. “What can I do when I suspect my friend or someone I otherwise care about has BPD?” or alternatively “How do I tell […friend’s name…] that I think s/he has BPD?”.

So I am going to write about that. That said, I do feel a bit overwhelmed with the question, because I feel like it is not my place to give people advice on something that can potentially have an effect on other people who I don’t even know, which is why I put this post together with the help of my mom (not the dysfunctional mother I grew up with, I might add, but the mom who’s my mom now, after adopting). She is a psychiatrist. Not my psychiatrist, obviously, because that would be just weird, but that’s her profession anyway. So she knows what she’s talking about and I feel more confident doing a ‘how to’ piece on this matter having discussed everything with her first.

So here we go: How do I tell someone I think they have Borderline Personality Disorder?

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1. Diagnosing someone is not a layperson’s call. Psychological conditions can be tricky. Symptoms overlap. It can be hard to diagnose someone with the right thing even for trained professionals whose job it is to know ALL the symptoms of ALL the disorders. Unless you are a trained professional who is seeing this person in a professional context, you can not diagnose anything and even if you are convinced BPD is it, you might be awfully wrong. Even professionals can get it wrong – and so you can, too. Always keep that in mind.

2. Before you tell anyone anything, stop and think about yourself for a moment. Why do you want to suggest to someone they might have BPD? Why is it important to you, if you are completely honest to yourself? If the answer to that is anything that comes from a place that is not solely genuine care and concern and love for the other person, then you are about to start off into an unhealthy direction anyway and should not go ahead with it. If there is anything at all that causes you to get own positive feelings out of telling someone, then stop reading right now, get the idea of telling the other person out of your head and start to deal with and take responsibility for your own feelings that put you on this path instead.

3. Keep in mind that self harm is not BPD. I have seriously seen people who thought that everyone who self-harms must automatically have BPD. That is totally not true. If your only clue is that someone self-harms, then you have an extremely thin case to go on and should not go ahead suggesting s/he has BPD at all.

4. Do not drop a label on anyone. If you carefully considered all of the above things and still feel like you want to let someone know you think they have BPD, then consider now that dropping a label on someone can be extremely harmful. Borderline Personality Disorder is a label with a lot of stigma attached. How would you feel if someone suggested you have something that people generally feel strongly and very negatively about? Therefore going ‘hey, I’m quite convinced that you have Borderline Personality Disorder’ is a really bad idea. After all if you come from a place of genuine care, concern and love – which is the only case in which you should still be reading this – you do not want to freak anyone out or harm them, or do you? Therefore you should be extremely cautious with dropping labels. Properly inform yourself instead and learn all you can about what BPD is and what it not is before you proceed.

5. Check if your relationship is one where suggesting someone has a psychological condition is appropriate. That’s a biggie. Are you a concerned friend or partner? Then you’re probably good. Are you just a co-worker, classmate or an acquaintance? Chances are it’s not your business to get so intimate with someone as to suggest they have a psychological problem. Are you a mother, father, sibling or other relative? Please go back to #2 and re-assess it. Carefully. Family – especially family of someone who might have BPD – is often a playground of hidden agendas, underlying power or mind games, wanting to tell someone for the sake of feeling superior or making the other feel inferior, etc. If you feel like you’d get any kind of personal satisfaction out of telling your family member they have BPD in the guise of being concerned, then don’t go ahead. If that is the case it’s quite likely you have just as much of an issue as the person you suspect has BPD and speaking up will only end up in your respective issues playing off of one another in an unhealthy way. Suggest you as a family have things going wrong instead and try to find professional help for the family as a whole – yourself included.

6. Always present what you are suggesting as your own opinion, because it’s not a fact and you might be wrong. If you have come this far and still want to go ahead, before you say anything at all, be aware of the relativity of your perception and thoughts. Even when you feel very convinced that you are right, you might still be wrong. What you are about to say is just a suggestion based on your own impression and opinion. State it as that: a possibility, not a fact.

7. Suggest it in a helpful and respectful way in a suitable moment.Suitable moments are moments where everyone is calm, when there is enough time to talk, even if it should turn into a longer talk, where you feel reasonably close to the other person and where you can make very clear that genuine care, concern and love is the place you’re coming from. Never talk in a place where others could overhear you, because that makes people generally uneasy. Suggesting something in a helpful and respectful way includes asking if the other person wants to hear your thoughts. You could say something like “I noticed you are struggling with a couple of things and I feel sad for you, which is why I am wondering if you would like my opinion/thoughts on it.” If you are actually friends and your friend or partner feels safe and positive about your relationship, chances are s/he will want to hear your opinion or thoughts. If s/he does not want to hear it, respect it, because if your thoughts are not welcome to start with, your thinking they have BPD is probably not going to go down well either.

8. Don’t say it in a way that suggests they have a bad personality or are a damaged person. If your thoughts are welcome, be careful to suggest your suspicion in a way that does not make the other person feel awful about herself. BPD is not a death sentence. It’s not a terminal, unalterable thing. It is simply a pattern of unhealthy ways of relating to people and the emotional issues that cause it are treatable. BPD isn’t the result of someone being a bad person either, but most of the time it’s a perfectly normal person who has experienced things that were really hard on him or her and made it necessary for her to develop these now unhealthy strategies to live their life somehow. Oftentimes they have survived things you have not and that’s something that deserves respect, not making the other person feel bad for themselves. That the ways of feeling and thinking and the behaviour are maladaptive now in normal contexts is all that is wrong, and that can be very hard. But there’s treatment available, people with BPD can be good people. Don’t feed into any misconceptions about BPD. And don’t use judgmental language and vocabulary.

9. Be prepared for the consequences. Even if you suggest it out of concern and love in a respectful, helpful way you might still trigger a response you didn’t want to trigger. The other person might get defensive. Or angry. Or sad. Or desperate. Or discard what you said. That you felt you needed to suggest to them that they might have BPD might temporarily damage your relationship. Or permanently. Be aware of that. If you are right about your suspicion, then the other person having BPD means that her relationship patterns follow their own dynamics to start with and those might include effects you didn’t want to cause. There’s little you can do about it. Knowing your own boundaries, staying calm yourself and not taking the response too personally (if you were actually coming from a place of concern and did not follow a hidden agenda) are the best things you can do. Ask if there is anything you can do for the other person. Be there for them if they want to. Give them space if they want space. You can’t force anything upon them.

10. Leave reacting upon it or not to the other person. You might think the other person should seek help, but whether or not they do it is their decision. Keep in mind that you have been thinking about the whole issue for a good while now, but to the other person your suggestion has suddenly caused a new situation. They might need time to think. They might come to a different conclusion than you. And that’s okay. You can point out options regarding what can be done, but no more. The rest is up to them. Respect their reaction. The only case in which you should intervene is if their reaction poses an immediate danger to themselves or other people. Everything else and they’re good, even if you don’t agree with it.

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So much for my suggestions about how to deal with telling someone you think they might have BPD. My mom and I did our best to try and consider all the aspects. We hope you find it helpful and wish you all the best. Feel free to let me know what you think.  🙂