Borderline Personality Disorder - anyone with experience?

Full disclosure, I am not a psychologist or therapist, but this is from personal experience,
my close friend's wife has BPD.

To be honest, his situation is brutal. His wife is unpredictable, screams at him, sometimes calls him at work 20-30 times a day, calls his friends and screams at us about him being stupid and ugly and why do we remain his friend. She is delusional and totally self-involved (apparently narcissistic personality component is common in Borderlines) and pushes him away yet is terrified of him leaving. But that is his situation with this disorder. Also, it is my understanding that since it is a Personality Disorder, it is not treatable but can be somewhat managed.

There is a good book about BPD, "I Hate You, Don't Leave Me", gave me perspective of his experiences. He does not socialize with her and his his friends as no one wants to subjected to her behavior. Interpersonal relationships are a struggle with Borderlines. I can provide dozens of examples of her behavior, some I have seen and heard, very disturbing and I really wonder why he stays with her.

The one time we tried to support my friend in his relationship and invited them over for dinner. Apparently due to her behavior before they left home they were 2 hours late. When they finally arrived the first thing she said, not hello, apologies for being late or anything else just, "when I walk into a department store, the clerks all stop and stare and tell me I am the perfect size zero". We provided special food for her which she refused and spent the evening in the bathroom texting her husband.

She is pretty deep end, cannot maintain employment or relationships. From what I have witnessed it is an insidious disorder.

Has your friend been in touch with NAMI? They offer lots of resources for parents of children with a mental illness. I took a class from them years ago that was very helpful, and it also put me in touch with other parents going through a lot of the same things.

So this is my daughter's primary diagnosis now. They're moving away from bipolar and more strongly toward BPD. This is the the daughter who recently attempted suicide and spent five days in the hospital, but on the other hand managed to graduate from college in all of that. There's more, so much more that I haven't shared here and don't intend to. Suffice to say that our lives are constant emotional chaos because we never know when the next crisis will occur or how bad it will be.

I'll be honest: when we first got this tentative diagnosis and I read more about it, and got involved with a couple of online support groups, I cried for days. This is not a struggle anyone wants for their child. BPD patients have high rates of suicide, substance abuse, and self harm. They often have trouble making and maintaining lasting relationships and many have difficulty maintaining employment. I found the books that were supposed to be helpful were actually very discouraging and made these kids out to be monsters, which was not something I wanted to read, but your friend may feel differently.

There's also a strong stigma attached to the disorder, as it was believed for years that it was caused by neglectful/abusive parenting. The psychiatric community now leans towards this being a genetic disorder that is often exacerbated by certain traumatic events or types of parenting that would be considered "good" parenting for any other child, like setting boundaries and loss of privileges for poor behavior. BPD kids and young people need to be parented in a very different way.

My daughter is currently on an anti-psychotic which seems to help with the negative behaviors and the lies her brain tells her (BPD patients often believe that everyone hates them, that their family and best friends don't want to see them, and other stuff). She also takes buspar for anxiety and that seems to help as well. Really, though, the gold standard treatment for BPD is dialectical behavior therapy, and it may take more than one "round" for it to really be helpful. Ours did a six-week intensive outpatient therapy session for BPD back in 2021 and she did find the exercises helpful, but we're all feeling that it's time for her to go back and do it again as she starts this new, adult phase of her life.

The most positive thing I've read/been told is that most BPD patients, with therapy, improve as they age and mature. I'm hopeful that will be the case.

I love my daughter dearly, and when she is feeling well, she's a sweet, funny, charming young woman. I can't quite express what it feels like to get a diagnosis in your child's early adulthood that forces you to entirely change what you imagine for your kid's life in terms of her basic safety and happiness. My best advice to your friend is to find a therapist for herself who has experience with BPD, because she will need someone to talk to who "gets it" and isn't emotionally involved.

ETA: she has also spoken with her psychiatrist about the possibility of an autism diagnosis as well, but I don't know where they are on that. She had to start over with a new psych after she was hospitalized - her old one "dumped" her after that - so we're back to square one on some things.

I recommend that she get into therapy with a provider who has experience with personality disorders. That therapist will get to know here and determine if BPD is an accurate diagnosis, but also work on the personality characteristics and symptoms that are causing impairment. DBT is well-known for being a treatment for BPD but it can also be used for other disorders. So getting into a DBT group or provider who uses DBT techniques could be helpful.

I’m not a trained therapist, but I know someone who works with BPD clients. I highly recommend DBT, or dialectical behavior therapy. It’s based on the work of Marsha Linehan. There are quite a few books and websites about it. In my opinion, it’s a program that helps patients understand why they feel the way they do and teaches practical skills for how to deal with everything. It can really be helpful.

I have a lifelong friend who had to be hospitalized briefly a few years’ ago and was diagnosed w/ BPD. She was referred to a provider for treatment, and the provider eventually determined that my friend was suffering from depression and PTSD rather than BPD. 

She still sees the therapist and is doing great.

One thing DD's current doctor said that stood out to me is that he's less concerned about labels and diagnoses than the behaviors that are keeping the patient from living life the way they want to. BPD-type behaviors, whether that is the right label or not, are very challenging for the patient and the family. My best wishes to your friend and her daughter. 

I agree. Sometimes people get too focused on a label, when in terms of mental health treatment that isn’t as concrete as it is with other health issues. The symptoms are really what is treated, not the specific diagnosis.

Also, it isn’t usually BPD or another diagnosis. Depression, anxiety, PTSD can and do often go along with personality disorders.