Relapse After Treatment for Borderline Personality Disorder (BPD)

It took 50 years for my mother to finally admit that she had a mental health issue – longer still for her to accept out loud that she fit all nine of the criteria for borderline personality disorder. Now that she has, I feel emotionally validated by her for the first time, and because she is choosing to learn ways to control her emotional reactivity, especially in relation to me, we are able to have a relationship, which we’ve never truly had before.

At 37, I feel like I have a mother – and a friend in my mother – for the first time. She is still a woman who has borderline personality disorder and this can be incredibly difficult, for her as well as for me, but because we are both aware of her disorder, we’re now able to navigate our exchanges in healthier, more empathetic ways. Sometimes there are still “flare ups” and I recognize that stress – even positive stress – can trigger my mother’s old behaviors. As she continues to heal and grow, she is gaining independence, but this independence comes with challenges particular to BPD. My mother doesn’t need people in the ways she used to. Because she isn’t clinging or manipulating people in order to keep them in her life the way she once did, she fears being alone, and alone equates to abandonment for her. In some ways, this means the road to recovery presents challenges that can easily push my mother back into old behaviors, causing her to emotionally regress or revert despite the fact that she has made tremendous progress. Knowing how much she has been able to improve – in relationships, at work, and in her interior world (she reports better self-esteem, better concentration, and a deeper sense of peace) – I am certain that my mother’s progression of wellness from borderline personality disorder will be a steady upward trajectory. There may be occasional pitfalls, but I know that she will continue to heal. I’m grateful that I did not remain “no-contact” from her. It has been deeply meaningful to me to be a part of her life now that she can be truly present for mine.

In a blog interview with Adult Children of Mothers with Borderline Personality Disorder (BPD), a woman describes a stage in the lives of mothers with BPD and their adult children that is perhaps vanishingly rare among those with the diagnosis and their closest loved ones. As many family members learn, helping their loved ones to acknowledge or admit they may have BPD is a herculean task; often it is impossible. The tendency among people with BPD is to believe that others are “wrong,” that they are the “victims.” Even when those with BPD have consistently overreacted, spoken harshly, criticized, judged, blamed, or even used abusive language, the person with BPD believes strongly that they were provoked – they were merely defending themselves against the terrible treatment of others. No one wants to believe their behavior is unjustifiable.

Stage Theory of Development and BPD

Several theories exist to describe psychological development; they are called stage theories. The premise behind stage theories is that, essentially, all humans develop more or less along a similar psychological and moral path, excepting those people who are handicapped by extremes of environment (early trauma or neglect) or by problems of the brain (e.g., schizophrenia, traumatic head injury, etc.). Because many people with BPD are intelligent, motivated, capable workers and/or creative thinkers, it’s not a far reach to assume that they are developing psychologically and morally as well, although perhaps they begin their emotional development at a somewhat later date or slower pace than others.

Risk of Relapse after Treatment

Despite the many difficulties BPD presents, it can be recovered from; it is only a matter of how much work the individual is willing to do – how motivated she is about changing her behaviors and reactions and becoming well. Once she decides she wants to be well and begins, her psychological and emotional development continues in earnest. As a person with BPD becomes more self-aware and more cognizant of how her behavior is affecting others, her growth expands perhaps exponentially. When our loved one begins treatment or therapy in earnest and we begin to see real progress for the first time it can be exciting, but as Gunderson and Berkowitz explained in Family Guidelines for the New England Personality Disorder Assn., our expressions of excitement can potentially create fear in our BPD loved ones and this may inadvertently trigger their relapse. As they become more independent, and as we become more pleased with their independence, they may begin to fear the loss of our closeness or attention. Fear of abandonment is the BPD’s deepest trigger, and even while real emotional and behavioral progress is being made for the first time, it is not unusual to see someone return to treatment for suicidality, self-mutilation, substance abuse, or binge eating, for example – even after having done very well in therapy for many months. The New England Personality Disorder Assn. advises family members and loved ones to refrain from positive statements that may imply to the person with BPD that she has made all the progress she needs to make, or that no more difficulty is on its way. Statements like, “You’ve done a great job getting better!” may seem innocuous on the surface, but after the inevitable difficult experiences come (life will always bring more difficult experiences as well as more positive ones), the person with BPD may have a harder time adjusting in spite of learning better coping skills in therapy. This kind of let down may be a set up for relapse. The important thing to recognize is that relapse is not a sign of failure. Relapse is merely a part of the process of recovery for some people; it may take a couple of steps backward before the long and tricky uphill climb is finally navigated. What we want to ensure is that the people we care about who happen to have BPD understand that they are not climbing that mountain alone.