Program Offers Support to Families of Patients With BPD

A peer-led, group program for family members of people with borderline personality disorder (BPD) can help speed the BPD recovery process, according to presenters at a panel session held at APA’s Annual Meeting in May.

Psychiatrists are increasingly realizing that borderline personality disorder—characterized by exaggerated, inappropriate reactions to perceived slights or rejections—is not just a behavioral dysregulation within an individual. “This is a disorder between multiple people, since how family members react to emotional outbursts affects the course of the disorder,” said Brian Palmer, M.D., a psychiatrist with Allina Health in Minnesota, who chaired the session.

David Hathcox

In the past, there were misperceptions that parental neglect or abuse were major contributors to BPD, Palmer noted. Today, psychiatrists are aware that family members are resources for positive change.

“If a family with a BPD individual can improve their interpersonal relationships by just 10% to 20%, that could significantly speed recovery,” Palmer continued.

One way to improve these relationships is through Family Connections, a 12-week, community-based program that combines psychoeducation, coping skills, and emotional support to families of people with BPD. The program, developed by the National Education Alliance for BPD (NEABPD), is free to participants and is led by program graduates.

“Research has shown that grief, depression, and stigma are common among [the] family of a BPD patient and [that they] have a burden that even exceeds that shouldered by family of someone with schizophrenia,” said Perry Hoffman, Ph.D., president of NEABPD. Hoffman cited the high rate of suicidal ideation among BPD patients as one of the greatest sources of stress for families.

The Family Connections program offers families the same two elements that are considered important in treating the patient with BPD: acceptance of the disorder and validation that this disorder is real and biological.

Two program graduates—Joy Rynearson and Liza Preminger, Psy.D.—participated in the session, where they shared their experiences and provided suggestions to psychiatrists in the audience.

“I think psychiatrists should not be afraid to take the program themselves,” noted Rynearson, whose daughter was diagnosed at age 18. “You will have a tremendously different perspective on BPD.”

Preminger, who completed the program in 2011 and was inspired to get her psychology degree after her brother’s diagnosis, touched on the unique relationship issues facing siblings of BPD patients, which she has gathered through many semi-structured interviews. Notable issues include an increased sense of loneliness, the worry that the sibling bond has been broken, and looming concerns over long-term caregiver responsibilities.

Importantly, siblings often feel that their needs are not met during sessions with mental health professionals and that their position as a “well sibling” is not validated to the same extent as the patient’s or parents’ position.

Other tips passed on by Rynearson, who has led several Family Connections sessions in the San Francisco Bay Area, are that parents do not want their children overmedicated; that physical activity and engaging with nature do improve behavior and should be considered clinical options; and most importantly, that their children with BPD do get better with care. “We are not hopeless,” she said. ■