Supporting someone with a personality disorder

Loving someone with a personality disorder can be rewarding and very hard at the same time. Feelings may run high. Closeness can swing to distance and back again. You may feel confused, worried, worn out, or all of these. None of this means you are failing.

This page shares what research and family programs suggest can help. Most of it is written with borderline personality disorder (BPD) in mind, since that is the condition families have been studied most. Many of the ideas also fit other personality disorders. Treatment helps many people with BPD have fewer symptoms and function better, and families can be part of that.¹

Start with understanding

A personality disorder is a long-lasting pattern of thinking, feeling and relating that causes real distress. It is a health condition. It is not a choice, and it is not bad character. You can read the basics in our personality disorders overview and our page on borderline personality disorder.

With BPD, feelings can be very strong and slow to settle. People may fear being left, and small signs of distance can feel like rejection.¹ Knowing this can help you read a hard moment as pain, not as an attack on you.

NIMH suggests that families learn about the disorder and offer emotional support, validation, patience and encouragement.¹ Learning is one of the most useful first steps.

What is validation, and how do you do it?

Validation means showing that you see and understand what another person is feeling or thinking. It does not mean you agree, and it does not mean you approve of what they did. You can say "I can see how angry you are" without saying the anger is right.⁶

Invalidation is the opposite. It is when someone's feelings are brushed off, criticized or treated as a symptom. Judgment and criticism can creep into any family, especially when everyone is scared or tired.⁶ Many people with BPD have also faced rejection, trauma and stigma, so kindness matters.⁷

A few tips from family skills training:⁶

• Describe, don't judge. "You seem very upset" works better than "you are too emotional."
• Pause before you reply. Strong feelings pass more easily when no one acts on them in the moment.
• Validate what is valid. Notice and thank the person for effort and progress, not only for problems.
• Validate yourself too. Your own feelings count. Being calm yourself makes it easier to stay kind.

Validation is a skill, and it takes practice. You will slip. That is normal.

Calm, steady limits

Support does not mean saying yes to everything. Limits keep a relationship safe and fair. They also help you avoid growing resentful.⁶

1. Know your own limits. Think about what you can and cannot do. Examples: no yelling, no calls at 3 a.m., no lending money.
2. Choose a calm moment. Do not set a limit in the middle of a fight. Wait until things are quiet.
3. Say it simply. Use "I" words. For example: "I want to keep talking, and I need us both to speak calmly. If we cannot, I will take a break and come back in an hour."
4. Follow through, kindly. A limit only works if you keep it. Say it again calmly. Do not punish.
5. Offer what you can do. "I can't talk now, but I can call you tomorrow at 5."

Family skills training teaches a method for asking for what you need, called DEAR MAN.⁶ It is the same skill taught in DBT interpersonal skills. For more on guilt, saying no and sharing the load, see setting boundaries as a caregiver.

Supporting treatment

Therapy is the main treatment for BPD. Medicines do not treat the core of the condition, though a doctor may use one for a specific problem such as low mood.¹ Therapies built for BPD, such as dialectical behavior therapy (DBT), teach skills for handling strong feelings.¹ Our page on treatment for personality disorders explains the options.

How you can help:

• Encourage the person to start treatment and stay with it.²
• If the person is in a skills-based therapy, learn its words so you can support it at home.²
• Make specific offers of help and follow through, such as a ride to an appointment.²
• Help with medicines as prescribed. Encourage the person to talk with a doctor before stopping or changing any medicine.¹
• Support daily routine, sleep and a healthy lifestyle.¹
• Remember that the person decides who is involved. UK guidelines say to ask the person whether they want family involved in their care, and to give families information about local support.⁷

Be patient. Getting better often takes time, and it is not a straight line. Setbacks do not mean treatment failed.

When there is self-harm or suicide risk

People with BPD have much higher rates of self-harm and suicidal thoughts than the general population.¹ Hurting oneself is often a way of coping with pain, and it is also a sign that help is needed. Anyone thinking of harming themselves or attempting suicide needs help right away.¹

The National Institute of Mental Health lists five steps to help someone who may be thinking about suicide:⁸

1. Ask. Ask directly: "Are you thinking about suicide?" Studies show that asking does not put the idea in someone's head.
2. Be there. Listen without judging. Talking about it can lower distress.
3. Help keep them safe. Ask if they have a plan. Help make dangerous items or places harder to reach.
4. Help them connect. Connect them with 988 and with a trusted person or professional.
5. Follow up. Stay in touch afterward. Steady contact matters.

A few more points on crises:

• Stay calm. Listen, help the person feel understood, then take the next step toward help.² Calm, non-threatening support is also what UK guidelines recommend. They advise avoiding minimizing the person's reasons for distress.⁷
• Do not leave the person alone if you think they may act on thoughts of suicide. Get help.
• Treat injuries as medical needs. If someone has hurt themselves, help them get medical care when needed, without shame or anger.
• Use the plan. A written safety plan lists warning signs, coping steps and who to call. UK guidelines advise a crisis plan that names triggers, coping steps and how to reach services at any hour. They suggest updating it after each crisis with the person and, if possible, family.⁷
• Short hospital stays may be needed during extreme stress or when behavior puts the person at risk.²

Our page on when a family member is in a mental health crisis has more about mobile crisis teams and what to expect.

Self-harm is never an excuse to shut someone out. UK guidelines say that people should not be denied care because they have self-harmed.⁷

Family programs that help you

Relatives of people with BPD often feel grief, guilt, fear and exhaustion. Programs made for families can help.

Family Connections is a 12-week program for family members, partners, caregivers and close friends of a person with BPD. It was designed by Alan Fruzzetti and Perry Hoffman and is offered by the National Education Alliance for Borderline Personality Disorder (NEA-BPD). Classes are led by trained leaders who are themselves family members. They teach facts about BPD, DBT-based skills in communication and validation, and ways to build a support network. There are in-person classes, and a phone option for families who live far away.³

What research shows: Moderate evidence

• In a 2005 study of 44 relatives, grief and burden dropped and sense of mastery rose after the program. Gains held at 6 months. That study had no comparison group.⁴
• A later study with 80 relatives compared Family Connections to another support program, without random assignment. Family Connections relatives improved on burden, grief, depression and mastery. The gap between groups was significant for burden and grief. The authors note that the study was not randomized and was run by the program's own team.⁵

So the results are encouraging, but not yet proven by large randomized trials. Check with NEA-BPD about class locations, fees and online options.

Other support. The NAMI Family Support Group is free, confidential and led by family members. Groups meet weekly, every other week or monthly, and many meet online.¹⁰ The NAMI HelpLine can point you to local help at 800-950-6264 (Monday to Friday, 10 a.m. to 10 p.m. Eastern time), or by texting "NAMI" to 62640.² NIMH also suggests that family members seek their own counseling, ideally with a different therapist than their loved one's.¹

Taking care of yourself

You cannot pour from an empty cup. Looking after yourself is not selfish. It is how you stay steady enough to help.²

• Keep your own doctor visits, sleep, meals and activities.
• Spend time with friends and others who are not part of the stress.
• Join a support group or a class, so you are not alone with this.
• Talk with a counselor of your own.
• Take breaks. Share tasks with others. Our care circle tool can help you organize who does what.
• Read about caregiver burnout and know the warning signs in yourself.

If supporting your loved one brings up hard feelings for you, 988 is there for you too.⁹

In later life

Personality disorders can show up differently with age, and adult children often care for a parent with long-standing patterns. A sudden change in personality in an older person is different. It should be checked by a doctor. See personality disorders and personality change in later life.

Questions families often ask

When to get help

• Call or text 988 if the person talks about suicide, or if you are worried. Chat at 988lifeline.org is also open.⁹
• Call 911 if someone has hurt themselves badly, has taken something harmful, or may act on thoughts of suicide right now.
• Call the doctor or therapist soon if you see more self-harm, more risky behavior, or a big drop in mood.
• Get help for yourself if you feel hopeless, cannot sleep or eat, or are afraid in your own home. Visit our help page.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.