Creating boundaries are important when dealing with someone with a mental health issue. It’s what allows you to be compassionate and supportive without getting hurt yourself.
I was asked about how to create boundaries with someone who has borderline personality disorder. This individual loves her husband, but, his mental health problems create emotionally destructive challenges for her.
The first thing to do when trying to be supportive but needing to create boundaries is to better understand the condition. Just as knowing my son has loose ligaments in his body helps us adjust his physical activity so he can play without getting hurt, understanding what is happening with a mental health problem helps us create boundaries to protect ourselves so that we CAN be supportive. Knowing what a person can or cannot control in terms of their behavior helps us to step away without anger when they are behaving in a way that hurts us or causes harm so that we can protect ourselves as necessary.
According to psych central: people with borderline personality disorder have abandonment issues, unstable intense relationships where they idealize and then dehumanize their partner. They also tend to have unstable self-image problems (probably related to the abandonment issues) and self damaging impulsivity problems. See:
http://psychcentral.com/lib/characteristics-of-borderline-personality-disorder/ for a fuller description.
What my friend wanted to know was how she can deal with her partner’s clinginess and dangerous impulses. My advice to her was that the clinginess has to be dealt with first as that is the most damaging to the person dealing with someone like this. Being restricted from having friends and a life outside the relationship prevents the caregiver from taking care of themselves. The challenge is to find a way to help the spouse feel secure while also making sure you take care of yourself. Knowing that you being away create anxiety, perhaps she can create a check in schedule with the spouse when she is away. This changes the dynamic from – he is checking up on me and controlling me, to me helping him to feel secure since that is something he struggles with and can’t really control.
The challenge with creating the boundary is where to put it so that hopefully both partners will get their needs met. But the boundary has to be put where the person who needs to create a boundary needs it to be placed. You cannot ever totally satisfy someone who is insecure and anxious and you should not try to. Should you create reasonable accommodations? Yes. Allow them to control you? No.
The point of a boundary is to create space between the person suffering from mental health problems and the person supporting the person with mental health problems. It’s about responsibility. The person suffering from the mental health problems has a responsibility to get help with their mental health issue. They cannot and should not put all the responsibility for coping with their condition on their partners or other people. That’s the boundary.
The other thing I would do with someone with borderline personality disorder is that I would ensure that their dangerous impulse problems do not affect me. I've had several friends with this problem and you just have to say no to doing certain activities with them. I have come to view dangerous impulse problems as a suicidal. They are trying to kill themselves by accident. Recognize it as such and then take appropriate steps to ensure that you don't get killed in their attempts to kill themselves.
Finally, try to make sure they get the professional help they need and they stick to it. This is not easy to do and there is only so much you can do. The person with the mental health problems has to take responsibility for managing their condition. You can’t force them to get help. All you can do is encourage them to get help. And if they don’t get that help and eventually succeed in harming themselves, that isn’t your fault. You can’t fix them and you aren’t responsible for fixing them. All you can do is support them and know, sometimes that isn’t enough.
To help with this – I would also seek out mental health care for myself because supporting someone with a mental illness or mental health issue is mentally distressing and exhausting. A professional will help you learn how to create the boundaries for your specific situation. Which is why the advice is – go to get counseling even if your partner does not. People’s whose job is to professional help people cope with mental health problems will give you way better advice than I can in a blog post. So if you find yourself in a difficult situation like this – get professional help!
