Editor’s note: All statistics cited in the review are taken from the book itself.
Borderline personality disorder (BPD) is a mystery to many of us, even clinicians. Still, BPD is more common than schizophrenia and twice as common as anorexia nervosa. Compared to the general public, a person with BPD is 400 times more at risk for suicide. BPD is a serious condition that is often misunderstood, misdiagnosed and overlooked. Families of individuals with BPD may be at their wit’s end, trying to figure out how to live with someone whose emotions resemble a rollercoaster.
This is where The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells comes in. It’s written by Randi Kreger, co-author of the bestselling Stop Walking on Eggshells and Stop Walking on Eggshells Workbook and operator of bpdcentral.com, a top resource for BPD.
Not only does The Essential Family Guide provide sheer comfort and empathy to families who feel frustrated, lost, alone, powerless and defeated, but it offers a wealth of information that helps loved ones better understand the disorder and start to lead healthier, happier lives themselves. The writing, structure and advice are easy to read and straightforward. Families will undoubtedly appreciate its step-by-step tips and frank tone.
The guide is divided into two parts. Part 1 focuses on “The ABCs of BPD,” which discusses BPD symptoms, risk factors and treatments; relationship challenges; and finding professional help. Kreger helps the reader gain a deeper understanding of how individuals with BPD think, feel and act. For instance, she delves into the Diagnostic and Statistical Manual version IV definition of BPD, discussing in detail its nine traits (including fear of abandonment, intense self-image, impulsivity and intense rage), other common characteristics (such as lying), types of BPD (e.g., high-functioning vs. low-functioning) and other populations with the disorder.
She also addresses prevalent misconceptions. First, many loved ones think that they should put themselves last and focus entirely on the individual with BPD. One of the key principles of The Essential Family Guide is to “help yourself first.” According to Kreger, “family members suffer from depression, isolation, helplessness, low self-esteem, sleep deprivation, and even physical illnesses (especially adult children of people with BPD).” And, ironically, these issues can eventually damage the relationship, anyway.
Families also assume that if their loved one won’t change, their lives can’t improve. But Kreger points out that this guidebook will teach you the tools and techniques to feel better and get the power back in your life – whether your loved one changes or not. She writes: “You control your own destiny much more than you think you do, though it takes learning, planning and practicing.”
Another big misconception surrounds the emotions, thoughts and behaviors of people with BPD. It can seem that these individuals differ dramatically in these areas from people without the disorder. However, people with BPD, Kreger writes, “feel the same emotions that we all do. The difference is the intensity of their emotions. On a scale of 1 (extreme negative feelings) to 10 (extreme positive feelings) the scale runs from an impossible 0 to 11.” Same with thoughts and behaviors, which are exaggerated and more frequent. To better grasp this, Kreger includes a unique exercise that helps families put themselves in their loved one’s shoes.
A great strength of the book is Kreger’s inclusion of anecdotes and examples. (Advice from experts is also included.) The personal stories are particularly powerful. Readers get perspectives from loved ones of individuals with BPD and the individuals themselves. For instance, in the chapter on relationships, Kreger describes what she terms the “five dysfunctional dances.” In the “testing tango,” she includes quotes from a woman who’s recovered from BPD:
I’ll never forget the first time I uttered the words, ‘I’m just testing you to see when you’ll leave me because everyone does. I know it’s wrong, but I just can’t help myself.’ What might start out as a casual gripe about finances would eventually become a three-day rage-fest over money management. I became a screaming, ranting, raging mess.
I knew that I couldn’t start with a full-blown BP rage. So I started softly and slowly. With each test I set forth and the person passed, I upped the ante and said, ‘If you loved me, you would do this or that.’ People usually accepted the most outrageous and inappropriate behavior to maintain the relationship.
Throughout the book, Kreger includes practical, real-world advice. For instance, in the chapter on “finding professional help,” she dissects the steps for searching out a reputable therapist, including tips on becoming an informed consumer, creating a medical file and finding referrals along with questions to ask.
Part 2 is heavy on the how-to’s, which provide invaluable insight for approaching individuals with BPD and helping yourself. These chapters dig deeper into self-care and provide families with five power tools: taking care of yourself; identifying why you’re “stuck” and how to get “unstuck;” communicating effectively with people with BPD; setting limits; and reinforcing the right behavior.
When communicating with someone who has BPD, you may feel like your exchange is lost in translation. Individuals with BPD can misinterpret everything from a conversation to a facial expression. Constructive criticism may be viewed as an assault on the person’s intelligence or integrity. You may say they made a mistake; they interpret this as you saying they’re stupid. Or you may do nothing at all. Either way, an argument ensues. Kreger explains why this happens and what you can do. She gives step-by-step strategies to improve communication, such as the “Row Your Boat” system (because it’s sung to the tune of the song, “Row, Row, Row Your Boat”).
Breathe, breathe, safety first,
Acknowledge what you hear,
Don’t defend, delay instead,
Distract, defuse, or DEAR.
Kreger defines each of these concepts and even gives you examples of phrases you can say to your loved one to fend off fueling the argument. In the chapter on reinforcing the right behavior, Kreger spells out scenarios that showcase how families may inadvertently reinforce bad behavior and how they can promote positive behavior. Again, it’s these real-life tips that make this book a must-read for families.
In addition, The Essential Family Guide is an empowering book. Families with loved ones with BPD often forget to stay attuned to their own feelings, desires and goals. This book empowers you to ask yourself thought-provoking questions about your life. For instance, in the chapter on getting unstuck, Kreger writes:
Look at your life the way it is right now. Are you living in accordance with your values or at odds with them? What are you passionate about, and what role does that play in your life? Do you know, in vivid detail, who the real you is, or do you live a compromised existence? Where will you end up if things keep going in the same direction?
And it empowers you to listen to yourself and take the control back:
Starting today, it’s time to trust your inner voice. No one but you has the power to define you. As you start to become more confident and trust your own judgment, you will stop giving other people control of how you feel and what you do. Trusting yourself enables you to set limits that work because you finally, truly, believe you have a right to set them.
You’ll also find a comprehensive list of helpful materials in the back of the book. Overall, this book is both instructive and inspiring. Family members will find great relief and valuable resources.
The Essential Family Guide To Borderline Personality Disorder: New Tools and Techniques To Stop Walking on Eggshells
By Randi Kreger
Hazelden: October 2008