Borderline personality disorder (BPD) is a troubling mental disorder with prevalence estimated at up to 2% in community surveys. BPD is characterized by fluctuating emotional arousal, intensely conflicted relationships and for many individuals, recurrent self harm. The lifetime mortality from suicide is 8-10%. From its origins as a psychoanalytic concept until its inclusion in the DSM in 1980 borderline personality disorder, or borderline syndrome, occupied something of a marginal place in the psychiatric landscape, with polarised views among therapists and clinicians about care and treatment of people with BPD. The work of Marsha Linehan, who provided the forward to this very accessible self-help guide by Shari Manning, did much to bring BPD into the mainstream, although it would still be fair to say that clinicians' views on BPD are quite divergent.
Loving Someone with Borderline Personality Disorder is aimed at translating the methods of Linehan's dialectical behavior therapy (DBT) into a practical set of self-help techniques for friends, partners, family members and others who find themselves in a relationship with BPD. Manning's message is that while the relationship can be difficult, even tempestuous, there are ways of managing the multitude of emotional conflicts. In three parts and thirteen chapters Manning makes BPD an accessible problem. She provides brief, clearly explained strategies together with explanations of the experience of the person with BPD. Her writing is sympathetic to the person with BPD and their supporters, but she is also very clear about the difficult decisions that supporters may need to make and the consequences of the "rescuing" responses that are so inviting to people under emotional duress. The book is richly illustrated by case examples that bring the dilemmas of BPD to life.
Manning's own background equips her well to provide this self-help resource. Manning trained in DBT under Marsha Linehan and has accumulated a wealth of experience working clinically with people with BPD. She makes frequent reference to DBT throughout the book, but her major achievement is to translate DBT principles and methods into practical steps and advice that are accessible to a lay person. Manning uses ordinary language and explains the use of DBT language and concepts clearly. She does not promote the book as sufficient in itself for managing severe emotional dysregulation. Her advice is always for the wellbeing and support for the friend, partner or family member. Manning does not want to make them into therapists.
While Loving Someone with Borderline Personality Disorder is not a clinical text, the book also deserves to be read by non-specialist clinicians who come into contact with people with BPD or borderline syndrome. The techniques of mindfulness, awareness of emotional triggers, validation and others can be usefully integrated into many areas of clinical practice, especially for clinicians advising supporters of people with BPD. The applicability of the book is not limited to those with a diagnosis of BPD but can helpfully be utilised with anyone who has problems with emotional regulation, vulnerability, and the tendency to use self-harmful behaviors to modulate stress.
Loving Someone with Borderline Personality Disorder is a clearly written and accessible guide that deserves to be widely read, and which should be available to lay members of the public and to health professionals.
© 2013 Anthony O'Brien
Anthony O'Brien, RN, MPhil is a lecturer in mental health nursing at the University of Auckland, New Zealand, and a clinical nurse specialist in liaison psychiatry at Auckland Hospital.