Molly Freyer, Assistant Director at BFL’s Non-Residential Domestic Violence Program, Secret Garden, discusses challenges and best practices when working with a survivor of domestic violence who also has a Borderline Personality Disorder.
Borderline Personality Disorder (BPD) is often linked to abuse, neglect and separation early in life. Behaviors such as impulsivity, ambivalence, and instability of mood, relationships, self-image, and behavior tend to be characteristic of Borderline Personality Disorder (BPD). Individuals tend to respond poorly to changes and have a difficult time maintaining relationships. Fear of abandonment, so often a factor in cases of domestic violence, may prevent an individual from leaving an abusive relationship.
If a person with borderline personality disorder does seek help for abuse, they may face discrimination from service providers. Behaviors typical of individuals with BPD can lead some helping professionals to label them as “uncooperative” or “difficult,” thus barring them from the help they need.It is important to remember that the ‘symptoms’ of BPD may have developed in response to a lifetime of abuse. Survivors of domestic violence with BPD deserve the same comprehensive services and advocacy as any survivor; it simply might be necessary to modify the way in which helping professionals work with that individual to best suit their needs.
Important points to keep in mind when working with someone with BPD:
*Pay close attention to suicidal ideation and self-harming behaviors. It may be necessary to hospitalize an individual if they are actively suicidal.
*Watch for splitting (alternately idealizing/demeaning others), particularly if the person is working with several clinicians, such as a psychiatrist and a social worker. Regular meetings with everyone involved in the individual’s care can help minimize splitting.
*Medication may be a key aspect of treatment. For individuals with BPD, medication can both help to stabilize one’s intense emotional reactions, as well as treat other conditions that tend to occur along with BPD, such as depression.
*Clarifying the roles different people can play in a person’s life is critical. Owning that any one person will not be able to solve all problems and helping an individual move beyond the model of idealizing or demonizing others is a central part of a helping relationship.
Miss A: Survivor’s Story
The following example highlights the challenges of helping an individual with BPD, as well as the possibilities for healing.
Miss A. is a 61-year-old survivor of domestic violence with a diagnosis of BPD. She came to Secret Garden with a history of physical and sexual abuse as a child. As an adult, she experienced daily abuse from her husband of eighteen years. She fled her abuser and found Secret Garden, but had devastating emotional scars from years of trauma.
Her fear of abandonment made it difficult for Miss A. to fully trust the Secret Garden staff. Miss A. initially had trouble expressing the anger she felt related to the abuse, and instead expressed her feelings through self-mutilation and suicide threats. Initially, she called the Secret Garden several times a day for support, yet would not attend her scheduled counseling appointments.
Secret Garden’s team approach provided Miss A with a social worker, case manager, and a psychiatrist. Over time, Miss A. learned healthy methods for coping with anger and also techniques of ‘self-soothing’. Eventually, she no longer felt the need to harm herself. These coping mechanisms, coupled with the establishment of firm boundaries by Secret Garden staff, also reduced Miss A’s calls to the program.
Through counseling with her social worker Miss A. began to discuss the years of abuse—revealing painful memories that haunted her. Through this therapy, and with the support of the Secret Garden staff, Miss A. signed up for Access-a-Ride Para transit services, which provides her door-to-door transportation to appointments and social events. Miss A. is now getting out of the house and developing healthy relationships with her peers.
Given how difficult it was for Miss A to initially leave her house, the fact that a case manager, social worker, and psychiatrist were available at one program drastically increased the likelihood that she would follow through with the entire team of helping professionals; likewise, the staff’s understanding of personality disorders helped them work with Miss A, as opposed to mislabeling her as ‘noncompliant.’ While many challenges still lie ahead, Miss A. now states that she is ‘looking forward to starting a new life.’
For more information on borderline personality disorder:
*National Alliance on Mental Illness: www.nami.org
*National Education Alliance for Borderline Personality Disorder www.neabpd.org
*Borderline Personality Disorder Resource Center: www.bpdresourcecenter.org
*Domestic Violence and Mental Illness – The Domestic Violence and Mental Health Policy Initiative: www.dvmhpi.org
