Living with someone with borderline personality disorder is not easy. “One minute I am her best friend and the next, she won’t talk to me. Everything is a crisis or a conflict. And I am wondering if I should even answer the constant text messages blowing up my phone.”

This all or nothing behavior is characteristic of the person with borderline personality disorder. The behavior can be exhausting for those in a relationship. The person has interpersonal difficulty with constant fear of being rejected, separated or abandoned. They can be impulsive, suicidal, engage in risky sexual behavior, substance use and have mood swings. And what is difficult for those around them is the lack of empathy often noticed.  For some people, intense anger and aggression can land them in trouble with the law.

There is no medication treatment for borderline personality disorder (BPD). Treatment involves interpersonal therapy. An effective type of therapy is Dialectical Behavior Therapy (DBT). DBT helps the person with interpersonal effectiveness, mindfulness, emotional regulation and distress tolerance. It addresses better ways to cope with intense emotional emptiness.

When conflict escalates, the best thing that helps is a calm and relaxed environment. When the person is in crisis, wait until the crisis is over to discuss anything of meaning. If conflict escalates, take a deep breath, stay calm and do not join in the emotional reactivity. That will only escalate things. Try listening. If that doesn’t help and things escalate, tell the person you are taking a time-out to get perspective.

Do not get defensive despite what they say or in any way invalidate their feelings. Do not try to convince the person they are wrong, rather simply state what your position is in a calm and friendly way. Make sure your tone of voice is firm but matter of fact. Communicate that there is a solution if you both can talk it through.

If the person starts threatening self-harm, even if it is attention-seeking, you have to take it seriously. This means you need a plan to deal with this behavior. Have the person call his or her therapist, go to the emergency room with you or call a hot line. Let the person know you care and are listening to their emotional pain. Reflect and summarize what they say so they know they are heard and not abandoned. This will help de-escalate the problem.

To calm down the situation, distract, deflect and delay. Most of all, do not take it personally. Remember, you can’t help the person’s intense reactions, all or nothing responses, or feelings of rejection, but you can control your response to the person. The more  family or friends know how to handle these outbursts, the better.