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May 12, 2020
“The coronavirus pandemic is uniquely difficult for those with borderline personality disorder (BPD). It challenges the way these individuals feel held together and supported on a basic level,” said McLean’s Brandon Unruh, MD.
Unruh, medical director at the hospital’s Gunderson Residence, explained that “there are four key areas of BPD symptoms—emotional, behavioral, interpersonal, and identity-related problems. COVID-19 affects each of these areas in some way.”
Calls for social distancing and physical isolation to combat the spread of the coronavirus make BPD symptoms harder to manage. “The absence or loss of interpersonal connection are some of the key triggers of destabilization in BPD,” Unruh said.
This social isolation can provoke a range of negative responses. “One response is an increasingly inward focus on the self, colored by core negative concepts of self and others, such as ‘I’m a bad person,’ or ‘I’m unlovable,’ or ‘other people are untrustworthy,’” he said.
To help his patients manage these feelings, Unruh encourages a higher level of interpersonal connection. “We are asking patients to do things proactively to cultivate connectedness,” Unruh reported. He is calling on his BPD patients to communicate more than normal by reaching out to friends and family “through phone calls, emails, video platforms, and old-fashioned letter writing.”
In times like these, Unruh said it is important to make a communication plan and stick with it. “With BPD, when one’s inner life is comprised of highly fragmented or conflicting experiences, it becomes harder to hold to a basic schedule about keeping up with others,” he said. “One might find many reasons not to follow through, reasons that have to do with enduring fears about relationships.”
To address these issues, Unruh tells his patients to “hold yourself accountable to following through on keeping connected to others. Ideally, this is not just communication with clinicians but other supports with whom you can check in regularly. This will help cultivate lasting connections outside the frame of treatment.”
Support and therapy groups can also help those with BPD maintain necessary connections. “For someone already in treatment, therapy groups may provide structure and a higher level of support around maintaining connections,” Unruh said. “For others, self-help groups, 12-step programs, and other support groups for BPD can be important.”
Unruh recommended some of the tools that millions of people around the world are suddenly using to stay connected during the pandemic. “I’m encouraging my patients to seek out activities that don’t have anything to do with treatment, like scheduling Zoom hangouts with friends, organizing Netflix watch parties, or using the House Party app to play games together,” he reported.
There are also a number of great online resources. Emotions Matter offers patient-led support groups and coronavirus-specific resources on their website. BPD patients and their families can also take advantage of the resources offered by the National Education Alliance for Borderline Personality Disorder. The site offers articles on COVID-19 coping strategies and how to validate emotions, as well as webinars on topics such as BPD and emotion dysregulation, self-validation, and mindfulness. Resources, such as helpful webinars and articles and information on BPD, can also be found on the McLean website.
Individuals with BPD also need to focus on other important parts of a well-rounded life. These elements include self-care activities, like getting enough sleep, proper eating, physical exercise, and practicing kindness toward the self. Other elements include reducing reliance on mind-altering substances, like drugs and alcohol, and taking part in “pleasurable activities or the things that we do for sheer joy.” Embracing the concept of “meaning-making” is another crucial element.
“How do any of us cling to what is most meaningful during a pandemic?” Unruh asked. “It’s challenging for all of us in the face of so much we cannot control, but particularly for people with BPD who question what is meaningful and worthwhile about themselves.”
The first step in meaning-making is “reality acceptance, or accepting that life poses practical challenges and existential risks that are beyond what we can control or manage on our own,” Unruh stated.
For BPD patients and for all of us, we can start with actions that are within our control. These may include optimizing self-care, structuring our use of time, and responsibly managing risk taking as a contribution to the welfare of those around us.
“I encourage my patients to consider the importance of a worldview—a larger story of coherence and meaning—that helps adapt our values and long-term goals to the realities of uncertainty, limited control, and loss that we are all facing,” said Unruh. “This may be a harder task for those with BPD but remains essential for solidifying a core identity.”
If you or a loved one are struggling with borderline personality disorder, call us today at 877.372.3068.