Does tough love help a person with BPD?

My grandmother, asking on behalf of a friend with a loved one with BPD, recently called me to inquire about the disorder. “Does my friend let [the person with BPD] get away with too much?” she wondered. “Would some tough love help?”

Short answer: absolutely not.

I understand my grandmother’s thinking. The “tough love” approach is frequently used (with very mixed results) by family members who have loved ones with substance use disorder. They might not provide the person with substance use disorder money or a place to live in hopes it will aid with overall well-being or coerce a person into treatment.

But BPD is a disorder rooted in invalidation. People with BPD are thought to develop the mental illness, in part, from growing up in environments where we learned our emotional expressions were too much for our caregivers to handle. As a result, we turn to unusual coping mechanisms like self-harm, dissociation, or impulsive behaviours to minimize the strength and impact of our feelings.

A person with BPD experiences emotions that are physically painful. More than anything, a person with the disorder wants to have their pain recognized. Though unusual and frustrating to our loved ones, the behaviours we engage in serve a purpose in that they dull our pain or communicate when help is needed. Coercive rules, punishments, or other forms of tough love tell a person with BPD that our emotions aren’t welcome, which leads to feelings of rejection and abandonment. To cope with these feelings, we’re very likely to turn to the behaviours that exasperated our loved ones in the first place.

In university, the person I was dating tried to practice tough love. He told me he would break up with me if I continued to self-harm. I don’t blame him for taking this approach. He was young and had no experience loving someone with a mental illness. It was the only tool he had in his toolbox. But it didn’t stop my self-harm. It increased the practice. The pain I experienced from the threat of abandonment was overwhelming. I coped the only way I knew how to, which spurred more fear and self-injury.

Instead, a person with BPD should be treated with compassion. This isn’t to say our loved ones can’t set boundaries that protect their own well-being but they can also help stop the cycle of invalidation we experience. And tough love isn’t the answer.