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Studies and experience shows that young women with borderline personality disorders can be difficult medical patients, especially when their condition is a long-term illness requiring medical management such as diabetes. This is because young women with borderline personality disorder often use medical non-compliance as a way to dramatize their emotional ups and downs and manipulate those around them.

If you are a parent or professional involved in helping a young woman with borderline personality disorder manage a medical condition, it is important to remember to address the borderline personality disorder first. By managing the personality disorder first, you will be more successful in helping her manage her illness.

The following reminders can help you engage a young woman with borderline personality disorder in a constructive and effective manner.

Hold firm boundaries. This may be the most important step in treating someone with borderline personality. Your expectations for her must be explained clearly and then followed through completely. A person with borderline personality disorder may try to get around this by threatening or actually causing self-harm. It is important to be clear about the consequences and to keep her safe without lapsing into caretaking behavior. It is ok to show her care and compassion, but at the same time to maintain clear boundaries and avoid being manipulated.

Expectations must be clear from the beginning for both her therapeutic and medical treatments. Praise her for good behavior and provide the appropriate consequences for negative behavior.

Reality checks. This is a psychotherapeutic technique for working with someone suffering from borderline personality disorder. There are several ways to do it. Role playing with her can help mirror and elucidate her behavior, increasing her self-awareness. You can also help her process options by playing devil’s advocate. Argue all sides of a difficult situation. Over exaggerate the situation to clearly describe what is going on. Create scenarios for all areas; in Karie’s case, this would mean describing scenarios and outcomes and options for cutting and for diabetes mismanagement.

Stay in the present. Do not get caught up in conversations about the future or the past. Conversations become ripe for manipulation and arguments when they are not focused on the present. If a student moves into the future in a futile, despairing, or distracting way, e.g. “my diabetes is never going to go away,” bring the conversation back to the present with, “how are you feeling right now? What can you do about it now? What choice are you going to make now?”

The same suggestion can be applied to focusing on the past. Statements such as, “I’ve never been able to trust anyone,” can be redirected to a more constructive present focus, such as, “who in your life now has shown signs of being trustworthy?”

Model healthy relationships. Young women with borderline personality disorder often create “love-hate” relationships. They pull people in to get what they want, and push them away if they don’t get what they want. They are very good at blaming others.

The best way to deal with this is to be consistent and, at times, non-emotional. This is not to say that we withhold love. But rather, we present a rational, calm presence that contrasts their dramatic tendencies and does not react to attempts at manipulation. We do not get riled up or sucked into her provocative or dramatic interactions; we are relatively neutral with regard to praise or criticism. We calmly tell her how we feel about a situation and then leave it at that. We demonstrate healthy interactions by verbalizing what we expect from the relationship and supporting these verbalizations with our actions.

Hold her accountable. Have her make a contract indicating what she is willing to do to take care of herself, then hold her to the contract. One of the most important things a young woman with borderline personality disorder can learn is to be responsible for her actions, her interactions, and her health.

The combined occurrence of borderline personality disorder and long-term physical illnesses like diabetes can prove to be a difficult combination for caregivers. However, addressing the borderline personality disorder in a focused and consistent manner can open the door to more effective medical treatment and, therefore, long-term safety and health.