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timtam00
Casual Contributor

How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

Hi all, 

A couple of months ago my sister was diagnosed with BPD. She has been hospitalised twice since June for suicidal ideations/actions. I have lost count of how many near misses we've had. She is waiting for DBT treatment in the New Year but currently has trouble engaging with mental health professionals (a lot of distrust and hopelessness about it).

A key issue has been that she does not follow safety planning once she is at a crisis point. So since she came home the last time she has felt she cannot be alone and keep herself safe. I have changed my life to support her so that she is not alone for more than a few hours at a time. I work from home, also reduced work hours and changed my social life from very active outdoor adventures to virtual catchups and twice weekly gym sessions.

So now a couple months into this arrangement I am struggling. I often feel my life is on hold and somewhat worthless as I only serve others (either my work or my sister). For reference I am young-ish, never had kids or cared for eldery. Before all this began I had just finished university and was set on building a career and travelling. I don't feel I'm ready to let go of these dreams, but I do really want to support my sister because I know she needs it and I want to see her thrive in life. In trying to find balance I have spoken to several counsellors and my GP who have all said I need to take space for myself.

I have tried to do this lately. I still help her organise for a friend or family member to be with her, but she finds this overwhelming and spirals into a dark place again. It hurts me to see her struggle, but I don't know what to do. She accuses me of not being supportive and asks me to miss work commitments and social events. It seems that there is no solution she is happy with other than me being there which I know isn't sustainable. I'll burn out and become useless. I already feel I am less compassionate and patient these last few weeks as it has really taken a toll to cancel all these things while she is in a crisis.

I know this time of year is difficult for her, in particular she does not want to celebrate Christmas or our birthday (also next week). I want to support her and keep her safe, but also feel it's unfair for her to ask me to miss these things (as they mean quite a lot to me). I have tried to plan with her how we can make these events a safer place for her so she can cope, but she shuts down and dissociates and becomes angry. Am I being unreasonable in expecting her to work with me on this? 

I guess I am looking for some advice and perspective. Are the doctors wrong for suggesting I set these boundaries for my own fulfillment and saying she is capable? (They are not trained in BPD treatment). I want to help her, but have become very sad about my own life. How do I stop this from leading to resentment? And how do I live my own life while supporting her? Am I trying to have too much? 

Thank you for reading and listening. 

9 REPLIES 9

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

No you are definitely being reasonable trying to maintain work, full functioning and a social life.  Are you much older than your sister? @timtam00 

 

I have long asked similar questions, eg., about preventing resentment.  Setting boundaries can be a lot easier in professional relationships than in family relationships.  Nevertheless, the best option is for her to find her own capabilities, and not try and manipulate you.  How many other family members does she have to lean on?  Sadly there are no guarantees, and often inadequate advice for siblings caught in these dilemnas.  If she has other supports, she has to allow you your own path to maturity.

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

Oh your twins.

Heart

Definteley extra hard to separate, but the only way is to individuate.  Be YOU.

@timtam00 

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

Sending you a warm welcome to the SANE forums @timtam00. It's wonderful that you've been able to reach out to share your story and to seek support from community members who are walking similar paths caring for a loved one.

With your sister diagnosed just a couple of months ago, this must be all so new and overwhelming for you both. It sounds like the DBT treatment will be a much needed support for your sister in the new year, though I hear that you're both struggling now. 

It is never wrong to set and express our personal boundaries, and it doesn't sound at all unreasonable to want to prevent your own burnout. We cannot pour from an empty cup, it's literally impossible. You are not trying to have to much, it is perfectly legitimate to want to enjoy your life and to reach your goals. Caring for someone with a mental illness is a balancing act. Some days you get it right and you both feel supported, some days we might stumble. The important thing is that you have all the support you need to live a full and active life whilst caring for your sister. 

Have you got your own supports in place i.e. a counsellor to chat with or a friend you can share the highs and lows with? If you are new to being a carer then this national resource might be a good place to start for information: https://www.carersaustralia.com.au/

I see that @Appleblossom has already reached out to greet you and has  provided you with some sound words of wisdom. I'm going to tag a few other members who are active in the family, friends and carer forum and may have the the time and space to support you too @Shaz51 @ShiningStar @BPDSurvivor @outlander @Krishna @MIFANTCARER @Tinker67 @Determined 

@BPDSurvivor started a really helpful thread on BPD here.

And you might find some resources here helpful too.

The team behind the scenes is also discussing an event geared towards caring for someone with BPD early in the new year so watch this space Smiley Happy

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

Hi @timtam00 and welcome. I am sorry to read of your sisters diagnoses and the struggles this brings to you both. It is so very important for you to retain a good balance with caring for your sister and your own needs. I liken it to trying to save someone who has fallen in a well by throwing them a rope but jumping in with it. You will be no help to your sister or yourself if self care is not a priority for you. From experience I know this to be true. I'm hoping there are other family members or friends that can step in when needed and understand how demanding the situation can be. I'm hoping you can find a balance with peace of mind. 

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

Oooooo @timtam00 , I can hear you're in a hard space.


Before you read on, all people with BPD are different so what imm about to share is based on my personal experiences.

 

Firstly, since making all these changes to your life to suit your sister, have there been any changes? If so, do you think these changes are lasting? If not, can you think of reasons why? 

Here's a bit of insight from a borderline's brain.... as I read your initial post, my heart sunk. I began to cringe. Why? Everything you did and are doing is what any caring person would do - put their life on hold and work around the person with BPD AND at your expense!

 

From experience, these actions actually validate and prove to a person with BPD that they need to be cared for. They then become reliant on someone  caring for them. The more that is given, the more that is taken.

 

What worked for me was having people set strong boundaries. Working collaboratively with me when I was in a calm state allowed boundaries to be set such as:

- I am working 9-5pm. I will phone you at 12 to see how you are. 
- if SH occurs, medical attention will be saught if necessary.

- when you are upset, I will walk away am come back to checkin with you at 2pm

 

Despite my screaming and shouting, ppl kept these boundaries, and deep down I felt safe. Initially, there will be resistance, but if the expectations and boundaries stand strong, a borderline will soon learn.

 

Remember, a borderline's emotional self is so disordered and unpredictable, that we need strong boundaries in place.

 

even today, I admire the people who didn't give in to me despite how much I raged at them and self-harmed.

 

And yes, the dbt will help - if she's ready to commit.

 

All the best,

BPDSurvivor

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

How are you @timtam00 ? Just checking in.

 

Take care,

BPDSurvivor

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

Hi @BPDSurvivor , Thanks for checking in. I had hoped to respond earlier, but it was a tough weekend. I really appreciate your comments and insight. I have worried that my sister is becoming dependent on me being around, but have really struggled to leave when it often means she becomes so overwhelmed we need to consider hospitalisation again. I think that since the lockdown (where I was always home and more available) my sister's expectations have become that that is the new norm. I am wondering how the people around you went about introducing these boundaries? Was it a hard line or a gradual introduction? I often worry a hard change will be too much for her, but that a gradual change could prolong the uncomfort of change and interfere with her ability to set a new routine and develop stability in her daily life. I am thinking perhaps a family counsellor may be able to help. If you have any thoughts on this I would greatly appreciate them.

 

And thank you @Rhye for the resources and @Appleblossom and @Krishna for your support. Your words resonate with me and it is comforting to hear from your collective wisdom. 

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

Hi @timtam00 ,

 

That definitely sounds like the case. You made yourself more available and now that's the expected norm....

 

Perhaps sitting with her and setting the boundaries together would be good. That way, she feels she somewhat has control - VERY important for a borderline. Remember, their world is so out of control and any control you give them helps. 

I could talk your ear off about the dos and don'ts of caring for someone with BPD, but one step at a time. I don't think it would be helpful to suddenly make so many changes as you said. Take it slowly.

 

All the best,

BPDSurvivor 

Re: How to set boundaries and take self care when caring for someone with BPD when suicide risk is high?

Thanks for your insight. I agree there is so much to learn. I will try as you suggested and hope she will be willing to discuss it.
Thank you again! I appreciate your time and words. Hope you are doing well.
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