What are the 3 Stages of Borderline Personality Disorder?

I Hate You- Don't Leave Me, Understanding the Borderline Personality by Jerold J. Kreisman, MD and Hal Straus

According to the book I Hate You - Don’t Leave Me when a person with borderline personality is dealing with a stressful situation they are experiencing three major feeling states: terrifying aloneness, feeling misunderstood and overwhelming helplessness. Therefore, reasoning with them is impossible because of the emotional dysregulation they are experiencing, leaving the other person left to deal with their outbursts of rage, impulsive destructiveness, self-harming threats or gestures and unreasonable demands. Yet do not despair, apparently developed in a hospital a SET-UP system of communication has been established when dealing with people with borderline personalities.

The S stage of SET means support which evokes the “I” statement of concern. “I am very worried about how you are feeling,” I’m concerned about what you are dealing with and want to help.” The speaker is expressing their own feelings and personal pledge to help.

Empathy acknowledges the person's anguish and chaotic feelings with “You” statements such as “How awful you must be feeling,” or “It is impossible to imagine what you must be going through.” Empathy must not be confused with sympathy “I feel sorry for you” as this may elicit rage over a perceived condescension. Also, compassion must be expressed in a neutral way with a minimal preference for your own personal feelings such as “I know how you must feel,” which could evoke a mocking response and aggravate the conflict.

Truth recognizes the reality of the situation and understands that the person with borderline personality disorder is ultimately accountable for their own life. While Support and Empathy are subjective statements, Truth statements acknowledge that a problem exists and addresses the issue at hand, with what can be done to solve it. “Well, what do you think we can do about it?” Again these statements need to be issued in a neutral matter-of-fact tone, with what happened, these are the consequences, this is what I can do, and what are you going to do?

The UP start of the SET-UP framework is Understanding and Perseverance. It is important that there is an understanding of the anguish of the illness, and that there is in need of a solution, but at the same time does not absolve them from their responsibilities. Perseverance means that a person has stayed in the relationship despite the frustrations that arise. Often one of the most important ways to improve, is that their doctors, therapists, family, friends and partners, as well as the person with the personality disorder, have hung in there despite the difficulties.

Again remember their ultimate fear is abandonment, coupled with a chronic feeling of emptiness and a sense of feeling overwhelmed. Applying these strategies, it is helping the person be able to calm down, communicate, and feel heard but also allows them to deal with the consequences.