A year ago, Ilana, a pseudonym, found herself facing what felt like an impossible choice. She had spent years living on edge alongside her 21-year-old daughter, who had been diagnosed with borderline personality disorder. Now the front door was closed. Ilana stood on one side. On the other sat her daughter, drunk, crying and begging to be allowed inside.
Ilana listened to her pleas. She knew what a mother was expected to do, but she also knew that opening the door could pull the entire household back into the same spiral. After years of crises, disappearances, threats and self-harm, their relationship had been reduced to one brutally simple question.
“It was a moment that forced me to confront something impossible,” says Ilana, a divorced mother from central Israel. “I went into my room, took a deep breath and tried to understand what my soul was telling me to do. Should I act out of maternal compassion, or find the courage to do something emotionally devastating?”
In the end, her head overruled her heart. She called the police. Not because she felt no compassion for her daughter, she says, but because she already knew the pattern.
“I wouldn’t wish this situation on any mother,” she says.
Officers arrived a short time later. “When I opened the door for them, she was standing behind them and ran straight into the house,” Ilana recalls. “I ran into my room and locked myself in because I couldn’t deal with it. I shouted to the officers through the door, ‘Why did you let her in?’ I didn’t want to face the manipulation, and I didn’t want to see what she looked like. I was afraid it would affect my decision and pull me back emotionally.”
Her son was left to handle the situation. He let his sister shower, tried to calm her and she was later taken to a residential facility.
On the surface, the crisis was over. In reality, that night also marked the end of the relationship between mother and daughter.
Nearly a year has passed since then. The estrangement has brought a measure of quiet to Ilana’s life, but also guilt, doubts and the persistent thought that perhaps, somehow, they could try again.
“I’ve been in a process of recovery for almost a year,” she says. “The separation gave me the chance to look at myself and understand what kind of whirlwind I had been living in. When it is happening every day and everything operates through emotional pressure, you lose the ability to see yourself. But this is still a mother-daughter relationship.”
'I wouldn’t wish this situation on any mother'
(Photo: shutterstock)
Between compassion and survival
Ilana has heard the advice countless times: “Just set boundaries. After years of experience, she knows how easy those words can sound when someone else is not the one who has to live with the consequences.
“Even setting boundaries is difficult because this is such a close relationship with someone who is suffering and needs help,” she says. “But what am I supposed to do when I reach out my hand to help and she bites it?”
She still sometimes thinks, “Maybe now.” “I have a framework in mind, and we could have conversations with a social worker,” she says. “I’m just afraid.”
Her story represents an extreme end of what life alongside someone with borderline personality disorder can look like. But the question at its center is familiar to many families: How do you keep loving a child whose emotional storms take over the home? When does support begin to reinforce destructive patterns? And how far can a parent go to protect themselves and the rest of the family?
‘It was constant chaos, insults, threats and jealousy’
“We began noticing unusual behavior when she was around 11 or 12,” Ilana says. “One of the first things we noticed was this intense need for attention.”
“If I hired a babysitter, for example, she might take a small table out into the middle of the neighborhood street, bring out a plate of schnitzels and start offering them to people passing by, so all the children around her would laugh, look and point. She really liked putting herself in situations where people would notice her.”
Over time, the scenes moved from the street into the home, and her siblings paid much of the price.
“There were constant fights and provocations,” Ilana says. “She was always lighting fires, saying things she knew would set everyone off, pushing them to the edge and stirring everything up. Chaos, insults, threats, enormous jealousy. If her sister brought a friend home, she had to blow up the visit. We reached the point where the other children couldn’t invite friends over.”
“She was like a galloping horse of emotions, opinions and aggression. It was completely different from anything we saw with our other children. It took us a long time to understand what was happening.” Illustration
The confrontations did more than fill the house with tension. They made ordinary family life almost impossible.
(Photo: shutterstock)
“The house belonged to her, and we were people somehow trying to live sane lives inside the chaos,” Ilana says. “We would try talking to her, calming her down or creating some kind of order, and we kept running into the same intensity. There was no one to reason with.”
“She was like a galloping horse of emotions, opinions and aggression,” she says. “It was something completely different from what we saw with our other children. It took us a long time to understand what it was.”
A whole family on edge
Over the years, the crises exhausted the household. “All our energy went into her because there was always an incident to manage, something to respond to, some decision to make,” Ilana says. “We also spent more money on her, bought more things, gave her more attention.”
Before her daughter turned 15, Ilana realized that the family home could no longer contain the situation. Her daughter moved into a therapeutic residential school following psychiatric hospitalization.
“We chose a very good and supportive setting because it genuinely wasn’t possible to manage her needs at home,” Ilana says. “I didn’t feel we could give her what a structured setting could, or provide the kind of social environment she needed. It was very difficult to get her cooperation.”
But residential placements were temporary, and returns home were not always smooth.
“The really extreme period started around 16, especially around sexual behavior,” Ilana says. “It began with running away and arranging to meet groups of boys. I understood there was a group of at-risk girls meeting young men. They would pick her up, sometimes with friends and sometimes alone, and then we couldn’t find her. It was basically, ‘Just give me alcohol and do whatever you want with me.’ It was one of my nightmares.”
“My partner once chased after her and caught her just before she got into a car,” she says. “Another time, I was at work and a friend called to say two men had come to pick her up. The only thing I could tell her was, ‘Take a picture of the license plate so that if something happens, I know who to contact.’”
“I went through experiences with her that caused secondary trauma,” Ilana says. “There was no judgment at all. It was like jumping straight into the fire, straight into danger.”
The danger was not confined to what happened outside the home.
“Every day I would get dozens of calls or messages: ‘Mom, I need this,’” she says. “If I didn’t do what she wanted, messages that started relatively mildly would become more and more extreme: ‘You’re this, you’re that.’ It could escalate into threats.”
“She would send me videos of herself cutting herself to push me into doing what she wanted. I would try to live inside that, call an ambulance and report it. She made many suicide attempts,” Ilana says. “She harmed herself a lot. There were times when she would run to the balcony and say she would jump if I didn’t agree to something, and the siblings would panic. We were constantly on alert.”
Around age 17, after years of partial diagnoses and descriptions, she received a formal diagnosis.
“Before that, there had been diagnoses involving emotional regulation, borderline intellectual functioning and all kinds of other things,” Ilana says.
She is careful not to attribute everything her daughter did to a single diagnosis. “I don’t know whether this is only borderline personality disorder,” she says. “This really is an extreme case.”
‘I reached the point where I would just sit and stare’
Her daughter remained in residential settings until she was 18. Throughout that period, Ilana held to one boundary she considered non-negotiable: Her daughter could not move back in with her and the other children.
“I told her, ‘I love you. I will be there for you. But you and I cannot live under the same roof. It cannot happen.’”
At one point, the girl’s father asked that she temporarily stay with Ilana while he arranged a rented apartment for her.
“The moment she arrived, we all left the house,” Ilana says. “I tried staying with her for a day or two. It was a kind of bullying. Imagine a drunk person wandering around your home and allowing themselves to do anything. The rudeness, the mess, the provocation, the disrespect.”
Her younger brother, now 19, had a girlfriend two years ago. Ilana says her daughter once returned for a visit after not seeing him for a month and immediately asked him a crude sexual question about his girlfriend.
For Ilana, the diagnosis helped explain something about her daughter, but said little about what was happening to everyone living around her.
“I think there needs to be far more attention paid to families,” she says. “I don’t think enough emphasis is placed on that. People don’t understand how exhausting this is for the nervous system and how it affects the way we function as human beings.”
“I’ve been out of contact with her for almost a year and I’m in a process of recovery,” she says. “Before that, I simply realized that if I didn’t choose myself, I wasn’t going to survive it. I reached the point where I would just sit and stare.”
But Ilana does not want her story to be understood only as a struggle between a mother and daughter.
For her, the family members who almost disappeared from view were the siblings. “I want to emphasize how hard this is for them because their pain is so invisible,” she says. “They are trying to build normal lives inside all of this, and their voices are heard less. They aren’t at an age when they necessarily know how to explain how deeply it affects them.”
Ilana’s younger daughter, now 18 and two and a half years younger than her sister, still struggles with the consequences, according to Ilana.
“A large part of this is the trauma of growing up with her,” she says. “Once she traveled out of town and called me in a panic: ‘I think she’s here. I saw her here.’ She used to have nightmares about her. She is still deeply affected emotionally, she receives medication and life is difficult for her. She has to keep pulling herself back up.”
That loneliness is now also apparent in the relationships that remain between Ilana’s older daughter and the rest of the family.
“I’m completely out of contact with her. Her siblings are unofficially out of contact,” Ilana says. “They go to their father’s home and see her, but nobody makes an effort to pick up the phone. She doesn’t have friends. She lives here in a rented apartment. I know she is suffering, but I don’t know how to solve that suffering for her.”
That is also the source of Ilana’s deepest frustration: seeing the person inside the storm, but not knowing how to reach her.
“I would describe it as someone being trapped,” she says. “I can see the good in her. I can see her potential. But she is trapped in the grip of something I can’t get past. I can’t reach the good in her. That is the essence of the frustration.”
When emotions become overwhelming: Understanding borderline personality disorder
Dr. Oren Tene, director of the psychiatric division at Tel Aviv Sourasky Medical Center, also known as Ichilov Hospital, and head of the Mentalics mental health clinic, stresses that a personality disorder is not an illness in the conventional sense.
“All of us have characteristic patterns in how we think, feel and respond to the world and the people around us,” he says. “We begin talking about a personality disorder when those patterns become rigid, keep repeating even when they no longer serve the person, and cause significant distress to the individual or those around them.”
“They can damage relationships, impair functioning and make it more difficult for a person to progress and adapt to different situations in life,” he says.
“We are discussing here the effect the disorder can have on the people around the individual, but it is important to remember that at the center is, first and foremost, a person who is suffering,” Tene says.
“These are people with very, very high sensitivity, combined with great difficulty regulating the intensity that sensitivity creates. Unfortunately, that often becomes most visible in relationships with the people who are closest to them and whom they love most.”
The causes of borderline personality disorder are not fully understood. “It is probably a combination of genetics and environment,” Tene says. “There is often a connection to trauma or difficult life experiences, but not necessarily.”
Dr. Oren TenePhoto: Tal GivoniThe disorder is not defined only by outbursts or isolated crises. One of its central features is instability, particularly emotional instability. Sometimes a seemingly small interpersonal cue can trigger a dramatic shift.
“One positive comment from your boss can send you soaring, while one negative comment from someone on the street can send you crashing,” Tene says.
“The fluctuations can be extreme. But unlike bipolar disorder, where mood episodes generally last days or weeks, here we may be talking about changes that occur over minutes or hours.”
Relationships can also swing rapidly between extremes. “There is a tendency to see things in black and white,” he says. “Someone close to you may be experienced one moment as good, loving and perfect. After a hurt or disappointment, even one that seems minor to other people, that same person may suddenly be experienced as bad or completely untrustworthy, dropping immediately from the ‘good’ pole and being erased. Then, if they do something positive, they may suddenly be idealized again.”
Between fear of abandonment and self-harm
Those fluctuations are often accompanied by an intense fear of abandonment. “The fear of abandonment can dictate entire relationships,” Tene says. “The person may keep checking their phone and asking, ‘Why didn’t you message me? Do you want to leave me?’ Sometimes it becomes a self-fulfilling prophecy.”
“Some people also push others away in advance or avoid entering relationships altogether in order to protect themselves from the abandonment they are convinced will eventually come.”
Another common feature is a deep and persistent sense of emptiness. “People can feel this enormous emptiness and search for all kinds of ways to fill it,” Tene says. “That can also help explain the connection with addiction and the search for reward through substances or external behaviors.”
Tene says conspicuous attention-seeking behavior, like that described by Ilana, should also be understood in a broader context.
“Borderline personality disorder is classified in the DSM, the Diagnostic and Statistical Manual of Mental Disorders, in a group characterized in part by dramatic and impulsive behavior,” he says. “That group also includes histrionic personality disorder, in which attention-seeking and the need to be at the center are especially prominent. There can sometimes be overlap between the disorders.”
To explain why even negative attention may sometimes feel preferable to no attention at all, Tene offers an analogy.
“Imagine someone who feels they are inside an endless black hole, completely alone,” he says. “If, in that moment, they manage to get someone to look at them, even to shout at them or become angry, at least someone sees them inside that hole. In their experience, even negative attention may be preferable to the nothingness of emptiness.”
Difficulty with emotional regulation can also manifest as impulsive acts carried out with little consideration of the consequences, intense anger and self-harm.
“The person is often trying to convert unbearable psychological pain into defined physical pain,” Tene explains. “Self-harm becomes a mechanism that produces relief. It is a very dangerous and maladaptive mechanism, but for the person who is suffering, it may feel in that moment like the only way they know to calm themselves.”
But identifying with some of these traits does not mean a person necessarily has a personality disorder.
“Many of us have borderline, narcissistic, avoidant or other traits without meeting the criteria for a personality disorder,” Tene says. “And the people who do meet the criteria are not one homogeneous group. Symptoms and their intensity vary enormously from person to person.”
'Through therapy, trust and the capacity for relationships can be rebuilt'
(Photo: sutterstock)
For that reason, he stresses that Ilana’s story should not be viewed as representative of everyone with borderline personality disorder.
“The case described here is severe and extreme,” he says. “The diagnosis is broad and includes many people who live in relationships and function in ordinary settings.”
“At the far end are cases in which the intensity, distress and behaviors become so difficult that a family is forced to set a boundary and say: This is as far as we can go.”
Tene also emphasizes a crucial distinction. “People diagnosed with borderline personality disorder are not monsters,” he says. “They do not wake up in the morning and deliberately decide to harm people or manipulate them.”
“It is important to try to separate the person from their behavior. You can love the person and not love the behavior. Sometimes that behavior is the only way they know to obtain a response from their environment or some form of relief from anxiety. These processes are largely unconscious.”
“At the same time, the fact that a person is suffering does not give them a green light to do harmful things to other people.”
‘The diagnosis is not a life sentence’
Diagnosis is made through an assessment with a mental health professional, based on symptoms and the person’s history. “We don’t make a diagnosis based on one or two days,” Tene says. “We look for a pattern that has accompanied the person over years.”
Borderline personality disorder can also coexist with other conditions. “We see a great deal of overlap with other disorders involving regulation, including ADHD, bipolar disorder, depression and anxiety,” he says. “Having borderline personality disorder does not mean a person cannot have additional diagnoses. In fact, we also often see alcohol or drug use and higher rates of addiction.”
Despite the stigma surrounding the diagnosis, Tene stresses that it should not be treated as a final verdict. “People sometimes receive the diagnosis and feel that it is a life sentence,” he says. “It can be the opposite. It can give a person a name and explanation for a pattern of suffering that has accompanied them throughout life and which they did not always understand.”
“People ask themselves, ‘Why am I so messed up? Why do my relationships always fail?’ Suddenly there is a framework for understanding what is happening, and you can begin working with it.”
The primary treatment is psychotherapy, and several approaches have been studied and shown to be effective.
One of the best known is dialectical behavior therapy, or DBT, developed by psychologist Marsha Linehan. “It is a treatment that works in a focused way on emotional regulation and the management of self-harm and suicidal behavior,” Tene says. “It can help significantly reduce many of the dangerous behaviors associated with the disorder.”
(Photo: sutterstock)
Other forms of psychotherapy can also help, and in many of them the therapeutic relationship itself plays a central role.
“Through the therapy room, you can rebuild trust and the capacity for relationships,” Tene says. “In long-term treatments, much of what happens within the therapeutic relationship is itself therapeutic.”
“Tools such as mindfulness can also help. We also know that many people improve as they get older,” he says. “Mechanisms that were extremely turbulent at a young age can become more moderate over time.”
Medication, when prescribed, does not treat borderline personality disorder itself.
“There is no medication for borderline personality disorder,” Tene says. “But medication can help when there is also depression, anxiety or significant mood instability. Medication is not the main treatment, but it can often provide support.”
The family toll
As Ilana’s story illustrates, the disorder can affect far more than the person who has been diagnosed. “Families are in an extremely difficult position because they have to hold two truths at the same time,” Tene says. “On one hand, the family member with the disorder is suffering greatly. On the other, the people who love that person can also suffer greatly.”
“There is a huge amount of guilt. Parents often feel they are walking on eggshells. They are afraid to set a boundary, and afraid of what will happen if that boundary is not respected. Something small can produce an enormous emotional reaction that seems completely disproportionate. The storm can pull everyone into it.”
The difficulty becomes especially acute when an attempt to set a boundary is met with threats of self-harm or suicide.
“It is terribly difficult,” Tene says. “It is important to stress that family members certainly should not be expected to manage suicide risk on their own.”
In such situations, he says, mental health professionals should be involved rather than leaving parents to determine by themselves whether a threat represents immediate danger.
The impact, however, does not stop with parents. “When one sibling is much more turbulent, the other siblings can find themselves taking on caregiving roles,” Tene says.
For precisely that reason, treatment does not necessarily end with the person who has been diagnosed. “Part of the intervention can involve the family because, without realizing it, family members can sometimes reinforce aspects of the disorder,” Tene says. “The aim is not to reinforce the disorder, but to support the person.”
“Family members do not have to accept every behavior and they do not have to give up their boundaries. There needs to be a distinction between simply being agreeable and being empathic.”
“Empathy means stepping into the other person’s shoes and giving them what they truly need in that moment. Sometimes what they need is a clear boundary.”
The sentence a parent needs to learn to practice, he says, contains both truths at once: “I understand how much pain you are in and I love you very much, but I cannot allow this behavior.”
The gap between stating that boundary and maintaining it, however, can be enormous. “This is something that is very easy to talk about and very difficult to do,” Tene says. “Ultimately, the challenge for families, and also for therapists, is to remain close without being swept into the storm.”
In extreme situations, he adds, preserving that boundary may require physical distance. “There are situations in which living together is no longer possible or safe, and separation can become necessary,” Tene says. “In very extreme cases, cutting contact may also be necessary for a period of time.”
“But the goal is not to punish or abandon the person. It is to protect the family, establish a boundary that can actually be maintained and, where possible, create the conditions for a healthier and safer relationship in the future.”