Updated May 23, 2026
The following is based on a conversation between Laura Eshelman and CooperRiis Chief Clinical Officer, Johnnie Featherston about borderline personality disorder, the challenges of navigating it, and the significance of family support.
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Understanding Borderline Personality Disorder: A Conversation About Compassion, Trauma, and Family Support
Borderline personality disorder remains one of the most misunderstood and stigmatized mental health conditions. The diagnosis carries weight that extends beyond clinical criteria, affecting how individuals are perceived by clinicians, family members, and society at large.
At CooperRiis, we approach personality disorder in a compassionate and trait-based way, with diagnoses only entering conversations when clinically necessary. Both of our locations, Asheville and The Farm in Mill Spring, offer programs treating borderline personality disorder for men, women, and trans+ adults. With safety, dignity, and the right clinical support, personality disorders are highly treatable.
Laura Eshelman sat down with Johnnie Featherston, Chief Clinical Officer at CooperRiis, to explore what BPD really means, how trauma shapes its presentation, and what families need to know to provide meaningful support. Their full interview is included after the following summary.
Beyond the DSM: Understanding BPD as a Human Experience
When asked to define BPD, Featherston starts with a fundamental truth about human nature, explaining that the traits associated with personality disorders exist on a spectrum and are part of normal human experience.
The difference is that certain factors make those features more intense for some individuals. Stress amplifies these traits in all of us, but for people who fall on the BPD spectrum, the experience becomes more pervasive and starts interfering with daily life.
This dimensional understanding is central to a less stigmatizing way of diagnosing and talking about personality disorders. Recent research confirms that BPD exists on a continuum, and individuals rarely present with symptoms of just one personality disorder. The DSM-5-TR Alternative Dimensional Model is based on personality traits that all people have to varying degrees, creating space for both mixed traits and for the change that personalities naturally undergo.
The Trauma Connection
BPD affects approximately 2.41% of the general population, meaning roughly 4 million Americans are diagnosed with it according to the older, categorical approach (which is still more prevalent).
Featherston emphasizes the strong correlations between trauma and BPD, particularly complex traumas that are pervasive and repeating. And he goes on to stress that helping families understand the role of trauma in BPD—and how to create a sense of safety—is a crucial part of treatment.
The research backs this up powerfully. A comprehensive analysis of 42 international studies found that 71.1% of individuals diagnosed with BPD reported at least one traumatic childhood experience. People with BPD are 13 times more likely to report childhood trauma than people without mental health conditions.
Physical neglect emerges as the most common form of childhood trauma in folks living with borderline personality disorder, at 48.9%, followed by emotional abuse at 42.5%.
These adverse childhood experiences create lasting biological changes that persist into adulthood, affecting multiple systems including the HPA axis, neurotransmission mechanisms, and brain structure. This validates a crucial understanding: BPD symptoms are rooted in genuine neurobiological adaptations to early trauma, not character flaws. In lay terms: it’s not someone’s fault they have BPD, even though it has become (if unfairly) their responsibility.
The Stigma Problem
When asked if BPD deserves its reputation as one of the more highly stigmatized personality disorders, Featherston doesn’t hesitate to acknowledge that its presentation can be challenging for loved ones.
He describes an individual experiencing significant pain and turmoil, expressing distress in ways that clash with the world around them. The result is behaviors get written off as dramatic or manipulative.
He explains that BPD involves a deep emotional dysregulation that stems in part from a fragile sense of self, and the behaviors are often efforts to create safety. This reframing explains the “push-pull” dynamic, the sense of “walking on eggshells” that family members describe. These patterns emerge from a fundamental fear of abandonment coupled with terror of dependency.
Evidence shows that BPD faces some of the most severe stigma of all mental health conditions, with individuals reporting very high levels of self-stigma.
The stigma runs deep, even among professionals. Clinicians often view people with BPD as “manipulative,” “attention seeking,” and “treatment resistant,” responding with fear and anger rather than empathy.
What Families Face
Family dynamics with BPD present unique challenges. Featherston points out that our families are where we feel most safe, and with that safety comes more range of expression.
Families try different approaches. They learn, adapt, and do everything they’re told to do. But there’s often so much history, so much water under the bridge, that it takes substantial foundational work to bring everyone back to the same page.
Featherston has seen people do well at CooperRiis, return home, and struggle in that familiar context. The family environment, with all its accumulated patterns and pain, becomes the hardest place to maintain progress.
Yet family connection provides critical protection. Among individuals with BPD who resist suicidal urges, the most common protective factor is a sense of responsibility to family. This underscores why family education and systemic approaches to treatment are essential.
How Loved Ones Can Help
For families navigating a relatively new diagnosis, Featherston offers clear guidance.
Learn as much as possible about BPD. But be careful. Because of the stigma, you’ll find plenty of material that reinforces negative attitudes. Some mental health practitioners still take a less compassionate, “tough love” stance.
Featherston notes that families often do better when they take in multiple perspectives on the issue and seek support through therapy, group settings, and psychoeducation.
The essential ingredients are:
- Seeking your own support through therapy and groups.
- Willingness to learn and not dismiss BPD as bad behavior.
- Validation for your loved one, even when it’s hard.
- Continuing to offer validation even when it’s rejected.
Setting Boundaries Without Causing Harm
Boundaries matter. But with a condition highly sensitive to rejection, how do you set limits without triggering the very pain you’re trying to avoid?
Featherston identifies a common pitfall: reactive or resentful boundaries set in an almost punitive way. He explains that boundaries work best when they’re consistent and clearly explained, rather than feeling arbitrary or disconnected from the reason behind them.
Effective boundaries with someone who has BPD require:
- Clarity about what you’re doing and why.
- Compassion in delivery.
- Consistency in following through.
- Showing back up, over and over.
That last point matters most. Showing back up repeatedly demonstrates that boundaries aren’t abandonment. They’re part of a relationship that continues despite difficulties.
Moving Forward With Understanding
BPD challenges everyone it touches. The individual experiences profound pain and dysregulation. Families navigate intense dynamics and accumulated hurt. Clinicians face their own biases and frustrations.
But understanding changes everything.
When you recognize that challenging behaviors represent attempts to create safety, when you see the trauma foundation beneath the symptoms, when you commit to showing up repeatedly with compassion and clear boundaries—recovery is absolutely possible.
Healing takes time and patience. The path forward demands education, support, and a willingness to see past stigma to the human being struggling to find their way. Reaching the fulfilling relationship on the other side require new patterns and approaches; but for families willing to do the work, the effort is profoundly rewarding.
CooperRiis: Treating BPD with Compassion & Dignity
No one has ever healed by being stigmatized, ostracized, or shamed. Instead, healing comes from consistent safety and support.
In fact, most adverse mental health experiences and presentations, including those of borderline personality disorder, are heavily influenced by the state of the nervous system. Settling the nervous system is its own kind of healing, but it also creates the space for intentional healing work–space that simply cannot exist without felt safety.
So, a very large part of what we do at CooperRiis is providing that safe space: quiet, structured but unhurried, supportive, and 100% voluntary. Within that space, residents start by articulating what they want their lives to look like. And then we create a treatment plan in support of their goals that helps them heal what might be standing in the way.
In carrying out that treatment plan, clinical support offers opportunities to learn new tools, identify maladaptive ways of coping, and convert those into strengths. Residents get real opportunities to practice their recovery within our positive community setting. If medication is part of treatment, psychiatric care is collaborative and responsive.
Our mental health recovery model empowers individuals in their own care so that it belongs to them when they leave CooperRiis.
Laura’s Interview with Johnny
Johnnie Featherston, MA, LCMHC is the Chief Clinical Officer at CooperRiis. He believes in providing holistic and relationship-based support to help individuals recover from mental health challenges and is especially passionate about working with people recovering from complex trauma.
What is BPD, as defined by a clinician?
JF: I think I would say that there’s a definition in terms of the DSM, but when you’re looking at any of what is categorized as a personality disorder, there are personality features that are part of the human experience. And then certain factors can make those features more intense for an individual. That happens to any of us under stress, but for folks that fall on that spectrum, it is a more pervasive issue and starts to interfere with their life. I think it’s important to start there versus going through [DSM] criteria partly because of our approach. Still, in general, it’s one of the more highly stigmatized areas of diagnosis. This is more broadly true about personality disorders, not just borderline’s particular presentation.
Can you speak to the role that trauma plays in a BPD diagnosis?
JF: There are strong correlations between trauma, especially complex traumas that are pervasive and repeating, and the way that impacts our sense of attachment. That’s a critical piece to work on with families, and that goes into the education about the diagnosis and how to build that sense of security that someone is sorely missing with trauma.
Would you say it’s fair that BPD is one of the more highly stigmatized personality disorders?
JF: Yes. The presentation is challenging. It’s an individual experiencing a lot of pain and turmoil, and that’s being expressed and clashing with the world around them often, so it gets written off very easily as being dramatic or manipulative. Some of the core features are around dysregulation. A key component of that is not having a strong sense of self. The other key feature is dysregulation. That shows up where a lot of the DSM criteria fall. But looking at the behaviors as symptomatic of somebody trying to create safety, there can be a lot of grasping and wanting to make sure relationships don’t go away, but also a real fear of that dependency on them, which leads to pushing them away. That’s what people talk about when they describe [dynamics with someone with BPD] as ‘push-pull’ or ‘walking on eggshells’.
What are some of the challenges faced by family members and loved ones?
JF: In our families is where there is more safety, and with that comes more range of expression. Particularly in our immediate family, there’s often more charge, even in solid, functional family systems. When you have somebody [with BPD], it’s often exponentially more pronounced and combustible. You can try different approaches, but things are so sensitive, and there’s a lot of history there. It’s crucial to do some work and healing within the family, but it’s often the most complex and intense place. We’ve seen people do well [at CooperRiis], return home, and struggle in that context. A big piece that I see is families taking feedback, learning, and doing everything right, so to speak, but there’s so much water under the bridge at that point that it takes a lot of foundational work to bring folks back together to get on the same page.
What are some important ways that loved ones can support someone with BPD?
JF: One way is to learn as much as possible about it. Unfortunately, because of the stigma, there’s a lot of stuff you can find that reinforces negative attitudes about it. Undoubtedly, mental health practitioners still take a less compassionate, ‘tough love’ stance on it. I’ve seen people find success when they get a variety of perspectives on it, and families find their support through therapy and groups to help them understand. Essentially, it is a willingness to learn and not just dismiss BPD as bad behavior. Lots of validation for their loved one, as hard as it is sometimes, even if it’s rejected by that individual. Those are some pieces that are important for families early on.
What might loving boundaries look like for family members of someone with BPD?
JF: One of the pieces in my experience that gets people tripped up is reactive or resentful boundaries, where you’re doing it in almost a punitive way. What I think is really important in terms of boundaries is for it not to be arbitrary, and finding ways to explain what you’re doing, like putting the ‘why’ to things. It’s also important to be clear and compassionate while you’re doing that. And a key piece is showing back up, over and over.
Common Family Questions About BPD
Dealing with a family member who has borderline personality disorder begins with understanding the behavior as distress, not simply “bad behavior.” Family members can help by learning about BPD from compassionate sources, validating the person’s emotions when possible, seeking their own therapy or support groups, and setting clear, consistent boundaries without using those boundaries punitively. The goal is to stay connected while reducing reactivity, blame, and confusion.
People with borderline personality disorder may be especially triggered by experiences that feel like rejection, abandonment, criticism, emotional distance, dependency, or instability in close relationships. Dysregulated reactions are generally attempts to create safety, which are tied to trauma or attachment wounds. Family relationships can be especially activating because they carry both emotional closeness and accumulated history.
Anecdotally, lying is considered a common behavior in people with borderline personality disorder. But BPD should not be reduced to any one trait or behavior. People with BPD are often written off as dramatic or manipulative when they’re actually trying to feel safe in the midst of pain, dysregulation, or fear. That does not mean every behavior is acceptable or harmless; it means families and clinicians should respond with boundaries, context, and compassion rather than stigma.
Not inherently. Borderline personality disorder can involve intense emotions, impulsivity, anger, conflict, and unstable relationships, but this is not a defining feature of BPD. Comorbidities like substance use disorder might increase the likelihood of violent behavior.
Communication with someone who has BPD should be clear, validating, and steady. Avoid reactive or resentful responses when possible. Name what you mean, explain the “why” behind your boundaries, and stay compassionate even when the conversation is difficult. Validation does not mean agreeing with everything; it means showing that you are trying to understand the emotion underneath the reaction.
You can help someone with BPD by learning about the condition, avoiding stigmatizing interpretations, validating their emotional experience, encouraging treatment, and getting support for yourself. Families often need their own therapy, education, or support groups because BPD affects the whole relational system. Help also includes setting compassionate boundaries and continuing to show up in ways that make clear the relationship has not been abandoned.