My best friend with BPD is spiraling, and I don’t know how to help anymore
I don’t have BPD myself, but one of my closest friends does. We’ve been friends for about a year, and over time I’ve started recognizing clear patterns of emotional dysregulation and self-destructive behavior. I can usually tell when she’s having an episode.
Unlike many people around her, I don’t take her behavior personally. I know the difference between someone intentionally trying to hurt others and someone spiraling emotionally. During episodes I stay calm, don’t escalate, and try to keep boundaries firm but stable. That approach has mostly worked so far.
The problem is that I’m realizing patience and understanding alone are not enough when the behaviors are actively harming her.
Things from her past are starting to make sense now - periods of heavy drug use when she was younger, impulsive/risky sexual behavior, emotional outbursts, self-harm history, etc. Everything seems to happen in extremes and is either 0 or 100.
Yesterday really scared me. Earlier in the day, she had an intense outburst at home: screaming, throwing things, and eventually kicking through a glass door. Some people who were there took her to the hospital afterward. Later, she called me from the hospital with her entire arm bandaged and covered in 16 stitches! She said she “fell” but also kept saying she “got nervous” and would “tell me later.” The injuries looked very obviously like cuts to me.
She seemed extremely distressed and unstable during the call. Then she stopped responding entirely afterward. Messages still deliver, so I assume she’s physically okay, but I honestly don’t know where she is or what state she’s in mentally.
From what she’s told me, her mental health issues started around age 14-16. She had a severe self-harm episode as a teenager and was hospitalized in a psych unit for a while, which is when she was diagnosed. She avoids discussing any of it. Any attempt to bring up traumatic events, harmful behaviors, or her mental health makes her visibly stressed and avoidant.
There are periods where her memory and stories become inconsistent. Sometimes she tells me something, then later describes the same event completely differently and seems to genuinely not remember the earlier version.
Her substance use also comes in cycles: months of heavy use, drinking, weight loss, no sleep, and then months of complete sobriety. It seems more as emotional instability than addiction.
What hurts most is seeing how much pain she’s in while also ignoring the harm being done to herself. She’s actually an extremely generous and caring person and she has tendency to over give - gives people money impulsively, overextends herself emotionally, and cares deeply about others. She’s talented, intelligent, charismatic, and still very young, but all of that gets overshadowed by her destructive patterns.
I’m also frustrated with her family. From what I’ve witnessed, they don’t seem emotionally supportive at all. They speak to her harshly, seem detached from her condition, and mostly treat her as a problem to manage instead of someone suffering.
I’m about 10 years older than her, and I feel a strong responsibility to protect her, but I’m not sure how to do most important part.
MY QUESTION IS:
What can I realistically do here?
What can I do and how? How do I start a conversation about all of this and her behaviors with her? How do I explain which behaviors concern me and why I think she needs to stop? Where should I direct her to? Which therapies are effective? I am willing to even go with her for the first time, it is not a problem for me. How do i convince her to do something about this and make her understand that this is harming herself, not anybody else, and that she is the only person she needs to care about the most?
I’d especially appreciate perspectives from people who have BPD themselves, but advice from loved ones who’ve been through this is also welcome.
EDIT: She had to go to a hospital because of a skin condition she is currently fighting, not her outburst. That is why seeing her with a stitched-up arm made my heart drop. also ppl that initially went with her were not there anymore and she keeps telling me she will tell me where they left and what happened later.