HaleyAnne, back in the 1980s, when people were first getting enthusiastic about BPD, even pierced ears were seen as a symptom. This was really over-reaching.

There was a time when tattoos were considered highly anti-social and a symptoms of "something." But they've now reached of point of being an accepted cultural phenomenon. Yes, they hurt when they're applied, but if your family member was using it for self-harm, she'd be running to the tattoo parlor on a regular basis, in the middle of the night, whenever she wanted/needed to relieve tension. Five tattoos don't qualify these day. But back in the '80s, when people were looking too hard, even getting an unconventional haircut was called self-harm.

That doesn't negate all the other symptoms. Maybe she does have BPD, but that's really something for her and her therapist to figure out.

It's admirable that you want to know what's causing your family member so much pain. But I don't know if knowing the diagnosis will actually help you in any way. The important thing is that she's in therapy and is taking medication and is back to work. It sounds as if she's doing all she can to get better. Sometimes it's a long-haul.

People in therapy often get worse before they get better because it's so upsetting to them to explore the elements of their distress. Not to mention that it takes practice to try on new, more healthy, behaviors. Few people get it right the first few times.

I remember when one of my close family members first went to therapy. She started expressing herself ... about everything. It took her time to balance out and realize that telling everyone exactly what you thought of them as soon as you thought it was not the same thing as acting assertively.

So, I recommend patience. It may seem like she's not getting better fast enough. But, honestly, I do think, from my own experience and the experience of my friends, that these things can take time. The love and support of family can help a lot ... even if you don't fully understand what's going on. A pat on the back and an encouraging word can go a long way to helping someone who's experiencing mental distress feel accepted.

I wish you the best of luck.