August 1, 2023 • 50 mins
Borderline Personality Disorder has been described as emotional “third degree burns over ninety percent of your body.” It’s as close to a curse as a personality disorder can be: deep fear of being abandoned creates behaviors that end up driving people off.
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Speaker 1 (00:00):
Hey, everyone, Josh and Chuck here to remind you that
our last three shows of the year. Boy, this is
a good show this year are taking place very soon
and tickets are still available.
Speaker 2 (00:10):
Yeah, so get in the saddle and come out and
see us partners in Orlando, Atlanta, and Nashville.
Speaker 1 (00:17):
Just go to stuff youshould know dot com and click
on the tour link and you can get all your
tickets right there. Welcome to Stuff you Should Know, a
production of iHeartRadio.
Speaker 2 (00:33):
Hey, and welcome to the podcast. I'm Josh and Chuck's
here too. It's just the two of us, and that's
cool because this is the stuff you should Know.
Speaker 1 (00:43):
Yeah, Jerry's got the week off and she said press on, dudes. Yeah,
party party on Wayne.
Speaker 2 (00:52):
That was also from Bill and Ted's excellent Adventure. Wasn't
it Party On?
Speaker 3 (00:56):
No? Was it? I think?
Speaker 2 (00:58):
So I can see George Carlin say it.
Speaker 4 (01:01):
Yeah, I'm probably wrong.
Speaker 2 (01:02):
I'm probably wrong. So, Chuck, we're talking today about something
we've kind of touched on before. But when we touched
on it, we're like, this is something that deserves its
own episode for sure.
Speaker 1 (01:15):
Yeah, we're talking. This is another in our suite on
mental health. Conditions, and boy, we've got a lot of them,
but we still got more to go. Yeah, we do,
you know, and I think these are important shows, and
every time we do these, I feel like we get
good feedback on people who suffer from these conditions and
(01:36):
say thanks for either educating me and or getting the
word out to people who may be a little, uh,
what's the word ignorant about some of the stuff.
Speaker 2 (01:46):
As Michael Jackson would have said, you're ignorant about this?
Speaker 4 (01:50):
What's that from?
Speaker 2 (01:51):
He just used that word a lot.
Speaker 4 (01:53):
Oh really, yeah, But.
Speaker 2 (01:55):
Regardless, that has nothing to do with anything. When you
mentioned just now that people like kind of wrote in
or write in when we do episodes like this, Well,
we did our emotional pain episode and we mentioned a
borderline personality disorder. A lot of people wrote in. Well,
I don't want to say a lot, but some people
wrote in and they said, you know, thank you for
treating it compassionately, because when most people talk about it,
(02:18):
they talk about it like they despise it, or they
despise people with BPD. And the more you look into
the more you realize, like, wow, this is maybe one
of the hardest mental illnesses that you can possibly have,
and I think we kind of said that in the
Emotional Pain episode, but if I didn't know it before,
I definitely do now after doing this research.
Speaker 1 (02:40):
Yeah, and it's also clear that it's one that somehow
seems to garner the least amount of empathy, right, not
only among just people who you know, may or may
not know much about it, but even clinicians and therapists
as that stuff you sent me like a lot of
times try to avoid or severely limit the number of
(03:01):
patients that they have that they treat with BPD, which
makes it even more sad because it is a really
tough one. I guess we'll just define it kind of
off the bat, and you know, a lot of this
episode will kind of be defining it in different ways
because it's fairly complex. But it is a what's known
as a cluster B personality disorder, which is in the
(03:25):
anti social personality disorder category along with historyonic personality disorder
and narcissistic personality.
Speaker 4 (03:33):
I'm just gonna start saying PD.
Speaker 2 (03:35):
Yeah, PDS. It will make it sound like, you know,
you're talking about.
Speaker 1 (03:38):
Yet more narcissistic PD, but it seems like a lot
of what it can be is sometimes a disorder of perception.
And while there are very real things that do that
can trigger people with BPD, a lot of times the
way things are perceived incorrectly, either about themselves or about
(03:59):
other or others actions.
Speaker 2 (04:01):
Yeah, and I saw a lot of people confuse borderline
personality disorder with bipolar, or at least think they're similar.
I guess because they got start with bees or something
like that. But no, they're not similar. Bipolar has much
more of a brain and central nervous system basis, whereas
while borderline personality disorder has a component of that, the
(04:26):
executive function of the person in their prefrontal cortex either
didn't develop in a fully normal way or it's not
functioning up to snuff, I guess, more than anything. And
the thing that differentiates it from bipolar is it's an
assignment of meaning it's psychological as much, if not more
(04:48):
than it is physiological.
Speaker 4 (04:51):
Yeah.
Speaker 1 (04:52):
And also bipolar is characterized, and we did a good
episode on that quite a while ago, but it's characterized
by like these highs and lows, and then in between
those periods they can be relatively stable, whereas with borderline
personality disorder it's sort of always there. This one thing
(05:13):
you sent me had to really kind of really nail
it on the head at the end. Those with bipolar
may have a hair trigger kind of response during an episode,
whereas when you have a borderline PD, you have a
hair trigger response all of the time. And I can't
imagine how sup that must be.
Speaker 2 (05:29):
Yeah, so that kind of calls out one of the
big hallmarks of BPD, which is it's emotional dysregulation. Yeah,
things that would affect other people a little bit, maybe
not at all. Stuff that most people that roll off
of their back right could set somebody with BPD off
(05:50):
into a rage that could last days.
Speaker 3 (05:53):
Potentially.
Speaker 2 (05:54):
They also might use self harm it's called non suicidal
self injury to kind of externalize the pain because the
emotional dysregulation is so profound, they don't know what they're feeling.
They just know they're feeling everything all at once. And
it's kind of like standing in an ocean and a
(06:17):
huge wave hits you, and you're just you're as profoundly
enveloped by emotion at that moment as you are by
a wave when it just completely knocks you off for
feet and sweeps you away.
Speaker 1 (06:30):
Yeah, there was another and we'll talk about her in
great detail. Her name is Marcia Lenahan or is it
line Han.
Speaker 2 (06:38):
I'm gonna go with Lenahan.
Speaker 1 (06:40):
Yeah, she as we'll see as someone who not only
suffered from BPD but kind of pioneered the treatment of BPD.
But she said, it's like having third degree burns on
ninety percent of your body metaphorically, So you're lacking emotional skin,
and you feel agony at the slightest touch er movement,
(07:02):
and since you did mention self harm, non suicidal self harm.
It also people with BPD have a suicide rate of
was it like fifty times higher than average in the population.
Speaker 4 (07:16):
Yeah, so this is this is no joke.
Speaker 1 (07:20):
This is a very hardcore disorder that bears more empathy
and understanding.
Speaker 2 (07:26):
Yeah, for sure. Let's go back to the beginning, shall we,
Because borderline personality disorder is one of those terms that
has taken on its own meaning in the general population,
but if you stop and think about it, it doesn't
really reveal much about what it's describing. It's just one
of those not at all frustratingly So, yeah, and that
(07:47):
goes back to a jerk named Adolph Stern who really
jerked it up back in nineteen thirty eight.
Speaker 1 (07:52):
Yeah, he was a psychoanalyst, and he basically I mean,
if you didn't know what it was, and I didn't
even fully know what it was, I always wondered what
borderline meant. And it very simply meant and means, this
is Stern saying, you're not quite on the psychotic level
and you're not quite psycho neeurotic. You're basically on the
(08:15):
border between those conditions while encompassing a bit of each.
So we're just going to call it borderline.
Speaker 2 (08:21):
Yeah, and psychosis is what we would still consider psychosis,
but under psychoanalysis, psychoneurosis is what we call anxiety depression,
those kinds of mental illnesses. So I guess Adolf Stern
wasn't really that big of a jerk, because he really
kind of did combine him appropriately. It was Auto Kernberg
(08:42):
who was the serious jerk in this situation.
Speaker 1 (08:46):
Okay, So he was a psychoanalyst in the mid nineteen seventies,
so that's you know, like forty something years later, and
he described it as an unstable personality and disorganized conception
of the cell. And this is just when it was
sort of starting to become more and more kind of
talked about, and officially I think five years after that
(09:08):
was in the DSM version three.
Speaker 2 (09:11):
Yeah. I mean that's pretty quick for something you just
started to identify, and five years later it makes it
in the DSM. Because they don't churn those dsms out
like you know, every few months. It takes years to
put one together. So Kurenberg seemed to have stumbled onto
something that was worth looking at, very very very quickly.
Speaker 4 (09:30):
Yeah.
Speaker 1 (09:31):
And isn't there a sort of movement or belief now
that it's a lot of people think it's something that
is like a diagnosis you shouldn't even give, right.
Speaker 2 (09:40):
Yeah, there's we'll talk about that. I think we can
kind of pepper it throughout, you know. Okay, But yes,
there is a school of thought that basically says BPD
is not a personality disorder. It's not even a mood disorder,
although some people say it would better be characterized as
a mood disorder. They say it's a cluster of symptoms
(10:01):
that overlap with a bunch of different actual disorders, and
that the problem with that, you say, who cares? You're
identifying people a group of people whose rate of suicide
is fifty times a general population, that alone is worth
like identifying and helping those people out. But what they're
saying is number one, BPD has gotten such a bad
(10:24):
name in the general population that you're literally stigmatizing somebody
when you give them that diagnosis. It is an enormously
heavy weight you put on somebody. We say, I'm a
trained psychiatrist, I know what I'm talking about, and you
have borderline personality disorder. Everybody step back.
Speaker 1 (10:44):
Basically, yeah, I mean it's it's almost in line with
saying someone as a sociopath. It's different things, but as
far as like the stigma goes very much.
Speaker 2 (10:54):
So, yeah, for sure, that's a great analogy. Actually, so
some people are like, Okay, it's stigmatizing, but even more
than that, just the science isn't necessarily there, like we're
saying it's symptoms rather than an actual disorder. And then
apparently the Working Group for Personality Disorders for the DSM
five that's the most recent one, they actually said, we're
(11:17):
not sure that this should be a categorical disorder, which
is the type that you either have it or you don't.
They suggested it should be dimensional, which means that it
exists on a spectrum, right, so you can have a
little bit of BPD, a lot of BPD, or right
in the middle or whatever. And that got rejected. And
now so it's a categorical diagnosis where if you don't
(11:42):
have BPD, you don't have BPD. If you don't fit
the criteria. If you do, you got BPD.
Speaker 1 (11:47):
Right, And we'll talk about the criterion in a second,
but we do want to sort of reintroduce Marcia Lenihan, who,
like I said, was a real pioneer for her work
in the treatment and recognition of BPD. Very late in
her life, revealed that she suffered from BPD. After you know,
(12:08):
patients and friends encouraged her to come forward and she said, basically,
you know, I'm gonna do it. I'm not gonna die
a coward, is what she said, but for the longest
time was not out with that information. Was born in
Oklahoma in I guess the fifties, and in the nineteen
sixties in high school, was diagnosed with schizophrenia, drugged up,
(12:31):
give an electro shock, hospitalized, was practicing self harm of
all kinds, and then had it sounds like a not
a moment of clarity, but a pretty profound religious experience.
Speaker 2 (12:46):
Yeah, the only thing missing was a visit from Saint
Michael pretty much.
Speaker 1 (12:50):
I mean, she's Catholic, and after this religious experience she
was able to which you know, had a lot to
do with self love. But after this she was able
to still have these emotions that she had before, but
managed it to the point where she wasn't practicing self harm.
And did she come up with the term radical acceptance
(13:13):
or did she just buy into that.
Speaker 2 (13:15):
I don't know if that was a descriptor of hers
or not.
Speaker 4 (13:18):
Okay, I don't think she came up with that.
Speaker 1 (13:20):
But basically, as you know, radical acceptance is like, hey, listen,
this is how things are with me, this is how
things are with the world. I accept this, and I'm
not going to compare this to what I think the
reality should be or what other people think it should be.
Speaker 2 (13:38):
There's a huge butt that follows that though.
Speaker 3 (13:41):
But but but.
Speaker 2 (13:45):
I am going to do what I can to change
those things about myself.
Speaker 4 (13:50):
Right.
Speaker 2 (13:50):
So that is the basis of a type of cognitive
behavioral therapy that she came up with called dialectical behavioral therapy,
and it is it's based in radical acceptance and the
desire to examine and change how you interact with the
world externally, and it's basically the gold standard for treating
(14:11):
a borderline personality disorder it right.
Speaker 1 (14:13):
Now, Yeah, and it seems like it really works. I
saw that it was kind of the only proven treatment
to reduce suicidal behavior, which is, you know, at the
tail end of what a lot of people experience with BPD.
And the good news and we'll talk about treatment later,
but the good news is if you have VPD or
(14:35):
know someone that does, you can get better. And they
have proven and shown time and time again now that
through the treatments that we'll discuss later, it is absolutely
something that someone can get a hold of in most cases, right,
which is great.
Speaker 2 (14:51):
It is great. I mean, like, for as bad of
a stigma as BPD has, the idea that like it
has a very high success rate of treatment is pretty couraging.
So Lenahan's basis of her understanding or her definition of
borderline personality disorder is that it's biosocial that people who
(15:12):
have BPD are either genetically or biologically predisposed to having BPD,
but not everybody who has that predisposition is going to
be triggered into developing BPD. It takes basically a biological
substrate for BPD. Usually your prefrontal cortex hasn't developed in
(15:34):
a certain way, and so your executive function isn't functioning
like an executive should. That gets joined together with a trigger,
usually mistreatment, whether it's abuse, neglect, invalidation by your parents
as a kid, and you put those things together and
(15:55):
very often it results in what you be diagnosed with
later as BPD.
Speaker 1 (15:59):
Yeah, and one thing I really took away from this,
and this is something that you know, Emily and I
and and most parents that I know are way into,
is h oh, you got to validate your kids.
Speaker 2 (16:09):
Yeah, that's new, which is crazy, but it's.
Speaker 1 (16:12):
It's Yeah, you got to validate their emotions and validate
their experiences and their feelings, even if it's something that
you don't think is uh, like has the most relevance
or whatever, or even if like the kid is wrong
about something or like emotionally wrong, like, you still have
to validate that and then talk them through it. What
(16:32):
you can't do is just discount a kid's feelings, because
that's like telling them that their truth isn't real, and
that's damaging I know, and.
Speaker 2 (16:43):
Doing parenting right sounds like a waking nightmare to me
doing wise parenting parenting correctly. Yeah. Nah, I can't imagine
the exhaustion along combined with the fear of just misstepping
once or twice and then there you go, you screwed
your kid up for life.
Speaker 4 (17:00):
Yeah.
Speaker 1 (17:00):
What you gotta do is, in my experience, is like
you can't beat yourself up too much because parenting fails,
you can really go down a rabbit hole.
Speaker 4 (17:09):
Of your own.
Speaker 1 (17:10):
I'll be depression if you screw up. And you can't
do that because kids are resilient and you just got to,
like you got to prove to them that you can
like pick yourself up and move on and do better,
you know.
Speaker 2 (17:23):
Yeah, And I don't think Lenahan's idea is that it
just takes one or two missteps. It takes like a parent,
he was a genuinely bad parent. Very frequently they have
BPD themselves. Yeah, and that is a real challenge to
parenting well in and of itself. But you don't have
to have had a parent with BPD to develop BPD.
(17:45):
But typically it's a parent that is not at all
meeting your needs, especially emotionally. And I say we take
a break and we'll come back and talk about how
you would be diagnosed with BPD.
Speaker 3 (17:57):
What do you think, let's do it, okay, Chuck.
Speaker 2 (18:19):
So we said that BPD's in the d S M five.
It's a personality disorder. And just to differentiate real quick,
a mood disorder describes patterns and feelings, like you have
mood swings in that you know highs and lows, and
that's pretty reliable that you're going to have it one
way or another. Personality disorder focuses more on how you
(18:41):
relate to others, and that definitely makes sense to me
that you would consider a BPD of personality disorder.
Speaker 1 (18:48):
Then, yeah, that seems to be a really key thing,
is that it's it's it really disturbs your relationships. So
to be diagnosed, you fit at least five out of
the following nine that we're gonna read for you. Chronic
feelings of emptiness and.
Speaker 2 (19:08):
That's emptiness, feeling like isolated or lonely or hopeless.
Speaker 1 (19:12):
Sure, emotional instability and reaction to day to day events.
That's the thing we were talking about earlier, Like saying
mountains out of molehills seems slightly reductive, but that's kind
of a basic way to say it. Okay, frantic efforts
to avoid abandonment, whether or not they're real or imagined.
As Yeah, as we'll see abandonment issues, and this very
(19:36):
very much includes emotional abandonment as a really big precursor
unstable self image or sense of self.
Speaker 2 (19:46):
What else, Impulsive behavior is usually a big one, and
you have to have impulsive behavior and at least two
areas that are harming your day to day life, like
an eating disorder and gambling addiction or something like that.
Another one is this is based on and so this
is where some psychiatrists would be like, see this is
(20:07):
not this is a symptom that we're talking about here,
but it's unstable and intense interpersonal relationships. I mean, like
you're really really close to somebody for you know, a
couple of days, and then they do something you don't
like and they're the worst person in the world. And
it can happen very very quickly with people with BPD,
(20:28):
And if you stick around and stay in that person's life,
you can find yourself walking on eggshells very quickly because
you don't want them to turn on you all of
a sudden. So that's a huge one. If you have
a lot of unstable, intense relationships with people, that's just
kind of the mo that is usually a big giveaway
with BPD.
Speaker 1 (20:48):
Yeah, the last three recurrent suicidal or self harming behaviors.
We've talked about that a little bit, stress related, paranoia
or dissociative symptoms, feeling like the self of the world
isn't real. It feels like that's probably the far end
of the spectrum, or the most severe end. And then
(21:09):
one we missed earlier was inappropriate and intense anger or
difficulty controlling anger.
Speaker 2 (21:15):
I didn't miss it. That was purposeful, Okay. I wanted
to end with that big one.
Speaker 4 (21:20):
Okay, all right, speak to it.
Speaker 2 (21:22):
Well, there's a lot of I always hate saying those qualifiers.
It's just so easy to say, but I know I
think it perks people's ears up, like, oh, this person
doesn't know what they're talking about. So let me rephrase that.
I have seen that there are schools of thought regarding
borderline personality disorder that it is a rage response to trauma. Okay,
(21:45):
that that is your response to unresolved trauma. That's how
you learn to deal with those feelings and those emotions.
Is to rage at people, because rage is as much
a hallmark of BPD as fear of abandonment, is right,
and that's why so people are critical of including it
as a categorical diagnosis in the d s M five.
They're saying, you're pathologizing rage. No, you just need to
(22:08):
teach people how to identify their emotions and how to
express them in a more appropriate, less hostile manner, and
then that's how you would treat somebody with BPD, or
not even with BPD, somebody with a rage disorder. But
some people think that that is what people are mistaking
for BPD.
Speaker 1 (22:25):
Oh I gotcha, okay, interesting, Uh, you're gonna to be diagnosed,
Like I said, five of those nine, it'll probably be
you know, like you'll be talking to a psychologist or
someone in an interview. You might fill out a questionnaire
or something they're going to make interesting click click click click,
or they may speak to your family or something like that.
(22:48):
It can be difficult to diagnose and there, like you said,
there's there's a lot of overlap between you know, things
like anxiety and depression and things like PTSD and eating disorders,
a lot of comorbidities. So I get why people can
have issues with like this diagnosis rather than it's like
(23:10):
a cluster of symptoms of other things.
Speaker 4 (23:12):
But I don't know.
Speaker 1 (23:13):
If you group that altogether then it and call it
its own thing, then I don't know. I'm not sure
I see the harm in that.
Speaker 2 (23:19):
Again, I think it's the stigma. And then also it
might be distracting from treating the other underlying.
Speaker 1 (23:25):
Stuff, maybe because there also isn't and we'll talk about pharmaceuticals,
but there isn't a specific pharmaceutical for VPD.
Speaker 2 (23:35):
That's another clue that some people point to that it's
not it's it's it's we're mistaking it somehow. And I
don't want to like overstate the that school of thought.
It is widely considered like an accepted diagnosis orderline personality
disorder is, so I don't want to make it seem
like the cracks are in the facade. It's about a
(23:57):
chromole any day. Now. My point is people make some
pretty good points about how well we understand it or
how well we're defining and we're possibly missing some component
of it.
Speaker 1 (24:10):
Yeah, and isn't that stuff debate usually or I guess
it should be, And I hope it's couched in how
to best treat people and help people, right, Yes, rather
than just like poopooing ideas.
Speaker 2 (24:23):
Yeah, no, I think that's exactly right. But I mean, again,
if we come to this place where even if if
a BPD is the center of a giant Venn diagram
of a bunch of different disorders, Yeah yeah, and we're
mistaking that center overlap of all of them as its
own thing. If you zero in on that group and
(24:44):
they have a fifty times higher rate of suicide than
the general population, again, that is worth zeroing in on,
you know, as its own thing. And like you said,
dialectical behavior therapy is focused initially on individual sessions that
are that are that are aimed to control that that behavior.
(25:04):
Suicide alalogy, Yeah, yeah, for sure.
Speaker 1 (25:07):
You did mention earlier as far as causes go, that
sometimes there is a genetic link, but it seems that
it's not really the disorder that is like maybe passed
from parent to child, but some of those traits and
maybe that's because it is sort of a cluster. Sometimes
you can't you know, you can have BPD and come
(25:29):
from like a pretty good, you know, stable upbringing, but
that seems to be the outlier, and it seems to
be that like most people that end up suffering from
this had a pretty lousy childhood.
Speaker 2 (25:43):
Yeah, so they were either neglected or just kind of
saddled with emotionally unavailable parents who just weren't really there
for them, didn't go to their dance recital kind of thing,
never went to a single one. Excessive control. It sounds
very Freudian, but I saw one classic example as an
(26:04):
absent father and a domineering mother, and it's like, how
many times have you guys tritted that one out? But
apparently it really does have a screwy effect on people
as a kid. And then also if your parents or
parent had a mood disordered themselves, or misused substances, that
(26:25):
would probably have affected their parenting as well.
Speaker 1 (26:29):
Yeah, this also made me think about like parenting of
old versus parenting now and parents can there are still,
of course, a huge range of bad parents these days.
I'm not saying that everyone's doing it right now, but
it definitely seems like things turned a corner and parents
are trying a lot harder these days, and like sort
(26:52):
of the old days of like, oh, you know, kids
raised themselves and you can ignore them and blah blah blah,
and like, I'm sure that, I mean, I know that's
so happen, but it just seems like that happened a
lot more back in the day. And maybe in the
future things like this will be less and less.
Speaker 2 (27:08):
Yeah, that's the hope for sure.
Speaker 1 (27:11):
I know that's sort of a basic, sort of an
elementary way of looking at it, but I just feel
like parents are more aware of stuff these days, and like,
you know, people of our generation and certainly the generations
before that, it was even worse as far as parental
involvement and parents who either one or the other. You know,
fathers a lot of times, you know, historically the ones
(27:31):
that are like, no, we're we're not going to parent
because we're doing the work and we're gonna bring home
the paycheck. And so like I had, I've talked about
it before. I had a dad that wasn't very involved,
but it wasn't like the kind of thing where I
ended up with BPD because of it, you know, yeah,
for sure, if that makes sense.
Speaker 2 (27:49):
You raise a question though, in my mind, I wonder
what percentage of boomer grandparents are allowed to see their grandchildren.
Speaker 4 (27:59):
I'll bet at hire you think are allowed to or not.
Speaker 2 (28:02):
Allowed to, like just don't have contact with their grandkids.
Speaker 1 (28:06):
Yeah, or it's very limited and supervised. And so actually
though a lot of those grandparents, all of a sudden,
are the most doting, and it's kind of like, I
know some parents are like, oh, okay, well this is great.
Yeah when I was a kids, right, sure, for sure.
Speaker 2 (28:21):
But also I think in some of the cases that
the more they dote, they're actually also undermining the parenting
of their kids.
Speaker 3 (28:28):
Yeah.
Speaker 1 (28:30):
Yes, And imagine it can be very painful for a
parent who had a unattentive parent to now have that
parent be a very intentive grandparent.
Speaker 2 (28:39):
You have BPD, I would guess that would be a
rage inducing trigger.
Speaker 4 (28:43):
I imagine it would be.
Speaker 2 (28:44):
So there are plenty of other ways that you could
probably develop VPD. Another very classic one is any kind
of abuse emotional, sexual, physical abuse at the hands of
your parent or a caregiver. And they say that about
eighty percent of people with BPD experience some level of
childhood trauma, whether it was emotional neglect or some sort
(29:08):
of abuse. It is. It's a huge factor, a huge
risk factor in developing BPD for sure.
Speaker 1 (29:15):
Yeah, absolutely, And it seems to be exacerbated if you're
a kid who is maybe you're just innately a little
more unsure of yourself or a little more vulnerable as
a person, and then that is reinforced with a parent
who is not validating your experience and your emotion as
(29:35):
a kid. So you're already starting back sort of behind
the eight ball, and then your parents are making it worse,
and so that can definitely, you know, easy toward that condition.
Speaker 2 (29:45):
Well, it's like that's a chicken or the egg question though,
like were you like that you know already and your
parents is reinforcing it, or did you get that kind
of did you learn to do that because of your parents' behavior.
It's like a chicken or the egg, parent or the disorder, right,
you know. But we said earlier that there's also believed
to be a biological component to it too, that it's
(30:06):
not all psychological, and it does seem to have something
to do with executive function in the brain. One of
the big things that executive functioning does is it helps
you control your emotions, not just in accepting things and
dealing with them and moving on, but also your outward
display of emotions. If you don't have executive function, your
(30:30):
emotional dysregulation is more likely to include explosions of anger,
uncontrollable anger. And then one of the things, it's not
just BPD that has that, there's plenty of other disorders
that have it. But one of the key traits of
BPD is it can last a really long time too.
Speaker 1 (30:51):
Can we make a T shirt that has a chicken
that says parent across the chicken's chest and then next
to it an egg that says mental disorder? Love it
and just that's the shirt. No explanation, figure it out
or don't.
Speaker 2 (31:06):
How about this though, On the back of the shirt,
Mork is coming out of the egg all right to
really confuse people.
Speaker 4 (31:16):
Oh wow, that just really changed things.
Speaker 2 (31:18):
I like it, Okay.
Speaker 1 (31:19):
So as far as the number of people who experience BPD,
it's kind of a wide range, like all this stuff,
because it's one of those disorders that is a lot
of people don't admit it or seek treatment, so it's
really hard to nail it down. But Lyba helped us
out with this one, and she said zero point five
percent to six percent, and they find it about four
(31:41):
times more in women but they've also found other studies
are like, no, it's the women who are brave enough
to come forward and seek treatment, and it happens just
as much in men.
Speaker 2 (31:50):
I also saw that it's a that's an indictment of
clinicians who basically have to figure out for themselves whether
the person has BPD, that they're more likely to assign
it to a woman than a man a male patient.
Speaker 4 (32:04):
Oh interesting.
Speaker 2 (32:05):
So regardless, it is very frequently diagnosed, more than you
would think. It's one of the more common serious mental illnesses. Apparently,
people receiving impatient mental health treatment, one in five of
those people are diagnosed with BPD. So it is very prevalent,
at least inside the clink.
Speaker 1 (32:28):
Yeah, the mental clink, Yeah, the mental clink. One other
aspect is a very black and white thinking. You kind
of talked before about splitting, which is, you know, really
revering and idolizing somebody and then very quickly despising them.
And this can happen very very frequently and like several
(32:50):
times throughout a day even or it can be like
just a switch that is permanent, like someone you used
to really like and idolize all of a sudden just
no more. You despise them, and they're they're on the
bad person list forever.
Speaker 2 (33:04):
Yeah, and that's that falls under the larger category of
black and white thinking. It's not just applied to people,
it's events, things, anything a dandelion can be entirely evil
or the fully good. And because you see things in
people and events as entirely one way or the other,
you set people up for unrealistic expectations. If you're like,
(33:27):
you're one percent pure and kind person and I love you,
that person is inevitably going to let you down in
some way, shape or form. Sure, because no one's one
hundred percent pure and kind. Similarly, no one's one hundred
percent evil. And most people that you would label evil
as if you have VPD, probably aren't evil at all.
They just did something you really didn't like. But now
(33:49):
to you, that person is evil, not to be trusted,
not you know, they did something wrong. At their core,
they're evil, And that's another huge hallmark of BPD as well.
Speaker 1 (34:03):
Yeah, I mean even Darth Vader was once a young boy, Yeah,
just trying to learn the ways of the force.
Speaker 2 (34:09):
But boy did he get pale as he aged.
Speaker 4 (34:13):
He sure did.
Speaker 1 (34:15):
This can also this splitting can happen with yourself. You
may vacillate wildly from feeling like you're you're okay and
that you feel good about yourself and you have a
little bit of self confidence to really loathing yourself. And
that's when like things like you know, self harm can
come into play. Your sense of your own personality can
(34:37):
really change your you know, you could very much switch,
like kind of do these wild switches between your goals
in life for or how you want to present yourself
to the world, or like your values and ethics and
things like that. And this I'm not really sure, but
it kind of seems like almost like sort of auditioning
(34:59):
yourself kind of over and over sometimes like let me
try this new me or whatever, or auditioning or trying
out a new thing that you think might help.
Speaker 4 (35:10):
Make sense.
Speaker 2 (35:10):
Yeah, no, totally. It's also circumstantial too. They might act
different ways to different people depending on what they think
those people want from them, or yes, to impress like
a friend or a new person or something like that.
They might adopt that person's like hobbies and interests. But
I saw it explained as the people who have VPD
(35:31):
and do that that they don't understand where they end
or the other person begins, because they have no idea
what they believe in. They just don't know, so they're
kind of open for suggestions. Basically interesting.
Speaker 1 (35:44):
Yeah, should we take a break?
Speaker 2 (35:48):
Oh jeez, that came out of left field.
Speaker 1 (35:50):
Sorry, sure, all right, I think it's a good time
to take a break, and then we're going to come
back and talk more about personal relationships. All right, we're
(36:18):
back and talking about borderline personality disorder. And one kind
of hallmark with someone with BPD is what's called like
a favorite person, or just a person in their life
that they have have not necessarily even chosen, who they've
hooked up with. It could be a spouse, it could
(36:40):
be a partner, It could be a friend or coworker,
anyone that you really have latched onto as someone maybe
the only person that you really really trust with yourself.
Speaker 2 (36:53):
Yeah, and I don't think you even trust that person.
You just that's the person you've come to find you
can lean on the most, I think. Okay, but yeah,
the FP, for those in the know, the favorite person
is very frequently somebody who is willing to kind of
go along with this, at least for a while. There's
(37:15):
a ton of flattery and admiration and praise, and all
of your greatest points are pointed out all the time.
But you're also in real danger of letting that person
down and facing that wrath of rage or anger or hostility.
And if you come back for more, you're going to
(37:35):
find that you, as the favorite person, might start altering
your behavior to fit the person with BPD's behavior, so
you might start considering them when you're making plans like, oh,
we can't go out of town this weekend because our
friend with BPD was going to, you know, wanted us
to come out for their Sunday picnic or something like that.
(37:55):
Right like, you would be afraid to not go to
their picnic, And you generally end up feeling like you're
walking on eggshells. And it's a codependent relationship that evolves.
The favorite person seems to be the person who's willing
to take it the longest or the most, and that
it's not a permanent thing. Typically people get burned out
(38:16):
on it and eventually abandon the person with BPD, which
is again at the root of what they are fearful of.
They're fearful of rejection or abandonment. The tragedy of the
whole thing is that their behavior almost inevitably guarantees that
they will be rejected or abandoned by the people around them.
Speaker 1 (38:36):
Yeah, that sort of self fulfilling feedback loop. Yeah, I mean,
it's a big burden for an FP. And if you
are a spouse or partner of someone and you are
the FP, like, that's a lot to manage, and so
a lot of empathy goes out to those people as
well when you're altering your own behaviors, like literally things
(38:58):
like I saw people or like you know, had to
I've had to step out of like really important meetings
just to answer a text within ten minutes because I
knew that that would set them off. And just little
things like that can really add up to someone's burden.
Speaker 2 (39:16):
One of the other things that is difficult to deal
with when you're an FP is that person wants you
all of themselves. They're yeah, right, and very much by
other people. So they will try to isolate you from
your other friends and your family so that they have
you all of themselves, not just for time, I'm sure
time is a big part of it, but also to
cut down on any I guess rational explanation or rational
(39:40):
points from those other people, like what are you doing?
Why are you putting up with this? Isolating them would
help cut down on that too.
Speaker 1 (39:47):
Yeah, and you know, if you're an FP, there's always
the sort of sad and scary possibility that there could
be a split incident that all of a sudden you
go from being the FP to be the most despised person.
I would imagine that's something that has probably comes over
time and is not like a quick thing. It can
(40:09):
be but it can be all right.
Speaker 2 (40:11):
For sure. It can happen, It can turn on a dime.
And the other problem with it as well, Chuck, is
that the person with BPD almost invariably immediately regrets doing
that right, and so they will make every effort to
try to win the person back, which probably feels pretty
gross for the FP, and they'll say things like I'll
(40:34):
never do that again, like they know what they've just
done is worth regretting, is worth feeling horrible about because
they've just been abandoned or rejected. They just did it
to themselves, so now they're trying to fix it or
mend it. But it's all just kind of built on
you know, hicky ground because it's it's gonna happen again,
because it's impossible for that person not to let the
person with BPD down again.
Speaker 1 (40:57):
Yeah, I mean, I get the impression that people with
bp D generally don't have any illusions about themselves because
it is such a struggle.
Speaker 2 (41:05):
Well, that is a big problem with not only getting treatment,
but seeking treatment, because when your brain is structured in
a certain way, and ever since you were a little kid,
you've just responded a certain way to things. Even if
people around you are telling you that is messed up
or that you're being hustle or whatever, to you, that's normal,
(41:25):
that's natural. So it's really really hard to interrogate your
own behavior, let alone change it, because it seems normal
and natural to you. It's not that you need to
change your behavior because you chase somebody away. It's that
that person left to you now you need to go
get them back. So even if you have people around
you telling you, it's going to take a lot of emphasis, repeated,
(41:50):
constant emphasis, that what you're doing right now is abnormal
and harmful and you need to go get help for this.
That's yeah, that's one of the curses of it. They
can't see it. They at least if they can see it,
most of the time they can't well.
Speaker 1 (42:07):
And this is I mean, all the mental health disorders
require a support system, but this one really seems to
sort of be at the top of the list of
needing a really solid, vast support system for treatment. Like
we said, the good news is that treatment works. They
used to think that personality disorders were untreatable and that
(42:30):
you were just kind of stuck with it.
Speaker 4 (42:33):
They have found that about half.
Speaker 1 (42:35):
The people who are treated, who seek treatment and are
treated no longer meet the criteria after five to ten years.
Speaker 2 (42:42):
Amazing.
Speaker 1 (42:43):
It doesn't mean that they're you know, they're perfect and
awesome and fixed. It means they can still have some symptoms,
but they have it under control enough to where they
don't meet that five out of nine criteria. And that's
what it's really sort of about, I think, is managing
something that, like you said, that you might have had
since you were like a baby, to live a productive,
(43:05):
you know, healthy life.
Speaker 2 (43:07):
Yeah, and that's kind of what you're going to learn
in DBT, which again is the gold standard for treating BPD,
is that you're going to be taught these skills, how
to deal with disappointment, with being let down, with somebody
not responding to your text. You're going to learn a
different set of skills and how to deal with that,
both internally and externally. And one of the things that
(43:30):
kind of differentiates DBT from other kinds of behavioral therapy
is that there's group sessions, but it's not a group
session that you know, you've seen in a movie like
My nice Mela was in a movie called No Exit,
and that featured a couple of group sessions. I think
you can still see that on Netflix.
Speaker 4 (43:49):
I think so.
Speaker 2 (43:49):
But it's not like that. It's more almost like a
classroom instead, and then people get up and practice these
skills in front of others and with others. But it's
not like a group therapy session in the traditional sense.
But that's a huge component of it is group work.
Speaker 1 (44:06):
Yeah, And it's you know, if it sounds a little
bit like cognitive behavioral therapy, it is sort of based
on that in part because it's a real and I
get how it works. It seems like a real sort
of rubber meets the road practical ways of learning new
behaviors rather than.
Speaker 4 (44:24):
And therapy is a huge part of it.
Speaker 1 (44:27):
But it's not just lets therapy and talk about your
past until you're blue in the face. It's like, all right,
we know what's going on, and we think we know
where it came from. Generally, Now, let's really talk about
putting this into daily practice, like literally doing things and
having a checklist and putting stuff into practice, which I
(44:48):
think is just I mean not only for DBT, but
stuff like that is so it so speaks to me
as a good way forward when you have any kinds
of problems because it's just a practical thing. It's learning
new behaviors.
Speaker 2 (45:04):
That's another criticism of BPD as its own disorder, that
DBT can be used to treat all sorts of different
symptoms of all sorts of different disorders. It just makes
sense like that, yeah, for sure. But there's also another
type of therapy that supposedly works really well for DBT
called psychodynamic therapy, and it is talking about what you
(45:28):
went through as a child. So you're blue in the face,
but it's more about relating to relating that to how
you deal with people in your current life, people in situations.
It's relating it back to it so that it's not
just one big confusing blob. You understand your own behavior
better as a result of interrogating what you went through
(45:49):
as a kid. And I guess it smells a lot
like it believes borderline is like a response to trauma
using a rather than anything else.
Speaker 1 (46:02):
Yeah, I mean, if you can sort of build out
your emotional life map, I imagine that's a very helpful
thing to do, you know.
Speaker 2 (46:11):
Yeah. And then one other thing that really kind of
underscores how difficult dealing with people with borderline personality disorder
can be. One of the main components of dialectical behavioral
therapy is what's called a therapist consultation team, which is
basically a group of therapists working with patients with BPD
(46:32):
having like a like a blowoff steam session about them, right,
and reminding one another like, these are people suffering and
we need to have empathy for them. That's how hard
it can be to treat people with BPD.
Speaker 1 (46:45):
Yeah, And like I said at the beginning, there are
therapists that will refuse treatment because.
Speaker 4 (46:52):
All the reasons that we talked about.
Speaker 1 (46:54):
They say that National Alliance on Mental Health basically says,
if you have BPD and you wreckon that and you
want to see treatment, whether it's you know, DBT or
any other kind you Uh, well, first of all, seek
out someone that specializes in DVT. But if there's no
one in your area that does that, then, like you,
you have a right and this this goes with any
(47:15):
sort of emotional or mental problems that anyone has that
they're working for you. So you have the right to
advocate for yourself and to find somebody who works for
you and who who will not stigmatize you, and like
really like it's okay to question them and make sure
it's a good fit for you.
Speaker 2 (47:36):
Yeah, for sure.
Speaker 1 (47:38):
I think people just I don't know, it's I think
part of the problems with a lot of these disorders
is people can't be advocates for themselves, and then that
might be part of their problems. So they're not going
to advocate for themselves when receiving treatment, and they'll just
take whatever they can get. And it's not all therapies
are created equal, and in therapists are created definitely not.
Speaker 2 (47:56):
I think one of the problems with BPD is that
they might over advocate for themselves. Else Oh, chaseus off,
basically right. But the thing is, Chuck is like you said,
people take what they can get, in part because there's
a huge shortage of psychiatrists in particular in the United States,
and people will just take whoever can get them in
(48:17):
within a year or less. If the waiting lists are crazy,
it is crazy. Well, if you want to know more
about BPD, there are a lot of articles and resources
all over the internet to help you. And since I
said that it's time for listener mail, I'm going to.
Speaker 4 (48:37):
Call this, uh, well, let's just call it listener mail.
Speaker 1 (48:42):
Hey guys, one day I will write the email that
I've been formulating in my mind for years, trying to
put into words, but the show is meant to me.
I'm tearing up just writing that sentence, which provides you
with a hint of why that email hasn't been written yet.
In the meantime, I want to let you know that
both of your names are listed on my Big Thanks
to portion of my bachelor thesis. It's customary in my
(49:04):
country to thank your college coach for their support during
your graduation year and.
Speaker 4 (49:08):
Your thesis forward.
Speaker 1 (49:10):
I have felt it was only right to also thank
the other people have supported me to the same extent
as my coach and this includes you, guys. I don't
feel the least bit dramatic when I say my thesis
would not have been written but wasn't for you guys
keeping me sane. That's what you've done for me over
the years, but this year I really needed it more
than ever. So thank you, all caps, double exclamations. I've
(49:33):
added a picture of my forward where your names are mentioned,
and since I'm Dutch, I'm afraid it won't make much
sense to you, but I figured it might bring you
some joy to see the proof.
Speaker 2 (49:40):
There are some Rando jays scattered throughout those words.
Speaker 1 (49:44):
Yeah, totally, and Chuck has a little null signed through it.
Speaker 4 (49:47):
That's weird unless sure what that means.
Speaker 2 (49:49):
It means your back.
Speaker 4 (49:50):
That means it don't count.
Speaker 1 (49:52):
And that is with much love and immense gratitude from Suzanne. Oh,
I'm going to do my best to here, Suzanne.
Speaker 2 (50:01):
Let's hear it again.
Speaker 4 (50:04):
Chris Silk sick. I like you, I s have you?
I JK if you like the second one.
Speaker 2 (50:10):
Yeah, thank you, Susan. I'm gonna call her Suzanne. Thank
you very much. Suzanne. That was very kind of you.
Thank you for tearing up. I think you did just
write that email. If you ask me, don't you.
Speaker 4 (50:21):
Chuck, I'm tearing up.
Speaker 2 (50:22):
If you want to be like Suzanne and let us
know what we meant to you. We always love hearing
that kind of thing, or you can just write it
and say anything you want. We're at stuff Podcasts at
iHeartRadio dot com.
Speaker 4 (50:38):
Stuff you Should Know is a production of iHeartRadio. For
more podcasts my heart Radio, visit the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows.
Hey, everyone, Josh and Chuck here to remind you that
our last three shows of the year. Boy, this is
a good show this year are taking place very soon
and tickets are still available.
Speaker 2 (00:10):
Yeah, so get in the saddle and come out and
see us partners in Orlando, Atlanta, and Nashville.
Speaker 1 (00:17):
Just go to stuff youshould know dot com and click
on the tour link and you can get all your
tickets right there. Welcome to Stuff you Should Know, a
production of iHeartRadio.
Speaker 2 (00:33):
Hey, and welcome to the podcast. I'm Josh and Chuck's
here too. It's just the two of us, and that's
cool because this is the stuff you should Know.
Speaker 1 (00:43):
Yeah, Jerry's got the week off and she said press on, dudes. Yeah,
party party on Wayne.
Speaker 2 (00:52):
That was also from Bill and Ted's excellent Adventure. Wasn't
it Party On?
Speaker 3 (00:56):
No? Was it? I think?
Speaker 2 (00:58):
So I can see George Carlin say it.
Speaker 4 (01:01):
Yeah, I'm probably wrong.
Speaker 2 (01:02):
I'm probably wrong. So, Chuck, we're talking today about something
we've kind of touched on before. But when we touched
on it, we're like, this is something that deserves its
own episode for sure.
Speaker 1 (01:15):
Yeah, we're talking. This is another in our suite on
mental health. Conditions, and boy, we've got a lot of them,
but we still got more to go. Yeah, we do,
you know, and I think these are important shows, and
every time we do these, I feel like we get
good feedback on people who suffer from these conditions and
(01:36):
say thanks for either educating me and or getting the
word out to people who may be a little, uh,
what's the word ignorant about some of the stuff.
Speaker 2 (01:46):
As Michael Jackson would have said, you're ignorant about this?
Speaker 4 (01:50):
What's that from?
Speaker 2 (01:51):
He just used that word a lot.
Speaker 4 (01:53):
Oh really, yeah, But.
Speaker 2 (01:55):
Regardless, that has nothing to do with anything. When you
mentioned just now that people like kind of wrote in
or write in when we do episodes like this, Well,
we did our emotional pain episode and we mentioned a
borderline personality disorder. A lot of people wrote in. Well,
I don't want to say a lot, but some people
wrote in and they said, you know, thank you for
treating it compassionately, because when most people talk about it,
(02:18):
they talk about it like they despise it, or they
despise people with BPD. And the more you look into
the more you realize, like, wow, this is maybe one
of the hardest mental illnesses that you can possibly have,
and I think we kind of said that in the
Emotional Pain episode, but if I didn't know it before,
I definitely do now after doing this research.
Speaker 1 (02:40):
Yeah, and it's also clear that it's one that somehow
seems to garner the least amount of empathy, right, not
only among just people who you know, may or may
not know much about it, but even clinicians and therapists
as that stuff you sent me like a lot of
times try to avoid or severely limit the number of
(03:01):
patients that they have that they treat with BPD, which
makes it even more sad because it is a really
tough one. I guess we'll just define it kind of
off the bat, and you know, a lot of this
episode will kind of be defining it in different ways
because it's fairly complex. But it is a what's known
as a cluster B personality disorder, which is in the
(03:25):
anti social personality disorder category along with historyonic personality disorder
and narcissistic personality.
Speaker 4 (03:33):
I'm just gonna start saying PD.
Speaker 2 (03:35):
Yeah, PDS. It will make it sound like, you know,
you're talking about.
Speaker 1 (03:38):
Yet more narcissistic PD, but it seems like a lot
of what it can be is sometimes a disorder of perception.
And while there are very real things that do that
can trigger people with BPD, a lot of times the
way things are perceived incorrectly, either about themselves or about
(03:59):
other or others actions.
Speaker 2 (04:01):
Yeah, and I saw a lot of people confuse borderline
personality disorder with bipolar, or at least think they're similar.
I guess because they got start with bees or something
like that. But no, they're not similar. Bipolar has much
more of a brain and central nervous system basis, whereas
while borderline personality disorder has a component of that, the
(04:26):
executive function of the person in their prefrontal cortex either
didn't develop in a fully normal way or it's not
functioning up to snuff, I guess, more than anything. And
the thing that differentiates it from bipolar is it's an
assignment of meaning it's psychological as much, if not more
(04:48):
than it is physiological.
Speaker 4 (04:51):
Yeah.
Speaker 1 (04:52):
And also bipolar is characterized, and we did a good
episode on that quite a while ago, but it's characterized
by like these highs and lows, and then in between
those periods they can be relatively stable, whereas with borderline
personality disorder it's sort of always there. This one thing
(05:13):
you sent me had to really kind of really nail
it on the head at the end. Those with bipolar
may have a hair trigger kind of response during an episode,
whereas when you have a borderline PD, you have a
hair trigger response all of the time. And I can't
imagine how sup that must be.
Speaker 2 (05:29):
Yeah, so that kind of calls out one of the
big hallmarks of BPD, which is it's emotional dysregulation. Yeah,
things that would affect other people a little bit, maybe
not at all. Stuff that most people that roll off
of their back right could set somebody with BPD off
(05:50):
into a rage that could last days.
Speaker 3 (05:53):
Potentially.
Speaker 2 (05:54):
They also might use self harm it's called non suicidal
self injury to kind of externalize the pain because the
emotional dysregulation is so profound, they don't know what they're feeling.
They just know they're feeling everything all at once. And
it's kind of like standing in an ocean and a
(06:17):
huge wave hits you, and you're just you're as profoundly
enveloped by emotion at that moment as you are by
a wave when it just completely knocks you off for
feet and sweeps you away.
Speaker 1 (06:30):
Yeah, there was another and we'll talk about her in
great detail. Her name is Marcia Lenahan or is it
line Han.
Speaker 2 (06:38):
I'm gonna go with Lenahan.
Speaker 1 (06:40):
Yeah, she as we'll see as someone who not only
suffered from BPD but kind of pioneered the treatment of BPD.
But she said, it's like having third degree burns on
ninety percent of your body metaphorically, So you're lacking emotional skin,
and you feel agony at the slightest touch er movement,
(07:02):
and since you did mention self harm, non suicidal self harm.
It also people with BPD have a suicide rate of
was it like fifty times higher than average in the population.
Speaker 4 (07:16):
Yeah, so this is this is no joke.
Speaker 1 (07:20):
This is a very hardcore disorder that bears more empathy
and understanding.
Speaker 2 (07:26):
Yeah, for sure. Let's go back to the beginning, shall we,
Because borderline personality disorder is one of those terms that
has taken on its own meaning in the general population,
but if you stop and think about it, it doesn't
really reveal much about what it's describing. It's just one
of those not at all frustratingly So, yeah, and that
(07:47):
goes back to a jerk named Adolph Stern who really
jerked it up back in nineteen thirty eight.
Speaker 1 (07:52):
Yeah, he was a psychoanalyst, and he basically I mean,
if you didn't know what it was, and I didn't
even fully know what it was, I always wondered what
borderline meant. And it very simply meant and means, this
is Stern saying, you're not quite on the psychotic level
and you're not quite psycho neeurotic. You're basically on the
(08:15):
border between those conditions while encompassing a bit of each.
So we're just going to call it borderline.
Speaker 2 (08:21):
Yeah, and psychosis is what we would still consider psychosis,
but under psychoanalysis, psychoneurosis is what we call anxiety depression,
those kinds of mental illnesses. So I guess Adolf Stern
wasn't really that big of a jerk, because he really
kind of did combine him appropriately. It was Auto Kernberg
(08:42):
who was the serious jerk in this situation.
Speaker 1 (08:46):
Okay, So he was a psychoanalyst in the mid nineteen seventies,
so that's you know, like forty something years later, and
he described it as an unstable personality and disorganized conception
of the cell. And this is just when it was
sort of starting to become more and more kind of
talked about, and officially I think five years after that
(09:08):
was in the DSM version three.
Speaker 2 (09:11):
Yeah. I mean that's pretty quick for something you just
started to identify, and five years later it makes it
in the DSM. Because they don't churn those dsms out
like you know, every few months. It takes years to
put one together. So Kurenberg seemed to have stumbled onto
something that was worth looking at, very very very quickly.
Speaker 4 (09:30):
Yeah.
Speaker 1 (09:31):
And isn't there a sort of movement or belief now
that it's a lot of people think it's something that
is like a diagnosis you shouldn't even give, right.
Speaker 2 (09:40):
Yeah, there's we'll talk about that. I think we can
kind of pepper it throughout, you know. Okay, But yes,
there is a school of thought that basically says BPD
is not a personality disorder. It's not even a mood disorder,
although some people say it would better be characterized as
a mood disorder. They say it's a cluster of symptoms
(10:01):
that overlap with a bunch of different actual disorders, and
that the problem with that, you say, who cares? You're
identifying people a group of people whose rate of suicide
is fifty times a general population, that alone is worth
like identifying and helping those people out. But what they're
saying is number one, BPD has gotten such a bad
(10:24):
name in the general population that you're literally stigmatizing somebody
when you give them that diagnosis. It is an enormously
heavy weight you put on somebody. We say, I'm a
trained psychiatrist, I know what I'm talking about, and you
have borderline personality disorder. Everybody step back.
Speaker 1 (10:44):
Basically, yeah, I mean it's it's almost in line with
saying someone as a sociopath. It's different things, but as
far as like the stigma goes very much.
Speaker 2 (10:54):
So, yeah, for sure, that's a great analogy. Actually, so
some people are like, Okay, it's stigmatizing, but even more
than that, just the science isn't necessarily there, like we're
saying it's symptoms rather than an actual disorder. And then
apparently the Working Group for Personality Disorders for the DSM
five that's the most recent one, they actually said, we're
(11:17):
not sure that this should be a categorical disorder, which
is the type that you either have it or you don't.
They suggested it should be dimensional, which means that it
exists on a spectrum, right, so you can have a
little bit of BPD, a lot of BPD, or right
in the middle or whatever. And that got rejected. And
now so it's a categorical diagnosis where if you don't
(11:42):
have BPD, you don't have BPD. If you don't fit
the criteria. If you do, you got BPD.
Speaker 1 (11:47):
Right, And we'll talk about the criterion in a second,
but we do want to sort of reintroduce Marcia Lenihan, who,
like I said, was a real pioneer for her work
in the treatment and recognition of BPD. Very late in
her life, revealed that she suffered from BPD. After you know,
(12:08):
patients and friends encouraged her to come forward and she said, basically,
you know, I'm gonna do it. I'm not gonna die
a coward, is what she said, but for the longest
time was not out with that information. Was born in
Oklahoma in I guess the fifties, and in the nineteen
sixties in high school, was diagnosed with schizophrenia, drugged up,
(12:31):
give an electro shock, hospitalized, was practicing self harm of
all kinds, and then had it sounds like a not
a moment of clarity, but a pretty profound religious experience.
Speaker 2 (12:46):
Yeah, the only thing missing was a visit from Saint
Michael pretty much.
Speaker 1 (12:50):
I mean, she's Catholic, and after this religious experience she
was able to which you know, had a lot to
do with self love. But after this she was able
to still have these emotions that she had before, but
managed it to the point where she wasn't practicing self harm.
And did she come up with the term radical acceptance
(13:13):
or did she just buy into that.
Speaker 2 (13:15):
I don't know if that was a descriptor of hers
or not.
Speaker 4 (13:18):
Okay, I don't think she came up with that.
Speaker 1 (13:20):
But basically, as you know, radical acceptance is like, hey, listen,
this is how things are with me, this is how
things are with the world. I accept this, and I'm
not going to compare this to what I think the
reality should be or what other people think it should be.
Speaker 2 (13:38):
There's a huge butt that follows that though.
Speaker 3 (13:41):
But but but.
Speaker 2 (13:45):
I am going to do what I can to change
those things about myself.
Speaker 4 (13:50):
Right.
Speaker 2 (13:50):
So that is the basis of a type of cognitive
behavioral therapy that she came up with called dialectical behavioral therapy,
and it is it's based in radical acceptance and the
desire to examine and change how you interact with the
world externally, and it's basically the gold standard for treating
(14:11):
a borderline personality disorder it right.
Speaker 1 (14:13):
Now, Yeah, and it seems like it really works. I
saw that it was kind of the only proven treatment
to reduce suicidal behavior, which is, you know, at the
tail end of what a lot of people experience with BPD.
And the good news and we'll talk about treatment later,
but the good news is if you have VPD or
(14:35):
know someone that does, you can get better. And they
have proven and shown time and time again now that
through the treatments that we'll discuss later, it is absolutely
something that someone can get a hold of in most cases, right,
which is great.
Speaker 2 (14:51):
It is great. I mean, like, for as bad of
a stigma as BPD has, the idea that like it
has a very high success rate of treatment is pretty couraging.
So Lenahan's basis of her understanding or her definition of
borderline personality disorder is that it's biosocial that people who
(15:12):
have BPD are either genetically or biologically predisposed to having BPD,
but not everybody who has that predisposition is going to
be triggered into developing BPD. It takes basically a biological
substrate for BPD. Usually your prefrontal cortex hasn't developed in
(15:34):
a certain way, and so your executive function isn't functioning
like an executive should. That gets joined together with a trigger,
usually mistreatment, whether it's abuse, neglect, invalidation by your parents
as a kid, and you put those things together and
(15:55):
very often it results in what you be diagnosed with
later as BPD.
Speaker 1 (15:59):
Yeah, and one thing I really took away from this,
and this is something that you know, Emily and I
and and most parents that I know are way into,
is h oh, you got to validate your kids.
Speaker 2 (16:09):
Yeah, that's new, which is crazy, but it's.
Speaker 1 (16:12):
It's Yeah, you got to validate their emotions and validate
their experiences and their feelings, even if it's something that
you don't think is uh, like has the most relevance
or whatever, or even if like the kid is wrong
about something or like emotionally wrong, like, you still have
to validate that and then talk them through it. What
(16:32):
you can't do is just discount a kid's feelings, because
that's like telling them that their truth isn't real, and
that's damaging I know, and.
Speaker 2 (16:43):
Doing parenting right sounds like a waking nightmare to me
doing wise parenting parenting correctly. Yeah. Nah, I can't imagine
the exhaustion along combined with the fear of just misstepping
once or twice and then there you go, you screwed
your kid up for life.
Speaker 4 (17:00):
Yeah.
Speaker 1 (17:00):
What you gotta do is, in my experience, is like
you can't beat yourself up too much because parenting fails,
you can really go down a rabbit hole.
Speaker 4 (17:09):
Of your own.
Speaker 1 (17:10):
I'll be depression if you screw up. And you can't
do that because kids are resilient and you just got to,
like you got to prove to them that you can
like pick yourself up and move on and do better,
you know.
Speaker 2 (17:23):
Yeah, And I don't think Lenahan's idea is that it
just takes one or two missteps. It takes like a parent,
he was a genuinely bad parent. Very frequently they have
BPD themselves. Yeah, and that is a real challenge to
parenting well in and of itself. But you don't have
to have had a parent with BPD to develop BPD.
(17:45):
But typically it's a parent that is not at all
meeting your needs, especially emotionally. And I say we take
a break and we'll come back and talk about how
you would be diagnosed with BPD.
Speaker 3 (17:57):
What do you think, let's do it, okay, Chuck.
Speaker 2 (18:19):
So we said that BPD's in the d S M five.
It's a personality disorder. And just to differentiate real quick,
a mood disorder describes patterns and feelings, like you have
mood swings in that you know highs and lows, and
that's pretty reliable that you're going to have it one
way or another. Personality disorder focuses more on how you
(18:41):
relate to others, and that definitely makes sense to me
that you would consider a BPD of personality disorder.
Speaker 1 (18:48):
Then, yeah, that seems to be a really key thing,
is that it's it's it really disturbs your relationships. So
to be diagnosed, you fit at least five out of
the following nine that we're gonna read for you. Chronic
feelings of emptiness and.
Speaker 2 (19:08):
That's emptiness, feeling like isolated or lonely or hopeless.
Speaker 1 (19:12):
Sure, emotional instability and reaction to day to day events.
That's the thing we were talking about earlier, Like saying
mountains out of molehills seems slightly reductive, but that's kind
of a basic way to say it. Okay, frantic efforts
to avoid abandonment, whether or not they're real or imagined.
As Yeah, as we'll see abandonment issues, and this very
(19:36):
very much includes emotional abandonment as a really big precursor
unstable self image or sense of self.
Speaker 2 (19:46):
What else, Impulsive behavior is usually a big one, and
you have to have impulsive behavior and at least two
areas that are harming your day to day life, like
an eating disorder and gambling addiction or something like that.
Another one is this is based on and so this
is where some psychiatrists would be like, see this is
(20:07):
not this is a symptom that we're talking about here,
but it's unstable and intense interpersonal relationships. I mean, like
you're really really close to somebody for you know, a
couple of days, and then they do something you don't
like and they're the worst person in the world. And
it can happen very very quickly with people with BPD,
(20:28):
And if you stick around and stay in that person's life,
you can find yourself walking on eggshells very quickly because
you don't want them to turn on you all of
a sudden. So that's a huge one. If you have
a lot of unstable, intense relationships with people, that's just
kind of the mo that is usually a big giveaway
with BPD.
Speaker 1 (20:48):
Yeah, the last three recurrent suicidal or self harming behaviors.
We've talked about that a little bit, stress related, paranoia
or dissociative symptoms, feeling like the self of the world
isn't real. It feels like that's probably the far end
of the spectrum, or the most severe end. And then
(21:09):
one we missed earlier was inappropriate and intense anger or
difficulty controlling anger.
Speaker 2 (21:15):
I didn't miss it. That was purposeful, Okay. I wanted
to end with that big one.
Speaker 4 (21:20):
Okay, all right, speak to it.
Speaker 2 (21:22):
Well, there's a lot of I always hate saying those qualifiers.
It's just so easy to say, but I know I
think it perks people's ears up, like, oh, this person
doesn't know what they're talking about. So let me rephrase that.
I have seen that there are schools of thought regarding
borderline personality disorder that it is a rage response to trauma. Okay,
(21:45):
that that is your response to unresolved trauma. That's how
you learn to deal with those feelings and those emotions.
Is to rage at people, because rage is as much
a hallmark of BPD as fear of abandonment, is right,
and that's why so people are critical of including it
as a categorical diagnosis in the d s M five.
They're saying, you're pathologizing rage. No, you just need to
(22:08):
teach people how to identify their emotions and how to
express them in a more appropriate, less hostile manner, and
then that's how you would treat somebody with BPD, or
not even with BPD, somebody with a rage disorder. But
some people think that that is what people are mistaking
for BPD.
Speaker 1 (22:25):
Oh I gotcha, okay, interesting, Uh, you're gonna to be diagnosed,
Like I said, five of those nine, it'll probably be
you know, like you'll be talking to a psychologist or
someone in an interview. You might fill out a questionnaire
or something they're going to make interesting click click click click,
or they may speak to your family or something like that.
(22:48):
It can be difficult to diagnose and there, like you said,
there's there's a lot of overlap between you know, things
like anxiety and depression and things like PTSD and eating disorders,
a lot of comorbidities. So I get why people can
have issues with like this diagnosis rather than it's like
(23:10):
a cluster of symptoms of other things.
Speaker 4 (23:12):
But I don't know.
Speaker 1 (23:13):
If you group that altogether then it and call it
its own thing, then I don't know. I'm not sure
I see the harm in that.
Speaker 2 (23:19):
Again, I think it's the stigma. And then also it
might be distracting from treating the other underlying.
Speaker 1 (23:25):
Stuff, maybe because there also isn't and we'll talk about pharmaceuticals,
but there isn't a specific pharmaceutical for VPD.
Speaker 2 (23:35):
That's another clue that some people point to that it's
not it's it's it's we're mistaking it somehow. And I
don't want to like overstate the that school of thought.
It is widely considered like an accepted diagnosis orderline personality
disorder is, so I don't want to make it seem
like the cracks are in the facade. It's about a
(23:57):
chromole any day. Now. My point is people make some
pretty good points about how well we understand it or
how well we're defining and we're possibly missing some component
of it.
Speaker 1 (24:10):
Yeah, and isn't that stuff debate usually or I guess
it should be, And I hope it's couched in how
to best treat people and help people, right, Yes, rather
than just like poopooing ideas.
Speaker 2 (24:23):
Yeah, no, I think that's exactly right. But I mean, again,
if we come to this place where even if if
a BPD is the center of a giant Venn diagram
of a bunch of different disorders, Yeah yeah, and we're
mistaking that center overlap of all of them as its
own thing. If you zero in on that group and
(24:44):
they have a fifty times higher rate of suicide than
the general population, again, that is worth zeroing in on,
you know, as its own thing. And like you said,
dialectical behavior therapy is focused initially on individual sessions that
are that are that are aimed to control that that behavior.
(25:04):
Suicide alalogy, Yeah, yeah, for sure.
Speaker 1 (25:07):
You did mention earlier as far as causes go, that
sometimes there is a genetic link, but it seems that
it's not really the disorder that is like maybe passed
from parent to child, but some of those traits and
maybe that's because it is sort of a cluster. Sometimes
you can't you know, you can have BPD and come
(25:29):
from like a pretty good, you know, stable upbringing, but
that seems to be the outlier, and it seems to
be that like most people that end up suffering from
this had a pretty lousy childhood.
Speaker 2 (25:43):
Yeah, so they were either neglected or just kind of
saddled with emotionally unavailable parents who just weren't really there
for them, didn't go to their dance recital kind of thing,
never went to a single one. Excessive control. It sounds
very Freudian, but I saw one classic example as an
(26:04):
absent father and a domineering mother, and it's like, how
many times have you guys tritted that one out? But
apparently it really does have a screwy effect on people
as a kid. And then also if your parents or
parent had a mood disordered themselves, or misused substances, that
(26:25):
would probably have affected their parenting as well.
Speaker 1 (26:29):
Yeah, this also made me think about like parenting of
old versus parenting now and parents can there are still,
of course, a huge range of bad parents these days.
I'm not saying that everyone's doing it right now, but
it definitely seems like things turned a corner and parents
are trying a lot harder these days, and like sort
(26:52):
of the old days of like, oh, you know, kids
raised themselves and you can ignore them and blah blah blah,
and like, I'm sure that, I mean, I know that's
so happen, but it just seems like that happened a
lot more back in the day. And maybe in the
future things like this will be less and less.
Speaker 2 (27:08):
Yeah, that's the hope for sure.
Speaker 1 (27:11):
I know that's sort of a basic, sort of an
elementary way of looking at it, but I just feel
like parents are more aware of stuff these days, and like,
you know, people of our generation and certainly the generations
before that, it was even worse as far as parental
involvement and parents who either one or the other. You know,
fathers a lot of times, you know, historically the ones
(27:31):
that are like, no, we're we're not going to parent
because we're doing the work and we're gonna bring home
the paycheck. And so like I had, I've talked about
it before. I had a dad that wasn't very involved,
but it wasn't like the kind of thing where I
ended up with BPD because of it, you know, yeah,
for sure, if that makes sense.
Speaker 2 (27:49):
You raise a question though, in my mind, I wonder
what percentage of boomer grandparents are allowed to see their grandchildren.
Speaker 4 (27:59):
I'll bet at hire you think are allowed to or not.
Speaker 2 (28:02):
Allowed to, like just don't have contact with their grandkids.
Speaker 1 (28:06):
Yeah, or it's very limited and supervised. And so actually
though a lot of those grandparents, all of a sudden,
are the most doting, and it's kind of like, I
know some parents are like, oh, okay, well this is great.
Yeah when I was a kids, right, sure, for sure.
Speaker 2 (28:21):
But also I think in some of the cases that
the more they dote, they're actually also undermining the parenting
of their kids.
Speaker 3 (28:28):
Yeah.
Speaker 1 (28:30):
Yes, And imagine it can be very painful for a
parent who had a unattentive parent to now have that
parent be a very intentive grandparent.
Speaker 2 (28:39):
You have BPD, I would guess that would be a
rage inducing trigger.
Speaker 4 (28:43):
I imagine it would be.
Speaker 2 (28:44):
So there are plenty of other ways that you could
probably develop VPD. Another very classic one is any kind
of abuse emotional, sexual, physical abuse at the hands of
your parent or a caregiver. And they say that about
eighty percent of people with BPD experience some level of
childhood trauma, whether it was emotional neglect or some sort
(29:08):
of abuse. It is. It's a huge factor, a huge
risk factor in developing BPD for sure.
Speaker 1 (29:15):
Yeah, absolutely, And it seems to be exacerbated if you're
a kid who is maybe you're just innately a little
more unsure of yourself or a little more vulnerable as
a person, and then that is reinforced with a parent
who is not validating your experience and your emotion as
(29:35):
a kid. So you're already starting back sort of behind
the eight ball, and then your parents are making it worse,
and so that can definitely, you know, easy toward that condition.
Speaker 2 (29:45):
Well, it's like that's a chicken or the egg question though,
like were you like that you know already and your
parents is reinforcing it, or did you get that kind
of did you learn to do that because of your parents' behavior.
It's like a chicken or the egg, parent or the disorder, right,
you know. But we said earlier that there's also believed
to be a biological component to it too, that it's
(30:06):
not all psychological, and it does seem to have something
to do with executive function in the brain. One of
the big things that executive functioning does is it helps
you control your emotions, not just in accepting things and
dealing with them and moving on, but also your outward
display of emotions. If you don't have executive function, your
(30:30):
emotional dysregulation is more likely to include explosions of anger,
uncontrollable anger. And then one of the things, it's not
just BPD that has that, there's plenty of other disorders
that have it. But one of the key traits of
BPD is it can last a really long time too.
Speaker 1 (30:51):
Can we make a T shirt that has a chicken
that says parent across the chicken's chest and then next
to it an egg that says mental disorder? Love it
and just that's the shirt. No explanation, figure it out
or don't.
Speaker 2 (31:06):
How about this though, On the back of the shirt,
Mork is coming out of the egg all right to
really confuse people.
Speaker 4 (31:16):
Oh wow, that just really changed things.
Speaker 2 (31:18):
I like it, Okay.
Speaker 1 (31:19):
So as far as the number of people who experience BPD,
it's kind of a wide range, like all this stuff,
because it's one of those disorders that is a lot
of people don't admit it or seek treatment, so it's
really hard to nail it down. But Lyba helped us
out with this one, and she said zero point five
percent to six percent, and they find it about four
(31:41):
times more in women but they've also found other studies
are like, no, it's the women who are brave enough
to come forward and seek treatment, and it happens just
as much in men.
Speaker 2 (31:50):
I also saw that it's a that's an indictment of
clinicians who basically have to figure out for themselves whether
the person has BPD, that they're more likely to assign
it to a woman than a man a male patient.
Speaker 4 (32:04):
Oh interesting.
Speaker 2 (32:05):
So regardless, it is very frequently diagnosed, more than you
would think. It's one of the more common serious mental illnesses. Apparently,
people receiving impatient mental health treatment, one in five of
those people are diagnosed with BPD. So it is very prevalent,
at least inside the clink.
Speaker 1 (32:28):
Yeah, the mental clink, Yeah, the mental clink. One other
aspect is a very black and white thinking. You kind
of talked before about splitting, which is, you know, really
revering and idolizing somebody and then very quickly despising them.
And this can happen very very frequently and like several
(32:50):
times throughout a day even or it can be like
just a switch that is permanent, like someone you used
to really like and idolize all of a sudden just
no more. You despise them, and they're they're on the
bad person list forever.
Speaker 2 (33:04):
Yeah, and that's that falls under the larger category of
black and white thinking. It's not just applied to people,
it's events, things, anything a dandelion can be entirely evil
or the fully good. And because you see things in
people and events as entirely one way or the other,
you set people up for unrealistic expectations. If you're like,
(33:27):
you're one percent pure and kind person and I love you,
that person is inevitably going to let you down in
some way, shape or form. Sure, because no one's one
hundred percent pure and kind. Similarly, no one's one hundred
percent evil. And most people that you would label evil
as if you have VPD, probably aren't evil at all.
They just did something you really didn't like. But now
(33:49):
to you, that person is evil, not to be trusted,
not you know, they did something wrong. At their core,
they're evil, And that's another huge hallmark of BPD as well.
Speaker 1 (34:03):
Yeah, I mean even Darth Vader was once a young boy, Yeah,
just trying to learn the ways of the force.
Speaker 2 (34:09):
But boy did he get pale as he aged.
Speaker 4 (34:13):
He sure did.
Speaker 1 (34:15):
This can also this splitting can happen with yourself. You
may vacillate wildly from feeling like you're you're okay and
that you feel good about yourself and you have a
little bit of self confidence to really loathing yourself. And
that's when like things like you know, self harm can
come into play. Your sense of your own personality can
(34:37):
really change your you know, you could very much switch,
like kind of do these wild switches between your goals
in life for or how you want to present yourself
to the world, or like your values and ethics and
things like that. And this I'm not really sure, but
it kind of seems like almost like sort of auditioning
(34:59):
yourself kind of over and over sometimes like let me
try this new me or whatever, or auditioning or trying
out a new thing that you think might help.
Speaker 4 (35:10):
Make sense.
Speaker 2 (35:10):
Yeah, no, totally. It's also circumstantial too. They might act
different ways to different people depending on what they think
those people want from them, or yes, to impress like
a friend or a new person or something like that.
They might adopt that person's like hobbies and interests. But
I saw it explained as the people who have VPD
(35:31):
and do that that they don't understand where they end
or the other person begins, because they have no idea
what they believe in. They just don't know, so they're
kind of open for suggestions. Basically interesting.
Speaker 1 (35:44):
Yeah, should we take a break?
Speaker 2 (35:48):
Oh jeez, that came out of left field.
Speaker 1 (35:50):
Sorry, sure, all right, I think it's a good time
to take a break, and then we're going to come
back and talk more about personal relationships. All right, we're
(36:18):
back and talking about borderline personality disorder. And one kind
of hallmark with someone with BPD is what's called like
a favorite person, or just a person in their life
that they have have not necessarily even chosen, who they've
hooked up with. It could be a spouse, it could
(36:40):
be a partner, It could be a friend or coworker,
anyone that you really have latched onto as someone maybe
the only person that you really really trust with yourself.
Speaker 2 (36:53):
Yeah, and I don't think you even trust that person.
You just that's the person you've come to find you
can lean on the most, I think. Okay, but yeah,
the FP, for those in the know, the favorite person
is very frequently somebody who is willing to kind of
go along with this, at least for a while. There's
(37:15):
a ton of flattery and admiration and praise, and all
of your greatest points are pointed out all the time.
But you're also in real danger of letting that person
down and facing that wrath of rage or anger or hostility.
And if you come back for more, you're going to
(37:35):
find that you, as the favorite person, might start altering
your behavior to fit the person with BPD's behavior, so
you might start considering them when you're making plans like, oh,
we can't go out of town this weekend because our
friend with BPD was going to, you know, wanted us
to come out for their Sunday picnic or something like that.
(37:55):
Right like, you would be afraid to not go to
their picnic, And you generally end up feeling like you're
walking on eggshells. And it's a codependent relationship that evolves.
The favorite person seems to be the person who's willing
to take it the longest or the most, and that
it's not a permanent thing. Typically people get burned out
(38:16):
on it and eventually abandon the person with BPD, which
is again at the root of what they are fearful of.
They're fearful of rejection or abandonment. The tragedy of the
whole thing is that their behavior almost inevitably guarantees that
they will be rejected or abandoned by the people around them.
Speaker 1 (38:36):
Yeah, that sort of self fulfilling feedback loop. Yeah, I mean,
it's a big burden for an FP. And if you
are a spouse or partner of someone and you are
the FP, like, that's a lot to manage, and so
a lot of empathy goes out to those people as
well when you're altering your own behaviors, like literally things
(38:58):
like I saw people or like you know, had to
I've had to step out of like really important meetings
just to answer a text within ten minutes because I
knew that that would set them off. And just little
things like that can really add up to someone's burden.
Speaker 2 (39:16):
One of the other things that is difficult to deal
with when you're an FP is that person wants you
all of themselves. They're yeah, right, and very much by
other people. So they will try to isolate you from
your other friends and your family so that they have
you all of themselves, not just for time, I'm sure
time is a big part of it, but also to
cut down on any I guess rational explanation or rational
(39:40):
points from those other people, like what are you doing?
Why are you putting up with this? Isolating them would
help cut down on that too.
Speaker 1 (39:47):
Yeah, and you know, if you're an FP, there's always
the sort of sad and scary possibility that there could
be a split incident that all of a sudden you
go from being the FP to be the most despised person.
I would imagine that's something that has probably comes over
time and is not like a quick thing. It can
(40:09):
be but it can be all right.
Speaker 2 (40:11):
For sure. It can happen, It can turn on a dime.
And the other problem with it as well, Chuck, is
that the person with BPD almost invariably immediately regrets doing
that right, and so they will make every effort to
try to win the person back, which probably feels pretty
gross for the FP, and they'll say things like I'll
(40:34):
never do that again, like they know what they've just
done is worth regretting, is worth feeling horrible about because
they've just been abandoned or rejected. They just did it
to themselves, so now they're trying to fix it or
mend it. But it's all just kind of built on
you know, hicky ground because it's it's gonna happen again,
because it's impossible for that person not to let the
person with BPD down again.
Speaker 1 (40:57):
Yeah, I mean, I get the impression that people with
bp D generally don't have any illusions about themselves because
it is such a struggle.
Speaker 2 (41:05):
Well, that is a big problem with not only getting treatment,
but seeking treatment, because when your brain is structured in
a certain way, and ever since you were a little kid,
you've just responded a certain way to things. Even if
people around you are telling you that is messed up
or that you're being hustle or whatever, to you, that's normal,
(41:25):
that's natural. So it's really really hard to interrogate your
own behavior, let alone change it, because it seems normal
and natural to you. It's not that you need to
change your behavior because you chase somebody away. It's that
that person left to you now you need to go
get them back. So even if you have people around
you telling you, it's going to take a lot of emphasis, repeated,
(41:50):
constant emphasis, that what you're doing right now is abnormal
and harmful and you need to go get help for this.
That's yeah, that's one of the curses of it. They
can't see it. They at least if they can see it,
most of the time they can't well.
Speaker 1 (42:07):
And this is I mean, all the mental health disorders
require a support system, but this one really seems to
sort of be at the top of the list of
needing a really solid, vast support system for treatment. Like
we said, the good news is that treatment works. They
used to think that personality disorders were untreatable and that
(42:30):
you were just kind of stuck with it.
Speaker 4 (42:33):
They have found that about half.
Speaker 1 (42:35):
The people who are treated, who seek treatment and are
treated no longer meet the criteria after five to ten years.
Speaker 2 (42:42):
Amazing.
Speaker 1 (42:43):
It doesn't mean that they're you know, they're perfect and
awesome and fixed. It means they can still have some symptoms,
but they have it under control enough to where they
don't meet that five out of nine criteria. And that's
what it's really sort of about, I think, is managing
something that, like you said, that you might have had
since you were like a baby, to live a productive,
(43:05):
you know, healthy life.
Speaker 2 (43:07):
Yeah, and that's kind of what you're going to learn
in DBT, which again is the gold standard for treating BPD,
is that you're going to be taught these skills, how
to deal with disappointment, with being let down, with somebody
not responding to your text. You're going to learn a
different set of skills and how to deal with that,
both internally and externally. And one of the things that
(43:30):
kind of differentiates DBT from other kinds of behavioral therapy
is that there's group sessions, but it's not a group
session that you know, you've seen in a movie like
My nice Mela was in a movie called No Exit,
and that featured a couple of group sessions. I think
you can still see that on Netflix.
Speaker 4 (43:49):
I think so.
Speaker 2 (43:49):
But it's not like that. It's more almost like a
classroom instead, and then people get up and practice these
skills in front of others and with others. But it's
not like a group therapy session in the traditional sense.
But that's a huge component of it is group work.
Speaker 1 (44:06):
Yeah, And it's you know, if it sounds a little
bit like cognitive behavioral therapy, it is sort of based
on that in part because it's a real and I
get how it works. It seems like a real sort
of rubber meets the road practical ways of learning new
behaviors rather than.
Speaker 4 (44:24):
And therapy is a huge part of it.
Speaker 1 (44:27):
But it's not just lets therapy and talk about your
past until you're blue in the face. It's like, all right,
we know what's going on, and we think we know
where it came from. Generally, Now, let's really talk about
putting this into daily practice, like literally doing things and
having a checklist and putting stuff into practice, which I
(44:48):
think is just I mean not only for DBT, but
stuff like that is so it so speaks to me
as a good way forward when you have any kinds
of problems because it's just a practical thing. It's learning
new behaviors.
Speaker 2 (45:04):
That's another criticism of BPD as its own disorder, that
DBT can be used to treat all sorts of different
symptoms of all sorts of different disorders. It just makes
sense like that, yeah, for sure. But there's also another
type of therapy that supposedly works really well for DBT
called psychodynamic therapy, and it is talking about what you
(45:28):
went through as a child. So you're blue in the face,
but it's more about relating to relating that to how
you deal with people in your current life, people in situations.
It's relating it back to it so that it's not
just one big confusing blob. You understand your own behavior
better as a result of interrogating what you went through
(45:49):
as a kid. And I guess it smells a lot
like it believes borderline is like a response to trauma
using a rather than anything else.
Speaker 1 (46:02):
Yeah, I mean, if you can sort of build out
your emotional life map, I imagine that's a very helpful
thing to do, you know.
Speaker 2 (46:11):
Yeah. And then one other thing that really kind of
underscores how difficult dealing with people with borderline personality disorder
can be. One of the main components of dialectical behavioral
therapy is what's called a therapist consultation team, which is
basically a group of therapists working with patients with BPD
(46:32):
having like a like a blowoff steam session about them, right,
and reminding one another like, these are people suffering and
we need to have empathy for them. That's how hard
it can be to treat people with BPD.
Speaker 1 (46:45):
Yeah, And like I said at the beginning, there are
therapists that will refuse treatment because.
Speaker 4 (46:52):
All the reasons that we talked about.
Speaker 1 (46:54):
They say that National Alliance on Mental Health basically says,
if you have BPD and you wreckon that and you
want to see treatment, whether it's you know, DBT or
any other kind you Uh, well, first of all, seek
out someone that specializes in DVT. But if there's no
one in your area that does that, then, like you,
you have a right and this this goes with any
(47:15):
sort of emotional or mental problems that anyone has that
they're working for you. So you have the right to
advocate for yourself and to find somebody who works for
you and who who will not stigmatize you, and like
really like it's okay to question them and make sure
it's a good fit for you.
Speaker 2 (47:36):
Yeah, for sure.
Speaker 1 (47:38):
I think people just I don't know, it's I think
part of the problems with a lot of these disorders
is people can't be advocates for themselves, and then that
might be part of their problems. So they're not going
to advocate for themselves when receiving treatment, and they'll just
take whatever they can get. And it's not all therapies
are created equal, and in therapists are created definitely not.
Speaker 2 (47:56):
I think one of the problems with BPD is that
they might over advocate for themselves. Else Oh, chaseus off,
basically right. But the thing is, Chuck is like you said,
people take what they can get, in part because there's
a huge shortage of psychiatrists in particular in the United States,
and people will just take whoever can get them in
(48:17):
within a year or less. If the waiting lists are crazy,
it is crazy. Well, if you want to know more
about BPD, there are a lot of articles and resources
all over the internet to help you. And since I
said that it's time for listener mail, I'm going to.
Speaker 4 (48:37):
Call this, uh, well, let's just call it listener mail.
Speaker 1 (48:42):
Hey guys, one day I will write the email that
I've been formulating in my mind for years, trying to
put into words, but the show is meant to me.
I'm tearing up just writing that sentence, which provides you
with a hint of why that email hasn't been written yet.
In the meantime, I want to let you know that
both of your names are listed on my Big Thanks
to portion of my bachelor thesis. It's customary in my
(49:04):
country to thank your college coach for their support during
your graduation year and.
Speaker 4 (49:08):
Your thesis forward.
Speaker 1 (49:10):
I have felt it was only right to also thank
the other people have supported me to the same extent
as my coach and this includes you, guys. I don't
feel the least bit dramatic when I say my thesis
would not have been written but wasn't for you guys
keeping me sane. That's what you've done for me over
the years, but this year I really needed it more
than ever. So thank you, all caps, double exclamations. I've
(49:33):
added a picture of my forward where your names are mentioned,
and since I'm Dutch, I'm afraid it won't make much
sense to you, but I figured it might bring you
some joy to see the proof.
Speaker 2 (49:40):
There are some Rando jays scattered throughout those words.
Speaker 1 (49:44):
Yeah, totally, and Chuck has a little null signed through it.
Speaker 4 (49:47):
That's weird unless sure what that means.
Speaker 2 (49:49):
It means your back.
Speaker 4 (49:50):
That means it don't count.
Speaker 1 (49:52):
And that is with much love and immense gratitude from Suzanne. Oh,
I'm going to do my best to here, Suzanne.
Speaker 2 (50:01):
Let's hear it again.
Speaker 4 (50:04):
Chris Silk sick. I like you, I s have you?
I JK if you like the second one.
Speaker 2 (50:10):
Yeah, thank you, Susan. I'm gonna call her Suzanne. Thank
you very much. Suzanne. That was very kind of you.
Thank you for tearing up. I think you did just
write that email. If you ask me, don't you.
Speaker 4 (50:21):
Chuck, I'm tearing up.
Speaker 2 (50:22):
If you want to be like Suzanne and let us
know what we meant to you. We always love hearing
that kind of thing, or you can just write it
and say anything you want. We're at stuff Podcasts at
iHeartRadio dot com.
Speaker 4 (50:38):
Stuff you Should Know is a production of iHeartRadio. For
more podcasts my heart Radio, visit the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows.
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Chuck Bryant
Josh Clark
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