January 17, 2026 • 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. Learn all about it in this classic episode.
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Speaker 1 (00:00):
A good morning everyone. This is Chuck here on a
Saturday with a curated selection of one of my favorite episodes.
This is bp D colon the Worst Disorder or not
a disorder at All. This is all about borderline personality
disorder and it's pretty fascinating stuff and I hope you
guys enjoy it. Welcome to Stuff you should know, a
(00:27):
production of iHeartRadio.
Speaker 2 (00:35):
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 stuff you should know.
Speaker 1 (00:44):
Yeah, Jerry's got the week off and she said press on, dudes. Yeah,
party party on Wayne.
Speaker 2 (00:54):
That was also from Bill and Ted's excellent Adventure. Wasn't
it Party On?
Speaker 1 (00:58):
No? Was it?
Speaker 3 (00:59):
I think?
Speaker 1 (00:59):
So?
Speaker 3 (00:59):
I can see George Carlin saying it.
Speaker 1 (01:02):
Yeah, I'm probably wrong.
Speaker 3 (01:04):
I'm probably wrong.
Speaker 2 (01:06):
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 (01:16):
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
(01:37):
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 (01:47):
As Michael Jackson would have said, you're ignorant about this?
Speaker 1 (01:52):
What's that from?
Speaker 3 (01:53):
He just used that word a lot.
Speaker 2 (01:55):
Oh really yeah, But regardless, that has nothing to do
with anything when you ment just now that people like
kind of wrote in or write in when we do.
Speaker 3 (02:05):
Episodes like this.
Speaker 2 (02:06):
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,
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
(02:29):
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 (02:41):
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
(03:02):
patients 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
(03:23):
personality disorder, which is in the anti social personality disorder
category along with histrionic personality disorder and narcissistic personality. I'm
just going to start saying PD.
Speaker 2 (03:36):
Yeah, PDS. It will make it sound like, you know,
you're talking about yet.
Speaker 1 (03:40):
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 is
the way things are perceived incorrectly, either about themselves or
(04:01):
about others or others actions.
Speaker 2 (04:03):
Yeah, and I saw a lot of people confuse borderline
personality disorder with bipolar, or at least think they're similar.
Speaker 3 (04:12):
I guess because they go to start with bees.
Speaker 1 (04:13):
Or something like that.
Speaker 2 (04:14):
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 executive function
of the person in their prefrontal cortex either didn't develop
in a fully normal way or it's not functioning up
(04:38):
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 than it
is physiological.
Speaker 1 (04:53):
Yeah. 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
(05:15):
thing 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 helps up that must be.
Speaker 2 (05:30):
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 let roll off
of their back, right, could set somebody with BPD off
(05:52):
into a rage that.
Speaker 3 (05:53):
Could last days.
Speaker 1 (05:54):
Potentially.
Speaker 2 (05:56):
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
(06:18):
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 (06:31):
Yeah, there was another and we'll talk about her in
great detail. Her name is Marcia Lenahan or is it
Line Han.
Speaker 3 (06:40):
I'm gonna go with Lenahan.
Speaker 1 (06:42):
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 or movement.
(07:04):
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. Yeah,
so this is this is no joke. This is a
very hardcore disorder that bears more empathy and understanding.
Speaker 3 (07:27):
Yeah, for sure.
Speaker 2 (07:29):
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.
Speaker 3 (07:44):
It's just one of those.
Speaker 1 (07:45):
Not at all frustratingly So, yeah.
Speaker 2 (07:48):
And that goes back to a jerk named Adolph Stern
who really jerked it up back in nineteen thirty eight.
Speaker 1 (07:54):
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
(08:16):
border between those conditions while encompassing a bit of each.
So we're just going to call it borderline.
Speaker 2 (08:22):
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
(08:44):
who was the serious jerk in this situation.
Speaker 1 (08:47):
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 organized conception
of the self. 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
(09:09):
was in the DSM version three.
Speaker 2 (09:12):
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 1 (09:32):
Yeah. 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 3 (09:42):
Yeah, there's we'll talk about that.
Speaker 2 (09:44):
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 is a mood disorder. They say it's a
cluster of symptoms that overlap with a bunch of different
(10:06):
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 name in the general population that you're
(10:29):
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.
Speaker 3 (10:45):
Everybody step back.
Speaker 1 (10:46):
Basically, yeah, I mean it's it's almost in line with
saying someone is a sociopath. It's different things, but as
far as like the stigma goes.
Speaker 2 (10:55):
Very much, 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,
(11:18):
we're 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
(11:43):
don't have BPD, you don't have BPD. If you don't
fit the criteria, if you do, you got BPD.
Speaker 1 (11:49):
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,
(12:10):
patients and friends encouraged her to come forward and she said, basically,
you know, I'm gonna do it. I'm not going to
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,
(12:33):
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 3 (12:48):
Yeah, the only thing missing was a visit from Saint Michael.
Speaker 1 (12:51):
Pretty much 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
(13:13):
radical acceptance or did she just buy into that.
Speaker 3 (13:16):
I don't know if that was a descriptor of hers
or not.
Speaker 1 (13:19):
Okay, I don't think she came up with that. 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 (13:39):
There's a huge butt that follows that though, But but
but I am going to do what I can to
change those things about myself.
Speaker 1 (13:51):
Right.
Speaker 2 (13:52):
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
(14:13):
a borderline personality disorder it right.
Speaker 1 (14:15):
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
(14:36):
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 3 (14:53):
It is great.
Speaker 2 (14:53):
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 encouraging. So Lenahan's
basis of her understanding or her definition of borderline personality
disorder is that it's biosocial that people who have BPD
(15:15):
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 a
(15:36):
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
(15:56):
very often it results in what you be diagnosed with later.
Speaker 1 (15:59):
As Yeah, and man, 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 uh oh, you got to validate your kids.
Speaker 3 (16:11):
Yeah, that's new, which is crazy, but it's.
Speaker 1 (16:13):
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
(16:34):
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.
Speaker 2 (16:44):
I know, and doing parenting right sounds like a waking
nightmare to me.
Speaker 1 (16:48):
Doing wise parenting.
Speaker 2 (16:49):
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.
Speaker 3 (17:00):
How'd you kid up for life?
Speaker 1 (17:01):
Yeah? 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 of your
own I'll bet depression if you if you screw up,
and you can't do that because kids are resilient and
you just got to, like you've got to prove to
them that you can like pick yourself up and move
(17:23):
on and do better, you know.
Speaker 2 (17:24):
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.
(17:47):
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. What do you think,
let's do it, okay, Chuck. So we said that BPD's
(18:23):
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 relate to others, and
(18:44):
that definitely makes sense to me that you would consider
a BPD of personality disorder.
Speaker 1 (18:49):
Then, Yeah, that seems to be a really key thing
is that 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.
Speaker 2 (19:09):
And that's emptiness feeling like isolated or lonely or hopeless.
Speaker 1 (19:13):
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. Frantic efforts to
avoid abandonment, whether or not they're real or imagined as Yeah,
(19:34):
as we'll see abandonment issues, and this very very much
includes emotional abandonment as a really big precursor unstable self
image or sense of self.
Speaker 2 (19:47):
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
(20:09):
not this is 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,
(20:29):
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 (20:50):
Yeah, the last three recurrent suicidal or self harming behaviors.
We've talked about that a little bit, stress related paranoia
or dissociative symptoms, like feeling like the self of the
world isn't real. It feels like that's probably at the
far end of the spectrum, or the most severe end.
(21:10):
And then when we missed earlier was inappropriate and intense
anger or difficulty controlling anger.
Speaker 2 (21:17):
I didn't miss it. That was purposeful, Okay. I wanted
to end with that big one.
Speaker 1 (21:22):
Okay, all right, speak to it.
Speaker 2 (21:23):
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.
Speaker 3 (21:33):
So let me rephrase that.
Speaker 2 (21:34):
I have seen that there are schools of thought regarding
borderline personality disorder that it is a rage response to trauma. Okay,
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
(21:55):
a hallmark of BPD as fear of abandonment is right,
and that's why some 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
teach people how to identify their emotions and how to
express them in a more appropriate, less hostile manner, and
(22:16):
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 what people are
mistaking for BPD.
Speaker 1 (22:26):
Oh, I got youa 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 right
click click click click, or they may speak to your
(22:47):
family or something like that. 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
(23:09):
this diagnosis rather than it's like a cluster of symptoms
of other things. But I don't know. 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 (23:21):
Again, I think it's the stigma. And then also it
might be distracting from treating the other underlying.
Speaker 1 (23:27):
Stuff, maybe because there also isn't and we'll talk about pharmaceuticals,
but there isn't a specific pharmaceutical for BPD.
Speaker 2 (23:36):
That's another clue that some people point to that it's
not it's it's we're mistaking it somehow. And I don't
want to like overstate that school of thought. It is
widely considered like an accepted diagnosis sorderline personality disorder is,
so I don't want to make it seem.
Speaker 3 (23:56):
Like the cracks are in the facade. It's about a
chromo any day now.
Speaker 2 (24:00):
Well, my point is people make some pretty good points
about how well we understand it or how well we're
defining it, and we're possibly missing some component of it.
Speaker 1 (24:12):
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 (24:25):
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 ven diagram
of a bunch.
Speaker 3 (24:36):
Of different disorders, Yeah yeah, and.
Speaker 2 (24:38):
We're mistaking that center overlap of all of them as
its own thing. If you zero in on that group
and 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
(25:02):
are that are that are aimed to control that behavior
suicide aalogy.
Speaker 1 (25:07):
Yeah, yeah, for sure. 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
(25:28):
have BPD and come 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 (25:45):
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
(26:06):
absent father and a domineering mother, and it's like, how
many times have you guys trtted 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
(26:26):
would probably have affected their parenting as well.
Speaker 1 (26:31):
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
(26:53):
of the old days of like, oh, you know, kids
raised themselves and you can ignore them and blah blah blah,
And I'm sure that I mean, I know that still happens,
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 3 (27:10):
Yeah, that's the hope for sure.
Speaker 1 (27:12):
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 that are like, no, we're we're not going
(27:34):
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 (27:50):
You raise a question though, in my mind, I wonder
what percentage of boomer grandparents are allowed to see their grandchildren.
Speaker 1 (28:00):
Well, bet it's higher than you think are allowed to
or not.
Speaker 2 (28:04):
Allowed to, like just don't have contact with their grandkids.
Speaker 1 (28:08):
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 kid, right, Sure.
Speaker 2 (28:22):
For sure, 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 1 (28:31):
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 (28:41):
You have BPD, I would guess that would be a
rage inducing trigger.
Speaker 1 (28:44):
I imagine it would be.
Speaker 2 (28:46):
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
(29:09):
of abuse.
Speaker 3 (29:10):
It is.
Speaker 2 (29:11):
It's a huge factor, a huge risk factor in developing BPD,
for sure.
Speaker 1 (29:16):
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
(29:36):
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 easy toward that condition.
Speaker 2 (29:46):
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, but parent the disorder.
Speaker 1 (30:01):
Right, you know.
Speaker 2 (30:02):
But we said earlier that there's also believed to be
a biological component to it too, that it's 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
(30:24):
moving on, but also your outward display of emotions. If
you don't have executive function, your 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
(30:47):
of the key traits of BPD is it can last
a really long time too.
Speaker 1 (30:53):
Can we make a T shirt that has a chicken
that says parent across the chicken's chest and then next
to an egg that says mental disorder? Love it and
just that's the shirt, no explanation, figure it out or don't.
Speaker 2 (31:08):
How about this though, on the back of the shirt,
Mork is coming out of the egg all right to
really confuse people.
Speaker 1 (31:18):
Oh wow, that just really changed things. I like it.
Speaker 3 (31:20):
Okay.
Speaker 1 (31:21):
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 Lybia helped us
out with this one, and she said zero point five
percent to six percent, and they find it about four
(31:42):
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 (31:52):
I also saw that it's a that's an indictment of
clinicians who basically have to figure out for themselves whether
the person as BPD, and that they're more likely to
assign it to a woman than a man a male patient.
Speaker 1 (32:05):
Oh interesting.
Speaker 2 (32:07):
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 in inside the clink.
Speaker 1 (32:29):
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
(32:52):
times throughout a day even or it can be like
just a switch that is permanent, like someone you used
to really like an eyeline, all of a sudden, just
no more, you despise them, and they're they're on the
bad person list forever.
Speaker 2 (33:05):
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.
Speaker 3 (33:19):
And because you see.
Speaker 2 (33:21):
Things in people and events as entirely one way or
the other, you set people up for unrealistic expectations. If
you're like, you're one hundred 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
(33:44):
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 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 (34:04):
Yeah, I mean even Darth Vader was once a young boy. Yeah,
just trying to learn the ways of the force.
Speaker 3 (34:10):
But boy did he get pale as he aged.
Speaker 1 (34:15):
He sure did. 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,
(34:35):
self harm can come into play. Your sense of your
own personality can 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
(34:55):
really sure, but it kind of seems like almost like
a sort of audition 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 make sense.
Speaker 2 (35:12):
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
(35:32):
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.
Speaker 3 (35:44):
Basically interesting.
Speaker 1 (35:46):
Yeah, should we take a break?
Speaker 3 (35:49):
Oh jeez, that came out of left field.
Speaker 1 (35:52):
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
(36:20):
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
(36:41):
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 (36:55):
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.
Speaker 3 (37:00):
The most, I think.
Speaker 2 (37:01):
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 a ton of flattery and admiration and praise,
and all of your greatest points are pointed out all
(37:22):
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 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
(37:45):
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. 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
(38:10):
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 on it and eventually abandon
the person with BPD, which is again at the root
of what.
Speaker 3 (38:24):
They are fearful of. They're fearful of rejection or abandonment.
Speaker 2 (38:28):
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 (38:37):
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, 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
(38:59):
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 (39:17):
One of the other things that is difficult to deal
with when you're an FP is that person wants you
all of themselves.
Speaker 3 (39:24):
They're yeah, rightned.
Speaker 2 (39:25):
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 points from those other people, like what are
you doing? Why are you putting up with this? Isolating
(39:46):
them would help cut down on that too.
Speaker 1 (39:48):
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 being the most despised person.
I would imagine that's something that is probably comes over
time and is not like a quick thing. It can
(40:10):
be but it can be all right.
Speaker 3 (40:13):
For sure. It can happen. It can turn on a dime.
Speaker 2 (40:17):
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'll 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 never
do that again, like they know what they've just done
(40:39):
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,
shinky 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 (40:58):
Yeah, I mean, I get the pression that people with
BPD generally don't have any illusions about themselves because it
is such a struggle.
Speaker 2 (41:06):
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,
(41:27):
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,
(41:51):
constant emphasis, that what you're doing right now is abnormal
and harmful and you need to go get help for this.
Speaker 1 (42:00):
That's yeah.
Speaker 2 (42:00):
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.
Speaker 1 (42:08):
Well, 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
(42:32):
that you were just kind of stuck with it. They
have found that about half the people who are treated,
who seek treatment and are treated no longer meet the
criteria after five to ten years.
Speaker 3 (42:44):
Amazing.
Speaker 1 (42:44):
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,
(43:07):
you know, healthy life.
Speaker 2 (43:08):
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
(43:32):
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 1 (43:50):
I think so. But it's not like that.
Speaker 2 (43:51):
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 (44:07):
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 and therapy as a huge part of it.
(44:28):
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
(44:50):
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 (45:06):
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
(45:29):
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
(45:51):
as a kid. And I guess it smells a lot
like it believes borderline is like a sponse to trauma
using accur rather than anything else.
Speaker 1 (46:04):
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 3 (46:12):
Yeah.
Speaker 2 (46:12):
And then one other thing that really kind of underscores
how difficult dealing with people with borderline personality disorder can be.
Speaker 3 (46:20):
One of the main components.
Speaker 2 (46:22):
Of dialectical behavioral therapy is what's called a therapist consultation team,
which is basically a group of therapists working with patients
with BPD 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.
(46:43):
That's how hard it can be to treat people with BPD.
Speaker 1 (46:47):
Yeah, And like I said at the beginning, there are
therapists that will refuse treatment because all the reasons that
we talked about. They say that National Alliance on Mental
Health basically says, if you have BPD and you recognize
that and you want to see treatment, whether it's you know,
DBT or any other kind, you uh, well, first of all,
(47:08):
seek out someone that specializes in DBT. 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
sort of emotional or mental problems that anyone has. 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
(47:32):
like it's okay to question them and make sure it's
a good fit for you.
Speaker 3 (47:37):
Yeah, for sure.
Speaker 1 (47:39):
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 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 (47:57):
I think one of the problems with BPD is that
they might over advocate for themselves.
Speaker 1 (48:03):
Oh, Chase puss Off basically right.
Speaker 2 (48:06):
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
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
(48:29):
all over the internet to help you.
Speaker 3 (48:32):
And since I said that it's time for listener mail,
I'm going.
Speaker 1 (48:38):
To call this, uh, well, let's just call it listener mail. 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
(48:59):
names are listed on my big Thanks to portion of
my bachelor thesis. It's customary in my country to thank
your college coach for their support during your graduation year
and your thesis forward. 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
(49:21):
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 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 (49:42):
There are some Rando jays scattered throughout those words.
Speaker 1 (49:45):
Yeah, totally, and Chuck has a little null signed through it.
That's weird unless sure what that means.
Speaker 3 (49:50):
It means watch your back.
Speaker 1 (49:52):
That means it don't count. And that is with much
love and immense gratitude from Suzanne. Oh, I'm going to
do my best here, Suzanne. Uh Christick, let's hear it again.
Chris Silk sick. I like KRK you I S have you?
I JK If you liked that one.
Speaker 2 (50:12):
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.
Speaker 1 (50:22):
You, Chuck, I'm tearing up.
Speaker 2 (50:24):
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 1 (50:39):
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.
A good morning everyone. This is Chuck here on a
Saturday with a curated selection of one of my favorite episodes.
This is bp D colon the Worst Disorder or not
a disorder at All. This is all about borderline personality
disorder and it's pretty fascinating stuff and I hope you
guys enjoy it. Welcome to Stuff you should know, a
(00:27):
production of iHeartRadio.
Speaker 2 (00:35):
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 stuff you should know.
Speaker 1 (00:44):
Yeah, Jerry's got the week off and she said press on, dudes. Yeah,
party party on Wayne.
Speaker 2 (00:54):
That was also from Bill and Ted's excellent Adventure. Wasn't
it Party On?
Speaker 1 (00:58):
No? Was it?
Speaker 3 (00:59):
I think?
Speaker 1 (00:59):
So?
Speaker 3 (00:59):
I can see George Carlin saying it.
Speaker 1 (01:02):
Yeah, I'm probably wrong.
Speaker 3 (01:04):
I'm probably wrong.
Speaker 2 (01:06):
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 (01:16):
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
(01:37):
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 (01:47):
As Michael Jackson would have said, you're ignorant about this?
Speaker 1 (01:52):
What's that from?
Speaker 3 (01:53):
He just used that word a lot.
Speaker 2 (01:55):
Oh really yeah, But regardless, that has nothing to do
with anything when you ment just now that people like
kind of wrote in or write in when we do.
Speaker 3 (02:05):
Episodes like this.
Speaker 2 (02:06):
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,
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
(02:29):
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 (02:41):
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
(03:02):
patients 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
(03:23):
personality disorder, which is in the anti social personality disorder
category along with histrionic personality disorder and narcissistic personality. I'm
just going to start saying PD.
Speaker 2 (03:36):
Yeah, PDS. It will make it sound like, you know,
you're talking about yet.
Speaker 1 (03:40):
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 is
the way things are perceived incorrectly, either about themselves or
(04:01):
about others or others actions.
Speaker 2 (04:03):
Yeah, and I saw a lot of people confuse borderline
personality disorder with bipolar, or at least think they're similar.
Speaker 3 (04:12):
I guess because they go to start with bees.
Speaker 1 (04:13):
Or something like that.
Speaker 2 (04:14):
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 executive function
of the person in their prefrontal cortex either didn't develop
in a fully normal way or it's not functioning up
(04:38):
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 than it
is physiological.
Speaker 1 (04:53):
Yeah. 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
(05:15):
thing 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 helps up that must be.
Speaker 2 (05:30):
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 let roll off
of their back, right, could set somebody with BPD off
(05:52):
into a rage that.
Speaker 3 (05:53):
Could last days.
Speaker 1 (05:54):
Potentially.
Speaker 2 (05:56):
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
(06:18):
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 (06:31):
Yeah, there was another and we'll talk about her in
great detail. Her name is Marcia Lenahan or is it
Line Han.
Speaker 3 (06:40):
I'm gonna go with Lenahan.
Speaker 1 (06:42):
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 or movement.
(07:04):
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. Yeah,
so this is this is no joke. This is a
very hardcore disorder that bears more empathy and understanding.
Speaker 3 (07:27):
Yeah, for sure.
Speaker 2 (07:29):
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.
Speaker 3 (07:44):
It's just one of those.
Speaker 1 (07:45):
Not at all frustratingly So, yeah.
Speaker 2 (07:48):
And that goes back to a jerk named Adolph Stern
who really jerked it up back in nineteen thirty eight.
Speaker 1 (07:54):
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
(08:16):
border between those conditions while encompassing a bit of each.
So we're just going to call it borderline.
Speaker 2 (08:22):
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
(08:44):
who was the serious jerk in this situation.
Speaker 1 (08:47):
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 organized conception
of the self. 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
(09:09):
was in the DSM version three.
Speaker 2 (09:12):
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 1 (09:32):
Yeah. 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 3 (09:42):
Yeah, there's we'll talk about that.
Speaker 2 (09:44):
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 is a mood disorder. They say it's a
cluster of symptoms that overlap with a bunch of different
(10:06):
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 name in the general population that you're
(10:29):
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.
Speaker 3 (10:45):
Everybody step back.
Speaker 1 (10:46):
Basically, yeah, I mean it's it's almost in line with
saying someone is a sociopath. It's different things, but as
far as like the stigma goes.
Speaker 2 (10:55):
Very much, 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,
(11:18):
we're 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
(11:43):
don't have BPD, you don't have BPD. If you don't
fit the criteria, if you do, you got BPD.
Speaker 1 (11:49):
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,
(12:10):
patients and friends encouraged her to come forward and she said, basically,
you know, I'm gonna do it. I'm not going to
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,
(12:33):
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 3 (12:48):
Yeah, the only thing missing was a visit from Saint Michael.
Speaker 1 (12:51):
Pretty much 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
(13:13):
radical acceptance or did she just buy into that.
Speaker 3 (13:16):
I don't know if that was a descriptor of hers
or not.
Speaker 1 (13:19):
Okay, I don't think she came up with that. 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 (13:39):
There's a huge butt that follows that though, But but
but I am going to do what I can to
change those things about myself.
Speaker 1 (13:51):
Right.
Speaker 2 (13:52):
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
(14:13):
a borderline personality disorder it right.
Speaker 1 (14:15):
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
(14:36):
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 3 (14:53):
It is great.
Speaker 2 (14:53):
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 encouraging. So Lenahan's
basis of her understanding or her definition of borderline personality
disorder is that it's biosocial that people who have BPD
(15:15):
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 a
(15:36):
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
(15:56):
very often it results in what you be diagnosed with later.
Speaker 1 (15:59):
As Yeah, and man, 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 uh oh, you got to validate your kids.
Speaker 3 (16:11):
Yeah, that's new, which is crazy, but it's.
Speaker 1 (16:13):
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
(16:34):
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.
Speaker 2 (16:44):
I know, and doing parenting right sounds like a waking
nightmare to me.
Speaker 1 (16:48):
Doing wise parenting.
Speaker 2 (16:49):
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.
Speaker 3 (17:00):
How'd you kid up for life?
Speaker 1 (17:01):
Yeah? 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 of your
own I'll bet depression if you if you screw up,
and you can't do that because kids are resilient and
you just got to, like you've got to prove to
them that you can like pick yourself up and move
(17:23):
on and do better, you know.
Speaker 2 (17:24):
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.
(17:47):
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. What do you think,
let's do it, okay, Chuck. So we said that BPD's
(18:23):
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 relate to others, and
(18:44):
that definitely makes sense to me that you would consider
a BPD of personality disorder.
Speaker 1 (18:49):
Then, Yeah, that seems to be a really key thing
is that 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.
Speaker 2 (19:09):
And that's emptiness feeling like isolated or lonely or hopeless.
Speaker 1 (19:13):
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. Frantic efforts to
avoid abandonment, whether or not they're real or imagined as Yeah,
(19:34):
as we'll see abandonment issues, and this very very much
includes emotional abandonment as a really big precursor unstable self
image or sense of self.
Speaker 2 (19:47):
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
(20:09):
not this is 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,
(20:29):
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 (20:50):
Yeah, the last three recurrent suicidal or self harming behaviors.
We've talked about that a little bit, stress related paranoia
or dissociative symptoms, like feeling like the self of the
world isn't real. It feels like that's probably at the
far end of the spectrum, or the most severe end.
(21:10):
And then when we missed earlier was inappropriate and intense
anger or difficulty controlling anger.
Speaker 2 (21:17):
I didn't miss it. That was purposeful, Okay. I wanted
to end with that big one.
Speaker 1 (21:22):
Okay, all right, speak to it.
Speaker 2 (21:23):
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.
Speaker 3 (21:33):
So let me rephrase that.
Speaker 2 (21:34):
I have seen that there are schools of thought regarding
borderline personality disorder that it is a rage response to trauma. Okay,
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
(21:55):
a hallmark of BPD as fear of abandonment is right,
and that's why some 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
teach people how to identify their emotions and how to
express them in a more appropriate, less hostile manner, and
(22:16):
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 what people are
mistaking for BPD.
Speaker 1 (22:26):
Oh, I got youa 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 right
click click click click, or they may speak to your
(22:47):
family or something like that. 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
(23:09):
this diagnosis rather than it's like a cluster of symptoms
of other things. But I don't know. 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 (23:21):
Again, I think it's the stigma. And then also it
might be distracting from treating the other underlying.
Speaker 1 (23:27):
Stuff, maybe because there also isn't and we'll talk about pharmaceuticals,
but there isn't a specific pharmaceutical for BPD.
Speaker 2 (23:36):
That's another clue that some people point to that it's
not it's it's we're mistaking it somehow. And I don't
want to like overstate that school of thought. It is
widely considered like an accepted diagnosis sorderline personality disorder is,
so I don't want to make it seem.
Speaker 3 (23:56):
Like the cracks are in the facade. It's about a
chromo any day now.
Speaker 2 (24:00):
Well, my point is people make some pretty good points
about how well we understand it or how well we're
defining it, and we're possibly missing some component of it.
Speaker 1 (24:12):
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 (24:25):
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 ven diagram
of a bunch.
Speaker 3 (24:36):
Of different disorders, Yeah yeah, and.
Speaker 2 (24:38):
We're mistaking that center overlap of all of them as
its own thing. If you zero in on that group
and 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
(25:02):
are that are that are aimed to control that behavior
suicide aalogy.
Speaker 1 (25:07):
Yeah, yeah, for sure. 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
(25:28):
have BPD and come 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 (25:45):
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
(26:06):
absent father and a domineering mother, and it's like, how
many times have you guys trtted 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
(26:26):
would probably have affected their parenting as well.
Speaker 1 (26:31):
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
(26:53):
of the old days of like, oh, you know, kids
raised themselves and you can ignore them and blah blah blah,
And I'm sure that I mean, I know that still happens,
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 3 (27:10):
Yeah, that's the hope for sure.
Speaker 1 (27:12):
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 that are like, no, we're we're not going
(27:34):
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 (27:50):
You raise a question though, in my mind, I wonder
what percentage of boomer grandparents are allowed to see their grandchildren.
Speaker 1 (28:00):
Well, bet it's higher than you think are allowed to
or not.
Speaker 2 (28:04):
Allowed to, like just don't have contact with their grandkids.
Speaker 1 (28:08):
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 kid, right, Sure.
Speaker 2 (28:22):
For sure, 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 1 (28:31):
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 (28:41):
You have BPD, I would guess that would be a
rage inducing trigger.
Speaker 1 (28:44):
I imagine it would be.
Speaker 2 (28:46):
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
(29:09):
of abuse.
Speaker 3 (29:10):
It is.
Speaker 2 (29:11):
It's a huge factor, a huge risk factor in developing BPD,
for sure.
Speaker 1 (29:16):
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
(29:36):
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 easy toward that condition.
Speaker 2 (29:46):
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, but parent the disorder.
Speaker 1 (30:01):
Right, you know.
Speaker 2 (30:02):
But we said earlier that there's also believed to be
a biological component to it too, that it's 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
(30:24):
moving on, but also your outward display of emotions. If
you don't have executive function, your 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
(30:47):
of the key traits of BPD is it can last
a really long time too.
Speaker 1 (30:53):
Can we make a T shirt that has a chicken
that says parent across the chicken's chest and then next
to an egg that says mental disorder? Love it and
just that's the shirt, no explanation, figure it out or don't.
Speaker 2 (31:08):
How about this though, on the back of the shirt,
Mork is coming out of the egg all right to
really confuse people.
Speaker 1 (31:18):
Oh wow, that just really changed things. I like it.
Speaker 3 (31:20):
Okay.
Speaker 1 (31:21):
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 Lybia helped us
out with this one, and she said zero point five
percent to six percent, and they find it about four
(31:42):
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 (31:52):
I also saw that it's a that's an indictment of
clinicians who basically have to figure out for themselves whether
the person as BPD, and that they're more likely to
assign it to a woman than a man a male patient.
Speaker 1 (32:05):
Oh interesting.
Speaker 2 (32:07):
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 in inside the clink.
Speaker 1 (32:29):
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
(32:52):
times throughout a day even or it can be like
just a switch that is permanent, like someone you used
to really like an eyeline, all of a sudden, just
no more, you despise them, and they're they're on the
bad person list forever.
Speaker 2 (33:05):
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.
Speaker 3 (33:19):
And because you see.
Speaker 2 (33:21):
Things in people and events as entirely one way or
the other, you set people up for unrealistic expectations. If
you're like, you're one hundred 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
(33:44):
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 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 (34:04):
Yeah, I mean even Darth Vader was once a young boy. Yeah,
just trying to learn the ways of the force.
Speaker 3 (34:10):
But boy did he get pale as he aged.
Speaker 1 (34:15):
He sure did. 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,
(34:35):
self harm can come into play. Your sense of your
own personality can 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
(34:55):
really sure, but it kind of seems like almost like
a sort of audition 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 make sense.
Speaker 2 (35:12):
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
(35:32):
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.
Speaker 3 (35:44):
Basically interesting.
Speaker 1 (35:46):
Yeah, should we take a break?
Speaker 3 (35:49):
Oh jeez, that came out of left field.
Speaker 1 (35:52):
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
(36:20):
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
(36:41):
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 (36:55):
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.
Speaker 3 (37:00):
The most, I think.
Speaker 2 (37:01):
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 a ton of flattery and admiration and praise,
and all of your greatest points are pointed out all
(37:22):
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 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
(37:45):
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. 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
(38:10):
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 on it and eventually abandon
the person with BPD, which is again at the root
of what.
Speaker 3 (38:24):
They are fearful of. They're fearful of rejection or abandonment.
Speaker 2 (38:28):
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 (38:37):
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, 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
(38:59):
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 (39:17):
One of the other things that is difficult to deal
with when you're an FP is that person wants you
all of themselves.
Speaker 3 (39:24):
They're yeah, rightned.
Speaker 2 (39:25):
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 points from those other people, like what are
you doing? Why are you putting up with this? Isolating
(39:46):
them would help cut down on that too.
Speaker 1 (39:48):
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 being the most despised person.
I would imagine that's something that is probably comes over
time and is not like a quick thing. It can
(40:10):
be but it can be all right.
Speaker 3 (40:13):
For sure. It can happen. It can turn on a dime.
Speaker 2 (40:17):
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'll 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 never
do that again, like they know what they've just done
(40:39):
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,
shinky 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 (40:58):
Yeah, I mean, I get the pression that people with
BPD generally don't have any illusions about themselves because it
is such a struggle.
Speaker 2 (41:06):
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,
(41:27):
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,
(41:51):
constant emphasis, that what you're doing right now is abnormal
and harmful and you need to go get help for this.
Speaker 1 (42:00):
That's yeah.
Speaker 2 (42:00):
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.
Speaker 1 (42:08):
Well, 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
(42:32):
that you were just kind of stuck with it. They
have found that about half the people who are treated,
who seek treatment and are treated no longer meet the
criteria after five to ten years.
Speaker 3 (42:44):
Amazing.
Speaker 1 (42:44):
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,
(43:07):
you know, healthy life.
Speaker 2 (43:08):
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
(43:32):
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 1 (43:50):
I think so. But it's not like that.
Speaker 2 (43:51):
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 (44:07):
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 and therapy as a huge part of it.
(44:28):
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
(44:50):
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 (45:06):
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
(45:29):
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
(45:51):
as a kid. And I guess it smells a lot
like it believes borderline is like a sponse to trauma
using accur rather than anything else.
Speaker 1 (46:04):
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 3 (46:12):
Yeah.
Speaker 2 (46:12):
And then one other thing that really kind of underscores
how difficult dealing with people with borderline personality disorder can be.
Speaker 3 (46:20):
One of the main components.
Speaker 2 (46:22):
Of dialectical behavioral therapy is what's called a therapist consultation team,
which is basically a group of therapists working with patients
with BPD 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.
(46:43):
That's how hard it can be to treat people with BPD.
Speaker 1 (46:47):
Yeah, And like I said at the beginning, there are
therapists that will refuse treatment because all the reasons that
we talked about. They say that National Alliance on Mental
Health basically says, if you have BPD and you recognize
that and you want to see treatment, whether it's you know,
DBT or any other kind, you uh, well, first of all,
(47:08):
seek out someone that specializes in DBT. 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
sort of emotional or mental problems that anyone has. 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
(47:32):
like it's okay to question them and make sure it's
a good fit for you.
Speaker 3 (47:37):
Yeah, for sure.
Speaker 1 (47:39):
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 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 (47:57):
I think one of the problems with BPD is that
they might over advocate for themselves.
Speaker 1 (48:03):
Oh, Chase puss Off basically right.
Speaker 2 (48:06):
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
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
(48:29):
all over the internet to help you.
Speaker 3 (48:32):
And since I said that it's time for listener mail,
I'm going.
Speaker 1 (48:38):
To call this, uh, well, let's just call it listener mail. 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
(48:59):
names are listed on my big Thanks to portion of
my bachelor thesis. It's customary in my country to thank
your college coach for their support during your graduation year
and your thesis forward. 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
(49:21):
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 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 (49:42):
There are some Rando jays scattered throughout those words.
Speaker 1 (49:45):
Yeah, totally, and Chuck has a little null signed through it.
That's weird unless sure what that means.
Speaker 3 (49:50):
It means watch your back.
Speaker 1 (49:52):
That means it don't count. And that is with much
love and immense gratitude from Suzanne. Oh, I'm going to
do my best here, Suzanne. Uh Christick, let's hear it again.
Chris Silk sick. I like KRK you I S have you?
I JK If you liked that one.
Speaker 2 (50:12):
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.
Speaker 1 (50:22):
You, Chuck, I'm tearing up.
Speaker 2 (50:24):
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 1 (50:39):
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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Hosts And Creators
Chuck Bryant
Josh Clark
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