September 29, 2025 • 58 mins
Borderline Personality Disorder (BPD) is one of the most misunderstood mental health conditions, clouded by stigma and misinformation. In this episode, we take a compassionate, research-based look at what BPD really is, where it comes from, and how people living with it can find healing and stability. From exploring the biological underpinnings and role of trauma, to the impact on relationships and the remarkable effectiveness of treatments like DBT and SCM, we look at both the challenges and hope.
We’ll explore:
• What BPD feels like and the key symptoms
• The biosocial model: how biology and the environment intertwine
• The impact BPD has on relationships and attachment
• Stigma, myths, and gendered assumptions around diagnosis
• Why loneliness is high, and support is essential
• How DBT and Structured Clinical Management help people adapt
• The encouraging truth about recovery and long-term prognosis
If you’ve ever wanted to learn more about this misunderstood condition, this episode is for you.
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The Psychology of your 20s is not a substitute for professional mental health help. If you are struggling, distressed or require personalised advice, please reach out to your doctor or a licensed psychologist.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Hello everybody, and welcome back to the Psychology of Your Twenties,
the podcast where we talk through some of the big
life changes and transitions of our twenties and what they
mean for our psychology. Hello everybody, Welcome back to the show.
(00:24):
Welcome back to the podcast. New listeners, old listeners. Wherever
you are in the world, it is so great to
have you here. Back for another highly requested episode as
we break down the psychology of our twenties. So, guys,
today we're going to talk about borderline personality disorder or BPD.
(00:45):
Maybe you have seen the term thrown around online, especially recently.
Maybe you have seen it used to describe people who
others think manipulative or dramatic or even dangerous, without really
even knowing the whole story or what BPD actually means.
Maybe for some of you listening, you know this is
a term that you've encountered more personally. Maybe this is
(01:07):
a diagnosis that you've received. Maybe you grew up with
a parent who had BBT and didn't really understand it
until recently, or maybe you are hearing it for the
very first time on this podcast. What I really want
to do today is give a proper and real introduction
(01:28):
into the world of people with BPD, into what this
condition actually means, and probably more importantly, what it doesn't,
because I think, as is the case with a lot
of mental health disorders or personality disorders, the truth gets
rather twisted, and I think it gets made smaller until
(01:50):
it becomes a bit of a stereotype. This has definitely
happened with borderline personality disorder. At its heart, this is
a condition. This is a disorder of emotional regulation and attachment,
meaning it massively affects how someone feels, their mood, their relationships,
how they see themselves, how they view love, one of
(02:13):
our core human experiences. Some of the ways that I've
seen people describe it is basically like a lack of identity.
You get such intense feelings of anger and nihilism that
you feel completely empty, and then the next day or
the next minute, you will be filled with such an intense,
astatic joy that you feel like the world could never
(02:38):
be an evil place again. It's scary kind of not
knowing how you feel about the same situation, and therefore
kind of not knowing who you are. Others have also
described this emotional pendulum by saying It's like having so
much emotion that you don't know what to do with it,
but also at the same time feeling so empty, and
(02:58):
having both of these exist at the same time. You
can go from loving a person so deeply you think
you know you might die, and then suddenly hating everything
about them. It is the disorder. It is a rollercloster disorder.
That's really like the best way to put it. And
what actually is behind this emotional intensity? Because I think
(03:20):
you may know the symptoms, you may know the general
character profile of what people assume people with BPD look like,
but do we really know the origins. Do we know
how this disorder impacts the mind, why it is so
linked to attachment. I think a lot of people don't,
So I really want to talk about it today. I
(03:41):
really want to reduce a little bit of the stigma
and just talk about some probably unknown facts and some
unknown research about BPD that you might not see presented
on TikTok and that you might not see in everyday
discussions about this about this condition. As always, I say
this every time with these specific episodes that we do
(04:03):
on mental health disorders. This is not a diagnostic tool.
It's not a diagnostic tool for yourself or to be
used for someone else, nor is it a substitute for
therapy or real life intervention. We're also going to be
talking about some sensitive topics today to deal with suicide,
suicidal adation, and self harm. So if that's something that
(04:25):
you are sensitive towards, just consider whether this episode is what.
Speaker 2 (04:30):
You need to hear today. It will be here in
a month, it will be here in a year. You
can always come back to it when you feel more prepared.
I will leave you some links in the description for
further resources. So if you or someone you know may
be experiencing borderline, if you think they may be experiencing borderline,
if this episode has left you distressed, hopefully those help
(04:52):
you find the help that you need in your local
area and for what you're going through. So I just
want to give that little disclaimer before we get into it.
It probably will be a more heavy episode than we
used to, but take care of yourself and without further ado,
let's dive into the psychology of borderline personality disorder. So
(05:18):
I want to begin with a little bit of like
an imagination exercise to really get across even just a
small part of the experience of someone with BPD. This
is how people describe it. Imagine for a moment that
every emotion that you have felt today or in the
last week, you are currently feeling right now, all at
(05:43):
the same time. You know, you don't just feel happy,
you feel ecstatic joy. You don't just feel sadness, you
feel bottomless despair. Every moment of rage, every moment of laughter,
every moment of hatred from the past week of your life,
your experience seeing it right now, These visceral emotions that
(06:04):
I think are only usually available to us for a
tiny portion of our lives and of our days. People
with BPD they feel them all the time. They feel
them much more often in much much higher definition. Now,
imagine that these emotions get split into positive and negative.
(06:26):
And now instead of just feeling all your emotions at once,
you're feeling all or nothing. You're feeling either entirely good
and loved and happy or entirely miserable and depressed and angry.
And that rapid effective or emotional instability can be triggered
by something that many of us would consider really really tiny,
(06:50):
really really minuscule. You know, a delayed reply to a
text message, a certain facial expression a certain slight or
perceive rejection. Not only is the depth of feeling amplified
for people with BPD, and there have been studies that
have shown that people who have borderline personality disorder may
(07:12):
actually have access to a more nuanced emotional scale, but
the rate at which these emotions is changing within someone
with borderline personality disorder is also accelerated. This is what
people often mean when they describe BPD as emotional instability,
and in fact that's exactly what some diagnostic manuals call it.
(07:36):
This is a really important caveat before we get any
further in the episode. If you are listening from somewhere
outside of Australia or outside of the US, you might
know borderline personality disorder is something entirely different in the UK,
in parts of Europe, in parts of Asia, you might
hear the term emotionally unstable personality disorder or eupdrather than
(08:00):
borderline personality disorder. Now, the reason I'm going to go
with BPD for this episode is obviously I am in
Australia and if you couldn't tell from my voice, but
also it is the term that is used by the
DSM which we've spoken about before many times on the podcast.
It is the diagnostic statistical manual of basically every single
(08:22):
mental disorder known and categorized. So you know, if I
was to start saying emotionally unstable personality disorder instead of
borderline personality disorder, I think I would kind of slip up.
So you may have heard this as a different term,
as a different in a different way. They do mean
the same things. There is a reason though, that they
(08:44):
are labeled differently. The term, or the preface of borderline
comes from kind of an older way of thinking. Back
in the day, clinicians believe that people with BPD with
this condition were on the borderline between psychosis and neurosis.
Neurosis is also known as anxiety. Today, most experts agree
(09:09):
that that is not actually what's happening. That description is outdated.
We don't really use terms like neurosis anymore. Emotional emotionally unstable,
I should say, gets closer to the reality.
Speaker 3 (09:21):
What is really.
Speaker 2 (09:22):
Happening with this disorder is a nervous system that has
been caused or forced to react intensely and unpredictably to
emotional triggers. Let's talk about prevalence here for a little bit.
BPD is estimated to be prevalent in anywhere between zero
point seven to five point eight percent of the general population.
(09:43):
Uber specific numbers right there, And I'll tell you why
those numbers.
Speaker 3 (09:48):
Are so specific.
Speaker 2 (09:48):
They're so specific because that is the minimum and the
maximum that researchers believe this condition could be present when
considering factors like a lack of diagnosis, especially in certain
population groups like men, or in certain countries with underdeveloped
mental health systems where there isn't as much I guess
(10:11):
like knowledge of this or opportunities for diagnosis. They're also
considering if there is an overrepresentation. So sometimes when people
try and find these estimates of like how common is
a disorder in the world, they like to go as
small as possible and as big as possible. So when
you hear five point eight percent, I don't want you
to think that anytime you go into work, anytime you're
(10:34):
walking down the street, one in every twenty people have
borderline personality disorder. Again, it's just like the max of
all maxes. Now let's talk about more deeply. Let's talk
about what this disorder actually contains. What are the hallmark symptoms?
Of BPD. So, according to the DSM five, if you
(10:58):
want to be diagnosed with borderline personality disorder, a couple
of things have to be true. Firstly, you have to
experience a certain number of the following symptoms. An intense
fear of abandonment, unstable relationships and unstable and stable self image,
so feeling amazing one minute terrible the next, impulsivity, recurrent
(11:20):
suicidal behavior or self harm, emotional instability, rapid intense mood changes,
chronic feelings of emptiness, intense anger inappropriate to the situation,
and at the extreme, stress related paranoia or dissociation. I
think that as of today, as of right now, as
(11:41):
I'm recording this, you need to have five or more
of these symptoms present over a significant period of time
and across various contexts. So you can't just feel emptiness, impulsivity,
and intense rage when you're around your family and your
family only, or you can't just experience that when you're
(12:02):
at the job that you hate. It has to be
something that unfortunately isn't purely environmental or context based, but
which sits with you throughout all social, physical, emotional contexts.
That is kind of the hurdle that you have to
jump over to be diagnosed with BPD. We're going to
talk about a couple of the other hurdles later on.
(12:22):
Don't worry, we'll get to it. So clearly, when we
talk about instability, this isn't just having a few mood
swings it These swings are full body. Their affect identity relationships.
They affect our relationship with ourself, even sometimes how we
see reality. One of the most devastating aspects of BPD
(12:48):
is the way that it heightens risk for self harm
and suicide. And this is kind of a known, very
sad secret of the community of people who in're and
suffer from this condition. I saw this statistic the other
day that as many as seventy percent I believe of
those with BPD will attempt suicide at some point in
(13:11):
their lifetime. That makes borderline personality disorder one, if not
the most high risk psychiatric diagnosis when it comes to mortality.
I would assume it would be second only to anorexia.
That statistic isn't necessarily meant to shock you, although it
definitely shocked me. Seventy percent is a ridiculously high number,
(13:36):
but it's meant to just highlight how intense and painful
this disorder can be for those who are living with it,
whereby the only response many of the people who are
enduring this condition believe they can have the only appropriate
response is a drastic, devastating, and permanent one. Another key
(13:59):
complexity to do with BPD is that it actually rarely
exists alone. We talked about those hurdles you need to
get across. This is the second biggest hurdle. Getting the
diagnosis is actually quite difficult because for someone with BPD,
it is highly likely, in fact, it is more probable
than not, that they will also be experiencing another co
(14:21):
occurring mental health condition. The research in this is a
little inconsistent, but in terms of the rate of co
occurrence with other mental health conditions, anywhere between sixty three
to ninety five percent of people with boderline personality disorder
will also have another diagnosis at the time of their diagnosis. Now,
(14:44):
that number, the sixty three to ninety five percent that
was found in a very well known twenty nineteen Swedish
population study which looked at almost two million people with BPD,
So I think that we can say that number is
fairly accurate. Two million people I think that is the
(15:07):
largest sample size of any study we have ever mentioned
on the podcast before. Ever, some of the most common
co occurring conditions are the ones that are obviously most
common in society in general, so depression, anxiety disorders, bipolar disorder,
but then also PTSD, complex PTSD CPTSD IS it's called
(15:29):
for short substance use disorders and eating disorders. This one,
especially eating disorders and BPD are incredibly common, especially bolimia
and binge eating disorder. Now this overlap, obviously can make
things quite tricky. Imagine going into a doctor's office and
(15:51):
you know, really all your symptoms are coming from a
large tumor, but instead of treating the tumor, they start
treating gas on your leg, and they start treating you
for a vitamin deficiency, and they start treating they send
you to the dentist to get like dental treatment, and
all along you have this big tumor that all of
this stuff is coming from. Like that's how some people
(16:13):
describe BPD. It's like you're treating you go onto I
don't know the medical system, specifically the mental health system,
and you have this big thing that is really bothering you,
that you can't figure out, and as in order to
get a final diagnosis, all these other little things get
treated or get labeled first, when the big thing kind
(16:34):
of goes undetected. I've heard so many stories of this
from listeners of people who, you know, they had not
even heard of the term BPD until they were in
an impatient treatment for an eating disorder five years after
they first developed said eating disorder, or they've been treated
(16:56):
for depression and anxiety for years before suddenly someone sit
down and says, you might have this, and it's like
the key that unlocks the door. I think that's similar
for late stage diagnosis for ADHD and for autism. Often
people don't get the label that they need and that
they would would really give them an answer until a
(17:17):
little bit later in life. So where does BPD actually
come from? Psychologists researchers. They will often turn to the
biosocial model to explain the origins of BPD. Now, the
biosocial model was originally proposed by Marshall Lyman in the nineties,
(17:38):
I think, and she also is the creator of Dialectical
behavior Therapy DBT, which you have probably heard about on
the podcast before. We're going to circle back to that
in a second. But according to this biosocial model, BPD
develops from a combination of a couple of things, almost
like a perfect storm. It is not a singular thing
(18:00):
that creates it. Firstly, there must be a biological vulnerability,
meaning a person is born naturally born with a heightened
emotional sensitivity, a certain specific kind of temperament, or heightened
emotional dysregulation. An individual basically is seen in this case
to have had a predisposition for either hyper arousal or
(18:22):
hyper reactivity, so their nervous system reacts more strongly to
emotional stimuli and takes longer to return to a baseline
because of their genetic blueprint. It has nothing to do
with environment. Yet there's a lot of different theories and
pieces of research looking at the specific biological basis behind
this hyper arousal or hyper reactivity. And what a lot
(18:46):
of people typically come back to is this one structure
in our brain, one of the smallest structures, which is
the amygdala. Now, the amygdala sits right in the center
of what we call our old brain. It is responsible
for detecting threats and for triggering an emotional response like
fear or anger, which will in turn also trigger a
(19:08):
physical response. Now in people with BPD, when they do
fMRI scans of these people's brains, what they tend to
find is that the amig deala is hyperactive, meaning that
when a rather ubiquitous or small emotionally experienced occurs, it
reacts in a disproportionate way compared to a so called
(19:32):
and I hate saying this, a so called normal brain
or a control brain. The brain's alarm system in this
case goes off the slightest sign of rejection or criticism
because it cannot distinguish between something that requires a two
percent reaction and a two hundred percent reaction. That is
(19:53):
part of the intensity behind this disorder. Now, on the
other side, we have the prefrontal cortex. Now, the prefrontal
cortex and the amigdala often get talked about together a
lot because they are like, how do I describe it?
They're like on two sides of the balance beam. The
prefrontal cortext she is logic, she is regulation. She is
(20:13):
the thing that provides reason, executive functioning and helps calmas down. Now,
if the amygdala shows hind reactivity, the frontal lobe shows
reduced activity or reduced connectivity in people with BPD. Basically
there are less roads, less fast pathways running around the
(20:34):
frontal lobes, so messages are a little bit slower. So
you've got a brain where the emotional accelerator is extra
sensitive and the braking system is less responsive. Slash doesn't
really work. That's a hard mind to control for anybody.
Of course, this does have a genetic component. If you
(20:55):
have a parent, if you have a sibling, if you
have an immediate family member with BPD, the chances of
you then developing that disorder sits around the forty to
sixty percent mark. It's about forty to sixty percent heritable. Now,
it's kind of hard to kind of hard to detach
(21:15):
whether it's because you've been raised in an environment where
someone has a disorder that causes them to be quite
polarizing it and reactive, or whether it is purely genetic.
The best way we can figure it out is through
twin studies, and it does seem to be that there
is both a genetic and an environmental context here. The
(21:39):
genetic aspect of having a family member or having a
certain genome and whatever it is that has been primed
for BPD is that that vulnerability can actually lay completely
dormant for somebody's whole life or for many many years
(22:00):
until something triggers it. And this is where we get
to talk about the second part of the biosocial model,
which is the role of an invalidating environment, meaning that
a lot of people who go into develop BPD from
a young age probably existed in a world that didn't
(22:20):
teach them how to manage their emotions, didn't give them
a safe space to manage their emotions, and who probably
experienced something very severe and extreme during their childhood that
they couldn't grasp, they couldn't control, they weren't supported to
understand as a child, and so from that point on,
(22:41):
all of their emotions were at level one hundred. You
guys know, my guilty secret is that if I am
researching an episode where I want to know more about
lived experience, I love going into Reddit and reading through
all like the I guess, like the support boards, and
in one of the ones for BPD, I found a
(23:03):
lot of people talking about this experience of before and after,
like a moment where they felt their brain, this new brain,
their BPD brain like switch on. And this is exactly
what we're talking about there's a biological vulnerability, a light
switch that has suddenly switched on by an environmental experience.
(23:26):
Now what might that environmental experience be, Well, there are
a lot of options, a lot of really actually terrible options.
But it's often trauma, either subtle or overt, that adds
to these effects, and that creates the personality disorder or
personality type we now call borderline or emotionally unstable. A
(23:49):
twenty eighteen study published in the Journal for Personality and
Mental Health looked at a sample of adolescents from thirteen
to seventeen who were at an inpatient unit as a
result of their BPD, and then of these people who
of these children who had BPD, they also matched them
with a sample of people of the same age who
(24:12):
didn't have BPD, and then a further two hundred and
ninety adult in patients with BPD, And they just got
every single group, the teenagers with BPD, the teenagers without BPD,
and the adults with BPD, to answer a few questions
about their childhood, specifically experiences of abuse or neglect. What
(24:34):
the study found was that adolescents with BPD described significantly
more abusive experiences than their psychologically healthy peers, but often
they did so in quite a detached way. Oh you know,
I don't really know why I'm like this, But then
they would go on to explain something that was just
(24:55):
like absolutely psychologically crushing. Even more interesting is that that
recall of those events, and I guess that rate of
trauma and emotional or childhood neglect was very similar in
the adult group as well, And a lot of these
people found that the impact of their childhood adversity was
(25:20):
almost more pronounced in adulthood, perhaps due to the prolonged
effects of early trauma and the fact that the inability
to regulate themselves through those experiences had meant that the
impact of those experiences had just been allowed to compound trauma,
(25:41):
especially when it's relational trauma, to do with how your
caregivers treated you, to do with maybe a death in
the family, to do with social rejection or social pain
or grief. It also heightens a fear of abandonment, and
it makes trust in relationships a lot more difficult, and
it re enforces that hyperreactivity to emotional stress, which is
(26:05):
another core element of BPD. Now, trauma doesn't have to
be this huge, major thing that you can point to
and reflect on and say, this is where it began.
For a lot of people with BPD, they actually say,
you know, my childhood was pretty good. They don't recount
having an abusive childhood. But as we said before, when
(26:27):
you ask them to describe it, it's you know, parents
who are physically present, who put food on the table,
but are deeply dismissive, parents who themselves had BPD, and
because that's the only caregiving and parental love the child
or the person has ever known that felt normal to them,
(26:49):
or it's just not being valued. It's environments that just
didn't match the child's sensitivity, where they felt like they
were too much or too dramatic, where they felt like
every time they said, don't abandon me, someone would or
someone would think that it was funny to play into
these insecurities. Really, what we are pointing to here is
(27:12):
how trauma interacts with biological vulnerability, which then interacts with
emotional invalidation or environmental invalidation. That is the trifecta that
creates BPD, and I would say ninety nine percent of cases,
and it's what shapes emotional regulation, self concept and of
(27:35):
course our attachment pattern. Now, with that in mind, we
are going to take a short break, but when we return,
let's really talk about how this impacts our relationships, because
I think this is the space where people are most
curious about BPD or often first introduced to BPD.
Speaker 3 (27:54):
So stay with us.
Speaker 2 (28:00):
Something really critical and key with BPD, as I mentioned before,
is the role of relationships. They carry so much of
the disorder's weight, and a lot of the times, I
think it is where BPD becomes most visible in everyday life,
especially to others. If you have watched Girl Interrupted, Fatal Attraction,
(28:26):
Silver Lightnings Playbook, these are like pop culture references that
I actually think are pretty good at explaining or showing
the intensity of this experience of people. I personally I
love Silver Lightning's Playbook. It is one of my all
time favorite movies. But if you've seen it, you will
feel or you will notice that the movie has this
(28:48):
weird way of making you feel stressed and making you
feel on edge, especially from the main character, like his
interactions with people, so they become so volatile at times,
and you can feel that through the movie. And I
apparently see I don't have BPD, but I've been told
it is a very good depiction of how this feels
(29:10):
inside the mind of someone with BPD, Like things are rising,
things are like just spiraling, and it's all joy the
next one moment, and it's all disappointment or anger or
hate the next. Psychologists often frame this through the lens
of obviously attachment theory. Many people with BPD show what's
called an anxious, preoccupied, or disorganized attachment style. That means
(29:33):
that they desperately crave closeness and connection, but at the
same time that intimacy, because it is something they desire
so much, feels deeply threatening. When closeness for them has
so often been paired with pain, rejection, or inconsistency. Love
(29:55):
becomes both the thing they need the most and the
thing they fe the most. They fear the loss of
that love. They fear that someone is just inevitably going
to leave them, and they fight very very hard internally
and externally to prevent that from happening. This plays out
(30:17):
in what we sometimes call a push pull dynamic. On
one hand, they're craving this bond, they're craving intimacy, they
are pulling it closer, and on the other hand, they're
so fearful of being hurt that they push away, and
that's what the withdrawal and the anger looks like. There's
a very famous phrase used to describe this, which is
(30:39):
I hate you, Please don't leave me. You've probably heard
of it.
Speaker 3 (30:42):
It is actually the.
Speaker 2 (30:42):
Name of one of the most well known books on BPD,
and it's exactly as it sounds. I hate you, please
don't leave me. I actually love you. What we sometimes
realize is that love for them feels so intense that
sometimes it just gets confused with all other intense emotions.
(31:05):
Or you start to anticipate the pain of someone leaving
before it happens, and so you're reacting, or you are
acting out this future imagination that you have of how
it's going to feel when this all comes to an end.
Relationships really do feel like, as they described, a pendulum
swimming between extremes of idealizing one's partner and then devaluing them.
(31:29):
At one moment, you know your partner is perfect. They're
the best thing that's ever happened to you. They are
gorgeous and beautiful and kind and everything you've ever wanted.
And the next, after some perceived slight or disappointment, that
same partner might be seen as cruel or untrustworthy, and
in that moment, it feels like you never want to
see them again. It's ruined. It's not that the person
(31:51):
with BPD wants to see things in this black and
white way. It's that their emotions are so overwhelming that
it's hard to hold both the good and the bad
in one mind at the same time. This has a name.
It's known as splitting, and it's basically the inability to
hold opposing thoughts, feelings, or beliefs all at once. Obviously,
(32:13):
no one is ever perfect, you know. Even if someone
is literally our soulmate and the love of our life
and we've managed to find them, things do go wrong.
But for someone with BPD, often to survive the internal
emotional volatility, they do find it easier to make outright
categorizations like this person is evil or this person is
(32:36):
an angel. And when someone sits in the middle, sits
in the gray area, they cannot just be a normal
person with flaws, with inconsistencies, with normal human reactions. That's
what makes everyday relational conflict, disagreements, disappointments so difficult for
someone with this disorder. I read a few reports of
(32:58):
what this felt like for people with BPD, and what
some people describe is this inability to detach the bad
feeling about the situation from the person in the situation. Obviously,
having arguments in a relationship is uncomfortable, but also there's
this whole rupture and repair idea of you do need
(33:19):
to sometimes have friction and conflict in order to build
the muscle and build the volume of your relationship and
to move forward, and so it's kind of just a
normal part of things. Even if it feels bad, now
you can move forward. Someone with BPD sees that situation
and is like, well, that's just all the evidence I
need that this person is going to treat me poorly
in the future, that our relationship is doomed, and so
(33:42):
of course they react accordingly. They react defensively or from
a place of pain. You know, you have this fight
with a friend, right, It's heated, it's rough, it's hard,
and if you have BPD, sometimes you might feel like afterwards, Okay,
well that friendship is over. I guess like, that's dumb.
That person is terrible person. They never want to see
me again. So I'll be the first one and never
(34:04):
want to see them again first, if that makes sense,
And then three days later, you know, they'll text you
wanting to grab a coffee or wanting to hang out
and talk it through. And it's this confusion of like,
what do you mean people can be nuanced? What do
you mean this wasn't the end? You know, I'd already
emotionally prepared to cut you off.
Speaker 3 (34:20):
What is this?
Speaker 2 (34:21):
Why doesn't everyone think the same way as me? One
account I read that was really profound was this person
who again was on Reddit and was like genuinely seemed
confused that someone who she had had an argument with
wanted to repair the relationship. She was like, what do
you mean? Surely this is all the evidence we need
(34:43):
and that we require to know that this friendship isn't
going to work out. Conflict is part of a relationship,
but if you have this emotional instability and these previous
experiences of being hurt or being let down, well, of
course it's going to be a lot harder to tolerate.
People who are actually the romantic partners of people with
(35:06):
BPD often report really struggling sometimes with this cycle of
closeness and conflict. Feeling deeply loved one moment and painfully
rejected the next There was a twenty fourteen study that
looked at this specifically the partners of people with BPD,
and what they found was that a lot of these
romantic partners reported an increased sense of hurt in the
(35:30):
aftermath of arguments and an increased sense of caregiver burnout
or caregiving anxiety. When you feel deeply personally responsible for
someone else's emotions all of the time and that person
is also, you know, a little bit difficult or impossible
to predict, that takes its toll. It takes its toll
on the other person, It takes its toll on the
(35:53):
structure of the relationship as a whole. Parents of young
adults or teenagers with BPD also report feeling There was
another study, I think in twenty twenty one that looked
at them as the main relationship in the life of
someone with BPD, and again, it's this weird it's this
weird difficulty of feeling helpless and guilty but also angry,
(36:14):
wanting to set boundaries, but also wanting to let this
person be in control because that might be the best
way to manage the situation. As a result of this,
which again, a lot of these people, actually all of them.
They cannot control this amplified emotional reaction, but as a
result of it, there is a huge link between BPD
(36:34):
and loneliness because of how individuals with this condition relate
and interact with others. It is really common for people
with BPD to self isolate as the only appropriate reaction
to these behavioral patterns that number one, they don't want,
but number two, they find themselves being unable to control.
They don't actually want to hurt people, They don't actually
(36:57):
want to have this competitive relational pattern of loving someone intensely,
trusting someone intensely, and then one thing going wrong and
feeling like the world is splitting open, and so because
they find it difficult to manage the emotional consequences of relationships,
(37:18):
they just avoid relationships. In general. Research shows that not
only are people with BPD more likely to be lonely
compared to the general population, but their social networks are
often much smaller, much less diverse, also less satisfying. And
maybe we could even trace this back to what we
were talking about before with the suicidal ideation and behavior.
(37:41):
Loneliness is of course going to be another factor, not
only can you not control your emotional state. You also
don't get that same support socially that maybe you really
need and that other people do receive. You know, I
just I can't imagine how isolating that would feel. To
want love and to want to be around people so badly,
(38:04):
and to really love the depth and the intensity and
beauty of relationships, but also know that there's a part
of you that just can't handle it, and just deciding
to opt out, like that's a crazy sacrifice and a
crazy decision that people have to make. And this is
the thing for people with BPD. There is this stigma
(38:26):
that their capacity to love is kind of broken, that
they can't do it normally. That's not true. It's simply
tethered to fear in a way that I guess a
lot of us don't really understand unless, of course, we're
in it, unless we're experiencing it. Let's talk some more
about the stigma around BPD, since we've kind of gotten
(38:49):
started on that now, because I do think it's one
of the most stigmatized mental health diagnoses out there. Part
of the stigma comes from a misunderstanding about the behavior's
associated with BPD, particularly the intention of these behaviors. Outwardly,
someone might appear to be doing things to get attention,
to be manipulative, to be dramatic. A partner might you
(39:14):
know this person might frantically call you or have these
very intense emotional outbursts, and you might think that that's
a control tactic that I hate you, don't leave me
experience it. You know, it might not be manipulation. It
actually rarely is manipulation in a calculated sense. It is
just the only panicked way that someone with VPD can
(39:38):
respond to a situation. They do not have the same
emotional and interpersonal regulation skills that the again average person has,
so they are not sitting there and thinking, well, if
I react this way, I'm going to get a certain response.
And even if they are, it's not because they want
to necessarily hurt someone. They're just doing anything to get
(40:03):
back to a place of emotional safety within the relationship.
It's a survival strategy that push pull that I want
to let you in, but I don't know how to.
I don't want to be disappointed. It does cause them
to do things that howardly might seem really strange, but
for them make perfect sense or don't make sense, but
they feel like they.
Speaker 3 (40:23):
Have no control.
Speaker 2 (40:25):
Of course, I do think cultural representations only make matters worse.
We've talked about some good representations. A lot of the
stuff we see these days, or the characterizations of people
with BPD online are less educational, less informative, And you know,
when you see social media or TV or movies frequently
(40:46):
portray people with BPD as toxic x's or dangerous individuals,
it reinforces this fear and this sense that they don't
have empathy, when that's totally not what's going on here.
I will say caveat here. In some ways, I do
understand sometimes why people want to talk about it that way,
because that's their perception and that's their truth. Their truth
(41:08):
was that they were in a relationship with someone who
had this condition, and they experience things that really hurt them,
and they experience behaviors that maybe left them feeling very
unstable and could be interpreted as dangerous. Two things can
be true here. Someone can be experiencing personality disorder they
really don't have a grasp of, and that's might not
(41:33):
be entirely their fault, and someone else can equally be
suffering from that same condition. On the other end, on
the kind of sharp pointing end of the behaviors that
the person with BPD is using to protect themselves. So
again it's complicated, it's nuanced. I think it's hard to
talk about because you want to validate someone's experience of
(41:55):
what is again a diagnosable mental health disorder, but you
also want to understand that, yeah, people do get hurt
by these behaviors, whether inttentionally or not. The thing is
is that people with BPD are not sociopaths, they're not narcissists.
They don't have the same lack of empathy as you
(42:18):
would maybe expect from someone who is deliberately manipulative. Maybe
they have comeobidity, but it's not a significant level of them.
So they get the shame, They understand it, They understand
their omratic behaviors. They don't want to be like this,
and that's really hard because that self criticism and these
(42:40):
misconceptions actually make them feel more isolated and hopeless, less
likely to get help. Another thing we need to talk about.
Another layer of this actually comes from gendered assumptions around PPD.
So something you may not know is that historically BPD
has been diagnosed significantly more often in women. Some estimate said, ye,
(43:00):
it's about seventy five percent of diagnosed cases are female.
And if we look back, this has basically reinforced this
cultural stereotype that emotional intensity, volatility, relational sensitivity is inherently feminine,
or that women who express strong emotions are somehow hysterical,
overly dramatic borderline. These stereotypes are really dangerous because they
(43:23):
don't just influence some random person on the streets judgment
like they shape clinical perception as well. And we know
this because of again those diagnosis rates. A woman who
is emotional anxious, having issues in their relationship, prone to
(43:43):
self harm, they may be more quickly labeled as borderline,
whilst a man with the same underlying issues and patterns
might be seen differently. And that's probably what's resulting in
men being underdiagnosed even when they meet the criteria for BPD.
Why partly because the same way that autism diagnosis has
(44:03):
been set up to catch more young boys due to
their socialization, a BPD diagnosis has been set up to
catch more women because of how they have been socialized.
Men tend to externalize distress in ways that society and
clinicians would interpret differently. Instead of expressing sadness or fear,
they might display anger or impulsivity or risk taking behaviors
(44:26):
or substance use. These expressions can lead clinicians to assign
very different diagnoses. As we talked about before, a lot
of people with BPD get a lot of different labels
before they find this final one that really does describe them.
So for men, it might be antisocial personality disorder, anger
management issues, conduct disorders, and that means that the treatment
(44:48):
they receive only addresses the reactions or the outbursts rather
than the cause. The result is, you know what we
know as a gendered blind spot. Women are overrepresented in statistics,
so that means that we have a very limited way
of seeing this disorder that has been influenced by gender,
and it means that the disorder has often been stigmatized
(45:09):
for just meaning that someone overreacts or is labeled as
manipulative not to be trusted, whilst men are underrecognized and
they go without support entirely. Here's the thing that we
have not mentioned once, which now I'm realizing I probably
should have mentioned it earlier.
Speaker 3 (45:25):
But BPD is treatable.
Speaker 2 (45:28):
For a long time, clinicians believed it wasn't. Patients with
BPD were seen as too difficult, too resistant, to uncooperative.
We now know recovery or what they call remission from
this disorder is not only possible, it is incredibly common,
more so than what you are thinking incredibly common. So
(45:51):
we are going to take a short break now, but
when we return, I want to talk about that. I
want to reveal why therapy for BPD is actually becoming
incredibly effective.
Speaker 3 (46:02):
So stay with us.
Speaker 2 (46:09):
So let me throw some statistics that you hear from
the National Institute of Health from twenty twelve. These results
have been reaffirmed later on, I think in twenty twenty
four they did a follow up study. They found that
this hasn't changed a whole lot. In the study, they
wanted to see if someone with BPD was put into
(46:29):
an appropriate treatment environment, how would they do and could
they quote unquote recover. What they found was that sixty
percent of borderline patients will achieve a recovery from borderline
personality disorder if they go through treatment. That number maybe
(46:50):
even higher. There was one such intervention where there was
a ninety nine percent remission rate, showing that of almost
all of the mental health disorders out there, this one
is actually one that responds to treatment very well. And
how they kind of categorize remission is a lack of
(47:14):
symptoms that create distress or cause problems socially, psychologically or physically.
A lot of people will find that the older they get,
the more symptoms will and can ease through getting therapy
and through having good therapeutic approaches to what they're experiencing.
(47:35):
The gold standard here is dialectical behavior therapy or DBT,
which we mentioned earlier. I promised that we would come
back to it, and here we are. What makes DBT
so effective is that it was designed specifically for what
you might call an under controlled personality type. Now, before
this therapy, people really couldn't figure out what to do
(47:58):
with BPD patients. And then this amazing woman came along
and she invented this, and what she really realized was
that people whose emotions are intense, whose emotions are quick
to flare, hard to regulate, who are kind of maybe
a little bit more socially abrasive at times, they need
(48:19):
a different approach to therapy compared to the traditional methods
of doing it, And so the key thing about DBT
is that it meets people with BPD where they're at.
It doesn't try and force them to control or suppress
their emotions or try to over explain them or reappraise
(48:40):
them the way that maybe other therapies do. It actually
asks for people to live within it and with the
emotions in a way that people talk about as being
highly highly effective. So it's built around four key skills
or pillars. The first is mindfulness. You might hear the
word mindfulness and be like, oh my God, can we
(49:01):
not talk about that anymore? And I get it, Like
I feel like mindfulness is this thing that gets thrown
at any mental health problem and it's like, well, have
you tried mindfulness? Have you tried exercise? Have you tried
this or that? And it's like, okay, I don't think
sitting in a room and thinking about my thoughts for
an hour or so it's going to help me. But really,
what it's about is being grounded in the present moment,
and that's something that you can control. And it's also
(49:23):
about observing feelings without judgment. This is a very hard
skill to develop. A lot of the time we will
feel a feeling and we either put it in the
good or the bad category. Now, if you're someone who
has these very polarized emotions, as is the case with BPD,
where that's an even more sharper contrast. Being able to
(49:44):
just respect an emotion and not force your way or
push against it or try and force your way through
it is incredibly helpful. Then there is distress tolerance, so
supporting the individual so that they can survive a crisis
without worsening a situation. Learning how to cope with pain
without acting impulsively. Then comes emotional regulation, identifying patterns, learning
(50:11):
strategies to reduce our vulnerability to extreme emotional swings. There's
this one strategy I heard of that's like the zoo
strategy so or the aquarium strategy. I can't remember what
it's called, either the aquarium or the zoo strategy. And
it's like watching your emotions like they're behind a glass
window pane, and you can stay there for as long
as you want, and you can watch how your emotions
(50:32):
want you to react or where they're moving in your body,
and then you can just walk away when you're done observing,
and when you get bored of that emotion and finally
there's interpersonal effectiveness, learning how to communicate needs, clearly, set boundaries,
maintain healthy relationships, not lash out, not immediately assume abandonment.
(50:52):
That's something that a lot of people with bb with
DBT have not always Sorry with BPD, Oh my god,
so many bees t's and d's and peace, that's something
that people with BPD haven't always been taught. This is
a really really powerful therapy. I feel like I've said
that a million times. One of its unique strengths is
(51:13):
the emphasis on validation. So it really acknowledges the reality
of someone's emotional pain. And it's not sitting there and
being like it's not asking someone to change overnight. It's
not asking someone to not have these feelings. It's just
asking for them to interact with them in a different way,
in a way that's actually maybe not going to work
(51:33):
for everyone, but for people with BPD, it really does.
Another approach, another evidence based approach, I should say, is
structured clinical management or SCM. This was developed in the UK.
As you can imagine, DBT incredibly time intensive, incredibly expensive,
and basically they wanted a more generalist alternative to such
(51:55):
a therapy. Research has shown SCM is that effective alternative.
At its core, this is about structure, consistency, and support.
As we've heard today, many people with BPD experience chaos
in their relationships and in their daily lives. So having
a reliable professional who provides clear expectations, who is there
(52:16):
as a consistent contact, who can literally just provide you
with practical guidance can be profoundly stabilizing. It's like having
a body. It offers really regular, reliable support, psycho education,
and basically someone who is like a sounding board when
your emotions are making your thoughts very loud, or making
(52:37):
it making you think that a certain reaction is appropriate
when it just might not be. Really, what this provides
is predictability for people whose early environments were unpredictable or invalidating.
Simply having like a clinician or a trusted individual who
consistently listens, who provides guidance, who doesn't withdraw raw in
(53:00):
moments of crisis can be just like the can be it,
that can be the thing that you need. It's incredibly affirming.
Although like the skills, these kinds of treatments teach are
so valuable, it's really about how they can start to
create that consistency for themselves and how they can basically
learn in a non avoidant way that someone leaving them,
(53:24):
someone being mad at them, a relationship not working is
not the end of the world. They can trust in
themselves to survive again. The prognosis is really really good.
And that's what makes it hard to hear about the
high rate of distress and the high suicide rates and
(53:44):
the high self harm rates to do with BPD because
it is so misunderstood, because people don't get a label
because they perhaps don't know this information. There is this
whole suffering silence. If I talk about it, someone's going
to immediately characterize me, is this kind of person? And
this is just something I have to get over kind
of mentality. And I hope this episode is kind of
(54:07):
lessened that for someone a little bit so they understand
that actually, with the right people, there won't be stigma.
And it's really like building a skill. You put the
time in, you put the effort in, you can experience
a different way of relating to people that you really
want to love and be close to, and of relating
(54:27):
to yourself. What looks like chaos for a lot of
people in these situations is usually just pain. What looks
like manipulation is usually just desperation, and what looks like
hopelessness is in reality like something that you can help
yourself with. Like there are so many stories of change
and transformation in this space. I will say, if you
(54:50):
are a romantic partner of someone with BPD, maybe that's
why you're listening. And I'm sure you can understand all this.
You can have empathy and compassion for this person and
still realize you may not want to be with them.
I've kind of circled this matter cautiously throughout this episode.
Abandonment is such a big issue for people with BPD,
(55:11):
But something I've always believed is that no one is
owned a relationship just because of what they're enduring or
going through. And you aren't obligated to stay with someone
when things are dysfunctional and when they haven't perhaps gotten
the help that they need yet and it is available
to them, even if they have limited control over this reaction.
It doesn't mean that you have to be there to
(55:31):
bear the brunt of it. You know. This is what
we define as a personality disorder, after all, And regardless
of all the really positive statistics we have about remission.
Maybe at the end of the day, your personalities just
don't align and the condition is just part of that.
They might just need to find their person the same
way that we all do. So if you are also
(55:52):
listening to this, thinking, how do I manage this incredibly
emotionally complex relationship with someone who's afraid of being but
I don't want to be.
Speaker 1 (56:01):
With them anymore?
Speaker 2 (56:02):
Approach it with a lot of kindness. See if you
can maybe get them some help. Maybe this isn't the
right time, Maybe they do need to get treatment and
know that the reaction they have is not always a
reflection of you, and that you are allowed to make
the best choice in your situation. You know, this is
(56:23):
a very complicated condition that's confusing even for those who
have been experiencing it and living it for decades. So
I just want to say, there are still a lot
of things we don't understand about this. Perhaps there will
one day be a whole manual and guidebook for navigating
this kind of like maze that is operating in the
mind of everybody, but specifically the maze in the mind
(56:46):
of people with BPD. But until then, I think it's
just good to have empathy for the things that we
don't understand and the things that we don't know, and
empathy for you if you're experiencing BPD, for living in
a brain that it's probably very different to everyone else's,
and I can imagine it's kind of confusing sometimes to
really want to be able to respond or behave in
(57:08):
the way that others are and just not knowing how.
So I'm sending you a lot of love. I hope
that this has been informative. I hope that you've gotten
a good introduction, yeah, and that things change for you
if you want them to, and that you find some
kind of hope at the at the end of the tunnel.
Thank you again for listening. If you have made it
this far, leave a little emoji down below.
Speaker 3 (57:31):
What am I gonna do? My emoji?
Speaker 2 (57:32):
Of guys, I always get this far and and I forget,
maybe like a little star I don't know. I'm feeling
a star emoji today, so I know that you've made
it this far. I want to thank our research at
Libby Colbert for her contributions to this episode. As a reminder,
there will be resources down below, I highly advise that
you go and check them. Out. If this episode resonated
(57:54):
with you, and if you want to learn more, or
if you just need some additional help, make sure you're
following us on Instagram a's that psychology podcast. Almost forgot
my own Instagram handle That's embarrassing, and that you are
following along on Apple, Spotify, iHeartRadio title wherever you are listening,
and give us a five star review if you're related
or felt seen by this episode. Until next time, stay safe,
(58:17):
be kind, be gentle with yourself, and we will talk
very very soon
Hello everybody, and welcome back to the Psychology of Your Twenties,
the podcast where we talk through some of the big
life changes and transitions of our twenties and what they
mean for our psychology. Hello everybody, Welcome back to the show.
(00:24):
Welcome back to the podcast. New listeners, old listeners. Wherever
you are in the world, it is so great to
have you here. Back for another highly requested episode as
we break down the psychology of our twenties. So, guys,
today we're going to talk about borderline personality disorder or BPD.
(00:45):
Maybe you have seen the term thrown around online, especially recently.
Maybe you have seen it used to describe people who
others think manipulative or dramatic or even dangerous, without really
even knowing the whole story or what BPD actually means.
Maybe for some of you listening, you know this is
a term that you've encountered more personally. Maybe this is
(01:07):
a diagnosis that you've received. Maybe you grew up with
a parent who had BBT and didn't really understand it
until recently, or maybe you are hearing it for the
very first time on this podcast. What I really want
to do today is give a proper and real introduction
(01:28):
into the world of people with BPD, into what this
condition actually means, and probably more importantly, what it doesn't,
because I think, as is the case with a lot
of mental health disorders or personality disorders, the truth gets
rather twisted, and I think it gets made smaller until
(01:50):
it becomes a bit of a stereotype. This has definitely
happened with borderline personality disorder. At its heart, this is
a condition. This is a disorder of emotional regulation and attachment,
meaning it massively affects how someone feels, their mood, their relationships,
how they see themselves, how they view love, one of
(02:13):
our core human experiences. Some of the ways that I've
seen people describe it is basically like a lack of identity.
You get such intense feelings of anger and nihilism that
you feel completely empty, and then the next day or
the next minute, you will be filled with such an intense,
astatic joy that you feel like the world could never
(02:38):
be an evil place again. It's scary kind of not
knowing how you feel about the same situation, and therefore
kind of not knowing who you are. Others have also
described this emotional pendulum by saying It's like having so
much emotion that you don't know what to do with it,
but also at the same time feeling so empty, and
(02:58):
having both of these exist at the same time. You
can go from loving a person so deeply you think
you know you might die, and then suddenly hating everything
about them. It is the disorder. It is a rollercloster disorder.
That's really like the best way to put it. And
what actually is behind this emotional intensity? Because I think
(03:20):
you may know the symptoms, you may know the general
character profile of what people assume people with BPD look like,
but do we really know the origins. Do we know
how this disorder impacts the mind, why it is so
linked to attachment. I think a lot of people don't,
So I really want to talk about it today. I
(03:41):
really want to reduce a little bit of the stigma
and just talk about some probably unknown facts and some
unknown research about BPD that you might not see presented
on TikTok and that you might not see in everyday
discussions about this about this condition. As always, I say
this every time with these specific episodes that we do
(04:03):
on mental health disorders. This is not a diagnostic tool.
It's not a diagnostic tool for yourself or to be
used for someone else, nor is it a substitute for
therapy or real life intervention. We're also going to be
talking about some sensitive topics today to deal with suicide,
suicidal adation, and self harm. So if that's something that
(04:25):
you are sensitive towards, just consider whether this episode is what.
Speaker 2 (04:30):
You need to hear today. It will be here in
a month, it will be here in a year. You
can always come back to it when you feel more prepared.
I will leave you some links in the description for
further resources. So if you or someone you know may
be experiencing borderline, if you think they may be experiencing borderline,
if this episode has left you distressed, hopefully those help
(04:52):
you find the help that you need in your local
area and for what you're going through. So I just
want to give that little disclaimer before we get into it.
It probably will be a more heavy episode than we
used to, but take care of yourself and without further ado,
let's dive into the psychology of borderline personality disorder. So
(05:18):
I want to begin with a little bit of like
an imagination exercise to really get across even just a
small part of the experience of someone with BPD. This
is how people describe it. Imagine for a moment that
every emotion that you have felt today or in the
last week, you are currently feeling right now, all at
(05:43):
the same time. You know, you don't just feel happy,
you feel ecstatic joy. You don't just feel sadness, you
feel bottomless despair. Every moment of rage, every moment of laughter,
every moment of hatred from the past week of your life,
your experience seeing it right now, These visceral emotions that
(06:04):
I think are only usually available to us for a
tiny portion of our lives and of our days. People
with BPD they feel them all the time. They feel
them much more often in much much higher definition. Now,
imagine that these emotions get split into positive and negative.
(06:26):
And now instead of just feeling all your emotions at once,
you're feeling all or nothing. You're feeling either entirely good
and loved and happy or entirely miserable and depressed and angry.
And that rapid effective or emotional instability can be triggered
by something that many of us would consider really really tiny,
(06:50):
really really minuscule. You know, a delayed reply to a
text message, a certain facial expression a certain slight or
perceive rejection. Not only is the depth of feeling amplified
for people with BPD, and there have been studies that
have shown that people who have borderline personality disorder may
(07:12):
actually have access to a more nuanced emotional scale, but
the rate at which these emotions is changing within someone
with borderline personality disorder is also accelerated. This is what
people often mean when they describe BPD as emotional instability,
and in fact that's exactly what some diagnostic manuals call it.
(07:36):
This is a really important caveat before we get any
further in the episode. If you are listening from somewhere
outside of Australia or outside of the US, you might
know borderline personality disorder is something entirely different in the UK,
in parts of Europe, in parts of Asia, you might
hear the term emotionally unstable personality disorder or eupdrather than
(08:00):
borderline personality disorder. Now, the reason I'm going to go
with BPD for this episode is obviously I am in
Australia and if you couldn't tell from my voice, but
also it is the term that is used by the
DSM which we've spoken about before many times on the podcast.
It is the diagnostic statistical manual of basically every single
(08:22):
mental disorder known and categorized. So you know, if I
was to start saying emotionally unstable personality disorder instead of
borderline personality disorder, I think I would kind of slip up.
So you may have heard this as a different term,
as a different in a different way. They do mean
the same things. There is a reason though, that they
(08:44):
are labeled differently. The term, or the preface of borderline
comes from kind of an older way of thinking. Back
in the day, clinicians believe that people with BPD with
this condition were on the borderline between psychosis and neurosis.
Neurosis is also known as anxiety. Today, most experts agree
(09:09):
that that is not actually what's happening. That description is outdated.
We don't really use terms like neurosis anymore. Emotional emotionally unstable,
I should say, gets closer to the reality.
Speaker 3 (09:21):
What is really.
Speaker 2 (09:22):
Happening with this disorder is a nervous system that has
been caused or forced to react intensely and unpredictably to
emotional triggers. Let's talk about prevalence here for a little bit.
BPD is estimated to be prevalent in anywhere between zero
point seven to five point eight percent of the general population.
(09:43):
Uber specific numbers right there, And I'll tell you why
those numbers.
Speaker 3 (09:48):
Are so specific.
Speaker 2 (09:48):
They're so specific because that is the minimum and the
maximum that researchers believe this condition could be present when
considering factors like a lack of diagnosis, especially in certain
population groups like men, or in certain countries with underdeveloped
mental health systems where there isn't as much I guess
(10:11):
like knowledge of this or opportunities for diagnosis. They're also
considering if there is an overrepresentation. So sometimes when people
try and find these estimates of like how common is
a disorder in the world, they like to go as
small as possible and as big as possible. So when
you hear five point eight percent, I don't want you
to think that anytime you go into work, anytime you're
(10:34):
walking down the street, one in every twenty people have
borderline personality disorder. Again, it's just like the max of
all maxes. Now let's talk about more deeply. Let's talk
about what this disorder actually contains. What are the hallmark symptoms?
Of BPD. So, according to the DSM five, if you
(10:58):
want to be diagnosed with borderline personality disorder, a couple
of things have to be true. Firstly, you have to
experience a certain number of the following symptoms. An intense
fear of abandonment, unstable relationships and unstable and stable self image,
so feeling amazing one minute terrible the next, impulsivity, recurrent
(11:20):
suicidal behavior or self harm, emotional instability, rapid intense mood changes,
chronic feelings of emptiness, intense anger inappropriate to the situation,
and at the extreme, stress related paranoia or dissociation. I
think that as of today, as of right now, as
(11:41):
I'm recording this, you need to have five or more
of these symptoms present over a significant period of time
and across various contexts. So you can't just feel emptiness, impulsivity,
and intense rage when you're around your family and your
family only, or you can't just experience that when you're
(12:02):
at the job that you hate. It has to be
something that unfortunately isn't purely environmental or context based, but
which sits with you throughout all social, physical, emotional contexts.
That is kind of the hurdle that you have to
jump over to be diagnosed with BPD. We're going to
talk about a couple of the other hurdles later on.
(12:22):
Don't worry, we'll get to it. So clearly, when we
talk about instability, this isn't just having a few mood
swings it These swings are full body. Their affect identity relationships.
They affect our relationship with ourself, even sometimes how we
see reality. One of the most devastating aspects of BPD
(12:48):
is the way that it heightens risk for self harm
and suicide. And this is kind of a known, very
sad secret of the community of people who in're and
suffer from this condition. I saw this statistic the other
day that as many as seventy percent I believe of
those with BPD will attempt suicide at some point in
(13:11):
their lifetime. That makes borderline personality disorder one, if not
the most high risk psychiatric diagnosis when it comes to mortality.
I would assume it would be second only to anorexia.
That statistic isn't necessarily meant to shock you, although it
definitely shocked me. Seventy percent is a ridiculously high number,
(13:36):
but it's meant to just highlight how intense and painful
this disorder can be for those who are living with it,
whereby the only response many of the people who are
enduring this condition believe they can have the only appropriate
response is a drastic, devastating, and permanent one. Another key
(13:59):
complexity to do with BPD is that it actually rarely
exists alone. We talked about those hurdles you need to
get across. This is the second biggest hurdle. Getting the
diagnosis is actually quite difficult because for someone with BPD,
it is highly likely, in fact, it is more probable
than not, that they will also be experiencing another co
(14:21):
occurring mental health condition. The research in this is a
little inconsistent, but in terms of the rate of co
occurrence with other mental health conditions, anywhere between sixty three
to ninety five percent of people with boderline personality disorder
will also have another diagnosis at the time of their diagnosis. Now,
(14:44):
that number, the sixty three to ninety five percent that
was found in a very well known twenty nineteen Swedish
population study which looked at almost two million people with BPD,
So I think that we can say that number is
fairly accurate. Two million people I think that is the
(15:07):
largest sample size of any study we have ever mentioned
on the podcast before. Ever, some of the most common
co occurring conditions are the ones that are obviously most
common in society in general, so depression, anxiety disorders, bipolar disorder,
but then also PTSD, complex PTSD CPTSD IS it's called
(15:29):
for short substance use disorders and eating disorders. This one,
especially eating disorders and BPD are incredibly common, especially bolimia
and binge eating disorder. Now this overlap, obviously can make
things quite tricky. Imagine going into a doctor's office and
(15:51):
you know, really all your symptoms are coming from a
large tumor, but instead of treating the tumor, they start
treating gas on your leg, and they start treating you
for a vitamin deficiency, and they start treating they send
you to the dentist to get like dental treatment, and
all along you have this big tumor that all of
this stuff is coming from. Like that's how some people
(16:13):
describe BPD. It's like you're treating you go onto I
don't know the medical system, specifically the mental health system,
and you have this big thing that is really bothering you,
that you can't figure out, and as in order to
get a final diagnosis, all these other little things get
treated or get labeled first, when the big thing kind
(16:34):
of goes undetected. I've heard so many stories of this
from listeners of people who, you know, they had not
even heard of the term BPD until they were in
an impatient treatment for an eating disorder five years after
they first developed said eating disorder, or they've been treated
(16:56):
for depression and anxiety for years before suddenly someone sit
down and says, you might have this, and it's like
the key that unlocks the door. I think that's similar
for late stage diagnosis for ADHD and for autism. Often
people don't get the label that they need and that
they would would really give them an answer until a
(17:17):
little bit later in life. So where does BPD actually
come from? Psychologists researchers. They will often turn to the
biosocial model to explain the origins of BPD. Now, the
biosocial model was originally proposed by Marshall Lyman in the nineties,
(17:38):
I think, and she also is the creator of Dialectical
behavior Therapy DBT, which you have probably heard about on
the podcast before. We're going to circle back to that
in a second. But according to this biosocial model, BPD
develops from a combination of a couple of things, almost
like a perfect storm. It is not a singular thing
(18:00):
that creates it. Firstly, there must be a biological vulnerability,
meaning a person is born naturally born with a heightened
emotional sensitivity, a certain specific kind of temperament, or heightened
emotional dysregulation. An individual basically is seen in this case
to have had a predisposition for either hyper arousal or
(18:22):
hyper reactivity, so their nervous system reacts more strongly to
emotional stimuli and takes longer to return to a baseline
because of their genetic blueprint. It has nothing to do
with environment. Yet there's a lot of different theories and
pieces of research looking at the specific biological basis behind
this hyper arousal or hyper reactivity. And what a lot
(18:46):
of people typically come back to is this one structure
in our brain, one of the smallest structures, which is
the amygdala. Now, the amygdala sits right in the center
of what we call our old brain. It is responsible
for detecting threats and for triggering an emotional response like
fear or anger, which will in turn also trigger a
(19:08):
physical response. Now in people with BPD, when they do
fMRI scans of these people's brains, what they tend to
find is that the amig deala is hyperactive, meaning that
when a rather ubiquitous or small emotionally experienced occurs, it
reacts in a disproportionate way compared to a so called
(19:32):
and I hate saying this, a so called normal brain
or a control brain. The brain's alarm system in this
case goes off the slightest sign of rejection or criticism
because it cannot distinguish between something that requires a two
percent reaction and a two hundred percent reaction. That is
(19:53):
part of the intensity behind this disorder. Now, on the
other side, we have the prefrontal cortex. Now, the prefrontal
cortex and the amigdala often get talked about together a
lot because they are like, how do I describe it?
They're like on two sides of the balance beam. The
prefrontal cortext she is logic, she is regulation. She is
(20:13):
the thing that provides reason, executive functioning and helps calmas down. Now,
if the amygdala shows hind reactivity, the frontal lobe shows
reduced activity or reduced connectivity in people with BPD. Basically
there are less roads, less fast pathways running around the
(20:34):
frontal lobes, so messages are a little bit slower. So
you've got a brain where the emotional accelerator is extra
sensitive and the braking system is less responsive. Slash doesn't
really work. That's a hard mind to control for anybody.
Of course, this does have a genetic component. If you
(20:55):
have a parent, if you have a sibling, if you
have an immediate family member with BPD, the chances of
you then developing that disorder sits around the forty to
sixty percent mark. It's about forty to sixty percent heritable. Now,
it's kind of hard to kind of hard to detach
(21:15):
whether it's because you've been raised in an environment where
someone has a disorder that causes them to be quite
polarizing it and reactive, or whether it is purely genetic.
The best way we can figure it out is through
twin studies, and it does seem to be that there
is both a genetic and an environmental context here. The
(21:39):
genetic aspect of having a family member or having a
certain genome and whatever it is that has been primed
for BPD is that that vulnerability can actually lay completely
dormant for somebody's whole life or for many many years
(22:00):
until something triggers it. And this is where we get
to talk about the second part of the biosocial model,
which is the role of an invalidating environment, meaning that
a lot of people who go into develop BPD from
a young age probably existed in a world that didn't
(22:20):
teach them how to manage their emotions, didn't give them
a safe space to manage their emotions, and who probably
experienced something very severe and extreme during their childhood that
they couldn't grasp, they couldn't control, they weren't supported to
understand as a child, and so from that point on,
(22:41):
all of their emotions were at level one hundred. You
guys know, my guilty secret is that if I am
researching an episode where I want to know more about
lived experience, I love going into Reddit and reading through
all like the I guess, like the support boards, and
in one of the ones for BPD, I found a
(23:03):
lot of people talking about this experience of before and after,
like a moment where they felt their brain, this new brain,
their BPD brain like switch on. And this is exactly
what we're talking about there's a biological vulnerability, a light
switch that has suddenly switched on by an environmental experience.
(23:26):
Now what might that environmental experience be, Well, there are
a lot of options, a lot of really actually terrible options.
But it's often trauma, either subtle or overt, that adds
to these effects, and that creates the personality disorder or
personality type we now call borderline or emotionally unstable. A
(23:49):
twenty eighteen study published in the Journal for Personality and
Mental Health looked at a sample of adolescents from thirteen
to seventeen who were at an inpatient unit as a
result of their BPD, and then of these people who
of these children who had BPD, they also matched them
with a sample of people of the same age who
(24:12):
didn't have BPD, and then a further two hundred and
ninety adult in patients with BPD, And they just got
every single group, the teenagers with BPD, the teenagers without BPD,
and the adults with BPD, to answer a few questions
about their childhood, specifically experiences of abuse or neglect. What
(24:34):
the study found was that adolescents with BPD described significantly
more abusive experiences than their psychologically healthy peers, but often
they did so in quite a detached way. Oh you know,
I don't really know why I'm like this, But then
they would go on to explain something that was just
(24:55):
like absolutely psychologically crushing. Even more interesting is that that
recall of those events, and I guess that rate of
trauma and emotional or childhood neglect was very similar in
the adult group as well, And a lot of these
people found that the impact of their childhood adversity was
(25:20):
almost more pronounced in adulthood, perhaps due to the prolonged
effects of early trauma and the fact that the inability
to regulate themselves through those experiences had meant that the
impact of those experiences had just been allowed to compound trauma,
(25:41):
especially when it's relational trauma, to do with how your
caregivers treated you, to do with maybe a death in
the family, to do with social rejection or social pain
or grief. It also heightens a fear of abandonment, and
it makes trust in relationships a lot more difficult, and
it re enforces that hyperreactivity to emotional stress, which is
(26:05):
another core element of BPD. Now, trauma doesn't have to
be this huge, major thing that you can point to
and reflect on and say, this is where it began.
For a lot of people with BPD, they actually say,
you know, my childhood was pretty good. They don't recount
having an abusive childhood. But as we said before, when
(26:27):
you ask them to describe it, it's you know, parents
who are physically present, who put food on the table,
but are deeply dismissive, parents who themselves had BPD, and
because that's the only caregiving and parental love the child
or the person has ever known that felt normal to them,
(26:49):
or it's just not being valued. It's environments that just
didn't match the child's sensitivity, where they felt like they
were too much or too dramatic, where they felt like
every time they said, don't abandon me, someone would or
someone would think that it was funny to play into
these insecurities. Really, what we are pointing to here is
(27:12):
how trauma interacts with biological vulnerability, which then interacts with
emotional invalidation or environmental invalidation. That is the trifecta that
creates BPD, and I would say ninety nine percent of cases,
and it's what shapes emotional regulation, self concept and of
(27:35):
course our attachment pattern. Now, with that in mind, we
are going to take a short break, but when we return,
let's really talk about how this impacts our relationships, because
I think this is the space where people are most
curious about BPD or often first introduced to BPD.
Speaker 3 (27:54):
So stay with us.
Speaker 2 (28:00):
Something really critical and key with BPD, as I mentioned before,
is the role of relationships. They carry so much of
the disorder's weight, and a lot of the times, I
think it is where BPD becomes most visible in everyday life,
especially to others. If you have watched Girl Interrupted, Fatal Attraction,
(28:26):
Silver Lightnings Playbook, these are like pop culture references that
I actually think are pretty good at explaining or showing
the intensity of this experience of people. I personally I
love Silver Lightning's Playbook. It is one of my all
time favorite movies. But if you've seen it, you will
feel or you will notice that the movie has this
(28:48):
weird way of making you feel stressed and making you
feel on edge, especially from the main character, like his
interactions with people, so they become so volatile at times,
and you can feel that through the movie. And I
apparently see I don't have BPD, but I've been told
it is a very good depiction of how this feels
(29:10):
inside the mind of someone with BPD, Like things are rising,
things are like just spiraling, and it's all joy the
next one moment, and it's all disappointment or anger or
hate the next. Psychologists often frame this through the lens
of obviously attachment theory. Many people with BPD show what's
called an anxious, preoccupied, or disorganized attachment style. That means
(29:33):
that they desperately crave closeness and connection, but at the
same time that intimacy, because it is something they desire
so much, feels deeply threatening. When closeness for them has
so often been paired with pain, rejection, or inconsistency. Love
(29:55):
becomes both the thing they need the most and the
thing they fe the most. They fear the loss of
that love. They fear that someone is just inevitably going
to leave them, and they fight very very hard internally
and externally to prevent that from happening. This plays out
(30:17):
in what we sometimes call a push pull dynamic. On
one hand, they're craving this bond, they're craving intimacy, they
are pulling it closer, and on the other hand, they're
so fearful of being hurt that they push away, and
that's what the withdrawal and the anger looks like. There's
a very famous phrase used to describe this, which is
(30:39):
I hate you, Please don't leave me. You've probably heard
of it.
Speaker 3 (30:42):
It is actually the.
Speaker 2 (30:42):
Name of one of the most well known books on BPD,
and it's exactly as it sounds. I hate you, please
don't leave me. I actually love you. What we sometimes
realize is that love for them feels so intense that
sometimes it just gets confused with all other intense emotions.
(31:05):
Or you start to anticipate the pain of someone leaving
before it happens, and so you're reacting, or you are
acting out this future imagination that you have of how
it's going to feel when this all comes to an end.
Relationships really do feel like, as they described, a pendulum
swimming between extremes of idealizing one's partner and then devaluing them.
(31:29):
At one moment, you know your partner is perfect. They're
the best thing that's ever happened to you. They are
gorgeous and beautiful and kind and everything you've ever wanted.
And the next, after some perceived slight or disappointment, that
same partner might be seen as cruel or untrustworthy, and
in that moment, it feels like you never want to
see them again. It's ruined. It's not that the person
(31:51):
with BPD wants to see things in this black and
white way. It's that their emotions are so overwhelming that
it's hard to hold both the good and the bad
in one mind at the same time. This has a name.
It's known as splitting, and it's basically the inability to
hold opposing thoughts, feelings, or beliefs all at once. Obviously,
(32:13):
no one is ever perfect, you know. Even if someone
is literally our soulmate and the love of our life
and we've managed to find them, things do go wrong.
But for someone with BPD, often to survive the internal
emotional volatility, they do find it easier to make outright
categorizations like this person is evil or this person is
(32:36):
an angel. And when someone sits in the middle, sits
in the gray area, they cannot just be a normal
person with flaws, with inconsistencies, with normal human reactions. That's
what makes everyday relational conflict, disagreements, disappointments so difficult for
someone with this disorder. I read a few reports of
(32:58):
what this felt like for people with BPD, and what
some people describe is this inability to detach the bad
feeling about the situation from the person in the situation. Obviously,
having arguments in a relationship is uncomfortable, but also there's
this whole rupture and repair idea of you do need
(33:19):
to sometimes have friction and conflict in order to build
the muscle and build the volume of your relationship and
to move forward, and so it's kind of just a
normal part of things. Even if it feels bad, now
you can move forward. Someone with BPD sees that situation
and is like, well, that's just all the evidence I
need that this person is going to treat me poorly
in the future, that our relationship is doomed, and so
(33:42):
of course they react accordingly. They react defensively or from
a place of pain. You know, you have this fight
with a friend, right, It's heated, it's rough, it's hard,
and if you have BPD, sometimes you might feel like afterwards, Okay,
well that friendship is over. I guess like, that's dumb.
That person is terrible person. They never want to see
me again. So I'll be the first one and never
(34:04):
want to see them again first, if that makes sense,
And then three days later, you know, they'll text you
wanting to grab a coffee or wanting to hang out
and talk it through. And it's this confusion of like,
what do you mean people can be nuanced? What do
you mean this wasn't the end? You know, I'd already
emotionally prepared to cut you off.
Speaker 3 (34:20):
What is this?
Speaker 2 (34:21):
Why doesn't everyone think the same way as me? One
account I read that was really profound was this person
who again was on Reddit and was like genuinely seemed
confused that someone who she had had an argument with
wanted to repair the relationship. She was like, what do
you mean? Surely this is all the evidence we need
(34:43):
and that we require to know that this friendship isn't
going to work out. Conflict is part of a relationship,
but if you have this emotional instability and these previous
experiences of being hurt or being let down, well, of
course it's going to be a lot harder to tolerate.
People who are actually the romantic partners of people with
(35:06):
BPD often report really struggling sometimes with this cycle of
closeness and conflict. Feeling deeply loved one moment and painfully
rejected the next There was a twenty fourteen study that
looked at this specifically the partners of people with BPD,
and what they found was that a lot of these
romantic partners reported an increased sense of hurt in the
(35:30):
aftermath of arguments and an increased sense of caregiver burnout
or caregiving anxiety. When you feel deeply personally responsible for
someone else's emotions all of the time and that person
is also, you know, a little bit difficult or impossible
to predict, that takes its toll. It takes its toll
on the other person, It takes its toll on the
(35:53):
structure of the relationship as a whole. Parents of young
adults or teenagers with BPD also report feeling There was
another study, I think in twenty twenty one that looked
at them as the main relationship in the life of
someone with BPD, and again, it's this weird it's this
weird difficulty of feeling helpless and guilty but also angry,
(36:14):
wanting to set boundaries, but also wanting to let this
person be in control because that might be the best
way to manage the situation. As a result of this,
which again, a lot of these people, actually all of them.
They cannot control this amplified emotional reaction, but as a
result of it, there is a huge link between BPD
(36:34):
and loneliness because of how individuals with this condition relate
and interact with others. It is really common for people
with BPD to self isolate as the only appropriate reaction
to these behavioral patterns that number one, they don't want,
but number two, they find themselves being unable to control.
They don't actually want to hurt people, They don't actually
(36:57):
want to have this competitive relational pattern of loving someone intensely,
trusting someone intensely, and then one thing going wrong and
feeling like the world is splitting open, and so because
they find it difficult to manage the emotional consequences of relationships,
(37:18):
they just avoid relationships. In general. Research shows that not
only are people with BPD more likely to be lonely
compared to the general population, but their social networks are
often much smaller, much less diverse, also less satisfying. And
maybe we could even trace this back to what we
were talking about before with the suicidal ideation and behavior.
(37:41):
Loneliness is of course going to be another factor, not
only can you not control your emotional state. You also
don't get that same support socially that maybe you really
need and that other people do receive. You know, I
just I can't imagine how isolating that would feel. To
want love and to want to be around people so badly,
(38:04):
and to really love the depth and the intensity and
beauty of relationships, but also know that there's a part
of you that just can't handle it, and just deciding
to opt out, like that's a crazy sacrifice and a
crazy decision that people have to make. And this is
the thing for people with BPD. There is this stigma
(38:26):
that their capacity to love is kind of broken, that
they can't do it normally. That's not true. It's simply
tethered to fear in a way that I guess a
lot of us don't really understand unless, of course, we're
in it, unless we're experiencing it. Let's talk some more
about the stigma around BPD, since we've kind of gotten
(38:49):
started on that now, because I do think it's one
of the most stigmatized mental health diagnoses out there. Part
of the stigma comes from a misunderstanding about the behavior's
associated with BPD, particularly the intention of these behaviors. Outwardly,
someone might appear to be doing things to get attention,
to be manipulative, to be dramatic. A partner might you
(39:14):
know this person might frantically call you or have these
very intense emotional outbursts, and you might think that that's
a control tactic that I hate you, don't leave me
experience it. You know, it might not be manipulation. It
actually rarely is manipulation in a calculated sense. It is
just the only panicked way that someone with VPD can
(39:38):
respond to a situation. They do not have the same
emotional and interpersonal regulation skills that the again average person has,
so they are not sitting there and thinking, well, if
I react this way, I'm going to get a certain response.
And even if they are, it's not because they want
to necessarily hurt someone. They're just doing anything to get
(40:03):
back to a place of emotional safety within the relationship.
It's a survival strategy that push pull that I want
to let you in, but I don't know how to.
I don't want to be disappointed. It does cause them
to do things that howardly might seem really strange, but
for them make perfect sense or don't make sense, but
they feel like they.
Speaker 3 (40:23):
Have no control.
Speaker 2 (40:25):
Of course, I do think cultural representations only make matters worse.
We've talked about some good representations. A lot of the
stuff we see these days, or the characterizations of people
with BPD online are less educational, less informative, And you know,
when you see social media or TV or movies frequently
(40:46):
portray people with BPD as toxic x's or dangerous individuals,
it reinforces this fear and this sense that they don't
have empathy, when that's totally not what's going on here.
I will say caveat here. In some ways, I do
understand sometimes why people want to talk about it that way,
because that's their perception and that's their truth. Their truth
(41:08):
was that they were in a relationship with someone who
had this condition, and they experience things that really hurt them,
and they experience behaviors that maybe left them feeling very
unstable and could be interpreted as dangerous. Two things can
be true here. Someone can be experiencing personality disorder they
really don't have a grasp of, and that's might not
(41:33):
be entirely their fault, and someone else can equally be
suffering from that same condition. On the other end, on
the kind of sharp pointing end of the behaviors that
the person with BPD is using to protect themselves. So
again it's complicated, it's nuanced. I think it's hard to
talk about because you want to validate someone's experience of
(41:55):
what is again a diagnosable mental health disorder, but you
also want to understand that, yeah, people do get hurt
by these behaviors, whether inttentionally or not. The thing is
is that people with BPD are not sociopaths, they're not narcissists.
They don't have the same lack of empathy as you
(42:18):
would maybe expect from someone who is deliberately manipulative. Maybe
they have comeobidity, but it's not a significant level of them.
So they get the shame, They understand it, They understand
their omratic behaviors. They don't want to be like this,
and that's really hard because that self criticism and these
(42:40):
misconceptions actually make them feel more isolated and hopeless, less
likely to get help. Another thing we need to talk about.
Another layer of this actually comes from gendered assumptions around PPD.
So something you may not know is that historically BPD
has been diagnosed significantly more often in women. Some estimate said, ye,
(43:00):
it's about seventy five percent of diagnosed cases are female.
And if we look back, this has basically reinforced this
cultural stereotype that emotional intensity, volatility, relational sensitivity is inherently feminine,
or that women who express strong emotions are somehow hysterical,
overly dramatic borderline. These stereotypes are really dangerous because they
(43:23):
don't just influence some random person on the streets judgment
like they shape clinical perception as well. And we know
this because of again those diagnosis rates. A woman who
is emotional anxious, having issues in their relationship, prone to
(43:43):
self harm, they may be more quickly labeled as borderline,
whilst a man with the same underlying issues and patterns
might be seen differently. And that's probably what's resulting in
men being underdiagnosed even when they meet the criteria for BPD.
Why partly because the same way that autism diagnosis has
(44:03):
been set up to catch more young boys due to
their socialization, a BPD diagnosis has been set up to
catch more women because of how they have been socialized.
Men tend to externalize distress in ways that society and
clinicians would interpret differently. Instead of expressing sadness or fear,
they might display anger or impulsivity or risk taking behaviors
(44:26):
or substance use. These expressions can lead clinicians to assign
very different diagnoses. As we talked about before, a lot
of people with BPD get a lot of different labels
before they find this final one that really does describe them.
So for men, it might be antisocial personality disorder, anger
management issues, conduct disorders, and that means that the treatment
(44:48):
they receive only addresses the reactions or the outbursts rather
than the cause. The result is, you know what we
know as a gendered blind spot. Women are overrepresented in statistics,
so that means that we have a very limited way
of seeing this disorder that has been influenced by gender,
and it means that the disorder has often been stigmatized
(45:09):
for just meaning that someone overreacts or is labeled as
manipulative not to be trusted, whilst men are underrecognized and
they go without support entirely. Here's the thing that we
have not mentioned once, which now I'm realizing I probably
should have mentioned it earlier.
Speaker 3 (45:25):
But BPD is treatable.
Speaker 2 (45:28):
For a long time, clinicians believed it wasn't. Patients with
BPD were seen as too difficult, too resistant, to uncooperative.
We now know recovery or what they call remission from
this disorder is not only possible, it is incredibly common,
more so than what you are thinking incredibly common. So
(45:51):
we are going to take a short break now, but
when we return, I want to talk about that. I
want to reveal why therapy for BPD is actually becoming
incredibly effective.
Speaker 3 (46:02):
So stay with us.
Speaker 2 (46:09):
So let me throw some statistics that you hear from
the National Institute of Health from twenty twelve. These results
have been reaffirmed later on, I think in twenty twenty
four they did a follow up study. They found that
this hasn't changed a whole lot. In the study, they
wanted to see if someone with BPD was put into
(46:29):
an appropriate treatment environment, how would they do and could
they quote unquote recover. What they found was that sixty
percent of borderline patients will achieve a recovery from borderline
personality disorder if they go through treatment. That number maybe
(46:50):
even higher. There was one such intervention where there was
a ninety nine percent remission rate, showing that of almost
all of the mental health disorders out there, this one
is actually one that responds to treatment very well. And
how they kind of categorize remission is a lack of
(47:14):
symptoms that create distress or cause problems socially, psychologically or physically.
A lot of people will find that the older they get,
the more symptoms will and can ease through getting therapy
and through having good therapeutic approaches to what they're experiencing.
(47:35):
The gold standard here is dialectical behavior therapy or DBT,
which we mentioned earlier. I promised that we would come
back to it, and here we are. What makes DBT
so effective is that it was designed specifically for what
you might call an under controlled personality type. Now, before
this therapy, people really couldn't figure out what to do
(47:58):
with BPD patients. And then this amazing woman came along
and she invented this, and what she really realized was
that people whose emotions are intense, whose emotions are quick
to flare, hard to regulate, who are kind of maybe
a little bit more socially abrasive at times, they need
(48:19):
a different approach to therapy compared to the traditional methods
of doing it, And so the key thing about DBT
is that it meets people with BPD where they're at.
It doesn't try and force them to control or suppress
their emotions or try to over explain them or reappraise
(48:40):
them the way that maybe other therapies do. It actually
asks for people to live within it and with the
emotions in a way that people talk about as being
highly highly effective. So it's built around four key skills
or pillars. The first is mindfulness. You might hear the
word mindfulness and be like, oh my God, can we
(49:01):
not talk about that anymore? And I get it, Like
I feel like mindfulness is this thing that gets thrown
at any mental health problem and it's like, well, have
you tried mindfulness? Have you tried exercise? Have you tried
this or that? And it's like, okay, I don't think
sitting in a room and thinking about my thoughts for
an hour or so it's going to help me. But really,
what it's about is being grounded in the present moment,
and that's something that you can control. And it's also
(49:23):
about observing feelings without judgment. This is a very hard
skill to develop. A lot of the time we will
feel a feeling and we either put it in the
good or the bad category. Now, if you're someone who
has these very polarized emotions, as is the case with BPD,
where that's an even more sharper contrast. Being able to
(49:44):
just respect an emotion and not force your way or
push against it or try and force your way through
it is incredibly helpful. Then there is distress tolerance, so
supporting the individual so that they can survive a crisis
without worsening a situation. Learning how to cope with pain
without acting impulsively. Then comes emotional regulation, identifying patterns, learning
(50:11):
strategies to reduce our vulnerability to extreme emotional swings. There's
this one strategy I heard of that's like the zoo
strategy so or the aquarium strategy. I can't remember what
it's called, either the aquarium or the zoo strategy. And
it's like watching your emotions like they're behind a glass
window pane, and you can stay there for as long
as you want, and you can watch how your emotions
(50:32):
want you to react or where they're moving in your body,
and then you can just walk away when you're done observing,
and when you get bored of that emotion and finally
there's interpersonal effectiveness, learning how to communicate needs, clearly, set boundaries,
maintain healthy relationships, not lash out, not immediately assume abandonment.
(50:52):
That's something that a lot of people with bb with
DBT have not always Sorry with BPD, Oh my god,
so many bees t's and d's and peace, that's something
that people with BPD haven't always been taught. This is
a really really powerful therapy. I feel like I've said
that a million times. One of its unique strengths is
(51:13):
the emphasis on validation. So it really acknowledges the reality
of someone's emotional pain. And it's not sitting there and
being like it's not asking someone to change overnight. It's
not asking someone to not have these feelings. It's just
asking for them to interact with them in a different way,
in a way that's actually maybe not going to work
(51:33):
for everyone, but for people with BPD, it really does.
Another approach, another evidence based approach, I should say, is
structured clinical management or SCM. This was developed in the UK.
As you can imagine, DBT incredibly time intensive, incredibly expensive,
and basically they wanted a more generalist alternative to such
(51:55):
a therapy. Research has shown SCM is that effective alternative.
At its core, this is about structure, consistency, and support.
As we've heard today, many people with BPD experience chaos
in their relationships and in their daily lives. So having
a reliable professional who provides clear expectations, who is there
(52:16):
as a consistent contact, who can literally just provide you
with practical guidance can be profoundly stabilizing. It's like having
a body. It offers really regular, reliable support, psycho education,
and basically someone who is like a sounding board when
your emotions are making your thoughts very loud, or making
(52:37):
it making you think that a certain reaction is appropriate
when it just might not be. Really, what this provides
is predictability for people whose early environments were unpredictable or invalidating.
Simply having like a clinician or a trusted individual who
consistently listens, who provides guidance, who doesn't withdraw raw in
(53:00):
moments of crisis can be just like the can be it,
that can be the thing that you need. It's incredibly affirming.
Although like the skills, these kinds of treatments teach are
so valuable, it's really about how they can start to
create that consistency for themselves and how they can basically
learn in a non avoidant way that someone leaving them,
(53:24):
someone being mad at them, a relationship not working is
not the end of the world. They can trust in
themselves to survive again. The prognosis is really really good.
And that's what makes it hard to hear about the
high rate of distress and the high suicide rates and
(53:44):
the high self harm rates to do with BPD because
it is so misunderstood, because people don't get a label
because they perhaps don't know this information. There is this
whole suffering silence. If I talk about it, someone's going
to immediately characterize me, is this kind of person? And
this is just something I have to get over kind
of mentality. And I hope this episode is kind of
(54:07):
lessened that for someone a little bit so they understand
that actually, with the right people, there won't be stigma.
And it's really like building a skill. You put the
time in, you put the effort in, you can experience
a different way of relating to people that you really
want to love and be close to, and of relating
(54:27):
to yourself. What looks like chaos for a lot of
people in these situations is usually just pain. What looks
like manipulation is usually just desperation, and what looks like
hopelessness is in reality like something that you can help
yourself with. Like there are so many stories of change
and transformation in this space. I will say, if you
(54:50):
are a romantic partner of someone with BPD, maybe that's
why you're listening. And I'm sure you can understand all this.
You can have empathy and compassion for this person and
still realize you may not want to be with them.
I've kind of circled this matter cautiously throughout this episode.
Abandonment is such a big issue for people with BPD,
(55:11):
But something I've always believed is that no one is
owned a relationship just because of what they're enduring or
going through. And you aren't obligated to stay with someone
when things are dysfunctional and when they haven't perhaps gotten
the help that they need yet and it is available
to them, even if they have limited control over this reaction.
It doesn't mean that you have to be there to
(55:31):
bear the brunt of it. You know. This is what
we define as a personality disorder, after all, And regardless
of all the really positive statistics we have about remission.
Maybe at the end of the day, your personalities just
don't align and the condition is just part of that.
They might just need to find their person the same
way that we all do. So if you are also
(55:52):
listening to this, thinking, how do I manage this incredibly
emotionally complex relationship with someone who's afraid of being but
I don't want to be.
Speaker 1 (56:01):
With them anymore?
Speaker 2 (56:02):
Approach it with a lot of kindness. See if you
can maybe get them some help. Maybe this isn't the
right time, Maybe they do need to get treatment and
know that the reaction they have is not always a
reflection of you, and that you are allowed to make
the best choice in your situation. You know, this is
(56:23):
a very complicated condition that's confusing even for those who
have been experiencing it and living it for decades. So
I just want to say, there are still a lot
of things we don't understand about this. Perhaps there will
one day be a whole manual and guidebook for navigating
this kind of like maze that is operating in the
mind of everybody, but specifically the maze in the mind
(56:46):
of people with BPD. But until then, I think it's
just good to have empathy for the things that we
don't understand and the things that we don't know, and
empathy for you if you're experiencing BPD, for living in
a brain that it's probably very different to everyone else's,
and I can imagine it's kind of confusing sometimes to
really want to be able to respond or behave in
(57:08):
the way that others are and just not knowing how.
So I'm sending you a lot of love. I hope
that this has been informative. I hope that you've gotten
a good introduction, yeah, and that things change for you
if you want them to, and that you find some
kind of hope at the at the end of the tunnel.
Thank you again for listening. If you have made it
this far, leave a little emoji down below.
Speaker 3 (57:31):
What am I gonna do? My emoji?
Speaker 2 (57:32):
Of guys, I always get this far and and I forget,
maybe like a little star I don't know. I'm feeling
a star emoji today, so I know that you've made
it this far. I want to thank our research at
Libby Colbert for her contributions to this episode. As a reminder,
there will be resources down below, I highly advise that
you go and check them. Out. If this episode resonated
(57:54):
with you, and if you want to learn more, or
if you just need some additional help, make sure you're
following us on Instagram a's that psychology podcast. Almost forgot
my own Instagram handle That's embarrassing, and that you are
following along on Apple, Spotify, iHeartRadio title wherever you are listening,
and give us a five star review if you're related
or felt seen by this episode. Until next time, stay safe,
(58:17):
be kind, be gentle with yourself, and we will talk
very very soon
Host
Jemma Sbeghen
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