October 22, 2024 • 41 mins
In this episode of the Personality Couch Podcast, we delve into the complexities of Borderline Personality Disorder (BPD). We discuss the stigma and misinformation surrounding BPD, the media's misrepresentation of the disorder, and the need for a more nuanced understanding of its symptoms and diagnosis. The conversation highlights the emotional experiences of individuals with BPD, the criteria for diagnosis, and the importance of recognizing the spectrum of presentations within the disorder. We advocate for a reboot in the classification of personality disorders to better reflect the lived experiences of those affected by BPD.
Chapters
00:00 Introduction to Borderline Personality Disorder 01:16 Media Misrepresentation of BPD 05:39 Borderline as a Movement, Not a Category 11:20 The Need for a Reboot in BPD Classification 15:09 Emptiness and Vague Symptoms in BPD 17:16 BPD and No Emotional Skin 18:37 Diagnosing BPD 20:12 Impulsivity in BPD 22:59 Instability in Sense of Self 26:50 Unstable Relationships 32:55 Unstable Moods 37:16 Symptoms in Quiet BPD 39:49 Summary and Closing
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Personality Couch Podcast, where we discuss all things personality andclinical practice.
I'm your host, Doc Bok, and I'm here with my co-host, Doc Fish.
We are both licensed clinical psychologists in private practice, and today we'll bediscussing borderline personality disorder symptoms and its origin.
(00:25):
So let's dive right in.
So Cheyenne, why start with borderline personality disorder?
Of all the different things that we could talk about in the DSM that we use to diagnose inthe different personality disorders that we could discuss, why borderline or BPD?
(00:46):
I think it's a hot button diagnosis at this point.
A hot button topic even in social media.
It's all over the place.
there's a ton of stigma and misinformation out there.
And it's one of the most frequently seen personality disorders or personality structuresthat at least that I see in clinical work.
(01:12):
But I do think that's a pretty common theme across the board.
too.
There's just so much information that isn't helpful that even in trying to find anexample, it was really
kind of vilified or villains that had BPD that were maybe murderous or more on thepsychopathic side.
(01:37):
Now, certainly that can happen, but that's not your average borderline case.
That's what would make good TV or a good movie is this really dramatic, kind of derangedcharacter, but your average person with this disorder
is not going to go on a killing spree or kill other people or really have thispsychopathic behavior.
(02:02):
So I didn't want to contribute to stigma by using some of these kind of quote unquoteclassic movie examples.
And then in searching for BPD examples, like in cartoons, there just there wasn't accurateinformation.
So some of the things I think you came across these two Cheyenne was like Elsa from frozenhas BPD.
(02:30):
I'm sorry, based on what based on what exactly?
The fact that she was chilly, that she was the ice queen.
Like, that has nothing to do with it.
My understanding is that she
distanced herself from others because she didn't want to hurt them, which could be, itcould be a part of BPD, but taking the whole picture that is not the personality structure
(03:00):
at all.
There's no push, pull, push, pull, push, pull.
She just protected herself and others.
With her, there was more of a consistent withdrawal.
Yes.
Yes.
Like her personality style was more just withdrawn, which is a different.
personality style or structure altogether than a push-pull from borderline.
(03:24):
Right.
Yeah, not borderline.
I think another example that came up was the Hulk.
And again, I'm really not sure where that came from or why that's kind of on the frontpage of Google as an example.
Any ideas, Cheyenne, why?
My first thought is the anger piece.
(03:44):
Right?
So like the Hulk literally gets angry, like...
The Hulk is anger.
The stereotypical angry borderline case, perhaps, where the anger is like destructive andthen goes away.
But that's not, that's not the Hulk.
The Hulk, don't, I don't know what the Hulk is, but it's not borderline.
(04:07):
I think in media we've created these caricatures or these maybe exaggerated features ofwhat we
think as laypeople what we think borderline is.
And it's just not true.
Or it is, it can be true, like in the cases of, you know, some more of the psychopathicbehavior, but it's not common, really not common.
(04:36):
There's a episode in Daredevil.
So I think it's like maybe season three, episode five, and they worked really hard.
to try to have a BPD character, Dex, he ended up killing his coach because his coachpulled him out of the game.
Dex saw a therapist when he was a child and the therapist wrote down borderlinepersonality disorder.
(05:00):
then later psychopathic tendencies, right?
But I think that's a great example of any time we're trying to portray borderline in themedia.
It's that psychopathic level.
It's over exaggerated, it's dramatized.
(05:20):
I think the mark was missed.
As it often is, because the murderous psychopathic character makes better TV, makes abetter storyline than your average person with a personality disorder or mental health
challenges.
It's a difficult diagnosis.
(05:41):
to fit into a category.
It's a movement.
It's a presentation that shifts all of the other personality disorders, personalitystructures.
They're going to be categorical.
The borderline, it's a movement.
The presentation can be so diverse.
And I think, too, it's a perfect diagnosis to be dramatized in the media.
(06:04):
I want to hear a little bit more about the movement piece.
Sure.
History lesson, there was categories of psychotic patients, which would be those with likeschizophrenia, hallucinations, delusions, people who weren't in touch with reality.
And then on the other side, there were the neurotic diagnoses.
(06:28):
So they're in touch with reality, but they're anxious, they're OCD, those kind ofdiagnoses.
Then there's like a whole middle ground.
or a whole array of presentations that are not going to fit within either of those.
(06:48):
I believe it was Kernberg had a borderline organizational level.
So we have the psychotic level, the neurotic level, and all that area in between is theborderline organization or borderline level.
So here we have a person who can...
(07:09):
be in touch with reality and then move into periods of not being in touch with reality.
But then they move out of it and then they move back in.
It's a movement which is really, really hard to capture as a category because it's alwaysshifting.
And again, the presentation is so diverse because it looks different depending on wherewe're at on that spectrum of movement.
(07:35):
Originally,
borderline organizational level applied to all the personality structures.
So you could have like a narcissist at the borderline level.
It wasn't a box.
It was a movement, a spectrum.
But then eventually 1980s DSM three, we tried to create criteria for, this huge, vast,still misunderstood borderline organization.
(08:03):
And we, created a category.
So now we have criteria.
We have to check off the boxes in order to have this borderline diagnosis.
It's still a descriptive way to just capture movement.
So it's not going to fit well.
And there's so many ways it can present.
(08:24):
That is super, super interesting.
So it sounds like borderline is vast and can really vary.
not only from individual to individual, but also within the individual themselves.
And it makes sense why previous ways of classification had it as an organization itselfversus a category.
(08:54):
So we don't say that this is a narcissistic or narcissism.
Narcissism isn't a movement.
It's a trait.
A borderline is it describes running that line between neurotic and psychotic, and that'sa huge spectrum.
(09:16):
But then we try to capture it with a diagnosis.
We're going to run into problems with the diagnostic piece of it.
I think that contributes to why it's so stigmatized and also the misinformation out there.
It also explains why
it can look so different from one person to the next.
I mean, I've seen a borderline personality disorder in kind of the like the classicdramatic presentation, which has more of a what we call histrionic flair or flavor.
(09:50):
So more out there, extroverted, outgoing, sometimes seductive.
But also, I have seen more of a what we call schizoid.
presentation, so that's more withdrawn to themselves, don't really want to be aroundpeople.
A lot of people may not even recognize that this is a borderline structure because theykeep to themselves so much, but there is an internal storm going on that is really
(10:21):
indicative of BPD.
So from one person to the next, I mean, that is wildly, wildly different presentations.
So in those two examples that I just gave, guess older classifications would have saidthat this is a schizoid structure with a borderline level of disintegration or
(10:44):
organization, however you want to capture it, or a histrionic personality structure with aborderline level of disintegration or organization.
Of course, no personality is going to be the same.
We don't have personality twins, even genetic twins don't have the same personality.
(11:05):
There's variation within people, of course, but specifically within the borderline term ingeneral, you can have two next to each other and it's so different.
Do you think that we will ever go back to that way of classifying disorders?
(11:28):
I want to.
I did have a thought because we did steer away from categorical criteria for autism and wewent back to like a spectrum.
Maybe there is hope for personality.
I'm not too sure.
I don't think it's gonna happen anytime soon, especially with the movement of empiricallysupported treatments.
(11:55):
We kind of lost the psychoanalytic or the psychodynamic roots.
it's harder to research that.
Yeah, I mean, I think we are moving more towards like a spectrum with personality orseverity categories.
I just did a training on that a few weeks ago about just kind of where we're trendingbecause even within all the different personality disorders, the level of severity can
(12:23):
look different.
So very similar to the if we're using borderline as
as talking about a level of severity, from one person to the next, a personality disordercan look very different depending on how severe it is.
So I think in upcoming editions of the DSM, we're probably gonna have more spectrum versuscategories and check boxes.
(12:49):
But I don't think the term borderline is going away.
I think...
We have come too far in our culture with that diagnosis, with that language to just changeit.
However, I wish that we would.
I think it needs a reboot.
I think it needs a refresher.
(13:11):
And that might help even quell some of the stigma around it.
If we start using
perhaps different terms that are more descriptive and not just kind of this trash candiagnosis of borderline or what used to be called borderland, the borderland of that kind
(13:32):
of mysterious place between neurotic and psychotic or out of touch with reality or inreality or patients that could be treated outpatient or patients that needed to be
hospitalized.
Like that's a huge pool.
I think we definitely need a reboot.
with personality disorders.
Although we still need more research, we have more research now than we had duringprevious editions of the DSM.
(13:56):
I was just even thinking when you said borderland, right?
So we have individuals that don't fit in the psychotic or neurotic box.
They're in borderland, right?
Like we throw them out.
They're a misfit.
And how unfortunate because borderline structures, they need validation.
That's part of deep.
the DBT theory or dialectical behavioral therapy, there's a hypothesis that there's justlike a lack of validation throughout individuals' lives.
(14:27):
And here we are throwing them in this mysterious land that borders other categories thatis not within it.
That's sad.
Yeah, it is.
It's like we have contributed to the stigma in
the naming, thinking back to what we were talking about with these patients living in thisborderline or borderland spectrum where it's sometimes there's not really a clear cut
(15:01):
clear cut borders.
It's just this kind of trash can diagnosis.
I think one of the interesting things about that is individuals with this condition oftenreport feeling empty.
inside or have really kind of nondescriptive ways to describe their symptoms orthemselves.
(15:27):
Like it's very, the word that comes to mind is nebulous.
Like it's just, it's fluffy.
It's not really tangible words or concrete ideas or symptoms.
Sometimes patients will come in
with like the whole laundry list, the alphabet soup of here's the different acronyms ofdiagnoses.
(15:50):
And often that's a flag in my mind.
Okay, we need to be looking at borderline because it's like these patients don't alwaysfit neatly into a category and we're trying to fit them in.
They're not fitting or the way that they're describing their symptoms is so vague that
(16:12):
we can really do a disservice and kind of jump ahead to make the diagnosis.
Or sometimes even if we're not careful and ask leading questions, we can potentiallyinfluence someone who doesn't really have a stable sense of self and is suggestible to
(16:33):
certain questions that, yep, that's me, that's me, that fits.
When it really doesn't, there's just not a stable sense of self.
kind of anchoring them or they have a really hard time describing how they really feel,what really happened, what their symptoms are, because it's just kind of like just a
(16:55):
fluffy, fluffy cloud.
Like they hurt so much.
Well, yes, this applies to me because it hurts and this applies to me because it hurts.
There's so much more sensitivity.
There's often clinically, we have to call it over reporting.
But really, at a human level, it's this hurts.
Like, see me, validate me.
(17:16):
If you don't have emotional skin, like think about not having skin.
You would be like a walking bag of bones and organs.
Yeah.
And nerves.
Yes.
And so sitting would be painful.
Walking would be painful.
Living would be painful without any sort of skin to encase all of that.
(17:39):
So without the emotional equivalent, you're just kind of a walking, kind of a walking rawnerve.
And out of that, yeah, everything hurts.
Everything's painful and everything's often on fire.
It's inflamed.
Everything in life is inflamed.
(18:00):
So one of the things I really appreciate about individuals with borderline is that
So often they genuinely want to get better.
They're wanting to seek treatment.
They want to hear, you know, what we have to say as part of therapy.
They're open to it.
In most cases, in some cases, there's actually a running from that empty spot that comesup too.
(18:26):
And then the different layers of personality look different on top, kind of running fromthat core empty spot.
And everything hurts so much, they're going to come to treatment.
What does the DSM actually say?
Like what are the criteria for borderline in this categorical system that we operateunder?
(18:48):
And for our listeners who aren't familiar with the DSM, that's our diagnostic andstatistical manual.
That's what we use to diagnose in clinical practice.
And yeah, we're gonna go through and just look at what.
this manual that we follow, that's again how we make diagnoses, what it has to say aboutthis condition.
(19:12):
So it has to be pervasive, right?
Personality disorders in general, it has to be long-term, but there's the instability inrelationships, the sense of self or self-image and emotions.
Then we also have the impulsivity.
And it's across the board, right?
It doesn't just happen at home.
It doesn't just happen at school or work.
(19:35):
It's across the board.
Well, the way that I, that I categorized this to try to make it more palatable was comingup with kind of four bite-sized chunks for BPD.
that's instability in sense of self, in moods and relationships.
(19:55):
So that's number one is instability.
And then you have three subcategories, self, moods.
relationships, then fear of abandonment, then self harm or suicidal threats or behavior,and then impulsivity.
Let's talk about impulsivity for a minute since the DSM has that at the top.
(20:17):
What is impulsivity?
What does it look like?
How do we know?
I think the first thing we have to do is the DSM specifically excludes any suicidalbehavior or like self harm.
from that, that's gonna fall in a different criterion.
Outside of that, impulsivity.
(20:38):
That could look like, racking up debt, filling an empty spot.
Disordered eating often can be an impulsive symptom within a borderline.
But it's almost like this voracious appetite to fill that empty spot.
(20:58):
And it's just, it's like,
It's on impulse.
The person isn't thinking about it.
It's a knee-jerk reaction to fill that void.
Like, I don't feel good.
Boom, gotta fill it.
And this probably starts to bleed into some of the other criterion that we have orcriteria that we have, indiscriminate intimate partners as well.
Like, I don't feel good about myself.
(21:19):
My partner just left.
So I'm gonna go sleep with the first person that pays attention to me.
Drug use, like I need that dopamine hit.
It can be definitely eating.
see a lot of comorbidity or co-occurring eating disorders and personality disorders.
Oftentimes, bulimia seems to track with borderline because there's a tendency to kind offill up and then there's a shame and then a way to counteract the binging.
(21:52):
Self-punishment.
Hobbies can be these impulsive kind of
filling up, fill up stations, if you will, but they're fleeting.
They don't last.
Yeah, the purpose is often to fill that empty spot, but it doesn't necessarily mean theperson is always cognizant or aware of why they're doing it, why they're pursuing these
(22:16):
things, why they're just kind of on this new, this new kick, this new high.
And the hobby or the kick itself is not self-damaging, right?
But usually the spending can be.
or the amount of time it takes away from other things.
The instability piece, I'm going out of order with the DSM, but I want to make sure we getto instability this time because that encompasses so much or so many of the criteria.
(22:45):
What does instability look like?
So I kind of narrowed it down into sense of self, moods, relationships, but like, how doesthat come across clinically or in?
in relationships.
So if we start with unstable sense of self or self image, it's going to also capture theemptiness.
(23:05):
So there's an empty spot inside.
And when trying to find a sense of self, right, taking pieces, and if they don't fit orthey get bored or they're not accepted, then we're going to like reject that piece, take
this piece.
So it can be at a more severe level.
I've seen like
like a splitting of personalities of like different parts of the self.
(23:30):
So like there's like your inner child and there's the adult you and there's the angry you,right?
Not separate personalities, but like a fractured sense of self.
It could look like being really, really into anime and video games, but then meeting apartner who's very much not into that and that we're shifting our entire sense of self.
(23:54):
And now we're into sports and football and the interests and hobbies can often beindicators of that shifting sense of self that can also be indicative of impulsivity,
like, you know, going from one thing to the next.
But if your maybe your way of dressing your your interests, your hobbies are changingdrastically because of a significant attachment in your life.
(24:24):
So maybe you have a new significant other and you are kind of in orbit around them.
Whatever they want is how you're going to present yourself.
It's what you're going to like.
And sometimes individuals with borderline don't even realize that they're doing this, thatthere's an enmeshment that happens with significant relationships, that we don't know
(24:50):
where our stuff
good and bad, ends and the next person's begins.
And so it just gets all intertwined, which can be really complicated when that otherperson is being human and going through stuff.
And then all of a sudden the individual with BPD is starting to feel those exact samethings or starting to react in the exact same ways because psychologically they have
(25:19):
become sometimes this other person.
Like they don't know that there's a separation.
Like they're an extension of their attachment figure.
They take on all of those different roles and it shifts.
So it's not stable.
There's no anchor that keeps their personality in one place because I mean, we're alwaysgrowing and adapting, but we're talking about like pretty dramatic shifts in sense of self
(25:49):
or self image.
I'm just thinking of like, just a personal example of like personality.
If someone were to ask me like, Hey, what Rebecca, what do you stand for?
Like what drives you?
I would be able to say, you know, for me, it's my faith.
I really enjoy helping people.
(26:10):
really appreciate music and creativity.
Like those things have been consistent.
someone who doesn't have a sense of self.
may not be able to answer that question, or the answers to that question may change basedon who they're in a relationship with or who they're hanging around.
(26:30):
I often like to ask, what are your strengths?
What do you see that is positive in yourself?
And someone who doesn't have a stable sense of who they are sometimes can't even answerthat question.
They don't know.
When they look inward, all they see is a void.
I wonder if that could bring us into like unstable relationships because I was thinkingwith that there's a huge push and pull in a relationship.
(27:00):
There's over attachment, a dependency on a significant other or a significant attachmentfigure.
It's a, it's a don't get too close to me.
Like I need you, I need you, I need you love me, but also don't get too close becausethat's not safe.
either.
So now I'm going to push you away and push away.
(27:22):
I'm going to avoid but now I'm lonely.
So all of a I need you again.
And even just saying that, right?
Like it can get confusing.
That can feel like the individual with BPD is flip-flopping all the time.
I love you.
I hate you.
Come here.
We're lovey-dovey.
I hate you.
You're the worst person ever.
(27:42):
You're the scum of the earth.
Go away.
We're breaking up.
We're never going to get back together.
Like
that type of language that there can be a really forceful push, yeah, to keep the personfrom getting too close or to keep the person from breaking the attachment first, from
breaking off the relationship first, like let me be the one to be in control of the pain,I'm gonna break it off first.
(28:05):
But then on the other end of the spectrum, you have what we've been talking about, thisenmeshment of like, am you and you are me and I don't know where I end and the next person
begins.
And that can create a really volatile relationship dynamic of ups and downs.
And we're together, we're not together.
(28:26):
We break up, we make up, like constantly up and down.
And how scary would it be to not have an understanding or like a stable sense of self?
You're finding it in someone else and then they might leave.
Who are you?
What do you do?
(28:47):
You have to start all over.
Like that's so scary.
So painful.
The example of the porcupines.
It's like, two porcupines on a cold night.
I love this metaphor.
It's a cold night.
There's two porcupines.
They're cold.
It's not comfortable to be cold.
It's really distressing.
(29:07):
If they go cuddle, right, they get the warmth.
They get the connection.
They get that need met.
But they're porcupines.
So they're going to prick each other.
That hurts.
Too close, ouch.
So now we're gonna distance, but now we're cold again.
There's a constant conflict, constant.
That takes a lot of energy.
The different types of BPD, it's so vast.
(29:29):
It can look like so many different things.
And correct me if I'm wrong on this, but I would think that even the higher functioningBPD, individuals with BPD are going to have some type of push-pull in their most intimate
relationships.
It may not be as overt or dramatic, but there's going to be something that is pushing andpulling.
(29:55):
Perhaps even just an internal struggle that somehow they've managed to keep under wraps,perhaps.
But I think more often than not, it's going to come out as conflict.
But I'm curious what your thoughts are on that.
I would agree with that.
So.
It's at a high functioning level, It perhaps is only shown in the closest relationships,right?
(30:23):
Like we can keep it together at work.
We might be able to keep it together at school, in the grocery store, right?
All of the other places, but at home behind closed doors where it's safe, we can't keep ittogether all the time.
And so whatever that closeness is, if it's a significant other,
That makes a lot of sense that that's where the push-pull is going to be.
(30:47):
Yeah.
And I'm just thinking of the criterion that it needs to be pervasive or across differentsettings.
So this is where someone who's really high functioning may be able to kind of to pull ittogether in different settings.
But that level of distress that holding it together
(31:12):
causes is often what we call clinically significant because you can't just clamp down onthat compulsive shell so hard that you're keeping it all together for everyone, every
setting at all times.
That's not humanly possible.
And at some point that starts to break down and that's causing distress that is typicallywhat we call clinically significant, meaning they're coming into treatment or they should
(31:38):
be coming into treatment anyway.
Yeah, even in higher functioning individuals that aren't as perhaps overtly symptomatic orshowing symptoms, there's a lot going on behind the scenes or under the surface to keep
things functioning so perfectly or functional.
(32:02):
All that energy that is taken to keep together, right, upon distress or like a
stressor or something devastating that occurs outside, they're not going to have enoughenergy to handle that.
And they'll fall apart more easily under that duress.
(32:23):
Absolutely.
Because life is not predictable.
We can control only so much of our lives and our responses.
And eventually something's going to happen and it's going to catch up because that's life.
That's life.
stressors happen, grief happens, it's part of the human experience, trauma happens, andoften when it does, that's enough to the person and they're not able to contain the image
(32:54):
anymore.
What does unstable moods look like in relationships and in clinical practice?
So unstable mood is going to be, I'm gonna use mood swings.
because that's a good term for it.
It's gonna be within hours, rarely lasting more than a couple of days.
(33:18):
So here's where I think it's really important to just throw a little nugget in.
It's not bipolar.
Bipolar lasts longer.
Bipolar is gonna be triggered by chemicals in the brain that are not controllable.
We're talking about something where something happens or something's perceived to happen.
(33:39):
and now it's upsetting the mood.
The mood can be intense anger.
It could be intense sadness.
It could be intense happiness even.
We're gonna swing from different moods to different moods.
It's unpredictable.
There's impulsive things that go with it, sure.
(34:00):
But it's triggered by something outside.
Oftentimes, it's gonna be triggered by...
Either perceived or real fear of abandonment, which isn't a different criterion.
Yeah, I would say mood swings is going to be my condensed label for that.
Perhaps it starts with poor distress tolerance.
(34:22):
So this goes back to not having emotional skin.
So when we don't have anything to buffer us between life stressors and ourselves, I'm
everything hurts, everything's a wound.
And often our defensive reactions are fight, flight, freeze, you know, just up, up anddown.
(34:50):
So that is happening constantly.
Usually within the day, feeling the full spectrum of emotions in a really short amount oftime, often as a result of
low distress tolerance, just not being able to handle adequately, not having the adequateresources, coping skills to manage the everyday stressors of life.
(35:16):
That every stressor is felt as a high scale magnitude earthquake versus for your averageperson, it's going to feel like just a little shaky perhaps.
all have days where we're maybe like more temperamental.
We have those mood swings.
whether it's like hormonal, it could be because we're going through a trauma or something,right?
(35:43):
But this unstable mood is pervasive, right?
This is like years and years across all the, like it's a pattern.
It's not just a period of depression.
It's not just a period where we're dealing with a trauma or a stressor.
I mean, those things can make it worse, sure.
(36:03):
But it's a pervasive pattern of unstable mood.
Totally.
Yeah.
All the little bumps and turbulence in life result in mood swings.
It's pervasive.
It's not just, hey, I'm having a bad day, a bad season.
This is a pattern.
It's a pattern of responding to stressors or just to life.
(36:25):
Not even to stressors.
Stressors, yes, but to life in general.
The other thing that I was thinking of was in the DSM,
it says anger is one of the criterion.
And I think that that's part of this, this mood swing.
can be, just seeing like going from zero to 60, like I'm fine to rage and depending on thestructure, depending on the type of BPD.
(36:56):
if it's the more maybe extroverted.
dramatic presentation of BPD that could be overt rage where we are, you know, sayingreally hurtful or hateful things to our partner versus an individual who is perhaps more
(37:16):
of a quote, quiet BPD or a more introverted BPD that anger is probably going to be turnedinward.
And it's going to look more depressive.
maybe an internal angst that doesn't come out necessarily in overt rage, zero to 60 orovert anger, but it's an internal simmer, a simmering anger.
(37:44):
I've seen, because anger is a spectrum as well.
And I've seen kind of the full range along with the full range of borderline, thedifferent flavors of anger in that.
Right, so in an extreme example, there can be a difference between anger that'sdestructive externally, right?
(38:08):
So like simplistically hitting partner versus self harming self, right?
It's still anger.
It's just pointed at a different direction.
And I'm thinking back.
Like looping back to what we talked about at the beginning with the Hulk, the Hulk wasangry.
(38:31):
all anger must be BPD.
No, no, no, no, no.
That's not true.
That's not true.
Anger is a normal human emotion.
The internal angst and the mood swings and the anger that can look like rage, it can looklike a deep depression is a hallmark sign of BPD, but it's not the only, it's not the only
(38:54):
symptom.
of it and that alone is not going to be enough for a diagnosis.
Yes, absolutely.
Little bit of a Marvel nerd, right?
But like the earlier movies for the Hulk, the Hulk's rejected.
He goes and he hides and he goes to a place where he doesn't get angry.
He doesn't want to be angry because anger is destructive.
(39:16):
Like literally the Hulk destroys.
That's the entire character.
In the later movies, he's able to stay as the Hulk.
and he's able to have control in that.
There are healthy ways to express anger, but if we're rejecting it, it still has to gosomewhere.
It's gonna pop up.
(39:37):
It might pop up like an explosion instead of just a little bubble.
It's good.
It'll come out somehow.
And if we don't express it psychologically, it's gonna come out in our body in some typeof way.
we covered a lot of ground and we're still not done.
talking about the different symptoms or criteria of BPD.
(39:58):
We've only just scratched the surface and talking about a little bit about impulsivity, alittle bit about instability as well, but there's still so much more to say about this
condition and how to spot it, what it looks like.
There's just so much more that we could get into that we don't have time to today.
(40:20):
So that's why we have a whole series.
on BPD that we're doing because we just need more time to talk about these things.
Okay, and on that note, that brings us to a close.
So thank you for joining us today on the topic of borderline personality disorder.
And if you enjoy the personality couch, please rate and review us on your favorite podcastapp.
(40:46):
Until next time, be well, be kind.
and join us for the next episode on the Personality Couch.
This podcast is for informational purposes only and does not constitute a professionalrelationship.
If you're in need of professional help, please seek out appropriate resources in yourarea.
(41:07):
Information about clinical trends or diagnoses are discussed in broad and universal termsand do not refer to any specific person or case.
Welcome to the Personality Couch Podcast, where we discuss all things personality andclinical practice.
I'm your host, Doc Bok, and I'm here with my co-host, Doc Fish.
We are both licensed clinical psychologists in private practice, and today we'll bediscussing borderline personality disorder symptoms and its origin.
(00:25):
So let's dive right in.
So Cheyenne, why start with borderline personality disorder?
Of all the different things that we could talk about in the DSM that we use to diagnose inthe different personality disorders that we could discuss, why borderline or BPD?
(00:46):
I think it's a hot button diagnosis at this point.
A hot button topic even in social media.
It's all over the place.
there's a ton of stigma and misinformation out there.
And it's one of the most frequently seen personality disorders or personality structuresthat at least that I see in clinical work.
(01:12):
But I do think that's a pretty common theme across the board.
too.
There's just so much information that isn't helpful that even in trying to find anexample, it was really
kind of vilified or villains that had BPD that were maybe murderous or more on thepsychopathic side.
(01:37):
Now, certainly that can happen, but that's not your average borderline case.
That's what would make good TV or a good movie is this really dramatic, kind of derangedcharacter, but your average person with this disorder
is not going to go on a killing spree or kill other people or really have thispsychopathic behavior.
(02:02):
So I didn't want to contribute to stigma by using some of these kind of quote unquoteclassic movie examples.
And then in searching for BPD examples, like in cartoons, there just there wasn't accurateinformation.
So some of the things I think you came across these two Cheyenne was like Elsa from frozenhas BPD.
(02:30):
I'm sorry, based on what based on what exactly?
The fact that she was chilly, that she was the ice queen.
Like, that has nothing to do with it.
My understanding is that she
distanced herself from others because she didn't want to hurt them, which could be, itcould be a part of BPD, but taking the whole picture that is not the personality structure
(03:00):
at all.
There's no push, pull, push, pull, push, pull.
She just protected herself and others.
With her, there was more of a consistent withdrawal.
Yes.
Yes.
Like her personality style was more just withdrawn, which is a different.
personality style or structure altogether than a push-pull from borderline.
(03:24):
Right.
Yeah, not borderline.
I think another example that came up was the Hulk.
And again, I'm really not sure where that came from or why that's kind of on the frontpage of Google as an example.
Any ideas, Cheyenne, why?
My first thought is the anger piece.
(03:44):
Right?
So like the Hulk literally gets angry, like...
The Hulk is anger.
The stereotypical angry borderline case, perhaps, where the anger is like destructive andthen goes away.
But that's not, that's not the Hulk.
The Hulk, don't, I don't know what the Hulk is, but it's not borderline.
(04:07):
I think in media we've created these caricatures or these maybe exaggerated features ofwhat we
think as laypeople what we think borderline is.
And it's just not true.
Or it is, it can be true, like in the cases of, you know, some more of the psychopathicbehavior, but it's not common, really not common.
(04:36):
There's a episode in Daredevil.
So I think it's like maybe season three, episode five, and they worked really hard.
to try to have a BPD character, Dex, he ended up killing his coach because his coachpulled him out of the game.
Dex saw a therapist when he was a child and the therapist wrote down borderlinepersonality disorder.
(05:00):
then later psychopathic tendencies, right?
But I think that's a great example of any time we're trying to portray borderline in themedia.
It's that psychopathic level.
It's over exaggerated, it's dramatized.
(05:20):
I think the mark was missed.
As it often is, because the murderous psychopathic character makes better TV, makes abetter storyline than your average person with a personality disorder or mental health
challenges.
It's a difficult diagnosis.
(05:41):
to fit into a category.
It's a movement.
It's a presentation that shifts all of the other personality disorders, personalitystructures.
They're going to be categorical.
The borderline, it's a movement.
The presentation can be so diverse.
And I think, too, it's a perfect diagnosis to be dramatized in the media.
(06:04):
I want to hear a little bit more about the movement piece.
Sure.
History lesson, there was categories of psychotic patients, which would be those with likeschizophrenia, hallucinations, delusions, people who weren't in touch with reality.
And then on the other side, there were the neurotic diagnoses.
(06:28):
So they're in touch with reality, but they're anxious, they're OCD, those kind ofdiagnoses.
Then there's like a whole middle ground.
or a whole array of presentations that are not going to fit within either of those.
(06:48):
I believe it was Kernberg had a borderline organizational level.
So we have the psychotic level, the neurotic level, and all that area in between is theborderline organization or borderline level.
So here we have a person who can...
(07:09):
be in touch with reality and then move into periods of not being in touch with reality.
But then they move out of it and then they move back in.
It's a movement which is really, really hard to capture as a category because it's alwaysshifting.
And again, the presentation is so diverse because it looks different depending on wherewe're at on that spectrum of movement.
(07:35):
Originally,
borderline organizational level applied to all the personality structures.
So you could have like a narcissist at the borderline level.
It wasn't a box.
It was a movement, a spectrum.
But then eventually 1980s DSM three, we tried to create criteria for, this huge, vast,still misunderstood borderline organization.
(08:03):
And we, created a category.
So now we have criteria.
We have to check off the boxes in order to have this borderline diagnosis.
It's still a descriptive way to just capture movement.
So it's not going to fit well.
And there's so many ways it can present.
(08:24):
That is super, super interesting.
So it sounds like borderline is vast and can really vary.
not only from individual to individual, but also within the individual themselves.
And it makes sense why previous ways of classification had it as an organization itselfversus a category.
(08:54):
So we don't say that this is a narcissistic or narcissism.
Narcissism isn't a movement.
It's a trait.
A borderline is it describes running that line between neurotic and psychotic, and that'sa huge spectrum.
(09:16):
But then we try to capture it with a diagnosis.
We're going to run into problems with the diagnostic piece of it.
I think that contributes to why it's so stigmatized and also the misinformation out there.
It also explains why
it can look so different from one person to the next.
I mean, I've seen a borderline personality disorder in kind of the like the classicdramatic presentation, which has more of a what we call histrionic flair or flavor.
(09:50):
So more out there, extroverted, outgoing, sometimes seductive.
But also, I have seen more of a what we call schizoid.
presentation, so that's more withdrawn to themselves, don't really want to be aroundpeople.
A lot of people may not even recognize that this is a borderline structure because theykeep to themselves so much, but there is an internal storm going on that is really
(10:21):
indicative of BPD.
So from one person to the next, I mean, that is wildly, wildly different presentations.
So in those two examples that I just gave, guess older classifications would have saidthat this is a schizoid structure with a borderline level of disintegration or
(10:44):
organization, however you want to capture it, or a histrionic personality structure with aborderline level of disintegration or organization.
Of course, no personality is going to be the same.
We don't have personality twins, even genetic twins don't have the same personality.
(11:05):
There's variation within people, of course, but specifically within the borderline term ingeneral, you can have two next to each other and it's so different.
Do you think that we will ever go back to that way of classifying disorders?
(11:28):
I want to.
I did have a thought because we did steer away from categorical criteria for autism and wewent back to like a spectrum.
Maybe there is hope for personality.
I'm not too sure.
I don't think it's gonna happen anytime soon, especially with the movement of empiricallysupported treatments.
(11:55):
We kind of lost the psychoanalytic or the psychodynamic roots.
it's harder to research that.
Yeah, I mean, I think we are moving more towards like a spectrum with personality orseverity categories.
I just did a training on that a few weeks ago about just kind of where we're trendingbecause even within all the different personality disorders, the level of severity can
(12:23):
look different.
So very similar to the if we're using borderline as
as talking about a level of severity, from one person to the next, a personality disordercan look very different depending on how severe it is.
So I think in upcoming editions of the DSM, we're probably gonna have more spectrum versuscategories and check boxes.
(12:49):
But I don't think the term borderline is going away.
I think...
We have come too far in our culture with that diagnosis, with that language to just changeit.
However, I wish that we would.
I think it needs a reboot.
I think it needs a refresher.
(13:11):
And that might help even quell some of the stigma around it.
If we start using
perhaps different terms that are more descriptive and not just kind of this trash candiagnosis of borderline or what used to be called borderland, the borderland of that kind
(13:32):
of mysterious place between neurotic and psychotic or out of touch with reality or inreality or patients that could be treated outpatient or patients that needed to be
hospitalized.
Like that's a huge pool.
I think we definitely need a reboot.
with personality disorders.
Although we still need more research, we have more research now than we had duringprevious editions of the DSM.
(13:56):
I was just even thinking when you said borderland, right?
So we have individuals that don't fit in the psychotic or neurotic box.
They're in borderland, right?
Like we throw them out.
They're a misfit.
And how unfortunate because borderline structures, they need validation.
That's part of deep.
the DBT theory or dialectical behavioral therapy, there's a hypothesis that there's justlike a lack of validation throughout individuals' lives.
(14:27):
And here we are throwing them in this mysterious land that borders other categories thatis not within it.
That's sad.
Yeah, it is.
It's like we have contributed to the stigma in
the naming, thinking back to what we were talking about with these patients living in thisborderline or borderland spectrum where it's sometimes there's not really a clear cut
(15:01):
clear cut borders.
It's just this kind of trash can diagnosis.
I think one of the interesting things about that is individuals with this condition oftenreport feeling empty.
inside or have really kind of nondescriptive ways to describe their symptoms orthemselves.
(15:27):
Like it's very, the word that comes to mind is nebulous.
Like it's just, it's fluffy.
It's not really tangible words or concrete ideas or symptoms.
Sometimes patients will come in
with like the whole laundry list, the alphabet soup of here's the different acronyms ofdiagnoses.
(15:50):
And often that's a flag in my mind.
Okay, we need to be looking at borderline because it's like these patients don't alwaysfit neatly into a category and we're trying to fit them in.
They're not fitting or the way that they're describing their symptoms is so vague that
(16:12):
we can really do a disservice and kind of jump ahead to make the diagnosis.
Or sometimes even if we're not careful and ask leading questions, we can potentiallyinfluence someone who doesn't really have a stable sense of self and is suggestible to
(16:33):
certain questions that, yep, that's me, that's me, that fits.
When it really doesn't, there's just not a stable sense of self.
kind of anchoring them or they have a really hard time describing how they really feel,what really happened, what their symptoms are, because it's just kind of like just a
(16:55):
fluffy, fluffy cloud.
Like they hurt so much.
Well, yes, this applies to me because it hurts and this applies to me because it hurts.
There's so much more sensitivity.
There's often clinically, we have to call it over reporting.
But really, at a human level, it's this hurts.
Like, see me, validate me.
(17:16):
If you don't have emotional skin, like think about not having skin.
You would be like a walking bag of bones and organs.
Yeah.
And nerves.
Yes.
And so sitting would be painful.
Walking would be painful.
Living would be painful without any sort of skin to encase all of that.
(17:39):
So without the emotional equivalent, you're just kind of a walking, kind of a walking rawnerve.
And out of that, yeah, everything hurts.
Everything's painful and everything's often on fire.
It's inflamed.
Everything in life is inflamed.
(18:00):
So one of the things I really appreciate about individuals with borderline is that
So often they genuinely want to get better.
They're wanting to seek treatment.
They want to hear, you know, what we have to say as part of therapy.
They're open to it.
In most cases, in some cases, there's actually a running from that empty spot that comesup too.
(18:26):
And then the different layers of personality look different on top, kind of running fromthat core empty spot.
And everything hurts so much, they're going to come to treatment.
What does the DSM actually say?
Like what are the criteria for borderline in this categorical system that we operateunder?
(18:48):
And for our listeners who aren't familiar with the DSM, that's our diagnostic andstatistical manual.
That's what we use to diagnose in clinical practice.
And yeah, we're gonna go through and just look at what.
this manual that we follow, that's again how we make diagnoses, what it has to say aboutthis condition.
(19:12):
So it has to be pervasive, right?
Personality disorders in general, it has to be long-term, but there's the instability inrelationships, the sense of self or self-image and emotions.
Then we also have the impulsivity.
And it's across the board, right?
It doesn't just happen at home.
It doesn't just happen at school or work.
(19:35):
It's across the board.
Well, the way that I, that I categorized this to try to make it more palatable was comingup with kind of four bite-sized chunks for BPD.
that's instability in sense of self, in moods and relationships.
(19:55):
So that's number one is instability.
And then you have three subcategories, self, moods.
relationships, then fear of abandonment, then self harm or suicidal threats or behavior,and then impulsivity.
Let's talk about impulsivity for a minute since the DSM has that at the top.
(20:17):
What is impulsivity?
What does it look like?
How do we know?
I think the first thing we have to do is the DSM specifically excludes any suicidalbehavior or like self harm.
from that, that's gonna fall in a different criterion.
Outside of that, impulsivity.
(20:38):
That could look like, racking up debt, filling an empty spot.
Disordered eating often can be an impulsive symptom within a borderline.
But it's almost like this voracious appetite to fill that empty spot.
(20:58):
And it's just, it's like,
It's on impulse.
The person isn't thinking about it.
It's a knee-jerk reaction to fill that void.
Like, I don't feel good.
Boom, gotta fill it.
And this probably starts to bleed into some of the other criterion that we have orcriteria that we have, indiscriminate intimate partners as well.
Like, I don't feel good about myself.
(21:19):
My partner just left.
So I'm gonna go sleep with the first person that pays attention to me.
Drug use, like I need that dopamine hit.
It can be definitely eating.
see a lot of comorbidity or co-occurring eating disorders and personality disorders.
Oftentimes, bulimia seems to track with borderline because there's a tendency to kind offill up and then there's a shame and then a way to counteract the binging.
(21:52):
Self-punishment.
Hobbies can be these impulsive kind of
filling up, fill up stations, if you will, but they're fleeting.
They don't last.
Yeah, the purpose is often to fill that empty spot, but it doesn't necessarily mean theperson is always cognizant or aware of why they're doing it, why they're pursuing these
(22:16):
things, why they're just kind of on this new, this new kick, this new high.
And the hobby or the kick itself is not self-damaging, right?
But usually the spending can be.
or the amount of time it takes away from other things.
The instability piece, I'm going out of order with the DSM, but I want to make sure we getto instability this time because that encompasses so much or so many of the criteria.
(22:45):
What does instability look like?
So I kind of narrowed it down into sense of self, moods, relationships, but like, how doesthat come across clinically or in?
in relationships.
So if we start with unstable sense of self or self image, it's going to also capture theemptiness.
(23:05):
So there's an empty spot inside.
And when trying to find a sense of self, right, taking pieces, and if they don't fit orthey get bored or they're not accepted, then we're going to like reject that piece, take
this piece.
So it can be at a more severe level.
I've seen like
like a splitting of personalities of like different parts of the self.
(23:30):
So like there's like your inner child and there's the adult you and there's the angry you,right?
Not separate personalities, but like a fractured sense of self.
It could look like being really, really into anime and video games, but then meeting apartner who's very much not into that and that we're shifting our entire sense of self.
(23:54):
And now we're into sports and football and the interests and hobbies can often beindicators of that shifting sense of self that can also be indicative of impulsivity,
like, you know, going from one thing to the next.
But if your maybe your way of dressing your your interests, your hobbies are changingdrastically because of a significant attachment in your life.
(24:24):
So maybe you have a new significant other and you are kind of in orbit around them.
Whatever they want is how you're going to present yourself.
It's what you're going to like.
And sometimes individuals with borderline don't even realize that they're doing this, thatthere's an enmeshment that happens with significant relationships, that we don't know
(24:50):
where our stuff
good and bad, ends and the next person's begins.
And so it just gets all intertwined, which can be really complicated when that otherperson is being human and going through stuff.
And then all of a sudden the individual with BPD is starting to feel those exact samethings or starting to react in the exact same ways because psychologically they have
(25:19):
become sometimes this other person.
Like they don't know that there's a separation.
Like they're an extension of their attachment figure.
They take on all of those different roles and it shifts.
So it's not stable.
There's no anchor that keeps their personality in one place because I mean, we're alwaysgrowing and adapting, but we're talking about like pretty dramatic shifts in sense of self
(25:49):
or self image.
I'm just thinking of like, just a personal example of like personality.
If someone were to ask me like, Hey, what Rebecca, what do you stand for?
Like what drives you?
I would be able to say, you know, for me, it's my faith.
I really enjoy helping people.
(26:10):
really appreciate music and creativity.
Like those things have been consistent.
someone who doesn't have a sense of self.
may not be able to answer that question, or the answers to that question may change basedon who they're in a relationship with or who they're hanging around.
(26:30):
I often like to ask, what are your strengths?
What do you see that is positive in yourself?
And someone who doesn't have a stable sense of who they are sometimes can't even answerthat question.
They don't know.
When they look inward, all they see is a void.
I wonder if that could bring us into like unstable relationships because I was thinkingwith that there's a huge push and pull in a relationship.
(27:00):
There's over attachment, a dependency on a significant other or a significant attachmentfigure.
It's a, it's a don't get too close to me.
Like I need you, I need you, I need you love me, but also don't get too close becausethat's not safe.
either.
So now I'm going to push you away and push away.
(27:22):
I'm going to avoid but now I'm lonely.
So all of a I need you again.
And even just saying that, right?
Like it can get confusing.
That can feel like the individual with BPD is flip-flopping all the time.
I love you.
I hate you.
Come here.
We're lovey-dovey.
I hate you.
You're the worst person ever.
(27:42):
You're the scum of the earth.
Go away.
We're breaking up.
We're never going to get back together.
Like
that type of language that there can be a really forceful push, yeah, to keep the personfrom getting too close or to keep the person from breaking the attachment first, from
breaking off the relationship first, like let me be the one to be in control of the pain,I'm gonna break it off first.
(28:05):
But then on the other end of the spectrum, you have what we've been talking about, thisenmeshment of like, am you and you are me and I don't know where I end and the next person
begins.
And that can create a really volatile relationship dynamic of ups and downs.
And we're together, we're not together.
(28:26):
We break up, we make up, like constantly up and down.
And how scary would it be to not have an understanding or like a stable sense of self?
You're finding it in someone else and then they might leave.
Who are you?
What do you do?
(28:47):
You have to start all over.
Like that's so scary.
So painful.
The example of the porcupines.
It's like, two porcupines on a cold night.
I love this metaphor.
It's a cold night.
There's two porcupines.
They're cold.
It's not comfortable to be cold.
It's really distressing.
(29:07):
If they go cuddle, right, they get the warmth.
They get the connection.
They get that need met.
But they're porcupines.
So they're going to prick each other.
That hurts.
Too close, ouch.
So now we're gonna distance, but now we're cold again.
There's a constant conflict, constant.
That takes a lot of energy.
The different types of BPD, it's so vast.
(29:29):
It can look like so many different things.
And correct me if I'm wrong on this, but I would think that even the higher functioningBPD, individuals with BPD are going to have some type of push-pull in their most intimate
relationships.
It may not be as overt or dramatic, but there's going to be something that is pushing andpulling.
(29:55):
Perhaps even just an internal struggle that somehow they've managed to keep under wraps,perhaps.
But I think more often than not, it's going to come out as conflict.
But I'm curious what your thoughts are on that.
I would agree with that.
So.
It's at a high functioning level, It perhaps is only shown in the closest relationships,right?
(30:23):
Like we can keep it together at work.
We might be able to keep it together at school, in the grocery store, right?
All of the other places, but at home behind closed doors where it's safe, we can't keep ittogether all the time.
And so whatever that closeness is, if it's a significant other,
That makes a lot of sense that that's where the push-pull is going to be.
(30:47):
Yeah.
And I'm just thinking of the criterion that it needs to be pervasive or across differentsettings.
So this is where someone who's really high functioning may be able to kind of to pull ittogether in different settings.
But that level of distress that holding it together
(31:12):
causes is often what we call clinically significant because you can't just clamp down onthat compulsive shell so hard that you're keeping it all together for everyone, every
setting at all times.
That's not humanly possible.
And at some point that starts to break down and that's causing distress that is typicallywhat we call clinically significant, meaning they're coming into treatment or they should
(31:38):
be coming into treatment anyway.
Yeah, even in higher functioning individuals that aren't as perhaps overtly symptomatic orshowing symptoms, there's a lot going on behind the scenes or under the surface to keep
things functioning so perfectly or functional.
(32:02):
All that energy that is taken to keep together, right, upon distress or like a
stressor or something devastating that occurs outside, they're not going to have enoughenergy to handle that.
And they'll fall apart more easily under that duress.
(32:23):
Absolutely.
Because life is not predictable.
We can control only so much of our lives and our responses.
And eventually something's going to happen and it's going to catch up because that's life.
That's life.
stressors happen, grief happens, it's part of the human experience, trauma happens, andoften when it does, that's enough to the person and they're not able to contain the image
(32:54):
anymore.
What does unstable moods look like in relationships and in clinical practice?
So unstable mood is going to be, I'm gonna use mood swings.
because that's a good term for it.
It's gonna be within hours, rarely lasting more than a couple of days.
(33:18):
So here's where I think it's really important to just throw a little nugget in.
It's not bipolar.
Bipolar lasts longer.
Bipolar is gonna be triggered by chemicals in the brain that are not controllable.
We're talking about something where something happens or something's perceived to happen.
(33:39):
and now it's upsetting the mood.
The mood can be intense anger.
It could be intense sadness.
It could be intense happiness even.
We're gonna swing from different moods to different moods.
It's unpredictable.
There's impulsive things that go with it, sure.
(34:00):
But it's triggered by something outside.
Oftentimes, it's gonna be triggered by...
Either perceived or real fear of abandonment, which isn't a different criterion.
Yeah, I would say mood swings is going to be my condensed label for that.
Perhaps it starts with poor distress tolerance.
(34:22):
So this goes back to not having emotional skin.
So when we don't have anything to buffer us between life stressors and ourselves, I'm
everything hurts, everything's a wound.
And often our defensive reactions are fight, flight, freeze, you know, just up, up anddown.
(34:50):
So that is happening constantly.
Usually within the day, feeling the full spectrum of emotions in a really short amount oftime, often as a result of
low distress tolerance, just not being able to handle adequately, not having the adequateresources, coping skills to manage the everyday stressors of life.
(35:16):
That every stressor is felt as a high scale magnitude earthquake versus for your averageperson, it's going to feel like just a little shaky perhaps.
all have days where we're maybe like more temperamental.
We have those mood swings.
whether it's like hormonal, it could be because we're going through a trauma or something,right?
(35:43):
But this unstable mood is pervasive, right?
This is like years and years across all the, like it's a pattern.
It's not just a period of depression.
It's not just a period where we're dealing with a trauma or a stressor.
I mean, those things can make it worse, sure.
(36:03):
But it's a pervasive pattern of unstable mood.
Totally.
Yeah.
All the little bumps and turbulence in life result in mood swings.
It's pervasive.
It's not just, hey, I'm having a bad day, a bad season.
This is a pattern.
It's a pattern of responding to stressors or just to life.
(36:25):
Not even to stressors.
Stressors, yes, but to life in general.
The other thing that I was thinking of was in the DSM,
it says anger is one of the criterion.
And I think that that's part of this, this mood swing.
can be, just seeing like going from zero to 60, like I'm fine to rage and depending on thestructure, depending on the type of BPD.
(36:56):
if it's the more maybe extroverted.
dramatic presentation of BPD that could be overt rage where we are, you know, sayingreally hurtful or hateful things to our partner versus an individual who is perhaps more
(37:16):
of a quote, quiet BPD or a more introverted BPD that anger is probably going to be turnedinward.
And it's going to look more depressive.
maybe an internal angst that doesn't come out necessarily in overt rage, zero to 60 orovert anger, but it's an internal simmer, a simmering anger.
(37:44):
I've seen, because anger is a spectrum as well.
And I've seen kind of the full range along with the full range of borderline, thedifferent flavors of anger in that.
Right, so in an extreme example, there can be a difference between anger that'sdestructive externally, right?
(38:08):
So like simplistically hitting partner versus self harming self, right?
It's still anger.
It's just pointed at a different direction.
And I'm thinking back.
Like looping back to what we talked about at the beginning with the Hulk, the Hulk wasangry.
(38:31):
all anger must be BPD.
No, no, no, no, no.
That's not true.
That's not true.
Anger is a normal human emotion.
The internal angst and the mood swings and the anger that can look like rage, it can looklike a deep depression is a hallmark sign of BPD, but it's not the only, it's not the only
(38:54):
symptom.
of it and that alone is not going to be enough for a diagnosis.
Yes, absolutely.
Little bit of a Marvel nerd, right?
But like the earlier movies for the Hulk, the Hulk's rejected.
He goes and he hides and he goes to a place where he doesn't get angry.
He doesn't want to be angry because anger is destructive.
(39:16):
Like literally the Hulk destroys.
That's the entire character.
In the later movies, he's able to stay as the Hulk.
and he's able to have control in that.
There are healthy ways to express anger, but if we're rejecting it, it still has to gosomewhere.
It's gonna pop up.
(39:37):
It might pop up like an explosion instead of just a little bubble.
It's good.
It'll come out somehow.
And if we don't express it psychologically, it's gonna come out in our body in some typeof way.
we covered a lot of ground and we're still not done.
talking about the different symptoms or criteria of BPD.
(39:58):
We've only just scratched the surface and talking about a little bit about impulsivity, alittle bit about instability as well, but there's still so much more to say about this
condition and how to spot it, what it looks like.
There's just so much more that we could get into that we don't have time to today.
(40:20):
So that's why we have a whole series.
on BPD that we're doing because we just need more time to talk about these things.
Okay, and on that note, that brings us to a close.
So thank you for joining us today on the topic of borderline personality disorder.
And if you enjoy the personality couch, please rate and review us on your favorite podcastapp.
(40:46):
Until next time, be well, be kind.
and join us for the next episode on the Personality Couch.
This podcast is for informational purposes only and does not constitute a professionalrelationship.
If you're in need of professional help, please seek out appropriate resources in yourarea.
(41:07):
Information about clinical trends or diagnoses are discussed in broad and universal termsand do not refer to any specific person or case.
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