November 19, 2024 • 39 mins
In this episode of the Personality Couch Podcast, we delve into the complexities of Borderline Personality Disorder (BPD), focusing on the themes of suicidal ideation and self-harm. We explore the DSM criteria for BPD, the motivations behind self-harming behaviors, and the stigma associated with these actions. The conversation emphasizes the importance of understanding the emotional pain experienced by individuals with BPD and the impact on their relationships. We provide insights into navigating these dynamics, the need for professional help, and the significance of setting boundaries.
Chapters
00:00 Introduction to Borderline Personality Disorder (BPD) Series 01:46 DSM Criteria for Suicidal Ideation and Self-Harm in BPD 03:31 Triggers for Self-Harm and Parasuicidal Behaviors 07:36 Reasons for Self-Harm and Parasuicidal Behaviors 10:11 Defining the Parasuicidal and Self-Harm Spectrum 13:59 Additional Reasons for Self-Harm and Parasuicidal Behaviors 17:24 Self-Harm and Parasuicidal Behaviors Outside of BPD 18:51 Hidden Self-Harm 20:36 Stigma and Motives of Behavior 29:39 Navigating Relationships and BPD 38:29 Conclusion and Key Takeaways
CRISIS RESOURCES
- Text Line: Text HOME to 741-741; a trained crisis counselor receives the text and responds quickly.
- National Hopeline Network: https://www.thehopeline.com/
- National Suicide Prevention Lifeline @ 988 or https://988lifeline.org/
- American Foundation for Suicide Prevention @ https://afsp.org/ -https://www.mentalhealthishealth.us/better-together-summit/
Psychoeducation
- https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
- https://www.nami.org/learn-more/mental-health-conditions/borderline-personality-disorder
- https://www.borderlinepersonalitydisorder.org/
Mark as Played
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 will becontinuing our Borderline Personality Disorder series.
(00:25):
Now, a note to our viewers and listeners.
Today is going to include heavier topics and may not be appropriate for everyone.
So discretion is advised.
We will be discussing the DSM criteria of suicidal ideation, behavior, threats, andself-harm, while also unpacking what self-harm looks like, why individuals with BPD
(00:51):
self-harm, the stigma,
about these behaviors and what loved ones and professionals can do.
Okay, we have got a lot to cover, so we better get started.
So we've been going through the DSM and talking about the different criteria forborderline personality disorder.
(01:12):
And specifically, we have been discussing one of the hallmark features of BPD, which isfear of abandonment.
And that
one is particularly tied to suicidal ideation, threats, behaviors, kind of all the thingsthat we want to unpack today.
So Doc Fish, why don't we crack open that DSM and see what it says about this criterionabout suicidal and self-harm threats, gestures, and behaviors?
(01:46):
So DSM criteria is recurrent suicidal behavior, gestures,
or threats or self-mutilating behavior.
So this is often why those with borderline personality disorder present for help.
It can be just for outpatient therapy.
It can also be something where there's hospitalization.
(02:07):
Oftentimes this is like an outward thing that happens and that's why there's apresentation for help.
Because it's distressing.
Right, right.
And it's scary.
It's scary.
The DSM also says that
There can be dissociation and sometimes there can be like cutting or burning is prettycommon during the dissociation.
(02:30):
So essentially like these acts often bring about relief by reaffirming their ability tofeel something essentially it's self punishment.
And I can imagine that this is going to happen, especially in times where there's maybe analtered state of consciousness that's common with BPD.
Like we've been talking about.
(02:50):
when we're kind of in this in-between stage and we can maybe lose touch with reality orlose touch with our own bodies that perhaps self-harm or hurting our bodies in some type
of way, it can happen probably at any point along that borderline continuum, whetheryou're in reality or kind of moving more towards that psychotic end.
(03:15):
But I imagine that especially when you're not fully present,
this is going to show up a lot more.
The inside pain is so intense that there's a disconnect from it.
And then it can be like, well, at least I feel something physically.
But these behaviors are often, often occur after threats of separation or rejection.
(03:40):
So something that impairs functioning job loss.
interrupted education, separation, divorce, that can be a stressor or a catalyst for theself harm or suicidal ideation.
like normal stressors, normal life transitions for someone with BPD, this can feel maybelarger than life.
(04:02):
And that stress coupled with low distress tolerance can lead to self harm, hurtingthemselves.
But also when there's some type of attachment break, like maybe at school there was ateacher that they felt really close to and, you know, school's coming to an end about
ready to graduate.
(04:23):
Like that stressor that's normally it's a transition.
It's stressful for everyone to some degree.
Someone with BPD, that's going to feel much greater.
And that transition or attachment loss from, you know, friends, teacher, whatever that is.
can lead to taking it out on themselves is what I'm understanding.
(04:46):
Then even just life transitions, especially ones where there's an increase inresponsibility.
Then we have the, can't do this, which connects with their sense of self.
I need someone to take care of me.
If I have someone to take care of me, then I have an attachment.
It's essentially dependence.
(05:06):
That's interesting because you wouldn't necessarily think of that.
as a part of BPD and self-harm.
Can you give an example of what that might look like?
Sure.
Graduating college, you have a transition.
Well, I guess it could be a good transition.
It doesn't necessarily have to be a good transition, but it's not necessarily a negativeone.
(05:29):
It's not necessarily something that has to do with attachment breaks.
It's just a life transition with increased responsibility.
You have to find a job.
You have to adult, right?
You have to grow up.
What better way to keep an attachment than to be childlike?
(05:49):
Children need to be taken care of, And so then they need to have an attachment.
They have to have someone that attaches to them to take care of them.
So I think essentially there's a resistance of pulling out of any kind of regression thatthey're in.
So in other words, what I'm understanding is that individuals with BPD can be in this morekind of dependent state where it's maybe difficult to take care of themselves or their
(06:24):
adult responsibilities and they kind of elicit maybe a rescuer or a nurturer, someonewho's more in a parent type role to
help them navigate life sometimes, especially in those transitions that it can beparticularly challenging.
(06:46):
It means taking on more responsibility and perhaps moving out of that regressed state thatis more childlike and dependent into one of independence.
And independence means potentially attachment changes or attachment breaks.
(07:06):
Right.
Wow.
It could even be a change of identity.
I'm going from college student, that's part of my identity now, to a job.
I'm no longer a college student.
I now have a job.
Like if I'm not a college student, what am I now?
I don't know how to be a person with a job or a person looking for a job.
I only know how to be a college student.
(07:28):
Wow.
This is really complex.
I think underneath all of that though.
No matter the stressor, it's a cry for help.
So the recurrent suicidal behavior, the gestures, any self-harm is a cry for help.
Like, see my pain.
I can't be alone.
Okay.
(07:48):
And that may happen at those big life changes.
I should say, and especially, attachment breaks.
Right.
Because we have that fear of abandonment.
Exactly.
So that's where these two are tied together fear of abandonment, along with self harm orsuicidal thoughts, gestures, behaviors, right, but also life transitions.
(08:13):
Sometimes there can also be a distraction from pain, right?
So just like, like, there's too much pain on the inside.
So I'm gonna put that pain on the outside, still a pool for help.
And this isn't something that
the individual with BPD is like consciously thinking through.
But these are the kind of unspoken dynamics that are happening that are playing out inrelationships that when we're on the receiving end of that, because we're a friend, loved
(08:42):
one, co worker, in a professional relationship with in some capacity, that we feel thatand it can feel this can feel manipulative.
to the person on the receiving end, who's like this person, individual with BPD is they'repulling for a rescuer, pulling for someone to save them, someone to be the parent, the
(09:09):
adult.
Yeah, just pulling for someone to come in, to step in and save the day.
And though that's not a conscious thing that they're working out in their minds, that'sleading to this behavior, you can feel the pull.
when you're in that drama triangle, really.
Right, because it's so human to see someone in pain and want to help.
(09:31):
And the distinguishing thing here is that someone with BPD, and really this is with allpersonality disorders, the ability to handle conflict appropriately is diminished.
The way that someone who doesn't have a personality disorder would handle challenges,conflicts, changes, life transitions,
(09:53):
would perhaps be more adaptive than these more, what we call regressed behaviors or kindof these childlike behaviors, pulling people in to rescue.
And again, not on a conscious level.
It's very challenging, very challenging.
So talk back.
We've been using some big words today already.
(10:13):
Self harm, self injury, self mutilation, non suicidal self injury.
There's so many words.
Can you help me understand?
Yeah, yeah.
Well, they're all really part of the same continuum.
So self-harm on one end of the spectrum and then all the way to the other end of thespectrum, you have inflicting harm on the self with the intent of ending your life.
(10:39):
And then there's all this area in between.
So that's when we say para-suicidal, we're talking about the spectrum, like everythingalong the range of self-harm.
to suicidal thoughts, gestures, behaviors.
Yeah, non-suicidal self-injury is on the one end of the spectrum, like not wanting to hurtyourself with the intent of ending your life.
(11:04):
But then there can also be in that middle range where it's inflicting some type of harmwith the thought of, well, maybe it could aid in the process of ending my life, all the
way to...
I actually have a plan of how I want to and here's how I'm going to inflict harm on myselfin order to make that happen.
(11:25):
So they're all part of the same continuum, but the motivations and the severity aredifferent.
What are some examples?
Yeah, yeah.
So there's a lot of different ways that this can look and it really depends on the person.
(11:46):
But if you think of on one side, more risky behaviors, so not necessarily with the plan toend your life, though maybe there's a thought of, well, if it happened, it wouldn't be so
bad.
But there's things like binge eating, using food to cope in unhealthy ways, maybe eatingtoo much and then doing something to counteract that.
(12:13):
So
that's inflicting pain on your body, taking it out on your body in some type of way.
It could be reckless driving, like I'm just gonna speed and see if someone stops me.
It can look like drinking in excess, to kind of numb, to forget, indiscriminate partnersor physical intimacy.
(12:35):
Bring in that person again, that attachment to feel something and to soothe because...
An individual with BPD has a really hard time soothing on their own using substances aswell.
Alcohol, drugs, cutting is another big one.
Actually inflicting wounds on our body that sometimes are a physical representation of theinner pain that we feel.
(13:03):
Like we don't know how else to express it.
So we're just expressing it on our bodies in some type of way, mutilating.
our bodies in some type of way.
It can also include burning as well, burning our bodies.
Head banging is another common one, just taking out the anger, frustration, hurt, pain onour bodies, hitting ourselves, punching, choking, any of that would fall in that sort of
(13:32):
parasuicidal spectrum or risky behavior.
So this is where
Some of these also go into impulsivity, which we've talked about a lot.
Like there's some overlap with the symptoms, but it's clear to see how they all kind ofcome together.
There's a lot of similarities here.
Self-sabotage and self-punishment are often kind of at the core of these behaviors aswell.
(13:59):
Yeah, because there's so much pain.
So it's an outward expression of that pain that's inside.
Yeah.
And it's a way to have that pain be seen.
Very much so.
Yeah.
I like to say that it is an outward expression of an inner self-loathing.
So in other words, when we think so little of ourselves, or we even hate ourselves so muchthat we start carving up our bodies or depriving our bodies of the nutrients that they
(14:34):
need or
putting harmful substances into our bodies in excess, then that's a way that we areexpressing how much we dislike ourselves and how deep that pain is.
We sometimes don't even know what else to do but to take it out on the body that housesthis personality.
(14:59):
Goodness, that's so much pain.
So the reasoning behind self harm, you're saying, right?
Like it can be a coping skill, whether it's pulling a result from the environment or evensoothing the self by, right?
There's endorphins, dopamine, serotonin.
I mean, essentially that could even be addictive.
(15:21):
Yeah, it can be.
There's been some research that has started to uncover some of the addictive pathways that
harming the self or cutting because of the endorphins being released when it happens, thatit can be similar to addictive behaviors.
And all of this when we're talking about coping skills, like maladaptive coping skills, ofcourse, these are ways that often individuals with BPD are using to cope, but they're not
(15:52):
working for them.
They're not serving them.
What are some other reasons why individuals self-harm?
take it out on their bodies.
To feel alive, right?
So if you're feeling numb or disconnected from that pain, think putting pain on thephysical outside body, that can be like, I am alive, at least.
Oppositely, it can be to feel more numb, right?
(16:15):
So I'm thinking maybe some substances to numb the pain.
It could be expressing anger at others.
It could be punishing the self or redoing trauma even.
Ooh, that's interesting.
like trying to maybe master the trauma.
So maybe inflicting the same wounds that were inflicted upon us as a sense of trying tocontrol or going back to the trauma.
(16:39):
Can be transferring emotional pain to physical pain.
A lot of times either paired with something else or just by itself, it's a cry for help.
So this is going to be to counteract any dissociation or feeling disconnected from yourbody or reality.
So this reminds me of what we were talking about at the beginning with these parasuicidalbehaviors and gestures can happen often in that sort of transient stress state where we're
(17:11):
maybe out of touch with reality or out of touch with our bodies.
so inflicting harm on the body is a maladaptive way of bringing us back down to center orgrounding us.
I think another important point.
is that all of this does not just occur in those with borderline personality disorder.
(17:36):
So it comes up in other diagnoses.
OK.
And so then this one criterion is not sufficient for a diagnosis of BPD.
Correct.
if we have a friend who's maybe struggling with suicidal ideation or behaviors,
That doesn't necessarily mean that they have BPD.
(17:59):
Borderline Personality Disorder is the only one that has that criterion, but it's not theonly one with the correlations for risk of suicide for self-harm behaviors.
Yes, that is an important distinction.
It is a criterion of BPD.
That's why we're talking about it today.
(18:20):
And the other personality disorders don't have it as a criterion.
But there are correlations with suicide risk, parasuicidal behaviors outside the contextof BPD.
I think of depression as one of them.
Sure.
That's common in depression, that the thoughts tend to turn more dark and negative, whichcan lead to hopelessness and then kind of backsliding down that continuum of self-harm or
(18:49):
suicidal ideation or behaviors.
Not everyone
who has a diagnosis of BPD self-harms either.
Right.
So their pain, right, maybe is kept hidden.
It's not always on the outside.
So this is where BPD in one individual can look totally different in another individual.
(19:12):
So those with maybe more high-functioning BPD, where in society they can function andother people don't really notice.
that they're not fitting in with the herd, as with most other personality disorders, youcan tell if they're not fitting in.
But in their most intimate, deepest relationships, there's gonna be some indicatorspopping up.
(19:35):
And maybe it's that there's suicidal ideation that's kept under wraps.
It might just be contained to the thoughts.
And I think it's also important to note here, this is where we see a lot of overlap withBPD and depression, because
there's some commonalities here.
So when there isn't a stable sense of self, which is the case with personality disorders,specifically BPD, there's not a stable sense of who we are.
(20:03):
And there's an empty spot.
And what often happens is that empty spot that void gets filled with depression.
And then that depressive cloud kind of carries through and can lead to more
negative thoughts, more hopelessness, more suicidal ideation, so they can kind ofstrengthen each other.
(20:23):
But those two conditions, BPD and depression, or dyscymia even, which is persistentdepression, those often are comorbid or coexist together.
I think it's also important right here to highlight the stigma about the motive underneaththese behaviors.
(20:45):
We previously talked about in media and even in psychological circles, the internet, mygoodness, everywhere.
There's a tendency to believe that these behaviors are manipulative or they're just forattention.
(21:05):
I think I have some ideas of where that comes from, but I want to hear more about yourthoughts, Doc Fish.
When we're in pain, we want to lessen it.
that's human.
It feels more like it's a reflex rather than a conscious decision to say, I'm going toharm myself so that this other person helps me.
(21:26):
It feels more like out of control emotions and like a lack of thinking because there's toomuch pain.
Have you ever been like so angry you couldn't even think or so sad like you couldn't eventhink?
I think when that happens, I call it emotional flooding, emotionally flooded.
You're not thinking, it's just a reflex.
(21:48):
So this reminds me of like when we go to the doctor, right?
And they like take the little knee knocker thing, I don't even know what you call it.
The knee knocker thing.
That's what it's called now.
Okay, okay.
I like it.
And you know, to see if your reflexes are working to see if you kick a little bit.
And with someone with BPD, that pain is so
(22:10):
great.
It's like pushing on a bruise.
And the natural reflex is to do something.
And it's often to elicit like, help, help me this hurts so much that I'm actually going toinflict more pain, physical pain on myself, I can't handle it.
So on the receiving end, that feels manipulative.
(22:34):
It feels like, this person's trying to pull me in because we feel the pull, right?
Because we've
we as humans want to help.
We want to be of service, but we feel pulled into rescue.
So it can feel like it's conscious.
This person is consciously kind of reeling us in and it's maybe more thought out andmanipulative.
(23:00):
Yeah, like a manipulative operation behind it when it's, it's a reflex.
Right?
Feels
It doesn't feel like a reflex to everybody else.
Right.
It's not like a military operation that was planned.
Right.
That doesn't make it any less difficult to handle on the receiving end.
(23:24):
But I think that's a great way to kind of enter into empathy.
This pain is so great that the natural reflex is to inflict more pain or to potentiallywant to end.
your life.
That's some severe pain.
hard part here is that we have to remember it hurts extra.
(23:47):
There's such a sensitivity, it hurts extra.
So even if it doesn't hurt in a way that we ourselves think that it should hurt, itdoesn't invalidate that the other person is feeling more deeply.
And I think of what Marsha Linehan said about individuals with BPD, that they'reessentially
(24:07):
We can think of it as if they're born without emotional skin.
So everything hurts, everything's a walking bra nerve.
And if a stressor comes, we're taking the little knee knocker thing and there's no skin,that's gonna feel horrible.
There's a pattern that plays into the stigma because remember BPD is often idealized anddevalued.
(24:34):
So you're all good or you're all bad.
So in order to keep an attachment, there's often a rescuer, right?
Someone who loves them, somebody who helps them.
Because that rescuer is most likely a human, they're not gonna be perfect.
They're gonna mess up.
And so when they fall from that pedestal that they're on, there can be anger.
(24:55):
But in order to keep the attachment, you can't necessarily get angry.
If you think anger is destructive, you can't necessarily get angry at the other person.
You don't want them to go away.
You have to keep them.
So it can sometimes look like punishment that is supposed to be towards someone else, butit's turned towards the self.
It's like, I'm angry with you, but it's not safe to be angry with you, so I have to beangry with me.
(25:19):
So now I'm going to hurt myself to punish myself.
But there can also be like, and I hope you feel bad about it, about what you did.
Now that's not necessarily conscious.
But it can feel that way.
It can feel that way.
On the receiving end.
The fear is losing that attachment.
Sometimes that means I'm gonna take the anger out on myself instead and hurt myself.
(25:45):
Now, sometimes it can lead to also being persecutory.
Like if we're thinking about the drama triangle, doing things towards someone else thatare unkind, pushing someone away before they reject you.
But in the case of self-harm or parasuicidal behaviors,
I mean, typically that's, it's taking it out on the self.
(26:08):
And it's so tricky too, because there's a learned reward that being hurt or being in painelicits help.
So there's a rejection of pain.
No one actually enjoys the pain, but at the same time, there's a conflict because there'sa reward for pain.
Now we come into that push-pull thing again of like help seeking, but also help rejecting.
(26:31):
So help me, help me, help me, but don't help me.
too much.
Don't make me all better.
Because then you won't need to me.
You won't need me anymore.
that is complicated.
And it's not conscious, which makes it even more complicated because it's not like it'sidentified in the moment.
(26:53):
So this is where we see individuals with BPD kind of stay in that sick role.
Like exactly, there's always always something
going on that they can't quite realize their own potential.
Like can't quite graduate from high school or college or whatever big thing can't quiteget that promotion can't quite get there on their own.
(27:19):
And this is that's the regression of I need I need someone to take care of me.
I need that attachment.
Right, like all this pain all of these dynamics run so deep.
right?
But the outward expression can be that self harm.
Yeah, in some ways, sure, there's a there's an attention need in that there's a need forattachment, I need you to help.
(27:44):
But I don't find it is often simplified to this person just is looking for attention.
That's too simple.
It's much more complex than that.
And I would say oftentimes, it is a cry for help, like see me.
see me, I'm drowning over here, I need help, this pain is too much, help me, pay attentionto me in that way because I'm in pain, but that's not where it ends.
(28:08):
It's not just, I want to be the center of attention or get attention.
It's, I would say almost always, if not exclusively, comes from a place of pain.
At least I would say so for BPD.
So it seems like this is where impulsivity symptoms again overlap with the self harm,suicidal ideation gestures, because if we do things on impulse, on reflex, we're not
(28:37):
thinking about it.
I'm going to do something to soothe the pain, which often includes, hey, see me, help me.
I'm in distress.
That impulsivity damages the self.
This is so challenging because all of this
pain and this hurt to anyone that's in relationship and close relationship to someone withthis condition.
(28:58):
It can feel so manipulative.
can feel because because you feel those rescue pulls and that's just that's not howrelationships are intended to go on a regular basis.
And this can create some really toxic personality dynamics within relationships wherethere's
(29:22):
constant push, pulls and fighting, makeup, breakup, because it's so challenging to be insuch close proximity to someone with this condition when there's that pulling.
Again, not necessarily conscious because the pain is so great.
What can loved ones do?
I mean, the first thing is seek professional help.
(29:46):
Like this is not something that you should.
or need to go alone, whether this is the person experiencing BPD, whether it's a friend, aloved one of someone with BPD, or even licensed professionals.
Like, this is challenging.
(30:08):
It's challenging.
speaking to licensed professionals for a minute, like, consult, consult, get the help ofyour colleagues to have maybe a second pair of eyes sometimes on things that are going on.
Ask for advice about how to handle tricky situations when you're feeling pulled.
And for, you know, family members getting support yourself, being able to talk through thetricky, tricky dynamics.
(30:34):
And certainly if you're the individual with BPD or you suspect that you may have it, goingto therapy with a trusted provider that you feel comfortable with, making sure that that's
a good fit, right?
Goodness of fit in that therapeutic relationship is the number one predictor of
a successful treatment.
Yeah, you do not have to go this alone seeking out a professional for sure.
(30:58):
Number one recommendation.
I'm also thinking about just a few other tidbits that we could give a few other nuggets,not taking the person's actions personally, as much as we can get sucked in.
Because that's what happens with these complex dynamics, not blaming yourself, not takingit personally.
(31:21):
seeking support.
even outside of professional relationships, seek support of trusted friends, familymembers.
This doesn't have to be something that happens in an isolated environment.
Again, whether you're the professional that's working with this complex condition, as ironsharpens iron, seeking out that that support from trusted colleagues, going to therapy
(31:46):
yourself, we all could use just support from each other.
with challenging dynamics.
Taking care of your own needs, taking responsibility for your own behavior.
I mean, I think awareness also just like increasing awareness of any reinforcing orenabling and then maybe setting boundaries and keeping boundaries.
(32:06):
For sure.
Because in any one of these dynamics, like go back to that drama triangle where someone isneeding to be rescued, there's likely a persecutor and a rescuer.
look for our triangles and we can see if we take the time and especially with the help ofa professional, okay, what am I doing that's reinforcing this pattern?
(32:28):
Perhaps how do we disrupt those reinforcers so we can roll on out of that drama triangle?
And a big part of that is making boundaries, not just kind of giving into every pool, butmaking appropriate boundaries that we all need.
We all need to navigate this world.
Boundaries are like fences, you know that, all right, this is a line that we don't cross.
(32:51):
This is my property, that's your property.
We don't cross that.
We have to have that in relationships so that we can all function in a healthier manner.
Right, and for safety, fences, yes, they restrict the area that you can roam around in.
And I think there can be anchor when boundaries are first set, but they're absolutelynecessary for safety.
(33:14):
So you don't wander out into
parts that are harmful.
Well, especially I think of like having young kiddos in a backyard, right?
Backyard that's not fenced in and then it's the backyard maybe buddies up to theinterstate or something like we need to think about safety boundaries and relationships
are the same way we have to have those.
(33:35):
So whether that's maybe not answering those texts at two or 3am, because you need yoursleep because you're human.
And we all need sleep or, you know, setting parameters of we're not going to talk aboutthese topics because I'm human and this is triggering to me or the possibilities are
endless for boundaries.
(33:57):
Absolutely.
It's so easy to get caught up in the dynamics of pain and anger and emotional flooding.
So I think just simply being gentle, communicating without defensiveness is alwayshelpful.
You know, not getting pulled in emotionally, like not reacting out of anger, like notgetting into your own kind of knee jerk reactions or reflex reactions, being in control,
(34:22):
pausing, taking a minute before responding and doing something that maybe you regret orthat could be damaging to the relationship or to the person, unhooking, taking a step
back, certainly not getting into a fit of rage.
That's not going to be helpful for anyone.
Yeah.
And I also think about potentially even creating like a safety plan when things doescalate to the point that it's really hard to control the anger.
(34:53):
Now, whether that's the individual with BPD or someone that's in relationship to thisindividual, we all have stuff, right?
So it could be that we have multiple personality dynamics going on in a relationship.
That's very, very common.
Narcissistic personality disorder and borderline personality disorder often dance, andthat can create a really toxic relationship pattern.
(35:18):
So it's important with these relationships in particular, but any relationship to have asafety plan if things are escalating to the point that harm could happen to another
individual.
Go to a safe space if you don't think you're gonna make good choices.
Unhook, leave, go take a walk.
get some fresh air, take a night, take 24 hours and come back and revisit the conflictafter time has passed.
(35:46):
it's too escalated, even call authorities if needed.
Yes.
Wilfer checks.
So you can call 911 and ask to check on the person.
Sure.
If safety is imminent.
Maybe not ignoring the person.
You can say, I'll talk to you when you're calm.
That might be a boundary.
Yeah.
Like you said, right?
(36:07):
not taking out your own rage in response to a pain, but also not taking responsibility fortheir actions, right?
So not blaming yourself, not blaming them, not blaming yourself.
If you need to take space that that's probably going to be triggering for the individualwith BPD saying to them, you know, we will talk later when you're calm or when I'm calm, I
(36:32):
need to take a minute that might not go well, because it's a boundary.
But if that's what you need, you must take that space, especially if you feel like there'snot gonna be good decisions or safe decisions that are made.
Absolutely.
I feel like that's even modeling too of like, I'm gonna disengage from this so I can takecare of myself before my actions impact you, which is responsible.
(36:59):
And you've mentioned this speaking of responsible, but not taking responsibility for...
other person's actions.
So if someone is making suicidal gestures, threats, behaviors, that is not your fault.
It is not your responsibility to rescue.
Certainly, if the authorities need to be called, or there needs to be some type of thirdparty intervention, yes, do that.
(37:28):
But to be pulled in as a rescuer,
every time in that relationship that is not healthy, that is not a healthy relationship,and it is not the individual's responsibility to be in that role.
So you're talking about basically the line between helping and rescuing.
Good help.
(37:48):
Sure.
Rescuing takes on that responsibility.
And then that's how we start enabling, right?
Yeah.
Because we don't learn to manage our own stuff, our own coping skills, we just rescue andtake care of it.
And that just keeps that cycle going.
Goodness, so complex, so scary.
I just want to validate that.
Like the individuals with BPD, so much pain, so much pain.
(38:14):
And the individuals that are in that sphere of the person with BPD, it can be reallyscary.
I just want to validate that.
It's scary for professionals too, because this is a complex condition.
It's really complex.
I feel like in the interest of time, we should probably wind down for today.
(38:36):
Well, that brings today's episode to a close.
Thank you for joining us today on this episode of The Personality Couch.
We hope you learned some valuable information on borderline personality disorder and thereasons behind suicidal and parasuicidal behavior.
It's so important not to blame yourself.
(38:58):
and to empathize with the pain that is always underneath these behaviors.
And on that note, be well, be kind, and we'll see you next time on the Personality Couch.
(39:27):
and 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 will becontinuing our Borderline Personality Disorder series.
(00:25):
Now, a note to our viewers and listeners.
Today is going to include heavier topics and may not be appropriate for everyone.
So discretion is advised.
We will be discussing the DSM criteria of suicidal ideation, behavior, threats, andself-harm, while also unpacking what self-harm looks like, why individuals with BPD
(00:51):
self-harm, the stigma,
about these behaviors and what loved ones and professionals can do.
Okay, we have got a lot to cover, so we better get started.
So we've been going through the DSM and talking about the different criteria forborderline personality disorder.
(01:12):
And specifically, we have been discussing one of the hallmark features of BPD, which isfear of abandonment.
And that
one is particularly tied to suicidal ideation, threats, behaviors, kind of all the thingsthat we want to unpack today.
So Doc Fish, why don't we crack open that DSM and see what it says about this criterionabout suicidal and self-harm threats, gestures, and behaviors?
(01:46):
So DSM criteria is recurrent suicidal behavior, gestures,
or threats or self-mutilating behavior.
So this is often why those with borderline personality disorder present for help.
It can be just for outpatient therapy.
It can also be something where there's hospitalization.
(02:07):
Oftentimes this is like an outward thing that happens and that's why there's apresentation for help.
Because it's distressing.
Right, right.
And it's scary.
It's scary.
The DSM also says that
There can be dissociation and sometimes there can be like cutting or burning is prettycommon during the dissociation.
(02:30):
So essentially like these acts often bring about relief by reaffirming their ability tofeel something essentially it's self punishment.
And I can imagine that this is going to happen, especially in times where there's maybe analtered state of consciousness that's common with BPD.
Like we've been talking about.
(02:50):
when we're kind of in this in-between stage and we can maybe lose touch with reality orlose touch with our own bodies that perhaps self-harm or hurting our bodies in some type
of way, it can happen probably at any point along that borderline continuum, whetheryou're in reality or kind of moving more towards that psychotic end.
(03:15):
But I imagine that especially when you're not fully present,
this is going to show up a lot more.
The inside pain is so intense that there's a disconnect from it.
And then it can be like, well, at least I feel something physically.
But these behaviors are often, often occur after threats of separation or rejection.
(03:40):
So something that impairs functioning job loss.
interrupted education, separation, divorce, that can be a stressor or a catalyst for theself harm or suicidal ideation.
like normal stressors, normal life transitions for someone with BPD, this can feel maybelarger than life.
(04:02):
And that stress coupled with low distress tolerance can lead to self harm, hurtingthemselves.
But also when there's some type of attachment break, like maybe at school there was ateacher that they felt really close to and, you know, school's coming to an end about
ready to graduate.
(04:23):
Like that stressor that's normally it's a transition.
It's stressful for everyone to some degree.
Someone with BPD, that's going to feel much greater.
And that transition or attachment loss from, you know, friends, teacher, whatever that is.
can lead to taking it out on themselves is what I'm understanding.
(04:46):
Then even just life transitions, especially ones where there's an increase inresponsibility.
Then we have the, can't do this, which connects with their sense of self.
I need someone to take care of me.
If I have someone to take care of me, then I have an attachment.
It's essentially dependence.
(05:06):
That's interesting because you wouldn't necessarily think of that.
as a part of BPD and self-harm.
Can you give an example of what that might look like?
Sure.
Graduating college, you have a transition.
Well, I guess it could be a good transition.
It doesn't necessarily have to be a good transition, but it's not necessarily a negativeone.
(05:29):
It's not necessarily something that has to do with attachment breaks.
It's just a life transition with increased responsibility.
You have to find a job.
You have to adult, right?
You have to grow up.
What better way to keep an attachment than to be childlike?
(05:49):
Children need to be taken care of, And so then they need to have an attachment.
They have to have someone that attaches to them to take care of them.
So I think essentially there's a resistance of pulling out of any kind of regression thatthey're in.
So in other words, what I'm understanding is that individuals with BPD can be in this morekind of dependent state where it's maybe difficult to take care of themselves or their
(06:24):
adult responsibilities and they kind of elicit maybe a rescuer or a nurturer, someonewho's more in a parent type role to
help them navigate life sometimes, especially in those transitions that it can beparticularly challenging.
(06:46):
It means taking on more responsibility and perhaps moving out of that regressed state thatis more childlike and dependent into one of independence.
And independence means potentially attachment changes or attachment breaks.
(07:06):
Right.
Wow.
It could even be a change of identity.
I'm going from college student, that's part of my identity now, to a job.
I'm no longer a college student.
I now have a job.
Like if I'm not a college student, what am I now?
I don't know how to be a person with a job or a person looking for a job.
I only know how to be a college student.
(07:28):
Wow.
This is really complex.
I think underneath all of that though.
No matter the stressor, it's a cry for help.
So the recurrent suicidal behavior, the gestures, any self-harm is a cry for help.
Like, see my pain.
I can't be alone.
Okay.
(07:48):
And that may happen at those big life changes.
I should say, and especially, attachment breaks.
Right.
Because we have that fear of abandonment.
Exactly.
So that's where these two are tied together fear of abandonment, along with self harm orsuicidal thoughts, gestures, behaviors, right, but also life transitions.
(08:13):
Sometimes there can also be a distraction from pain, right?
So just like, like, there's too much pain on the inside.
So I'm gonna put that pain on the outside, still a pool for help.
And this isn't something that
the individual with BPD is like consciously thinking through.
But these are the kind of unspoken dynamics that are happening that are playing out inrelationships that when we're on the receiving end of that, because we're a friend, loved
(08:42):
one, co worker, in a professional relationship with in some capacity, that we feel thatand it can feel this can feel manipulative.
to the person on the receiving end, who's like this person, individual with BPD is they'repulling for a rescuer, pulling for someone to save them, someone to be the parent, the
(09:09):
adult.
Yeah, just pulling for someone to come in, to step in and save the day.
And though that's not a conscious thing that they're working out in their minds, that'sleading to this behavior, you can feel the pull.
when you're in that drama triangle, really.
Right, because it's so human to see someone in pain and want to help.
(09:31):
And the distinguishing thing here is that someone with BPD, and really this is with allpersonality disorders, the ability to handle conflict appropriately is diminished.
The way that someone who doesn't have a personality disorder would handle challenges,conflicts, changes, life transitions,
(09:53):
would perhaps be more adaptive than these more, what we call regressed behaviors or kindof these childlike behaviors, pulling people in to rescue.
And again, not on a conscious level.
It's very challenging, very challenging.
So talk back.
We've been using some big words today already.
(10:13):
Self harm, self injury, self mutilation, non suicidal self injury.
There's so many words.
Can you help me understand?
Yeah, yeah.
Well, they're all really part of the same continuum.
So self-harm on one end of the spectrum and then all the way to the other end of thespectrum, you have inflicting harm on the self with the intent of ending your life.
(10:39):
And then there's all this area in between.
So that's when we say para-suicidal, we're talking about the spectrum, like everythingalong the range of self-harm.
to suicidal thoughts, gestures, behaviors.
Yeah, non-suicidal self-injury is on the one end of the spectrum, like not wanting to hurtyourself with the intent of ending your life.
(11:04):
But then there can also be in that middle range where it's inflicting some type of harmwith the thought of, well, maybe it could aid in the process of ending my life, all the
way to...
I actually have a plan of how I want to and here's how I'm going to inflict harm on myselfin order to make that happen.
(11:25):
So they're all part of the same continuum, but the motivations and the severity aredifferent.
What are some examples?
Yeah, yeah.
So there's a lot of different ways that this can look and it really depends on the person.
(11:46):
But if you think of on one side, more risky behaviors, so not necessarily with the plan toend your life, though maybe there's a thought of, well, if it happened, it wouldn't be so
bad.
But there's things like binge eating, using food to cope in unhealthy ways, maybe eatingtoo much and then doing something to counteract that.
(12:13):
So
that's inflicting pain on your body, taking it out on your body in some type of way.
It could be reckless driving, like I'm just gonna speed and see if someone stops me.
It can look like drinking in excess, to kind of numb, to forget, indiscriminate partnersor physical intimacy.
(12:35):
Bring in that person again, that attachment to feel something and to soothe because...
An individual with BPD has a really hard time soothing on their own using substances aswell.
Alcohol, drugs, cutting is another big one.
Actually inflicting wounds on our body that sometimes are a physical representation of theinner pain that we feel.
(13:03):
Like we don't know how else to express it.
So we're just expressing it on our bodies in some type of way, mutilating.
our bodies in some type of way.
It can also include burning as well, burning our bodies.
Head banging is another common one, just taking out the anger, frustration, hurt, pain onour bodies, hitting ourselves, punching, choking, any of that would fall in that sort of
(13:32):
parasuicidal spectrum or risky behavior.
So this is where
Some of these also go into impulsivity, which we've talked about a lot.
Like there's some overlap with the symptoms, but it's clear to see how they all kind ofcome together.
There's a lot of similarities here.
Self-sabotage and self-punishment are often kind of at the core of these behaviors aswell.
(13:59):
Yeah, because there's so much pain.
So it's an outward expression of that pain that's inside.
Yeah.
And it's a way to have that pain be seen.
Very much so.
Yeah.
I like to say that it is an outward expression of an inner self-loathing.
So in other words, when we think so little of ourselves, or we even hate ourselves so muchthat we start carving up our bodies or depriving our bodies of the nutrients that they
(14:34):
need or
putting harmful substances into our bodies in excess, then that's a way that we areexpressing how much we dislike ourselves and how deep that pain is.
We sometimes don't even know what else to do but to take it out on the body that housesthis personality.
(14:59):
Goodness, that's so much pain.
So the reasoning behind self harm, you're saying, right?
Like it can be a coping skill, whether it's pulling a result from the environment or evensoothing the self by, right?
There's endorphins, dopamine, serotonin.
I mean, essentially that could even be addictive.
(15:21):
Yeah, it can be.
There's been some research that has started to uncover some of the addictive pathways that
harming the self or cutting because of the endorphins being released when it happens, thatit can be similar to addictive behaviors.
And all of this when we're talking about coping skills, like maladaptive coping skills, ofcourse, these are ways that often individuals with BPD are using to cope, but they're not
(15:52):
working for them.
They're not serving them.
What are some other reasons why individuals self-harm?
take it out on their bodies.
To feel alive, right?
So if you're feeling numb or disconnected from that pain, think putting pain on thephysical outside body, that can be like, I am alive, at least.
Oppositely, it can be to feel more numb, right?
(16:15):
So I'm thinking maybe some substances to numb the pain.
It could be expressing anger at others.
It could be punishing the self or redoing trauma even.
Ooh, that's interesting.
like trying to maybe master the trauma.
So maybe inflicting the same wounds that were inflicted upon us as a sense of trying tocontrol or going back to the trauma.
(16:39):
Can be transferring emotional pain to physical pain.
A lot of times either paired with something else or just by itself, it's a cry for help.
So this is going to be to counteract any dissociation or feeling disconnected from yourbody or reality.
So this reminds me of what we were talking about at the beginning with these parasuicidalbehaviors and gestures can happen often in that sort of transient stress state where we're
(17:11):
maybe out of touch with reality or out of touch with our bodies.
so inflicting harm on the body is a maladaptive way of bringing us back down to center orgrounding us.
I think another important point.
is that all of this does not just occur in those with borderline personality disorder.
(17:36):
So it comes up in other diagnoses.
OK.
And so then this one criterion is not sufficient for a diagnosis of BPD.
Correct.
if we have a friend who's maybe struggling with suicidal ideation or behaviors,
That doesn't necessarily mean that they have BPD.
(17:59):
Borderline Personality Disorder is the only one that has that criterion, but it's not theonly one with the correlations for risk of suicide for self-harm behaviors.
Yes, that is an important distinction.
It is a criterion of BPD.
That's why we're talking about it today.
(18:20):
And the other personality disorders don't have it as a criterion.
But there are correlations with suicide risk, parasuicidal behaviors outside the contextof BPD.
I think of depression as one of them.
Sure.
That's common in depression, that the thoughts tend to turn more dark and negative, whichcan lead to hopelessness and then kind of backsliding down that continuum of self-harm or
(18:49):
suicidal ideation or behaviors.
Not everyone
who has a diagnosis of BPD self-harms either.
Right.
So their pain, right, maybe is kept hidden.
It's not always on the outside.
So this is where BPD in one individual can look totally different in another individual.
(19:12):
So those with maybe more high-functioning BPD, where in society they can function andother people don't really notice.
that they're not fitting in with the herd, as with most other personality disorders, youcan tell if they're not fitting in.
But in their most intimate, deepest relationships, there's gonna be some indicatorspopping up.
(19:35):
And maybe it's that there's suicidal ideation that's kept under wraps.
It might just be contained to the thoughts.
And I think it's also important to note here, this is where we see a lot of overlap withBPD and depression, because
there's some commonalities here.
So when there isn't a stable sense of self, which is the case with personality disorders,specifically BPD, there's not a stable sense of who we are.
(20:03):
And there's an empty spot.
And what often happens is that empty spot that void gets filled with depression.
And then that depressive cloud kind of carries through and can lead to more
negative thoughts, more hopelessness, more suicidal ideation, so they can kind ofstrengthen each other.
(20:23):
But those two conditions, BPD and depression, or dyscymia even, which is persistentdepression, those often are comorbid or coexist together.
I think it's also important right here to highlight the stigma about the motive underneaththese behaviors.
(20:45):
We previously talked about in media and even in psychological circles, the internet, mygoodness, everywhere.
There's a tendency to believe that these behaviors are manipulative or they're just forattention.
(21:05):
I think I have some ideas of where that comes from, but I want to hear more about yourthoughts, Doc Fish.
When we're in pain, we want to lessen it.
that's human.
It feels more like it's a reflex rather than a conscious decision to say, I'm going toharm myself so that this other person helps me.
(21:26):
It feels more like out of control emotions and like a lack of thinking because there's toomuch pain.
Have you ever been like so angry you couldn't even think or so sad like you couldn't eventhink?
I think when that happens, I call it emotional flooding, emotionally flooded.
You're not thinking, it's just a reflex.
(21:48):
So this reminds me of like when we go to the doctor, right?
And they like take the little knee knocker thing, I don't even know what you call it.
The knee knocker thing.
That's what it's called now.
Okay, okay.
I like it.
And you know, to see if your reflexes are working to see if you kick a little bit.
And with someone with BPD, that pain is so
(22:10):
great.
It's like pushing on a bruise.
And the natural reflex is to do something.
And it's often to elicit like, help, help me this hurts so much that I'm actually going toinflict more pain, physical pain on myself, I can't handle it.
So on the receiving end, that feels manipulative.
(22:34):
It feels like, this person's trying to pull me in because we feel the pull, right?
Because we've
we as humans want to help.
We want to be of service, but we feel pulled into rescue.
So it can feel like it's conscious.
This person is consciously kind of reeling us in and it's maybe more thought out andmanipulative.
(23:00):
Yeah, like a manipulative operation behind it when it's, it's a reflex.
Right?
Feels
It doesn't feel like a reflex to everybody else.
Right.
It's not like a military operation that was planned.
Right.
That doesn't make it any less difficult to handle on the receiving end.
(23:24):
But I think that's a great way to kind of enter into empathy.
This pain is so great that the natural reflex is to inflict more pain or to potentiallywant to end.
your life.
That's some severe pain.
hard part here is that we have to remember it hurts extra.
(23:47):
There's such a sensitivity, it hurts extra.
So even if it doesn't hurt in a way that we ourselves think that it should hurt, itdoesn't invalidate that the other person is feeling more deeply.
And I think of what Marsha Linehan said about individuals with BPD, that they'reessentially
(24:07):
We can think of it as if they're born without emotional skin.
So everything hurts, everything's a walking bra nerve.
And if a stressor comes, we're taking the little knee knocker thing and there's no skin,that's gonna feel horrible.
There's a pattern that plays into the stigma because remember BPD is often idealized anddevalued.
(24:34):
So you're all good or you're all bad.
So in order to keep an attachment, there's often a rescuer, right?
Someone who loves them, somebody who helps them.
Because that rescuer is most likely a human, they're not gonna be perfect.
They're gonna mess up.
And so when they fall from that pedestal that they're on, there can be anger.
(24:55):
But in order to keep the attachment, you can't necessarily get angry.
If you think anger is destructive, you can't necessarily get angry at the other person.
You don't want them to go away.
You have to keep them.
So it can sometimes look like punishment that is supposed to be towards someone else, butit's turned towards the self.
It's like, I'm angry with you, but it's not safe to be angry with you, so I have to beangry with me.
(25:19):
So now I'm going to hurt myself to punish myself.
But there can also be like, and I hope you feel bad about it, about what you did.
Now that's not necessarily conscious.
But it can feel that way.
It can feel that way.
On the receiving end.
The fear is losing that attachment.
Sometimes that means I'm gonna take the anger out on myself instead and hurt myself.
(25:45):
Now, sometimes it can lead to also being persecutory.
Like if we're thinking about the drama triangle, doing things towards someone else thatare unkind, pushing someone away before they reject you.
But in the case of self-harm or parasuicidal behaviors,
I mean, typically that's, it's taking it out on the self.
(26:08):
And it's so tricky too, because there's a learned reward that being hurt or being in painelicits help.
So there's a rejection of pain.
No one actually enjoys the pain, but at the same time, there's a conflict because there'sa reward for pain.
Now we come into that push-pull thing again of like help seeking, but also help rejecting.
(26:31):
So help me, help me, help me, but don't help me.
too much.
Don't make me all better.
Because then you won't need to me.
You won't need me anymore.
that is complicated.
And it's not conscious, which makes it even more complicated because it's not like it'sidentified in the moment.
(26:53):
So this is where we see individuals with BPD kind of stay in that sick role.
Like exactly, there's always always something
going on that they can't quite realize their own potential.
Like can't quite graduate from high school or college or whatever big thing can't quiteget that promotion can't quite get there on their own.
(27:19):
And this is that's the regression of I need I need someone to take care of me.
I need that attachment.
Right, like all this pain all of these dynamics run so deep.
right?
But the outward expression can be that self harm.
Yeah, in some ways, sure, there's a there's an attention need in that there's a need forattachment, I need you to help.
(27:44):
But I don't find it is often simplified to this person just is looking for attention.
That's too simple.
It's much more complex than that.
And I would say oftentimes, it is a cry for help, like see me.
see me, I'm drowning over here, I need help, this pain is too much, help me, pay attentionto me in that way because I'm in pain, but that's not where it ends.
(28:08):
It's not just, I want to be the center of attention or get attention.
It's, I would say almost always, if not exclusively, comes from a place of pain.
At least I would say so for BPD.
So it seems like this is where impulsivity symptoms again overlap with the self harm,suicidal ideation gestures, because if we do things on impulse, on reflex, we're not
(28:37):
thinking about it.
I'm going to do something to soothe the pain, which often includes, hey, see me, help me.
I'm in distress.
That impulsivity damages the self.
This is so challenging because all of this
pain and this hurt to anyone that's in relationship and close relationship to someone withthis condition.
(28:58):
It can feel so manipulative.
can feel because because you feel those rescue pulls and that's just that's not howrelationships are intended to go on a regular basis.
And this can create some really toxic personality dynamics within relationships wherethere's
(29:22):
constant push, pulls and fighting, makeup, breakup, because it's so challenging to be insuch close proximity to someone with this condition when there's that pulling.
Again, not necessarily conscious because the pain is so great.
What can loved ones do?
I mean, the first thing is seek professional help.
(29:46):
Like this is not something that you should.
or need to go alone, whether this is the person experiencing BPD, whether it's a friend, aloved one of someone with BPD, or even licensed professionals.
Like, this is challenging.
(30:08):
It's challenging.
speaking to licensed professionals for a minute, like, consult, consult, get the help ofyour colleagues to have maybe a second pair of eyes sometimes on things that are going on.
Ask for advice about how to handle tricky situations when you're feeling pulled.
And for, you know, family members getting support yourself, being able to talk through thetricky, tricky dynamics.
(30:34):
And certainly if you're the individual with BPD or you suspect that you may have it, goingto therapy with a trusted provider that you feel comfortable with, making sure that that's
a good fit, right?
Goodness of fit in that therapeutic relationship is the number one predictor of
a successful treatment.
Yeah, you do not have to go this alone seeking out a professional for sure.
(30:58):
Number one recommendation.
I'm also thinking about just a few other tidbits that we could give a few other nuggets,not taking the person's actions personally, as much as we can get sucked in.
Because that's what happens with these complex dynamics, not blaming yourself, not takingit personally.
(31:21):
seeking support.
even outside of professional relationships, seek support of trusted friends, familymembers.
This doesn't have to be something that happens in an isolated environment.
Again, whether you're the professional that's working with this complex condition, as ironsharpens iron, seeking out that that support from trusted colleagues, going to therapy
(31:46):
yourself, we all could use just support from each other.
with challenging dynamics.
Taking care of your own needs, taking responsibility for your own behavior.
I mean, I think awareness also just like increasing awareness of any reinforcing orenabling and then maybe setting boundaries and keeping boundaries.
(32:06):
For sure.
Because in any one of these dynamics, like go back to that drama triangle where someone isneeding to be rescued, there's likely a persecutor and a rescuer.
look for our triangles and we can see if we take the time and especially with the help ofa professional, okay, what am I doing that's reinforcing this pattern?
(32:28):
Perhaps how do we disrupt those reinforcers so we can roll on out of that drama triangle?
And a big part of that is making boundaries, not just kind of giving into every pool, butmaking appropriate boundaries that we all need.
We all need to navigate this world.
Boundaries are like fences, you know that, all right, this is a line that we don't cross.
(32:51):
This is my property, that's your property.
We don't cross that.
We have to have that in relationships so that we can all function in a healthier manner.
Right, and for safety, fences, yes, they restrict the area that you can roam around in.
And I think there can be anchor when boundaries are first set, but they're absolutelynecessary for safety.
(33:14):
So you don't wander out into
parts that are harmful.
Well, especially I think of like having young kiddos in a backyard, right?
Backyard that's not fenced in and then it's the backyard maybe buddies up to theinterstate or something like we need to think about safety boundaries and relationships
are the same way we have to have those.
(33:35):
So whether that's maybe not answering those texts at two or 3am, because you need yoursleep because you're human.
And we all need sleep or, you know, setting parameters of we're not going to talk aboutthese topics because I'm human and this is triggering to me or the possibilities are
endless for boundaries.
(33:57):
Absolutely.
It's so easy to get caught up in the dynamics of pain and anger and emotional flooding.
So I think just simply being gentle, communicating without defensiveness is alwayshelpful.
You know, not getting pulled in emotionally, like not reacting out of anger, like notgetting into your own kind of knee jerk reactions or reflex reactions, being in control,
(34:22):
pausing, taking a minute before responding and doing something that maybe you regret orthat could be damaging to the relationship or to the person, unhooking, taking a step
back, certainly not getting into a fit of rage.
That's not going to be helpful for anyone.
Yeah.
And I also think about potentially even creating like a safety plan when things doescalate to the point that it's really hard to control the anger.
(34:53):
Now, whether that's the individual with BPD or someone that's in relationship to thisindividual, we all have stuff, right?
So it could be that we have multiple personality dynamics going on in a relationship.
That's very, very common.
Narcissistic personality disorder and borderline personality disorder often dance, andthat can create a really toxic relationship pattern.
(35:18):
So it's important with these relationships in particular, but any relationship to have asafety plan if things are escalating to the point that harm could happen to another
individual.
Go to a safe space if you don't think you're gonna make good choices.
Unhook, leave, go take a walk.
get some fresh air, take a night, take 24 hours and come back and revisit the conflictafter time has passed.
(35:46):
it's too escalated, even call authorities if needed.
Yes.
Wilfer checks.
So you can call 911 and ask to check on the person.
Sure.
If safety is imminent.
Maybe not ignoring the person.
You can say, I'll talk to you when you're calm.
That might be a boundary.
Yeah.
Like you said, right?
(36:07):
not taking out your own rage in response to a pain, but also not taking responsibility fortheir actions, right?
So not blaming yourself, not blaming them, not blaming yourself.
If you need to take space that that's probably going to be triggering for the individualwith BPD saying to them, you know, we will talk later when you're calm or when I'm calm, I
(36:32):
need to take a minute that might not go well, because it's a boundary.
But if that's what you need, you must take that space, especially if you feel like there'snot gonna be good decisions or safe decisions that are made.
Absolutely.
I feel like that's even modeling too of like, I'm gonna disengage from this so I can takecare of myself before my actions impact you, which is responsible.
(36:59):
And you've mentioned this speaking of responsible, but not taking responsibility for...
other person's actions.
So if someone is making suicidal gestures, threats, behaviors, that is not your fault.
It is not your responsibility to rescue.
Certainly, if the authorities need to be called, or there needs to be some type of thirdparty intervention, yes, do that.
(37:28):
But to be pulled in as a rescuer,
every time in that relationship that is not healthy, that is not a healthy relationship,and it is not the individual's responsibility to be in that role.
So you're talking about basically the line between helping and rescuing.
Good help.
(37:48):
Sure.
Rescuing takes on that responsibility.
And then that's how we start enabling, right?
Yeah.
Because we don't learn to manage our own stuff, our own coping skills, we just rescue andtake care of it.
And that just keeps that cycle going.
Goodness, so complex, so scary.
I just want to validate that.
Like the individuals with BPD, so much pain, so much pain.
(38:14):
And the individuals that are in that sphere of the person with BPD, it can be reallyscary.
I just want to validate that.
It's scary for professionals too, because this is a complex condition.
It's really complex.
I feel like in the interest of time, we should probably wind down for today.
(38:36):
Well, that brings today's episode to a close.
Thank you for joining us today on this episode of The Personality Couch.
We hope you learned some valuable information on borderline personality disorder and thereasons behind suicidal and parasuicidal behavior.
It's so important not to blame yourself.
(38:58):
and to empathize with the pain that is always underneath these behaviors.
And on that note, be well, be kind, and we'll see you next time on the Personality Couch.
(39:27):
and do not refer to any specific person or case.
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