August 10, 2015 • 48 mins
What is borderline personality disorder, and why did doctors think it disproportionately affected women? Cristen and Caroline examine the history and emerging treatments of this mental health condition that continues to puzzle practitioners.
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Episode Transcript
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Speaker 1 (00:03):
Welcome to Stuff Mom Never Told You from House Supports
dot com. Hello, and welcome to the podcast. I'm Kristen
and I'm Caroline, and we've talked about mental health a
number of times on Stuff I've Never Told You, and
we have received requests from a lot of listeners to
(00:23):
talk about what we're going to talk about today, which
is borderline personality disorder. And Caroline, I want to bounce
the ball to you first because you're the one who
you know, in addition to us getting these listener requests,
you also were interested in researching and talking about this.
Was there something in particular that sparked your desire to
(00:47):
learn more about it? Yeah, because when I have heard
about borderline personality disorder, traditionally, it's been and in relation
to women, traditionally, it has been along the lines of
that girl is crazy, um, or I dated this crazy girl,
or my friend dated this crazy girl, and you know,
(01:08):
I think she was like borderline or something, and so
people being very flip about it, the way that they
people in general are flip about so many mental health conditions. Um.
You know, we talked about that very same issue in
our in our episode on obsessive compulsive disorder that people
are are very not eager, but very ready to just
throw out a mental health term to describe something not serious,
(01:34):
when in reality you're mislabeling a set of behaviors. Yeah,
and also miss gendering it in a way, because, like
you said, a lot of times, when it is applied
more sarcastically, it's usually exclusively describing women. And even if
we look at pop culture and depictions of borderline personality disorder,
(01:55):
all of the characters we rounded up are women as well.
So for instance, Girl Interrupted starting one on a Writer
and Angelina Jolie One own a Writer's character is supposed
to have BPD, but she kind of shows little evidence
of it in the movie. Yeah, it's almost like Angelina
Jolie's character shows a little bit more of that traditional
(02:19):
BPD behavior. Um there's also Glenn Close and fatal attraction
and before anyone gets upset, she is definitely a caricature
of someone with BP d um and and that's that's
another issue too. So not only do you have the
gendering of borderline personality disorder in pop culture and in
the media, but you do tend to see it as
(02:39):
a caricature, not as something real that someone is struggling with. UM.
Psychiatrist David m. Allen, who is a professor at the
University of Tennessee, also pointed out that Anne Hathaway in
the movie Rachel Getting Married UH portrays someone with borderline
personality disorder, but they don't actually delve deep into the
(03:01):
relationship between her and her mother, which uh in real life,
I r L could have triggered BPD in someone and
a movie that I actually had not heard of before,
but I'm now curious to say, partially because I love
this actress, Jessica Laying in the movie. Francis Um is also,
as Dr Allen points out, someone who is meant to
(03:24):
portray borderline personality disorder because of the way that she
manipulates her psychiatrists by exploiting his insecurities. And that is
something that you see with borderline where people do tend
to be master manipulators because they read people really, really,
really well. Yeah. And also he points out that the
(03:45):
tipping point in this character's life, well, actually it was
a character based on a woman who actually existed, an
actress named Francis Um. But she also has this controlling,
hostile mother who tried to live vicariously through her, and
so we will talk about more about these family connections.
Does this get a little mommy dearest? Yeah, that was
another one that commenters were like, Um, I have another
(04:06):
one suggestion. Yeah. Um. He also was really big on
the movie Third Team, which start Evan rachel Wood and
Nicky Reid. He says that it should be subtitled how
to turn your teenager into a borderline without ever being abusive. Yeah.
I was trying to remember watching that. It's been so
(04:28):
long since I've seen thirteen, and I certainly was not
aware as I was watching that that that might have
been something going on with these characters. Well right, And
I think that when we look at kids, teens, young
people who are developing BPD, a lot of the times
(04:49):
they're just portrayed as like bad kids, bad seed. Wild. Yeah,
they're just wild and out of control, and you know,
maybe they should just be shipped off to boarding school
or you know, you're just gonna wind up in prison.
But there are very real things that are beginning to
manifest around that age. Because if borderline personality disorder and
(05:09):
it's accompanying symptoms aren't caught early on, and technically are
not supposed to diagnose a child with BPD. Um, you
can almost just watch the condition develop as kids get older. Well,
speaking of watching the condition develop, let's talk about what
this is. So according to the National Institutes of Health,
(05:30):
borderline personality disorder is defined as a serious mental illness
marked by unstable moods, behaviors, and relationships, which does sound
like a very umbrella type of germ. I gotta be honest, yeah, absolutely,
and those unstable moods can be triggered by, honestly, really
what we would consider maybe mundane events or minor separations,
(05:52):
because people with BPD are terrified of abandonment and they
tend to lack a strong or stable sense of self
IDENTI and then um, as we mentioned talking about Jessica
Lang portraying Francis, people with borderline personality tend to be
hyper adept at reading people, and this was something explored
(06:12):
more in November two thousand and six study in the
journal Emotion, which found that quote an enhanced ability to
recognize expressions of happiness, sadness, anger, and fear might contribute
to the unstable relationships and intense emotions characteristic of the disorder.
So essentially, these people are able to read other people
(06:36):
and then sort of shapeshift in a way based on that.
But it's almost it's almost such a burden because they
are so adept at picking up on she's really happy
or she's really upset, or she's really angry. They tend
to experience this emotional roller coaster. And so basically in
this study, when they were shown faces, they were able
(06:56):
to pick up on an emotion, whether it was anger
or whether it was happy nous, so much earlier in
the emotions expression on the face than people without BPD.
So like, I might be having just like a flicker
of anger across my face, but somebody with BPD would
pick up on that end imagine that I'm just enraged
or so upset with them. Um. And it's the same
(07:19):
thing with happiness, which leads to a lot of very
turbulent emotional connections because if if I'm looking at you
and I'm just like vaguely happy or you know, not
looking upset, you might think like, oh, she she really
likes me, or you know, they tend to develop these
these really strong emotional connections and have turbulent romantic relationships
(07:41):
because there's almost too much of her reading into when
it comes to emotions, facial expressions, body language. Oh so
it's not it's not even just that they're correct in
assessing someone's emotions, but they tend to blow it out
of proportion. Yeah, okay. And on top of these kinds
of factors, there are also high rates of comorbid conditions
(08:05):
like anxiety, which is the most common. M BPD and
anxiety tend to go pretty hand in hand, as well
as things like depression, substance abuse, and eating disorders, as
well as self harm and suicide. And that self harm
and and self cutting behavior was something that came up
in a lot of the research that we read, especially
(08:26):
when it came to women with borderline personality disorder. Yeah.
And other common comorbid conditions include post traumatic stress disorder,
bipolar to disorders, and a d h D. And the
whole PTSD thing is interesting because there is a large
group of psychiatrists and people in the mental health community
who think that borderline personality disorder is just a type
(08:51):
of PTSD, and so we'll we'll talk about that a
little bit more in a minute. But the impulsiveness that
comes along with vp D lot of times can lead
to risky behavior things like spending, spreeze, unsafe sex substances
which we mentioned, reckless driving, and even binge eating. And
this risky behavior means that a lot of VPD people
(09:15):
are more likely to be victims of violence, including rape.
And continuing with the behavioral symptoms, there tend to be
lots of stormy relationships that swing on that pendulum from
I hate you, don't leave me, um intense and highly
changeable moves, fluctuating from confidence to despair, chronic feelings of
(09:35):
emptiness or boredom, having inappropriate or intense anger, or problems
controlling anger. Like you said earlier, Caroline, they are these
what we might consider to be mundane events that can
send someone kind of over the edge, and then also
stress related paranoid thoughts or severe dissociative symptoms such as
(09:57):
feeling cut off from oneself, observing oneself outside of one's body,
or just losing touch with reality entirely. And that too
is where we will in a few minutes get into
why borderline is called borderline, right, But in terms of
that inappropriate or ill controlled anger, we see road rage
(10:19):
come up a lot in terms of things that are
associated with bp D, but then people like Judith Herman,
who will talk about in a little bit, also come
back and say, you know, there are things that are
associated with anger or masculinity that are okay. So it's
almost like it's more okay for certain symptoms of BPD
(10:40):
when it's a man showing them versus a woman. But well,
and this list of symptoms too, or behavioral manifestations sounds
like it could be so many different things. And also
there are a lot of things on this list that
I experienced from time or time too, So you can
see how borderline probably becomes so challenging, if anything, just
(11:04):
to get a diagnosis. Yeah, but it turns out that
it's twice as common as schizophrenia in the population, and
about two of the general population has borderline personality disorder,
and it is treatable to a degree. It takes pretty
intensive therapy. Um, but that means that therapists with traditional
analytic training aren't incredibly effective. They might view BPD patients
(11:29):
as manipulative and demanding of too much time. Uh, and
BPD patients do tend to sabotage their therapy and might
not trust their therapist. Nor is there any psychotherapeutic drug
developed to specifically treat borderline personality disorders, so drugs might
be prescribed, but at the same time, se of borderline
(11:53):
patients drop out of traditional treatments. So as a result
of the chat olenges to addressing, treating, and managing borderline
personality disorder, eight percent of people with it have suicidal behaviors,
with an estimated three attempts and about ten commit suicide.
And because of that huge link to suicidality and also
(12:18):
how common it is compared to something like schizophrenia, that
we tend to hear about a lot more, that tends
to get a lot more funding and research, um, a
lot of uh, you know, healthcare providers and researchers have
called for greater public awareness and attention to this. Yeah,
And in terms of the research that's been done, researchers
(12:42):
say that both genetic and environmental factors are at play
because studies have shown that it's inheritable and things like
mood disregulation and aggression could be related to low levels
of serotonin. But other researchers have asked whether we inherit
temperament and person a reality traits like compulsiveness and aggression,
(13:02):
and then environmental factors like abuse, neglect, and instability in
the home end up triggering the personality disorder. So it
sounds like there's some correlation causation that has to be
untangled going on. Um, And it should be said that
some people with borderline personality disorder come from stable homes,
(13:23):
but deprivation and or instability and relationships are more likely
to promote it. So going back to David and Allen,
whom we said it earlier, UM, he says that it
doesn't require abuse. It could be more about receiving conflicting
messages as a kid. So the example that he paints
(13:44):
is of parents who might see their parental role as
the ultimate life goal, but deep down they kind of
hate being parents resent it might resent their children. So
the parent then vacillates between hostile over involvement and under involvement,
and so it creates this invalidating environment, which, honestly, Caroline,
(14:07):
when I first read the phrase invalidating environment, that sounded
very much like a helicopter parenting kind of term of like, oh, no,
we must give children trophies forever, little thing they do,
but it's not it's not that right, right, Yeah, invalidating
basically refers to a child experiencing cognitive dissonance, essentially getting
two messages maybe one spoken and one implied uh, and
(14:32):
not knowing what's real, not feeling safe, not feeling genuine
love and affection, And so as that child gets older,
she ends up turning around. David and Allen uses the
phrase a lot like they're giving as good as they
get in terms of BPD developing in a child, they
turn around and invalidate everything the parent does, filling the
(14:53):
role of the so called spoiler. Basically, as she gets older,
the child remains dependent on the parents to a agree,
even as a young adult or an adult, allowing the
parents to remain obsessed with her wow at the same
time belittling everything the parents try to do for her,
and the parents, you know, can't do anything right in
this situation. But the thing is, this is a learned behavior.
(15:17):
You've grown up in this invalidating environment. You strike out
by invalidating the invalidating parent, and then you end up
feeling that same quote spoiler role in other relationships, not
surprisingly your romantic relationships. Yeah, and which also reminded me
of pickup artistry terminology because it sounds a lot like
(15:39):
familial negging, like drawing someone in by continually belittling them,
and that becomes sort of the very unhealthy glue that binds. Yeah. Yeah, absolutely, um,
And it's interesting the patterns that emerge that are pretty consistent.
(16:00):
This is coming from the National Institutes of Health as well.
People with BPD are significantly more likely to see their
mother as distant or overprotective in their relationship with her
full of conflict, while the father tends to be seen
as less involved and more distant. And so a caregiver's
emotional denial of a child's experiences becomes a huge predictor
(16:21):
of BPD. And that's what it means to say an
invalidating environment. It's the emotional denial of a child's experience.
So is it we should all blame our parents basically basically,
but they have to be neurological factors going on as
well that might um sort of predicate this sort of
(16:43):
reaction to emotional and sensitivity or emotional denial. I should say,
I mean yes, absolutely, and and I wish I knew
more about it, especially in terms of the amygdala and seratonin. Um,
but my my thinking just being a total lay person
podcast or having read a bunch of stuff about BPD,
(17:05):
would be like, um, well, what did their parents do
and what did their parents do? Because stuff does get
passed down, emotional baggage and the way that we treat
each other does get passed down. This is what frightens
my womb, Caroline, this is what does like sent my
uterus hysterical. This just bouncing around like pawing in there.
(17:30):
Um no, this is this is why I like legit.
This is why I say that everybody should go to therapy,
because there are things like I will get in fights
with my boyfriend or whatever, and it brings up stuff
and it's like, oh I I have literally never dealt
with that. Yeah, it's amazing how often mom and dad
are in the room, whether you invited him there or not. Seriously,
(17:51):
I mean that sounds creepy, and it is. It is.
It is. But this kind of research that we're talking about,
this understanding of VPD, is relatively new, and when we
come back from a quick break, we're going to look
at how we came to this point, because it took
(18:11):
a little while for the medical community to identify and
begin to wrap their heads around what this really means.
So the term borderline personality disorder UH used to be
(18:33):
sort of a waste basket term. People actually called it
a waste basket term. How rude Stephanie Tanner would say, um,
because psychiatrists, psychologist researchers were sort of perplexed by the
set of behaviors that they were seeing. It was very
common and so anyway, let's let's look into the history
(18:56):
of the development of this diagnosis. In nineteen thirties, the
term borderline personality is coined, and it's called borderline as
a reference to being on the border between neurosis and psychosis,
and analysts at this time thought that people with neuroses
(19:18):
we're treatable, but people with psychosis were not. And to
clarify between neurosis and psychosis, because I needed to be clarified,
neuroses and psychoses. Neuroses are what I have. Means a
mild mental illness is not caused by organic disease involving
symptoms of stress, so things like depression, anxiety, obsessive behavior, hypochondria,
(19:42):
but not a radical loss of touch with reality, whereas
psychosis or psychosis used in the plural um. This is
a severe mental disorder in which thought and emotions are
so impaired that you really lose touch with reality. Yeah,
and so this this idea of what borderline personality disorder
(20:04):
or what the borderline group of patients is is not
really an accurate description. But doctors just basically didn't know
what to do with these people. Um, so why did
they think that this is what borderline personality disorder or
at the time, just borderline patients were. It's because some
people with VPD have brief psychotic episodes, so experts thought
(20:25):
of it as just an atypical version of other existing conditions.
And then it's in ninety eight that we get American
psychoanalyst aid Off Stern who first describes the symptoms that
now make up borderline personality disorder. He said that this
quote borderline group of patients is extremely difficult to handle
effectively by any psychotherapeutic method, writing that these folks suffer
(20:50):
from effective narcissistic malnutrition. In other words, their parents didn't
give them that sense of security from being genuinely loved
when they were growing up. And the common view in
Stern's era was that BPD was a modified form of schizophrenia,
so they would point to certain patients tendencies to regress
(21:11):
into what they called borderline schizophrenia amid unstructured situations. Well so,
not too long after that, in the nineteen forties we
get a really interesting figure in Helen Deutsch. She left
Europe a mid World War two UH and was a
controversial figure. She still remains kind of a controversial figure,
(21:32):
but she contributed a lot to our understanding, or our
early understanding of what BPD was. And so Helen Deutsch
is a psychoanalyst. She was the first woman that Freud
ever analyzed, and ended up after that training under him
to become the first woman to lead a psycho analysis
clinic in Vienna, and in nineteen forty four she published
(21:55):
The Psychology of Women, in which she said that femininities
three essential traits are narcissism, passivity, and masochism. And it's
because of this idea that Second Waivers called her a
traitor to her sex and Helen Deutsch was like, no,
I'm not listen. I'm just trying to call it like
(22:16):
I see it with Royden's psycho analysis, and listen, I'm
an outspoken advocate for legal abortion and also too in
Vienna she worked to organize women workers and protested the
University of Vienna law schools ban on women's students. So
she was like, wait, no, come on, come on, I'm
pro women. I'm just you know, it sounds like a
(22:39):
history episode waiting to happen. It is Deutsch might have
to stop by or some analysis. Wells moved back two
years before The Psychology of Women was published, and in
nine two Deutche pens an article that modern psychiatrist Michael
Ston says laid the foundation for the contemporary psycho analytic
(23:00):
formulations of the borderline. Basically, she described a group of
women patients who seemed normal, like on the outside, they
seem normal, but lacked a depth and a warmth and
had an inner emptiness. She called them as if personalities.
Is this is this an early reference to Cluness? I
know that is the first thing I thought. Yeah, Share
(23:24):
Horowitz's portrait was on the front page of of this
this groundbreaking paper. And I like how she uh, and
I like how she acknowledges that as if is not
the most eloquent way to phrase it. But she essentially said, listen,
let's just this is the best we can do for this.
(23:46):
So what does as if mean well. She says that
the reason she used this quote unoriginal label for this woman,
specifically this woman, um, is that when you talk to her,
or look at her, or interact with her, you get
quote the inescapable impression that the individual's whole relationship to
life has something about it which is lacking in genuineness
(24:09):
and yet outwardly runs along as if it were complete.
And she says, anybody, not even a psychiatrist, would eventually
look at this person, having interacted with them for a while,
and and say like, what's wrong with you? Where? Where
is the depth? And she says that this, this question
of where is your depth? Where is the warmth? Is
that they have a quote highly plastic readiness to mold
(24:33):
themselves to their surrounding environment. And that hearkens back to
what we said from the National Institutes of Health about
not having that strong or stable sense of identity, about
being constantly ready to mold yourself to your situation, which
probably had a lot to do with living in an
invalidating environment with parents who might not be sending you
(24:54):
consistent messages, Caroline, all of which are themes of the
movie Clueless Perfect. It all comes together, um, but yeah,
she she thought that this group of people was pretty confusing,
as did pretty much all psychiatrists at the time, and
(25:14):
she posited that the as if personality might be a
phase leading to schizophrenia. But she points out her patients
do not belong among the commonly accepted forms of neurosis
and they're too well adjusted to really be called psychotics.
So again, people still in the forties are like, I
don't know what to do with these people. And in
(25:36):
the fifties they're like, hey, the war is over and
this is a waste basket term. No, really that that
that is exactly what was happening. And it's not until
the sixties and seventies that borderline starts to become something
more than jess a colloquialism among psychoanalysts. It becomes clearer
and clearer that the disorder is not related to schizophrenia,
(26:01):
which seems like it's that's a huge development in this
and psychiatrists start to recognize borderline patients stable instability as
they call it, as well as abandonment fears, desperate need
to attach to others as transitional objects, as well as
unstable or distorted senses of self and others and the
reliance on splitting themselves UM between like good and bad qualities,
(26:26):
everything's either great or awful. It sounds like, I mean
the world and yourself are all in black and white terms. Yeah,
it goes back to that commonly repeated I think it's
actually a book title about borderline personality disorder that's I
hate you, don't leave me. It's you're either everyone in
your life is either like great and wonderful and a
goddess and you're you're my best friend, or just like,
(26:48):
I hate you, You're the skum of the earth. Get
away from me, and that that's basically what splitting is
UM And in nineteen sixty six, psychiatrists Richard Chessick notes
that borderline patients are on the periph free of psychology
and society. He's one of many UM researchers at the
time who are basically like still putting their hands up,
like I don't know, they're just sort of out there.
(27:10):
But he also divides men and women along lines of
VPDs manifestations that we still see today in research, and
he says that the borderline or quote unquote pan neurotic
group was mostly women, while the group struggling with addictions
was mostly men, and everyone that he looked at had
received treatment with with few results. And so this is
(27:32):
an observation that we will talk about more in terms
of like common manifestations today, that it's still kind of
divided along those lines, with women getting diagnosed with the quote,
you know, the more neurotic issues of anxiety and depression,
with men more often manifesting their BPD with substance abuse issues.
And it's not until nineteen eighty that it's first listed
(27:53):
as a diagnosable illness in the Diagnostic and Statistical Manual
for Mental Disorders. Is this the d s M three,
And it included the qualifier that it's overwhelmingly more common
in women. Hello gender, But is it really because, as
we've learned so many times on the podcast, uh the
(28:17):
even though the d s M is nicknamed the mental
health Bible, there have been a number of times that
it has been proven fallible. And that's something that we
learn more about in the nineteen nineties from psychiatrists Marcia
and Linum who starts to develop some therapy around this. Yeah,
(28:37):
she's another huge name in borderline personality research. She develops
dialectical behavioral therapy, which is a type of cognitive behavioral
therapy to treat chronically suicidal BPD patients. And this therapy
focuses on mindfulness, distressed tolerance, and emotional regulation. And we
were reading a first person account of living with the
(29:00):
p D over on cracked um. And so not only
was that really enlightening and very interesting to read, but
the comments under it, some of the comments under it
were heartbreaking. And I know, we say, you know, never
read the comments, but like these were actually very enlightening
as well. A lot of people who have either lived
with BPD or been related to, or dated or married
(29:20):
people with bp D really chimed in and had some
great things to say. One commenter, who describes him or
herself as very very lucky uh says that they found
a therapist who specialized in DBT dialectical behavior therapy, which
they describe as the closest thing the psychiatric community has
to a silver bullet for bp D UM. They go
(29:42):
on to describe it as having kind of a hand
holding approach to treatment that it says, hey, guys, you've
been poorly equipped in your mental toolbox to deal with
certain things in life in terms of relationships, reactions, emotions,
everything is a little bit dialed up to high. And
so you essentially take classes, so to speak, on working
(30:05):
through those extreme reactions to things and learn how to
interact with people in a healthy way. And so that
commoner goes on to say, you know, like we have
to take classes to learn how normal people act. But
that's just how it is, and DBT is, like this
commoner was saying a huge deal for people with borderline
personality disorder because just regular therapy or regular counseling doesn't
(30:29):
really dive deep enough to sort of get to the
root of those um dysfunctional relationships that may have sparked
the condition. And one thing too that jumped out to
me in that comment was how DVT also teaches alternatives
to destructive behaviors. And so the commenter wrote, quote read
(30:50):
cut back on the cutting, seriously, you aren't doing yourself
any favor. So these kinds of things that on the
outside we might be able to identify as oh course
that's self destructive and unhealthy and harmful. Those our behaviors
that have to be not only unlearned, but also probably
replaced with healthier alternatives. So it's it's really fascinating to
(31:15):
learn about, UM that different kind of therapeutic approach that
is starting to develop in the nineties and also happening
in the nineties UM is that finally we have a
recognition of the effects of childhood trauma and abuse, specifically
sexual abuse and even more specifically among girls and women. Yes,
(31:36):
psychiatrist Judith Herman in the interview said that sexual abuse
has been taboo re pressed for so long that it's
now entering our consciousness in a very dialectical, polarized way.
It has to if it threatens establishment views, it should
because therapists have really missed the boat in an important way,
one that was predictable in a male dominated profession with
(31:57):
a female patient population. So for Herman, this whole thing
is clearly more about external events triggering by borderline personality
disorder than an issue of character and personality defaults. She
is one of the doctors who thinks that it's a
form of PTSD and or an adaptation to trauma, and
(32:18):
she also has the interesting point that many of the
symptoms associated with the diagnoses received by women who were
victims of sexual abuse, including not only borderline but also
bipolar among other things, we're all once under the category
of hysteria. And so her theory is that here are
(32:38):
these women having normal reactions to abnormal situations in life,
and that we are living in a society that's hostile
to victims, and so we're essentially pathologizing victimhood. But it
should also be noted too that a lot of the
I mean, because she's talking about this, some of the
(33:00):
more contemporary studies we were reading underscored how um child
abuse or sexual abuse is not a necessary, you know,
qualifier for borderline personality disorders. So I mean, she arguing
that it doesn't she doesn't think it exists or in
the subset of this populous abused population, that maybe jumping
(33:24):
to the conclusion of borderline is misguided. As I understand it,
it's more along the lines of among women and girls
who have been abused, uh, the rush to diagnose them
with a mental health condition is perhaps rash, and instead
we need to look at the culture that creates abusers
(33:46):
and the culture that essentially is disgusted with victims and
blames victims. And so I think she goes on to
talk about the early days of psychoanalysis and that nobody
dealt with abuse of any kind really, and it was
all just like, what have you you done? You know,
why are you hysterical? What have you done to lead
yourself into this situation? Not what has happened around you
(34:07):
that might contribute to these symptoms. But moving away just
from looking at girls and expanding our view to both
men and women, we have to ask whether borderline personality
disorder manifests itself differently in men versus women. Yeah, because
earlier we mentioned how that first d s M definition, UM,
you know, specified it to women. But I mean, it
(34:30):
turns out that, you know, it also affects a lot
of men. It doesn't actually affect um more women than men.
But borderline personality disorder related impulses are different between men
and women. And this is coming from some research published
in the American Journal of Psychiatry as well as innovations
(34:53):
in Clinical Neuroscience UM, which highlighted how substance use disorders
were more common among male patient whereas eating disorders or
more common among female patients. But it's not black and white.
About half of those female patients had abuse substances at
some point, and about a fifth of the male patients
had a history of serious eating disorders, and men were
(35:14):
also likelier to have had an explosive temperament and more
novelty seeking behavior, which isn't terribly surprising when we think
about testosterone in the brain and risk taking behavior and
all that. Yeah, and some of the comorbidities differ as well.
Women are more likely to have mood, anxiety and post
traumatic stress disorders, whereas men are more likely to experience antisocial, statistic, narcissistic, paranoid,
(35:39):
and passive aggressive personality disorders. And so as one might expect,
the treatment histories of men and women differ. Men are
more likely to have had a history of treatment for
substance abuse, whereas women's treatments have historically been characterized more
often by psychotherapy and medication. And to again us, probably
(36:00):
the biggest myth outfare about borderline is that recent research
has discounted any higher prevalence of it among women, And
again that's coming from innovations in clinical neuroscience. But why
did we used to think that more women had it?
Was it because of the whole hysteria kind of thing. Well,
(36:24):
for a while, and and maybe even now to an extent,
there were more women simply getting diagnosed with that um
as we see in a lot of mental health conditions
psychological conditions where more women come forward and ask for help,
whereas more men maybe are ending up in those substance
abuse arenas. But according to that study that Christian just mentioned,
(36:48):
for a couple of decades now, investigators have found that
some clinicians have a subtle gender bias when it comes
to diagnosing bp D. So perhaps that psychiatrist or that
psychologist or therapist is more likely if you're a woman
exhibiting some of these behaviors to pinpoint bp D as
opposed to either looking deeper looking for something else, or
(37:09):
perhaps they're just not as ready to diagnose it in
men as they are in women. And there also seems
to be a sampling bias, which makes total sense when
you consider the traditional settings for prevalent studies. Which makes
sense when you consider how the traditional settings for prevalence
studies used to assess you know how common something is
(37:30):
among a population are psychiatric or mental health treatment facilities.
So if women with BPD perform more self harm behavior
and wind up in mental health treatment facilities more often
than men, then the studies will find a higher population
of women. Meanwhile, you have more men suffering from substance
(37:54):
abuse and antisocial features, which leads them often to treatment
program ms or jail. So you have guys being under
reported in those mental health settings. Essentially, the dudes just
weren't being counted for a while, and I think that's unfortunate.
I mean, to make a general statement, I mean, I
just think it's so sad that anybody would possibly receive
(38:16):
the wrong diagnosis or not enough attention for the condition
that they're suffering from, simply because it's misunderstood or stigmatized,
or the the way a person is acting based on
what's going on in their brains and their bodies and
their chemistry. It's it's making them act a certain way,
and so perhaps they're going to jail instead of getting
(38:37):
proper mental health treatment that they need. But speaking of treatment,
treatment does exist. People with BPD can get better. We
already talked about dialectical behavior therapy, and and that is
a big deal talk therapy, especially therapy that falls under
that cognitive behavioral therapy umbrella helps people identify and change
(38:57):
the core beliefs and behaviors underla ing their inaccurate perceptions
about themselves and others. So in addition to DBT, there's
also something called schema focus therapy that helps people reframe
the way they see themselves, overcoming those negative self images
that were instilled in childhood. And we mentioned earlier that
(39:18):
there isn't any specific medication to target BPD alone. Um,
But there are medications obviously to address symptoms like anxiety, aggression,
or depression, but they might not be effective overall. But
there was one interesting dietary finding. Um, there's a study
(39:40):
on thirty women with borderline personality disorder which showed that
Omega three fatty assets may help reduce symptoms of aggression
and depression. So so fish, oil supplements and lots of salmon,
I'm just gonna eat. Yeah, well, we should be eating
fish all the time anyway for its self benefits in general,
except for sea bass being overfished right now. Really stay
(40:03):
away from sea bath. I have sea baths in the freezer.
That these are Mega three fatty acids. CAROLINEA did seems
highly effective. The study found that it was as well
tolerated as commonly prescribed mood stabilizers and not surprisingly had
a few side effects. I mean, that's so fascinating, and
I would love to hear from someone in the medical
(40:24):
community who could potentially enlighten us a little bit more
on that, because the there's a skeptical part of me
that's just going like, is that some weird pseudoscience thing?
But oh and it's thirty people, very very small sample size,
so who knows what else could have been at work there. Um,
But I mean, I think it just goes to show
that if indeed that was accurate, and this is something
(40:45):
that could be extrapolated to more people. It's just so
fascinating to think about those very delicate connections between nature
and nurture and things that were born with things that
we inherit from our parents, and then the way that
those things can be set off and develop as we grow. Um.
And I think it's so important to stress how much
(41:07):
talk therapy, especially that intensive talk therapy, can help people
really root out they're sort of dysfunctional, damaging behaviors, damaging
to themselves, but also their relationships. Yeah, and and we
hope that this podcast Primer has often offered, you know,
a little bit of clarity on something that it seems
(41:29):
like a lot of people misunderstand. I know, that I
had a lot of preconceived notions about going into the research,
which turned out to be just based on pure stereotype. Really, um, So,
we're so curious to hear from listeners on this who
might deal with this in their lives and in any
type of way. If you would like to share your experience,
(41:52):
you can email us mom Stuff at how stuff Works
dot com. Um. You can also tweet us at mom
Stuff podcast or message us on Facebook. And we got
a couple of messages to share with you. So I
have a letter here from Katrina on our podcast a
while back on Women in Construction um, and she writes,
(42:15):
I apologize that I'm just not getting around to writing
this email in response to her Women in Construction podcast,
but I often listen to them weeks behind, and I
also listened to two other podcasts from housewark dot com.
And side note, Katrina, no need to apologize it is
it's hard for me to keep up with my podcast,
que um. So she goes on to say, I just
wanted to say that I think you did a fabulous
(42:36):
job really covering what women go through in a highly
male dominated field. I am an entertainment rigger in Las Vegas,
which is an extremely male dominated field due to the
nature of the work. I've only ever met four other
ladies who rig and only two of them are on
the same level of capability, certification, or general knowledge as
(42:56):
I am. I did want to say that I know
of one thing. It's been very difficult for me. Although
I can personally say I have never experienced sexual harassment,
my boyfriend has at my expense. See, my boyfriend and
I met while working the same place rigging and went
on to work in multiple venues for multiple companies together
with the understanding between us that it was easier for
(43:18):
me to be respected and garner respect for my physical
capabilities by not letting our coworkers know we were a
couple at work. We were just two co workers and
were able to keep this up for over a year.
The entire link of that year, however, my boyfriend often
came home upset and telling me he had to put
up with listening to our coworkers talk about trying to
hit on me, sleep with me my breast, et cetera.
(43:39):
And he felt he couldn't say anything without jeopardizing the
respect I had worked so hard for, and without hurting
his own job. For reacting. I always thanked him. It
made sure he knew how much I loved and appreciate
the sacrifice from him. And when we moved, we were
finally able to be in a work environment that allows
us to be a couple publicly and let our work
stand for itself individually. That being said, as women are
(43:59):
so from the targets of such behavior and sexual harassment
and how it affects a woman is so typically the
topic discussed. I just wonder how many other loving boyfriends
and husbands are out there suffering the expense of trying
not to hurt the respect and career paths of the
women they love who may be in the same line
of work. And I will say that with that like,
(44:21):
kudos to your boyfriend for for dealing with that, absolutely,
But I think I think that guys, whether they are
romantically in relationships with women on the job or not,
have it like so much power, arguably even more power
than women on those job sites to say, hey, that's nonsense,
(44:43):
let's shut it down, because as we all know, guys
can and do lead by example as well. So curious
to hear from fellas about that, because I'm sure that
there can be risks associated with being the one calling
out that kind of inappropriate behavior too, So let us
(45:03):
know your thoughts. But thanks so much Katrina for writing
in and and Rigging, which sounds like quite a job. Well,
I have a letter here from Ariel who says I
absolutely love the podcast, though I don't get to listen
as often as I like. As such, I am currently
catching up on past episodes and just finished enjoying your
interview with Nina McLaughlin, which made me think about my
(45:24):
self image as something of a handywoman. Though my husband
and I do fall into stereotypical gender roles and that
he is the breadwinner and I am the main caregiver,
we also have something of a role reversal and that
he is the main man in the kitchen while I
do most of the household repair work. As a fiercely
independent person, I've never been one to wait on another,
whether it be male or female person, to do something
(45:46):
for me, and so have enjoyed learning how to take
on handy type projects myself. I even have my own
toolbox set apart from the general toolbox that houses the
basic hammers and screwdrivers, and if the threatened the men
in my house broken fingers should I ever go looking
from one of my tools and find it missing. I
love my husband dearly, but the man has lost the
power word for drill, the drill bits, and more than
(46:08):
a few other odd tools. Over the years, as a
young driver, my father taught me basic car maintenance and
I often helped with minor repairs when he would work
on my car. Now, I am usually the first to
notice something amiss in our vehicles, and with the Haynes
Manual a k a. Mechanics Bible as my dad called it,
can often troubleshoot the problem even before I call the
auto shop. My mechanic loves the fact that he can
(46:29):
talk to me about my vehicle and technical terms and
doesn't have to sugarcoat the problem. I love hearing from
women who live and work in a man's world while
retaining their sense of femininity, bucking against perceived gender norms,
will still proudly holding true to the ones they hold. Dear,
thanks for another amazing podcast, and thanks to you, Ariel.
I read this email and was immediately like I have
(46:50):
to do some learning, Like I need to learn how
to do things that are technical and mechanical, and I
don't know anything about my car. And here at my
way friend changes his oil aerial and he can like
fix his brake pads. I don't even know where your
brake pads. You know what, Caroline. I bet he'll teach you.
He's offered, so you just have to say yes. Just
(47:14):
say yes to the dress. Wait, no, that's different, So
yes to the brake pads, Caroline, Yes to the brake
pads in the oil change and I will just have
to wear raggedy clothes when I do it because he
always gets the dirty. But where is this is nice? Genie?
You get some cover rolls. I knew, I know you know.
I get some fancy cover alls. So basically, arial, what
I'm trying to tell you is that you're an inspiration
(47:37):
and I appreciate your letter, and we appreciate all of
your letters. Mom. Stuff at how stuff works dot com
is where you can send them and for a links
to all of our social media as well as all
of our blogs, videos and podcasts. With our links to
our sources, you know where to go. It's stuff Mom
Never told You dot com For more on this and
(48:03):
thousands of other topics. Is it how stuff works dot
com
Welcome to Stuff Mom Never Told You from House Supports
dot com. Hello, and welcome to the podcast. I'm Kristen
and I'm Caroline, and we've talked about mental health a
number of times on Stuff I've Never Told You, and
we have received requests from a lot of listeners to
(00:23):
talk about what we're going to talk about today, which
is borderline personality disorder. And Caroline, I want to bounce
the ball to you first because you're the one who
you know, in addition to us getting these listener requests,
you also were interested in researching and talking about this.
Was there something in particular that sparked your desire to
(00:47):
learn more about it? Yeah, because when I have heard
about borderline personality disorder, traditionally, it's been and in relation
to women, traditionally, it has been along the lines of
that girl is crazy, um, or I dated this crazy girl,
or my friend dated this crazy girl, and you know,
(01:08):
I think she was like borderline or something, and so
people being very flip about it, the way that they
people in general are flip about so many mental health conditions. Um.
You know, we talked about that very same issue in
our in our episode on obsessive compulsive disorder that people
are are very not eager, but very ready to just
throw out a mental health term to describe something not serious,
(01:34):
when in reality you're mislabeling a set of behaviors. Yeah,
and also miss gendering it in a way, because, like
you said, a lot of times, when it is applied
more sarcastically, it's usually exclusively describing women. And even if
we look at pop culture and depictions of borderline personality disorder,
(01:55):
all of the characters we rounded up are women as well.
So for instance, Girl Interrupted starting one on a Writer
and Angelina Jolie One own a Writer's character is supposed
to have BPD, but she kind of shows little evidence
of it in the movie. Yeah, it's almost like Angelina
Jolie's character shows a little bit more of that traditional
(02:19):
BPD behavior. Um there's also Glenn Close and fatal attraction
and before anyone gets upset, she is definitely a caricature
of someone with BP d um and and that's that's
another issue too. So not only do you have the
gendering of borderline personality disorder in pop culture and in
the media, but you do tend to see it as
(02:39):
a caricature, not as something real that someone is struggling with. UM.
Psychiatrist David m. Allen, who is a professor at the
University of Tennessee, also pointed out that Anne Hathaway in
the movie Rachel Getting Married UH portrays someone with borderline
personality disorder, but they don't actually delve deep into the
(03:01):
relationship between her and her mother, which uh in real life,
I r L could have triggered BPD in someone and
a movie that I actually had not heard of before,
but I'm now curious to say, partially because I love
this actress, Jessica Laying in the movie. Francis Um is also,
as Dr Allen points out, someone who is meant to
(03:24):
portray borderline personality disorder because of the way that she
manipulates her psychiatrists by exploiting his insecurities. And that is
something that you see with borderline where people do tend
to be master manipulators because they read people really, really,
really well. Yeah. And also he points out that the
(03:45):
tipping point in this character's life, well, actually it was
a character based on a woman who actually existed, an
actress named Francis Um. But she also has this controlling,
hostile mother who tried to live vicariously through her, and
so we will talk about more about these family connections.
Does this get a little mommy dearest? Yeah, that was
another one that commenters were like, Um, I have another
(04:06):
one suggestion. Yeah. Um. He also was really big on
the movie Third Team, which start Evan rachel Wood and
Nicky Reid. He says that it should be subtitled how
to turn your teenager into a borderline without ever being abusive. Yeah.
I was trying to remember watching that. It's been so
(04:28):
long since I've seen thirteen, and I certainly was not
aware as I was watching that that that might have
been something going on with these characters. Well right, And
I think that when we look at kids, teens, young
people who are developing BPD, a lot of the times
(04:49):
they're just portrayed as like bad kids, bad seed. Wild. Yeah,
they're just wild and out of control, and you know,
maybe they should just be shipped off to boarding school
or you know, you're just gonna wind up in prison.
But there are very real things that are beginning to
manifest around that age. Because if borderline personality disorder and
(05:09):
it's accompanying symptoms aren't caught early on, and technically are
not supposed to diagnose a child with BPD. Um, you
can almost just watch the condition develop as kids get older. Well,
speaking of watching the condition develop, let's talk about what
this is. So according to the National Institutes of Health,
(05:30):
borderline personality disorder is defined as a serious mental illness
marked by unstable moods, behaviors, and relationships, which does sound
like a very umbrella type of germ. I gotta be honest, yeah, absolutely,
and those unstable moods can be triggered by, honestly, really
what we would consider maybe mundane events or minor separations,
(05:52):
because people with BPD are terrified of abandonment and they
tend to lack a strong or stable sense of self
IDENTI and then um, as we mentioned talking about Jessica
Lang portraying Francis, people with borderline personality tend to be
hyper adept at reading people, and this was something explored
(06:12):
more in November two thousand and six study in the
journal Emotion, which found that quote an enhanced ability to
recognize expressions of happiness, sadness, anger, and fear might contribute
to the unstable relationships and intense emotions characteristic of the disorder.
So essentially, these people are able to read other people
(06:36):
and then sort of shapeshift in a way based on that.
But it's almost it's almost such a burden because they
are so adept at picking up on she's really happy
or she's really upset, or she's really angry. They tend
to experience this emotional roller coaster. And so basically in
this study, when they were shown faces, they were able
(06:56):
to pick up on an emotion, whether it was anger
or whether it was happy nous, so much earlier in
the emotions expression on the face than people without BPD.
So like, I might be having just like a flicker
of anger across my face, but somebody with BPD would
pick up on that end imagine that I'm just enraged
or so upset with them. Um. And it's the same
(07:19):
thing with happiness, which leads to a lot of very
turbulent emotional connections because if if I'm looking at you
and I'm just like vaguely happy or you know, not
looking upset, you might think like, oh, she she really
likes me, or you know, they tend to develop these
these really strong emotional connections and have turbulent romantic relationships
(07:41):
because there's almost too much of her reading into when
it comes to emotions, facial expressions, body language. Oh so
it's not it's not even just that they're correct in
assessing someone's emotions, but they tend to blow it out
of proportion. Yeah, okay. And on top of these kinds
of factors, there are also high rates of comorbid conditions
(08:05):
like anxiety, which is the most common. M BPD and
anxiety tend to go pretty hand in hand, as well
as things like depression, substance abuse, and eating disorders, as
well as self harm and suicide. And that self harm
and and self cutting behavior was something that came up
in a lot of the research that we read, especially
(08:26):
when it came to women with borderline personality disorder. Yeah.
And other common comorbid conditions include post traumatic stress disorder,
bipolar to disorders, and a d h D. And the
whole PTSD thing is interesting because there is a large
group of psychiatrists and people in the mental health community
who think that borderline personality disorder is just a type
(08:51):
of PTSD, and so we'll we'll talk about that a
little bit more in a minute. But the impulsiveness that
comes along with vp D lot of times can lead
to risky behavior things like spending, spreeze, unsafe sex substances
which we mentioned, reckless driving, and even binge eating. And
this risky behavior means that a lot of VPD people
(09:15):
are more likely to be victims of violence, including rape.
And continuing with the behavioral symptoms, there tend to be
lots of stormy relationships that swing on that pendulum from
I hate you, don't leave me, um intense and highly
changeable moves, fluctuating from confidence to despair, chronic feelings of
(09:35):
emptiness or boredom, having inappropriate or intense anger, or problems
controlling anger. Like you said earlier, Caroline, they are these
what we might consider to be mundane events that can
send someone kind of over the edge, and then also
stress related paranoid thoughts or severe dissociative symptoms such as
(09:57):
feeling cut off from oneself, observing oneself outside of one's body,
or just losing touch with reality entirely. And that too
is where we will in a few minutes get into
why borderline is called borderline, right, But in terms of
that inappropriate or ill controlled anger, we see road rage
(10:19):
come up a lot in terms of things that are
associated with bp D, but then people like Judith Herman,
who will talk about in a little bit, also come
back and say, you know, there are things that are
associated with anger or masculinity that are okay. So it's
almost like it's more okay for certain symptoms of BPD
(10:40):
when it's a man showing them versus a woman. But well,
and this list of symptoms too, or behavioral manifestations sounds
like it could be so many different things. And also
there are a lot of things on this list that
I experienced from time or time too, So you can
see how borderline probably becomes so challenging, if anything, just
(11:04):
to get a diagnosis. Yeah, but it turns out that
it's twice as common as schizophrenia in the population, and
about two of the general population has borderline personality disorder,
and it is treatable to a degree. It takes pretty
intensive therapy. Um, but that means that therapists with traditional
analytic training aren't incredibly effective. They might view BPD patients
(11:29):
as manipulative and demanding of too much time. Uh, and
BPD patients do tend to sabotage their therapy and might
not trust their therapist. Nor is there any psychotherapeutic drug
developed to specifically treat borderline personality disorders, so drugs might
be prescribed, but at the same time, se of borderline
(11:53):
patients drop out of traditional treatments. So as a result
of the chat olenges to addressing, treating, and managing borderline
personality disorder, eight percent of people with it have suicidal behaviors,
with an estimated three attempts and about ten commit suicide.
And because of that huge link to suicidality and also
(12:18):
how common it is compared to something like schizophrenia, that
we tend to hear about a lot more, that tends
to get a lot more funding and research, um, a
lot of uh, you know, healthcare providers and researchers have
called for greater public awareness and attention to this. Yeah,
And in terms of the research that's been done, researchers
(12:42):
say that both genetic and environmental factors are at play
because studies have shown that it's inheritable and things like
mood disregulation and aggression could be related to low levels
of serotonin. But other researchers have asked whether we inherit
temperament and person a reality traits like compulsiveness and aggression,
(13:02):
and then environmental factors like abuse, neglect, and instability in
the home end up triggering the personality disorder. So it
sounds like there's some correlation causation that has to be
untangled going on. Um, And it should be said that
some people with borderline personality disorder come from stable homes,
(13:23):
but deprivation and or instability and relationships are more likely
to promote it. So going back to David and Allen,
whom we said it earlier, UM, he says that it
doesn't require abuse. It could be more about receiving conflicting
messages as a kid. So the example that he paints
(13:44):
is of parents who might see their parental role as
the ultimate life goal, but deep down they kind of
hate being parents resent it might resent their children. So
the parent then vacillates between hostile over involvement and under involvement,
and so it creates this invalidating environment, which, honestly, Caroline,
(14:07):
when I first read the phrase invalidating environment, that sounded
very much like a helicopter parenting kind of term of like, oh, no,
we must give children trophies forever, little thing they do,
but it's not it's not that right, right, Yeah, invalidating
basically refers to a child experiencing cognitive dissonance, essentially getting
two messages maybe one spoken and one implied uh, and
(14:32):
not knowing what's real, not feeling safe, not feeling genuine
love and affection, And so as that child gets older,
she ends up turning around. David and Allen uses the
phrase a lot like they're giving as good as they
get in terms of BPD developing in a child, they
turn around and invalidate everything the parent does, filling the
(14:53):
role of the so called spoiler. Basically, as she gets older,
the child remains dependent on the parents to a agree,
even as a young adult or an adult, allowing the
parents to remain obsessed with her wow at the same
time belittling everything the parents try to do for her,
and the parents, you know, can't do anything right in
this situation. But the thing is, this is a learned behavior.
(15:17):
You've grown up in this invalidating environment. You strike out
by invalidating the invalidating parent, and then you end up
feeling that same quote spoiler role in other relationships, not
surprisingly your romantic relationships. Yeah, and which also reminded me
of pickup artistry terminology because it sounds a lot like
(15:39):
familial negging, like drawing someone in by continually belittling them,
and that becomes sort of the very unhealthy glue that binds. Yeah. Yeah, absolutely, um,
And it's interesting the patterns that emerge that are pretty consistent.
(16:00):
This is coming from the National Institutes of Health as well.
People with BPD are significantly more likely to see their
mother as distant or overprotective in their relationship with her
full of conflict, while the father tends to be seen
as less involved and more distant. And so a caregiver's
emotional denial of a child's experiences becomes a huge predictor
(16:21):
of BPD. And that's what it means to say an
invalidating environment. It's the emotional denial of a child's experience.
So is it we should all blame our parents basically basically,
but they have to be neurological factors going on as
well that might um sort of predicate this sort of
(16:43):
reaction to emotional and sensitivity or emotional denial. I should say,
I mean yes, absolutely, and and I wish I knew
more about it, especially in terms of the amygdala and seratonin. Um,
but my my thinking just being a total lay person
podcast or having read a bunch of stuff about BPD,
(17:05):
would be like, um, well, what did their parents do
and what did their parents do? Because stuff does get
passed down, emotional baggage and the way that we treat
each other does get passed down. This is what frightens
my womb, Caroline, this is what does like sent my
uterus hysterical. This just bouncing around like pawing in there.
(17:30):
Um no, this is this is why I like legit.
This is why I say that everybody should go to therapy,
because there are things like I will get in fights
with my boyfriend or whatever, and it brings up stuff
and it's like, oh I I have literally never dealt
with that. Yeah, it's amazing how often mom and dad
are in the room, whether you invited him there or not. Seriously,
(17:51):
I mean that sounds creepy, and it is. It is.
It is. But this kind of research that we're talking about,
this understanding of VPD, is relatively new, and when we
come back from a quick break, we're going to look
at how we came to this point, because it took
(18:11):
a little while for the medical community to identify and
begin to wrap their heads around what this really means.
So the term borderline personality disorder UH used to be
(18:33):
sort of a waste basket term. People actually called it
a waste basket term. How rude Stephanie Tanner would say, um,
because psychiatrists, psychologist researchers were sort of perplexed by the
set of behaviors that they were seeing. It was very
common and so anyway, let's let's look into the history
(18:56):
of the development of this diagnosis. In nineteen thirties, the
term borderline personality is coined, and it's called borderline as
a reference to being on the border between neurosis and psychosis,
and analysts at this time thought that people with neuroses
(19:18):
we're treatable, but people with psychosis were not. And to
clarify between neurosis and psychosis, because I needed to be clarified,
neuroses and psychoses. Neuroses are what I have. Means a
mild mental illness is not caused by organic disease involving
symptoms of stress, so things like depression, anxiety, obsessive behavior, hypochondria,
(19:42):
but not a radical loss of touch with reality, whereas
psychosis or psychosis used in the plural um. This is
a severe mental disorder in which thought and emotions are
so impaired that you really lose touch with reality. Yeah,
and so this this idea of what borderline personality disorder
(20:04):
or what the borderline group of patients is is not
really an accurate description. But doctors just basically didn't know
what to do with these people. Um, so why did
they think that this is what borderline personality disorder or
at the time, just borderline patients were. It's because some
people with VPD have brief psychotic episodes, so experts thought
(20:25):
of it as just an atypical version of other existing conditions.
And then it's in ninety eight that we get American
psychoanalyst aid Off Stern who first describes the symptoms that
now make up borderline personality disorder. He said that this
quote borderline group of patients is extremely difficult to handle
effectively by any psychotherapeutic method, writing that these folks suffer
(20:50):
from effective narcissistic malnutrition. In other words, their parents didn't
give them that sense of security from being genuinely loved
when they were growing up. And the common view in
Stern's era was that BPD was a modified form of schizophrenia,
so they would point to certain patients tendencies to regress
(21:11):
into what they called borderline schizophrenia amid unstructured situations. Well so,
not too long after that, in the nineteen forties we
get a really interesting figure in Helen Deutsch. She left
Europe a mid World War two UH and was a
controversial figure. She still remains kind of a controversial figure,
(21:32):
but she contributed a lot to our understanding, or our
early understanding of what BPD was. And so Helen Deutsch
is a psychoanalyst. She was the first woman that Freud
ever analyzed, and ended up after that training under him
to become the first woman to lead a psycho analysis
clinic in Vienna, and in nineteen forty four she published
(21:55):
The Psychology of Women, in which she said that femininities
three essential traits are narcissism, passivity, and masochism. And it's
because of this idea that Second Waivers called her a
traitor to her sex and Helen Deutsch was like, no,
I'm not listen. I'm just trying to call it like
(22:16):
I see it with Royden's psycho analysis, and listen, I'm
an outspoken advocate for legal abortion and also too in
Vienna she worked to organize women workers and protested the
University of Vienna law schools ban on women's students. So
she was like, wait, no, come on, come on, I'm
pro women. I'm just you know, it sounds like a
(22:39):
history episode waiting to happen. It is Deutsch might have
to stop by or some analysis. Wells moved back two
years before The Psychology of Women was published, and in
nine two Deutche pens an article that modern psychiatrist Michael
Ston says laid the foundation for the contemporary psycho analytic
(23:00):
formulations of the borderline. Basically, she described a group of
women patients who seemed normal, like on the outside, they
seem normal, but lacked a depth and a warmth and
had an inner emptiness. She called them as if personalities.
Is this is this an early reference to Cluness? I
know that is the first thing I thought. Yeah, Share
(23:24):
Horowitz's portrait was on the front page of of this
this groundbreaking paper. And I like how she uh, and
I like how she acknowledges that as if is not
the most eloquent way to phrase it. But she essentially said, listen,
let's just this is the best we can do for this.
(23:46):
So what does as if mean well. She says that
the reason she used this quote unoriginal label for this woman,
specifically this woman, um, is that when you talk to her,
or look at her, or interact with her, you get
quote the inescapable impression that the individual's whole relationship to
life has something about it which is lacking in genuineness
(24:09):
and yet outwardly runs along as if it were complete.
And she says, anybody, not even a psychiatrist, would eventually
look at this person, having interacted with them for a while,
and and say like, what's wrong with you? Where? Where
is the depth? And she says that this, this question
of where is your depth? Where is the warmth? Is
that they have a quote highly plastic readiness to mold
(24:33):
themselves to their surrounding environment. And that hearkens back to
what we said from the National Institutes of Health about
not having that strong or stable sense of identity, about
being constantly ready to mold yourself to your situation, which
probably had a lot to do with living in an
invalidating environment with parents who might not be sending you
(24:54):
consistent messages, Caroline, all of which are themes of the
movie Clueless Perfect. It all comes together, um, but yeah,
she she thought that this group of people was pretty confusing,
as did pretty much all psychiatrists at the time, and
(25:14):
she posited that the as if personality might be a
phase leading to schizophrenia. But she points out her patients
do not belong among the commonly accepted forms of neurosis
and they're too well adjusted to really be called psychotics.
So again, people still in the forties are like, I
don't know what to do with these people. And in
(25:36):
the fifties they're like, hey, the war is over and
this is a waste basket term. No, really that that
that is exactly what was happening. And it's not until
the sixties and seventies that borderline starts to become something
more than jess a colloquialism among psychoanalysts. It becomes clearer
and clearer that the disorder is not related to schizophrenia,
(26:01):
which seems like it's that's a huge development in this
and psychiatrists start to recognize borderline patients stable instability as
they call it, as well as abandonment fears, desperate need
to attach to others as transitional objects, as well as
unstable or distorted senses of self and others and the
reliance on splitting themselves UM between like good and bad qualities,
(26:26):
everything's either great or awful. It sounds like, I mean
the world and yourself are all in black and white terms. Yeah,
it goes back to that commonly repeated I think it's
actually a book title about borderline personality disorder that's I
hate you, don't leave me. It's you're either everyone in
your life is either like great and wonderful and a
goddess and you're you're my best friend, or just like,
(26:48):
I hate you, You're the skum of the earth. Get
away from me, and that that's basically what splitting is
UM And in nineteen sixty six, psychiatrists Richard Chessick notes
that borderline patients are on the periph free of psychology
and society. He's one of many UM researchers at the
time who are basically like still putting their hands up,
like I don't know, they're just sort of out there.
(27:10):
But he also divides men and women along lines of
VPDs manifestations that we still see today in research, and
he says that the borderline or quote unquote pan neurotic
group was mostly women, while the group struggling with addictions
was mostly men, and everyone that he looked at had
received treatment with with few results. And so this is
(27:32):
an observation that we will talk about more in terms
of like common manifestations today, that it's still kind of
divided along those lines, with women getting diagnosed with the quote,
you know, the more neurotic issues of anxiety and depression,
with men more often manifesting their BPD with substance abuse issues.
And it's not until nineteen eighty that it's first listed
(27:53):
as a diagnosable illness in the Diagnostic and Statistical Manual
for Mental Disorders. Is this the d s M three,
And it included the qualifier that it's overwhelmingly more common
in women. Hello gender, But is it really because, as
we've learned so many times on the podcast, uh the
(28:17):
even though the d s M is nicknamed the mental
health Bible, there have been a number of times that
it has been proven fallible. And that's something that we
learn more about in the nineteen nineties from psychiatrists Marcia
and Linum who starts to develop some therapy around this. Yeah,
(28:37):
she's another huge name in borderline personality research. She develops
dialectical behavioral therapy, which is a type of cognitive behavioral
therapy to treat chronically suicidal BPD patients. And this therapy
focuses on mindfulness, distressed tolerance, and emotional regulation. And we
were reading a first person account of living with the
(29:00):
p D over on cracked um. And so not only
was that really enlightening and very interesting to read, but
the comments under it, some of the comments under it
were heartbreaking. And I know, we say, you know, never
read the comments, but like these were actually very enlightening
as well. A lot of people who have either lived
with BPD or been related to, or dated or married
(29:20):
people with bp D really chimed in and had some
great things to say. One commenter, who describes him or
herself as very very lucky uh says that they found
a therapist who specialized in DBT dialectical behavior therapy, which
they describe as the closest thing the psychiatric community has
to a silver bullet for bp D UM. They go
(29:42):
on to describe it as having kind of a hand
holding approach to treatment that it says, hey, guys, you've
been poorly equipped in your mental toolbox to deal with
certain things in life in terms of relationships, reactions, emotions,
everything is a little bit dialed up to high. And
so you essentially take classes, so to speak, on working
(30:05):
through those extreme reactions to things and learn how to
interact with people in a healthy way. And so that
commoner goes on to say, you know, like we have
to take classes to learn how normal people act. But
that's just how it is, and DBT is, like this
commoner was saying a huge deal for people with borderline
personality disorder because just regular therapy or regular counseling doesn't
(30:29):
really dive deep enough to sort of get to the
root of those um dysfunctional relationships that may have sparked
the condition. And one thing too that jumped out to
me in that comment was how DVT also teaches alternatives
to destructive behaviors. And so the commenter wrote, quote read
(30:50):
cut back on the cutting, seriously, you aren't doing yourself
any favor. So these kinds of things that on the
outside we might be able to identify as oh course
that's self destructive and unhealthy and harmful. Those our behaviors
that have to be not only unlearned, but also probably
replaced with healthier alternatives. So it's it's really fascinating to
(31:15):
learn about, UM that different kind of therapeutic approach that
is starting to develop in the nineties and also happening
in the nineties UM is that finally we have a
recognition of the effects of childhood trauma and abuse, specifically
sexual abuse and even more specifically among girls and women. Yes,
(31:36):
psychiatrist Judith Herman in the interview said that sexual abuse
has been taboo re pressed for so long that it's
now entering our consciousness in a very dialectical, polarized way.
It has to if it threatens establishment views, it should
because therapists have really missed the boat in an important way,
one that was predictable in a male dominated profession with
(31:57):
a female patient population. So for Herman, this whole thing
is clearly more about external events triggering by borderline personality
disorder than an issue of character and personality defaults. She
is one of the doctors who thinks that it's a
form of PTSD and or an adaptation to trauma, and
(32:18):
she also has the interesting point that many of the
symptoms associated with the diagnoses received by women who were
victims of sexual abuse, including not only borderline but also
bipolar among other things, we're all once under the category
of hysteria. And so her theory is that here are
(32:38):
these women having normal reactions to abnormal situations in life,
and that we are living in a society that's hostile
to victims, and so we're essentially pathologizing victimhood. But it
should also be noted too that a lot of the
I mean, because she's talking about this, some of the
(33:00):
more contemporary studies we were reading underscored how um child
abuse or sexual abuse is not a necessary, you know,
qualifier for borderline personality disorders. So I mean, she arguing
that it doesn't she doesn't think it exists or in
the subset of this populous abused population, that maybe jumping
(33:24):
to the conclusion of borderline is misguided. As I understand it,
it's more along the lines of among women and girls
who have been abused, uh, the rush to diagnose them
with a mental health condition is perhaps rash, and instead
we need to look at the culture that creates abusers
(33:46):
and the culture that essentially is disgusted with victims and
blames victims. And so I think she goes on to
talk about the early days of psychoanalysis and that nobody
dealt with abuse of any kind really, and it was
all just like, what have you you done? You know,
why are you hysterical? What have you done to lead
yourself into this situation? Not what has happened around you
(34:07):
that might contribute to these symptoms. But moving away just
from looking at girls and expanding our view to both
men and women, we have to ask whether borderline personality
disorder manifests itself differently in men versus women. Yeah, because
earlier we mentioned how that first d s M definition, UM,
you know, specified it to women. But I mean, it
(34:30):
turns out that, you know, it also affects a lot
of men. It doesn't actually affect um more women than men.
But borderline personality disorder related impulses are different between men
and women. And this is coming from some research published
in the American Journal of Psychiatry as well as innovations
(34:53):
in Clinical Neuroscience UM, which highlighted how substance use disorders
were more common among male patient whereas eating disorders or
more common among female patients. But it's not black and white.
About half of those female patients had abuse substances at
some point, and about a fifth of the male patients
had a history of serious eating disorders, and men were
(35:14):
also likelier to have had an explosive temperament and more
novelty seeking behavior, which isn't terribly surprising when we think
about testosterone in the brain and risk taking behavior and
all that. Yeah, and some of the comorbidities differ as well.
Women are more likely to have mood, anxiety and post
traumatic stress disorders, whereas men are more likely to experience antisocial, statistic, narcissistic, paranoid,
(35:39):
and passive aggressive personality disorders. And so as one might expect,
the treatment histories of men and women differ. Men are
more likely to have had a history of treatment for
substance abuse, whereas women's treatments have historically been characterized more
often by psychotherapy and medication. And to again us, probably
(36:00):
the biggest myth outfare about borderline is that recent research
has discounted any higher prevalence of it among women, And
again that's coming from innovations in clinical neuroscience. But why
did we used to think that more women had it?
Was it because of the whole hysteria kind of thing. Well,
(36:24):
for a while, and and maybe even now to an extent,
there were more women simply getting diagnosed with that um
as we see in a lot of mental health conditions
psychological conditions where more women come forward and ask for help,
whereas more men maybe are ending up in those substance
abuse arenas. But according to that study that Christian just mentioned,
(36:48):
for a couple of decades now, investigators have found that
some clinicians have a subtle gender bias when it comes
to diagnosing bp D. So perhaps that psychiatrist or that
psychologist or therapist is more likely if you're a woman
exhibiting some of these behaviors to pinpoint bp D as
opposed to either looking deeper looking for something else, or
(37:09):
perhaps they're just not as ready to diagnose it in
men as they are in women. And there also seems
to be a sampling bias, which makes total sense when
you consider the traditional settings for prevalent studies. Which makes
sense when you consider how the traditional settings for prevalence
studies used to assess you know how common something is
(37:30):
among a population are psychiatric or mental health treatment facilities.
So if women with BPD perform more self harm behavior
and wind up in mental health treatment facilities more often
than men, then the studies will find a higher population
of women. Meanwhile, you have more men suffering from substance
(37:54):
abuse and antisocial features, which leads them often to treatment
program ms or jail. So you have guys being under
reported in those mental health settings. Essentially, the dudes just
weren't being counted for a while, and I think that's unfortunate.
I mean, to make a general statement, I mean, I
just think it's so sad that anybody would possibly receive
(38:16):
the wrong diagnosis or not enough attention for the condition
that they're suffering from, simply because it's misunderstood or stigmatized,
or the the way a person is acting based on
what's going on in their brains and their bodies and
their chemistry. It's it's making them act a certain way,
and so perhaps they're going to jail instead of getting
(38:37):
proper mental health treatment that they need. But speaking of treatment,
treatment does exist. People with BPD can get better. We
already talked about dialectical behavior therapy, and and that is
a big deal talk therapy, especially therapy that falls under
that cognitive behavioral therapy umbrella helps people identify and change
(38:57):
the core beliefs and behaviors underla ing their inaccurate perceptions
about themselves and others. So in addition to DBT, there's
also something called schema focus therapy that helps people reframe
the way they see themselves, overcoming those negative self images
that were instilled in childhood. And we mentioned earlier that
(39:18):
there isn't any specific medication to target BPD alone. Um,
But there are medications obviously to address symptoms like anxiety, aggression,
or depression, but they might not be effective overall. But
there was one interesting dietary finding. Um, there's a study
(39:40):
on thirty women with borderline personality disorder which showed that
Omega three fatty assets may help reduce symptoms of aggression
and depression. So so fish, oil supplements and lots of salmon,
I'm just gonna eat. Yeah, well, we should be eating
fish all the time anyway for its self benefits in general,
except for sea bass being overfished right now. Really stay
(40:03):
away from sea bath. I have sea baths in the freezer.
That these are Mega three fatty acids. CAROLINEA did seems
highly effective. The study found that it was as well
tolerated as commonly prescribed mood stabilizers and not surprisingly had
a few side effects. I mean, that's so fascinating, and
I would love to hear from someone in the medical
(40:24):
community who could potentially enlighten us a little bit more
on that, because the there's a skeptical part of me
that's just going like, is that some weird pseudoscience thing?
But oh and it's thirty people, very very small sample size,
so who knows what else could have been at work there. Um,
But I mean, I think it just goes to show
that if indeed that was accurate, and this is something
(40:45):
that could be extrapolated to more people. It's just so
fascinating to think about those very delicate connections between nature
and nurture and things that were born with things that
we inherit from our parents, and then the way that
those things can be set off and develop as we grow. Um.
And I think it's so important to stress how much
(41:07):
talk therapy, especially that intensive talk therapy, can help people
really root out they're sort of dysfunctional, damaging behaviors, damaging
to themselves, but also their relationships. Yeah, and and we
hope that this podcast Primer has often offered, you know,
a little bit of clarity on something that it seems
(41:29):
like a lot of people misunderstand. I know, that I
had a lot of preconceived notions about going into the research,
which turned out to be just based on pure stereotype. Really, um, So,
we're so curious to hear from listeners on this who
might deal with this in their lives and in any
type of way. If you would like to share your experience,
(41:52):
you can email us mom Stuff at how stuff Works
dot com. Um. You can also tweet us at mom
Stuff podcast or message us on Facebook. And we got
a couple of messages to share with you. So I
have a letter here from Katrina on our podcast a
while back on Women in Construction um, and she writes,
(42:15):
I apologize that I'm just not getting around to writing
this email in response to her Women in Construction podcast,
but I often listen to them weeks behind, and I
also listened to two other podcasts from housewark dot com.
And side note, Katrina, no need to apologize it is
it's hard for me to keep up with my podcast,
que um. So she goes on to say, I just
wanted to say that I think you did a fabulous
(42:36):
job really covering what women go through in a highly
male dominated field. I am an entertainment rigger in Las Vegas,
which is an extremely male dominated field due to the
nature of the work. I've only ever met four other
ladies who rig and only two of them are on
the same level of capability, certification, or general knowledge as
(42:56):
I am. I did want to say that I know
of one thing. It's been very difficult for me. Although
I can personally say I have never experienced sexual harassment,
my boyfriend has at my expense. See, my boyfriend and
I met while working the same place rigging and went
on to work in multiple venues for multiple companies together
with the understanding between us that it was easier for
(43:18):
me to be respected and garner respect for my physical
capabilities by not letting our coworkers know we were a
couple at work. We were just two co workers and
were able to keep this up for over a year.
The entire link of that year, however, my boyfriend often
came home upset and telling me he had to put
up with listening to our coworkers talk about trying to
hit on me, sleep with me my breast, et cetera.
(43:39):
And he felt he couldn't say anything without jeopardizing the
respect I had worked so hard for, and without hurting
his own job. For reacting. I always thanked him. It
made sure he knew how much I loved and appreciate
the sacrifice from him. And when we moved, we were
finally able to be in a work environment that allows
us to be a couple publicly and let our work
stand for itself individually. That being said, as women are
(43:59):
so from the targets of such behavior and sexual harassment
and how it affects a woman is so typically the
topic discussed. I just wonder how many other loving boyfriends
and husbands are out there suffering the expense of trying
not to hurt the respect and career paths of the
women they love who may be in the same line
of work. And I will say that with that like,
(44:21):
kudos to your boyfriend for for dealing with that, absolutely,
But I think I think that guys, whether they are
romantically in relationships with women on the job or not,
have it like so much power, arguably even more power
than women on those job sites to say, hey, that's nonsense,
(44:43):
let's shut it down, because as we all know, guys
can and do lead by example as well. So curious
to hear from fellas about that, because I'm sure that
there can be risks associated with being the one calling
out that kind of inappropriate behavior too, So let us
(45:03):
know your thoughts. But thanks so much Katrina for writing
in and and Rigging, which sounds like quite a job. Well,
I have a letter here from Ariel who says I
absolutely love the podcast, though I don't get to listen
as often as I like. As such, I am currently
catching up on past episodes and just finished enjoying your
interview with Nina McLaughlin, which made me think about my
(45:24):
self image as something of a handywoman. Though my husband
and I do fall into stereotypical gender roles and that
he is the breadwinner and I am the main caregiver,
we also have something of a role reversal and that
he is the main man in the kitchen while I
do most of the household repair work. As a fiercely
independent person, I've never been one to wait on another,
whether it be male or female person, to do something
(45:46):
for me, and so have enjoyed learning how to take
on handy type projects myself. I even have my own
toolbox set apart from the general toolbox that houses the
basic hammers and screwdrivers, and if the threatened the men
in my house broken fingers should I ever go looking
from one of my tools and find it missing. I
love my husband dearly, but the man has lost the
power word for drill, the drill bits, and more than
(46:08):
a few other odd tools. Over the years, as a
young driver, my father taught me basic car maintenance and
I often helped with minor repairs when he would work
on my car. Now, I am usually the first to
notice something amiss in our vehicles, and with the Haynes
Manual a k a. Mechanics Bible as my dad called it,
can often troubleshoot the problem even before I call the
auto shop. My mechanic loves the fact that he can
(46:29):
talk to me about my vehicle and technical terms and
doesn't have to sugarcoat the problem. I love hearing from
women who live and work in a man's world while
retaining their sense of femininity, bucking against perceived gender norms,
will still proudly holding true to the ones they hold. Dear,
thanks for another amazing podcast, and thanks to you, Ariel.
I read this email and was immediately like I have
(46:50):
to do some learning, Like I need to learn how
to do things that are technical and mechanical, and I
don't know anything about my car. And here at my
way friend changes his oil aerial and he can like
fix his brake pads. I don't even know where your
brake pads. You know what, Caroline. I bet he'll teach you.
He's offered, so you just have to say yes. Just
(47:14):
say yes to the dress. Wait, no, that's different, So
yes to the brake pads, Caroline, Yes to the brake
pads in the oil change and I will just have
to wear raggedy clothes when I do it because he
always gets the dirty. But where is this is nice? Genie?
You get some cover rolls. I knew, I know you know.
I get some fancy cover alls. So basically, arial, what
I'm trying to tell you is that you're an inspiration
(47:37):
and I appreciate your letter, and we appreciate all of
your letters. Mom. Stuff at how stuff works dot com
is where you can send them and for a links
to all of our social media as well as all
of our blogs, videos and podcasts. With our links to
our sources, you know where to go. It's stuff Mom
Never told You dot com For more on this and
(48:03):
thousands of other topics. Is it how stuff works dot
com
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