July 14, 2025 • 61 mins
TW: This episode discusses personality disorders.
This week we are joined by Dr. Frederic Bien, President of the Personality Disorders Awareness Network (PDAN). He has served as Director of Development and was on the Board of National Education Alliance for Borderline Personality Disorder. This conversation sheds light on the different types of personality disorders, to help bring awareness and offer support to those with disorders or who have family members and friends who have disorders.
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Episode Transcript
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(00:03):
Hello and welcome back to another episode of The Conscious
Artist, a safe space for conversations around mental
health awareness for musicians, artists, and all human beings.
I am your host, Pallavi Mahidera, and I'm thrilled that
you are joining us today. I love the community we have
developed together through this show, and I'm committed to
continuing to give a platform for voices and stories to be
(00:26):
shared. When we allow others and
ourselves to feel seen and heard, we create much needed
change in this industry and in this world.
So thank you for supporting thiscommunity.
Don't forget to subscribe wherever you get your podcasts
and let's get started. My guest today is the president
(00:52):
of the Personality Disorders Awareness Network.
He has served as Director of Development and was on the board
of National Education Alliance for Borderline Personality
Disorders where he focused on sponsorship relations and Co
organized conferences on the subject.
Please join me in welcoming my guest, Doctor Frederick Bien to
the conscious Artist. Frederick, thank you so much for
(01:12):
joining us today. Hello, Paravi, Thank you so much
for having me. It's an honor to be on your
podcast. It is my pleasure.
Today's episode is about personality disorders and
awareness, and I feel that there's quite a large lack of
awareness in terms of the disorders themselves, but also
causes recovery and any sort of context around the disorders.
(01:36):
In fact, I think as a society wecan be quite quick to label
someone, for example, as a narcissist or a behavior as OCD,
for example, without full understanding of the terms and
disorders. So to begin, could you discuss
firstly what are some of the different personality disorders?
So indeed, the family of disorders might have issues
(02:01):
called personality disorders arenot very well known by the
public. Still, it's starting to change
in the last 20 years or so and it's only been about, you know,
50 years. I would say that personality
disorders are being taught and and used a lot in the mental
(02:21):
health profession and therefore it's a more recent family of
mental health issues than depression, anxiety or bipolar
disorder. And therefore it's perhaps
normal that people are still trying to understand, you know,
what is exactly a personality disorder.
(02:43):
The categorization of these disorders, you know, was made
official through the Diagnostic Statistical Manual in the US,
the DSM as well as the International Classification of
Disease, The ICD in the rest of the world, I would say.
And the two of them are not completely In Sync with, you
(03:05):
know, the classification of those mental health issues,
which has added to perhaps the public lack of understanding of
what we really we're dealing with.
A second aspect of this is the terms right personality disorder
are very much putting in question the person who received
(03:29):
the diagnosis and therefore the number of people who might be
deemed to have a personality disorders are rejecting the fact
that they actually have a disorder.
Third, I would say, and I'll getinto this a little more later,
there is, you know, a general distinction in mental health
(03:51):
between sort of the very conscious disorders, so-called
axis 1 disorders and, you know, the less directly conscious
disorder called axis 2 disordersand personality disorders.
For a while were categorizing the axis two side, which means
that they were not necessarily, you know, symptomatic on the
(04:13):
forefront of people's behavior. And the move from axis 2 to axis
1, you know, is relatively recent.
But with that being said, you know, I can explain that
officially in the traditional DSM 4, DSM 4, or DSM 5, there
(04:35):
were five, there were 10, sorry,personality disorders that were
listed, paranoid, schizoid, schizotypal, antisocial,
borderline, histrionic, narcissistic, obsessive,
compulsive, anxious, or avoidantindependent personality with an
(04:57):
11th 1, which was the unspecified category.
These, you know, 10 or 11 were grouped into clusters, cluster
AB and C as they were called. You know, cluster A contained
paranoid schizoid, schizotypal, Cluster B contain antisocial,
borderline, histrionic, narcissistic.
(05:19):
Those were probably by now the more popular one, the better
understood. Cluster B is also labeled
sometime emotional or erratic disorders.
And then in cluster C you have the anxious or fearful
disorders, which is avoidant, dependent, obsessive compulsive.
And just to give the nickname for cluster A was the odd or or
(05:44):
eccentric disorders at P Dan, the personality disorder
awareness Network. So it was originally created in
2001 by Randy Craiger, who is a famous author in the US of the
book stopped walking on egg shells and she had a couple of
partners worked with her and theinitial goal of the group was
(06:05):
really to focus on family members of people who have
personality disorders. Family members sometimes suffer
from the challenging, erratic, some might say at times feeling
like manipulative behavior of people with disorders.
And Brandy's specialty has been to write books, you know, for
(06:27):
family members. And the group evolved for the
next 10 years with a little bit of support from the community,
but I would say didn't really blossom, partly because of lack
of organizational skills, administrative skills from the
founders who, you know, were notthat interested in running a
(06:51):
large organization. And then in 2011, I came into
the field, as you mentioned in the introduction, through
NEABPD, which is the National Education Alliance for
Borderline Personality Disorder.We organized a conference
together in Atlanta, which was quite successful at the Carter
Center from President Jimmy Carter, whose wife Rosalie
(07:15):
Carter, was a big advocate for mental health and especially
insurance parity in the US. After that conference in a
similar one in New York, Westchester, I felt that we
needed to refocus perhaps the message of any ABPD on families
and children in particular. And so Randy was ready to sort
(07:38):
of pass on the reins of Pidan. There was a lady named Mary in
between who had also taken on leadership but didn't want to
really continue. And so I inherited, you know,
the little group that existed. We reincorporated in Georgia
since I live in Atlanta, and we started publishing books for
(08:02):
children that explain to kids the idea of emotions being a bit
like the weather around us and therefore our parents
potentially having emotions thatthey cannot control.
And the kids are on the receiving ends of these emotions
and sometimes are blamed for those emotions by the parents.
(08:27):
And it was important to sort of strengthen the identity, the
personality of the children to realize, OK, you know, there is
what I do and my behavior, but then there is also the mood that
my parents might be in. And this has to be
distinguished, separated somehow.
So I, I don't think that I am responsible necessarily for the
(08:51):
way I'm being talked to. So the conversation around these
books started in social media and this was 2012.
You know, Facebook had maybe only couple 100 million users at
the time. I had just come out of a startup
(09:12):
company in the field of social media called Blink Media, which
was focused on helping big brands bring their messages into
the field of social media. And I utilize some my skills
there to sort of promote conversations around the
children books in social media. And something very surprising
(09:33):
perhaps happened because until then, you know, it's important
to say because we kind of forgotnow, 13 years later, that at
that time, the reputation of people with borderline
personality disorder was largelyshaped by books like Stop
Working on Egg Shells on one side, by movies like Fatal
(09:54):
Attraction or Girl Interrupted, You know, where the people with
BPD in particular, you know, were portrayed as sort of the
most difficult of the difficult people to deal with.
Yet we took at PDN as well as atNEA BPD, an approach that was
much more caring to say, OK, these people did not ask to have
(10:15):
BPD. We didn't ask them to have BPD.
But they have something. And therefore we need to figure
out a way to live with them, to adapt to them so that we can
continue all living, you know, the rest of our lives somewhat
happily. And that message of compassion
and empathy towards people with personality disorders resonated
(10:37):
in social media like an echo chamber.
And it was very surprising, I would say almost spectacular to
see in 2000 and 12/13/14 that suddenly we attracted a large
group of people with BPD who notonly followed us but said, hey,
(10:58):
I want to speak because I want to tell the world how I feel and
what it feels like to have BPD. This was really sort of
miraculous for us in terms of growth of the organization in
social media, but also because these people came out of the
woodwork from having been castigated, you know, as the
(11:18):
para years on the edge of society to now, you know, be
able to explain how they were feeling and the fact that many
of them were in therapy and weretrying to be better and some
even were actually recovered. And so that shift that happened,
you know, was what P then sort of was able to support
(11:38):
Turbocharge, Amplify. And now, you know, we have close
to 800,000 followers in social media.
The page has often reached several million people per month
and many of them are suffering from a personality disorders.
Many are feeling supported by the group and are happy to find
(11:58):
other people like them. And it's a very different
situation in 2025 than it was inin 2012.
Wow, thank you so much for sharing all of that.
You sort of already answered a few questions I wanted to ask
you and I, I so appreciate that because I think the bottom line
of everything regarding this topic, I would say is a lack of
(12:19):
education. Lack of awareness comes from
lack of education, right? And lack of education often
leads to stigma and shunning people to the side, as you said.
And so I appreciate very much what you are doing with the
organization, with the awareness, with creating very,
very large and widespread community where people do feel
(12:41):
seen and heard and valued as human beings.
Because at the end of the day, I'm pretty sure every single one
of us has some sort of disorder or the other.
And it was very interesting for me when you were listing the
different personality disorders.Of course I was aware of
schizoid, paranoid, bipolar, multiple personalities,
(13:03):
borderline narcissistic, but what I was less sort of aware of
as a disorder was like the avoidant, the dependent.
And I wonder if there's also a lot of lack of understanding and
education and awareness with that.
Because I think anyone that goeson social media that follows any
sort of therapist or therapy page or mental health page will
(13:26):
see the kind of buzzwords that are like avoidant attachment
style or anxious attachment style.
And that there's a lot of talk about that in relationships, for
example. I wasn't even aware that those
are also classified as actual personality disorders.
Could you explain a little bit more?
I mean, I understand that you'renot, you know, a psychologist or
(13:47):
psychiatrist, but you have a lotof experience with this and you
know, so if you can, would you, would you be able to clarify a
little bit more what is avoidantpersonality disorder versus
dependent versus anxious, et cetera?
Sure. So the personality disorders and
I can refer people to, you know,ideally the DSM and DSM 5 in
(14:09):
particular, but one has to pay to be able to read it.
Otherwise, Wikipedia actually does a pretty good job at
summarizing the information thatcomes from the DSM, the pdn.org
website. Pdn.org also has a few pages
about the various disorders. So there is a way to, you know,
(14:32):
look at first personality, rightIn these different models of
personality, you know what shapes of personality there is 2
main components to a personalityis a character and a
temperament. So the temperament is viewed as
what we inherit from the environment we were born in,
(14:56):
inherited biologically, while the character is more kind of
our own will that, you know, creates a behavior that is our
choice, so to speak. Essentially, nature versus
nurture. Correct, correct.
Exactly. Now, nature and nurture, perhaps
(15:17):
a slightly different division inthe sense that there is where we
inherit biologically, there's what we inherit through being
taught, right? And then there is still where we
choose to do right. So that part is very important.
You know, do we have a choice tobe lashing out when we are angry
(15:39):
or do we have to do it? OK.
And do we have to do it because our genes tell us to do it, or
just because that's how we saw it done before?
Well, most behavior is learned, right?
Because, for example, we all have a choice in terms of how to
react or not react to something,but it comes to what we've
(16:01):
learned or not learned. And we can change and rewire
things. But of course, like a lot of
people tend to be very reactive because we aren't taught how to
regulate our emotions from the beginning, right?
So how does that fit into all ofthis?
Right, right. Well, that's a very deep
question that you just stated, right.
Do do we have a choice? Do we really have free will?
(16:25):
OK, as you know, there are professors of psychology at
Stanford University. You know that I questioned the
idea of free will even recently.On top of free will, we have to
add the ideas of religion and God, like destiny and fate.
So we have to accept the fact that the behavior we see from
(16:49):
other people is coming from, youknow, two or three sources as
I've mentioned, right? One is the genes that they are
made of. They were taught a certain way
to behave based on their childhood.
And then there are still choicesthat we hope they can make on
their own. But those choices are not always
(17:12):
as strong as people think, right?
And I would like to suggest to people listening that what you
think about addiction, for instance, and especially
substance use, alcohol addictionor possibly, you know, addiction
these days, even to social mediaor to digital media, could be a
(17:35):
model for what happens in personality with emotions that
are more traditional. You know, such as you irritate
me and now I'm going to do something to you because you
irritated me. And those reactions are not easy
to control. We all have a little bit of
addictive behavior in US. We all have a little bit of
(17:58):
disordered behavior in US. And it's sort of a blood
pressure model that we need to adjust or think about as we move
through the world, right? Too little blood pressure is not
good. Too much blood pressure is not
good either. We ideally are in the middle of
somewhere. And similarly, if you do
(18:18):
something to me and I find that irritable, then it's actually a
good thing that I feel something, right?
If I didn't feel anything, I would be in the camp of too few
emotions, you know, which is sometime where potentially the
world of autism lives, right? And then on the other side, you
(18:41):
have hypersensitivity and peoplewho feel too much, the slightest
little irritation becomes kind of a grinding your teeth next to
their ears or something with that makes them feel like really
upset. And yet you felt I was just
doing my usual stuff. You know, why are you
overreacting? So we all have different blood
(19:05):
pressures, right? We all have different capacity
to regulate our own blood pressure.
And similarly with emotions, we all have different capacities to
control emotions, to maintain flexibility, to maintain
reasonable behaviour and to haveinterpersonal skills that are
fitting well. So I know I want to get back to
(19:27):
your question about the different type of personality
disorders, but I wanted to make sure people understand that in
order to talk about disordered personality, we first have to
agree on what we talk about withpersonality.
What is our personality? And there are different models
of personality that exist, can refer people to, you know,
psychology textbooks to learn kind of a three-dimensional
(19:49):
model, A5 dimensional model. And once we agree, you know that
there's a certain thing that constitutes this inner statue
within us, which is a personality.
Then we can start talking about potential disturbance to that
inner statue. That would be in the realm of
disorders, right? And so when you talk about
(20:12):
paranoia, schizoade, schizotypal, the odd or
eccentric disorders, you know, they are connected to the fact
that the people there have irrational suspicion of others,
mistrust of others, or they havesort of a core effect and a
detachment from other relationships, relationship with
(20:32):
others. And those are classified as type
A you said. Type A Type A correct?
And those, for example, do they are they constituted as a
chemical imbalance in the brain or are they constituted as
something that can be rewired because it's a personality
disorder, as you're saying? Like, you know, for example,
(20:53):
often people will say with anxiety, with depression, that
it is a chemical imbalance in the brain.
And therefore, with medication, that imbalance can come to a
balance. And so how does it work in this
case? Very good question.
So this sort of connects to the relationship between personality
(21:16):
disorders and mood disorders. And again, when we'd have to
define what is a mood exactly, right compared to a personality,
because sometimes you'd think that mood is sort of a visible
part of our personality. Mood disorders tend to live in
the axis one that I had mentioned earlier.
They are typically hormonal imbalance, chemical imbalance in
(21:39):
they can be often corrected by medication, but not always.
People talk about drug resistantdepression, for instance, right?
And so by the way, depression ispart of mood disorders, so is
bipolar disorder. So personality disorders are, as
I mentioned earlier, perhaps connected to this inner statue
(22:00):
that we have in US that constitute who we are as a
person. You know, temper or character or
reaction to stimulus coming fromthe outside.
They could be expressed in termsof mood.
They could be expressed also just by a behavior which is to
withdraw, right, and to sort of essentially hide our moods.
(22:21):
We don't know exactly where personality disorders exists in
our brain, in our mind. It's still a debate, which is in
fact going as far as some peoplesaying that there are no
personality disorders. You only have personality
adaptations. That would adaptation would be a
better term than disorders. Truly.
(22:43):
Because, you know, we are all humans.
We have to accept that some are hypersensitive.
So I'm less sensitive. However, the idea of disorder
for personality has now become part of the general acceptance
of psychiatry and psychology. If I can focus for a minute
(23:03):
about cluster, BI will explain abit better.
But just to finish off, cluster AI will say that the cluster A
personality disorders lead to people having the potential to
develop schizophrenia and psychosis, psychotic disorders,
OK, which is what schizoade and schizotypal refers to.
In the cluster B, you have what is called fear based disorders.
(23:27):
And so those disorders tend to be stemming from certain types
of fears that people experience to a degree that can be extreme.
So borderline personality disorder, BPD is often
associated with the fear of being abandoned.
(23:47):
Being abandoned physically, emotionally can be a very
challenging fear for some peoplewho have lived in their
childhood through such episodes,including trauma, which is very
connected to BPD. Trauma can be defined as any re
(24:10):
credible threat on our sense of survival.
So if you analyze that idea of credible threat on the sense of
survival, of course it includes being in a car accident where
potentially someone else very close to you dies.
Or it could also be being made to feel worthless to the point
that you want to disappear or disintegrate.
(24:33):
OK, through psychological abuse or physical abuse or sexual
abuse, potentially through circumstances like being in
caught in a war and suddenly becoming a refugee and being
chased by people who want your family dead, right?
So those circumstances that you can think of, you know, with the
(24:56):
wars we have around us these days are still affecting
thousands, if not millions of people continue to live in our
psyche as we age, as we go from age 5 to 25 and can, you know,
create scars, like essentially the damaged body of a car after
(25:18):
a car accident, right? Except we don't see it like a
damaged car. And so people are living with
those cars and suddenly meeting a conversation or a person who
makes them feel again, like, I don't want to be with you, it's
too much, blah, blah, blah. I'm going to leave.
(25:40):
And you're going back to that place of trauma where you felt
really like, OK, this is the endof my life now.
And now you overreact, right? And the person who just said,
oh, I just meant I'm going to goto the movie without you because
you can't decide what you want to see or something like that.
You know, feels like, why are you reacting this way?
(26:02):
You know, I just said I'm going to the movie.
I'll be back. I see.
And so if I've understood correctly, all of these
different types of personality disorders, as you say, are a
combination of what has been passed down genetically, what
has been transmitted through upbringing and the environment,
(26:22):
whether it's parents, school, country, war, atmosphere,
whatever it is. And then, of course, trauma that
each person has gone through andat some point in their life,
everyone has experienced some sort of trauma.
You know, pain is pain, whether it's a paper cut or a gunshot
wound, the word is the same, right?
(26:43):
So have I understood that correctly?
Yes, yes, I think that's a good summary of the things I've said.
I do want to say that there are four important types of fears
that are associated with a cluster B I've talked about the
fear of being abandoned, connected to borderline
disorder. Then there is the fear of being
(27:06):
ignored, which is connected to histrionic disorder, the fear of
being inferior which is connected to a narcissistic
disorder, and the fear of being controlled which is connected to
antisocial disorder. So to take them, you know 1 by 1
and especially talk about the fear of being inferior which is
(27:28):
connected to a narcissistic. So first thing I want to mention
is for a quote UN quote normal person, the fear of being
abandoned or the fear of being inferior are not big triggers.
Because if you feel stable in yourself, if you feel OK, you
have a sense that's OK, I'll survive, right?
(27:48):
But for someone who has been in traumatic situation in
especially in their childhood, who has been made to feel
inferior or on the verge of abandonment, those can really
bring back very strong emotions.So there's a BPDNPD, you know,
dichotomy or you know, duality perhaps that makes these two
(28:11):
types of fears sometime get people to be attracted to each
other. So you'll find a lot of couples
where a person has traits of BPDand as attracted to person with
traits of NPD and vice versa. BPD NPD couples, you know there
(28:31):
are many examples. NPD men often with BPD women NPD
men maybe you know alpha type male, but also prone potentially
to having more than one partner in seeking that validation
coming from being you know attractive to many females while
(28:55):
BPD person you know is very sensitive.
You know, we tend to yearn for the things we want to have,
right? And of course the BPD person can
be amazing girlfriend a wonderful person to be with,
often very physically attractivealso, but then conquers an NPD
(29:18):
man thinking that the NPD man isnot going to change.
And now of course, people do change through life and the
clash happens after a few years.Those to personalities, you
know, I often found as being somewhat toxic for each other.
But yet there is important aspect to personality, which is
(29:41):
sexuality can lead to romance that initially feels like
amazing but then after some timebecomes kind of a explosive if
not catastrophic. Right.
And the thing about like anxiousattachment style with avoidant
attachment style, it sounds verysimilar to what you're saying.
From what I understand, stand there through what psychologists
(30:04):
say that it's essentially the opposites that are attracting
because each is seeking in the other, unintentionally attracted
to what they had in their childhood.
So for example, an anxious attachment person will often end
up in an unhealed way, of course, if they're not aware of
(30:25):
their tendencies, if they're notaware of the sort of triggers,
but they'll often end up with anavoidant attachment person
because that is often what they had in their childhood, may be a
parent that was emotionally unavailable or emotionally
absent, right? And so I guess in all of these
(30:45):
situations, they are quite toxicpairs because they are the
unhealed versions of ourselves that are seeking that healing in
partners without consciously understanding why or where it
comes from. Correct.
Yes, yes. I was told once a theory which
(31:07):
is pretty interesting. You know, I don't know if it's
true or completely or not, but that we tend to pick as partner
a person who has a personality type of the parents.
We got along with the least. And it's an interesting idea,
right, that we want to be loved equally by both parents.
(31:28):
But sometime we feel a stronger connection with one of our
parents, but yet we pick as partner in life a person who
resembles more the other parents.
That's because in us, we want tofeel sort of equally worthy from
both of our parents. And sometime we end up putting
into, you know, the role of the unrequited love.
(31:49):
I would say the partner that that we pick this association
between personality disorders and fears that become sort of
irrational fears. I've talked about BPD and NPD.
Those two I want to say are the most talked about and perhaps
most recognized personality disorders within the family of
(32:13):
10 that I mentioned earlier. There are very few people who
will come through as saying I have pioneer with PD or schizoid
PD, whatever. I have met some who had been
diagnosed but they're very few compared to the throngs and
(32:34):
thousands of people who have BPDaccepted it or claimed it.
And you know, there's also good therapies that exist for BPD
that have become now quite popular, such as dialectical
behavioural therapy, which is sort of a superset of CBT,
(32:56):
cognitive behavioural therapy. The work of Aaron Beck for CBT
was expanded by Marshall Einhan with DBT.
So in the US, in America, the DBT standard of therapy has been
viewed as very effective for borderline personality disorder.
(33:17):
In Europe there are a couple of alternatives.
Mentalization in the UK is a very good start of therapy
developed by Peter Fonagy and Anthony Bateman.
You also have something called TFP Transference Focused
Psychotherapy, which was developed by Otto Curran.
(33:37):
I think that was sort of a contemporary and almost of the
the great school of psychotherapy from Vienna.
I had a chance to meet him a fewtimes.
Very nice man. You know, almost like, but you
would expect from Freud if you could meet Freud.
For BPD, the situation is much better than for the other types
(33:57):
of therapies. NPD also has a style of therapy
called schema therapy, which hasbeen viewed as working pretty
well, developed by Jeff Young inNew York City and has a whole
Society of practitioners. The Society of Schema Therapy
has also had some success with antisocial personality disorder,
(34:20):
which is often found in individuals who unfortunately
end up committing criminal acts and maybe in jail.
So countries like the Netherlands have done amazing
job at working on therapy for people who are caught in the
justice system. You know, the numbers speak for
themselves. The Netherlands have 110th the
(34:44):
population density in jail compared to the US, so it's a
huge difference to have. 110th in the US is about 2 million
people in jail. If it were the Netherlands we'd
have 200,000 people in jail, so 1.8 million people would be
free. I've worked with some of the
therapists in the Netherlands, some of whom come from New York,
(35:05):
by the way, but couldn't get theaudience, couldn't be heard in
New York, for their ideas to recover people with, you know,
personality that commit illegal acts and many of them can be
reintegrated, you know, And I work with a therapist of a man
who had been a murderer when he was younger and now was a father
(35:26):
to his kids and was a good person.
And so the idea of change is fundamental.
Also to understand personality disorders.
I want to spend just a few minutes talking about this
because it's so important peoplethink about personality as
something we have and will keep forever.
That's what has caused people who have been labeled or
(35:49):
diagnosed with personality disorders to be irremediable, to
not be able to change. But the truth is that our
personality is a bit like our teeth.
Our teeth, you know, are a very solid part of our body and we
tend to think we can't really change our teeth.
Fast forward from, you know, beginning of humanity to 1950 or
(36:12):
so when orthodontics was discovered.
And nowadays anybody can change their teeth.
It takes 2 years. It's not something that happens
over a couple of appointments, but it's been accepted that you
don't have to live with the teeth you were born with.
And similarly, I strongly believe and I think a lot of
therapists would say that we canreshape our personality.
(36:35):
We may have been born and had accidents to our childhood,
traumatic exposure that made or the body of our car.
You know, the statue we have inside us is somewhat dented,
but we can reshape it. And through therapies like
dilution behavioral therapy, we can retrain ourselves to respond
(36:58):
to something that is very irritable, potentially feels
like a traumatic attack inside us with a response that is calm
and is allowing relationship to continue.
So this idea rewiring of the brain, I'd like to think of it
as I say realignment of our strong reactions.
(37:20):
Right. This is so interesting and
actually hearing you speak aboutthis is reminding me of the
first time that I came across the difference between character
and personality. And this was in a book by
British Indian monk turned author Jay Shetty.
His book is called Think Like a Monk and he spoke about the
difference between character andpersonality.
(37:42):
Character is who we are truly atour core, our deepest authentic
selves at our core. And generally that character is
shown and shaped early on in childhood and that remains till
the end of our days because it is who we are at our core, deep
down inside. But personality is what we have
(38:03):
been taught essentially what howwe have been shaped based on
what we have learned from the environment around us or from
what people say. And I'll give like a specific
example. I have in my life been labeled
always as a perfectionist because I have been always very
detail oriented. And I'm a Virgo.
(38:25):
And, you know, one of the classic sort of bullet points of
Virgos are, oh, perfectionists. Society has told me since I was
young that I'm a perfectionist. I had absorbed that into my
personality for a very long time.
And I remember the day I discovered in therapy with my
therapist that I don't have to be a perfectionist.
(38:49):
It is a choice that I can make, how I want to respond to
something. Because essentially,
perfectionism is a desire to control what generally is not
controllable, right? It's a desire to make everything
around us perfect in order when actually we don't have that
control of anything outside of ourselves.
(39:11):
And I remember the day I realized, like, wait, I don't, I
don't have to be a perfectionist.
I don't have to do everything perfectly.
It's OK if it's just 80%. That was like a huge revelation
for me. And it was such a big reminder
that our personalities do changeand can change with time.
And sometimes they change for the worse, sometimes they change
(39:32):
for the better. But we can also consciously
change them. And it's hard because when
you've been wired a certain way for X number of years or X
number of decades, and suddenly to wake up and realize that, oh,
maybe I don't want to be that way, or I don't like that part
of myself and I don't like how Ifeel when I'm in that sort of
(39:53):
mindset. I would like to have a freer
connection with myself or a freer connection with the things
around me. How can I get there?
That's a really scary. Path and it takes a lot of time
to rewire and to unlearn so muchthat was either self-imposed or
societally imposed or culturallyimposed, imposed from family
members, et cetera. So if I'm understanding
(40:14):
correctly, that's basically whatyou're saying.
And that, for me, was a huge revelation.
Yes, and I'm glad you give this example, right?
And I hope people listening willbe able to distinguish the step
that you made in that therapy session where you realize, OK, I
don't have to be a perfectionistbecause this is exactly the key
(40:36):
step in, I would say, recoveringor realigning, you know, our
personality traits that are off the main line that they should
be on, I would say. And so, you know, he goes back
to this model of saying, OK, we have our temperament or
character and or behaviour, right, And we choose a
(40:56):
behaviour. The character was sort of
nurtured to us, temperament was natured to us, but we can choose
the reaction. And it's interesting that you
mentioned just Shelly, because it was listening to an interview
of of him interviewing a lady recently and talking about the
let them theory. I don't know if you saw.
Yeah, Mel Robbins, right. Yes, yes.
(41:20):
And I thought that lead them theory is very good and very
useful, right. And she was distinguishing the
difference between let them and let it go.
And so this let them empowers you to say to yourself or to
people, OK, I can let them yell at me.
(41:41):
I don't have to yell back, right?
Rather than let it go where, OK,I'm going to ignore it and
pretend that I'm not hearing it or whatever.
No, you actually inside. You give them permission to talk
this way, but it doesn't mean you have to internalize that for
yourself. Right, you take the power back
in your hands with how you're going to respond.
(42:04):
Exactly the power is in your hands to how to choose your
response. It's hard to implement.
It's really hard to implement, especially if one is sensitive,
one has had the habit of taking things personally, one is afraid
that people might be upset with them or whatever.
It's It's very hard to not try and manage someone else's
emotions or reactions or responses to something you say.
(42:27):
But that kind of managing ends up leading to a lack of
boundaries and a lack of self-care very often.
People resist allowing others the behaviour that they feel is
unacceptable for them. And so the question, you know,
is where do I put the boundary and how do I implement my
border? It's just something I think
(42:49):
about a lot these days as we arein the US, you know, starting to
treat immigrant like terrorists.It's like, OK, if you break the
law, how do I respond to that? If you break my boundary, do I
now have the the right to destroy you because you broke
the boundary or or do I have to still show some empathy for
that? But that being said, you know,
(43:10):
back to your example of perfectionism.
So people who are perfectionist typically fall into the
obsessive compulsive category. It can be a good thing, of
course, right? And this is something very
important to mention is that allthese personality disorders,
they always start as a very goodthing, right?
To be very sensitive, to be attached to somebody that you
(43:33):
don't want them to abandon you or to to feel like you want to
be strong for the partner you'rewith or attractive to.
You know, a lot of people, that can be a very good trait.
The problem comes when you have too much of it anywhere in your
behaviour bumps into boundaries of the other or even social
(43:55):
norms. And so there's another key idea
to integrate in all of this, which is the idea of ego
syntonicity versus distonicity. So for a perfectionist person,
initially the choice is I'm a perfectionist because I want to
be the best musician I can be, right?
(44:17):
And the only way to do that is to be obsessive about practicing
and playing and, you know, thinking about music all the
time, OK, great. But then it become potentially
too much at some point that it creates interpersonal stress.
However, as a person, you might still say my choice is to
(44:37):
become, you know, the best at what I'm doing.
So I'm going to continue doing it because it pleases my ego.
And then comes a point where suddenly you say, wait, by doing
that, I'm also destroying some of the other things in my life
that are very important. So maybe I need to put that, you
(44:58):
know, goal of being the best in check.
I have to put some boundaries onit, right?
And so at this point you realizethat you have displeased your
ego somehow and you change your behavior.
This distinction, ego, syntonic ego dystonic was think first
codified or introduced by Sigmund Freud, in fact, when he
(45:21):
talked about narcissism and the fact that for many narcissists,
having a narcissistic behavior is pleasing to their ego and
they cannot imagine not doing that.
But the moment that you realize,OK, I'm actually destroying
people around me by having this super strong personality I'm
(45:43):
trying to impose on others, whenin fact inside it's a quite
fragile ego, then I am opening myself to change.
I'm opening myself potentially to therapy.
And so the challenge of personality disorder is that
many people who have them don't recognize they have a disorder.
Well, because it takes self-awareness to be able to
(46:03):
look in the mirror. Exactly.
Somewhat objectively and be ableto see the harsh reality, accept
the harsh truth, and then make the decision whether you have
the willingness to open Pandora's box and go through the
the difficult sort of journey ofchange and rewiring.
And you know, some people chooseto do that.
(46:25):
Some people don't choose to do that.
There's absolutely no judgement one way or the other.
In my very limited life experience, very often I have
seen that those with narcissistic personality traits
or disorders tend to have a big lack of self-awareness.
Or maybe they are self aware to a certain extent, but there is a
(46:49):
lack of desire to change. Maybe.
Yeah, but that's a very specificcase, I think.
Yes, correct, correct. So ego syntonicity, you know, is
sort of a force within us that can lead to greatness, but if
it's not kept in check at some point it can lead to permanent
behaviors that are destructive or self-destructive.
(47:11):
Within narcissism there's an important distinction, which is
competent narcissism and incompetent narcissism, right?
And so somebody could be great as the CEO of a company because
they have that narcissistic Dr. I would say to change the world.
They have competency in there, but then they move their thirst
(47:32):
for power from, you know, their company to maybe wanting to lead
a whole country and something like that and may not
necessarily have the same competence.
I think it's important to recognize this idea of
egodistonicity. For a lot of people with mood
disorders, ego distonicity comesnaturally because they hit a low
(47:54):
point in their moods for so long, like several weeks that
they realize, OK, there is something about me that I need
to change. Challenge of many personality
disorders is that the lows are hit for short moments,
potentially few hours to a few days, and then the person comes
back up and they don't view necessarily the problem that was
(48:19):
created as something that needs to be changed, cared for.
I think you had a, a previous guest who had a, a podcast with
you in in June 2022 named DoctorVishwajit Ningarukar, correct?
And we talked about insights. Right.
(48:40):
Right. And so insights in in medicine,
in psychiatry in particular, is important for people to
recognize that they have a problem that needs to be
addressed. And sometimes people with
personality disorders don't havethat insight at the height of
their disorder, I would say. Wow, there's so much to talk
about. And I do want to ask one last
(49:01):
question. As you've been walking us
through the different types of personality disorders and I'm
listening to the names of different disorders and some of
the definitions or descriptions of certain certain disorders.
I felt like I was self diagnosing myself saying like,
oh, well then I must have this and this and this and this.
And I think it's kind of a common issue in our society that
(49:26):
we tend to self diagnose a lot. And I would say even self
misdiagnose a lot, as well as misdiagnosing others or
characterizing people in a certain way, sort of like
throwing out buzzwords without really understanding the full
terms of the disorders. As I mentioned in the beginning.
What is being done in terms of more awareness publicly about
(49:52):
diagnosis and to help us as a society not to just self
diagnose ourselves or others, particularly in a
mischaracterizing way? Well, so it's a good question.
It has multiple answers depending where we stand in
society, in which country we are.
You know, there's still vast difference, I would say from
(50:16):
developed countries or developing countries where
traumatic situations are more commonly found potentially than
in more developed countries. The words like borderline
narcissists are used by the psychiatric profession but also
have meanings on the street. Someone who is borderline on the
(50:37):
street is viewed as somewhat problematic, but it's a
different type of problems potentially than the borderline
personality. Same thing with narcissistic
people will throw that around for someone who is potentially
selfish. You know, there is a continuum,
you know, from being selfish to being narcissistic.
I would say it's important to view the world on series of
(51:01):
scales and dimensions. The model of personality
disorders that I've talked aboutin the DSM is being changed by
the ICD classification. That's used a lot in Europe in
particular and throughout the rest of the world.
It is not distinguishing 10 disorders, but only a few.
(51:24):
The the classification is changing.
There's also a problem with the fact that in countries like the
UK, with the National Health Service providing access to
personal data to predictioners who care for patients, receiving
a diagnosis of personality disorders can lead to being
(51:46):
treated differently by the medical profession.
Because people think that if youhave, you know, a personality
disorders, you will be potentially A problematic
patient and therefore they may not give you the same level of
care or even may refuse to take you on as a patient.
Which, of course, is absolutely unjust, unfair and stigmatizing
(52:10):
once again. It can be right now.
I will say that I've also met a very nice therapist who, you
know, we're on the edge of retirement and told me that in
the whole career, you know, the only two patients that had
issues with were people who had personality issues and who ended
(52:30):
up becoming threatening or, you know, to the point where they
were scared. I would say that it's difficult
to really understand what it feels like to be in close
relationship with someone with apersonality disorder and who can
have like a blowtorch in your face for something that you felt
(52:52):
was not deserving that reaction.All of this.
You say that the model is evolving.
In the US, there is a famous psychiatrist named John Oldham
who has proposed an alternative model of personality.
And it is in the third book of the DSM presented as something
(53:13):
that may be a better way to diagnose people than through the
traditional model, which I haven't talked much about.
But in the traditional model, they sort of throw at you 8 or 9
criteria. And then if you have five of
these criteria you considered ashaving the disorder, the
challenge of this traditional method is that you're sort of on
(53:37):
or off, OK, you have BPD or you don't have BPD.
Instead of having a much more gradual view where, you know,
maybe the, the gradient goes from zero to 36 and maybe I'm a
5 and the person over there is a13, right?
And then you can decide, OK, if you're over 9 or 10, then you,
(54:00):
you have a problem, right? Almost like with addiction,
right? At what point do you size that
you have certain addiction connected to personality as
eventually before is sexuality which is very important.
So the model of sexual addictionis an interesting one to
consider in comparison to personality disorders to see at
(54:21):
what point does it really becomea problem.
And so the personality types arestill evolving.
I want to also say that one question that has fascinated me
from the start, especially as a parent, was to understand the
potential transmission of personality disorder to other
people, including to our children.
(54:43):
There are studies that are made about mothers with borderline or
fathers with narcissism on the impact it has on their children.
And of course, you know, they can be narcissistic women.
It can be borderline men as well.
And unfortunately those sometimeare and not recognize as much or
as quickly. But understanding the
(55:05):
transmission of personality disorders is very interesting
topic and I've talked about it when I gave my first conference
in 2011 for an EABPD. So emotions tend to be
contagious, right? And you know this as an artist
Paravi, that you can create emotions in people through your
music, right? And music especially is a great
(55:27):
vehicle for, I would say, contaminating other people with
emotions. Then the question is, can
emotional dysregulation be contagious?
And so if I overreact due to my emotion, is that something that
might have become part of my personality due to my upbringing
or due to contacts I had as a child?
(55:47):
I hope eventually we will develop an epidemiology of
emotions and of emotional dysregulation, because I think
that a lot of the transmission of emotions happened through
tiny little communications between people that are like at
the level of viruses compared toour cells, which are even much
(56:11):
smaller than our bodies. Similarly, I think that they are
unspoken, maybe just a look or afeeling that can contaminate
people with a sense of emotions that can become extreme.
And I'm hoping that eventually we will realize that in the
(56:32):
world we live in, we do unfortunately sometimes send
toxic messages to others. We will learn to clean this up a
lot more. So in the same way as you know,
hygiene has changed the world right in the last 200 years.
Sometimes people wonder how did tuberculosis disappear?
The main reason tuberculosis is gone is because we take showers
(56:53):
every day, we wash our hands, weclean our food before we eat it,
the stores are clean and things like that.
And similarly, upbringing, parenting, dedication has
changed a lot, right? Most schools don't hit kids
anymore. Most parents don't hit kids.
In fact, by now the 63 countriesthat have made spanking children
(57:14):
illegal in some of these countries like Sweden have done
it now for I think 45 years, something like that.
And those the world hasn't gone to hell by making spanking
illegal. So people realize, oh, maybe
there's a way to raise children without putting fear in them.
By doing that, we raise better people, right?
(57:35):
And so my hope for 100 years from now is that the world of
mental health will evolve like the world of physical health has
evolved thanks to hygiene and better communication.
We have understood virology. We've lived through pandemics
that made us realize that, you know, sometimes just breathing
towards a person can actually bedangerous.
(57:56):
And similarly, in mental health,maybe there are ways we need to
discover certain ways of saying things to somebody.
There are better ways of saying it, more healthy ways to say it.
Absolutely. And sort of the bottom line I
take from everything we've talked about today is a reminder
that nothing in this world is black or white, good or bad,
(58:20):
right or wrong, one way or the other.
Everything is sort of a spectrumand they're different levels and
layers and grades of everything.We are complex, multi layered
human beings. And to allow both ourselves
compassion and empathy and others compassion and empathy, I
(58:40):
think hopefully will help to create a much healthier world
all around. Yes, yes, I think your podcast
is is wonderful, amazing and a welcoming place for people to
hear about these ideas. And so I really thank you for
not only being a great pianist. I had a chance to listen to and
(59:02):
fell in love your music but alsodevoting your time to raising
awareness for better mental health.
Thank you so much. I appreciate you saying that,
and it's something I'm very passionate about and something I
feel very strongly about becauseat the end of the day, if all of
us are able to be just a little bit better, it contributes
(59:23):
globally to a better society andbetter humanity.
But thank you so much for being here with us today.
This was an extremely enlightening conversation, very
educational, and I really hope that our listeners have learned
something. I'm going to add links to both
your foundation and other relevant websites and resources
(59:45):
in the podcast episode information so that our guests
can have a chance to see your work directly and reach out to
resources should they need. I would say also that, you know,
social media and in particular the Facebook page of Pedan have
been sort of perfect storm. That allowed us to to radiate
some of these ideas to to millions of people.
(01:00:07):
So if people want to join us through the Piden page in
Facebook, that would be a great place to start.
Absolutely. I will link everything in the
description. Thank you so much for joining us
today. Thank you Paradi.
Again, take care. Thank you all so much for
listening. I am truly grateful for the
(01:00:28):
support. Please share this episode in
this podcast because the more awareness we bring to mental
health, the sooner we can break the stigmas around these topics
and the faster we can help make our world a healthier place.
Don't forget to subscribe wherever you get your podcasts
and see you next week for another episode of The Conscious
Artist.
Hello and welcome back to another episode of The Conscious
Artist, a safe space for conversations around mental
health awareness for musicians, artists, and all human beings.
I am your host, Pallavi Mahidera, and I'm thrilled that
you are joining us today. I love the community we have
developed together through this show, and I'm committed to
continuing to give a platform for voices and stories to be
(00:26):
shared. When we allow others and
ourselves to feel seen and heard, we create much needed
change in this industry and in this world.
So thank you for supporting thiscommunity.
Don't forget to subscribe wherever you get your podcasts
and let's get started. My guest today is the president
(00:52):
of the Personality Disorders Awareness Network.
He has served as Director of Development and was on the board
of National Education Alliance for Borderline Personality
Disorders where he focused on sponsorship relations and Co
organized conferences on the subject.
Please join me in welcoming my guest, Doctor Frederick Bien to
the conscious Artist. Frederick, thank you so much for
(01:12):
joining us today. Hello, Paravi, Thank you so much
for having me. It's an honor to be on your
podcast. It is my pleasure.
Today's episode is about personality disorders and
awareness, and I feel that there's quite a large lack of
awareness in terms of the disorders themselves, but also
causes recovery and any sort of context around the disorders.
(01:36):
In fact, I think as a society wecan be quite quick to label
someone, for example, as a narcissist or a behavior as OCD,
for example, without full understanding of the terms and
disorders. So to begin, could you discuss
firstly what are some of the different personality disorders?
So indeed, the family of disorders might have issues
(02:01):
called personality disorders arenot very well known by the
public. Still, it's starting to change
in the last 20 years or so and it's only been about, you know,
50 years. I would say that personality
disorders are being taught and and used a lot in the mental
(02:21):
health profession and therefore it's a more recent family of
mental health issues than depression, anxiety or bipolar
disorder. And therefore it's perhaps
normal that people are still trying to understand, you know,
what is exactly a personality disorder.
(02:43):
The categorization of these disorders, you know, was made
official through the Diagnostic Statistical Manual in the US,
the DSM as well as the International Classification of
Disease, The ICD in the rest of the world, I would say.
And the two of them are not completely In Sync with, you
(03:05):
know, the classification of those mental health issues,
which has added to perhaps the public lack of understanding of
what we really we're dealing with.
A second aspect of this is the terms right personality disorder
are very much putting in question the person who received
(03:29):
the diagnosis and therefore the number of people who might be
deemed to have a personality disorders are rejecting the fact
that they actually have a disorder.
Third, I would say, and I'll getinto this a little more later,
there is, you know, a general distinction in mental health
(03:51):
between sort of the very conscious disorders, so-called
axis 1 disorders and, you know, the less directly conscious
disorder called axis 2 disordersand personality disorders.
For a while were categorizing the axis two side, which means
that they were not necessarily, you know, symptomatic on the
(04:13):
forefront of people's behavior. And the move from axis 2 to axis
1, you know, is relatively recent.
But with that being said, you know, I can explain that
officially in the traditional DSM 4, DSM 4, or DSM 5, there
(04:35):
were five, there were 10, sorry,personality disorders that were
listed, paranoid, schizoid, schizotypal, antisocial,
borderline, histrionic, narcissistic, obsessive,
compulsive, anxious, or avoidantindependent personality with an
(04:57):
11th 1, which was the unspecified category.
These, you know, 10 or 11 were grouped into clusters, cluster
AB and C as they were called. You know, cluster A contained
paranoid schizoid, schizotypal, Cluster B contain antisocial,
borderline, histrionic, narcissistic.
(05:19):
Those were probably by now the more popular one, the better
understood. Cluster B is also labeled
sometime emotional or erratic disorders.
And then in cluster C you have the anxious or fearful
disorders, which is avoidant, dependent, obsessive compulsive.
And just to give the nickname for cluster A was the odd or or
(05:44):
eccentric disorders at P Dan, the personality disorder
awareness Network. So it was originally created in
2001 by Randy Craiger, who is a famous author in the US of the
book stopped walking on egg shells and she had a couple of
partners worked with her and theinitial goal of the group was
(06:05):
really to focus on family members of people who have
personality disorders. Family members sometimes suffer
from the challenging, erratic, some might say at times feeling
like manipulative behavior of people with disorders.
And Brandy's specialty has been to write books, you know, for
(06:27):
family members. And the group evolved for the
next 10 years with a little bit of support from the community,
but I would say didn't really blossom, partly because of lack
of organizational skills, administrative skills from the
founders who, you know, were notthat interested in running a
(06:51):
large organization. And then in 2011, I came into
the field, as you mentioned in the introduction, through
NEABPD, which is the National Education Alliance for
Borderline Personality Disorder.We organized a conference
together in Atlanta, which was quite successful at the Carter
Center from President Jimmy Carter, whose wife Rosalie
(07:15):
Carter, was a big advocate for mental health and especially
insurance parity in the US. After that conference in a
similar one in New York, Westchester, I felt that we
needed to refocus perhaps the message of any ABPD on families
and children in particular. And so Randy was ready to sort
(07:38):
of pass on the reins of Pidan. There was a lady named Mary in
between who had also taken on leadership but didn't want to
really continue. And so I inherited, you know,
the little group that existed. We reincorporated in Georgia
since I live in Atlanta, and we started publishing books for
(08:02):
children that explain to kids the idea of emotions being a bit
like the weather around us and therefore our parents
potentially having emotions thatthey cannot control.
And the kids are on the receiving ends of these emotions
and sometimes are blamed for those emotions by the parents.
(08:27):
And it was important to sort of strengthen the identity, the
personality of the children to realize, OK, you know, there is
what I do and my behavior, but then there is also the mood that
my parents might be in. And this has to be
distinguished, separated somehow.
So I, I don't think that I am responsible necessarily for the
(08:51):
way I'm being talked to. So the conversation around these
books started in social media and this was 2012.
You know, Facebook had maybe only couple 100 million users at
the time. I had just come out of a startup
(09:12):
company in the field of social media called Blink Media, which
was focused on helping big brands bring their messages into
the field of social media. And I utilize some my skills
there to sort of promote conversations around the
children books in social media. And something very surprising
(09:33):
perhaps happened because until then, you know, it's important
to say because we kind of forgotnow, 13 years later, that at
that time, the reputation of people with borderline
personality disorder was largelyshaped by books like Stop
Working on Egg Shells on one side, by movies like Fatal
(09:54):
Attraction or Girl Interrupted, You know, where the people with
BPD in particular, you know, were portrayed as sort of the
most difficult of the difficult people to deal with.
Yet we took at PDN as well as atNEA BPD, an approach that was
much more caring to say, OK, these people did not ask to have
(10:15):
BPD. We didn't ask them to have BPD.
But they have something. And therefore we need to figure
out a way to live with them, to adapt to them so that we can
continue all living, you know, the rest of our lives somewhat
happily. And that message of compassion
and empathy towards people with personality disorders resonated
(10:37):
in social media like an echo chamber.
And it was very surprising, I would say almost spectacular to
see in 2000 and 12/13/14 that suddenly we attracted a large
group of people with BPD who notonly followed us but said, hey,
(10:58):
I want to speak because I want to tell the world how I feel and
what it feels like to have BPD. This was really sort of
miraculous for us in terms of growth of the organization in
social media, but also because these people came out of the
woodwork from having been castigated, you know, as the
(11:18):
para years on the edge of society to now, you know, be
able to explain how they were feeling and the fact that many
of them were in therapy and weretrying to be better and some
even were actually recovered. And so that shift that happened,
you know, was what P then sort of was able to support
(11:38):
Turbocharge, Amplify. And now, you know, we have close
to 800,000 followers in social media.
The page has often reached several million people per month
and many of them are suffering from a personality disorders.
Many are feeling supported by the group and are happy to find
(11:58):
other people like them. And it's a very different
situation in 2025 than it was inin 2012.
Wow, thank you so much for sharing all of that.
You sort of already answered a few questions I wanted to ask
you and I, I so appreciate that because I think the bottom line
of everything regarding this topic, I would say is a lack of
(12:19):
education. Lack of awareness comes from
lack of education, right? And lack of education often
leads to stigma and shunning people to the side, as you said.
And so I appreciate very much what you are doing with the
organization, with the awareness, with creating very,
very large and widespread community where people do feel
(12:41):
seen and heard and valued as human beings.
Because at the end of the day, I'm pretty sure every single one
of us has some sort of disorder or the other.
And it was very interesting for me when you were listing the
different personality disorders.Of course I was aware of
schizoid, paranoid, bipolar, multiple personalities,
(13:03):
borderline narcissistic, but what I was less sort of aware of
as a disorder was like the avoidant, the dependent.
And I wonder if there's also a lot of lack of understanding and
education and awareness with that.
Because I think anyone that goeson social media that follows any
sort of therapist or therapy page or mental health page will
(13:26):
see the kind of buzzwords that are like avoidant attachment
style or anxious attachment style.
And that there's a lot of talk about that in relationships, for
example. I wasn't even aware that those
are also classified as actual personality disorders.
Could you explain a little bit more?
I mean, I understand that you'renot, you know, a psychologist or
(13:47):
psychiatrist, but you have a lotof experience with this and you
know, so if you can, would you, would you be able to clarify a
little bit more what is avoidantpersonality disorder versus
dependent versus anxious, et cetera?
Sure. So the personality disorders and
I can refer people to, you know,ideally the DSM and DSM 5 in
(14:09):
particular, but one has to pay to be able to read it.
Otherwise, Wikipedia actually does a pretty good job at
summarizing the information thatcomes from the DSM, the pdn.org
website. Pdn.org also has a few pages
about the various disorders. So there is a way to, you know,
(14:32):
look at first personality, rightIn these different models of
personality, you know what shapes of personality there is 2
main components to a personalityis a character and a
temperament. So the temperament is viewed as
what we inherit from the environment we were born in,
(14:56):
inherited biologically, while the character is more kind of
our own will that, you know, creates a behavior that is our
choice, so to speak. Essentially, nature versus
nurture. Correct, correct.
Exactly. Now, nature and nurture, perhaps
(15:17):
a slightly different division inthe sense that there is where we
inherit biologically, there's what we inherit through being
taught, right? And then there is still where we
choose to do right. So that part is very important.
You know, do we have a choice tobe lashing out when we are angry
(15:39):
or do we have to do it? OK.
And do we have to do it because our genes tell us to do it, or
just because that's how we saw it done before?
Well, most behavior is learned, right?
Because, for example, we all have a choice in terms of how to
react or not react to something,but it comes to what we've
(16:01):
learned or not learned. And we can change and rewire
things. But of course, like a lot of
people tend to be very reactive because we aren't taught how to
regulate our emotions from the beginning, right?
So how does that fit into all ofthis?
Right, right. Well, that's a very deep
question that you just stated, right.
Do do we have a choice? Do we really have free will?
(16:25):
OK, as you know, there are professors of psychology at
Stanford University. You know that I questioned the
idea of free will even recently.On top of free will, we have to
add the ideas of religion and God, like destiny and fate.
So we have to accept the fact that the behavior we see from
(16:49):
other people is coming from, youknow, two or three sources as
I've mentioned, right? One is the genes that they are
made of. They were taught a certain way
to behave based on their childhood.
And then there are still choicesthat we hope they can make on
their own. But those choices are not always
(17:12):
as strong as people think, right?
And I would like to suggest to people listening that what you
think about addiction, for instance, and especially
substance use, alcohol addictionor possibly, you know, addiction
these days, even to social mediaor to digital media, could be a
(17:35):
model for what happens in personality with emotions that
are more traditional. You know, such as you irritate
me and now I'm going to do something to you because you
irritated me. And those reactions are not easy
to control. We all have a little bit of
addictive behavior in US. We all have a little bit of
(17:58):
disordered behavior in US. And it's sort of a blood
pressure model that we need to adjust or think about as we move
through the world, right? Too little blood pressure is not
good. Too much blood pressure is not
good either. We ideally are in the middle of
somewhere. And similarly, if you do
(18:18):
something to me and I find that irritable, then it's actually a
good thing that I feel something, right?
If I didn't feel anything, I would be in the camp of too few
emotions, you know, which is sometime where potentially the
world of autism lives, right? And then on the other side, you
(18:41):
have hypersensitivity and peoplewho feel too much, the slightest
little irritation becomes kind of a grinding your teeth next to
their ears or something with that makes them feel like really
upset. And yet you felt I was just
doing my usual stuff. You know, why are you
overreacting? So we all have different blood
(19:05):
pressures, right? We all have different capacity
to regulate our own blood pressure.
And similarly with emotions, we all have different capacities to
control emotions, to maintain flexibility, to maintain
reasonable behaviour and to haveinterpersonal skills that are
fitting well. So I know I want to get back to
(19:27):
your question about the different type of personality
disorders, but I wanted to make sure people understand that in
order to talk about disordered personality, we first have to
agree on what we talk about withpersonality.
What is our personality? And there are different models
of personality that exist, can refer people to, you know,
psychology textbooks to learn kind of a three-dimensional
(19:49):
model, A5 dimensional model. And once we agree, you know that
there's a certain thing that constitutes this inner statue
within us, which is a personality.
Then we can start talking about potential disturbance to that
inner statue. That would be in the realm of
disorders, right? And so when you talk about
(20:12):
paranoia, schizoade, schizotypal, the odd or
eccentric disorders, you know, they are connected to the fact
that the people there have irrational suspicion of others,
mistrust of others, or they havesort of a core effect and a
detachment from other relationships, relationship with
(20:32):
others. And those are classified as type
A you said. Type A Type A correct?
And those, for example, do they are they constituted as a
chemical imbalance in the brain or are they constituted as
something that can be rewired because it's a personality
disorder, as you're saying? Like, you know, for example,
(20:53):
often people will say with anxiety, with depression, that
it is a chemical imbalance in the brain.
And therefore, with medication, that imbalance can come to a
balance. And so how does it work in this
case? Very good question.
So this sort of connects to the relationship between personality
(21:16):
disorders and mood disorders. And again, when we'd have to
define what is a mood exactly, right compared to a personality,
because sometimes you'd think that mood is sort of a visible
part of our personality. Mood disorders tend to live in
the axis one that I had mentioned earlier.
They are typically hormonal imbalance, chemical imbalance in
(21:39):
they can be often corrected by medication, but not always.
People talk about drug resistantdepression, for instance, right?
And so by the way, depression ispart of mood disorders, so is
bipolar disorder. So personality disorders are, as
I mentioned earlier, perhaps connected to this inner statue
(22:00):
that we have in US that constitute who we are as a
person. You know, temper or character or
reaction to stimulus coming fromthe outside.
They could be expressed in termsof mood.
They could be expressed also just by a behavior which is to
withdraw, right, and to sort of essentially hide our moods.
(22:21):
We don't know exactly where personality disorders exists in
our brain, in our mind. It's still a debate, which is in
fact going as far as some peoplesaying that there are no
personality disorders. You only have personality
adaptations. That would adaptation would be a
better term than disorders. Truly.
(22:43):
Because, you know, we are all humans.
We have to accept that some are hypersensitive.
So I'm less sensitive. However, the idea of disorder
for personality has now become part of the general acceptance
of psychiatry and psychology. If I can focus for a minute
(23:03):
about cluster, BI will explain abit better.
But just to finish off, cluster AI will say that the cluster A
personality disorders lead to people having the potential to
develop schizophrenia and psychosis, psychotic disorders,
OK, which is what schizoade and schizotypal refers to.
In the cluster B, you have what is called fear based disorders.
(23:27):
And so those disorders tend to be stemming from certain types
of fears that people experience to a degree that can be extreme.
So borderline personality disorder, BPD is often
associated with the fear of being abandoned.
(23:47):
Being abandoned physically, emotionally can be a very
challenging fear for some peoplewho have lived in their
childhood through such episodes,including trauma, which is very
connected to BPD. Trauma can be defined as any re
(24:10):
credible threat on our sense of survival.
So if you analyze that idea of credible threat on the sense of
survival, of course it includes being in a car accident where
potentially someone else very close to you dies.
Or it could also be being made to feel worthless to the point
that you want to disappear or disintegrate.
(24:33):
OK, through psychological abuse or physical abuse or sexual
abuse, potentially through circumstances like being in
caught in a war and suddenly becoming a refugee and being
chased by people who want your family dead, right?
So those circumstances that you can think of, you know, with the
(24:56):
wars we have around us these days are still affecting
thousands, if not millions of people continue to live in our
psyche as we age, as we go from age 5 to 25 and can, you know,
create scars, like essentially the damaged body of a car after
(25:18):
a car accident, right? Except we don't see it like a
damaged car. And so people are living with
those cars and suddenly meeting a conversation or a person who
makes them feel again, like, I don't want to be with you, it's
too much, blah, blah, blah. I'm going to leave.
(25:40):
And you're going back to that place of trauma where you felt
really like, OK, this is the endof my life now.
And now you overreact, right? And the person who just said,
oh, I just meant I'm going to goto the movie without you because
you can't decide what you want to see or something like that.
You know, feels like, why are you reacting this way?
(26:02):
You know, I just said I'm going to the movie.
I'll be back. I see.
And so if I've understood correctly, all of these
different types of personality disorders, as you say, are a
combination of what has been passed down genetically, what
has been transmitted through upbringing and the environment,
(26:22):
whether it's parents, school, country, war, atmosphere,
whatever it is. And then, of course, trauma that
each person has gone through andat some point in their life,
everyone has experienced some sort of trauma.
You know, pain is pain, whether it's a paper cut or a gunshot
wound, the word is the same, right?
(26:43):
So have I understood that correctly?
Yes, yes, I think that's a good summary of the things I've said.
I do want to say that there are four important types of fears
that are associated with a cluster B I've talked about the
fear of being abandoned, connected to borderline
disorder. Then there is the fear of being
(27:06):
ignored, which is connected to histrionic disorder, the fear of
being inferior which is connected to a narcissistic
disorder, and the fear of being controlled which is connected to
antisocial disorder. So to take them, you know 1 by 1
and especially talk about the fear of being inferior which is
(27:28):
connected to a narcissistic. So first thing I want to mention
is for a quote UN quote normal person, the fear of being
abandoned or the fear of being inferior are not big triggers.
Because if you feel stable in yourself, if you feel OK, you
have a sense that's OK, I'll survive, right?
(27:48):
But for someone who has been in traumatic situation in
especially in their childhood, who has been made to feel
inferior or on the verge of abandonment, those can really
bring back very strong emotions.So there's a BPDNPD, you know,
dichotomy or you know, duality perhaps that makes these two
(28:11):
types of fears sometime get people to be attracted to each
other. So you'll find a lot of couples
where a person has traits of BPDand as attracted to person with
traits of NPD and vice versa. BPD NPD couples, you know there
(28:31):
are many examples. NPD men often with BPD women NPD
men maybe you know alpha type male, but also prone potentially
to having more than one partner in seeking that validation
coming from being you know attractive to many females while
(28:55):
BPD person you know is very sensitive.
You know, we tend to yearn for the things we want to have,
right? And of course the BPD person can
be amazing girlfriend a wonderful person to be with,
often very physically attractivealso, but then conquers an NPD
(29:18):
man thinking that the NPD man isnot going to change.
And now of course, people do change through life and the
clash happens after a few years.Those to personalities, you
know, I often found as being somewhat toxic for each other.
But yet there is important aspect to personality, which is
(29:41):
sexuality can lead to romance that initially feels like
amazing but then after some timebecomes kind of a explosive if
not catastrophic. Right.
And the thing about like anxiousattachment style with avoidant
attachment style, it sounds verysimilar to what you're saying.
From what I understand, stand there through what psychologists
(30:04):
say that it's essentially the opposites that are attracting
because each is seeking in the other, unintentionally attracted
to what they had in their childhood.
So for example, an anxious attachment person will often end
up in an unhealed way, of course, if they're not aware of
(30:25):
their tendencies, if they're notaware of the sort of triggers,
but they'll often end up with anavoidant attachment person
because that is often what they had in their childhood, may be a
parent that was emotionally unavailable or emotionally
absent, right? And so I guess in all of these
(30:45):
situations, they are quite toxicpairs because they are the
unhealed versions of ourselves that are seeking that healing in
partners without consciously understanding why or where it
comes from. Correct.
Yes, yes. I was told once a theory which
(31:07):
is pretty interesting. You know, I don't know if it's
true or completely or not, but that we tend to pick as partner
a person who has a personality type of the parents.
We got along with the least. And it's an interesting idea,
right, that we want to be loved equally by both parents.
(31:28):
But sometime we feel a stronger connection with one of our
parents, but yet we pick as partner in life a person who
resembles more the other parents.
That's because in us, we want tofeel sort of equally worthy from
both of our parents. And sometime we end up putting
into, you know, the role of the unrequited love.
(31:49):
I would say the partner that that we pick this association
between personality disorders and fears that become sort of
irrational fears. I've talked about BPD and NPD.
Those two I want to say are the most talked about and perhaps
most recognized personality disorders within the family of
(32:13):
10 that I mentioned earlier. There are very few people who
will come through as saying I have pioneer with PD or schizoid
PD, whatever. I have met some who had been
diagnosed but they're very few compared to the throngs and
(32:34):
thousands of people who have BPDaccepted it or claimed it.
And you know, there's also good therapies that exist for BPD
that have become now quite popular, such as dialectical
behavioural therapy, which is sort of a superset of CBT,
(32:56):
cognitive behavioural therapy. The work of Aaron Beck for CBT
was expanded by Marshall Einhan with DBT.
So in the US, in America, the DBT standard of therapy has been
viewed as very effective for borderline personality disorder.
(33:17):
In Europe there are a couple of alternatives.
Mentalization in the UK is a very good start of therapy
developed by Peter Fonagy and Anthony Bateman.
You also have something called TFP Transference Focused
Psychotherapy, which was developed by Otto Curran.
(33:37):
I think that was sort of a contemporary and almost of the
the great school of psychotherapy from Vienna.
I had a chance to meet him a fewtimes.
Very nice man. You know, almost like, but you
would expect from Freud if you could meet Freud.
For BPD, the situation is much better than for the other types
(33:57):
of therapies. NPD also has a style of therapy
called schema therapy, which hasbeen viewed as working pretty
well, developed by Jeff Young inNew York City and has a whole
Society of practitioners. The Society of Schema Therapy
has also had some success with antisocial personality disorder,
(34:20):
which is often found in individuals who unfortunately
end up committing criminal acts and maybe in jail.
So countries like the Netherlands have done amazing
job at working on therapy for people who are caught in the
justice system. You know, the numbers speak for
themselves. The Netherlands have 110th the
(34:44):
population density in jail compared to the US, so it's a
huge difference to have. 110th in the US is about 2 million
people in jail. If it were the Netherlands we'd
have 200,000 people in jail, so 1.8 million people would be
free. I've worked with some of the
therapists in the Netherlands, some of whom come from New York,
(35:05):
by the way, but couldn't get theaudience, couldn't be heard in
New York, for their ideas to recover people with, you know,
personality that commit illegal acts and many of them can be
reintegrated, you know, And I work with a therapist of a man
who had been a murderer when he was younger and now was a father
(35:26):
to his kids and was a good person.
And so the idea of change is fundamental.
Also to understand personality disorders.
I want to spend just a few minutes talking about this
because it's so important peoplethink about personality as
something we have and will keep forever.
That's what has caused people who have been labeled or
(35:49):
diagnosed with personality disorders to be irremediable, to
not be able to change. But the truth is that our
personality is a bit like our teeth.
Our teeth, you know, are a very solid part of our body and we
tend to think we can't really change our teeth.
Fast forward from, you know, beginning of humanity to 1950 or
(36:12):
so when orthodontics was discovered.
And nowadays anybody can change their teeth.
It takes 2 years. It's not something that happens
over a couple of appointments, but it's been accepted that you
don't have to live with the teeth you were born with.
And similarly, I strongly believe and I think a lot of
therapists would say that we canreshape our personality.
(36:35):
We may have been born and had accidents to our childhood,
traumatic exposure that made or the body of our car.
You know, the statue we have inside us is somewhat dented,
but we can reshape it. And through therapies like
dilution behavioral therapy, we can retrain ourselves to respond
(36:58):
to something that is very irritable, potentially feels
like a traumatic attack inside us with a response that is calm
and is allowing relationship to continue.
So this idea rewiring of the brain, I'd like to think of it
as I say realignment of our strong reactions.
(37:20):
Right. This is so interesting and
actually hearing you speak aboutthis is reminding me of the
first time that I came across the difference between character
and personality. And this was in a book by
British Indian monk turned author Jay Shetty.
His book is called Think Like a Monk and he spoke about the
difference between character andpersonality.
(37:42):
Character is who we are truly atour core, our deepest authentic
selves at our core. And generally that character is
shown and shaped early on in childhood and that remains till
the end of our days because it is who we are at our core, deep
down inside. But personality is what we have
(38:03):
been taught essentially what howwe have been shaped based on
what we have learned from the environment around us or from
what people say. And I'll give like a specific
example. I have in my life been labeled
always as a perfectionist because I have been always very
detail oriented. And I'm a Virgo.
(38:25):
And, you know, one of the classic sort of bullet points of
Virgos are, oh, perfectionists. Society has told me since I was
young that I'm a perfectionist. I had absorbed that into my
personality for a very long time.
And I remember the day I discovered in therapy with my
therapist that I don't have to be a perfectionist.
(38:49):
It is a choice that I can make, how I want to respond to
something. Because essentially,
perfectionism is a desire to control what generally is not
controllable, right? It's a desire to make everything
around us perfect in order when actually we don't have that
control of anything outside of ourselves.
(39:11):
And I remember the day I realized, like, wait, I don't, I
don't have to be a perfectionist.
I don't have to do everything perfectly.
It's OK if it's just 80%. That was like a huge revelation
for me. And it was such a big reminder
that our personalities do changeand can change with time.
And sometimes they change for the worse, sometimes they change
(39:32):
for the better. But we can also consciously
change them. And it's hard because when
you've been wired a certain way for X number of years or X
number of decades, and suddenly to wake up and realize that, oh,
maybe I don't want to be that way, or I don't like that part
of myself and I don't like how Ifeel when I'm in that sort of
(39:53):
mindset. I would like to have a freer
connection with myself or a freer connection with the things
around me. How can I get there?
That's a really scary. Path and it takes a lot of time
to rewire and to unlearn so muchthat was either self-imposed or
societally imposed or culturallyimposed, imposed from family
members, et cetera. So if I'm understanding
(40:14):
correctly, that's basically whatyou're saying.
And that, for me, was a huge revelation.
Yes, and I'm glad you give this example, right?
And I hope people listening willbe able to distinguish the step
that you made in that therapy session where you realize, OK, I
don't have to be a perfectionistbecause this is exactly the key
(40:36):
step in, I would say, recoveringor realigning, you know, our
personality traits that are off the main line that they should
be on, I would say. And so, you know, he goes back
to this model of saying, OK, we have our temperament or
character and or behaviour, right, And we choose a
(40:56):
behaviour. The character was sort of
nurtured to us, temperament was natured to us, but we can choose
the reaction. And it's interesting that you
mentioned just Shelly, because it was listening to an interview
of of him interviewing a lady recently and talking about the
let them theory. I don't know if you saw.
Yeah, Mel Robbins, right. Yes, yes.
(41:20):
And I thought that lead them theory is very good and very
useful, right. And she was distinguishing the
difference between let them and let it go.
And so this let them empowers you to say to yourself or to
people, OK, I can let them yell at me.
(41:41):
I don't have to yell back, right?
Rather than let it go where, OK,I'm going to ignore it and
pretend that I'm not hearing it or whatever.
No, you actually inside. You give them permission to talk
this way, but it doesn't mean you have to internalize that for
yourself. Right, you take the power back
in your hands with how you're going to respond.
(42:04):
Exactly the power is in your hands to how to choose your
response. It's hard to implement.
It's really hard to implement, especially if one is sensitive,
one has had the habit of taking things personally, one is afraid
that people might be upset with them or whatever.
It's It's very hard to not try and manage someone else's
emotions or reactions or responses to something you say.
(42:27):
But that kind of managing ends up leading to a lack of
boundaries and a lack of self-care very often.
People resist allowing others the behaviour that they feel is
unacceptable for them. And so the question, you know,
is where do I put the boundary and how do I implement my
border? It's just something I think
(42:49):
about a lot these days as we arein the US, you know, starting to
treat immigrant like terrorists.It's like, OK, if you break the
law, how do I respond to that? If you break my boundary, do I
now have the the right to destroy you because you broke
the boundary or or do I have to still show some empathy for
that? But that being said, you know,
(43:10):
back to your example of perfectionism.
So people who are perfectionist typically fall into the
obsessive compulsive category. It can be a good thing, of
course, right? And this is something very
important to mention is that allthese personality disorders,
they always start as a very goodthing, right?
To be very sensitive, to be attached to somebody that you
(43:33):
don't want them to abandon you or to to feel like you want to
be strong for the partner you'rewith or attractive to.
You know, a lot of people, that can be a very good trait.
The problem comes when you have too much of it anywhere in your
behaviour bumps into boundaries of the other or even social
(43:55):
norms. And so there's another key idea
to integrate in all of this, which is the idea of ego
syntonicity versus distonicity. So for a perfectionist person,
initially the choice is I'm a perfectionist because I want to
be the best musician I can be, right?
(44:17):
And the only way to do that is to be obsessive about practicing
and playing and, you know, thinking about music all the
time, OK, great. But then it become potentially
too much at some point that it creates interpersonal stress.
However, as a person, you might still say my choice is to
(44:37):
become, you know, the best at what I'm doing.
So I'm going to continue doing it because it pleases my ego.
And then comes a point where suddenly you say, wait, by doing
that, I'm also destroying some of the other things in my life
that are very important. So maybe I need to put that, you
(44:58):
know, goal of being the best in check.
I have to put some boundaries onit, right?
And so at this point you realizethat you have displeased your
ego somehow and you change your behavior.
This distinction, ego, syntonic ego dystonic was think first
codified or introduced by Sigmund Freud, in fact, when he
(45:21):
talked about narcissism and the fact that for many narcissists,
having a narcissistic behavior is pleasing to their ego and
they cannot imagine not doing that.
But the moment that you realize,OK, I'm actually destroying
people around me by having this super strong personality I'm
(45:43):
trying to impose on others, whenin fact inside it's a quite
fragile ego, then I am opening myself to change.
I'm opening myself potentially to therapy.
And so the challenge of personality disorder is that
many people who have them don't recognize they have a disorder.
Well, because it takes self-awareness to be able to
(46:03):
look in the mirror. Exactly.
Somewhat objectively and be ableto see the harsh reality, accept
the harsh truth, and then make the decision whether you have
the willingness to open Pandora's box and go through the
the difficult sort of journey ofchange and rewiring.
And you know, some people chooseto do that.
(46:25):
Some people don't choose to do that.
There's absolutely no judgement one way or the other.
In my very limited life experience, very often I have
seen that those with narcissistic personality traits
or disorders tend to have a big lack of self-awareness.
Or maybe they are self aware to a certain extent, but there is a
(46:49):
lack of desire to change. Maybe.
Yeah, but that's a very specificcase, I think.
Yes, correct, correct. So ego syntonicity, you know, is
sort of a force within us that can lead to greatness, but if
it's not kept in check at some point it can lead to permanent
behaviors that are destructive or self-destructive.
(47:11):
Within narcissism there's an important distinction, which is
competent narcissism and incompetent narcissism, right?
And so somebody could be great as the CEO of a company because
they have that narcissistic Dr. I would say to change the world.
They have competency in there, but then they move their thirst
(47:32):
for power from, you know, their company to maybe wanting to lead
a whole country and something like that and may not
necessarily have the same competence.
I think it's important to recognize this idea of
egodistonicity. For a lot of people with mood
disorders, ego distonicity comesnaturally because they hit a low
(47:54):
point in their moods for so long, like several weeks that
they realize, OK, there is something about me that I need
to change. Challenge of many personality
disorders is that the lows are hit for short moments,
potentially few hours to a few days, and then the person comes
back up and they don't view necessarily the problem that was
(48:19):
created as something that needs to be changed, cared for.
I think you had a, a previous guest who had a, a podcast with
you in in June 2022 named DoctorVishwajit Ningarukar, correct?
And we talked about insights. Right.
(48:40):
Right. And so insights in in medicine,
in psychiatry in particular, is important for people to
recognize that they have a problem that needs to be
addressed. And sometimes people with
personality disorders don't havethat insight at the height of
their disorder, I would say. Wow, there's so much to talk
about. And I do want to ask one last
(49:01):
question. As you've been walking us
through the different types of personality disorders and I'm
listening to the names of different disorders and some of
the definitions or descriptions of certain certain disorders.
I felt like I was self diagnosing myself saying like,
oh, well then I must have this and this and this and this.
And I think it's kind of a common issue in our society that
(49:26):
we tend to self diagnose a lot. And I would say even self
misdiagnose a lot, as well as misdiagnosing others or
characterizing people in a certain way, sort of like
throwing out buzzwords without really understanding the full
terms of the disorders. As I mentioned in the beginning.
What is being done in terms of more awareness publicly about
(49:52):
diagnosis and to help us as a society not to just self
diagnose ourselves or others, particularly in a
mischaracterizing way? Well, so it's a good question.
It has multiple answers depending where we stand in
society, in which country we are.
You know, there's still vast difference, I would say from
(50:16):
developed countries or developing countries where
traumatic situations are more commonly found potentially than
in more developed countries. The words like borderline
narcissists are used by the psychiatric profession but also
have meanings on the street. Someone who is borderline on the
(50:37):
street is viewed as somewhat problematic, but it's a
different type of problems potentially than the borderline
personality. Same thing with narcissistic
people will throw that around for someone who is potentially
selfish. You know, there is a continuum,
you know, from being selfish to being narcissistic.
I would say it's important to view the world on series of
(51:01):
scales and dimensions. The model of personality
disorders that I've talked aboutin the DSM is being changed by
the ICD classification. That's used a lot in Europe in
particular and throughout the rest of the world.
It is not distinguishing 10 disorders, but only a few.
(51:24):
The the classification is changing.
There's also a problem with the fact that in countries like the
UK, with the National Health Service providing access to
personal data to predictioners who care for patients, receiving
a diagnosis of personality disorders can lead to being
(51:46):
treated differently by the medical profession.
Because people think that if youhave, you know, a personality
disorders, you will be potentially A problematic
patient and therefore they may not give you the same level of
care or even may refuse to take you on as a patient.
Which, of course, is absolutely unjust, unfair and stigmatizing
(52:10):
once again. It can be right now.
I will say that I've also met a very nice therapist who, you
know, we're on the edge of retirement and told me that in
the whole career, you know, the only two patients that had
issues with were people who had personality issues and who ended
(52:30):
up becoming threatening or, you know, to the point where they
were scared. I would say that it's difficult
to really understand what it feels like to be in close
relationship with someone with apersonality disorder and who can
have like a blowtorch in your face for something that you felt
(52:52):
was not deserving that reaction.All of this.
You say that the model is evolving.
In the US, there is a famous psychiatrist named John Oldham
who has proposed an alternative model of personality.
And it is in the third book of the DSM presented as something
(53:13):
that may be a better way to diagnose people than through the
traditional model, which I haven't talked much about.
But in the traditional model, they sort of throw at you 8 or 9
criteria. And then if you have five of
these criteria you considered ashaving the disorder, the
challenge of this traditional method is that you're sort of on
(53:37):
or off, OK, you have BPD or you don't have BPD.
Instead of having a much more gradual view where, you know,
maybe the, the gradient goes from zero to 36 and maybe I'm a
5 and the person over there is a13, right?
And then you can decide, OK, if you're over 9 or 10, then you,
(54:00):
you have a problem, right? Almost like with addiction,
right? At what point do you size that
you have certain addiction connected to personality as
eventually before is sexuality which is very important.
So the model of sexual addictionis an interesting one to
consider in comparison to personality disorders to see at
(54:21):
what point does it really becomea problem.
And so the personality types arestill evolving.
I want to also say that one question that has fascinated me
from the start, especially as a parent, was to understand the
potential transmission of personality disorder to other
people, including to our children.
(54:43):
There are studies that are made about mothers with borderline or
fathers with narcissism on the impact it has on their children.
And of course, you know, they can be narcissistic women.
It can be borderline men as well.
And unfortunately those sometimeare and not recognize as much or
as quickly. But understanding the
(55:05):
transmission of personality disorders is very interesting
topic and I've talked about it when I gave my first conference
in 2011 for an EABPD. So emotions tend to be
contagious, right? And you know this as an artist
Paravi, that you can create emotions in people through your
music, right? And music especially is a great
(55:27):
vehicle for, I would say, contaminating other people with
emotions. Then the question is, can
emotional dysregulation be contagious?
And so if I overreact due to my emotion, is that something that
might have become part of my personality due to my upbringing
or due to contacts I had as a child?
(55:47):
I hope eventually we will develop an epidemiology of
emotions and of emotional dysregulation, because I think
that a lot of the transmission of emotions happened through
tiny little communications between people that are like at
the level of viruses compared toour cells, which are even much
(56:11):
smaller than our bodies. Similarly, I think that they are
unspoken, maybe just a look or afeeling that can contaminate
people with a sense of emotions that can become extreme.
And I'm hoping that eventually we will realize that in the
(56:32):
world we live in, we do unfortunately sometimes send
toxic messages to others. We will learn to clean this up a
lot more. So in the same way as you know,
hygiene has changed the world right in the last 200 years.
Sometimes people wonder how did tuberculosis disappear?
The main reason tuberculosis is gone is because we take showers
(56:53):
every day, we wash our hands, weclean our food before we eat it,
the stores are clean and things like that.
And similarly, upbringing, parenting, dedication has
changed a lot, right? Most schools don't hit kids
anymore. Most parents don't hit kids.
In fact, by now the 63 countriesthat have made spanking children
(57:14):
illegal in some of these countries like Sweden have done
it now for I think 45 years, something like that.
And those the world hasn't gone to hell by making spanking
illegal. So people realize, oh, maybe
there's a way to raise children without putting fear in them.
By doing that, we raise better people, right?
(57:35):
And so my hope for 100 years from now is that the world of
mental health will evolve like the world of physical health has
evolved thanks to hygiene and better communication.
We have understood virology. We've lived through pandemics
that made us realize that, you know, sometimes just breathing
towards a person can actually bedangerous.
(57:56):
And similarly, in mental health,maybe there are ways we need to
discover certain ways of saying things to somebody.
There are better ways of saying it, more healthy ways to say it.
Absolutely. And sort of the bottom line I
take from everything we've talked about today is a reminder
that nothing in this world is black or white, good or bad,
(58:20):
right or wrong, one way or the other.
Everything is sort of a spectrumand they're different levels and
layers and grades of everything.We are complex, multi layered
human beings. And to allow both ourselves
compassion and empathy and others compassion and empathy, I
(58:40):
think hopefully will help to create a much healthier world
all around. Yes, yes, I think your podcast
is is wonderful, amazing and a welcoming place for people to
hear about these ideas. And so I really thank you for
not only being a great pianist. I had a chance to listen to and
(59:02):
fell in love your music but alsodevoting your time to raising
awareness for better mental health.
Thank you so much. I appreciate you saying that,
and it's something I'm very passionate about and something I
feel very strongly about becauseat the end of the day, if all of
us are able to be just a little bit better, it contributes
(59:23):
globally to a better society andbetter humanity.
But thank you so much for being here with us today.
This was an extremely enlightening conversation, very
educational, and I really hope that our listeners have learned
something. I'm going to add links to both
your foundation and other relevant websites and resources
(59:45):
in the podcast episode information so that our guests
can have a chance to see your work directly and reach out to
resources should they need. I would say also that, you know,
social media and in particular the Facebook page of Pedan have
been sort of perfect storm. That allowed us to to radiate
some of these ideas to to millions of people.
(01:00:07):
So if people want to join us through the Piden page in
Facebook, that would be a great place to start.
Absolutely. I will link everything in the
description. Thank you so much for joining us
today. Thank you Paradi.
Again, take care. Thank you all so much for
listening. I am truly grateful for the
(01:00:28):
support. Please share this episode in
this podcast because the more awareness we bring to mental
health, the sooner we can break the stigmas around these topics
and the faster we can help make our world a healthier place.
Don't forget to subscribe wherever you get your podcasts
and see you next week for another episode of The Conscious
Artist.
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