November 19, 2025 • 26 mins
What if that sudden emotional storm isn’t manipulation but a nervous system crying out for safety? We dive into borderline personality disorder with open eyes and open hands, mapping the path from trauma to dysregulation and from stigma to skills. Drawing on clinical experience and brain science, we explain why BPD often feels like living with emotional third-degree burns: an amygdala that fires at shadows, a prefrontal cortex that goes offline when stress peaks, and an insula that amplifies empathy and pain. It’s a tough mix—high emotion, high sensitivity, low regulation—but it’s not a life sentence.
We get practical about what actually helps. Hear how dialectical behavior therapy teaches distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness in a way that builds the “wise mind,” the space where logic meets compassion. We talk about EMDR for trauma memory processing, attachment-based therapy for early wounds, and where medication fits for co-occurring anxiety or depression. We also get real about the work: progress is possible and common with consistent treatment, yet it takes time, repetition, and support. Along the way, we highlight the overlooked strengths many with BPD carry—fierce loyalty, deep intuition, and profound empathy—and how those traits become assets when paired with regulation skills.
If you love someone with BPD, your role matters. Consistency counters abandonment fear, kind boundaries protect both sides, and small wins deserve big celebrations. We share clear, usable strategies so relationships feel less like a battlefield and more like a safe place to grow. For those living with BPD, you are more than a diagnosis, and your brain can learn new patterns. Hope isn’t abstract; it looks like sessions, skills, steady people, and a growing sense of self that isn’t defined by the past.
Press play, bring your questions, and stay for the tools. If the conversation helps, share it with a friend, subscribe for more trauma-informed episodes, and leave a review to help others find their way to hope.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
Maybe you're thinking she sounds like a mess.
But trust me when I say she'sdoing her best.
Doing her best.
SPEAKER_01 (00:13):
Hey everybody and welcome back to the Wednesdays
with Watson podcast.
If you have stumbled onto thispodcast for the first time,
allow me to introduce myselfofficially for the first time.
My name is Dr.
Amy Watson.
For those of you that have beenwith us on this journey for the
last almost six years, April ofnext year will be six years, you
(00:35):
already know that this has beena journey.
I finished my doctorate degreein traumacology, focusing on
community care at the end ofOctober.
All of my life he has beenfaithful, guys.
We will be coming back strong inthe new year with episodes more
frequently, back to the everytwo weeks, and we will continue
(00:59):
to focus on trauma and how wecan live with it and the things
that it may cause in our lives.
And today is an example of that.
I had been asked to do anepisode on borderline
personality disorder a couple oftimes, and as I was walking
through the end of my doctoraljourney, I did not have the
brain space for it.
(01:20):
So this is the promised episodeon borderline personality
disorder.
And so let's drop into thisepisode where we try to
understand the connection, ifthere is one, between trauma and
borderline personality disorder.
For those of you that don'tknow, borderline personality
disorder has an incrediblestigma.
(01:41):
Patients that are diagnosed withborderline personality disorder
are often considered difficultto deal with.
Often people who suffer withborderline personality disorder
also suffer with addictions.
All of them almost, and I have afriend that breaks this mold,
but all of them have issues inrelationships.
(02:01):
And so a lot of times borderlinepersonality disorder just kind
of gets put as somebody as beingdifficult.
And so today, I hope that thisepisode demystifies that in a
sense.
Let's talk about what borderlinepersonality actually is.
(02:26):
All right, guys, as I mentioned,welcome back to the Wednesdays
with Watson podcast where wewill continue to explore the
intersection of trauma, mentalhealth, faith, and also, guys,
the incredible resilience of thehuman spirit.
As I mentioned, my name is Dr.
Amy Watson, and I am your host.
And today, as I mentioned, we'regoing to walk into a topic that
(02:49):
is often misunderstood,misrepresented, or even avoided
altogether.
I work with these patients,these borderline personality
patients at work, and everytime, I'll be honest with you,
I've been part of the crew thatjust kind of takes a deep breath
when we are going to be workingwith a borderline personality
patient, because oftentimesthese are some of the most
(03:12):
difficult cases totherapeutically interact with
patients with borderlinepersonality disorder.
Before you skip ahead on thispodcast episode, and before you
think, I don't have borderlinepersonality disorder, and
neither does anybody that Ilove.
I'd like to invite you to stayaround because borderline
personality disorder is one ofthe most trauma-rooted severe
(03:37):
mental illnesses.
It is relationship-shaped,meaning borderline personality
disorder at its foundation, whenyou rip it down to the studs,
affect relationships and isaffected by relationships.
But as severe mental illnessesgo, borderline personality
disorder is hope-filled becausethere is healing, there is
(04:02):
support when it's found in theright places.
So today my goal is simple is tobring clarity about borderline
personality disorder where therehas been confusion.
I'd like us to attempt to enterin some compassion where there
has been judgment, and moreimportantly, hope where there
(04:23):
has been stigma.
Borderline personality affectsabout one to two percent of the
population, though, like otherthings that are only effective
of one to two percent of thepopulation, most experts believe
that it's underdiagnosed or evenmisdiagnosed.
At its core, here's the thing weneed to understand and how it's
(04:44):
connected to trauma.
Because trauma, remember,dysregulates the brain and the
nervous system.
And so at its core, borderlinepersonality disorder is a
regulation disorder, meaningthat the brain struggles to
regulate emotions,relationships, identity,
(05:08):
impulses.
So we see patients withborderline personality disorder,
their emotions are all over theplace, their relationships can
be, it doesn't have to be.
I have a friend who defieseverything I'm gonna talk about
today, but relationships who uhare affected by borderline
personality, certainly thepatient when they don't know who
(05:32):
they are, their identity isaffected, that their quality of
life and and and then alsoimpulses, lots of times
addictions with patients withborderline personality disorder,
and I mean addictions toeverything from food to drugs to
alcohol to relationships tosuccess to performance to all of
those things, whatever it is,borderline personality patients
(05:53):
have a hard time controlling, ifyou will, for lack of a better
word, impulses.
So here's what that might looklike in real life.
A borderline patient may say, Myemotions feel like a roller
coaster.
I didn't buy a ticket for this.
(06:13):
A borderline patient in thismight sync with some of you.
A borderline patient may say,Oh, I love you, please don't
leave me.
Oh, I hate you.
Please come back.
That's why borderline patientsget this stigma because their
emotions are all over the place.
That's a perfect example.
I love you, please don't leaveme.
(06:34):
I hate you.
Please come back.
They may say, I don't know who Iam unless somebody tells me.
Their fear of abandonment, theymay say that my fear of
abandonment controls my wholebody.
But here is what borderlinepersonality disorder is not.
It is not them manipulating you.
(06:56):
It is not attention seeking, itis not a character flaw.
And hopefully, we know this, itis not a life sentence.
Borderline personality disordercan be deeply tied to early
trauma to include attachmentwounds, emotional neglect,
(07:19):
trauma in general, and rememberour definition of trauma is
anything that compromised yoursafety and took your choice.
And so borderline personalitydisorder is deeply rooted in an
event that compromised safetyand removed your choice.
People living with borderlinepersonality disorder often
(07:40):
developed survival strategies inchildhood that once kept them
safe, but they appearmanipulative in adulthood.
That's not someone being crazy,as oftentimes people like to say
about borderline patients.
That is purely somebodysurviving.
(08:02):
So let's talk about because youguys already know, I'm a little
bit of a neuroscience uh geek.
I am a doctor now, by the way.
I'm not gonna lose opportunitiesto it to say that to you guys,
especially those of you who'vebeen with me since 2020.
But let's look at what the brainof a borderline patient may look
like.
And so you've got the amygdala,which we've talked about often,
(08:25):
your fear center, the emotionalfire alarm, and so your amygdala
is constantly scanning theenvironment for threat, and when
it sees anything that is athreat or even sort of a threat,
it's going to give you anemotional fire alarm.
Well, in borderline patients,that amygdala, that that threat
sensor that's always scanning,is super sensitive.
(08:47):
So, for example, it may scanyour environment and just the
shadow of a threat, your theamygdala of a borderline patient
is going to go haywire.
And so their amygdala is oftenover-reactive and hyper
sensitive.
The prefrontal cortex, which isjust the front of your brain
where we uh stay say logical,where we're able to regulate our
(09:10):
behaviors and our words and ouractions.
When trauma, and again, thatworking definition of trauma is
anything that compromised yoursafety and took your choice.
When we experience trauma, theprefrontal cortex goes offline.
We call it flipping your lid.
And so the the borderlinepatients don't have access to
(09:32):
logical thinking or a regulatedbrain, and so they may uh make
quick, impulsive decisions andbe difficult to help them
regulate things, and oftentimesthis comes across as issues in
relationships.
The the insula part of thebrain, too, interestingly, and
borderline patients, this is thearea that is connected to
(09:54):
empathy, self-awareness, andemotional pain.
With in patients with uhborderline personality disorder,
this is also hypersensitive.
And so these patients are oftenmore empathetic, absorbing the
pain of their environment, whichjust adds to the dysregulation
of the nervous system.
So put all that together withthe amygdala, the prefrontal
(10:17):
cortex, and the insula beingaffected, put it all together
and imagine this.
Having your emotional painturned up to a volume of ten,
your empathy is also turned upto a volume of ten, but your
ability to regulate all of that,your emotional regulation, is
turned down to a two.
(10:38):
That's the brain of a borderlinepersonality disorder patient.
So no wonder relationships feellike life or death to them.
They don't have an ability tokeep it in between the
navigational beacons and putrelationships in context of
where they belong.
(10:59):
Everything is high pain andeverything is high empathy, and
these patients don't have anyability unless they learn to do
it in treatment to turn down allof that.
Their emotional regulation ortheir nervous system regulation
is pretty much non existent.
And so, like I said, no wonderrelationships feel like life or
(11:20):
death.
When we understand the brain ofthese patients, compassion
grows.
And when compassion grows as weknow, healing becomes possible.
So, what is it like on theinside of a borderline patient?
Let me share what so manyborderline patients have told
(11:41):
clinicians, friends, andtherapists.
And some of these are first handaccounts as I work with the
patients in the hospital withborderline personality disorder.
They will say things like, Ifeel emotions more deeply than
anybody I know.
Or I can go from zero to onehundred in seconds.
I don't want to do that.
They'll say I'm terrified thatthe people I love will leave.
(12:06):
That is likely obviouslyconnected to early attachment
trauma and uh abandonmentissues.
Uh they may also say, I work sohard not to ruin relationships
that mean the most to me.
Or they might say somethinglike, I'm exhausted from
battling my own mind.
Borderline personality disorderis often described as emotional
(12:31):
third degree burns.
Let's put that into perspective.
When you have a third degreeburn, it's burned down to the
studs, basically, to the lowerlevels of your skin, and then
you can imagine how painful thatis.
So when you think of that froman emotional standpoint, a
borderline personality disorderpatient often described as
(12:52):
walking around with emotionalthird-degree burns.
Everything hurts, everythingfeels intense, everything feels
personal.
But here is the cool part.
That very same sensitivity thatbrings pain also makes people
with borderline personalitydisorder deeply intuitive,
(13:15):
deeply empathetic, they arecreative, they are loyal, and
they are capable of fierce love.
Because there is a beauty in thesensitivity.
We just have to help the brainregulate it.
And so, how do we do that?
There are treatments that work,there is real hope.
(13:38):
If you've listened to thispodcast for any amount of time,
you've heard me say this yourtrauma is not your fault, but
healing is your responsibility.
But the hard thing withborderline personality disorder
is that it's not easily fixed byjust taking medication.
Healing requires therapy andintense therapy at that.
(14:03):
The best therapy that we knowout there is dialectical
behavior therapy or DBT.
And DBT teaches patients withborderline personality disorder
how to practice distresstolerance, how they can
emotionally regulate, how to howto have interpersonal
effectiveness in theirrelationships, how they can be
(14:26):
mindful.
DBT, I love this modalitybecause it allows us to live in
that tension of what we are whatwe call the wise mind in DBT,
meaning if you look, if youconsider a Venn diagram from the
emotional brain, which onlyfeels emotions and wants us to
drive our decisions by emotion,or the logical brain, which is
(14:49):
the left linear fact side of ourbrain, when we merge those two
together, that middle ground,what we call as the wise mind
and dialectical behaviortherapy.
And it takes it takes time, ittakes intentionality to bring
some in from the emotional mindand some in from the logical
(15:10):
mind and share a little bit ofthat in that middle ground that
we call the wise mind.
That takes work, it may eventake trauma therapy where you
visit the traumatic event and sothat it stops dysregulating your
nervous system.
Of course, you would do thatunder the care of a counselor.
(15:30):
These are skills that can calmdown that amygdala or that
emotional fire alarm andstrengthen that prefrontal
cortex so it doesn't go offlineas easily.
Other helpful treatments mightinclude trauma uh focused
therapy like EMDR.
I've talked about that on thispodcast, attachment-based
therapy, medication forco-occurring uh anxiety or
(15:53):
depression, though medication isonly part of the treatment here.
Group therapy also can help, aswell as skill skills coaching.
So here's the hope for this.
Over 80% of the people with abipolar or excuse me, a
borderline personalityexperience, significant
improvement with treatment, andthey may no longer meet the
(16:17):
diagnostic criteria afterconsistent therapy.
Let me say that again for thepeople in the cheap the cheap
seats.
Borderline personality disorderis treatable, and when you add
Jesus to the mix, there is suchvictory.
There is the opportunity for youto walk around on this planet
(16:40):
whole and your relationships arewhole.
You're walking around with aregulated nervous system, and
you are just moving forward withyour life and saying, I'm not
going to be defined byborderline personality disorder.
I'm going to be defined by thehope that I have in the
completed work of Jesus on thecross that will help me gain
(17:03):
victory of borderlinepersonality disorder.
Because here's the thing (17:07):
if you know somebody with borderline
personality disorder, you toomay live in a period of ground
that needs to be healed.
Because again, oftentimesrelationships are affected by
patients with borderlinepersonality disorder.
So if you love someone withborderline personality disorder,
(17:27):
you play an important role.
Here are a few things that youcan uh do that would help both
you and the situation.
Stay consistent in yourinteractions with them because
people with borderlinepersonality disorder often fear
abandonment.
And so your reliability is agift to them.
(17:47):
Set boundaries, but do it withkindness.
Boundaries say, I care enoughabout our relationship to
protect it.
So set those boundaries and movethem if you need to, but they
should be relatively concrete.
Don't take the emotional stormsof a borderline personality
patient personally.
Their intensity is not aboutyour worth, it's about their
(18:11):
wiring.
I'm gonna say that again.
Their intensity is not aboutyour worth, but it's about their
wiring back to that brainchemistry.
Celebrate progress with them.
Even small wins are big wins fora dysregulated brain.
And I just want to make surewe've hammered home that is that
patients walking around withborderline personality disorder
(18:32):
have a dysregulated brain.
That is likely connected toearly childhood trauma.
Not always.
I am sure there's somebody inthe sound of my voice who has
borderline personality disorderand who did not experience
trauma.
But mostly trauma is what causedthe dysregulated brain.
Hear this loving someone withborderline personality disorder
(18:53):
does not require that you loseyourself because your well-being
matters too.
On this podcast, we always comeback to identity, and you
noticed that one of the thingsthat borderline patients
struggle with is identity.
Because trauma tries to rewriteidentity, but Jesus restored it.
(19:15):
And you know, I love that versein Joel 225, I will restore all
that the locusts have stolen.
If you are the person listeningto this episode and you have
borderline personality disorder,let me speak directly to you.
You are not your diagnosis, youare the precious child of the
(19:36):
Most High God.
You are not your emotionalstorms, you are not your fears,
you are not too much, you arenot broken beyond repair, you
are loved by a God who does notabandon.
(19:56):
You are worth steadyrelationships, and you deserve
compassion, including compassionfrom yourself.
This is a difficult diagnosis tobe sure, but it is hope-filled
because there are treatmentsthat help it.
(20:17):
And the hard part aboutborderline personality disorder
is I mentioned earlier when Ireminded you that your trauma is
not your fault, but your healingis your responsibility.
This is difficult, a difficultdiagnosis because it's not
easily fixed with a pill.
And so if you are under thesound of my voice and you have
borderline personality disorder,I hope that you would know that
(20:42):
you are not that diagnosis, thatyou, as I mentioned, are the
precious child of the most highGod.
I pray for healing for you, andI pray that as you consider what
might be next for you, that youwould reach out to those people
who love you and sit in theirsupport.
(21:02):
And for those of us who are thesupport of people with
borderline personality disorder,we have a job to remind our
friends, our family, that theyare not their diagnosis, that we
love them unconditionally, andthat we're here to walk this
journey with them.
Thank you guys so much forspending part of your day with
(21:23):
me.
I am recording this on aWednesday and this is Wednesdays
with Watson.
Borderline personality iscomplex for sure, but it is also
full of potential.
Healing is possible and hope isreal.
If this episode helped you orsomeone you know who needs to
hear it, please share it.
And as always, if you're in amental health crisis, please
(21:45):
reach out to a professional orcall your local hotline,
including 988.
We've got exciting things goingon here at the Wednesdays with
Watson podcast.
We will uh walk into the yearwith brand new episodes and
during the month of uh the restof November and December, we'll
be dropping episodes uh likethis, which are topical in
nature.
(22:05):
We will get back to themedseasons in January of 2026.
Until next time, this is Dr.
Amy Watson, and these are yourWednesdays with Watson.
You are seen, you are known, youare heard, you are loved, and
you are so so valued.
(22:26):
See you guys in two weeks.
SPEAKER_00 (22:28):
What do you do when every morning the first thing
you think is you just wanna stayin bed?
I'm just asking for a friend.
(22:51):
What do you say when all of yourfeelings are so overwhelming
that you're too tired topretend?
I'm just asking for a friend.
(23:14):
Maybe you're thinking she soundslike a mess.
But trust me when I say she'sdoing her best, doing her best.
We all need, we all need a safething.
Someone told us in we all need,we all need a safe place.
(23:41):
We don't have to defend I'm notasking for all the pain in all
the end.
I'm just asking for a friend.
(24:03):
How do you come?
Losing all you have.
You are so afraid.
You'll just lose it all again.
(24:35):
Someone's got to be able to doit.
Maybe you're thinking she sounds like a mess.
But trust me when I say she'sdoing her best.
Doing her best.
SPEAKER_01 (00:13):
Hey everybody and welcome back to the Wednesdays
with Watson podcast.
If you have stumbled onto thispodcast for the first time,
allow me to introduce myselfofficially for the first time.
My name is Dr.
Amy Watson.
For those of you that have beenwith us on this journey for the
last almost six years, April ofnext year will be six years, you
(00:35):
already know that this has beena journey.
I finished my doctorate degreein traumacology, focusing on
community care at the end ofOctober.
All of my life he has beenfaithful, guys.
We will be coming back strong inthe new year with episodes more
frequently, back to the everytwo weeks, and we will continue
(00:59):
to focus on trauma and how wecan live with it and the things
that it may cause in our lives.
And today is an example of that.
I had been asked to do anepisode on borderline
personality disorder a couple oftimes, and as I was walking
through the end of my doctoraljourney, I did not have the
brain space for it.
(01:20):
So this is the promised episodeon borderline personality
disorder.
And so let's drop into thisepisode where we try to
understand the connection, ifthere is one, between trauma and
borderline personality disorder.
For those of you that don'tknow, borderline personality
disorder has an incrediblestigma.
(01:41):
Patients that are diagnosed withborderline personality disorder
are often considered difficultto deal with.
Often people who suffer withborderline personality disorder
also suffer with addictions.
All of them almost, and I have afriend that breaks this mold,
but all of them have issues inrelationships.
(02:01):
And so a lot of times borderlinepersonality disorder just kind
of gets put as somebody as beingdifficult.
And so today, I hope that thisepisode demystifies that in a
sense.
Let's talk about what borderlinepersonality actually is.
(02:26):
All right, guys, as I mentioned,welcome back to the Wednesdays
with Watson podcast where wewill continue to explore the
intersection of trauma, mentalhealth, faith, and also, guys,
the incredible resilience of thehuman spirit.
As I mentioned, my name is Dr.
Amy Watson, and I am your host.
And today, as I mentioned, we'regoing to walk into a topic that
(02:49):
is often misunderstood,misrepresented, or even avoided
altogether.
I work with these patients,these borderline personality
patients at work, and everytime, I'll be honest with you,
I've been part of the crew thatjust kind of takes a deep breath
when we are going to be workingwith a borderline personality
patient, because oftentimesthese are some of the most
(03:12):
difficult cases totherapeutically interact with
patients with borderlinepersonality disorder.
Before you skip ahead on thispodcast episode, and before you
think, I don't have borderlinepersonality disorder, and
neither does anybody that Ilove.
I'd like to invite you to stayaround because borderline
personality disorder is one ofthe most trauma-rooted severe
(03:37):
mental illnesses.
It is relationship-shaped,meaning borderline personality
disorder at its foundation, whenyou rip it down to the studs,
affect relationships and isaffected by relationships.
But as severe mental illnessesgo, borderline personality
disorder is hope-filled becausethere is healing, there is
(04:02):
support when it's found in theright places.
So today my goal is simple is tobring clarity about borderline
personality disorder where therehas been confusion.
I'd like us to attempt to enterin some compassion where there
has been judgment, and moreimportantly, hope where there
(04:23):
has been stigma.
Borderline personality affectsabout one to two percent of the
population, though, like otherthings that are only effective
of one to two percent of thepopulation, most experts believe
that it's underdiagnosed or evenmisdiagnosed.
At its core, here's the thing weneed to understand and how it's
(04:44):
connected to trauma.
Because trauma, remember,dysregulates the brain and the
nervous system.
And so at its core, borderlinepersonality disorder is a
regulation disorder, meaningthat the brain struggles to
regulate emotions,relationships, identity,
(05:08):
impulses.
So we see patients withborderline personality disorder,
their emotions are all over theplace, their relationships can
be, it doesn't have to be.
I have a friend who defieseverything I'm gonna talk about
today, but relationships who uhare affected by borderline
personality, certainly thepatient when they don't know who
(05:32):
they are, their identity isaffected, that their quality of
life and and and then alsoimpulses, lots of times
addictions with patients withborderline personality disorder,
and I mean addictions toeverything from food to drugs to
alcohol to relationships tosuccess to performance to all of
those things, whatever it is,borderline personality patients
(05:53):
have a hard time controlling, ifyou will, for lack of a better
word, impulses.
So here's what that might looklike in real life.
A borderline patient may say, Myemotions feel like a roller
coaster.
I didn't buy a ticket for this.
(06:13):
A borderline patient in thismight sync with some of you.
A borderline patient may say,Oh, I love you, please don't
leave me.
Oh, I hate you.
Please come back.
That's why borderline patientsget this stigma because their
emotions are all over the place.
That's a perfect example.
I love you, please don't leaveme.
(06:34):
I hate you.
Please come back.
They may say, I don't know who Iam unless somebody tells me.
Their fear of abandonment, theymay say that my fear of
abandonment controls my wholebody.
But here is what borderlinepersonality disorder is not.
It is not them manipulating you.
(06:56):
It is not attention seeking, itis not a character flaw.
And hopefully, we know this, itis not a life sentence.
Borderline personality disordercan be deeply tied to early
trauma to include attachmentwounds, emotional neglect,
(07:19):
trauma in general, and rememberour definition of trauma is
anything that compromised yoursafety and took your choice.
And so borderline personalitydisorder is deeply rooted in an
event that compromised safetyand removed your choice.
People living with borderlinepersonality disorder often
(07:40):
developed survival strategies inchildhood that once kept them
safe, but they appearmanipulative in adulthood.
That's not someone being crazy,as oftentimes people like to say
about borderline patients.
That is purely somebodysurviving.
(08:02):
So let's talk about because youguys already know, I'm a little
bit of a neuroscience uh geek.
I am a doctor now, by the way.
I'm not gonna lose opportunitiesto it to say that to you guys,
especially those of you who'vebeen with me since 2020.
But let's look at what the brainof a borderline patient may look
like.
And so you've got the amygdala,which we've talked about often,
(08:25):
your fear center, the emotionalfire alarm, and so your amygdala
is constantly scanning theenvironment for threat, and when
it sees anything that is athreat or even sort of a threat,
it's going to give you anemotional fire alarm.
Well, in borderline patients,that amygdala, that that threat
sensor that's always scanning,is super sensitive.
(08:47):
So, for example, it may scanyour environment and just the
shadow of a threat, your theamygdala of a borderline patient
is going to go haywire.
And so their amygdala is oftenover-reactive and hyper
sensitive.
The prefrontal cortex, which isjust the front of your brain
where we uh stay say logical,where we're able to regulate our
(09:10):
behaviors and our words and ouractions.
When trauma, and again, thatworking definition of trauma is
anything that compromised yoursafety and took your choice.
When we experience trauma, theprefrontal cortex goes offline.
We call it flipping your lid.
And so the the borderlinepatients don't have access to
(09:32):
logical thinking or a regulatedbrain, and so they may uh make
quick, impulsive decisions andbe difficult to help them
regulate things, and oftentimesthis comes across as issues in
relationships.
The the insula part of thebrain, too, interestingly, and
borderline patients, this is thearea that is connected to
(09:54):
empathy, self-awareness, andemotional pain.
With in patients with uhborderline personality disorder,
this is also hypersensitive.
And so these patients are oftenmore empathetic, absorbing the
pain of their environment, whichjust adds to the dysregulation
of the nervous system.
So put all that together withthe amygdala, the prefrontal
(10:17):
cortex, and the insula beingaffected, put it all together
and imagine this.
Having your emotional painturned up to a volume of ten,
your empathy is also turned upto a volume of ten, but your
ability to regulate all of that,your emotional regulation, is
turned down to a two.
(10:38):
That's the brain of a borderlinepersonality disorder patient.
So no wonder relationships feellike life or death to them.
They don't have an ability tokeep it in between the
navigational beacons and putrelationships in context of
where they belong.
(10:59):
Everything is high pain andeverything is high empathy, and
these patients don't have anyability unless they learn to do
it in treatment to turn down allof that.
Their emotional regulation ortheir nervous system regulation
is pretty much non existent.
And so, like I said, no wonderrelationships feel like life or
(11:20):
death.
When we understand the brain ofthese patients, compassion
grows.
And when compassion grows as weknow, healing becomes possible.
So, what is it like on theinside of a borderline patient?
Let me share what so manyborderline patients have told
(11:41):
clinicians, friends, andtherapists.
And some of these are first handaccounts as I work with the
patients in the hospital withborderline personality disorder.
They will say things like, Ifeel emotions more deeply than
anybody I know.
Or I can go from zero to onehundred in seconds.
I don't want to do that.
They'll say I'm terrified thatthe people I love will leave.
(12:06):
That is likely obviouslyconnected to early attachment
trauma and uh abandonmentissues.
Uh they may also say, I work sohard not to ruin relationships
that mean the most to me.
Or they might say somethinglike, I'm exhausted from
battling my own mind.
Borderline personality disorderis often described as emotional
(12:31):
third degree burns.
Let's put that into perspective.
When you have a third degreeburn, it's burned down to the
studs, basically, to the lowerlevels of your skin, and then
you can imagine how painful thatis.
So when you think of that froman emotional standpoint, a
borderline personality disorderpatient often described as
(12:52):
walking around with emotionalthird-degree burns.
Everything hurts, everythingfeels intense, everything feels
personal.
But here is the cool part.
That very same sensitivity thatbrings pain also makes people
with borderline personalitydisorder deeply intuitive,
(13:15):
deeply empathetic, they arecreative, they are loyal, and
they are capable of fierce love.
Because there is a beauty in thesensitivity.
We just have to help the brainregulate it.
And so, how do we do that?
There are treatments that work,there is real hope.
(13:38):
If you've listened to thispodcast for any amount of time,
you've heard me say this yourtrauma is not your fault, but
healing is your responsibility.
But the hard thing withborderline personality disorder
is that it's not easily fixed byjust taking medication.
Healing requires therapy andintense therapy at that.
(14:03):
The best therapy that we knowout there is dialectical
behavior therapy or DBT.
And DBT teaches patients withborderline personality disorder
how to practice distresstolerance, how they can
emotionally regulate, how to howto have interpersonal
effectiveness in theirrelationships, how they can be
(14:26):
mindful.
DBT, I love this modalitybecause it allows us to live in
that tension of what we are whatwe call the wise mind in DBT,
meaning if you look, if youconsider a Venn diagram from the
emotional brain, which onlyfeels emotions and wants us to
drive our decisions by emotion,or the logical brain, which is
(14:49):
the left linear fact side of ourbrain, when we merge those two
together, that middle ground,what we call as the wise mind
and dialectical behaviortherapy.
And it takes it takes time, ittakes intentionality to bring
some in from the emotional mindand some in from the logical
(15:10):
mind and share a little bit ofthat in that middle ground that
we call the wise mind.
That takes work, it may eventake trauma therapy where you
visit the traumatic event and sothat it stops dysregulating your
nervous system.
Of course, you would do thatunder the care of a counselor.
(15:30):
These are skills that can calmdown that amygdala or that
emotional fire alarm andstrengthen that prefrontal
cortex so it doesn't go offlineas easily.
Other helpful treatments mightinclude trauma uh focused
therapy like EMDR.
I've talked about that on thispodcast, attachment-based
therapy, medication forco-occurring uh anxiety or
(15:53):
depression, though medication isonly part of the treatment here.
Group therapy also can help, aswell as skill skills coaching.
So here's the hope for this.
Over 80% of the people with abipolar or excuse me, a
borderline personalityexperience, significant
improvement with treatment, andthey may no longer meet the
(16:17):
diagnostic criteria afterconsistent therapy.
Let me say that again for thepeople in the cheap the cheap
seats.
Borderline personality disorderis treatable, and when you add
Jesus to the mix, there is suchvictory.
There is the opportunity for youto walk around on this planet
(16:40):
whole and your relationships arewhole.
You're walking around with aregulated nervous system, and
you are just moving forward withyour life and saying, I'm not
going to be defined byborderline personality disorder.
I'm going to be defined by thehope that I have in the
completed work of Jesus on thecross that will help me gain
(17:03):
victory of borderlinepersonality disorder.
Because here's the thing (17:07):
if you know somebody with borderline
personality disorder, you toomay live in a period of ground
that needs to be healed.
Because again, oftentimesrelationships are affected by
patients with borderlinepersonality disorder.
So if you love someone withborderline personality disorder,
(17:27):
you play an important role.
Here are a few things that youcan uh do that would help both
you and the situation.
Stay consistent in yourinteractions with them because
people with borderlinepersonality disorder often fear
abandonment.
And so your reliability is agift to them.
(17:47):
Set boundaries, but do it withkindness.
Boundaries say, I care enoughabout our relationship to
protect it.
So set those boundaries and movethem if you need to, but they
should be relatively concrete.
Don't take the emotional stormsof a borderline personality
patient personally.
Their intensity is not aboutyour worth, it's about their
(18:11):
wiring.
I'm gonna say that again.
Their intensity is not aboutyour worth, but it's about their
wiring back to that brainchemistry.
Celebrate progress with them.
Even small wins are big wins fora dysregulated brain.
And I just want to make surewe've hammered home that is that
patients walking around withborderline personality disorder
(18:32):
have a dysregulated brain.
That is likely connected toearly childhood trauma.
Not always.
I am sure there's somebody inthe sound of my voice who has
borderline personality disorderand who did not experience
trauma.
But mostly trauma is what causedthe dysregulated brain.
Hear this loving someone withborderline personality disorder
(18:53):
does not require that you loseyourself because your well-being
matters too.
On this podcast, we always comeback to identity, and you
noticed that one of the thingsthat borderline patients
struggle with is identity.
Because trauma tries to rewriteidentity, but Jesus restored it.
(19:15):
And you know, I love that versein Joel 225, I will restore all
that the locusts have stolen.
If you are the person listeningto this episode and you have
borderline personality disorder,let me speak directly to you.
You are not your diagnosis, youare the precious child of the
(19:36):
Most High God.
You are not your emotionalstorms, you are not your fears,
you are not too much, you arenot broken beyond repair, you
are loved by a God who does notabandon.
(19:56):
You are worth steadyrelationships, and you deserve
compassion, including compassionfrom yourself.
This is a difficult diagnosis tobe sure, but it is hope-filled
because there are treatmentsthat help it.
(20:17):
And the hard part aboutborderline personality disorder
is I mentioned earlier when Ireminded you that your trauma is
not your fault, but your healingis your responsibility.
This is difficult, a difficultdiagnosis because it's not
easily fixed with a pill.
And so if you are under thesound of my voice and you have
borderline personality disorder,I hope that you would know that
(20:42):
you are not that diagnosis, thatyou, as I mentioned, are the
precious child of the most highGod.
I pray for healing for you, andI pray that as you consider what
might be next for you, that youwould reach out to those people
who love you and sit in theirsupport.
(21:02):
And for those of us who are thesupport of people with
borderline personality disorder,we have a job to remind our
friends, our family, that theyare not their diagnosis, that we
love them unconditionally, andthat we're here to walk this
journey with them.
Thank you guys so much forspending part of your day with
(21:23):
me.
I am recording this on aWednesday and this is Wednesdays
with Watson.
Borderline personality iscomplex for sure, but it is also
full of potential.
Healing is possible and hope isreal.
If this episode helped you orsomeone you know who needs to
hear it, please share it.
And as always, if you're in amental health crisis, please
(21:45):
reach out to a professional orcall your local hotline,
including 988.
We've got exciting things goingon here at the Wednesdays with
Watson podcast.
We will uh walk into the yearwith brand new episodes and
during the month of uh the restof November and December, we'll
be dropping episodes uh likethis, which are topical in
nature.
(22:05):
We will get back to themedseasons in January of 2026.
Until next time, this is Dr.
Amy Watson, and these are yourWednesdays with Watson.
You are seen, you are known, youare heard, you are loved, and
you are so so valued.
(22:26):
See you guys in two weeks.
SPEAKER_00 (22:28):
What do you do when every morning the first thing
you think is you just wanna stayin bed?
I'm just asking for a friend.
(22:51):
What do you say when all of yourfeelings are so overwhelming
that you're too tired topretend?
I'm just asking for a friend.
(23:14):
Maybe you're thinking she soundslike a mess.
But trust me when I say she'sdoing her best, doing her best.
We all need, we all need a safething.
Someone told us in we all need,we all need a safe place.
(23:41):
We don't have to defend I'm notasking for all the pain in all
the end.
I'm just asking for a friend.
(24:03):
How do you come?
Losing all you have.
You are so afraid.
You'll just lose it all again.
(24:35):
Someone's got to be able to doit.
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