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BPD: The Worst Disorder or Not a Disorder at All? · Stuff You Should Know

• 0:00
  Speaker 1: Hey, everyone, Josh and Chuck here to remind you that
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• 0:33
  Speaker 2: Hey, and welcome to the podcast. I'm Josh and Chuck's
• 0:36
  Speaker 2: here too. It's just the two of us, and that's
• 0:38
  Speaker 2: cool because this is the stuff you should Know.
• 0:43
  Speaker 1: Yeah, Jerry's got the week off and she said press on, dudes. Yeah,
• 0:48
  Speaker 1: party party on Wayne.
• 0:52
  Speaker 2: That was also from Bill and Ted's excellent Adventure. Wasn't
• 0:55
  Speaker 2: it Party On?
• 0:56
  Speaker 3: No? Was it? I think?
• 0:58
  Speaker 2: So I can see George Carlin say it.
• 1:01
  Speaker 4: Yeah, I'm probably wrong.
• 1:02
  Speaker 2: I'm probably wrong. So, Chuck, we're talking today about something
• 1:06
  Speaker 2: we've kind of touched on before. But when we touched
• 1:09
  Speaker 2: on it, we're like, this is something that deserves its
• 1:12
  Speaker 2: own episode for sure.
• 1:15
  Speaker 1: Yeah, we're talking. This is another in our suite on
• 1:20
  Speaker 1: mental health. Conditions, and boy, we've got a lot of them,
• 1:24
  Speaker 1: but we still got more to go. Yeah, we do,
• 1:27
  Speaker 1: you know, and I think these are important shows, and
• 1:29
  Speaker 1: every time we do these, I feel like we get
• 1:31
  Speaker 1: good feedback on people who suffer from these conditions and
• 1:36
  Speaker 1: say thanks for either educating me and or getting the
• 1:40
  Speaker 1: word out to people who may be a little, uh,
• 1:43
  Speaker 1: what's the word ignorant about some of the stuff.
• 1:46
  Speaker 2: As Michael Jackson would have said, you're ignorant about this?
• 1:50
  Speaker 4: What's that from?
• 1:51
  Speaker 2: He just used that word a lot.
• 1:53
  Speaker 4: Oh really, yeah, But.
• 1:55
  Speaker 2: Regardless, that has nothing to do with anything. When you
• 1:58
  Speaker 2: mentioned just now that people like kind of wrote in
• 2:02
  Speaker 2: or write in when we do episodes like this, Well,
• 2:04
  Speaker 2: we did our emotional pain episode and we mentioned a
• 2:08
  Speaker 2: borderline personality disorder. A lot of people wrote in. Well,
• 2:12
  Speaker 2: I don't want to say a lot, but some people
• 2:13
  Speaker 2: wrote in and they said, you know, thank you for
• 2:15
  Speaker 2: treating it compassionately, because when most people talk about it,
• 2:18
  Speaker 2: they talk about it like they despise it, or they
• 2:21
  Speaker 2: despise people with BPD. And the more you look into
• 2:24
  Speaker 2: the more you realize, like, wow, this is maybe one
• 2:27
  Speaker 2: of the hardest mental illnesses that you can possibly have,
• 2:32
  Speaker 2: and I think we kind of said that in the
• 2:34
  Speaker 2: Emotional Pain episode, but if I didn't know it before,
• 2:37
  Speaker 2: I definitely do now after doing this research.
• 2:40
  Speaker 1: Yeah, and it's also clear that it's one that somehow
• 2:44
  Speaker 1: seems to garner the least amount of empathy, right, not
• 2:48
  Speaker 1: only among just people who you know, may or may
• 2:51
  Speaker 1: not know much about it, but even clinicians and therapists
• 2:55
  Speaker 1: as that stuff you sent me like a lot of
• 2:57
  Speaker 1: times try to avoid or severely limit the number of
• 3:01
  Speaker 1: patients that they have that they treat with BPD, which
• 3:04
  Speaker 1: makes it even more sad because it is a really
• 3:08
  Speaker 1: tough one. I guess we'll just define it kind of
• 3:11
  Speaker 1: off the bat, and you know, a lot of this
• 3:13
  Speaker 1: episode will kind of be defining it in different ways
• 3:17
  Speaker 1: because it's fairly complex. But it is a what's known
• 3:20
  Speaker 1: as a cluster B personality disorder, which is in the
• 3:25
  Speaker 1: anti social personality disorder category along with historyonic personality disorder
• 3:30
  Speaker 1: and narcissistic personality.
• 3:33
  Speaker 4: I'm just gonna start saying PD.
• 3:35
  Speaker 2: Yeah, PDS. It will make it sound like, you know,
• 3:37
  Speaker 2: you're talking about.
• 3:38
  Speaker 1: Yet more narcissistic PD, but it seems like a lot
• 3:43
  Speaker 1: of what it can be is sometimes a disorder of perception.
• 3:48
  Speaker 1: And while there are very real things that do that
• 3:52
  Speaker 1: can trigger people with BPD, a lot of times the
• 3:56
  Speaker 1: way things are perceived incorrectly, either about themselves or about
• 3:59
  Speaker 1: other or others actions.
• 4:01
  Speaker 2: Yeah, and I saw a lot of people confuse borderline
• 4:06
  Speaker 2: personality disorder with bipolar, or at least think they're similar.
• 4:10
  Speaker 2: I guess because they got start with bees or something
• 4:12
  Speaker 2: like that. But no, they're not similar. Bipolar has much
• 4:15
  Speaker 2: more of a brain and central nervous system basis, whereas
• 4:20
  Speaker 2: while borderline personality disorder has a component of that, the
• 4:26
  Speaker 2: executive function of the person in their prefrontal cortex either
• 4:30
  Speaker 2: didn't develop in a fully normal way or it's not
• 4:35
  Speaker 2: functioning up to snuff, I guess, more than anything. And
• 4:39
  Speaker 2: the thing that differentiates it from bipolar is it's an
• 4:44
  Speaker 2: assignment of meaning it's psychological as much, if not more
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  Speaker 2: than it is physiological.
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  Speaker 4: Yeah.
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  Speaker 1: And also bipolar is characterized, and we did a good
• 4:56
  Speaker 1: episode on that quite a while ago, but it's characterized
• 4:59
  Speaker 1: by like these highs and lows, and then in between
• 5:03
  Speaker 1: those periods they can be relatively stable, whereas with borderline
• 5:09
  Speaker 1: personality disorder it's sort of always there. This one thing
• 5:13
  Speaker 1: you sent me had to really kind of really nail
• 5:16
  Speaker 1: it on the head at the end. Those with bipolar
• 5:18
  Speaker 1: may have a hair trigger kind of response during an episode,
• 5:21
  Speaker 1: whereas when you have a borderline PD, you have a
• 5:24
  Speaker 1: hair trigger response all of the time. And I can't
• 5:27
  Speaker 1: imagine how sup that must be.
• 5:29
  Speaker 2: Yeah, so that kind of calls out one of the
• 5:32
  Speaker 2: big hallmarks of BPD, which is it's emotional dysregulation. Yeah,
• 5:39
  Speaker 2: things that would affect other people a little bit, maybe
• 5:43
  Speaker 2: not at all. Stuff that most people that roll off
• 5:46
  Speaker 2: of their back right could set somebody with BPD off
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  Speaker 2: into a rage that could last days.
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  Speaker 3: Potentially.
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  Speaker 2: They also might use self harm it's called non suicidal
• 5:59
  Speaker 2: self injury to kind of externalize the pain because the
• 6:05
  Speaker 2: emotional dysregulation is so profound, they don't know what they're feeling.
• 6:10
  Speaker 2: They just know they're feeling everything all at once. And
• 6:13
  Speaker 2: it's kind of like standing in an ocean and a
• 6:17
  Speaker 2: huge wave hits you, and you're just you're as profoundly
• 6:22
  Speaker 2: enveloped by emotion at that moment as you are by
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  Speaker 2: a wave when it just completely knocks you off for
• 6:28
  Speaker 2: feet and sweeps you away.
• 6:30
  Speaker 1: Yeah, there was another and we'll talk about her in
• 6:33
  Speaker 1: great detail. Her name is Marcia Lenahan or is it
• 6:37
  Speaker 1: line Han.
• 6:38
  Speaker 2: I'm gonna go with Lenahan.
• 6:40
  Speaker 1: Yeah, she as we'll see as someone who not only
• 6:44
  Speaker 1: suffered from BPD but kind of pioneered the treatment of BPD.
• 6:50
  Speaker 1: But she said, it's like having third degree burns on
• 6:53
  Speaker 1: ninety percent of your body metaphorically, So you're lacking emotional skin,
• 6:58
  Speaker 1: and you feel agony at the slightest touch er movement,
• 7:02
  Speaker 1: and since you did mention self harm, non suicidal self harm.
• 7:07
  Speaker 1: It also people with BPD have a suicide rate of
• 7:11
  Speaker 1: was it like fifty times higher than average in the population.
• 7:16
  Speaker 4: Yeah, so this is this is no joke.
• 7:20
  Speaker 1: This is a very hardcore disorder that bears more empathy
• 7:25
  Speaker 1: and understanding.
• 7:26
  Speaker 2: Yeah, for sure. Let's go back to the beginning, shall we,
• 7:29
  Speaker 2: Because borderline personality disorder is one of those terms that
• 7:34
  Speaker 2: has taken on its own meaning in the general population,
• 7:38
  Speaker 2: but if you stop and think about it, it doesn't
• 7:40
  Speaker 2: really reveal much about what it's describing. It's just one
• 7:43
  Speaker 2: of those not at all frustratingly So, yeah, and that
• 7:47
  Speaker 2: goes back to a jerk named Adolph Stern who really
• 7:50
  Speaker 2: jerked it up back in nineteen thirty eight.
• 7:52
  Speaker 1: Yeah, he was a psychoanalyst, and he basically I mean,
• 7:58
  Speaker 1: if you didn't know what it was, and I didn't
• 7:59
  Speaker 1: even fully know what it was, I always wondered what
• 8:02
  Speaker 1: borderline meant. And it very simply meant and means, this
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  Speaker 1: is Stern saying, you're not quite on the psychotic level
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  Speaker 1: and you're not quite psycho neeurotic. You're basically on the
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  Speaker 1: border between those conditions while encompassing a bit of each.
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  Speaker 1: So we're just going to call it borderline.
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  Speaker 2: Yeah, and psychosis is what we would still consider psychosis,
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  Speaker 2: but under psychoanalysis, psychoneurosis is what we call anxiety depression,
• 8:32
  Speaker 2: those kinds of mental illnesses. So I guess Adolf Stern
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  Speaker 2: wasn't really that big of a jerk, because he really
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  Speaker 2: kind of did combine him appropriately. It was Auto Kernberg
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  Speaker 2: who was the serious jerk in this situation.
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  Speaker 1: Okay, So he was a psychoanalyst in the mid nineteen seventies,
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  Speaker 1: so that's you know, like forty something years later, and
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  Speaker 1: he described it as an unstable personality and disorganized conception
• 8:59
  Speaker 1: of the cell. And this is just when it was
• 9:02
  Speaker 1: sort of starting to become more and more kind of
• 9:05
  Speaker 1: talked about, and officially I think five years after that
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  Speaker 1: was in the DSM version three.
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  Speaker 2: Yeah. I mean that's pretty quick for something you just
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  Speaker 2: started to identify, and five years later it makes it
• 9:16
  Speaker 2: in the DSM. Because they don't churn those dsms out
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  Speaker 2: like you know, every few months. It takes years to
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  Speaker 2: put one together. So Kurenberg seemed to have stumbled onto
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  Speaker 2: something that was worth looking at, very very very quickly.
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  Speaker 4: Yeah.
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  Speaker 1: And isn't there a sort of movement or belief now
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  Speaker 1: that it's a lot of people think it's something that
• 9:37
  Speaker 1: is like a diagnosis you shouldn't even give, right.
• 9:40
  Speaker 2: Yeah, there's we'll talk about that. I think we can
• 9:43
  Speaker 2: kind of pepper it throughout, you know. Okay, But yes,
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  Speaker 2: there is a school of thought that basically says BPD
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  Speaker 2: is not a personality disorder. It's not even a mood disorder,
• 9:56
  Speaker 2: although some people say it would better be characterized as
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  Speaker 2: a mood disorder. They say it's a cluster of symptoms
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  Speaker 2: that overlap with a bunch of different actual disorders, and
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  Speaker 2: that the problem with that, you say, who cares? You're
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  Speaker 2: identifying people a group of people whose rate of suicide
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  Speaker 2: is fifty times a general population, that alone is worth
• 10:16
  Speaker 2: like identifying and helping those people out. But what they're
• 10:20
  Speaker 2: saying is number one, BPD has gotten such a bad
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  Speaker 2: name in the general population that you're literally stigmatizing somebody
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  Speaker 2: when you give them that diagnosis. It is an enormously
• 10:34
  Speaker 2: heavy weight you put on somebody. We say, I'm a
• 10:37
  Speaker 2: trained psychiatrist, I know what I'm talking about, and you
• 10:41
  Speaker 2: have borderline personality disorder. Everybody step back.
• 10:44
  Speaker 1: Basically, yeah, I mean it's it's almost in line with
• 10:49
  Speaker 1: saying someone as a sociopath. It's different things, but as
• 10:52
  Speaker 1: far as like the stigma goes very much.
• 10:54
  Speaker 2: So, yeah, for sure, that's a great analogy. Actually, so
• 10:57
  Speaker 2: some people are like, Okay, it's stigmatizing, but even more
• 11:01
  Speaker 2: than that, just the science isn't necessarily there, like we're
• 11:03
  Speaker 2: saying it's symptoms rather than an actual disorder. And then
• 11:07
  Speaker 2: apparently the Working Group for Personality Disorders for the DSM
• 11:12
  Speaker 2: five that's the most recent one, they actually said, we're
• 11:17
  Speaker 2: not sure that this should be a categorical disorder, which
• 11:21
  Speaker 2: is the type that you either have it or you don't.
• 11:24
  Speaker 2: They suggested it should be dimensional, which means that it
• 11:28
  Speaker 2: exists on a spectrum, right, so you can have a
• 11:30
  Speaker 2: little bit of BPD, a lot of BPD, or right
• 11:33
  Speaker 2: in the middle or whatever. And that got rejected. And
• 11:36
  Speaker 2: now so it's a categorical diagnosis where if you don't
• 11:42
  Speaker 2: have BPD, you don't have BPD. If you don't fit
• 11:45
  Speaker 2: the criteria. If you do, you got BPD.
• 11:47
  Speaker 1: Right, And we'll talk about the criterion in a second,
• 11:50
  Speaker 1: but we do want to sort of reintroduce Marcia Lenihan, who,
• 11:54
  Speaker 1: like I said, was a real pioneer for her work
• 11:58
  Speaker 1: in the treatment and recognition of BPD. Very late in
• 12:03
  Speaker 1: her life, revealed that she suffered from BPD. After you know,
• 12:08
  Speaker 1: patients and friends encouraged her to come forward and she said, basically,
• 12:12
  Speaker 1: you know, I'm gonna do it. I'm not gonna die
• 12:14
  Speaker 1: a coward, is what she said, but for the longest
• 12:17
  Speaker 1: time was not out with that information. Was born in
• 12:21
  Speaker 1: Oklahoma in I guess the fifties, and in the nineteen
• 12:26
  Speaker 1: sixties in high school, was diagnosed with schizophrenia, drugged up,
• 12:31
  Speaker 1: give an electro shock, hospitalized, was practicing self harm of
• 12:38
  Speaker 1: all kinds, and then had it sounds like a not
• 12:42
  Speaker 1: a moment of clarity, but a pretty profound religious experience.
• 12:46
  Speaker 2: Yeah, the only thing missing was a visit from Saint
• 12:48
  Speaker 2: Michael pretty much.
• 12:50
  Speaker 1: I mean, she's Catholic, and after this religious experience she
• 12:56
  Speaker 1: was able to which you know, had a lot to
• 12:59
  Speaker 1: do with self love. But after this she was able
• 13:01
  Speaker 1: to still have these emotions that she had before, but
• 13:06
  Speaker 1: managed it to the point where she wasn't practicing self harm.
• 13:10
  Speaker 1: And did she come up with the term radical acceptance
• 13:13
  Speaker 1: or did she just buy into that.
• 13:15
  Speaker 2: I don't know if that was a descriptor of hers
• 13:17
  Speaker 2: or not.
• 13:18
  Speaker 4: Okay, I don't think she came up with that.
• 13:20
  Speaker 1: But basically, as you know, radical acceptance is like, hey, listen,
• 13:24
  Speaker 1: this is how things are with me, this is how
• 13:27
  Speaker 1: things are with the world. I accept this, and I'm
• 13:31
  Speaker 1: not going to compare this to what I think the
• 13:35
  Speaker 1: reality should be or what other people think it should be.
• 13:38
  Speaker 2: There's a huge butt that follows that though.
• 13:41
  Speaker 3: But but but.
• 13:45
  Speaker 2: I am going to do what I can to change
• 13:48
  Speaker 2: those things about myself.
• 13:50
  Speaker 4: Right.
• 13:50
  Speaker 2: So that is the basis of a type of cognitive
• 13:54
  Speaker 2: behavioral therapy that she came up with called dialectical behavioral therapy,
• 13:58
  Speaker 2: and it is it's based in radical acceptance and the
• 14:02
  Speaker 2: desire to examine and change how you interact with the
• 14:06
  Speaker 2: world externally, and it's basically the gold standard for treating
• 14:11
  Speaker 2: a borderline personality disorder it right.
• 14:13
  Speaker 1: Now, Yeah, and it seems like it really works. I
• 14:17
  Speaker 1: saw that it was kind of the only proven treatment
• 14:20
  Speaker 1: to reduce suicidal behavior, which is, you know, at the
• 14:25
  Speaker 1: tail end of what a lot of people experience with BPD.
• 14:29
  Speaker 1: And the good news and we'll talk about treatment later,
• 14:32
  Speaker 1: but the good news is if you have VPD or
• 14:35
  Speaker 1: know someone that does, you can get better. And they
• 14:38
  Speaker 1: have proven and shown time and time again now that
• 14:42
  Speaker 1: through the treatments that we'll discuss later, it is absolutely
• 14:45
  Speaker 1: something that someone can get a hold of in most cases, right,
• 14:50
  Speaker 1: which is great.
• 14:51
  Speaker 2: It is great. I mean, like, for as bad of
• 14:54
  Speaker 2: a stigma as BPD has, the idea that like it
• 14:57
  Speaker 2: has a very high success rate of treatment is pretty couraging.
• 15:01
  Speaker 2: So Lenahan's basis of her understanding or her definition of
• 15:06
  Speaker 2: borderline personality disorder is that it's biosocial that people who
• 15:12
  Speaker 2: have BPD are either genetically or biologically predisposed to having BPD,
• 15:20
  Speaker 2: but not everybody who has that predisposition is going to
• 15:24
  Speaker 2: be triggered into developing BPD. It takes basically a biological
• 15:29
  Speaker 2: substrate for BPD. Usually your prefrontal cortex hasn't developed in
• 15:34
  Speaker 2: a certain way, and so your executive function isn't functioning
• 15:37
  Speaker 2: like an executive should. That gets joined together with a trigger,
• 15:44
  Speaker 2: usually mistreatment, whether it's abuse, neglect, invalidation by your parents
• 15:51
  Speaker 2: as a kid, and you put those things together and
• 15:55
  Speaker 2: very often it results in what you be diagnosed with
• 15:57
  Speaker 2: later as BPD.
• 15:59
  Speaker 1: Yeah, and one thing I really took away from this,
• 16:02
  Speaker 1: and this is something that you know, Emily and I
• 16:04
  Speaker 1: and and most parents that I know are way into,
• 16:06
  Speaker 1: is h oh, you got to validate your kids.
• 16:09
  Speaker 2: Yeah, that's new, which is crazy, but it's.
• 16:12
  Speaker 1: It's Yeah, you got to validate their emotions and validate
• 16:15
  Speaker 1: their experiences and their feelings, even if it's something that
• 16:20
  Speaker 1: you don't think is uh, like has the most relevance
• 16:25
  Speaker 1: or whatever, or even if like the kid is wrong
• 16:27
  Speaker 1: about something or like emotionally wrong, like, you still have
• 16:30
  Speaker 1: to validate that and then talk them through it. What
• 16:32
  Speaker 1: you can't do is just discount a kid's feelings, because
• 16:37
  Speaker 1: that's like telling them that their truth isn't real, and
• 16:41
  Speaker 1: that's damaging I know, and.
• 16:43
  Speaker 2: Doing parenting right sounds like a waking nightmare to me
• 16:47
  Speaker 2: doing wise parenting parenting correctly. Yeah. Nah, I can't imagine
• 16:52
  Speaker 2: the exhaustion along combined with the fear of just misstepping
• 16:56
  Speaker 2: once or twice and then there you go, you screwed
• 16:58
  Speaker 2: your kid up for life.
• 17:00
  Speaker 4: Yeah.
• 17:00
  Speaker 1: What you gotta do is, in my experience, is like
• 17:03
  Speaker 1: you can't beat yourself up too much because parenting fails,
• 17:08
  Speaker 1: you can really go down a rabbit hole.
• 17:09
  Speaker 4: Of your own.
• 17:10
  Speaker 1: I'll be depression if you screw up. And you can't
• 17:15
  Speaker 1: do that because kids are resilient and you just got to,
• 17:17
  Speaker 1: like you got to prove to them that you can
• 17:20
  Speaker 1: like pick yourself up and move on and do better,
• 17:22
  Speaker 1: you know.
• 17:23
  Speaker 2: Yeah, And I don't think Lenahan's idea is that it
• 17:28
  Speaker 2: just takes one or two missteps. It takes like a parent,
• 17:31
  Speaker 2: he was a genuinely bad parent. Very frequently they have
• 17:34
  Speaker 2: BPD themselves. Yeah, and that is a real challenge to
• 17:38
  Speaker 2: parenting well in and of itself. But you don't have
• 17:42
  Speaker 2: to have had a parent with BPD to develop BPD.
• 17:45
  Speaker 2: But typically it's a parent that is not at all
• 17:48
  Speaker 2: meeting your needs, especially emotionally. And I say we take
• 17:53
  Speaker 2: a break and we'll come back and talk about how
• 17:55
  Speaker 2: you would be diagnosed with BPD.
• 17:57
  Speaker 3: What do you think, let's do it, okay, Chuck.
• 18:19
  Speaker 2: So we said that BPD's in the d S M five.
• 18:23
  Speaker 2: It's a personality disorder. And just to differentiate real quick,
• 18:26
  Speaker 2: a mood disorder describes patterns and feelings, like you have
• 18:32
  Speaker 2: mood swings in that you know highs and lows, and
• 18:35
  Speaker 2: that's pretty reliable that you're going to have it one
• 18:38
  Speaker 2: way or another. Personality disorder focuses more on how you
• 18:41
  Speaker 2: relate to others, and that definitely makes sense to me
• 18:44
  Speaker 2: that you would consider a BPD of personality disorder.
• 18:48
  Speaker 1: Then, yeah, that seems to be a really key thing,
• 18:52
  Speaker 1: is that it's it's it really disturbs your relationships. So
• 18:59
  Speaker 1: to be diagnosed, you fit at least five out of
• 19:03
  Speaker 1: the following nine that we're gonna read for you. Chronic
• 19:06
  Speaker 1: feelings of emptiness and.
• 19:08
  Speaker 2: That's emptiness, feeling like isolated or lonely or hopeless.
• 19:12
  Speaker 1: Sure, emotional instability and reaction to day to day events.
• 19:17
  Speaker 1: That's the thing we were talking about earlier, Like saying
• 19:20
  Speaker 1: mountains out of molehills seems slightly reductive, but that's kind
• 19:24
  Speaker 1: of a basic way to say it. Okay, frantic efforts
• 19:27
  Speaker 1: to avoid abandonment, whether or not they're real or imagined.
• 19:31
  Speaker 1: As Yeah, as we'll see abandonment issues, and this very
• 19:36
  Speaker 1: very much includes emotional abandonment as a really big precursor
• 19:42
  Speaker 1: unstable self image or sense of self.
• 19:46
  Speaker 2: What else, Impulsive behavior is usually a big one, and
• 19:49
  Speaker 2: you have to have impulsive behavior and at least two
• 19:52
  Speaker 2: areas that are harming your day to day life, like
• 19:56
  Speaker 2: an eating disorder and gambling addiction or something like that.
• 20:01
  Speaker 2: Another one is this is based on and so this
• 20:05
  Speaker 2: is where some psychiatrists would be like, see this is
• 20:07
  Speaker 2: not this is a symptom that we're talking about here,
• 20:11
  Speaker 2: but it's unstable and intense interpersonal relationships. I mean, like
• 20:15
  Speaker 2: you're really really close to somebody for you know, a
• 20:19
  Speaker 2: couple of days, and then they do something you don't
• 20:21
  Speaker 2: like and they're the worst person in the world. And
• 20:24
  Speaker 2: it can happen very very quickly with people with BPD,
• 20:28
  Speaker 2: And if you stick around and stay in that person's life,
• 20:30
  Speaker 2: you can find yourself walking on eggshells very quickly because
• 20:33
  Speaker 2: you don't want them to turn on you all of
• 20:35
  Speaker 2: a sudden. So that's a huge one. If you have
• 20:39
  Speaker 2: a lot of unstable, intense relationships with people, that's just
• 20:43
  Speaker 2: kind of the mo that is usually a big giveaway
• 20:46
  Speaker 2: with BPD.
• 20:48
  Speaker 1: Yeah, the last three recurrent suicidal or self harming behaviors.
• 20:54
  Speaker 1: We've talked about that a little bit, stress related, paranoia
• 20:58
  Speaker 1: or dissociative symptoms, feeling like the self of the world
• 21:01
  Speaker 1: isn't real. It feels like that's probably the far end
• 21:06
  Speaker 1: of the spectrum, or the most severe end. And then
• 21:09
  Speaker 1: one we missed earlier was inappropriate and intense anger or
• 21:14
  Speaker 1: difficulty controlling anger.
• 21:15
  Speaker 2: I didn't miss it. That was purposeful, Okay. I wanted
• 21:18
  Speaker 2: to end with that big one.
• 21:20
  Speaker 4: Okay, all right, speak to it.
• 21:22
  Speaker 2: Well, there's a lot of I always hate saying those qualifiers.
• 21:26
  Speaker 2: It's just so easy to say, but I know I
• 21:28
  Speaker 2: think it perks people's ears up, like, oh, this person
• 21:30
  Speaker 2: doesn't know what they're talking about. So let me rephrase that.
• 21:32
  Speaker 2: I have seen that there are schools of thought regarding
• 21:36
  Speaker 2: borderline personality disorder that it is a rage response to trauma. Okay,
• 21:45
  Speaker 2: that that is your response to unresolved trauma. That's how
• 21:48
  Speaker 2: you learn to deal with those feelings and those emotions.
• 21:51
  Speaker 2: Is to rage at people, because rage is as much
• 21:54
  Speaker 2: a hallmark of BPD as fear of abandonment, is right,
• 21:58
  Speaker 2: and that's why so people are critical of including it
• 22:01
  Speaker 2: as a categorical diagnosis in the d s M five.
• 22:05
  Speaker 2: They're saying, you're pathologizing rage. No, you just need to
• 22:08
  Speaker 2: teach people how to identify their emotions and how to
• 22:11
  Speaker 2: express them in a more appropriate, less hostile manner, and
• 22:15
  Speaker 2: then that's how you would treat somebody with BPD, or
• 22:18
  Speaker 2: not even with BPD, somebody with a rage disorder. But
• 22:21
  Speaker 2: some people think that that is what people are mistaking
• 22:24
  Speaker 2: for BPD.
• 22:25
  Speaker 1: Oh I gotcha, okay, interesting, Uh, you're gonna to be diagnosed,
• 22:30
  Speaker 1: Like I said, five of those nine, it'll probably be
• 22:33
  Speaker 1: you know, like you'll be talking to a psychologist or
• 22:36
  Speaker 1: someone in an interview. You might fill out a questionnaire
• 22:38
  Speaker 1: or something they're going to make interesting click click click click,
• 22:44
  Speaker 1: or they may speak to your family or something like that.
• 22:48
  Speaker 1: It can be difficult to diagnose and there, like you said,
• 22:53
  Speaker 1: there's there's a lot of overlap between you know, things
• 22:56
  Speaker 1: like anxiety and depression and things like PTSD and eating disorders,
• 23:00
  Speaker 1: a lot of comorbidities. So I get why people can
• 23:06
  Speaker 1: have issues with like this diagnosis rather than it's like
• 23:10
  Speaker 1: a cluster of symptoms of other things.
• 23:12
  Speaker 4: But I don't know.
• 23:13
  Speaker 1: If you group that altogether then it and call it
• 23:16
  Speaker 1: its own thing, then I don't know. I'm not sure
• 23:17
  Speaker 1: I see the harm in that.
• 23:19
  Speaker 2: Again, I think it's the stigma. And then also it
• 23:22
  Speaker 2: might be distracting from treating the other underlying.
• 23:25
  Speaker 1: Stuff, maybe because there also isn't and we'll talk about pharmaceuticals,
• 23:31
  Speaker 1: but there isn't a specific pharmaceutical for VPD.
• 23:35
  Speaker 2: That's another clue that some people point to that it's
• 23:38
  Speaker 2: not it's it's it's we're mistaking it somehow. And I
• 23:41
  Speaker 2: don't want to like overstate the that school of thought.
• 23:45
  Speaker 2: It is widely considered like an accepted diagnosis orderline personality
• 23:53
  Speaker 2: disorder is, so I don't want to make it seem
• 23:55
  Speaker 2: like the cracks are in the facade. It's about a
• 23:57
  Speaker 2: chromole any day. Now. My point is people make some
• 24:01
  Speaker 2: pretty good points about how well we understand it or
• 24:06
  Speaker 2: how well we're defining and we're possibly missing some component
• 24:09
  Speaker 2: of it.
• 24:10
  Speaker 1: Yeah, and isn't that stuff debate usually or I guess
• 24:15
  Speaker 1: it should be, And I hope it's couched in how
• 24:17
  Speaker 1: to best treat people and help people, right, Yes, rather
• 24:21
  Speaker 1: than just like poopooing ideas.
• 24:23
  Speaker 2: Yeah, no, I think that's exactly right. But I mean, again,
• 24:27
  Speaker 2: if we come to this place where even if if
• 24:30
  Speaker 2: a BPD is the center of a giant Venn diagram
• 24:34
  Speaker 2: of a bunch of different disorders, Yeah yeah, and we're
• 24:37
  Speaker 2: mistaking that center overlap of all of them as its
• 24:40
  Speaker 2: own thing. If you zero in on that group and
• 24:44
  Speaker 2: they have a fifty times higher rate of suicide than
• 24:47
  Speaker 2: the general population, again, that is worth zeroing in on,
• 24:51
  Speaker 2: you know, as its own thing. And like you said,
• 24:54
  Speaker 2: dialectical behavior therapy is focused initially on individual sessions that
• 25:00
  Speaker 2: are that are that are aimed to control that that behavior.
• 25:04
  Speaker 2: Suicide alalogy, Yeah, yeah, for sure.
• 25:07
  Speaker 1: You did mention earlier as far as causes go, that
• 25:10
  Speaker 1: sometimes there is a genetic link, but it seems that
• 25:14
  Speaker 1: it's not really the disorder that is like maybe passed
• 25:18
  Speaker 1: from parent to child, but some of those traits and
• 25:20
  Speaker 1: maybe that's because it is sort of a cluster. Sometimes
• 25:26
  Speaker 1: you can't you know, you can have BPD and come
• 25:29
  Speaker 1: from like a pretty good, you know, stable upbringing, but
• 25:34
  Speaker 1: that seems to be the outlier, and it seems to
• 25:37
  Speaker 1: be that like most people that end up suffering from
• 25:41
  Speaker 1: this had a pretty lousy childhood.
• 25:43
  Speaker 2: Yeah, so they were either neglected or just kind of
• 25:48
  Speaker 2: saddled with emotionally unavailable parents who just weren't really there
• 25:52
  Speaker 2: for them, didn't go to their dance recital kind of thing,
• 25:55
  Speaker 2: never went to a single one. Excessive control. It sounds
• 26:01
  Speaker 2: very Freudian, but I saw one classic example as an
• 26:04
  Speaker 2: absent father and a domineering mother, and it's like, how
• 26:09
  Speaker 2: many times have you guys tritted that one out? But
• 26:11
  Speaker 2: apparently it really does have a screwy effect on people
• 26:14
  Speaker 2: as a kid. And then also if your parents or
• 26:18
  Speaker 2: parent had a mood disordered themselves, or misused substances, that
• 26:25
  Speaker 2: would probably have affected their parenting as well.
• 26:29
  Speaker 1: Yeah, this also made me think about like parenting of
• 26:33
  Speaker 1: old versus parenting now and parents can there are still,
• 26:37
  Speaker 1: of course, a huge range of bad parents these days.
• 26:42
  Speaker 1: I'm not saying that everyone's doing it right now, but
• 26:45
  Speaker 1: it definitely seems like things turned a corner and parents
• 26:48
  Speaker 1: are trying a lot harder these days, and like sort
• 26:52
  Speaker 1: of the old days of like, oh, you know, kids
• 26:54
  Speaker 1: raised themselves and you can ignore them and blah blah blah,
• 26:57
  Speaker 1: and like, I'm sure that, I mean, I know that's
• 26:59
  Speaker 1: so happen, but it just seems like that happened a
• 27:02
  Speaker 1: lot more back in the day. And maybe in the
• 27:05
  Speaker 1: future things like this will be less and less.
• 27:08
  Speaker 2: Yeah, that's the hope for sure.
• 27:11
  Speaker 1: I know that's sort of a basic, sort of an
• 27:14
  Speaker 1: elementary way of looking at it, but I just feel
• 27:16
  Speaker 1: like parents are more aware of stuff these days, and like,
• 27:19
  Speaker 1: you know, people of our generation and certainly the generations
• 27:22
  Speaker 1: before that, it was even worse as far as parental
• 27:25
  Speaker 1: involvement and parents who either one or the other. You know,
• 27:29
  Speaker 1: fathers a lot of times, you know, historically the ones
• 27:31
  Speaker 1: that are like, no, we're we're not going to parent
• 27:33
  Speaker 1: because we're doing the work and we're gonna bring home
• 27:35
  Speaker 1: the paycheck. And so like I had, I've talked about
• 27:38
  Speaker 1: it before. I had a dad that wasn't very involved,
• 27:41
  Speaker 1: but it wasn't like the kind of thing where I
• 27:45
  Speaker 1: ended up with BPD because of it, you know, yeah,
• 27:47
  Speaker 1: for sure, if that makes sense.
• 27:49
  Speaker 2: You raise a question though, in my mind, I wonder
• 27:52
  Speaker 2: what percentage of boomer grandparents are allowed to see their grandchildren.
• 27:59
  Speaker 4: I'll bet at hire you think are allowed to or not.
• 28:02
  Speaker 2: Allowed to, like just don't have contact with their grandkids.
• 28:06
  Speaker 1: Yeah, or it's very limited and supervised. And so actually
• 28:10
  Speaker 1: though a lot of those grandparents, all of a sudden,
• 28:13
  Speaker 1: are the most doting, and it's kind of like, I
• 28:15
  Speaker 1: know some parents are like, oh, okay, well this is great.
• 28:18
  Speaker 1: Yeah when I was a kids, right, sure, for sure.
• 28:21
  Speaker 2: But also I think in some of the cases that
• 28:24
  Speaker 2: the more they dote, they're actually also undermining the parenting
• 28:27
  Speaker 2: of their kids.
• 28:28
  Speaker 3: Yeah.
• 28:30
  Speaker 1: Yes, And imagine it can be very painful for a
• 28:33
  Speaker 1: parent who had a unattentive parent to now have that
• 28:37
  Speaker 1: parent be a very intentive grandparent.
• 28:39
  Speaker 2: You have BPD, I would guess that would be a
• 28:41
  Speaker 2: rage inducing trigger.
• 28:43
  Speaker 4: I imagine it would be.
• 28:44
  Speaker 2: So there are plenty of other ways that you could
• 28:48
  Speaker 2: probably develop VPD. Another very classic one is any kind
• 28:52
  Speaker 2: of abuse emotional, sexual, physical abuse at the hands of
• 28:55
  Speaker 2: your parent or a caregiver. And they say that about
• 28:59
  Speaker 2: eighty percent of people with BPD experience some level of
• 29:03
  Speaker 2: childhood trauma, whether it was emotional neglect or some sort
• 29:08
  Speaker 2: of abuse. It is. It's a huge factor, a huge
• 29:12
  Speaker 2: risk factor in developing BPD for sure.
• 29:15
  Speaker 1: Yeah, absolutely, And it seems to be exacerbated if you're
• 29:19
  Speaker 1: a kid who is maybe you're just innately a little
• 29:23
  Speaker 1: more unsure of yourself or a little more vulnerable as
• 29:26
  Speaker 1: a person, and then that is reinforced with a parent
• 29:31
  Speaker 1: who is not validating your experience and your emotion as
• 29:35
  Speaker 1: a kid. So you're already starting back sort of behind
• 29:38
  Speaker 1: the eight ball, and then your parents are making it worse,
• 29:41
  Speaker 1: and so that can definitely, you know, easy toward that condition.
• 29:45
  Speaker 2: Well, it's like that's a chicken or the egg question though,
• 29:48
  Speaker 2: like were you like that you know already and your
• 29:51
  Speaker 2: parents is reinforcing it, or did you get that kind
• 29:53
  Speaker 2: of did you learn to do that because of your parents' behavior.
• 29:56
  Speaker 2: It's like a chicken or the egg, parent or the disorder, right,
• 30:00
  Speaker 2: you know. But we said earlier that there's also believed
• 30:03
  Speaker 2: to be a biological component to it too, that it's
• 30:06
  Speaker 2: not all psychological, and it does seem to have something
• 30:10
  Speaker 2: to do with executive function in the brain. One of
• 30:13
  Speaker 2: the big things that executive functioning does is it helps
• 30:17
  Speaker 2: you control your emotions, not just in accepting things and
• 30:22
  Speaker 2: dealing with them and moving on, but also your outward
• 30:26
  Speaker 2: display of emotions. If you don't have executive function, your
• 30:30
  Speaker 2: emotional dysregulation is more likely to include explosions of anger,
• 30:37
  Speaker 2: uncontrollable anger. And then one of the things, it's not
• 30:40
  Speaker 2: just BPD that has that, there's plenty of other disorders
• 30:44
  Speaker 2: that have it. But one of the key traits of
• 30:47
  Speaker 2: BPD is it can last a really long time too.
• 30:51
  Speaker 1: Can we make a T shirt that has a chicken
• 30:56
  Speaker 1: that says parent across the chicken's chest and then next
• 30:59
  Speaker 1: to it an egg that says mental disorder? Love it
• 31:03
  Speaker 1: and just that's the shirt. No explanation, figure it out
• 31:06
  Speaker 1: or don't.
• 31:06
  Speaker 2: How about this though, On the back of the shirt,
• 31:09
  Speaker 2: Mork is coming out of the egg all right to
• 31:12
  Speaker 2: really confuse people.
• 31:16
  Speaker 4: Oh wow, that just really changed things.
• 31:18
  Speaker 2: I like it, Okay.
• 31:19
  Speaker 1: So as far as the number of people who experience BPD,
• 31:25
  Speaker 1: it's kind of a wide range, like all this stuff,
• 31:27
  Speaker 1: because it's one of those disorders that is a lot
• 31:30
  Speaker 1: of people don't admit it or seek treatment, so it's
• 31:32
  Speaker 1: really hard to nail it down. But Lyba helped us
• 31:35
  Speaker 1: out with this one, and she said zero point five
• 31:38
  Speaker 1: percent to six percent, and they find it about four
• 31:41
  Speaker 1: times more in women but they've also found other studies
• 31:44
  Speaker 1: are like, no, it's the women who are brave enough
• 31:46
  Speaker 1: to come forward and seek treatment, and it happens just
• 31:49
  Speaker 1: as much in men.
• 31:50
  Speaker 2: I also saw that it's a that's an indictment of
• 31:53
  Speaker 2: clinicians who basically have to figure out for themselves whether
• 31:58
  Speaker 2: the person has BPD, that they're more likely to assign
• 32:01
  Speaker 2: it to a woman than a man a male patient.
• 32:04
  Speaker 4: Oh interesting.
• 32:05
  Speaker 2: So regardless, it is very frequently diagnosed, more than you
• 32:10
  Speaker 2: would think. It's one of the more common serious mental illnesses. Apparently,
• 32:14
  Speaker 2: people receiving impatient mental health treatment, one in five of
• 32:19
  Speaker 2: those people are diagnosed with BPD. So it is very prevalent,
• 32:23
  Speaker 2: at least inside the clink.
• 32:28
  Speaker 1: Yeah, the mental clink, Yeah, the mental clink. One other
• 32:32
  Speaker 1: aspect is a very black and white thinking. You kind
• 32:37
  Speaker 1: of talked before about splitting, which is, you know, really
• 32:42
  Speaker 1: revering and idolizing somebody and then very quickly despising them.
• 32:47
  Speaker 1: And this can happen very very frequently and like several
• 32:50
  Speaker 1: times throughout a day even or it can be like
• 32:53
  Speaker 1: just a switch that is permanent, like someone you used
• 32:57
  Speaker 1: to really like and idolize all of a sudden just
• 33:00
  Speaker 1: no more. You despise them, and they're they're on the
• 33:02
  Speaker 1: bad person list forever.
• 33:04
  Speaker 2: Yeah, and that's that falls under the larger category of
• 33:06
  Speaker 2: black and white thinking. It's not just applied to people,
• 33:09
  Speaker 2: it's events, things, anything a dandelion can be entirely evil
• 33:15
  Speaker 2: or the fully good. And because you see things in
• 33:20
  Speaker 2: people and events as entirely one way or the other,
• 33:24
  Speaker 2: you set people up for unrealistic expectations. If you're like,
• 33:27
  Speaker 2: you're one percent pure and kind person and I love you,
• 33:32
  Speaker 2: that person is inevitably going to let you down in
• 33:34
  Speaker 2: some way, shape or form. Sure, because no one's one
• 33:37
  Speaker 2: hundred percent pure and kind. Similarly, no one's one hundred
• 33:40
  Speaker 2: percent evil. And most people that you would label evil
• 33:44
  Speaker 2: as if you have VPD, probably aren't evil at all.
• 33:46
  Speaker 2: They just did something you really didn't like. But now
• 33:49
  Speaker 2: to you, that person is evil, not to be trusted,
• 33:54
  Speaker 2: not you know, they did something wrong. At their core,
• 33:58
  Speaker 2: they're evil, And that's another huge hallmark of BPD as well.
• 34:03
  Speaker 1: Yeah, I mean even Darth Vader was once a young boy, Yeah,
• 34:07
  Speaker 1: just trying to learn the ways of the force.
• 34:09
  Speaker 2: But boy did he get pale as he aged.
• 34:13
  Speaker 4: He sure did.
• 34:15
  Speaker 1: This can also this splitting can happen with yourself. You
• 34:20
  Speaker 1: may vacillate wildly from feeling like you're you're okay and
• 34:24
  Speaker 1: that you feel good about yourself and you have a
• 34:26
  Speaker 1: little bit of self confidence to really loathing yourself. And
• 34:31
  Speaker 1: that's when like things like you know, self harm can
• 34:34
  Speaker 1: come into play. Your sense of your own personality can
• 34:37
  Speaker 1: really change your you know, you could very much switch,
• 34:42
  Speaker 1: like kind of do these wild switches between your goals
• 34:46
  Speaker 1: in life for or how you want to present yourself
• 34:48
  Speaker 1: to the world, or like your values and ethics and
• 34:51
  Speaker 1: things like that. And this I'm not really sure, but
• 34:54
  Speaker 1: it kind of seems like almost like sort of auditioning
• 34:59
  Speaker 1: yourself kind of over and over sometimes like let me
• 35:03
  Speaker 1: try this new me or whatever, or auditioning or trying
• 35:06
  Speaker 1: out a new thing that you think might help.
• 35:10
  Speaker 4: Make sense.
• 35:10
  Speaker 2: Yeah, no, totally. It's also circumstantial too. They might act
• 35:13
  Speaker 2: different ways to different people depending on what they think
• 35:16
  Speaker 2: those people want from them, or yes, to impress like
• 35:20
  Speaker 2: a friend or a new person or something like that.
• 35:23
  Speaker 2: They might adopt that person's like hobbies and interests. But
• 35:28
  Speaker 2: I saw it explained as the people who have VPD
• 35:31
  Speaker 2: and do that that they don't understand where they end
• 35:34
  Speaker 2: or the other person begins, because they have no idea
• 35:37
  Speaker 2: what they believe in. They just don't know, so they're
• 35:40
  Speaker 2: kind of open for suggestions. Basically interesting.
• 35:44
  Speaker 1: Yeah, should we take a break?
• 35:48
  Speaker 2: Oh jeez, that came out of left field.
• 35:50
  Speaker 1: Sorry, sure, all right, I think it's a good time
• 35:53
  Speaker 1: to take a break, and then we're going to come
• 35:54
  Speaker 1: back and talk more about personal relationships. All right, we're
• 36:18
  Speaker 1: back and talking about borderline personality disorder. And one kind
• 36:23
  Speaker 1: of hallmark with someone with BPD is what's called like
• 36:30
  Speaker 1: a favorite person, or just a person in their life
• 36:34
  Speaker 1: that they have have not necessarily even chosen, who they've
• 36:38
  Speaker 1: hooked up with. It could be a spouse, it could
• 36:40
  Speaker 1: be a partner, It could be a friend or coworker,
• 36:43
  Speaker 1: anyone that you really have latched onto as someone maybe
• 36:48
  Speaker 1: the only person that you really really trust with yourself.
• 36:53
  Speaker 2: Yeah, and I don't think you even trust that person.
• 36:56
  Speaker 2: You just that's the person you've come to find you
• 36:58
  Speaker 2: can lean on the most, I think. Okay, but yeah,
• 37:01
  Speaker 2: the FP, for those in the know, the favorite person
• 37:05
  Speaker 2: is very frequently somebody who is willing to kind of
• 37:12
  Speaker 2: go along with this, at least for a while. There's
• 37:15
  Speaker 2: a ton of flattery and admiration and praise, and all
• 37:18
  Speaker 2: of your greatest points are pointed out all the time.
• 37:22
  Speaker 2: But you're also in real danger of letting that person
• 37:27
  Speaker 2: down and facing that wrath of rage or anger or hostility.
• 37:32
  Speaker 2: And if you come back for more, you're going to
• 37:35
  Speaker 2: find that you, as the favorite person, might start altering
• 37:38
  Speaker 2: your behavior to fit the person with BPD's behavior, so
• 37:42
  Speaker 2: you might start considering them when you're making plans like, oh,
• 37:45
  Speaker 2: we can't go out of town this weekend because our
• 37:49
  Speaker 2: friend with BPD was going to, you know, wanted us
• 37:52
  Speaker 2: to come out for their Sunday picnic or something like that.
• 37:55
  Speaker 2: Right like, you would be afraid to not go to
• 37:58
  Speaker 2: their picnic, And you generally end up feeling like you're
• 38:02
  Speaker 2: walking on eggshells. And it's a codependent relationship that evolves.
• 38:07
  Speaker 2: The favorite person seems to be the person who's willing
• 38:10
  Speaker 2: to take it the longest or the most, and that
• 38:12
  Speaker 2: it's not a permanent thing. Typically people get burned out
• 38:16
  Speaker 2: on it and eventually abandon the person with BPD, which
• 38:20
  Speaker 2: is again at the root of what they are fearful of.
• 38:23
  Speaker 2: They're fearful of rejection or abandonment. The tragedy of the
• 38:27
  Speaker 2: whole thing is that their behavior almost inevitably guarantees that
• 38:32
  Speaker 2: they will be rejected or abandoned by the people around them.
• 38:36
  Speaker 1: Yeah, that sort of self fulfilling feedback loop. Yeah, I mean,
• 38:41
  Speaker 1: it's a big burden for an FP. And if you
• 38:45
  Speaker 1: are a spouse or partner of someone and you are
• 38:49
  Speaker 1: the FP, like, that's a lot to manage, and so
• 38:52
  Speaker 1: a lot of empathy goes out to those people as
• 38:54
  Speaker 1: well when you're altering your own behaviors, like literally things
• 38:58
  Speaker 1: like I saw people or like you know, had to
• 39:02
  Speaker 1: I've had to step out of like really important meetings
• 39:05
  Speaker 1: just to answer a text within ten minutes because I
• 39:08
  Speaker 1: knew that that would set them off. And just little
• 39:11
  Speaker 1: things like that can really add up to someone's burden.
• 39:16
  Speaker 2: One of the other things that is difficult to deal
• 39:18
  Speaker 2: with when you're an FP is that person wants you
• 39:21
  Speaker 2: all of themselves. They're yeah, right, and very much by
• 39:25
  Speaker 2: other people. So they will try to isolate you from
• 39:27
  Speaker 2: your other friends and your family so that they have
• 39:30
  Speaker 2: you all of themselves, not just for time, I'm sure
• 39:32
  Speaker 2: time is a big part of it, but also to
• 39:34
  Speaker 2: cut down on any I guess rational explanation or rational
• 39:40
  Speaker 2: points from those other people, like what are you doing?
• 39:42
  Speaker 2: Why are you putting up with this? Isolating them would
• 39:45
  Speaker 2: help cut down on that too.
• 39:47
  Speaker 1: Yeah, and you know, if you're an FP, there's always
• 39:50
  Speaker 1: the sort of sad and scary possibility that there could
• 39:54
  Speaker 1: be a split incident that all of a sudden you
• 39:58
  Speaker 1: go from being the FP to be the most despised person.
• 40:03
  Speaker 1: I would imagine that's something that has probably comes over
• 40:06
  Speaker 1: time and is not like a quick thing. It can
• 40:09
  Speaker 1: be but it can be all right.
• 40:11
  Speaker 2: For sure. It can happen, It can turn on a dime.
• 40:15
  Speaker 2: And the other problem with it as well, Chuck, is
• 40:18
  Speaker 2: that the person with BPD almost invariably immediately regrets doing
• 40:25
  Speaker 2: that right, and so they will make every effort to
• 40:28
  Speaker 2: try to win the person back, which probably feels pretty
• 40:31
  Speaker 2: gross for the FP, and they'll say things like I'll
• 40:34
  Speaker 2: never do that again, like they know what they've just
• 40:37
  Speaker 2: done is worth regretting, is worth feeling horrible about because
• 40:40
  Speaker 2: they've just been abandoned or rejected. They just did it
• 40:43
  Speaker 2: to themselves, so now they're trying to fix it or
• 40:45
  Speaker 2: mend it. But it's all just kind of built on
• 40:48
  Speaker 2: you know, hicky ground because it's it's gonna happen again,
• 40:52
  Speaker 2: because it's impossible for that person not to let the
• 40:54
  Speaker 2: person with BPD down again.
• 40:57
  Speaker 1: Yeah, I mean, I get the impression that people with
• 40:59
  Speaker 1: bp D generally don't have any illusions about themselves because
• 41:04
  Speaker 1: it is such a struggle.
• 41:05
  Speaker 2: Well, that is a big problem with not only getting treatment,
• 41:09
  Speaker 2: but seeking treatment, because when your brain is structured in
• 41:13
  Speaker 2: a certain way, and ever since you were a little kid,
• 41:16
  Speaker 2: you've just responded a certain way to things. Even if
• 41:19
  Speaker 2: people around you are telling you that is messed up
• 41:22
  Speaker 2: or that you're being hustle or whatever, to you, that's normal,
• 41:25
  Speaker 2: that's natural. So it's really really hard to interrogate your
• 41:29
  Speaker 2: own behavior, let alone change it, because it seems normal
• 41:33
  Speaker 2: and natural to you. It's not that you need to
• 41:36
  Speaker 2: change your behavior because you chase somebody away. It's that
• 41:40
  Speaker 2: that person left to you now you need to go
• 41:42
  Speaker 2: get them back. So even if you have people around
• 41:45
  Speaker 2: you telling you, it's going to take a lot of emphasis, repeated,
• 41:50
  Speaker 2: constant emphasis, that what you're doing right now is abnormal
• 41:54
  Speaker 2: and harmful and you need to go get help for this.
• 41:58
  Speaker 2: That's yeah, that's one of the curses of it. They
• 42:01
  Speaker 2: can't see it. They at least if they can see it,
• 42:04
  Speaker 2: most of the time they can't well.
• 42:07
  Speaker 1: And this is I mean, all the mental health disorders
• 42:09
  Speaker 1: require a support system, but this one really seems to
• 42:13
  Speaker 1: sort of be at the top of the list of
• 42:14
  Speaker 1: needing a really solid, vast support system for treatment. Like
• 42:21
  Speaker 1: we said, the good news is that treatment works. They
• 42:26
  Speaker 1: used to think that personality disorders were untreatable and that
• 42:30
  Speaker 1: you were just kind of stuck with it.
• 42:33
  Speaker 4: They have found that about half.
• 42:35
  Speaker 1: The people who are treated, who seek treatment and are
• 42:39
  Speaker 1: treated no longer meet the criteria after five to ten years.
• 42:42
  Speaker 2: Amazing.
• 42:43
  Speaker 1: It doesn't mean that they're you know, they're perfect and
• 42:45
  Speaker 1: awesome and fixed. It means they can still have some symptoms,
• 42:49
  Speaker 1: but they have it under control enough to where they
• 42:51
  Speaker 1: don't meet that five out of nine criteria. And that's
• 42:54
  Speaker 1: what it's really sort of about, I think, is managing
• 42:58
  Speaker 1: something that, like you said, that you might have had
• 43:01
  Speaker 1: since you were like a baby, to live a productive,
• 43:05
  Speaker 1: you know, healthy life.
• 43:07
  Speaker 2: Yeah, and that's kind of what you're going to learn
• 43:08
  Speaker 2: in DBT, which again is the gold standard for treating BPD,
• 43:14
  Speaker 2: is that you're going to be taught these skills, how
• 43:16
  Speaker 2: to deal with disappointment, with being let down, with somebody
• 43:21
  Speaker 2: not responding to your text. You're going to learn a
• 43:23
  Speaker 2: different set of skills and how to deal with that,
• 43:26
  Speaker 2: both internally and externally. And one of the things that
• 43:30
  Speaker 2: kind of differentiates DBT from other kinds of behavioral therapy
• 43:35
  Speaker 2: is that there's group sessions, but it's not a group
• 43:39
  Speaker 2: session that you know, you've seen in a movie like
• 43:42
  Speaker 2: My nice Mela was in a movie called No Exit,
• 43:44
  Speaker 2: and that featured a couple of group sessions. I think
• 43:46
  Speaker 2: you can still see that on Netflix.
• 43:49
  Speaker 4: I think so.
• 43:49
  Speaker 2: But it's not like that. It's more almost like a
• 43:51
  Speaker 2: classroom instead, and then people get up and practice these
• 43:55
  Speaker 2: skills in front of others and with others. But it's
• 43:58
  Speaker 2: not like a group therapy session in the traditional sense.
• 44:02
  Speaker 2: But that's a huge component of it is group work.
• 44:06
  Speaker 1: Yeah, And it's you know, if it sounds a little
• 44:08
  Speaker 1: bit like cognitive behavioral therapy, it is sort of based
• 44:11
  Speaker 1: on that in part because it's a real and I
• 44:14
  Speaker 1: get how it works. It seems like a real sort
• 44:17
  Speaker 1: of rubber meets the road practical ways of learning new
• 44:21
  Speaker 1: behaviors rather than.
• 44:24
  Speaker 4: And therapy is a huge part of it.
• 44:27
  Speaker 1: But it's not just lets therapy and talk about your
• 44:30
  Speaker 1: past until you're blue in the face. It's like, all right,
• 44:33
  Speaker 1: we know what's going on, and we think we know
• 44:35
  Speaker 1: where it came from. Generally, Now, let's really talk about
• 44:39
  Speaker 1: putting this into daily practice, like literally doing things and
• 44:44
  Speaker 1: having a checklist and putting stuff into practice, which I
• 44:48
  Speaker 1: think is just I mean not only for DBT, but
• 44:51
  Speaker 1: stuff like that is so it so speaks to me
• 44:54
  Speaker 1: as a good way forward when you have any kinds
• 44:57
  Speaker 1: of problems because it's just a practical thing. It's learning
• 45:03
  Speaker 1: new behaviors.
• 45:04
  Speaker 2: That's another criticism of BPD as its own disorder, that
• 45:11
  Speaker 2: DBT can be used to treat all sorts of different
• 45:15
  Speaker 2: symptoms of all sorts of different disorders. It just makes
• 45:17
  Speaker 2: sense like that, yeah, for sure. But there's also another
• 45:21
  Speaker 2: type of therapy that supposedly works really well for DBT
• 45:24
  Speaker 2: called psychodynamic therapy, and it is talking about what you
• 45:28
  Speaker 2: went through as a child. So you're blue in the face,
• 45:30
  Speaker 2: but it's more about relating to relating that to how
• 45:34
  Speaker 2: you deal with people in your current life, people in situations.
• 45:38
  Speaker 2: It's relating it back to it so that it's not
• 45:40
  Speaker 2: just one big confusing blob. You understand your own behavior
• 45:45
  Speaker 2: better as a result of interrogating what you went through
• 45:49
  Speaker 2: as a kid. And I guess it smells a lot
• 45:52
  Speaker 2: like it believes borderline is like a response to trauma
• 46:00
  Speaker 2: using a rather than anything else.
• 46:02
  Speaker 1: Yeah, I mean, if you can sort of build out
• 46:05
  Speaker 1: your emotional life map, I imagine that's a very helpful
• 46:09
  Speaker 1: thing to do, you know.
• 46:11
  Speaker 2: Yeah. And then one other thing that really kind of
• 46:12
  Speaker 2: underscores how difficult dealing with people with borderline personality disorder
• 46:17
  Speaker 2: can be. One of the main components of dialectical behavioral
• 46:22
  Speaker 2: therapy is what's called a therapist consultation team, which is
• 46:27
  Speaker 2: basically a group of therapists working with patients with BPD
• 46:32
  Speaker 2: having like a like a blowoff steam session about them, right,
• 46:37
  Speaker 2: and reminding one another like, these are people suffering and
• 46:40
  Speaker 2: we need to have empathy for them. That's how hard
• 46:42
  Speaker 2: it can be to treat people with BPD.
• 46:45
  Speaker 1: Yeah, And like I said at the beginning, there are
• 46:47
  Speaker 1: therapists that will refuse treatment because.
• 46:52
  Speaker 4: All the reasons that we talked about.
• 46:54
  Speaker 1: They say that National Alliance on Mental Health basically says,
• 46:57
  Speaker 1: if you have BPD and you wreckon that and you
• 47:00
  Speaker 1: want to see treatment, whether it's you know, DBT or
• 47:04
  Speaker 1: any other kind you Uh, well, first of all, seek
• 47:07
  Speaker 1: out someone that specializes in DVT. But if there's no
• 47:10
  Speaker 1: one in your area that does that, then, like you,
• 47:13
  Speaker 1: you have a right and this this goes with any
• 47:15
  Speaker 1: sort of emotional or mental problems that anyone has that
• 47:19
  Speaker 1: they're working for you. So you have the right to
• 47:22
  Speaker 1: advocate for yourself and to find somebody who works for
• 47:25
  Speaker 1: you and who who will not stigmatize you, and like
• 47:30
  Speaker 1: really like it's okay to question them and make sure
• 47:34
  Speaker 1: it's a good fit for you.
• 47:36
  Speaker 2: Yeah, for sure.
• 47:38
  Speaker 1: I think people just I don't know, it's I think
• 47:41
  Speaker 1: part of the problems with a lot of these disorders
• 47:42
  Speaker 1: is people can't be advocates for themselves, and then that
• 47:45
  Speaker 1: might be part of their problems. So they're not going
• 47:47
  Speaker 1: to advocate for themselves when receiving treatment, and they'll just
• 47:50
  Speaker 1: take whatever they can get. And it's not all therapies
• 47:53
  Speaker 1: are created equal, and in therapists are created definitely not.
• 47:56
  Speaker 2: I think one of the problems with BPD is that
• 47:57
  Speaker 2: they might over advocate for themselves. Else Oh, chaseus off,
• 48:03
  Speaker 2: basically right. But the thing is, Chuck is like you said,
• 48:07
  Speaker 2: people take what they can get, in part because there's
• 48:09
  Speaker 2: a huge shortage of psychiatrists in particular in the United States,
• 48:14
  Speaker 2: and people will just take whoever can get them in
• 48:17
  Speaker 2: within a year or less. If the waiting lists are crazy,
• 48:21
  Speaker 2: it is crazy. Well, if you want to know more
• 48:23
  Speaker 2: about BPD, there are a lot of articles and resources
• 48:27
  Speaker 2: all over the internet to help you. And since I
• 48:31
  Speaker 2: said that it's time for listener mail, I'm going to.
• 48:37
  Speaker 4: Call this, uh, well, let's just call it listener mail.
• 48:42
  Speaker 1: Hey guys, one day I will write the email that
• 48:44
  Speaker 1: I've been formulating in my mind for years, trying to
• 48:46
  Speaker 1: put into words, but the show is meant to me.
• 48:49
  Speaker 1: I'm tearing up just writing that sentence, which provides you
• 48:52
  Speaker 1: with a hint of why that email hasn't been written yet.
• 48:55
  Speaker 1: In the meantime, I want to let you know that
• 48:57
  Speaker 1: both of your names are listed on my Big Thanks
• 49:00
  Speaker 1: to portion of my bachelor thesis. It's customary in my
• 49:04
  Speaker 1: country to thank your college coach for their support during
• 49:07
  Speaker 1: your graduation year and.
• 49:08
  Speaker 4: Your thesis forward.
• 49:10
  Speaker 1: I have felt it was only right to also thank
• 49:12
  Speaker 1: the other people have supported me to the same extent
• 49:15
  Speaker 1: as my coach and this includes you, guys. I don't
• 49:18
  Speaker 1: feel the least bit dramatic when I say my thesis
• 49:20
  Speaker 1: would not have been written but wasn't for you guys
• 49:22
  Speaker 1: keeping me sane. That's what you've done for me over
• 49:24
  Speaker 1: the years, but this year I really needed it more
• 49:27
  Speaker 1: than ever. So thank you, all caps, double exclamations. I've
• 49:33
  Speaker 1: added a picture of my forward where your names are mentioned,
• 49:35
  Speaker 1: and since I'm Dutch, I'm afraid it won't make much
• 49:37
  Speaker 1: sense to you, but I figured it might bring you
• 49:39
  Speaker 1: some joy to see the proof.
• 49:40
  Speaker 2: There are some Rando jays scattered throughout those words.
• 49:44
  Speaker 1: Yeah, totally, and Chuck has a little null signed through it.
• 49:47
  Speaker 4: That's weird unless sure what that means.
• 49:49
  Speaker 2: It means your back.
• 49:50
  Speaker 4: That means it don't count.
• 49:52
  Speaker 1: And that is with much love and immense gratitude from Suzanne. Oh,
• 49:56
  Speaker 1: I'm going to do my best to here, Suzanne.
• 50:01
  Speaker 2: Let's hear it again.
• 50:04
  Speaker 4: Chris Silk sick. I like you, I s have you?
• 50:08
  Speaker 4: I JK if you like the second one.
• 50:10
  Speaker 2: Yeah, thank you, Susan. I'm gonna call her Suzanne. Thank
• 50:13
  Speaker 2: you very much. Suzanne. That was very kind of you.
• 50:16
  Speaker 2: Thank you for tearing up. I think you did just
• 50:18
  Speaker 2: write that email. If you ask me, don't you.
• 50:21
  Speaker 4: Chuck, I'm tearing up.
• 50:22
  Speaker 2: If you want to be like Suzanne and let us
• 50:25
  Speaker 2: know what we meant to you. We always love hearing
• 50:27
  Speaker 2: that kind of thing, or you can just write it
• 50:29
  Speaker 2: and say anything you want. We're at stuff Podcasts at
• 50:33
  Speaker 2: iHeartRadio dot com.
• 50:38
  Speaker 4: Stuff you Should Know is a production of iHeartRadio. For
• 50:41
  Speaker 4: more podcasts my heart Radio, visit the iHeartRadio app, Apple Podcasts,
• 50:45
  Speaker 4: or wherever you listen to your favorite shows.