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

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