Selects: BPD: The Worst Disorder or Not a Disorder at All? | STUFF YOU SHOULD KNOW

Hey, good morning everyone. This is. Chuck here on a Saturday with a curated. selection of one of my favorite. episodes. This is BPD colon the worst. disorder or not a disorder at all. This. is all about borderline personality. disorder and it's pretty fascinating. stuff and I hope you guys enjoy it. Welcome to Stuff You Should Know, a. production of iHeart Radio.

Hey, and welcome to the podcast. I'm. Josh and Chuck's here, too. It's just. the two of us, and that's cool, cuz this. is stuff you should know. >> Yeah, Jerry's got the week off and she. said, "Press on, dudes.". >> Yeah, party on, dudes. >> Party on, Wayne. >> Uh, that was also from Bill and Ted's. Excellent Adventure, wasn't it? Party. on. Oh, was it? >> I think so. I can see George Carlin.

saying it. >> Yeah, I'm probably wrong. >> I'm probably wrong. So, Chuck, we're talking today about. something we've kind of touched on. before, but when we touched on it, we. were like, well, this is something that. deserves its own episode for sure. >> Yeah, we're we're talking this is. another in our suite on uh mental health. conditions. And boy, we've got a lot of them, but we. still got more to go. >> Yeah, we do. >> You know, and I think these are.

important shows. And every time we do. these, I feel like we get good feedback. on people who who suffer from these. conditions and and say, "Thanks for uh. either educating me and or getting the. word out to people who may be a little. uh what's the word? Ignorant about some. of this stuff.". >> As Michael Jackson would have said, you're ignorant about this. >> What's that from? He just used that word. a lot. >> Oh, really? >> Yeah. But regardless, that has nothing. to do with anything. when you mentioned.

just now that um people like kind of. wrote in or write in when we do episodes. like this when we did our emotional pain. episode and we mentioned um borderline. personality disorder a lot of people. wrote in well I don't want to say a lot. but some people wrote in and they said. you know thank you for treating it. compassionately because when most people. talk about it they talk about it like. they despise it or they despise people. with BPD and the more you look into it. the more you realize like wow this is. may be one of the hardest um mental.

illnesses that you can possibly have. Uh. and I think we kind of said that in the. emotional pain episode, but if I didn't. know it before, I definitely do now. after doing this research. >> Yeah. And it's also clear that it's one. that somehow seems to garner the least. amount of empathy, >> right? >> Uh not only among just people who, you. know, may or may not know much about it, but even clinicians and therapists. uh. as that stuff you sent me like a lot of. times try to avoid uh or or severely.

limit the number of patients they have. that they treat with BPD. >> uh which makes it even more sad because. it is a really tough one. Um, I guess. we'll just define it kind of off the bat. and you know, a lot of this episode will. kind of be defining it in different ways. because it's it's fairly complex, but it. is a what's known as a cluster B. personality disorder. >> Uh, which is in the antisocial. personality disorder category along with.

histrionic personality disorder and. narcissistic uh, personality. I'm just. going to start saying PD. >> Yeah, PD's. it will make it sound like. you know you're talking about even more. >> narcissistic PD but um it seems like a. lot of what it can be is sometimes a. disorder of perception. uh and while there are very real things. that that do um that can trigger people. with BPD um a lot of times it's the way. things are perceived incorrectly either.

about themselves or about others or. others actions. >> Yeah. And I saw um a lot of people. confuse um borderline personality. disorder with bipolar or at least think. they're similar, I guess, because they. both start with B's or something like. that. But no, they're not similar. Bipolar has much more of a um a brain. and central nervous system basis. Whereas while um borderline personality. disorder has a a component of that the. executive function of the person in. their prefrontal cortex either didn't.

develop in in a fully normal way or it. um it's not functioning uh up to snuff. I guess. >> more than anything and the thing that. differentiates it from bipolar is it's a. an um an assignment of meaning. It's. psychological as much if not more than. it is um physiological. >> Yeah. And also bipolar is characterized. and we we did a a good episode on that. quite a while ago, but um it's.

characterized by like these highs and. lows. >> and then in between those periods they. can be relatively stable. Uh whereas. with b uh borderline personality. disorder, it's it's sort of always. there. Um, this one thing you sent me. had to really kind of really nail it on. the head at the end. Those with bipolar. may have a hair trigger kind of response. during an episode, >> whereas when you have borderline PD, you. have a hair trigger response all of the. time. And I can't imagine how tough that.

must be. >> Yeah. So, that that kind of um calls out. one of the big hallmarks of BPD, which. is um it's emotional dysregulation. >> Yeah. >> Things that would affect other people. a. little bit, maybe not at all. Stuff that. most people that let roll off their. back, >> right? >> Could set somebody uh with BPD off into. a rage that could last days potentially. >> Um they also might use self harm. >> um what's called non-suicidal.

self-injury. >> uh to kind of externalize the pain. because they're the emotional. dysregulation is so profound. They don't. know what they're feeling. They just. know they're feeling everything all at. once. And it's kind of like standing in. a in an ocean and a huge wave hits you. >> and you're just you're as profoundly. enveloped by emotion at that moment as. you are when a by a wave when it just. completely knocks you off your feet and.

sweeps you away. >> Yeah. There was another um and we'll. talk about her in great detail. Her name. is Marca uh Linhan. >> or is it Linhan? >> I'm going to go with Lahan. Yeah, she, as we'll see, is a uh someone who not. only suffered from BPD, but um kind of. pioneered the the treatment uh of BPD, but she said it's like having thirdderee. burns on 90% of your body uh. metaphorically. So, you're lacking. emotional skin and you feel agony at the.

slightest touch or movement. Mhm. >> Um, and since you did mention self harm, uh, non-suicidal self harm, it also, uh, people with BPD have a suicide rate of, was it like 50 times higher than average. in the population. >> Mhm. >> Yeah. So, this is, um, this is no joke. This is a very hardcore disorder that. bears more empathy and understanding. >> Yeah, for sure. Let's let's uh go back.

to the beginning, shall we? Because. borderline personality disorder is one. of those terms that has taken on its own. meaning in the general population, but. if you stop and think about it, it. doesn't really reveal much about what. it's describing. It's just one of those, you know, frustratingly so. >> Yeah. And that goes back to a jerk named. Adolf Stern who really jerked it up back. in 1938. >> Yeah. He was a psychoanalyst and he. basically. I mean if you if you didn't know what it.

was and I didn't even fully know what it. was. I always wondered what borderline. meant and it very simply meant and means. uh this is Stern saying you're you're. not quite on the psychotic level and. you're not quite uh psychonurotic. Uh. you're basically on the border between. those conditions while encompassing a. bit of each. So we're just going to call. it borderline. >> Yeah. And psychosis is what we would. still consider psychosis, but under. psychoanalysis, um, psychonurosis is what we call like.

anxiety, depression, that those kinds of. mental illnesses. So, I guess Adolf. Stern wasn't really that big of a jerk. because he really kind of did combine. them appropriately. >> It was Otto Kernberg who was the serious. jerk in this in this situation. >> Okay, so he was a psychoanalyst in the. mid 1970s. So that's, you know, like 40 something. years later. >> And um he described it as an unstable. personality and disorganized conception.

of the self. And this is just when it. was sort of starting to become more and. more um kind of talked about and. officially I think 5 years after that. was uh in the DSM version three. >> Yeah. I mean, that's pretty quick for. something you just started to identify. and five years later makes it in the DSM. because they don't churn those DSMs out. like, you know, every few months. It. takes years to put one together. So, Kernberg seemed to have stumbled onto. something that was worth um looking at. very very um very quickly.

>> Yeah. And isn't there a a sort of. movement or belief now that it's a lot. of people think it's something that it's. like a diagnosis you shouldn't even. give, right? >> Yeah. There's we'll talk about that. I. think we can kind of pepper it. throughout, you know. Okay. But I but. yes, there is um a school of thought. that basically says BPD is not a. personality disorder. It's not even a. mood disorder. Although some people say. it would better be characterized as a.

mood disorder. They say it's it's a. cluster of symptoms that overlap with a. bunch of different actual disorders. >> And that the problem with that, you say, "What? Who cares? you're identifying. people, a group of people whose um rate. of suicide is 50 times the general. population. That alone is worth like. identifying and helping those people. out. >> But they're what they're saying is. number one, BPD has gotten such a bad. name in the general population that you. >> literally stigmatizing somebody when you.

give them that diagnosis. It is an. enormously. um heavy weight you put on somebody when. you say, "I am a trained psychiatrist. I. know what I'm talking about. And you. have borderline personality disorder. Everybody step back basically. >> Yeah. I mean, it's it's almost in line. with saying someone is a sociopath. >> It's different things, but as far as. like the stigma goes, >> very much so. Yeah, for sure. That's a. great analogy actually. So, so some. people are like, okay, it it's.

stigmatizing, but even more than that, just the science isn't necessarily. there. Like we were saying, it's a it's. symptoms rather than an actual disorder. And then apparently the working group. for personality disorders for the DSM5, that's the most recent one. >> They actually said um we're not sure. that this should be a categorical. disorder, which is the type that you. either have it or you don't. They they. suggested it should be dimensional, which means that it exists on a.

spectrum, >> right? >> So you can have a little bit of BPD, a. lot of BPD, or right in the middle or. whatever. um and that got rejected and. now so it's a categorical. um diagnosis where if you don't have BPD. you don't have BPD if you don't fit the. criteria if you do you got BPD. >> right and we'll talk about the criteria. in a second um but we do want to sort of. reintroduce Marsha Lahan who like I said. uh was a real pioneer for her work uh in.

the treatment and recognition of BPD. >> uh very late in her life um revealed. that she suffered from BPD uh after, you. know, patients and friends encouraged. her to come forward. Uh and she said. basically, you know, I'm going to do it. I'm not going to die a coward is what. she said. Um but for the longest time, uh was not out with that information. um. was born in Oklahoma uh in I guess the. 50s and in the 1960s in high school was. diagnosed with schizophrenia.

uh drugged up um given electroshock. hospitalized uh was in was was. practicing self harm uh of all kinds and. then had it sounds like a not a moment. of clarity but a pretty profound uh. religious experience. >> Yeah. The only thing missing was a visit. from St. Michael. pretty much I mean. she's Catholic and uh after this. religious experience she was able to uh.

which you know had a lot to do with. self-love but after this she was able to. still have these emotions that she had. before but managed it uh to the point. where she wasn't practicing self harm. and did she come up with the term. radical acceptance or did she just buy. into that? >> I don't know if that was a descriptor of. hers or not. >> Okay. I don't think she came up with. that but basically is you know radical. acceptance is like hey listen this is. how things are with me this is how. things are with the world uh I accept.

this and I'm not going to compare this. uh to what I think the reality should be. or what other people think it should be. >> There's a huge butt that follows that. though. But. >> but. um I am going to do what I can to change. those things about myself. >> Right? >> So that is the basis of um a type of. cognitive behavioral therapy that she. came up with called dialectical. behavioral therapy. And it is it's based.

in radical acceptance and the desire to. examine and change how you interact with. the world externally. And it's basically. the gold standard for treating um. borderline personality disorder right. now. >> Yeah. And it seems like it really works. I saw that it was um kind of the only. proven treatment to reduce um suicidal. behavior, >> which is, you know, the at the the tail. end of um what a lot of people. experience with BPD. And the good news,

and we'll we'll talk about treatment. later, but the good news is if if you. have BPD or know someone that does, you. can get better. And they have they have. proven and shown time and time again now. that through the treatments that we'll. discuss later, it is it is absolutely. something that someone can get a hold of. in most cases, >> right? >> Which is great. >> It is great. I mean like as for as as. bad of a stigma as BPD has, the idea. that like it has a very high success.

rate of treatment is pretty encouraging. >> Yeah. >> So, um, Lahan's basis of of or her. understanding or her definition of. borderline personality disorder is that. it it's bioscial that people who have. BPD are either genetically or. biologically predisposed. to having BPD. But not everybody who has. that predisposition is going to be. triggered into developing BPD. It takes. basically a a biological substrate for.

BPD. Usually your prefrontal cortex. hasn't developed in a certain way and so. your executive function isn't. functioning like an executive should. >> That gets joined together with a. trigger. um usually mistreatment uh. whether it's abuse, neglect, invalidation by your parents as a kid. and you put those things together and. very often it results in what you be. diagnosed with later as BPD.

>> Yeah. And man, one thing I really took. away from this and this is something. that you know Emily and I and and most. parents that I know our way into is uh. boy, you got to validate your kids. >> Yeah. That's new, which is crazy. But. it's it's. >> you Yeah. You got to validate their. emotions and validate their experiences. and their feelings. >> Even if it's something that you don't. think is uh. uh like has the most relevance or. whatever, or even if like the kid is. wrong about something or like. emotionally wrong, like you still have.

to validate that and then talk them. through it. What you can't do is just. discount a kid's feelings cuz that. that's like telling them that their. truth isn't real and that's damaging. >> I know. And doing parenting right sounds. like a waking nightmare to me. >> Doing what? Parenting right? >> Parenting correctly. Yeah. >> No, >> I can't imagine the exhaustion along. combined with the fear of just. misststepping once or twice and then. there you go. You screwed your kid up.

for life. >> Yeah. What you got to do is in my. experience is like you can't beat. yourself up too much because parenting. fails. You can really go down a rabbit. hole of your own. >> I'll bet. >> depression if you if you screw up. Uh. and you can't do that because kids are. resilient and you just got to like you. got to prove to them that you can like. pick yourself up and move on and do. better, you know. >> Yeah. And I I I don't think Lahan's um. idea is that it just takes one or two.

missteps. It takes like a parent who is. a genuinely bad parent. Very frequently. they have BPD themselves. Yeah. >> And um that is a real challenge to. parenting well in and of itself. But you. don't have to have had a a parent with. BPD to develop BPD. But typically it's a. a parent that is not at all meeting your. needs, >> especially emotionally. And um I say we. take a break and we'll come back and. talk about how you would be diagnosed. with BPD. What do you think? >> Let's do it.

Okay, Chuck. So, we said that BPD is in. the DSM5. It's a personality disorder. And just to differentiate real quick, a. mood disorder um describes patterns in.

in feelings like you have mood swings in. that um you know highs and lows and it's. pretty reliable that you're going to. have it one way or another. Personality. disorder focuses more on how you relate. to others. And that definitely makes. sense to me that you would consider BPD. a personality disorder then. Yeah, that. seems to be a really key thing is uh. that it's a it's it really disturbs your. relationships. >> Mhm. >> Um so, uh to be diagnosed, you fit at.

least five out of the following nine. that we're going to read for you. Uh. chronic feelings of emptiness, >> and that's emptiness, feeling like. isolated or lonely or hopeless. >> Sure. Um emotional instability uh and. reaction to day-to-day events. Um, that's the thing we were talking about. earlier, like u saying mountains out of. mole hills seems slightly reductive, but. that's kind of a basic way to say it. >> Okay. >> Uh, frantic efforts to avoid. abandonment, uh, whether or not they're.

real or imagined. >> Each one, >> yeah, as we'll see, abandonment issues. and and this very very much includes. emotional abandonment, uh, is a really. big, um, precursor. >> Yeah. >> Uh, unstable self-image or sense of. self. Uh what else? >> Um impulsive behavior is usually a big. one and you have to have impulsive. behavior in at least two areas that are. um harming your day-to-day life. >> like an eating disorder and gambling.

addiction or something like that, >> right? Um, another one is this is based. on and so this is where some. psychiatrists would be like see this is. not this is this is a symptom that we're. talking about here but it's um unstable. and intense interpersonal relationships. >> meaning like you're really really close. to somebody for you know a couple of. days and then they do something you. don't like and they're the worst person. in the world. >> and it can happen very very quickly with. people with BPD. Um, and if you stick.

around and stay in that person's life, you can find yourself walking on. eggshells very quickly because you don't. want them to turn on you all of a. sudden, right? >> Um, so that's a huge one. If you have a. lot of unstable, intense relationships. with people, that's just kind of the MO. That is usually a big giveaway with with. BPD. >> Yeah. Um, the last three, uh, recurrent. suicidal or selfharming behaviors. We've. talked about that a little bit. um stress related paranoia or.

dissociative symptoms like feeling like. the self or the world isn't real. >> Yeah. >> Uh that's it feels like that's probably. at the far end of the spectrum or the. most severe end. >> Uh and then one we u missed earlier was. uh inappropriate and intense anger or. difficulty controlling anger. >> Well, I didn't miss it. That was. purposeful. >> Okay. >> Wanted to end with that big one. >> Okay. All right. Speak to it. Well, there's a lot of um I I always hate. saying those qualifiers. It's just so. easy to say, but I think it perks.

people's ears up like, "Oh, this person. doesn't know what they're talking. about." So, let me rephrase that. I have. seen that there are schools of thought. regarding borderline personality. disorder that it is a a rage. response to trauma. >> Okay? >> That that is your response to unresolved. trauma. It's how you learn to deal with. those feelings and those emotions is to. rage at people because rage is as much a. hallmark of BPD as fear of abandonment. is. >> Right.

>> And um that's why some people are. critical of including it as a. categorical diagnosis in the DSM5. They're saying you're pathizing rage. No, you just need to teach people how to. identify their emotions and how to. express them in a more appropriate, less. hostile manner. And then that's how you. would treat somebody with BPD or not. even with BPD, somebody with a rage. disorder. But some people think that. that is what what people are mistaking. for BPD. >> Oh, I gotcha. Okay. Interesting. Uh.

you're going to to be diagnosed, like I. said, five of those nine. Um it'll. probably be, you know, like you'll be. talking to a psychologist or or someone. in an interview. You might fill out a. questionnaire or something. >> Interesting. >> They may click click click click. uh or. they may speak to your family or. something like that. Uh it can be. difficult to diagnose. Um and there like. you said there's there's a lot of. overlap between you know things like. anxiety and depression and things like.

PTSD and eating disorders, a lot of. comorbidities. So I get why people. can have issues with like this diagnosis. rather than it's like a cluster of. symptoms of other things. But I don't. know if you group that all together then. it and call it its own thing then I. don't know. I'm not sure I see the harm. in that. >> Uh again I think it's the stigma and. then also it might be distracting from. treating the other underlying stuff. >> Maybe because they there also isn't and.

we'll talk about um pharmaceuticals but. there isn't a specific pharmaceutical. for BPD. >> That's another clue that some people. point to that it's not it's it's it's. we're mistaking it somehow. And I don't. want to like overstate the um that. school of thought. It is widely. considered like a an accepted um. diagnosis, right? >> Borderline personality disorder is. So I. don't want to make it seem like oh the. cracks are in the facade. It's about to. chromal any day. Now my point is.

>> people make some pretty good um points. about how well we understand it or how. well we're defining it and we're. possibly missing some component of it. Yeah. And isn't that stuff debate. usually. or I guess it should be and I hope it's. couched in how to best treat people and. help people, right? >> Yes. >> Rather than just like poo pooing ideas. >> Yeah. No, I I think that's exactly. right. But I mean again, if we come to. this place where even if if a BPD is the.

center of a giant vin diagram of a bunch. of different disorders. >> Yeah. Yeah. >> And we're mistaking that center overlap. of all of them as its own thing. >> If you if you zero in on that group and. they have a 50 50 times higher rate of. suicide than the general population, again, yeah, >> that is worth zeroing in on, you know, as its own thing. And like you said, um. dialectical behavior uh therapy is. focused initially on individual sessions.

that are that are that are aimed to. control that that behavior. Suicidality. >> Yeah. Yeah, for sure. Um, you did. mention earlier as far as causes go that. sometimes there is a genetic link. Um, but it seems that it's not really the. disorder that is like maybe passed from. parent to child, but some of those. traits and maybe that's because it is. sort of a cluster. Um, sometimes you. can, you know, you can have BPD and come.

from like, uh, a pretty good, you know, um, stable upbringing, but that seems to. be the outlier. And it seems to be that. like most people that end up suffering. from this had a pretty lousy childhood. >> Yeah. So, they were either neglected or. just kind of um saddled with emotionally. unavailable parents who just weren't. really there for them. Didn't go to. their dance recital kind of thing. >> Never went to single one. >> Um excessive control.

>> I It sounds very Freudian, but I saw one. um classic example is a an absent father. and an a doineering mother, and it's. like how many times have you guys. trotted that one out? But apparently it. really does have a screwy effect on. people as a kid. >> Um, and then also if your parents um or. parent had a mood disorder themsel or um. misused substances that would probably. have affected their parenting as well.

>> Yeah, it this also made me think about. like parenting of old versus parenting. now. and and parents can there there are. still of course a huge uh range of bad. parents these days. I'm not saying that. everyone's doing it right now, >> but it definitely seems like things. turned a corner and parents are trying a. lot harder these days and like sort of. the old days of like, oh, you know, kids. raise themselves and you can ignore them. and blah blah blah. And like I'm sure.

that I mean I know that still happens. but it just seems like that happened a. lot more. >> back in the day and and maybe in the. future things like this will be less and. less. >> Yeah, that's the hope for sure. I know. that's sort of a basic uh sort of an. elementary way of looking at it, but I. just feel like parents are more aware of. stuff these days and. >> like you know people of our generation. and certainly the generations before. that was even worse as far as parental. involvement and parents who either one. or the other you know fathers a lot of.

times you know historically the ones. that were like no we're we're not going. to parent because we're doing the work. and we're going to bring home the. paycheck and. >> so uh like I had a I've talked about it. before I had a dad that wasn't very. involved, but it it wasn't like the kind. of thing where he I ended up with BPD. because of it, you know. >> Yeah, for sure. >> If that makes sense. >> You raised a question though in my mind. I wonder what percentage of boomer. grandparents are allowed to see their. grandchildren.

>> I'll bet it's higher than you'd think. >> Are allowed to or not? >> Are not allowed to like just don't have. contact with their grandkids. >> Yeah. Or it's very limited and. supervised. And so actually though a lot. of those grandparents all of a sudden. are the most doing. >> and it's kind of like I know some. parents are like oh okay well this is. great where was that when I was a kid. >> right yeah for sure but also I' I think. in some of cases the the more they don't. they're actually also undermining the. parenting of their kids under their.

>> Yes. and imagine it can be very painful. for a parent who had a unattentive. parent to now have that parent be a very. intentive grandparent. >> If you have BPD, I would guess that. would be a rageinducing trigger. >> I imagine it would be. >> So, um, there are plenty of other ways. that you could probably develop BPD. Another very classic one is any kind of. abuse, emotional, sexual, physical. abuse, at the hands of your parent or a. caregiver. Um, and they say that about.

80% of people with BPD experienced some. level of childhood trauma, whether it. was emotional neglect, um, or some sort. of abuse. It is a it's a huge factor, a. huge risk factor in developing BPD. For. sure. >> Yeah, absolutely. Uh, and it it seems to. be exacerbated if you're a kid who is um. maybe you're just innately a little more. unsure of yourself or a little more. vulnerable as a person and then that is.

reinforced with a parent who is not uh. validating your experience and your. emotion as a kid. So, you're you're. already starting back sort of behind the. eightball and then your parents are. making it worse and uh so that can. definitely you know ease you toward that. condition. Well, it's like a that's a. chicken or the egg question though. Like. were you like that, you know, already. and your parents just reinforcing it or. did you get that kind of did you learn. to do that because of your parents. behavior? It's like a not chicken or the. egg but parent or the disorder,

>> right? >> You know, but we said earlier that. there's also believed to be a biological. component to it too that it's not all. psychological and it does seem to um. have something to do with executive. function in the brain. One of the big. things that executive functioning does. is it helps you control your emotions. Not just in accepting things and dealing. with them and moving on, but also your. outward display of emotions. Um, if you.

don't have executive function, your. emotional dysregulation uh is more. likely to include explosions of anger, uncontrollable anger. Um, and then one. of the thing, it's not just BPD that has. that. There's plenty of other um. disorders that have it, but one of the. one of the key traits of BPD is it can. last a really long time, too. >> Can we make a t-shirt that has a chicken. that says parent across the chicken's. chest.

>> and then next to an egg that says mental. disorder. >> Love it. >> And just that's the shirt. No. explanation. Figure it out or don't. >> How about this though? On the back of. the shirt, Mor is coming out of the egg. >> Okay. >> All right. To really confuse people. >> Uh-huh. >> Yep. >> Oh, wow. That just really changed. things. I like it. >> Okay. >> So, as far as the number of people who. experience BPD, um it's kind of a wide. range like all this stuff because it's. one of those disorders that is uh a lot.

of people don't admit it or seek. treatment. So, it's really hard to to. nail it down. But um Livia helped us out. with this one and she said.5% to 6% um. and they find it about four times more. in women. But they've also found other. studies are like no it's the women who. are brave enough to come forward and. seek treatment and it happens just as. much in men. I also saw that it's a um. that's an indictment of clinicians who. um basically have to figure out for. themselves whether the person has BPD.

and that they're more likely to assign. it to a woman than a a man, a male. patient. >> Oh, interesting. >> Yeah. So, regardless, it is very. frequently diagnosed more than you would. think. It's one of the more common. serious mental illnesses. Apparently um. people receiving impatient mental health. treatment uh one in five of those people. are diagnosed with BPD. So it is very. prevalent at least in inside the the the. clink. >> Yeah.

>> The mental clink. >> Yeah. The mental clink. Um one other. aspect is um a very black and white. thinking. Um you kind of talked before. about uh splitting which is um you know. really revering and idolizing somebody. and then very quickly despising them. >> Uh and this can happen very very. frequently and like several times. throughout a day even or it can be like. just a switch that is permanent. Um like. someone you used to really like and. idolize all of a sudden it just no more.

You despise them and they're they're on. the the bad person list forever. >> Yeah. And that's that falls under the. larger category of black and white. thinking. It's not just applied to. people. It's right events, things, anything. A dandelion can be entirely. evil or the the fully good. >> And because you see things and people. and events as entirely one way or the. other, >> you set people up for unrealistic. expectations. If you're like you're 100%.

pure and kind person and I love you, that person is inevitably going to let. you down in some way, shape or form. because no one's 100% pure and kind. Similarly, no one's 100% evil. >> Uh and most people that uh you would. label evil as if you have BPD probably. aren't evil at all. They just did. something you really didn't like. But. now to you, that person is evil. not not. to be trusted, not um you know, they did. something wrong. At their core, they're.

evil. And that's another huge um. hallmark of BPD as well. >> Yeah. I mean, even Darth Vader was was. once a young boy. >> Yeah. >> Just trying to learn the ways of the. force. >> But boy, did he get pale as he aged. >> Uh he sure did. Um this can also this. splitting can happen uh with yourself. um you you may vacasillate wildly from. feeling like you're you're okay and that. you feel good about yourself and you. have a little bit of self-confidence to.

really loathing yourself and um that's. when like things like you know self harm. can come into play. Um your sense of. your own personality can really change. uh you're you know you could very much. switch like kind of do these wild. switches between um your goals in life. or or how you want to present yourself. to the world or like your values and. ethics and things like that. And it this. I'm not really sure but it kind of seems. like almost like uh. sort of auditioning yourself kind of.

over and over sometimes like oh let me. let me try this new me or whatever or. auditioning or trying out a new thing. that you think might help. Um, >> does that make sense? >> Yeah. No, totally. It's also. circumstantial, too. They might act. different ways to different people. depending on what they think those. people want from them. >> Um, or yes, to impress like a a friend. or a new person or something like that. They might adopt that person's um like. hobbies and interests. But I saw it.

explained as um people who have BPD and. do that that they they don't understand. where they end or the other person. begins because. >> they have no idea what they believe in. They just don't know. So they're kind of. open for suggestions basically. >> Interesting. >> Yeah. >> Um should we take a break? >> Oh jeez, that came out of left field. >> Sorry. >> Sure. >> All right. All right, I think it's a. good time to take a break and then we're. going to come back and talk more about. uh personal relationships.

All right. Uh we're back and talking. about um borderline personality. disorder. And one kind of hallmark um. with someone with BPD is.

what's called like a favorite person or. just a a person in their life that they. have um have not necessarily even chosen. who they've hooked up with. Could be a. spouse. It could be a partner. It could. be a friend or co-orker. Anyone that you. really have latched on to as someone. maybe the only person that you really. really trust with yourself. >> Yeah. And I don't think you even trust. that person. You just that's the person. you've come to find you can lean on the.

most, I think. >> Okay. >> But yeah, the FP for those in the know, the favorite person um is very. frequently. somebody who. is willing to kind of go along with this. at least for a while. There's a ton of. flattery and admiration and praise and. all of your greatest points are pointed. out all the time. >> Um, but you're also in real danger of. letting that person down and facing that.

wrath of rage or anger or hostility. Um, and if you come back for more, you're. going to find that you as the favorite. person might start altering your. behavior to fit the person with BPD's. behavior. So, you might start. considering them when you're making. plans like, "Oh, we can't go out of town. this weekend because um this our friend. with BPD was going to, you know, wanted. us to to come out for their Sunday. picnic or something like that, right?". Like, you would be afraid to not go to.

their picnic. Um, and you generally end. up feeling like you're walking on. eggshells. And it's a codependent. relationship that evolves. Um, the. favorite person seems to be the person. who's willing to take it the longest or. the most. And that it's not a permanent. thing. Typically, people get burned out. on it and eventually abandon the person. with BPD, which is again at the root of. what they're fearful of. They're fearful. of rejection or abandonment. Mhm. >> The the tragedy of the whole thing is.

that their behavior almost inevitably. guarantees that they will be rejected or. abandoned by the people around them. >> Yeah. That sort of self-fulfilling. feedback loop. >> Um yeah, I mean it's it's a it's a big. burden for an FP. Um and if you are a. spouse or partner of someone and you are. the FP, like that's a lot to manage. And. so a lot of empathy goes out to those. people as well. uh when you're altering. your own behaviors, like literally. things like I saw people are like, you.

know, I had to I've had to step out of. like really important meetings just to. answer a text within 10 minutes because. I knew that that would set them off. And. just little things like that can really. add up um to someone's burden. >> Um one of the other things that uh is. difficult to deal with when you're an FP. is uh that person wants you all to. themsel. They're threatened very much by. other people. So, they will try to. isolate you from your other friends and.

your family so that they have you all to. themselves. Not just for time. I'm sure. time is a big part of it, but also to. cut down on any um I guess rational. explanation or rational points from. those other people like what are you. doing? Why are you putting up with this? Um isolating them would help cut down on. that too. >> Yeah. And you know, if you're an FP, there's always the um sort of sad and. scary possibility that there could be a. split um incident that all of a sudden. you go from being the FP to being the.

most despised person. Um I I would. imagine that's something that has is. probably comes over time and is not like. a a quick thing. >> It can be. >> Uh but it can be. All right. >> For sure. It it can happen. It can turn. on a dime. >> Wow. And the other the other problem. with it as well, Chuck, is that um the. person with BPD almost invariably. immediately regrets doing that, right? >> And so they'll make every effort to try.

to win the person back, which probably. feels pretty gross for the FP. >> Um and they'll say things like, "I'll. never do that again." Like they know. what they've just done is worth. regretting, is worth feeling horrible. about because they've just been. abandoned or rejected. They just did it. to themselves. So now they're trying to. fix it or mend it, but it's all just. kind of built on, you know, shaky ground. because it's it's going to happen again. because it's impossible for that person. not to let the person with BPD down. again. >> Yeah. I mean, I get the impression that.

people with BPD generally don't have any. illusions about themselves. because it is such a struggle. Well, that is a big problem with not only. getting treatment, but seeking. treatment. Because when your brain is. structured in a certain way, and ever. since you were a little kid, you've just. responded a certain way to things, even. if people around you are telling you. that is messed up or that you're being. hostile or whatever, to you, that's. normal. That's natural. So, it's really, really hard to interrogate your own.

behavior, let alone change it, because. it seems normal and natural to you. It's. not that you need to change your. behavior because you you chase somebody. away. It's that that person left you and. now you need to go get them back. Um, so. even if you have people around you. telling you it's going to take a lot of. emphasis, repeated. >> constant emphasis that what you're doing. right now is abnormal and harmful and. you need to go get help for this. Um,

that's yeah, that's one of the curses of. it. They can't see it. They at least if. they can see it, most of the time they. can't. Well, and this is I mean all the. mental health disorders require a. support system, but this one really. seems to to sort of be at the top of the. list of needing a really solid uh vast. support system. >> Um for treatment, uh like we said, the. good news is is that treatment um works. Um they used to think that personality. disorders were uh untreatable and that.

you were just kind of stuck with it. um. they have found that um about half the. people who are treated uh who seek. treatment and are treated no longer meet. the criteria after 5 to 10 years. Amazing. >> It doesn't mean that they're, you know, they're perfect and awesome and fixed. It means uh they can still have some. symptoms, but they have it under control. enough to where they don't meet that. five out of nine criteria. And that's. what it's really sort of about, I think, is managing. um something that that like you said.

that that you might have had since you. were like a baby. >> um to live a productive, you know, healthy life. >> Yeah. And that's kind of what you're. going to learn in DBT um which again is. the gold standard for treating uh BPD is. that you're going to be taught these. skills, how to deal with. >> disappointment, with um being let down, with somebody not responding to your. text. you're going to learn a different. set of skills on how to deal with that. both internally and externally. And one.

of the things that um that kind of. differentiates DBT from other kinds of. behavioral therapy uh is that there's. group sessions, but it's not a group. session that you know you've seen in a. movie like my niece Mila was in a movie. called No Exit and it featured a couple. of group sessions. I think you can still. see that on Netflix. >> I think so. >> But it's not like that. It's more almost. like a classroom instead and then people. get up and practice these skills in. front of others and with others, but.

it's not like a a group therapy session. in the traditional sense, but that's a. huge component of it is a is group work. >> Yeah. And it's, you know, if it sounds a. little bit like cognitive behavioral. therapy, it is sort of based on that in. part because it's a real and and I get. how it works. It seems like a real sort. of rubber meets the road practical ways. of learning new behaviors rather than um. and and therapy is is a huge part of it. But it's not just let's therapy and talk.

about your past until you're blue in the. face. It's like all right, we we we know. what's going on and we think we know. where it came from generally. Now, let's. really talk about putting this into. daily practice, like literally doing. things and having a checklist and and. putting stuff into practice, which I. think is just I mean, not only for DBT, but stuff like that is so it so speaks. to me as a a good way forward when you. have any kinds of problems. Um, because.

it's it's just a practical thing. It's. learning new behaviors. That's another. um criticism of of BPD as its own. disorder that DBT. can be used to treat all sorts of. different symptoms of all sorts of. different disorders. It just makes sense. like that. >> Yeah. No, for sure. But um there's also. another type of therapy that supposedly. works really well for DBT called. psychonamic therapy and it is talking. about what you went through as a child.

until you're blue in the face. But it's. more about relating to relating that to. how you deal with people in your current. life, people in situations. It's. relating it back to it so that it's not. just one big confusing blob. You. understand your own behavior better um. >> as a result of interrogating what you. went through as a kid. And I guess it. smells a lot like it it believes um. borderline is a a like a a a response to.

trauma using anger rather than anything. else. >> Yeah. I mean, if you can sort of build. out your emotional life map, I imagine. that's a very helpful thing to do, you. know. >> Yeah. And then one other thing that. really kind of underscores how difficult. dealing with people with borderline. personality disorder can be, one of the. main components of dialectical. behavioral therapy is um what's called a. therapist consultation team, >> which is basically a group of therapists.

working with patients with BPD. >> having like a a like a blowoff steam. session about them, right? and reminding. one another like these are people. suffering and we need to have empathy. for them. That's how hard it can be to. treat people with BPD. >> Yeah. And like I said at the beginning, there are therapists that will refuse. treatment because uh all the reasons. that we talked about, uh they say the. National Alliance on Mental Health. basically says if you have BPD and you.

recognize that and you want to seek. treatment, um whether it's, you know, DBT or any other kind, you uh well, first of all, seek out someone that. specializes in DBT. But if there's no. one in your area that does that, then. like you you have a right and this this. goes with any sort of emotional or. mental problems that anyone has, they're. working for you. So you have the right. to advocate for yourself and to find. somebody who works for you and who um. who will not stigmatize you and like.

really like it's okay to question them. and make sure it's a good fit for you. >> Yeah, for sure. I think people just I don't know. It's I. think part of the problems with a lot of. these disorders is people can't be. advocates for themselves and and that. might be part of their problem. So, they're not going to advocate for. themselves when receiving treatment and. they'll just take whatever they can get. and it's not all therapies are created. equal and therapists are created equal. >> Definitely not. I think one of the. problems with BPD is that they might.

over advocate for themselves. >> Oh. >> And like chase a therapist off. basically, >> right? But the the thing is, Chuck, is. like you said, people take what they can. get in part because there's a huge. shortage of um psychiatrists in. particular in the United States. >> and people will just take whoever can. get them in within a year or less. Um. like the waiting lists are crazy. >> It is crazy. Yeah. >> Well, if you want to know more about. BPD, uh there are a lot of articles and. resources all over the internet to help.

you. Um and uh since I said that, it's. time for listener mail. Uh, I'm going to call this. uh, well, let's just call it listener. mail. Hey guys, uh, one day I will write. the email that I've been formulating in. my mind for years, trying to put into. words what the show has meant to me. I'm. tearing up just writing that sentence, which provides you with a hint of why. that email hasn't been written yet. Wink. wink. >> Uh, in the meantime, I want to let you. know that uh, both of your names are.

listed on my big thanks to portion of my. bachelor thesis. Nice. >> Uh it's customary in my country to thank. your college coach for their support. during your graduation year and your. thesis forward. Um I have felt it was. only right to also thank the other. people who have supported me to the same. extent as my coach and this includes you. guys. Uh I don't feel the least bit. dramatic when I say my thesis would not. have been written if it wasn't for you. guys keeping me sane. It's what you've. done for me over the years. Uh but this. year I really needed it more than ever. So thank you. all caps, double.

exclamations. Uh, I've added a picture. of my forward where your names are. mentioned. And since I'm Dutch, I'm. afraid it won't make much sense to you, but I figured it might bring you some. joy to see the proof. >> There are some rando J's scattered. throughout those words. >> Yeah, totally. And uh, Chuck has a. little null sign through it. That's. weird. I'm not sure what that means. >> That means watch your back. >> That means I don't count. Uh, and that. is with much love and immense gratitude. from Suzanne. Uh, oh, I'm going to do my. best here, Suzanne. Uh, Chris.

>> Let's hear it again. >> Chrysilic. >> I like the. >> K R Y S W I J K. You like the second. one? Crystal. >> Yeah. Thank you, Suzanne. I'm going to. call her Suzanne. Thank you very much, Suzanne. That was very kind of you. Thank you for tearing up. Uh, I think. you did just write that email if you ask. me. Don't you, Chuck? >> I'm tearing up. Uh, if you want to be. like Suzanne and let us know what we. meant to you, we always love hearing. that kind of thing. Or you can just.

write in and say anything you want. We're at StuffPodcast at. iheartradio.com. Stuff you should know is a production of. iheartradio. For more podcasts, iMheart. Radio, visit the iheartradio app, Apple. podcasts, or wherever you listen to your. favorite shows.