WEBVTT - BPD: The Worst Disorder or Not a Disorder at All? 0:00:00.960 --> 0:00:03.880 Hey, everyone, Josh and Chuck here to remind you that 0:00:03.960 --> 0:00:06.480 our last three shows of the year. Boy, this is 0:00:06.519 --> 0:00:09.239 a good show this year are taking place very soon 0:00:09.280 --> 0:00:10.560 and tickets are still available. 0:00:10.800 --> 0:00:12.840 Yeah, so get in the saddle and come out and 0:00:12.840 --> 0:00:16.680 see us partners in Orlando, Atlanta, and Nashville. 0:00:17.120 --> 0:00:19.120 Just go to stuff youshould know dot com and click 0:00:19.200 --> 0:00:20.960 on the tour link and you can get all your 0:00:20.960 --> 0:00:25.840 tickets right there. Welcome to Stuff you Should Know, a 0:00:25.920 --> 0:00:31.680 production of iHeartRadio. 0:00:33.640 --> 0:00:36.280 Hey, and welcome to the podcast. I'm Josh and Chuck's 0:00:36.320 --> 0:00:38.840 here too. It's just the two of us, and that's 0:00:38.880 --> 0:00:40.920 cool because this is the stuff you should Know. 0:00:43.320 --> 0:00:48.080 Yeah, Jerry's got the week off and she said press on, dudes. Yeah, 0:00:48.479 --> 0:00:50.960 party party on Wayne. 0:00:52.640 --> 0:00:55.280 That was also from Bill and Ted's excellent Adventure. Wasn't 0:00:55.280 --> 0:00:56.360 it Party On? 0:00:56.480 --> 0:00:58.120 No? Was it? I think? 0:00:58.160 --> 0:01:00.480 So I can see George Carlin say it. 0:01:01.080 --> 0:01:02.400 Yeah, I'm probably wrong. 0:01:02.680 --> 0:01:06.880 I'm probably wrong. So, Chuck, we're talking today about something 0:01:06.880 --> 0:01:09.520 we've kind of touched on before. But when we touched 0:01:09.560 --> 0:01:12.840 on it, we're like, this is something that deserves its 0:01:12.880 --> 0:01:14.160 own episode for sure. 0:01:15.000 --> 0:01:19.319 Yeah, we're talking. This is another in our suite on 0:01:20.160 --> 0:01:24.520 mental health. Conditions, and boy, we've got a lot of them, 0:01:24.520 --> 0:01:27.160 but we still got more to go. Yeah, we do, 0:01:27.560 --> 0:01:29.760 you know, and I think these are important shows, and 0:01:29.760 --> 0:01:31.679 every time we do these, I feel like we get 0:01:31.720 --> 0:01:35.760 good feedback on people who suffer from these conditions and 0:01:36.360 --> 0:01:40.440 say thanks for either educating me and or getting the 0:01:40.440 --> 0:01:42.920 word out to people who may be a little, uh, 0:01:43.360 --> 0:01:45.679 what's the word ignorant about some of the stuff. 0:01:46.440 --> 0:01:49.360 As Michael Jackson would have said, you're ignorant about this? 0:01:50.640 --> 0:01:51.240 What's that from? 0:01:51.920 --> 0:01:53.440 He just used that word a lot. 0:01:53.880 --> 0:01:55.640 Oh really, yeah, But. 0:01:55.680 --> 0:01:58.240 Regardless, that has nothing to do with anything. When you 0:01:58.360 --> 0:02:02.440 mentioned just now that people like kind of wrote in 0:02:02.520 --> 0:02:04.920 or write in when we do episodes like this, Well, 0:02:04.960 --> 0:02:08.320 we did our emotional pain episode and we mentioned a 0:02:08.440 --> 0:02:11.960 borderline personality disorder. A lot of people wrote in. Well, 0:02:12.000 --> 0:02:13.360 I don't want to say a lot, but some people 0:02:13.360 --> 0:02:15.160 wrote in and they said, you know, thank you for 0:02:15.200 --> 0:02:18.560 treating it compassionately, because when most people talk about it, 0:02:18.600 --> 0:02:21.639 they talk about it like they despise it, or they 0:02:21.680 --> 0:02:24.720 despise people with BPD. And the more you look into 0:02:24.760 --> 0:02:27.680 the more you realize, like, wow, this is maybe one 0:02:27.760 --> 0:02:32.040 of the hardest mental illnesses that you can possibly have, 0:02:32.760 --> 0:02:34.280 and I think we kind of said that in the 0:02:34.360 --> 0:02:37.200 Emotional Pain episode, but if I didn't know it before, 0:02:37.240 --> 0:02:39.399 I definitely do now after doing this research. 0:02:40.080 --> 0:02:43.600 Yeah, and it's also clear that it's one that somehow 0:02:44.000 --> 0:02:48.160 seems to garner the least amount of empathy, right, not 0:02:48.200 --> 0:02:51.200 only among just people who you know, may or may 0:02:51.240 --> 0:02:55.560 not know much about it, but even clinicians and therapists 0:02:55.360 --> 0:02:57.280 as that stuff you sent me like a lot of 0:02:57.280 --> 0:03:01.320 times try to avoid or severely limit the number of 0:03:01.320 --> 0:03:04.800 patients that they have that they treat with BPD, which 0:03:04.840 --> 0:03:08.280 makes it even more sad because it is a really 0:03:08.280 --> 0:03:11.360 tough one. I guess we'll just define it kind of 0:03:11.360 --> 0:03:13.800 off the bat, and you know, a lot of this 0:03:13.880 --> 0:03:16.520 episode will kind of be defining it in different ways 0:03:17.000 --> 0:03:20.400 because it's fairly complex. But it is a what's known 0:03:20.400 --> 0:03:25.120 as a cluster B personality disorder, which is in the 0:03:25.280 --> 0:03:30.400 anti social personality disorder category along with historyonic personality disorder 0:03:30.440 --> 0:03:32.720 and narcissistic personality. 0:03:33.040 --> 0:03:34.800 I'm just gonna start saying PD. 0:03:35.240 --> 0:03:37.840 Yeah, PDS. It will make it sound like, you know, 0:03:37.920 --> 0:03:38.840 you're talking about. 0:03:38.640 --> 0:03:43.480 Yet more narcissistic PD, but it seems like a lot 0:03:43.480 --> 0:03:46.880 of what it can be is sometimes a disorder of perception. 0:03:48.320 --> 0:03:52.320 And while there are very real things that do that 0:03:52.400 --> 0:03:56.480 can trigger people with BPD, a lot of times the 0:03:56.520 --> 0:03:59.760 way things are perceived incorrectly, either about themselves or about 0:03:59.800 --> 0:04:01.320 other or others actions. 0:04:01.760 --> 0:04:06.200 Yeah, and I saw a lot of people confuse borderline 0:04:06.240 --> 0:04:10.040 personality disorder with bipolar, or at least think they're similar. 0:04:10.480 --> 0:04:12.840 I guess because they got start with bees or something 0:04:12.920 --> 0:04:15.680 like that. But no, they're not similar. Bipolar has much 0:04:15.720 --> 0:04:20.760 more of a brain and central nervous system basis, whereas 0:04:20.839 --> 0:04:25.880 while borderline personality disorder has a component of that, the 0:04:26.120 --> 0:04:30.400 executive function of the person in their prefrontal cortex either 0:04:30.920 --> 0:04:35.640 didn't develop in a fully normal way or it's not 0:04:35.800 --> 0:04:39.880 functioning up to snuff, I guess, more than anything. And 0:04:39.880 --> 0:04:43.040 the thing that differentiates it from bipolar is it's an 0:04:44.160 --> 0:04:48.760 assignment of meaning it's psychological as much, if not more 0:04:48.839 --> 0:04:50.960 than it is physiological. 0:04:51.680 --> 0:04:52.040 Yeah. 0:04:52.160 --> 0:04:56.400 And also bipolar is characterized, and we did a good 0:04:56.440 --> 0:04:59.640 episode on that quite a while ago, but it's characterized 0:04:59.720 --> 0:05:03.039 by like these highs and lows, and then in between 0:05:03.080 --> 0:05:09.479 those periods they can be relatively stable, whereas with borderline 0:05:09.520 --> 0:05:13.600 personality disorder it's sort of always there. This one thing 0:05:13.640 --> 0:05:16.200 you sent me had to really kind of really nail 0:05:16.240 --> 0:05:18.640 it on the head at the end. Those with bipolar 0:05:18.640 --> 0:05:21.159 may have a hair trigger kind of response during an episode, 0:05:21.640 --> 0:05:24.479 whereas when you have a borderline PD, you have a 0:05:24.480 --> 0:05:27.320 hair trigger response all of the time. And I can't 0:05:27.360 --> 0:05:28.760 imagine how sup that must be. 0:05:29.000 --> 0:05:32.120 Yeah, so that kind of calls out one of the 0:05:32.160 --> 0:05:39.120 big hallmarks of BPD, which is it's emotional dysregulation. Yeah, 0:05:39.240 --> 0:05:43.679 things that would affect other people a little bit, maybe 0:05:43.720 --> 0:05:46.000 not at all. Stuff that most people that roll off 0:05:46.040 --> 0:05:50.440 of their back right could set somebody with BPD off 0:05:50.440 --> 0:05:52.880 into a rage that could last days. 0:05:53.080 --> 0:05:53.719 Potentially. 0:05:54.680 --> 0:05:59.240 They also might use self harm it's called non suicidal 0:05:59.320 --> 0:06:05.000 self injury to kind of externalize the pain because the 0:06:05.800 --> 0:06:10.359 emotional dysregulation is so profound, they don't know what they're feeling. 0:06:10.880 --> 0:06:13.839 They just know they're feeling everything all at once. And 0:06:13.880 --> 0:06:17.200 it's kind of like standing in an ocean and a 0:06:17.320 --> 0:06:21.800 huge wave hits you, and you're just you're as profoundly 0:06:22.120 --> 0:06:26.320 enveloped by emotion at that moment as you are by 0:06:26.360 --> 0:06:28.320 a wave when it just completely knocks you off for 0:06:28.360 --> 0:06:29.480 feet and sweeps you away. 0:06:30.320 --> 0:06:33.159 Yeah, there was another and we'll talk about her in 0:06:33.200 --> 0:06:36.919 great detail. Her name is Marcia Lenahan or is it 0:06:37.040 --> 0:06:37.520 line Han. 0:06:38.600 --> 0:06:39.760 I'm gonna go with Lenahan. 0:06:40.600 --> 0:06:44.640 Yeah, she as we'll see as someone who not only 0:06:44.640 --> 0:06:49.880 suffered from BPD but kind of pioneered the treatment of BPD. 0:06:50.080 --> 0:06:52.880 But she said, it's like having third degree burns on 0:06:53.000 --> 0:06:58.039 ninety percent of your body metaphorically, So you're lacking emotional skin, 0:06:58.520 --> 0:07:00.839 and you feel agony at the slightest touch er movement, 0:07:02.760 --> 0:07:07.800 and since you did mention self harm, non suicidal self harm. 0:07:07.800 --> 0:07:11.040 It also people with BPD have a suicide rate of 0:07:11.560 --> 0:07:15.600 was it like fifty times higher than average in the population. 0:07:16.600 --> 0:07:20.200 Yeah, so this is this is no joke. 0:07:20.280 --> 0:07:25.239 This is a very hardcore disorder that bears more empathy 0:07:25.280 --> 0:07:26.000 and understanding. 0:07:26.240 --> 0:07:29.720 Yeah, for sure. Let's go back to the beginning, shall we, 0:07:29.800 --> 0:07:33.600 Because borderline personality disorder is one of those terms that 0:07:34.160 --> 0:07:37.800 has taken on its own meaning in the general population, 0:07:38.280 --> 0:07:40.120 but if you stop and think about it, it doesn't 0:07:40.120 --> 0:07:43.800 really reveal much about what it's describing. It's just one 0:07:43.840 --> 0:07:47.240 of those not at all frustratingly So, yeah, and that 0:07:47.360 --> 0:07:50.040 goes back to a jerk named Adolph Stern who really 0:07:50.160 --> 0:07:51.920 jerked it up back in nineteen thirty eight. 0:07:52.920 --> 0:07:57.840 Yeah, he was a psychoanalyst, and he basically I mean, 0:07:58.240 --> 0:07:59.720 if you didn't know what it was, and I didn't 0:07:59.720 --> 0:08:02.480 even fully know what it was, I always wondered what 0:08:02.600 --> 0:08:07.040 borderline meant. And it very simply meant and means, this 0:08:07.200 --> 0:08:11.280 is Stern saying, you're not quite on the psychotic level 0:08:11.600 --> 0:08:15.360 and you're not quite psycho neeurotic. You're basically on the 0:08:15.360 --> 0:08:19.200 border between those conditions while encompassing a bit of each. 0:08:19.280 --> 0:08:20.960 So we're just going to call it borderline. 0:08:21.040 --> 0:08:24.240 Yeah, and psychosis is what we would still consider psychosis, 0:08:24.280 --> 0:08:31.320 but under psychoanalysis, psychoneurosis is what we call anxiety depression, 0:08:32.000 --> 0:08:35.720 those kinds of mental illnesses. So I guess Adolf Stern 0:08:35.920 --> 0:08:39.040 wasn't really that big of a jerk, because he really 0:08:39.120 --> 0:08:42.920 kind of did combine him appropriately. It was Auto Kernberg 0:08:42.960 --> 0:08:45.640 who was the serious jerk in this situation. 0:08:46.320 --> 0:08:49.640 Okay, So he was a psychoanalyst in the mid nineteen seventies, 0:08:50.400 --> 0:08:54.400 so that's you know, like forty something years later, and 0:08:55.600 --> 0:08:59.480 he described it as an unstable personality and disorganized conception 0:08:59.520 --> 0:09:01.960 of the cell. And this is just when it was 0:09:02.080 --> 0:09:05.080 sort of starting to become more and more kind of 0:09:05.120 --> 0:09:08.040 talked about, and officially I think five years after that 0:09:08.200 --> 0:09:10.400 was in the DSM version three. 0:09:11.000 --> 0:09:14.000 Yeah. I mean that's pretty quick for something you just 0:09:14.240 --> 0:09:16.480 started to identify, and five years later it makes it 0:09:16.520 --> 0:09:19.320 in the DSM. Because they don't churn those dsms out 0:09:19.360 --> 0:09:21.720 like you know, every few months. It takes years to 0:09:21.720 --> 0:09:24.880 put one together. So Kurenberg seemed to have stumbled onto 0:09:24.880 --> 0:09:29.960 something that was worth looking at, very very very quickly. 0:09:30.679 --> 0:09:31.040 Yeah. 0:09:31.080 --> 0:09:34.840 And isn't there a sort of movement or belief now 0:09:34.880 --> 0:09:37.200 that it's a lot of people think it's something that 0:09:37.400 --> 0:09:40.319 is like a diagnosis you shouldn't even give, right. 0:09:40.480 --> 0:09:43.079 Yeah, there's we'll talk about that. I think we can 0:09:43.160 --> 0:09:47.079 kind of pepper it throughout, you know. Okay, But yes, 0:09:47.240 --> 0:09:52.600 there is a school of thought that basically says BPD 0:09:52.800 --> 0:09:56.199 is not a personality disorder. It's not even a mood disorder, 0:09:56.480 --> 0:09:58.679 although some people say it would better be characterized as 0:09:58.679 --> 0:10:01.599 a mood disorder. They say it's a cluster of symptoms 0:10:01.880 --> 0:10:06.880 that overlap with a bunch of different actual disorders, and 0:10:06.920 --> 0:10:10.440 that the problem with that, you say, who cares? You're 0:10:10.440 --> 0:10:13.760 identifying people a group of people whose rate of suicide 0:10:13.800 --> 0:10:16.679 is fifty times a general population, that alone is worth 0:10:16.720 --> 0:10:20.880 like identifying and helping those people out. But what they're 0:10:20.880 --> 0:10:24.800 saying is number one, BPD has gotten such a bad 0:10:24.880 --> 0:10:29.480 name in the general population that you're literally stigmatizing somebody 0:10:29.480 --> 0:10:32.880 when you give them that diagnosis. It is an enormously 0:10:34.480 --> 0:10:37.520 heavy weight you put on somebody. We say, I'm a 0:10:37.760 --> 0:10:41.240 trained psychiatrist, I know what I'm talking about, and you 0:10:41.360 --> 0:10:44.560 have borderline personality disorder. Everybody step back. 0:10:44.760 --> 0:10:48.400 Basically, yeah, I mean it's it's almost in line with 0:10:49.120 --> 0:10:52.440 saying someone as a sociopath. It's different things, but as 0:10:52.440 --> 0:10:54.520 far as like the stigma goes very much. 0:10:54.400 --> 0:10:57.319 So, yeah, for sure, that's a great analogy. Actually, so 0:10:57.760 --> 0:11:01.040 some people are like, Okay, it's stigmatizing, but even more 0:11:01.040 --> 0:11:03.480 than that, just the science isn't necessarily there, like we're 0:11:03.480 --> 0:11:07.080 saying it's symptoms rather than an actual disorder. And then 0:11:07.160 --> 0:11:12.199 apparently the Working Group for Personality Disorders for the DSM 0:11:12.240 --> 0:11:17.360 five that's the most recent one, they actually said, we're 0:11:17.400 --> 0:11:21.320 not sure that this should be a categorical disorder, which 0:11:21.440 --> 0:11:23.760 is the type that you either have it or you don't. 0:11:24.559 --> 0:11:28.080 They suggested it should be dimensional, which means that it 0:11:28.120 --> 0:11:30.480 exists on a spectrum, right, so you can have a 0:11:30.520 --> 0:11:33.439 little bit of BPD, a lot of BPD, or right 0:11:33.440 --> 0:11:36.559 in the middle or whatever. And that got rejected. And 0:11:36.600 --> 0:11:42.240 now so it's a categorical diagnosis where if you don't 0:11:42.280 --> 0:11:45.040 have BPD, you don't have BPD. If you don't fit 0:11:45.080 --> 0:11:47.360 the criteria. If you do, you got BPD. 0:11:47.960 --> 0:11:50.080 Right, And we'll talk about the criterion in a second, 0:11:50.800 --> 0:11:54.680 but we do want to sort of reintroduce Marcia Lenihan, who, 0:11:54.720 --> 0:11:58.040 like I said, was a real pioneer for her work 0:11:58.760 --> 0:12:03.040 in the treatment and recognition of BPD. Very late in 0:12:03.080 --> 0:12:07.920 her life, revealed that she suffered from BPD. After you know, 0:12:08.480 --> 0:12:12.920 patients and friends encouraged her to come forward and she said, basically, 0:12:12.960 --> 0:12:14.679 you know, I'm gonna do it. I'm not gonna die 0:12:14.679 --> 0:12:17.600 a coward, is what she said, but for the longest 0:12:17.640 --> 0:12:21.360 time was not out with that information. Was born in 0:12:21.440 --> 0:12:26.120 Oklahoma in I guess the fifties, and in the nineteen 0:12:26.240 --> 0:12:31.319 sixties in high school, was diagnosed with schizophrenia, drugged up, 0:12:31.880 --> 0:12:38.120 give an electro shock, hospitalized, was practicing self harm of 0:12:38.160 --> 0:12:42.200 all kinds, and then had it sounds like a not 0:12:42.280 --> 0:12:46.760 a moment of clarity, but a pretty profound religious experience. 0:12:46.920 --> 0:12:48.960 Yeah, the only thing missing was a visit from Saint 0:12:48.960 --> 0:12:50.640 Michael pretty much. 0:12:50.720 --> 0:12:56.560 I mean, she's Catholic, and after this religious experience she 0:12:56.840 --> 0:12:59.400 was able to which you know, had a lot to 0:12:59.400 --> 0:13:01.760 do with self love. But after this she was able 0:13:01.800 --> 0:13:05.600 to still have these emotions that she had before, but 0:13:06.120 --> 0:13:09.760 managed it to the point where she wasn't practicing self harm. 0:13:10.320 --> 0:13:13.040 And did she come up with the term radical acceptance 0:13:13.120 --> 0:13:14.880 or did she just buy into that. 0:13:15.280 --> 0:13:17.480 I don't know if that was a descriptor of hers 0:13:17.600 --> 0:13:17.800 or not. 0:13:18.320 --> 0:13:20.200 Okay, I don't think she came up with that. 0:13:20.400 --> 0:13:23.840 But basically, as you know, radical acceptance is like, hey, listen, 0:13:24.720 --> 0:13:27.760 this is how things are with me, this is how 0:13:27.760 --> 0:13:31.000 things are with the world. I accept this, and I'm 0:13:31.040 --> 0:13:35.800 not going to compare this to what I think the 0:13:35.880 --> 0:13:38.160 reality should be or what other people think it should be. 0:13:38.400 --> 0:13:41.160 There's a huge butt that follows that though. 0:13:41.559 --> 0:13:43.520 But but but. 0:13:45.440 --> 0:13:48.560 I am going to do what I can to change 0:13:48.600 --> 0:13:49.840 those things about myself. 0:13:50.200 --> 0:13:50.400 Right. 0:13:50.760 --> 0:13:54.280 So that is the basis of a type of cognitive 0:13:54.280 --> 0:13:58.160 behavioral therapy that she came up with called dialectical behavioral therapy, 0:13:58.800 --> 0:14:02.439 and it is it's based in radical acceptance and the 0:14:02.559 --> 0:14:06.120 desire to examine and change how you interact with the 0:14:06.160 --> 0:14:09.920 world externally, and it's basically the gold standard for treating 0:14:11.600 --> 0:14:13.920 a borderline personality disorder it right. 0:14:13.760 --> 0:14:17.040 Now, Yeah, and it seems like it really works. I 0:14:17.080 --> 0:14:20.160 saw that it was kind of the only proven treatment 0:14:20.200 --> 0:14:24.920 to reduce suicidal behavior, which is, you know, at the 0:14:25.320 --> 0:14:28.680 tail end of what a lot of people experience with BPD. 0:14:29.480 --> 0:14:32.360 And the good news and we'll talk about treatment later, 0:14:32.400 --> 0:14:35.360 but the good news is if you have VPD or 0:14:35.400 --> 0:14:38.800 know someone that does, you can get better. And they 0:14:38.880 --> 0:14:41.080 have proven and shown time and time again now that 0:14:42.040 --> 0:14:45.880 through the treatments that we'll discuss later, it is absolutely 0:14:45.880 --> 0:14:49.920 something that someone can get a hold of in most cases, right, 0:14:50.760 --> 0:14:51.400 which is great. 0:14:51.600 --> 0:14:54.360 It is great. I mean, like, for as bad of 0:14:54.400 --> 0:14:57.280 a stigma as BPD has, the idea that like it 0:14:57.320 --> 0:15:00.520 has a very high success rate of treatment is pretty couraging. 0:15:01.640 --> 0:15:06.560 So Lenahan's basis of her understanding or her definition of 0:15:06.600 --> 0:15:12.640 borderline personality disorder is that it's biosocial that people who 0:15:12.680 --> 0:15:20.240 have BPD are either genetically or biologically predisposed to having BPD, 0:15:20.560 --> 0:15:24.360 but not everybody who has that predisposition is going to 0:15:24.480 --> 0:15:29.240 be triggered into developing BPD. It takes basically a biological 0:15:29.320 --> 0:15:34.520 substrate for BPD. Usually your prefrontal cortex hasn't developed in 0:15:34.560 --> 0:15:37.680 a certain way, and so your executive function isn't functioning 0:15:37.760 --> 0:15:43.160 like an executive should. That gets joined together with a trigger, 0:15:44.680 --> 0:15:51.160 usually mistreatment, whether it's abuse, neglect, invalidation by your parents 0:15:51.480 --> 0:15:54.920 as a kid, and you put those things together and 0:15:55.400 --> 0:15:57.880 very often it results in what you be diagnosed with 0:15:57.960 --> 0:15:58.840 later as BPD. 0:15:59.480 --> 0:16:01.840 Yeah, and one thing I really took away from this, 0:16:02.120 --> 0:16:03.920 and this is something that you know, Emily and I 0:16:04.000 --> 0:16:06.040 and and most parents that I know are way into, 0:16:06.320 --> 0:16:09.480 is h oh, you got to validate your kids. 0:16:09.840 --> 0:16:12.000 Yeah, that's new, which is crazy, but it's. 0:16:12.000 --> 0:16:15.600 It's Yeah, you got to validate their emotions and validate 0:16:15.640 --> 0:16:19.920 their experiences and their feelings, even if it's something that 0:16:20.000 --> 0:16:25.200 you don't think is uh, like has the most relevance 0:16:25.280 --> 0:16:27.360 or whatever, or even if like the kid is wrong 0:16:27.400 --> 0:16:30.080 about something or like emotionally wrong, like, you still have 0:16:30.160 --> 0:16:32.760 to validate that and then talk them through it. What 0:16:32.840 --> 0:16:37.160 you can't do is just discount a kid's feelings, because 0:16:37.600 --> 0:16:41.240 that's like telling them that their truth isn't real, and 0:16:41.240 --> 0:16:43.160 that's damaging I know, and. 0:16:43.520 --> 0:16:46.160 Doing parenting right sounds like a waking nightmare to me 0:16:47.160 --> 0:16:52.280 doing wise parenting parenting correctly. Yeah. Nah, I can't imagine 0:16:52.280 --> 0:16:56.080 the exhaustion along combined with the fear of just misstepping 0:16:56.160 --> 0:16:58.600 once or twice and then there you go, you screwed 0:16:58.600 --> 0:16:59.640 your kid up for life. 0:17:00.120 --> 0:17:00.360 Yeah. 0:17:00.400 --> 0:17:03.320 What you gotta do is, in my experience, is like 0:17:03.680 --> 0:17:07.400 you can't beat yourself up too much because parenting fails, 0:17:08.000 --> 0:17:10.080 you can really go down a rabbit hole. 0:17:09.920 --> 0:17:10.440 Of your own. 0:17:10.680 --> 0:17:15.320 I'll be depression if you screw up. And you can't 0:17:15.359 --> 0:17:17.639 do that because kids are resilient and you just got to, 0:17:17.760 --> 0:17:20.280 like you got to prove to them that you can 0:17:20.400 --> 0:17:22.760 like pick yourself up and move on and do better, 0:17:22.840 --> 0:17:23.040 you know. 0:17:23.240 --> 0:17:28.199 Yeah, And I don't think Lenahan's idea is that it 0:17:28.359 --> 0:17:31.040 just takes one or two missteps. It takes like a parent, 0:17:31.119 --> 0:17:34.679 he was a genuinely bad parent. Very frequently they have 0:17:34.800 --> 0:17:38.600 BPD themselves. Yeah, and that is a real challenge to 0:17:38.720 --> 0:17:42.280 parenting well in and of itself. But you don't have 0:17:42.359 --> 0:17:45.159 to have had a parent with BPD to develop BPD. 0:17:45.600 --> 0:17:48.480 But typically it's a parent that is not at all 0:17:48.640 --> 0:17:53.520 meeting your needs, especially emotionally. And I say we take 0:17:53.520 --> 0:17:55.280 a break and we'll come back and talk about how 0:17:55.320 --> 0:17:56.960 you would be diagnosed with BPD. 0:17:57.040 --> 0:18:19.080 What do you think, let's do it, okay, Chuck. 0:18:19.160 --> 0:18:22.760 So we said that BPD's in the d S M five. 0:18:23.000 --> 0:18:26.840 It's a personality disorder. And just to differentiate real quick, 0:18:26.880 --> 0:18:31.879 a mood disorder describes patterns and feelings, like you have 0:18:32.000 --> 0:18:35.560 mood swings in that you know highs and lows, and 0:18:35.600 --> 0:18:38.119 that's pretty reliable that you're going to have it one 0:18:38.160 --> 0:18:41.840 way or another. Personality disorder focuses more on how you 0:18:41.880 --> 0:18:44.800 relate to others, and that definitely makes sense to me 0:18:44.880 --> 0:18:48.120 that you would consider a BPD of personality disorder. 0:18:48.160 --> 0:18:51.840 Then, yeah, that seems to be a really key thing, 0:18:52.000 --> 0:18:58.760 is that it's it's it really disturbs your relationships. So 0:18:59.800 --> 0:19:03.600 to be diagnosed, you fit at least five out of 0:19:03.600 --> 0:19:06.960 the following nine that we're gonna read for you. Chronic 0:19:06.960 --> 0:19:08.280 feelings of emptiness and. 0:19:08.200 --> 0:19:11.639 That's emptiness, feeling like isolated or lonely or hopeless. 0:19:12.000 --> 0:19:16.760 Sure, emotional instability and reaction to day to day events. 0:19:17.119 --> 0:19:20.960 That's the thing we were talking about earlier, Like saying 0:19:20.960 --> 0:19:24.120 mountains out of molehills seems slightly reductive, but that's kind 0:19:24.119 --> 0:19:27.520 of a basic way to say it. Okay, frantic efforts 0:19:27.560 --> 0:19:31.280 to avoid abandonment, whether or not they're real or imagined. 0:19:31.680 --> 0:19:36.560 As Yeah, as we'll see abandonment issues, and this very 0:19:36.680 --> 0:19:41.359 very much includes emotional abandonment as a really big precursor 0:19:42.480 --> 0:19:44.560 unstable self image or sense of self. 0:19:46.160 --> 0:19:49.600 What else, Impulsive behavior is usually a big one, and 0:19:49.680 --> 0:19:52.480 you have to have impulsive behavior and at least two 0:19:52.560 --> 0:19:56.320 areas that are harming your day to day life, like 0:19:56.359 --> 0:20:00.480 an eating disorder and gambling addiction or something like that. 0:20:01.800 --> 0:20:05.520 Another one is this is based on and so this 0:20:05.560 --> 0:20:07.840 is where some psychiatrists would be like, see this is 0:20:07.840 --> 0:20:11.160 not this is a symptom that we're talking about here, 0:20:11.400 --> 0:20:15.919 but it's unstable and intense interpersonal relationships. I mean, like 0:20:15.960 --> 0:20:19.399 you're really really close to somebody for you know, a 0:20:19.440 --> 0:20:21.200 couple of days, and then they do something you don't 0:20:21.320 --> 0:20:24.159 like and they're the worst person in the world. And 0:20:24.200 --> 0:20:27.120 it can happen very very quickly with people with BPD, 0:20:28.000 --> 0:20:30.560 And if you stick around and stay in that person's life, 0:20:30.600 --> 0:20:33.240 you can find yourself walking on eggshells very quickly because 0:20:33.480 --> 0:20:35.679 you don't want them to turn on you all of 0:20:35.680 --> 0:20:39.400 a sudden. So that's a huge one. If you have 0:20:39.520 --> 0:20:43.439 a lot of unstable, intense relationships with people, that's just 0:20:43.520 --> 0:20:47.520 kind of the mo that is usually a big giveaway 0:20:46.800 --> 0:20:48.160 with BPD. 0:20:48.760 --> 0:20:54.119 Yeah, the last three recurrent suicidal or self harming behaviors. 0:20:54.160 --> 0:20:58.520 We've talked about that a little bit, stress related, paranoia 0:20:58.680 --> 0:21:01.800 or dissociative symptoms, feeling like the self of the world 0:21:01.840 --> 0:21:06.199 isn't real. It feels like that's probably the far end 0:21:06.280 --> 0:21:09.280 of the spectrum, or the most severe end. And then 0:21:09.320 --> 0:21:14.080 one we missed earlier was inappropriate and intense anger or 0:21:14.119 --> 0:21:15.520 difficulty controlling anger. 0:21:15.680 --> 0:21:18.960 I didn't miss it. That was purposeful, Okay. I wanted 0:21:18.960 --> 0:21:20.320 to end with that big one. 0:21:20.760 --> 0:21:22.240 Okay, all right, speak to it. 0:21:22.400 --> 0:21:26.320 Well, there's a lot of I always hate saying those qualifiers. 0:21:26.400 --> 0:21:28.159 It's just so easy to say, but I know I 0:21:28.200 --> 0:21:30.320 think it perks people's ears up, like, oh, this person 0:21:30.359 --> 0:21:32.640 doesn't know what they're talking about. So let me rephrase that. 0:21:32.760 --> 0:21:36.119 I have seen that there are schools of thought regarding 0:21:36.760 --> 0:21:45.840 borderline personality disorder that it is a rage response to trauma. Okay, 0:21:45.880 --> 0:21:48.400 that that is your response to unresolved trauma. That's how 0:21:48.440 --> 0:21:51.280 you learn to deal with those feelings and those emotions. 0:21:51.320 --> 0:21:54.440 Is to rage at people, because rage is as much 0:21:54.440 --> 0:21:58.199 a hallmark of BPD as fear of abandonment, is right, 0:21:58.440 --> 0:22:01.679 and that's why so people are critical of including it 0:22:01.720 --> 0:22:04.560 as a categorical diagnosis in the d s M five. 0:22:05.000 --> 0:22:08.000 They're saying, you're pathologizing rage. No, you just need to 0:22:08.040 --> 0:22:11.119 teach people how to identify their emotions and how to 0:22:11.160 --> 0:22:14.960 express them in a more appropriate, less hostile manner, and 0:22:15.000 --> 0:22:17.840 then that's how you would treat somebody with BPD, or 0:22:18.040 --> 0:22:21.080 not even with BPD, somebody with a rage disorder. But 0:22:21.160 --> 0:22:24.000 some people think that that is what people are mistaking 0:22:24.040 --> 0:22:24.640 for BPD. 0:22:25.240 --> 0:22:30.160 Oh I gotcha, okay, interesting, Uh, you're gonna to be diagnosed, 0:22:30.160 --> 0:22:33.200 Like I said, five of those nine, it'll probably be 0:22:33.480 --> 0:22:35.960 you know, like you'll be talking to a psychologist or 0:22:36.000 --> 0:22:38.880 someone in an interview. You might fill out a questionnaire 0:22:38.960 --> 0:22:43.400 or something they're going to make interesting click click click click, 0:22:44.320 --> 0:22:47.200 or they may speak to your family or something like that. 0:22:48.320 --> 0:22:53.000 It can be difficult to diagnose and there, like you said, 0:22:53.000 --> 0:22:56.400 there's there's a lot of overlap between you know, things 0:22:56.440 --> 0:23:00.679 like anxiety and depression and things like PTSD and eating disorders, 0:23:00.760 --> 0:23:06.800 a lot of comorbidities. So I get why people can 0:23:06.840 --> 0:23:10.399 have issues with like this diagnosis rather than it's like 0:23:10.440 --> 0:23:12.320 a cluster of symptoms of other things. 0:23:12.359 --> 0:23:13.560 But I don't know. 0:23:13.720 --> 0:23:16.399 If you group that altogether then it and call it 0:23:16.400 --> 0:23:17.840 its own thing, then I don't know. I'm not sure 0:23:17.840 --> 0:23:18.680 I see the harm in that. 0:23:19.480 --> 0:23:22.199 Again, I think it's the stigma. And then also it 0:23:22.280 --> 0:23:26.000