WEBVTT - Selects: BPD: The Worst Disorder or Not a Disorder at All? 0:00:00.800 --> 0:00:02.920 A good morning everyone. This is Chuck here on a 0:00:02.920 --> 0:00:06.880 Saturday with a curated selection of one of my favorite episodes. 0:00:06.960 --> 0:00:12.880 This is bp D colon the Worst Disorder or not 0:00:12.960 --> 0:00:16.560 a disorder at All. This is all about borderline personality 0:00:16.600 --> 0:00:20.279 disorder and it's pretty fascinating stuff and I hope you 0:00:20.280 --> 0:00:27.360 guys enjoy it. Welcome to Stuff you should know, a 0:00:27.440 --> 0:00:33.200 production of iHeartRadio. 0:00:35.159 --> 0:00:37.800 Hey, and welcome to the podcast. I'm Josh and Chuck's 0:00:37.840 --> 0:00:40.360 here too. It's just the two of us and that's 0:00:40.400 --> 0:00:42.440 cool because this is stuff you should know. 0:00:44.840 --> 0:00:49.599 Yeah, Jerry's got the week off and she said press on, dudes. Yeah, 0:00:50.000 --> 0:00:52.599 party party on Wayne. 0:00:54.160 --> 0:00:56.800 That was also from Bill and Ted's excellent Adventure. Wasn't 0:00:56.840 --> 0:00:57.880 it Party On? 0:00:58.000 --> 0:00:59.080 No? Was it? 0:00:59.280 --> 0:00:59.600 I think? 0:00:59.680 --> 0:00:59.760 So? 0:00:59.840 --> 0:01:02.000 I can see George Carlin saying it. 0:01:02.600 --> 0:01:03.920 Yeah, I'm probably wrong. 0:01:04.200 --> 0:01:05.279 I'm probably wrong. 0:01:06.680 --> 0:01:08.959 So, Chuck, we're talking today about something we've kind of 0:01:09.000 --> 0:01:12.240 touched on before. But when we touched on it, we're like, 0:01:12.840 --> 0:01:15.679 this is something that deserves its own episode for sure. 0:01:16.520 --> 0:01:20.840 Yeah, we're talking. This is another in our suite on 0:01:21.680 --> 0:01:26.039 mental health conditions, and boy, we've got a lot of them, 0:01:26.080 --> 0:01:28.720 but we still got more to go. Yeah, we do 0:01:29.080 --> 0:01:31.280 you know, and I think these are important shows, and 0:01:31.280 --> 0:01:33.200 every time we do these, I feel like we get 0:01:33.240 --> 0:01:37.280 good feedback on people who suffer from these conditions and 0:01:37.880 --> 0:01:41.959 say thanks for either educating me and or getting the 0:01:41.959 --> 0:01:44.440 word out to people who may be a little, uh, 0:01:44.880 --> 0:01:47.199 what's the word ignorant about some of the stuff. 0:01:47.960 --> 0:01:50.880 As Michael Jackson would have said, you're ignorant about this? 0:01:52.160 --> 0:01:52.840 What's that from? 0:01:53.440 --> 0:01:54.960 He just used that word a lot. 0:01:55.440 --> 0:01:58.600 Oh really yeah, But regardless, that has nothing to do 0:01:58.640 --> 0:02:03.120 with anything when you ment just now that people like 0:02:03.240 --> 0:02:05.000 kind of wrote in or write in when we do. 0:02:05.000 --> 0:02:05.920 Episodes like this. 0:02:06.280 --> 0:02:09.840 We did our emotional pain episode and we mentioned a 0:02:09.960 --> 0:02:13.520 borderline personality disorder. A lot of people wrote in, Well, 0:02:13.520 --> 0:02:14.880 I don't want to say a lot, but some people 0:02:14.880 --> 0:02:16.680 wrote in and they said, you know, thank you for 0:02:16.720 --> 0:02:20.080 treating it compassionately, because when most people talk about it, 0:02:20.120 --> 0:02:23.160 they talk about it like they despise it, or they 0:02:23.200 --> 0:02:26.239 despise people with BPD. And the more you look into 0:02:26.280 --> 0:02:29.240 the more you realize, like, wow, this is maybe one 0:02:29.280 --> 0:02:33.560 of the hardest mental illnesses that you can possibly have. 0:02:34.280 --> 0:02:35.840 And I think we kind of said that in the 0:02:35.880 --> 0:02:38.720 Emotional Pain episode. But if I didn't know it before 0:02:38.760 --> 0:02:40.919 I definitely do now after doing this research. 0:02:41.600 --> 0:02:45.120 Yeah, and it's also clear that it's one that somehow 0:02:45.520 --> 0:02:49.680 seems to garner the least amount of empathy, right, not 0:02:49.720 --> 0:02:52.760 only among just people who you know may or may 0:02:52.760 --> 0:02:57.079 not know much about it, but even clinicians and therapists 0:02:56.880 --> 0:02:58.799 as that stuff you sent me like a lot of 0:02:58.840 --> 0:03:02.840 times try to avoid or severely limit the number of 0:03:02.880 --> 0:03:06.600 patients they have that they treat with BPD, which makes 0:03:06.600 --> 0:03:10.280 it even more sad because it is a really tough one. 0:03:11.280 --> 0:03:13.440 I guess we'll just define it kind of off the bat, 0:03:13.480 --> 0:03:16.359 and you know, a lot of this episode will kind 0:03:16.400 --> 0:03:20.120 of be defining it in different ways because it's fairly complex. 0:03:20.200 --> 0:03:22.720 But it is a what's known as a cluster B 0:03:23.000 --> 0:03:28.840 personality disorder, which is in the anti social personality disorder 0:03:28.919 --> 0:03:34.800 category along with histrionic personality disorder and narcissistic personality. I'm 0:03:34.920 --> 0:03:36.320 just going to start saying PD. 0:03:36.760 --> 0:03:39.360 Yeah, PDS. It will make it sound like, you know, 0:03:39.440 --> 0:03:40.520 you're talking about yet. 0:03:40.360 --> 0:03:45.120 More narcissistic PD, but it seems like a lot of 0:03:45.120 --> 0:03:48.400 what it can be is sometimes a disorder of perception. 0:03:49.880 --> 0:03:53.800 And while there are very real things that do that 0:03:53.920 --> 0:03:57.680 can trigger people with BPD a lot of times is 0:03:57.920 --> 0:04:01.080 the way things are perceived incorrectly, either about themselves or 0:04:01.120 --> 0:04:03.000 about others or others actions. 0:04:03.320 --> 0:04:07.720 Yeah, and I saw a lot of people confuse borderline 0:04:07.760 --> 0:04:12.080 personality disorder with bipolar, or at least think they're similar. 0:04:12.000 --> 0:04:14.119 I guess because they go to start with bees. 0:04:13.960 --> 0:04:14.720 Or something like that. 0:04:14.760 --> 0:04:17.600 But no, they're not similar. Bipolar has much more of 0:04:17.640 --> 0:04:23.640 a brain and central nervous system basis, whereas while borderline 0:04:23.680 --> 0:04:28.520 personality disorder has a component of that, the executive function 0:04:28.600 --> 0:04:33.240 of the person in their prefrontal cortex either didn't develop 0:04:33.279 --> 0:04:38.840 in a fully normal way or it's not functioning up 0:04:38.839 --> 0:04:41.640 to snuff, I guess, more than anything. And the thing 0:04:41.680 --> 0:04:46.479 that differentiates it from bipolar is it's an assignment of 0:04:46.600 --> 0:04:50.680 meaning it's psychological as much, if not more than it 0:04:50.760 --> 0:04:52.480 is physiological. 0:04:53.200 --> 0:04:57.760 Yeah. And also bipolar is characterized, and we did a 0:04:57.760 --> 0:05:00.560 good episode on that quite a while ago, but it's 0:05:00.640 --> 0:05:04.120 characterized by like these highs and lows, and then in 0:05:04.160 --> 0:05:09.720 between those periods they can be relatively stable, whereas with 0:05:10.480 --> 0:05:15.000 borderline personality disorder it's sort of always there. This one 0:05:15.000 --> 0:05:17.400 thing you sent me had to really kind of really 0:05:17.520 --> 0:05:19.560 nail it on the head at the end. Those with 0:05:19.640 --> 0:05:22.039 bipolar may have a hair trigger kind of response during 0:05:22.040 --> 0:05:25.800 an episode, whereas when you have a borderline PD, you 0:05:25.839 --> 0:05:28.120 have a hair trigger response all of the time and 0:05:28.440 --> 0:05:30.279 I can't imagine helps up that must be. 0:05:30.520 --> 0:05:33.640 Yeah, so that kind of calls out one of the 0:05:33.720 --> 0:05:40.640 big hallmarks of BPD, which is it's emotional dysregulation. Yeah, 0:05:40.760 --> 0:05:45.200 things that would affect other people a little bit, maybe 0:05:45.240 --> 0:05:47.520 not at all, stuff that most people let roll off 0:05:47.560 --> 0:05:51.960 of their back, right, could set somebody with BPD off 0:05:52.000 --> 0:05:53.320 into a rage that. 0:05:53.279 --> 0:05:54.400 Could last days. 0:05:54.600 --> 0:05:55.280 Potentially. 0:05:56.200 --> 0:06:00.800 They also might use self harm it's called non suicidal 0:06:00.839 --> 0:06:06.520 self injury to kind of externalize the pain because the 0:06:07.320 --> 0:06:11.919 emotional dysregulation is so profound, they don't know what they're feeling. 0:06:12.400 --> 0:06:15.359 They just know they're feeling everything all at once, and 0:06:15.440 --> 0:06:18.760 it's kind of like standing in an ocean and a 0:06:18.839 --> 0:06:23.320 huge wave hits you and you're just you're as profoundly 0:06:23.640 --> 0:06:27.839 enveloped by emotion at that moment as you are by 0:06:27.880 --> 0:06:29.840 a wave when it just completely knocks you off for 0:06:29.880 --> 0:06:31.000 feet and sweeps you away. 0:06:31.839 --> 0:06:34.680 Yeah, there was another and we'll talk about her in 0:06:34.720 --> 0:06:38.440 great detail. Her name is Marcia Lenahan or is it 0:06:38.560 --> 0:06:39.239 Line Han. 0:06:40.120 --> 0:06:41.320 I'm gonna go with Lenahan. 0:06:42.120 --> 0:06:46.159 Yeah, she as we'll see as someone who not only 0:06:46.160 --> 0:06:51.400 suffered from BPD but kind of pioneered the treatment of BPD. 0:06:51.600 --> 0:06:54.400 But she said, it's like having third degree burns on 0:06:54.520 --> 0:06:59.240 ninety percent of your body metaphorically, So you're lacking emotional 0:06:59.279 --> 0:07:02.359 skin and you feel agony at the slightest touch or movement. 0:07:04.279 --> 0:07:09.320 And since you did mention self harm, non suicidal self harm. 0:07:09.360 --> 0:07:12.560 It also people with BPD have a suicide rate of 0:07:13.080 --> 0:07:18.440 was it like fifty times higher than average in the population. Yeah, 0:07:18.480 --> 0:07:22.160 so this is this is no joke. This is a 0:07:22.320 --> 0:07:27.520 very hardcore disorder that bears more empathy and understanding. 0:07:27.760 --> 0:07:28.480 Yeah, for sure. 0:07:29.520 --> 0:07:32.160 Let's go back to the beginning, shall we, Because borderline 0:07:32.160 --> 0:07:36.320 personality disorder is one of those terms that has taken 0:07:36.400 --> 0:07:40.120 on its own meaning in the general population, but if 0:07:40.160 --> 0:07:42.920 you stop and think about it, it doesn't really reveal 0:07:43.040 --> 0:07:44.760 much about what it's describing. 0:07:44.840 --> 0:07:45.840 It's just one of those. 0:07:45.720 --> 0:07:48.800 Not at all frustratingly So, yeah. 0:07:48.600 --> 0:07:51.160 And that goes back to a jerk named Adolph Stern 0:07:51.200 --> 0:07:53.440 who really jerked it up back in nineteen thirty eight. 0:07:54.440 --> 0:07:59.360 Yeah, he was a psychoanalyst and he basically I mean, 0:07:59.760 --> 0:08:01.280 if you didn't know what it was, and I didn't 0:08:01.280 --> 0:08:04.040 even fully know what it was, I always wondered what 0:08:04.120 --> 0:08:08.560 borderline meant. And it very simply meant and means, this 0:08:08.720 --> 0:08:12.800 is Stern saying, you're not quite on the psychotic level 0:08:13.120 --> 0:08:16.880 and you're not quite psycho neeurotic. You're basically on the 0:08:16.880 --> 0:08:20.720 border between those conditions while encompassing a bit of each. 0:08:20.840 --> 0:08:22.480 So we're just going to call it borderline. 0:08:22.560 --> 0:08:25.760 Yeah, and psychosis is what we would still consider psychosis, 0:08:25.800 --> 0:08:32.800 but under psychoanalysis, psychoneurosis is what we call anxiety depression, 0:08:33.520 --> 0:08:37.280 those kinds of mental illnesses. So I guess Adolf Stern 0:08:37.440 --> 0:08:40.560 wasn't really that big of a jerk, because he really 0:08:40.640 --> 0:08:44.440 kind of did combine him appropriately. It was Auto Kernberg 0:08:44.520 --> 0:08:47.160 who was the serious jerk in this situation. 0:08:47.840 --> 0:08:51.160 Okay, so he was a psychoanalyst in the mid nineteen seventies, 0:08:51.960 --> 0:08:55.920 so that's you know, like forty something years later, and 0:08:57.120 --> 0:09:01.000 he described it as an unstable personality and organized conception 0:09:01.080 --> 0:09:03.520 of the self. And this is just when it was 0:09:03.600 --> 0:09:06.600 sort of starting to become more and more kind of 0:09:06.640 --> 0:09:09.559 talked about, and officially I think five years after that 0:09:09.720 --> 0:09:11.920 was in the DSM version three. 0:09:12.520 --> 0:09:15.600 Yeah, I mean that's pretty quick for something you just 0:09:15.760 --> 0:09:18.000 started to identify and five years later it makes it 0:09:18.040 --> 0:09:20.840 in the DSM. Because they don't churn those dsms out 0:09:20.880 --> 0:09:23.240 like you know, every few months. It takes years to 0:09:23.240 --> 0:09:26.400 put one together. So Kurenberg seemed to have stumbled onto 0:09:26.440 --> 0:09:31.520 something that was worth looking at, very very very quickly. 0:09:32.200 --> 0:09:36.040 Yeah. And isn't there a sort of movement or belief 0:09:36.160 --> 0:09:38.560 now that it's a lot of people think it's something 0:09:38.600 --> 0:09:41.840 that is like a diagnosis you shouldn't even give, right. 0:09:42.000 --> 0:09:43.880 Yeah, there's we'll talk about that. 0:09:44.040 --> 0:09:46.800 I think we can kind of pepper it throughout, you know, Okay, 0:09:46.920 --> 0:09:52.760 But yes, there is a school of thought that basically 0:09:52.800 --> 0:09:56.800 says BPD is not a personality disorder. It's not even 0:09:56.840 --> 0:09:59.440 a mood disorder, although some people say it would better 0:09:59.440 --> 0:10:02.040 be characterized is a mood disorder. They say it's a 0:10:02.040 --> 0:10:05.680 cluster of symptoms that overlap with a bunch of different 0:10:06.360 --> 0:10:10.800 actual disorders, and that the problem with that, You say, 0:10:11.160 --> 0:10:14.280 who cares? You're identifying people a group of people whose 0:10:14.559 --> 0:10:17.200 rate of suicide is fifty times a general population, that 0:10:17.320 --> 0:10:20.400 alone is worth like identifying and helping those people out. 0:10:21.200 --> 0:10:25.440 But what they're saying, is number one. BPD has gotten 0:10:25.720 --> 0:10:28.520 such a bad name in the general population that you're 0:10:29.240 --> 0:10:33.080 literally stigmatizing somebody when you give them that diagnosis. It 0:10:33.160 --> 0:10:38.160 is an enormously heavy weight you put on somebody. We say, 0:10:38.559 --> 0:10:42.320 I'm a trained psychiatrist, I know what I'm talking about, 0:10:42.400 --> 0:10:44.920 and you have borderline personality disorder. 0:10:45.040 --> 0:10:46.080 Everybody step back. 0:10:46.280 --> 0:10:49.920 Basically, yeah, I mean it's it's almost in line with 0:10:50.640 --> 0:10:53.960 saying someone is a sociopath. It's different things, but as 0:10:54.000 --> 0:10:55.520 far as like the stigma goes. 0:10:55.520 --> 0:10:58.640 Very much, so, yeah, for sure, that's a great analogy. Actually, 0:10:58.800 --> 0:11:02.400 so some people are like, Okay, it's stigmatizing, but even 0:11:02.400 --> 0:11:04.760 more than that, just the science isn't necessarily there, like 0:11:04.800 --> 0:11:08.480 we're saying it's symptoms rather than an actual disorder. And 0:11:08.520 --> 0:11:12.959 then apparently the Working Group for Personality Disorders for the 0:11:13.040 --> 0:11:17.280 DSM five that's the most recent one, they actually said, 0:11:18.640 --> 0:11:22.520 we're not sure that this should be a categorical disorder, 0:11:22.640 --> 0:11:24.760 which is the type that you either have it or 0:11:24.800 --> 0:11:29.360 you don't. They suggested it should be dimensional, which means 0:11:29.360 --> 0:11:31.800 that it exists on a spectrum. Right, so you can 0:11:31.840 --> 0:11:33.880 have a little bit of BPD, a lot of BPD, 0:11:34.520 --> 0:11:37.840 or right in the middle or whatever, and that got rejected. 0:11:37.920 --> 0:11:43.440 And now so it's a categorical diagnosis where if you 0:11:43.480 --> 0:11:46.360 don't have BPD, you don't have BPD. If you don't 0:11:46.400 --> 0:11:49.360 fit the criteria, if you do, you got BPD. 0:11:49.480 --> 0:11:51.600 Right, And we'll talk about the criterion in a second, 0:11:52.320 --> 0:11:56.200 but we do want to sort of reintroduce Marcia Lenihan, who, 0:11:56.240 --> 0:11:59.640 like I said, was a real pioneer for her work 0:12:00.280 --> 0:12:04.560 in the treatment and recognition of BPD. Very late in 0:12:04.600 --> 0:12:09.480 her life, revealed that she suffered from BPD. After you know, 0:12:10.000 --> 0:12:14.439 patients and friends encouraged her to come forward and she said, basically, 0:12:14.480 --> 0:12:16.000 you know, I'm gonna do it. I'm not going to 0:12:16.080 --> 0:12:18.760 die a coward, is what she said, but for the 0:12:18.760 --> 0:12:22.760 longest time was not out with that information. Was born 0:12:22.800 --> 0:12:27.160 in Oklahoma in I guess the fifties, and in the 0:12:27.240 --> 0:12:32.840 nineteen sixties in high school, was diagnosed with schizophrenia, drugged up, 0:12:33.400 --> 0:12:39.640 give an electro shock, hospitalized, was practicing self harm of 0:12:39.720 --> 0:12:43.720 all kinds, and then had it. Sounds like a not 0:12:43.800 --> 0:12:48.280 a moment of clarity, but a pretty profound religious experience. 0:12:48.440 --> 0:12:50.880 Yeah, the only thing missing was a visit from Saint Michael. 0:12:51.520 --> 0:12:56.559 Pretty much I mean, she's Catholic, and after this religious 0:12:56.600 --> 0:13:00.720 experience she was able to which you know, had a 0:13:00.720 --> 0:13:02.800 lot to do with self love. But after this she 0:13:02.880 --> 0:13:06.560 was able to still have these emotions that she had before, 0:13:07.040 --> 0:13:10.559 but managed it to the point where she wasn't practicing 0:13:10.679 --> 0:13:13.560 self harm. And did she come up with the term 0:13:13.640 --> 0:13:16.440 radical acceptance or did she just buy into that. 0:13:16.800 --> 0:13:19.000 I don't know if that was a descriptor of hers 0:13:19.120 --> 0:13:19.320 or not. 0:13:19.840 --> 0:13:23.000 Okay, I don't think she came up with that. But basically, 0:13:23.000 --> 0:13:26.440 as you know, radical acceptance is like, hey, listen, this 0:13:26.559 --> 0:13:29.520 is how things are with me, this is how things 0:13:29.520 --> 0:13:32.640 are with the world. I accept this, and I'm not 0:13:32.679 --> 0:13:37.840 going to compare this to what I think the reality 0:13:37.880 --> 0:13:39.720 should be or what other people think it should be. 0:13:39.920 --> 0:13:44.880 There's a huge butt that follows that though, But but 0:13:44.880 --> 0:13:49.560 but I am going to do what I can to 0:13:49.720 --> 0:13:51.360 change those things about myself. 0:13:51.720 --> 0:13:51.920 Right. 0:13:52.280 --> 0:13:55.800 So that is the basis of a type of cognitive 0:13:55.800 --> 0:13:59.679 behavioral therapy that she came up with called dialectical behavioral therapy, 0:14:00.320 --> 0:14:03.959 and it is it's based in radical acceptance and the 0:14:04.120 --> 0:14:07.640 desire to examine and change how you interact with the 0:14:07.679 --> 0:14:11.439 world externally. And it's basically the gold standard for treating 0:14:13.120 --> 0:14:15.440 a borderline personality disorder it right. 0:14:15.280 --> 0:14:18.560 Now, Yeah, and it seems like it really works. I 0:14:18.600 --> 0:14:21.680 saw that it was kind of the only proven treatment 0:14:21.760 --> 0:14:26.440 to reduce suicidal behavior, which is, you know, at the 0:14:26.840 --> 0:14:30.200 tail end of what a lot of people experience with BPD. 0:14:31.000 --> 0:14:33.880 And the good news and we'll talk about treatment later, 0:14:33.920 --> 0:14:36.880 but the good news is if you have VPD or 0:14:36.920 --> 0:14:40.359 know someone that does, you can get better. And they 0:14:40.400 --> 0:14:42.600 have proven and shown time and time again now that 0:14:43.560 --> 0:14:47.400 through the treatments that we'll discuss later, it is absolutely 0:14:47.440 --> 0:14:51.440 something that someone can get a hold of in most cases, right, 0:14:52.280 --> 0:14:53.000 which is great. 0:14:53.120 --> 0:14:53.720 It is great. 0:14:53.800 --> 0:14:56.680 I mean, like, for as bad of a stigma as 0:14:56.720 --> 0:14:59.320 BPD has, the idea that like it has a very 0:14:59.360 --> 0:15:04.800 high success rate of treatment is pretty encouraging. So Lenahan's 0:15:04.920 --> 0:15:09.280 basis of her understanding or her definition of borderline personality 0:15:09.320 --> 0:15:14.920 disorder is that it's biosocial that people who have BPD 0:15:15.600 --> 0:15:22.160 are either genetically or biologically predisposed to having BPD, but 0:15:22.280 --> 0:15:26.120 not everybody who has that predisposition is going to be 0:15:26.280 --> 0:15:31.480 triggered into developing BPD. It takes basically a biological substrate 0:15:32.240 --> 0:15:36.160 for BPD, usually your prefrontal cortex hasn't developed in a 0:15:36.240 --> 0:15:39.360 certain way, and so your executive function isn't functioning like 0:15:39.440 --> 0:15:44.680 an executive should. That gets joined together with a trigger, 0:15:46.200 --> 0:15:52.640 usually mistreatment, whether it's abuse, neglect, invalidation by your parents 0:15:53.000 --> 0:15:56.440 as a kid, and you put those things together and 0:15:56.920 --> 0:15:59.880 very often it results in what you be diagnosed with later. 0:15:59.760 --> 0:16:03.000 As Yeah, and man, one thing I really took away 0:16:03.040 --> 0:16:05.200 from this, and this is something that you know, Emily 0:16:05.200 --> 0:16:07.080 and I and and most parents that I know are 0:16:07.120 --> 0:16:11.000 way into, is uh oh, you got to validate your kids. 0:16:11.360 --> 0:16:13.520 Yeah, that's new, which is crazy, but it's. 0:16:13.520 --> 0:16:17.120 It's Yeah, you got to validate their emotions and validate 0:16:17.160 --> 0:16:21.440 their experiences and their feelings, even if it's something that 0:16:21.520 --> 0:16:26.720 you don't think is uh like has the most relevance 0:16:26.840 --> 0:16:28.880 or whatever, or even if like the kid is wrong 0:16:28.920 --> 0:16:31.640 about something or like emotionally wrong, like, you still have 0:16:31.680 --> 0:16:34.280 to validate that and then talk them through it. What 0:16:34.360 --> 0:16:38.760 you can't do is just discount a kid's feelings, because 0:16:39.160 --> 0:16:42.760 that's like telling them that their truth isn't real, and 0:16:42.800 --> 0:16:43.680 that's damaging. 0:16:44.280 --> 0:16:46.920 I know, and doing parenting right sounds like a waking 0:16:47.040 --> 0:16:47.680 nightmare to me. 0:16:48.680 --> 0:16:50.120 Doing wise parenting. 0:16:49.960 --> 0:16:55.240 Parenting correctly, Yeah, Nah. I can't imagine the exhaustion along 0:16:55.320 --> 0:16:58.320 combined with the fear of just misstepping once or twice 0:16:58.360 --> 0:16:59.480 and then there you go. 0:17:00.000 --> 0:17:01.160 How'd you kid up for life? 0:17:01.600 --> 0:17:04.719 Yeah? What you gotta do is, in my experience, is 0:17:04.760 --> 0:17:08.920 like you can't beat yourself up too much because parenting fails, 0:17:09.520 --> 0:17:11.720 you can really go down a rabbit hole of your 0:17:11.720 --> 0:17:15.320 own I'll bet depression if you if you screw up, 0:17:16.240 --> 0:17:18.480 and you can't do that because kids are resilient and 0:17:18.520 --> 0:17:21.000 you just got to, like you've got to prove to 0:17:21.040 --> 0:17:23.400 them that you can like pick yourself up and move 0:17:23.440 --> 0:17:24.560 on and do better, you know. 0:17:24.760 --> 0:17:29.720 Yeah, And I don't think Lenahan's idea is that it 0:17:29.880 --> 0:17:32.560 just takes one or two missteps. It takes like a parent, 0:17:32.640 --> 0:17:36.199 he was a genuinely bad parent. Very frequently they have 0:17:36.320 --> 0:17:40.159 BPD themselves. Yeah, and that is a real challenge to 0:17:40.240 --> 0:17:43.800 parenting well in and of itself. But you don't have 0:17:43.880 --> 0:17:46.679 to have had a parent with BPD to develop BPD. 0:17:47.119 --> 0:17:50.040 But typically it's a parent that is not at all 0:17:50.160 --> 0:17:55.040 meeting your needs, especially emotionally. And I say, we take 0:17:55.040 --> 0:17:56.800 a break and we'll come back and talk about how 0:17:56.840 --> 0:17:59.119 you would be diagnosed with BPD. What do you think, 0:17:59.520 --> 0:18:23.080 let's do it, okay, Chuck. So we said that BPD's 0:18:23.119 --> 0:18:26.080 in the d S M five. It's a personality disorder. 0:18:26.720 --> 0:18:30.560 And just to differentiate real quick, a mood disorder describes 0:18:30.920 --> 0:18:34.520 patterns and feelings like you have mood swings in that 0:18:35.480 --> 0:18:38.800 you know highs and lows, and that's pretty reliable that 0:18:38.840 --> 0:18:41.400 you're going to have it one way or another. Personality 0:18:41.440 --> 0:18:44.800 disorder focuses more on how you relate to others, and 0:18:44.880 --> 0:18:47.480 that definitely makes sense to me that you would consider 0:18:47.640 --> 0:18:49.640 a BPD of personality disorder. 0:18:49.680 --> 0:18:53.359 Then, Yeah, that seems to be a really key thing 0:18:53.520 --> 0:19:02.280 is that it really disturbs your relationships. So to be diagnosed, 0:19:02.400 --> 0:19:07.000 you fit at least five out of the following nine 0:19:07.119 --> 0:19:10.000 that we're gonna read for you. Chronic feelings of emptiness. 0:19:09.600 --> 0:19:13.160 And that's emptiness feeling like isolated or lonely or hopeless. 0:19:13.520 --> 0:19:18.320 Sure, emotional instability and reaction to day to day events. 0:19:18.640 --> 0:19:22.480 That's the thing we were talking about earlier, Like saying 0:19:22.480 --> 0:19:25.600 mountains out of molehills seems slightly reductive, but that's kind 0:19:25.640 --> 0:19:29.159 of a basic way to say it. Frantic efforts to 0:19:29.240 --> 0:19:34.200 avoid abandonment, whether or not they're real or imagined as Yeah, 0:19:34.200 --> 0:19:38.560 as we'll see abandonment issues, and this very very much 0:19:38.600 --> 0:19:44.800 includes emotional abandonment as a really big precursor unstable self 0:19:44.840 --> 0:19:46.080 image or sense of self. 0:19:47.680 --> 0:19:51.119 What else, Impulsive behavior is usually a big one, and 0:19:51.200 --> 0:19:54.000 you have to have impulsive behavior and at least two 0:19:54.080 --> 0:19:57.840 areas that are harming your day to day life, like 0:19:57.880 --> 0:20:02.040 an eating disorder and gambling addiction or something like that. 0:20:03.320 --> 0:20:07.040 Another one is this is based on and so this 0:20:07.080 --> 0:20:09.359 is where some psychiatrists would be like, see this is 0:20:09.400 --> 0:20:12.120 not this is this is a symptom that we're talking 0:20:12.160 --> 0:20:17.160 about here, but it's unstable and intense interpersonal relationships. I mean, 0:20:17.359 --> 0:20:20.480 like you're really really close to somebody for you know, 0:20:20.840 --> 0:20:22.480 a couple of days, and then they do something you 0:20:22.520 --> 0:20:24.959 don't like and they're the worst person in the world. 0:20:25.600 --> 0:20:28.960 And it can happen very very quickly with people with BPD, 0:20:29.520 --> 0:20:32.080 and if you stick around and stay in that person's life, 0:20:32.119 --> 0:20:34.760 you can find yourself walking on eggshells very quickly because 0:20:35.000 --> 0:20:37.199 you don't want them to turn on you all of 0:20:37.200 --> 0:20:40.920 a sudden. So that's a huge one. If you have 0:20:41.040 --> 0:20:44.960 a lot of unstable, intense relationships with people, that's just 0:20:45.040 --> 0:20:48.920 kind of the MO that is usually a big giveaway 0:20:48.320 --> 0:20:49.680 with BPD. 0:20:50.320 --> 0:20:55.680 Yeah, the last three recurrent suicidal or self harming behaviors. 0:20:55.680 --> 0:21:00.000 We've talked about that a little bit, stress related paranoia 0:21:00.240 --> 0:21:03.080 or dissociative symptoms, like feeling like the self of the 0:21:03.080 --> 0:21:07.280 world isn't real. It feels like that's probably at the 0:21:07.320 --> 0:21:09.760 far end of the spectrum, or the most severe end. 0:21:10.520 --> 0:21:14.680 And then when we missed earlier was inappropriate and intense 0:21:14.720 --> 0:21:17.040 anger or difficulty controlling anger. 0:21:17.200 --> 0:21:20.480 I didn't miss it. That was purposeful, Okay. I wanted 0:21:20.480 --> 0:21:21.879 to end with that big one. 0:21:22.280 --> 0:21:23.760 Okay, all right, speak to it. 0:21:23.960 --> 0:21:27.879 Well, there's a lot of I always hate saying those qualifiers. 0:21:27.920 --> 0:21:29.679 It's just so easy to say, but I know I 0:21:29.720 --> 0:21:31.800 think it perks people's ears up, like, oh, this person 0:21:31.880 --> 0:21:33.000 doesn't know what they're talking about. 0:21:33.080 --> 0:21:34.160 So let me rephrase that. 0:21:34.280 --> 0:21:37.639 I have seen that there are schools of thought regarding 0:21:38.280 --> 0:21:47.359 borderline personality disorder that it is a rage response to trauma. Okay, 0:21:47.400 --> 0:21:49.920 that that is your response to unresolved trauma. That's how 0:21:49.960 --> 0:21:52.800 you learn to deal with those feelings and those emotions 0:21:52.880 --> 0:21:55.960 is to rage at people. Because rage is as much 0:21:55.960 --> 0:21:59.720 a hallmark of BPD as fear of abandonment is right, 0:22:00.040 --> 0:22:03.199 and that's why some people are critical of including it 0:22:03.240 --> 0:22:06.080 as a categorical diagnosis in the d s M five. 0:22:06.520 --> 0:22:09.520 They're saying, you're pathologizing rage. No, you just need to 0:22:09.560 --> 0:22:12.639 teach people how to identify their emotions and how to 0:22:12.680 --> 0:22:16.480 express them in a more appropriate, less hostile manner, and 0:22:16.520 --> 0:22:19.360 then that's how you would treat somebody with BPD, or 0:22:19.560 --> 0:22:22.600 not even with BPD, somebody with a rage disorder. But 0:22:22.680 --> 0:22:25.000 some people think that that is what what people are 0:22:25.040 --> 0:22:26.160 mistaking for BPD. 0:22:26.760 --> 0:22:31.000 Oh, I got youa okay, interesting, Uh, you're gonna to 0:22:31.040 --> 0:22:34.160 be diagnosed, Like I said, five of those nine, it'll 0:22:34.160 --> 0:22:36.359 probably be you know, like you'll be talking to a 0:22:36.359 --> 0:22:39.800 psychologist or someone in an interview. You might fill out 0:22:39.800 --> 0:22:43.320 a questionnaire or something they're going to make interesting right 0:22:43.920 --> 0:22:47.240 click click click click, or they may speak to your 0:22:47.320 --> 0:22:51.199 family or something like that. It can be difficult to 0:22:51.280 --> 0:22:55.360 diagnose and there, like you said, there's there's a lot 0:22:55.400 --> 0:22:59.480 of overlap between you know, things like anxiety and depression 0:22:59.560 --> 0:23:03.640 and things like PTSD and eating disorders, a lot of comorbidities. 0:23:04.359 --> 0:23:09.320 So I get why people can have issues with like 0:23:09.680 --> 0:23:13.120 this diagnosis rather than it's like a cluster of symptoms 0:23:13.160 --> 0:23:15.720 of other things. But I don't know. If you group 0:23:15.800 --> 0:23:18.399 that altogether then it and call it its own thing, 0:23:18.440 --> 0:23:19.680 then I don't know. I'm not sure I see the 0:23:19.720 --> 0:23:20.200 harm in that. 0:23:21.000 --> 0:23:23.720 Again, I think it's the stigma. And then also it 0:23:23.800 --> 0:23:27.520 might be distracting from treating the other underlying. 0:23:27.000 --> 0:23:33.040 Stuff, maybe because there also isn't and we'll talk about pharmaceuticals, 0:23:33.040 --> 0:23:36.560