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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 iHeartRadio.
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, because 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.
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 talking this is another in our suite on mental health conditions.
And, boy, we've got a lot of them, but we've 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 suffer from these conditions and say thanks for either educating me and or getting the word out to people who may be a little 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.
Yeah, but regardless, that has nothing to do with anything.
You mentioned just now that people kind of wrote in or write in when we do episodes like this.
When we did our emotional pain episode and we mentioned 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 maybe one of the hardest –
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, not only among just people who you know, may or may not know much about it, but even clinicians and therapists that stuff you sent me like a lot of times try to avoid or severely limit the number of patients they have that they treat with BPD, which makes it even more sad because it is a really tough one.
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 fairly complex.
But it is a what's known as a cluster B personality disorder, which is in the antisocial personality disorder category, along with histrionic personality disorder and narcissistic personality.
I'm just going to start saying PD.
Yeah, PDs.
It'll make it sound like you know you're talking about even more narcissistic PD, but it seems like a lot of what it can be is sometimes a disorder of perception.
And while there are very real things that do, that can trigger people with BPD, 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 a lot of people confuse borderline personality disorder with bipolar, or at least think they're similar.
I guess because they both start with Bs or something like that.
But no, they're not similar.
Bipolar has much more of a brain and central nervous system basis.
Mm-hmm.
Whereas, while borderline personality disorder has a component of that, the executive function of the person in their prefrontal cortex either didn't develop in a fully normal way or it's not functioning up to snuff, I guess.
More than anything, and the thing that differentiates it from bipolar is it's a – an assignment of meaning.
It's psychological as much, if not more, than it is physiological.
Yeah, and also bipolar is characterized and we did a good episode on that quite a while ago but it's characterized by these highs and lows and then in between those periods They can be relatively stable, whereas with borderline personality disorder it's sort of always there.
This one thing you sent me had a really, kind of really nailed 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 kind of calls out one of the big hallmarks of BPD, which is emotional dysregulation.
Things that would affect other people a little bit, maybe not at all.
Stuff that most people let roll off of their back could set somebody with BPD off into a rage that could last days, potentially.
Yeah.
They also might use self-harm.
It's called non-suicidal self-injury to kind of externalize the pain because 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 an ocean and a huge wave hits you, and you're as profoundly enveloped by emotion at that moment as you are by a wave when it just completely knocks you off your feet and sweeps you away.
Yeah, there was another, and we'll talk about her in great detail.
Her name is Marsha Linhan, or is it Linehan?
I'm going to go with Linhan.
Yeah she, as we'll see, is someone who not only suffered from BPD but kind of pioneered the treatment of BPD.
But she said it's like having third-degree burns on 90% of your body metaphorically.
So you're lacking emotional skin and you feel agony at the slightest touch or movement.
Mm-hmm.
And since you did mention self-harm non-suicidal self-harm it also.
People with BPD have a suicide rate of, was it like, 50 times higher than average in the population.
Yeah.
So this is no joke.
This is a very hardcore disorder that bears more empathy and understanding.
Yeah, for sure.
Let's 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 terms.
Not at all.
Frustratingly so.
Yeah, and that goes back to a jerk named Adolph Stern who really jerked it up back in 1938.
Yeah.
Yeah, he was a psychoanalyst, and he basically...
I mean, 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 this is Stern saying you're not quite on the psychotic level and you're not quite psychoneurotic.
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.
Psychoneurosis is what we call like anxiety depression, 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 situation.
Yeah.
Okay, so he was a psychoanalyst in the mid 1970s.
So that's, you know, like 40 something years later.
And 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 kind of talked about.
And officially, I think five years after that was 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 looking at very very, very quickly.
Yeah, and isn't there 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, we'll talk about that.
I think we can kind of pepper it throughout, you know.
Okay, sure.
But, yes, there is 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 a cluster of symptoms that overlap with a bunch of different –
Actual disorders.
And that the problem with that, you say, who cares?
You're identifying people, a group of people whose rate of suicide is 50 times the general population.
That alone is worth, like, identifying and helping those people out.
But what they're saying is number one BPD has gotten such a bad name in the general population that you are literally stigmatizing somebody when you give them that diagnosis.
It is an enormously heavy weight you put on somebody when you say, I'm a trained psychiatrist.
I know what I'm talking about.
And you have borderline personality disorder.
Everybody step back, basically.
Yeah.
Yeah, I mean, 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 some people are like, okay, it's stigmatizing.
But even more than that, just the science isn't necessarily there.
Like we were saying, it's symptoms rather than an actual disorder.
And then apparently, the working group for personality disorders for the DSM-5.
That's the most recent one.
Mm-hmm.
They actually said 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 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.
And that got rejected.
And now?
So it's a categorical 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.
Right, and we'll talk about the criteria in a second.
But we do want to sort of reintroduce Marsha Linehan who, like I said, was a real pioneer for her work in the treatment and recognition of BPD.
Very late in her life revealed that she suffered from BPD after patients and friends encouraged her to come forward And she said basically you know, I'm going to do it.
I'm not going to die a coward is what she said.
But for the longest time was not out with that information.
Was born in Oklahoma in, I guess, the 50s and in the 1960s.
In high school was diagnosed with schizophrenia, drugged up, given electroshock hospitalized, was practicing self-harm of all kinds and then had it sounds like a not a moment of clarity, but a pretty profound religious experience.
Yeah, the only thing missing was a visit from St.
Michael.
Pretty much.
I mean, she's Catholic.
And after this religious experience she was able to, 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 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, radical acceptance is like, hey, listen, this is how things are with me.
This is how things are with the world.
I accept this and I'm not going to compare this to what I think the reality should be or what other people think it should be.
There's a huge but that follows that, though.
But—
But I am going to do what I can to change those things about myself.
Right.
So that is the basis of a type of cognitive behavioral therapy that she came up with called dialectical behavioral therapy.
And 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 a borderline personality disorder right now.
Yeah, and it seems like it really works.
I saw that it was kind of the only proven treatment to reduce suicidal behavior, which is at the tail end of what a lot of people experience with BPD.
And the good news and we'll talk about treatment later but the good news is, if you have BPD or know someone that does, you can get better.
And they have proven and shown time and time again now that, Through the treatments that we'll discuss later, it is absolutely something that someone can get a hold of in most cases.
Right.
Which is great.
It is great.
I mean for as bad of a stigma as BPD has.
The idea that it has a very high success rate of treatment is pretty encouraging.
Yeah.
So Linehan's basis of – or her understanding or her definition of borderline personality disorder is that it's biosocial.
That people who have BPD are either genetically or biologically predisposed to to having BPD.
But not everybody who has that predisposition is going to be triggered into developing BPD.
It takes basically 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, usually mistreatment, 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'd 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 most parents that I know are way into is oh, you got to validate your kids.
Yeah, that's new, which is crazy, but it's.
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 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, because 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?
Parenting correctly.
Yeah.
No.
I can't imagine the exhaustion along, combined with the fear of just misstepping 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 depression if you if you screw up.
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 don't think Linehan's 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 and that is a real challenge to parenting well in and of itself.
But you don't have to have had a parent with BPD to develop BPD.
But typically, it's a parent that is not at all meeting your needs, especially emotionally.
And 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.
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Okay, Chuck, so we said that BPD is in the DSM-5.
It's a personality disorder.
And just to differentiate real quick.
A mood disorder describes patterns in feelings, like you have mood swings, in that 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 that it really disturbs your relationships.
Mm-hmm.
So to be diagnosed.
You fit at least five out of the following nine that we're going to read for you.
Chronic feelings of emptiness.
And that's emptiness feeling like isolated or lonely or hopeless.
Sure.
Emotional instability and reaction to day-to-day events.
That's the thing we were talking about earlier.
Like seeing mountains out of molehills seems slightly reductive, but that's kind of a basic way to say it.
Okay.
Frantic efforts to avoid abandonment, whether or not they're real or imagined.
That's a huge one.
Yeah, as we'll see abandonment issues and this very, very much includes emotional abandonment as a really big precursor.
Yeah.
Unstable self-image or sense of self.
What else?
Impulsive behavior is usually a big one, and you have to have impulsive behavior in at least two areas that are harming your day-to-day life, like an eating disorder and gambling addiction or something like that.
Right.
Another one is –
This is based on – and so this is where some psychiatrists would be like see, this is not – this is a symptom that we're talking about here.
But it's 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.
Yeah.
And it can happen very, very quickly with people with BPD.
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.
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 BPD.
Right.
Yeah.
The last three, recurrent suicidal or self-harming behaviors.
We've talked about that a little bit.
Stress-related paranoia or dissociative symptoms like feeling like the self or the world isn't real.
It feels like that's probably at the far end of the spectrum or the most severe end.
And then one we missed earlier was inappropriate and intense anger behavior or difficulty controlling anger.
I didn't miss it.
That was purposeful.
Wanted to end with that big one.
Okay.
All right.
Speak to it.
Well, there's a lot of – I always hate saying those qualifiers.
It's just so easy to say.
I know.
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 rage response to trauma.
Okay.
That is your response to unresolved trauma.
That'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 that's why some people are critical of including it as a categorical diagnosis in the DSM-5.
They're saying you're pathologizing 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 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 people are mistaking for BPD.
Oh, I got you.
Okay.
Interesting.
You're going to be diagnosed, like I said, five of those nine.
It'll probably be like you'll be talking to a psychologist or someone in an interview.
You might fill out a questionnaire or something.
They're going to go, interesting.
Click, click, click, click.
Or they may speak to your family or something like that.
It can be difficult to diagnose.
And, like you said, 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 and call it its own thing, then I don't know.
I'm not sure I see the harm in that.
Again, I think it's the stigma.
And then also it might be distracting from treating the other underlying stuff.
Maybe because there also isn't and we'll talk about pharmaceuticals, but there isn't a specific pharmaceutical for BPD.
That's another clue that some people point to that it's not – we're mistaking it somehow.
And I don't want to like overstate that school of thought.
It is widely considered like an accepted diagnosis.
Borderline personality disorder is.
So I don't want to make it seem like the cracks are in the facade.
It's about a crumple any day now.
My point is people make some pretty good 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 think that's exactly right.
But I mean again, if we come to this place where, even if a BPD is the center of a giant Venn diagram of a bunch of different disorders,
Yeah, yeah.
And we're mistaking that center overlap of all of them as its own thing.
Mm-hmm.
If you zero in on that group and they have a 50 times higher rate of suicide than the general population, again that is worth zeroing in on, you know, as its own thing.
And, like you said, dialectical behavior therapy is focused initially on individual sessions that are aimed to control that behavior suicidality.
Yeah.
Yeah, for sure.
You did mention earlier, as far as causes go, that sometimes there is a genetic link, but it seems that it's not really the disorder.
That is maybe passed from parent to child, but some of those traits, and maybe that's because it is sort of a cluster.
Sometimes you can have BPD and come from a pretty good, stable upbringing, but that seems to be the outlier, and it seems to be that most people that end up suffering from this had a pretty lousy childhood.
Yeah, so they were either neglected or just kind of...
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 a single one.
Excessive control.
It sounds very Freudian, but I saw one classic example is an absent father and a domineering 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.
And then also if your parents or parent had a mood disorder themselves or misused substances, that would probably have affected their parenting as well.
Yeah.
This also made me think about like parenting of old versus parenting now.
And parents can – there are still, of course, a huge – 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.
I mean, I know that still happens, but it just seems like that happened a lot more back in the day.
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 – sort of an elementary way of looking at it, but I just feel like parents are more aware of stuff these days.
And you know people of our generation and certainly the generations before that.
It 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 not going to parent because we're doing the work and we're going to bring home the paycheck.
And so like I had, I've talked about it before.
I had a dad that wasn't very involved, but it wasn't like the kind of thing where I ended up with BPD because of it, you know.
Yeah, for sure.
If that makes sense.
You raise a question, though, in my mind.
I wonder what percentage of boomer grandparents aren't allowed to see their grandchildren.
I'll bet it's higher than you think.
Are allowed to or not allowed to?
Are not allowed to.
Like just don't have contact with their grandkids.
Yeah, or it's very limited and supervised.
Actually, though, a lot of those grandparents all of a sudden are the most doting.
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 think, in some cases, the more they don't, they're actually also undermining the parenting of their kids.
Yeah.
Yes, and imagine it can be very painful sometimes.
For a parent who had an inattentive parent to now have that parent be a very intensive grandparent.
If you have BPD, I would guess that would be a rage-inducing trigger.
I imagine it would be.
So 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.
And they say that about 80 percent of people with BPD experience some level of childhood trauma, whether it was emotional neglect or Or some sort of abuse.
It's a huge factor, a huge risk factor in developing BPD for sure.
Yeah, absolutely.
And it seems to be exacerbated if you're a kid who is, 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 validating your experience and your emotion as a kid.
So you're already starting back sort of behind the eight ball, and then your parents are making it worse.
And so that can definitely, you know, ease you toward that condition.
Well, it's like 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 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 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.
If you don't have executive function, your emotional dysregulation is more likely to include explosions of anger, uncontrollable anger.
And then one of the things – it's not just BPD that has that.
There's plenty of other disorders that have it.
But 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 it, 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, mork 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, it's kind of a wide range, like all this stuff, because it's one of those disorders that is, a lot of people don't admit it or seek treatment.
So it's really hard to nail it down.
But Livia helped us out with this one, and she said 0.5% to 6%.
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, that's an indictment of clinicians who 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 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 people receiving inpatient mental health treatment.
One in five of those people are diagnosed with BPD.
So it is very prevalent, at least inside the clink, the mental clink.
Yeah, the mental clink.
One other aspect is a very black and white thinking.
You kind of talked before about splitting, which is, you know, really revering and idolizing somebody and then very quickly despising them.
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, like someone you used to really like and idolize all of a sudden just no more.
You despise them and they're on the bad person list forever.
Yeah, and that falls under the larger category of black and white thinking.
It's not just applied to people.
It's events, things, anything.
A dandelion can be entirely evil or 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.
And most people that 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, you know, they did something wrong at their core.
They're evil.
And that's another huge hallmark of BPD as well.
I mean, even Darth Vader was once a young boy.
Yeah.
Just trying to learn the ways of the Force.
But boy, did he get pale as he aged.
He sure did.
This can also this splitting can happen with yourself.
You may vacillate wildly from feeling like you're OK and that you feel good about yourself and you have a little bit of self-confidence to really loathing yourself.
And that's when like things like, you know, self-harm can come into play.
Your sense of your own personality can really change your.
You know you could very much switch, like kind of do these wild switches between 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 this I'm not really sure, but it kind of seems like almost like a sort of auditioning yourself kind of over and over, sometimes like oh, let me try this new me or whatever, or auditioning or trying out a new thing that you think might help.
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.
Or yes, to impress like a friend or a new person or something like that they might adopt that person's like hobbies and interests.
But I saw it explained as people who have BPD and do that, that 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.
Should we take a break?
Oh, geez, that came out of left field.
Sorry.
Sure.
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 personal relationships.
Hi, I'm Dr. Priyanka Wally.
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This is Dr Jesse Mills, Director of the Men's Clinic at UCLA Health and host of the Mailroom Podcast.
Each January, guys everywhere make the same resolutions.
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Or wherever you get your favorite shows.
All right, we're back and talking about borderline personality disorder, and one kind of hallmark with someone with BPD is what's called like a favorite person or just a person in their life that they have not necessarily even chosen who they've hooked up with.
It could be a spouse.
It could be a partner.
It could be a friend or coworker, anyone that you really have latched onto as someone, maybe the only person that you really really trust with yourself.
Yeah, and I don't think you even trust that person.
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 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.
But you're also in real danger of letting that person down and facing that wrath of rage or anger or hostility.
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 our friend with BPD was going to, you know, wanted us to come out for their Sunday picnic, or something like that.
Right.
Like you would be afraid to not go to their picnic.
Right.
And you generally end up feeling like you're walking on eggshells.
And it's a codependent relationship that evolves.
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 are fearful of.
They're fearful of rejection or abandonment.
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.
Yeah, I mean, it's a big burden for an FP.
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 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 to someone's burden.
One of the other things that is difficult to deal with when you're an FP is that person wants you all to themselves.
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 –
I guess rational explanation or rational points from those other people like, what are you doing?
Why are you putting up with this?
Isolating them would help cut down on that too.
Yeah.
And you know, if you're an FP, there's always the – sort of sad and scary possibility that there could be a split incident, that all of a sudden you go from being the FP to being the most despised person.
I would imagine that's something that probably comes over time and is not like a quick thing.
It can be.
But it can be?
All right.
For sure.
It can happen.
It can turn on a dime.
Wow.
And the other problem with it as well Chuck, is that 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, 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 going to happen again, because it's impossible for that person not to let the person with BPD down again.
Yeah.
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 chased somebody away.
It's that that person left you and now you need to go get them back.
Right.
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.
Yeah.
Yeah.
That's one of the curses of it.
They can't see it.
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 sort of be at the top of the list of needing a really solid, vast support system.
For treatment, like we said, the good news is that treatment works.
They used to think that personality disorders were untreatable and that you were just kind of stuck with it.
They have found that...
About half the people who are treated, who seek treatment and are treated, no longer meet the criteria after five to ten years.
That's amazing.
It doesn't mean that they're perfect and awesome and fixed.
It means 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 something that –
Like you said, that you might have had, since you were like a baby to live a productive you know healthy life.
Yeah, and that's kind of what you're going to learn in DBT, which again is the gold standard for treating BPD.
Is that you're going to be taught these skills how to deal with disappointment, with 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 kind of differentiates DBT from other kinds of behavioral therapy is is that there's group sessions, but it's not a group session that 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 group therapy session in the traditional sense.
But that's a huge component of it is group work.
Yeah, and 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 I get how it works.
It seems like a real sort of rubber meets the road practical ways of learning new behaviors rather than – and therapy 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 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 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 good way forward when you have any kinds of problems, because it's just a practical thing.
It's learning new behaviors, right?
That's another criticism 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, for sure.
But there's also another type of therapy that supposedly works really well for DBT, called psychodynamic 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 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.
Mm-hmm. as a result of interrogating what you went through as a kid.
And I guess it smells a lot like it believes borderline is like 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 what's called a therapist consultation team, which is basically a group of therapists working with patients with BPD, having like a blow-off steam session about them 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.
Right.
Yeah.
And, like I said at the beginning, there are therapists that will refuse treatment because all the reasons that we talked about they say the National Alliance on Mental Health basically says if you have BPD and you recognize that and you want to seek treatment, whether it's, you know, DBT or any other kind, you will 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 who will not stigmatize you.
And like really like it's OK to question them and make sure it's a good fit for you.
Yeah, for sure.
I think people just – I don't know.
I think part of the problems with a lot of these disorders is people can't be advocates for themselves, 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.
Yeah.
But the thing is, Chuck is like you said people take what they can get, in part because there's a huge shortage of psychiatrists, in particular in the United States.
And people will just take whoever can get them in within a year or less.
The waiting lists are crazy.
It is crazy.
Yeah.
Well, if you want to know more about BPD, there are a lot of articles and resources all over the Internet to help you.
And since I said that, it's time for listener mail.
I'm going to call this.
Well, let's just call it listener mail.
Hey, guys.
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.
In the meantime, I want to let you know that both of your names are listed on my big thanks to portion of my bachelor thesis.
Nice.
It's customary in my country to thank your college coach for their support during your graduation year and your thesis forward.
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.
I don't feel the least bit dramatic when I say my thesis would not have been written but wasn't for you guys keeping me sane.
It's what you've done for me over the years, but this year I really needed it more than ever.
So thank you, all caps, double exclamations.
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 Chuck has a little null sign through it.
That's weird.
I'm not sure what that means.
It means watch your back.
It means I don't count.
And that is with much love and immense gratitude from Suzanne.
Oh, I'm going to do my best here, Suzanne.
Kreiswick.
Let's hear it again.
Kreiswick.
Kreiswick.
I like the second one.
K-R-U-I-S-W-I-J-K.
You like the second one?
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.
I think you did just write that email, if you ask me.
Don't you, Chuck?
I'm tearing up.
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 stuffpodcasts at iheartradio.com.
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Hi, I'm Dr. Priyanka Wally.
And I'm Hari Kundabolu.
It's a new year, and on the podcast Health Stuff, we're resetting the way we talk about our health.
Which means being honest about what we know, what we don't know, and how messy it can all be.
I like to sleep in late and sleep early.
Is there a chronotype for that, or am I just depressed?
Health Stuff is about learning, laughing, and feeling a little less alone.
Listen on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.
This is Dr. Jesse Mills, host of the Mailroom Podcast.
Each January, men promise to get stronger, work harder, and fix what's broken.
But what if the real work isn't physical at all?
I sat down with psychologist Dr. Steve Poulter to unpack shame, anxiety, and the emotional pain men were never taught how to name.
Part of the way through the valley of despair is realizing this has happened and you have to make a choice whether you're going to stay in it or move forward.
Our two-part conversation is available now.
Listen to The Mailroom on the iHeartRadio app, Apple Podcasts or wherever you get your favorite shows.
Hey, it's Joel.
And Matt.
From How To Money.
If your New Year's resolution is to finally get your finances in shape, we've got your back.
Prices, they're still high, and the economy is all over the place.
But 2026 is the year for you to get intentional and make real progress.
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Kick off the year with confidence.
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