Speaker 1: Welcome to Stuff Mom Never Told You from House Supports
Speaker 1: dot com. Hello, and welcome to the podcast. I'm Kristen
Speaker 1: and I'm Caroline, and we've talked about mental health a
Speaker 1: number of times on Stuff I've Never Told You, and
Speaker 1: we have received requests from a lot of listeners to
Speaker 1: talk about what we're going to talk about today, which
Speaker 1: is borderline personality disorder. And Caroline, I want to bounce
Speaker 1: the ball to you first because you're the one who
Speaker 1: you know, in addition to us getting these listener requests,
Speaker 1: you also were interested in researching and talking about this.
Speaker 1: Was there something in particular that sparked your desire to
Speaker 1: learn more about it? Yeah, because when I have heard
Speaker 1: about borderline personality disorder, traditionally, it's been and in relation
Speaker 1: to women, traditionally, it has been along the lines of
Speaker 1: that girl is crazy, um, or I dated this crazy girl,
Speaker 1: or my friend dated this crazy girl, and you know,
Speaker 1: I think she was like borderline or something, and so
Speaker 1: people being very flip about it, the way that they
Speaker 1: people in general are flip about so many mental health conditions. Um.
Speaker 1: You know, we talked about that very same issue in
Speaker 1: our in our episode on obsessive compulsive disorder that people
Speaker 1: are are very not eager, but very ready to just
Speaker 1: throw out a mental health term to describe something not serious,
Speaker 1: when in reality you're mislabeling a set of behaviors. Yeah,
Speaker 1: and also miss gendering it in a way, because, like
Speaker 1: you said, a lot of times, when it is applied
Speaker 1: more sarcastically, it's usually exclusively describing women. And even if
Speaker 1: we look at pop culture and depictions of borderline personality disorder,
Speaker 1: all of the characters we rounded up are women as well.
Speaker 1: So for instance, Girl Interrupted starting one on a Writer
Speaker 1: and Angelina Jolie One own a Writer's character is supposed
Speaker 1: to have BPD, but she kind of shows little evidence
Speaker 1: of it in the movie. Yeah, it's almost like Angelina
Speaker 1: Jolie's character shows a little bit more of that traditional
Speaker 1: BPD behavior. Um there's also Glenn Close and fatal attraction
Speaker 1: and before anyone gets upset, she is definitely a caricature
Speaker 1: of someone with BP d um and and that's that's
Speaker 1: another issue too. So not only do you have the
Speaker 1: gendering of borderline personality disorder in pop culture and in
Speaker 1: the media, but you do tend to see it as
Speaker 1: a caricature, not as something real that someone is struggling with. UM.
Speaker 1: Psychiatrist David m. Allen, who is a professor at the
Speaker 1: University of Tennessee, also pointed out that Anne Hathaway in
Speaker 1: the movie Rachel Getting Married UH portrays someone with borderline
Speaker 1: personality disorder, but they don't actually delve deep into the
Speaker 1: relationship between her and her mother, which uh in real life,
Speaker 1: I r L could have triggered BPD in someone and
Speaker 1: a movie that I actually had not heard of before,
Speaker 1: but I'm now curious to say, partially because I love
Speaker 1: this actress, Jessica Laying in the movie. Francis Um is also,
Speaker 1: as Dr Allen points out, someone who is meant to
Speaker 1: portray borderline personality disorder because of the way that she
Speaker 1: manipulates her psychiatrists by exploiting his insecurities. And that is
Speaker 1: something that you see with borderline where people do tend
Speaker 1: to be master manipulators because they read people really, really,
Speaker 1: really well. Yeah. And also he points out that the
Speaker 1: tipping point in this character's life, well, actually it was
Speaker 1: a character based on a woman who actually existed, an
Speaker 1: actress named Francis Um. But she also has this controlling,
Speaker 1: hostile mother who tried to live vicariously through her, and
Speaker 1: so we will talk about more about these family connections.
Speaker 1: Does this get a little mommy dearest? Yeah, that was
Speaker 1: another one that commenters were like, Um, I have another
Speaker 1: one suggestion. Yeah. Um. He also was really big on
Speaker 1: the movie Third Team, which start Evan rachel Wood and
Speaker 1: Nicky Reid. He says that it should be subtitled how
Speaker 1: to turn your teenager into a borderline without ever being abusive. Yeah.
Speaker 1: I was trying to remember watching that. It's been so
Speaker 1: long since I've seen thirteen, and I certainly was not
Speaker 1: aware as I was watching that that that might have
Speaker 1: been something going on with these characters. Well right, And
Speaker 1: I think that when we look at kids, teens, young
Speaker 1: people who are developing BPD, a lot of the times
Speaker 1: they're just portrayed as like bad kids, bad seed. Wild. Yeah,
Speaker 1: they're just wild and out of control, and you know,
Speaker 1: maybe they should just be shipped off to boarding school
Speaker 1: or you know, you're just gonna wind up in prison.
Speaker 1: But there are very real things that are beginning to
Speaker 1: manifest around that age. Because if borderline personality disorder and
Speaker 1: it's accompanying symptoms aren't caught early on, and technically are
Speaker 1: not supposed to diagnose a child with BPD. Um, you
Speaker 1: can almost just watch the condition develop as kids get older. Well,
Speaker 1: speaking of watching the condition develop, let's talk about what
Speaker 1: this is. So according to the National Institutes of Health,
Speaker 1: borderline personality disorder is defined as a serious mental illness
Speaker 1: marked by unstable moods, behaviors, and relationships, which does sound
Speaker 1: like a very umbrella type of germ. I gotta be honest, yeah, absolutely,
Speaker 1: and those unstable moods can be triggered by, honestly, really
Speaker 1: what we would consider maybe mundane events or minor separations,
Speaker 1: because people with BPD are terrified of abandonment and they
Speaker 1: tend to lack a strong or stable sense of self
Speaker 1: IDENTI and then um, as we mentioned talking about Jessica
Speaker 1: Lang portraying Francis, people with borderline personality tend to be
Speaker 1: hyper adept at reading people, and this was something explored
Speaker 1: more in November two thousand and six study in the
Speaker 1: journal Emotion, which found that quote an enhanced ability to
Speaker 1: recognize expressions of happiness, sadness, anger, and fear might contribute
Speaker 1: to the unstable relationships and intense emotions characteristic of the disorder.
Speaker 1: So essentially, these people are able to read other people
Speaker 1: and then sort of shapeshift in a way based on that.
Speaker 1: But it's almost it's almost such a burden because they
Speaker 1: are so adept at picking up on she's really happy
Speaker 1: or she's really upset, or she's really angry. They tend
Speaker 1: to experience this emotional roller coaster. And so basically in
Speaker 1: this study, when they were shown faces, they were able
Speaker 1: to pick up on an emotion, whether it was anger
Speaker 1: or whether it was happy nous, so much earlier in
Speaker 1: the emotions expression on the face than people without BPD.
Speaker 1: So like, I might be having just like a flicker
Speaker 1: of anger across my face, but somebody with BPD would
Speaker 1: pick up on that end imagine that I'm just enraged
Speaker 1: or so upset with them. Um. And it's the same
Speaker 1: thing with happiness, which leads to a lot of very
Speaker 1: turbulent emotional connections because if if I'm looking at you
Speaker 1: and I'm just like vaguely happy or you know, not
Speaker 1: looking upset, you might think like, oh, she she really
Speaker 1: likes me, or you know, they tend to develop these
Speaker 1: these really strong emotional connections and have turbulent romantic relationships
Speaker 1: because there's almost too much of her reading into when
Speaker 1: it comes to emotions, facial expressions, body language. Oh so
Speaker 1: it's not it's not even just that they're correct in
Speaker 1: assessing someone's emotions, but they tend to blow it out
Speaker 1: of proportion. Yeah, okay. And on top of these kinds
Speaker 1: of factors, there are also high rates of comorbid conditions
Speaker 1: like anxiety, which is the most common. M BPD and
Speaker 1: anxiety tend to go pretty hand in hand, as well
Speaker 1: as things like depression, substance abuse, and eating disorders, as
Speaker 1: well as self harm and suicide. And that self harm
Speaker 1: and and self cutting behavior was something that came up
Speaker 1: in a lot of the research that we read, especially
Speaker 1: when it came to women with borderline personality disorder. Yeah.
Speaker 1: And other common comorbid conditions include post traumatic stress disorder,
Speaker 1: bipolar to disorders, and a d h D. And the
Speaker 1: whole PTSD thing is interesting because there is a large
Speaker 1: group of psychiatrists and people in the mental health community
Speaker 1: who think that borderline personality disorder is just a type
Speaker 1: of PTSD, and so we'll we'll talk about that a
Speaker 1: little bit more in a minute. But the impulsiveness that
Speaker 1: comes along with vp D lot of times can lead
Speaker 1: to risky behavior things like spending, spreeze, unsafe sex substances
Speaker 1: which we mentioned, reckless driving, and even binge eating. And
Speaker 1: this risky behavior means that a lot of VPD people
Speaker 1: are more likely to be victims of violence, including rape.
Speaker 1: And continuing with the behavioral symptoms, there tend to be
Speaker 1: lots of stormy relationships that swing on that pendulum from
Speaker 1: I hate you, don't leave me, um intense and highly
Speaker 1: changeable moves, fluctuating from confidence to despair, chronic feelings of
Speaker 1: emptiness or boredom, having inappropriate or intense anger, or problems
Speaker 1: controlling anger. Like you said earlier, Caroline, they are these
Speaker 1: what we might consider to be mundane events that can
Speaker 1: send someone kind of over the edge, and then also
Speaker 1: stress related paranoid thoughts or severe dissociative symptoms such as
Speaker 1: feeling cut off from oneself, observing oneself outside of one's body,
Speaker 1: or just losing touch with reality entirely. And that too
Speaker 1: is where we will in a few minutes get into
Speaker 1: why borderline is called borderline, right, But in terms of
Speaker 1: that inappropriate or ill controlled anger, we see road rage
Speaker 1: come up a lot in terms of things that are
Speaker 1: associated with bp D, but then people like Judith Herman,
Speaker 1: who will talk about in a little bit, also come
Speaker 1: back and say, you know, there are things that are
Speaker 1: associated with anger or masculinity that are okay. So it's
Speaker 1: almost like it's more okay for certain symptoms of BPD
Speaker 1: when it's a man showing them versus a woman. But well,
Speaker 1: and this list of symptoms too, or behavioral manifestations sounds
Speaker 1: like it could be so many different things. And also
Speaker 1: there are a lot of things on this list that
Speaker 1: I experienced from time or time too, So you can
Speaker 1: see how borderline probably becomes so challenging, if anything, just
Speaker 1: to get a diagnosis. Yeah, but it turns out that
Speaker 1: it's twice as common as schizophrenia in the population, and
Speaker 1: about two of the general population has borderline personality disorder,
Speaker 1: and it is treatable to a degree. It takes pretty
Speaker 1: intensive therapy. Um, but that means that therapists with traditional
Speaker 1: analytic training aren't incredibly effective. They might view BPD patients
Speaker 1: as manipulative and demanding of too much time. Uh, and
Speaker 1: BPD patients do tend to sabotage their therapy and might
Speaker 1: not trust their therapist. Nor is there any psychotherapeutic drug
Speaker 1: developed to specifically treat borderline personality disorders, so drugs might
Speaker 1: be prescribed, but at the same time, se of borderline
Speaker 1: patients drop out of traditional treatments. So as a result
Speaker 1: of the chat olenges to addressing, treating, and managing borderline
Speaker 1: personality disorder, eight percent of people with it have suicidal behaviors,
Speaker 1: with an estimated three attempts and about ten commit suicide.
Speaker 1: And because of that huge link to suicidality and also
Speaker 1: how common it is compared to something like schizophrenia, that
Speaker 1: we tend to hear about a lot more, that tends
Speaker 1: to get a lot more funding and research, um, a
Speaker 1: lot of uh, you know, healthcare providers and researchers have
Speaker 1: called for greater public awareness and attention to this. Yeah,
Speaker 1: And in terms of the research that's been done, researchers
Speaker 1: say that both genetic and environmental factors are at play
Speaker 1: because studies have shown that it's inheritable and things like
Speaker 1: mood disregulation and aggression could be related to low levels
Speaker 1: of serotonin. But other researchers have asked whether we inherit
Speaker 1: temperament and person a reality traits like compulsiveness and aggression,
Speaker 1: and then environmental factors like abuse, neglect, and instability in
Speaker 1: the home end up triggering the personality disorder. So it
Speaker 1: sounds like there's some correlation causation that has to be
Speaker 1: untangled going on. Um, And it should be said that
Speaker 1: some people with borderline personality disorder come from stable homes,
Speaker 1: but deprivation and or instability and relationships are more likely
Speaker 1: to promote it. So going back to David and Allen,
Speaker 1: whom we said it earlier, UM, he says that it
Speaker 1: doesn't require abuse. It could be more about receiving conflicting
Speaker 1: messages as a kid. So the example that he paints
Speaker 1: is of parents who might see their parental role as
Speaker 1: the ultimate life goal, but deep down they kind of
Speaker 1: hate being parents resent it might resent their children. So
Speaker 1: the parent then vacillates between hostile over involvement and under involvement,
Speaker 1: and so it creates this invalidating environment, which, honestly, Caroline,
Speaker 1: when I first read the phrase invalidating environment, that sounded
Speaker 1: very much like a helicopter parenting kind of term of like, oh, no,
Speaker 1: we must give children trophies forever, little thing they do,
Speaker 1: but it's not it's not that right, right, Yeah, invalidating
Speaker 1: basically refers to a child experiencing cognitive dissonance, essentially getting
Speaker 1: two messages maybe one spoken and one implied uh, and
Speaker 1: not knowing what's real, not feeling safe, not feeling genuine
Speaker 1: love and affection, And so as that child gets older,
Speaker 1: she ends up turning around. David and Allen uses the
Speaker 1: phrase a lot like they're giving as good as they
Speaker 1: get in terms of BPD developing in a child, they
Speaker 1: turn around and invalidate everything the parent does, filling the
Speaker 1: role of the so called spoiler. Basically, as she gets older,
Speaker 1: the child remains dependent on the parents to a agree,
Speaker 1: even as a young adult or an adult, allowing the
Speaker 1: parents to remain obsessed with her wow at the same
Speaker 1: time belittling everything the parents try to do for her,
Speaker 1: and the parents, you know, can't do anything right in
Speaker 1: this situation. But the thing is, this is a learned behavior.
Speaker 1: You've grown up in this invalidating environment. You strike out
Speaker 1: by invalidating the invalidating parent, and then you end up
Speaker 1: feeling that same quote spoiler role in other relationships, not
Speaker 1: surprisingly your romantic relationships. Yeah, and which also reminded me
Speaker 1: of pickup artistry terminology because it sounds a lot like
Speaker 1: familial negging, like drawing someone in by continually belittling them,
Speaker 1: and that becomes sort of the very unhealthy glue that binds. Yeah. Yeah, absolutely, um,
Speaker 1: And it's interesting the patterns that emerge that are pretty consistent.
Speaker 1: This is coming from the National Institutes of Health as well.
Speaker 1: People with BPD are significantly more likely to see their
Speaker 1: mother as distant or overprotective in their relationship with her
Speaker 1: full of conflict, while the father tends to be seen
Speaker 1: as less involved and more distant. And so a caregiver's
Speaker 1: emotional denial of a child's experiences becomes a huge predictor
Speaker 1: of BPD. And that's what it means to say an
Speaker 1: invalidating environment. It's the emotional denial of a child's experience.
Speaker 1: So is it we should all blame our parents basically basically,
Speaker 1: but they have to be neurological factors going on as
Speaker 1: well that might um sort of predicate this sort of
Speaker 1: reaction to emotional and sensitivity or emotional denial. I should say,
Speaker 1: I mean yes, absolutely, and and I wish I knew
Speaker 1: more about it, especially in terms of the amygdala and seratonin. Um,
Speaker 1: but my my thinking just being a total lay person
Speaker 1: podcast or having read a bunch of stuff about BPD,
Speaker 1: would be like, um, well, what did their parents do
Speaker 1: and what did their parents do? Because stuff does get
Speaker 1: passed down, emotional baggage and the way that we treat
Speaker 1: each other does get passed down. This is what frightens
Speaker 1: my womb, Caroline, this is what does like sent my
Speaker 1: uterus hysterical. This just bouncing around like pawing in there.
Speaker 1: Um no, this is this is why I like legit.
Speaker 1: This is why I say that everybody should go to therapy,
Speaker 1: because there are things like I will get in fights
Speaker 1: with my boyfriend or whatever, and it brings up stuff
Speaker 1: and it's like, oh I I have literally never dealt
Speaker 1: with that. Yeah, it's amazing how often mom and dad
Speaker 1: are in the room, whether you invited him there or not. Seriously,
Speaker 1: I mean that sounds creepy, and it is. It is.
Speaker 1: It is. But this kind of research that we're talking about,
Speaker 1: this understanding of VPD, is relatively new, and when we
Speaker 1: come back from a quick break, we're going to look
Speaker 1: at how we came to this point, because it took
Speaker 1: a little while for the medical community to identify and
Speaker 1: begin to wrap their heads around what this really means.
Speaker 1: So the term borderline personality disorder UH used to be
Speaker 1: sort of a waste basket term. People actually called it
Speaker 1: a waste basket term. How rude Stephanie Tanner would say, um,
Speaker 1: because psychiatrists, psychologist researchers were sort of perplexed by the
Speaker 1: set of behaviors that they were seeing. It was very
Speaker 1: common and so anyway, let's let's look into the history
Speaker 1: of the development of this diagnosis. In nineteen thirties, the
Speaker 1: term borderline personality is coined, and it's called borderline as
Speaker 1: a reference to being on the border between neurosis and psychosis,
Speaker 1: and analysts at this time thought that people with neuroses
Speaker 1: we're treatable, but people with psychosis were not. And to
Speaker 1: clarify between neurosis and psychosis, because I needed to be clarified,
Speaker 1: neuroses and psychoses. Neuroses are what I have. Means a
Speaker 1: mild mental illness is not caused by organic disease involving
Speaker 1: symptoms of stress, so things like depression, anxiety, obsessive behavior, hypochondria,
Speaker 1: but not a radical loss of touch with reality, whereas
Speaker 1: psychosis or psychosis used in the plural um. This is
Speaker 1: a severe mental disorder in which thought and emotions are
Speaker 1: so impaired that you really lose touch with reality. Yeah,
Speaker 1: and so this this idea of what borderline personality disorder
Speaker 1: or what the borderline group of patients is is not
Speaker 1: really an accurate description. But doctors just basically didn't know
Speaker 1: what to do with these people. Um, so why did
Speaker 1: they think that this is what borderline personality disorder or
Speaker 1: at the time, just borderline patients were. It's because some
Speaker 1: people with VPD have brief psychotic episodes, so experts thought
Speaker 1: of it as just an atypical version of other existing conditions.
Speaker 1: And then it's in ninety eight that we get American
Speaker 1: psychoanalyst aid Off Stern who first describes the symptoms that
Speaker 1: now make up borderline personality disorder. He said that this
Speaker 1: quote borderline group of patients is extremely difficult to handle
Speaker 1: effectively by any psychotherapeutic method, writing that these folks suffer
Speaker 1: from effective narcissistic malnutrition. In other words, their parents didn't
Speaker 1: give them that sense of security from being genuinely loved
Speaker 1: when they were growing up. And the common view in
Speaker 1: Stern's era was that BPD was a modified form of schizophrenia,
Speaker 1: so they would point to certain patients tendencies to regress
Speaker 1: into what they called borderline schizophrenia amid unstructured situations. Well so,
Speaker 1: not too long after that, in the nineteen forties we
Speaker 1: get a really interesting figure in Helen Deutsch. She left
Speaker 1: Europe a mid World War two UH and was a
Speaker 1: controversial figure. She still remains kind of a controversial figure,
Speaker 1: but she contributed a lot to our understanding, or our
Speaker 1: early understanding of what BPD was. And so Helen Deutsch
Speaker 1: is a psychoanalyst. She was the first woman that Freud
Speaker 1: ever analyzed, and ended up after that training under him
Speaker 1: to become the first woman to lead a psycho analysis
Speaker 1: clinic in Vienna, and in nineteen forty four she published
Speaker 1: The Psychology of Women, in which she said that femininities
Speaker 1: three essential traits are narcissism, passivity, and masochism. And it's
Speaker 1: because of this idea that Second Waivers called her a
Speaker 1: traitor to her sex and Helen Deutsch was like, no,
Speaker 1: I'm not listen. I'm just trying to call it like
Speaker 1: I see it with Royden's psycho analysis, and listen, I'm
Speaker 1: an outspoken advocate for legal abortion and also too in
Speaker 1: Vienna she worked to organize women workers and protested the
Speaker 1: University of Vienna law schools ban on women's students. So
Speaker 1: she was like, wait, no, come on, come on, I'm
Speaker 1: pro women. I'm just you know, it sounds like a
Speaker 1: history episode waiting to happen. It is Deutsch might have
Speaker 1: to stop by or some analysis. Wells moved back two
Speaker 1: years before The Psychology of Women was published, and in
Speaker 1: nine two Deutche pens an article that modern psychiatrist Michael
Speaker 1: Ston says laid the foundation for the contemporary psycho analytic
Speaker 1: formulations of the borderline. Basically, she described a group of
Speaker 1: women patients who seemed normal, like on the outside, they
Speaker 1: seem normal, but lacked a depth and a warmth and
Speaker 1: had an inner emptiness. She called them as if personalities.
Speaker 1: Is this is this an early reference to Cluness? I
Speaker 1: know that is the first thing I thought. Yeah, Share
Speaker 1: Horowitz's portrait was on the front page of of this
Speaker 1: this groundbreaking paper. And I like how she uh, and
Speaker 1: I like how she acknowledges that as if is not
Speaker 1: the most eloquent way to phrase it. But she essentially said, listen,
Speaker 1: let's just this is the best we can do for this.
Speaker 1: So what does as if mean well. She says that
Speaker 1: the reason she used this quote unoriginal label for this woman,
Speaker 1: specifically this woman, um, is that when you talk to her,
Speaker 1: or look at her, or interact with her, you get
Speaker 1: quote the inescapable impression that the individual's whole relationship to
Speaker 1: life has something about it which is lacking in genuineness
Speaker 1: and yet outwardly runs along as if it were complete.
Speaker 1: And she says, anybody, not even a psychiatrist, would eventually
Speaker 1: look at this person, having interacted with them for a while,
Speaker 1: and and say like, what's wrong with you? Where? Where
Speaker 1: is the depth? And she says that this, this question
Speaker 1: of where is your depth? Where is the warmth? Is
Speaker 1: that they have a quote highly plastic readiness to mold
Speaker 1: themselves to their surrounding environment. And that hearkens back to
Speaker 1: what we said from the National Institutes of Health about
Speaker 1: not having that strong or stable sense of identity, about
Speaker 1: being constantly ready to mold yourself to your situation, which
Speaker 1: probably had a lot to do with living in an
Speaker 1: invalidating environment with parents who might not be sending you
Speaker 1: consistent messages, Caroline, all of which are themes of the
Speaker 1: movie Clueless Perfect. It all comes together, um, but yeah,
Speaker 1: she she thought that this group of people was pretty confusing,
Speaker 1: as did pretty much all psychiatrists at the time, and
Speaker 1: she posited that the as if personality might be a
Speaker 1: phase leading to schizophrenia. But she points out her patients
Speaker 1: do not belong among the commonly accepted forms of neurosis
Speaker 1: and they're too well adjusted to really be called psychotics.
Speaker 1: So again, people still in the forties are like, I
Speaker 1: don't know what to do with these people. And in
Speaker 1: the fifties they're like, hey, the war is over and
Speaker 1: this is a waste basket term. No, really that that
Speaker 1: that is exactly what was happening. And it's not until
Speaker 1: the sixties and seventies that borderline starts to become something
Speaker 1: more than jess a colloquialism among psychoanalysts. It becomes clearer
Speaker 1: and clearer that the disorder is not related to schizophrenia,
Speaker 1: which seems like it's that's a huge development in this
Speaker 1: and psychiatrists start to recognize borderline patients stable instability as
Speaker 1: they call it, as well as abandonment fears, desperate need
Speaker 1: to attach to others as transitional objects, as well as
Speaker 1: unstable or distorted senses of self and others and the
Speaker 1: reliance on splitting themselves UM between like good and bad qualities,
Speaker 1: everything's either great or awful. It sounds like, I mean
Speaker 1: the world and yourself are all in black and white terms. Yeah,
Speaker 1: it goes back to that commonly repeated I think it's
Speaker 1: actually a book title about borderline personality disorder that's I
Speaker 1: hate you, don't leave me. It's you're either everyone in
Speaker 1: your life is either like great and wonderful and a
Speaker 1: goddess and you're you're my best friend, or just like,
Speaker 1: I hate you, You're the skum of the earth. Get
Speaker 1: away from me, and that that's basically what splitting is
Speaker 1: UM And in nineteen sixty six, psychiatrists Richard Chessick notes
Speaker 1: that borderline patients are on the periph free of psychology
Speaker 1: and society. He's one of many UM researchers at the
Speaker 1: time who are basically like still putting their hands up,
Speaker 1: like I don't know, they're just sort of out there.
Speaker 1: But he also divides men and women along lines of
Speaker 1: VPDs manifestations that we still see today in research, and
Speaker 1: he says that the borderline or quote unquote pan neurotic
Speaker 1: group was mostly women, while the group struggling with addictions
Speaker 1: was mostly men, and everyone that he looked at had
Speaker 1: received treatment with with few results. And so this is
Speaker 1: an observation that we will talk about more in terms
Speaker 1: of like common manifestations today, that it's still kind of
Speaker 1: divided along those lines, with women getting diagnosed with the quote,
Speaker 1: you know, the more neurotic issues of anxiety and depression,
Speaker 1: with men more often manifesting their BPD with substance abuse issues.
Speaker 1: And it's not until nineteen eighty that it's first listed
Speaker 1: as a diagnosable illness in the Diagnostic and Statistical Manual
Speaker 1: for Mental Disorders. Is this the d s M three,
Speaker 1: And it included the qualifier that it's overwhelmingly more common
Speaker 1: in women. Hello gender, But is it really because, as
Speaker 1: we've learned so many times on the podcast, uh the
Speaker 1: even though the d s M is nicknamed the mental
Speaker 1: health Bible, there have been a number of times that
Speaker 1: it has been proven fallible. And that's something that we
Speaker 1: learn more about in the nineteen nineties from psychiatrists Marcia
Speaker 1: and Linum who starts to develop some therapy around this. Yeah,
Speaker 1: she's another huge name in borderline personality research. She develops
Speaker 1: dialectical behavioral therapy, which is a type of cognitive behavioral
Speaker 1: therapy to treat chronically suicidal BPD patients. And this therapy
Speaker 1: focuses on mindfulness, distressed tolerance, and emotional regulation. And we
Speaker 1: were reading a first person account of living with the
Speaker 1: p D over on cracked um. And so not only
Speaker 1: was that really enlightening and very interesting to read, but
Speaker 1: the comments under it, some of the comments under it
Speaker 1: were heartbreaking. And I know, we say, you know, never
Speaker 1: read the comments, but like these were actually very enlightening
Speaker 1: as well. A lot of people who have either lived
Speaker 1: with BPD or been related to, or dated or married
Speaker 1: people with bp D really chimed in and had some
Speaker 1: great things to say. One commenter, who describes him or
Speaker 1: herself as very very lucky uh says that they found
Speaker 1: a therapist who specialized in DBT dialectical behavior therapy, which
Speaker 1: they describe as the closest thing the psychiatric community has
Speaker 1: to a silver bullet for bp D UM. They go
Speaker 1: on to describe it as having kind of a hand
Speaker 1: holding approach to treatment that it says, hey, guys, you've
Speaker 1: been poorly equipped in your mental toolbox to deal with
Speaker 1: certain things in life in terms of relationships, reactions, emotions,
Speaker 1: everything is a little bit dialed up to high. And
Speaker 1: so you essentially take classes, so to speak, on working
Speaker 1: through those extreme reactions to things and learn how to
Speaker 1: interact with people in a healthy way. And so that
Speaker 1: commoner goes on to say, you know, like we have
Speaker 1: to take classes to learn how normal people act. But
Speaker 1: that's just how it is, and DBT is, like this
Speaker 1: commoner was saying a huge deal for people with borderline
Speaker 1: personality disorder because just regular therapy or regular counseling doesn't
Speaker 1: really dive deep enough to sort of get to the
Speaker 1: root of those um dysfunctional relationships that may have sparked
Speaker 1: the condition. And one thing too that jumped out to
Speaker 1: me in that comment was how DVT also teaches alternatives
Speaker 1: to destructive behaviors. And so the commenter wrote, quote read
Speaker 1: cut back on the cutting, seriously, you aren't doing yourself
Speaker 1: any favor. So these kinds of things that on the
Speaker 1: outside we might be able to identify as oh course
Speaker 1: that's self destructive and unhealthy and harmful. Those our behaviors
Speaker 1: that have to be not only unlearned, but also probably
Speaker 1: replaced with healthier alternatives. So it's it's really fascinating to
Speaker 1: learn about, UM that different kind of therapeutic approach that
Speaker 1: is starting to develop in the nineties and also happening
Speaker 1: in the nineties UM is that finally we have a
Speaker 1: recognition of the effects of childhood trauma and abuse, specifically
Speaker 1: sexual abuse and even more specifically among girls and women. Yes,
Speaker 1: psychiatrist Judith Herman in the interview said that sexual abuse
Speaker 1: has been taboo re pressed for so long that it's
Speaker 1: now entering our consciousness in a very dialectical, polarized way.
Speaker 1: It has to if it threatens establishment views, it should
Speaker 1: because therapists have really missed the boat in an important way,
Speaker 1: one that was predictable in a male dominated profession with
Speaker 1: a female patient population. So for Herman, this whole thing
Speaker 1: is clearly more about external events triggering by borderline personality
Speaker 1: disorder than an issue of character and personality defaults. She
Speaker 1: is one of the doctors who thinks that it's a
Speaker 1: form of PTSD and or an adaptation to trauma, and
Speaker 1: she also has the interesting point that many of the
Speaker 1: symptoms associated with the diagnoses received by women who were
Speaker 1: victims of sexual abuse, including not only borderline but also
Speaker 1: bipolar among other things, we're all once under the category
Speaker 1: of hysteria. And so her theory is that here are
Speaker 1: these women having normal reactions to abnormal situations in life,
Speaker 1: and that we are living in a society that's hostile
Speaker 1: to victims, and so we're essentially pathologizing victimhood. But it
Speaker 1: should also be noted too that a lot of the
Speaker 1: I mean, because she's talking about this, some of the
Speaker 1: more contemporary studies we were reading underscored how um child
Speaker 1: abuse or sexual abuse is not a necessary, you know,
Speaker 1: qualifier for borderline personality disorders. So I mean, she arguing
Speaker 1: that it doesn't she doesn't think it exists or in
Speaker 1: the subset of this populous abused population, that maybe jumping
Speaker 1: to the conclusion of borderline is misguided. As I understand it,
Speaker 1: it's more along the lines of among women and girls
Speaker 1: who have been abused, uh, the rush to diagnose them
Speaker 1: with a mental health condition is perhaps rash, and instead
Speaker 1: we need to look at the culture that creates abusers
Speaker 1: and the culture that essentially is disgusted with victims and
Speaker 1: blames victims. And so I think she goes on to
Speaker 1: talk about the early days of psychoanalysis and that nobody
Speaker 1: dealt with abuse of any kind really, and it was
Speaker 1: all just like, what have you you done? You know,
Speaker 1: why are you hysterical? What have you done to lead
Speaker 1: yourself into this situation? Not what has happened around you
Speaker 1: that might contribute to these symptoms. But moving away just
Speaker 1: from looking at girls and expanding our view to both
Speaker 1: men and women, we have to ask whether borderline personality
Speaker 1: disorder manifests itself differently in men versus women. Yeah, because
Speaker 1: earlier we mentioned how that first d s M definition, UM,
Speaker 1: you know, specified it to women. But I mean, it
Speaker 1: turns out that, you know, it also affects a lot
Speaker 1: of men. It doesn't actually affect um more women than men.
Speaker 1: But borderline personality disorder related impulses are different between men
Speaker 1: and women. And this is coming from some research published
Speaker 1: in the American Journal of Psychiatry as well as innovations
Speaker 1: in Clinical Neuroscience UM, which highlighted how substance use disorders
Speaker 1: were more common among male patient whereas eating disorders or
Speaker 1: more common among female patients. But it's not black and white.
Speaker 1: About half of those female patients had abuse substances at
Speaker 1: some point, and about a fifth of the male patients
Speaker 1: had a history of serious eating disorders, and men were
Speaker 1: also likelier to have had an explosive temperament and more
Speaker 1: novelty seeking behavior, which isn't terribly surprising when we think
Speaker 1: about testosterone in the brain and risk taking behavior and
Speaker 1: all that. Yeah, and some of the comorbidities differ as well.
Speaker 1: Women are more likely to have mood, anxiety and post
Speaker 1: traumatic stress disorders, whereas men are more likely to experience antisocial, statistic, narcissistic, paranoid,
Speaker 1: and passive aggressive personality disorders. And so as one might expect,
Speaker 1: the treatment histories of men and women differ. Men are
Speaker 1: more likely to have had a history of treatment for
Speaker 1: substance abuse, whereas women's treatments have historically been characterized more
Speaker 1: often by psychotherapy and medication. And to again us, probably
Speaker 1: the biggest myth outfare about borderline is that recent research
Speaker 1: has discounted any higher prevalence of it among women, And
Speaker 1: again that's coming from innovations in clinical neuroscience. But why
Speaker 1: did we used to think that more women had it?
Speaker 1: Was it because of the whole hysteria kind of thing. Well,
Speaker 1: for a while, and and maybe even now to an extent,
Speaker 1: there were more women simply getting diagnosed with that um
Speaker 1: as we see in a lot of mental health conditions
Speaker 1: psychological conditions where more women come forward and ask for help,
Speaker 1: whereas more men maybe are ending up in those substance
Speaker 1: abuse arenas. But according to that study that Christian just mentioned,
Speaker 1: for a couple of decades now, investigators have found that
Speaker 1: some clinicians have a subtle gender bias when it comes
Speaker 1: to diagnosing bp D. So perhaps that psychiatrist or that
Speaker 1: psychologist or therapist is more likely if you're a woman
Speaker 1: exhibiting some of these behaviors to pinpoint bp D as
Speaker 1: opposed to either looking deeper looking for something else, or
Speaker 1: perhaps they're just not as ready to diagnose it in
Speaker 1: men as they are in women. And there also seems
Speaker 1: to be a sampling bias, which makes total sense when
Speaker 1: you consider the traditional settings for prevalent studies. Which makes
Speaker 1: sense when you consider how the traditional settings for prevalence
Speaker 1: studies used to assess you know how common something is
Speaker 1: among a population are psychiatric or mental health treatment facilities.
Speaker 1: So if women with BPD perform more self harm behavior
Speaker 1: and wind up in mental health treatment facilities more often
Speaker 1: than men, then the studies will find a higher population
Speaker 1: of women. Meanwhile, you have more men suffering from substance
Speaker 1: abuse and antisocial features, which leads them often to treatment
Speaker 1: program ms or jail. So you have guys being under
Speaker 1: reported in those mental health settings. Essentially, the dudes just
Speaker 1: weren't being counted for a while, and I think that's unfortunate.
Speaker 1: I mean, to make a general statement, I mean, I
Speaker 1: just think it's so sad that anybody would possibly receive
Speaker 1: the wrong diagnosis or not enough attention for the condition
Speaker 1: that they're suffering from, simply because it's misunderstood or stigmatized,
Speaker 1: or the the way a person is acting based on
Speaker 1: what's going on in their brains and their bodies and
Speaker 1: their chemistry. It's it's making them act a certain way,
Speaker 1: and so perhaps they're going to jail instead of getting
Speaker 1: proper mental health treatment that they need. But speaking of treatment,
Speaker 1: treatment does exist. People with BPD can get better. We
Speaker 1: already talked about dialectical behavior therapy, and and that is
Speaker 1: a big deal talk therapy, especially therapy that falls under
Speaker 1: that cognitive behavioral therapy umbrella helps people identify and change
Speaker 1: the core beliefs and behaviors underla ing their inaccurate perceptions
Speaker 1: about themselves and others. So in addition to DBT, there's
Speaker 1: also something called schema focus therapy that helps people reframe
Speaker 1: the way they see themselves, overcoming those negative self images
Speaker 1: that were instilled in childhood. And we mentioned earlier that
Speaker 1: there isn't any specific medication to target BPD alone. Um,
Speaker 1: But there are medications obviously to address symptoms like anxiety, aggression,
Speaker 1: or depression, but they might not be effective overall. But
Speaker 1: there was one interesting dietary finding. Um, there's a study
Speaker 1: on thirty women with borderline personality disorder which showed that
Speaker 1: Omega three fatty assets may help reduce symptoms of aggression
Speaker 1: and depression. So so fish, oil supplements and lots of salmon,
Speaker 1: I'm just gonna eat. Yeah, well, we should be eating
Speaker 1: fish all the time anyway for its self benefits in general,
Speaker 1: except for sea bass being overfished right now. Really stay
Speaker 1: away from sea bath. I have sea baths in the freezer.
Speaker 1: That these are Mega three fatty acids. CAROLINEA did seems
Speaker 1: highly effective. The study found that it was as well
Speaker 1: tolerated as commonly prescribed mood stabilizers and not surprisingly had
Speaker 1: a few side effects. I mean, that's so fascinating, and
Speaker 1: I would love to hear from someone in the medical
Speaker 1: community who could potentially enlighten us a little bit more
Speaker 1: on that, because the there's a skeptical part of me
Speaker 1: that's just going like, is that some weird pseudoscience thing?
Speaker 1: But oh and it's thirty people, very very small sample size,
Speaker 1: so who knows what else could have been at work there. Um,
Speaker 1: But I mean, I think it just goes to show
Speaker 1: that if indeed that was accurate, and this is something
Speaker 1: that could be extrapolated to more people. It's just so
Speaker 1: fascinating to think about those very delicate connections between nature
Speaker 1: and nurture and things that were born with things that
Speaker 1: we inherit from our parents, and then the way that
Speaker 1: those things can be set off and develop as we grow. Um.
Speaker 1: And I think it's so important to stress how much
Speaker 1: talk therapy, especially that intensive talk therapy, can help people
Speaker 1: really root out they're sort of dysfunctional, damaging behaviors, damaging
Speaker 1: to themselves, but also their relationships. Yeah, and and we
Speaker 1: hope that this podcast Primer has often offered, you know,
Speaker 1: a little bit of clarity on something that it seems
Speaker 1: like a lot of people misunderstand. I know, that I
Speaker 1: had a lot of preconceived notions about going into the research,
Speaker 1: which turned out to be just based on pure stereotype. Really, um, So,
Speaker 1: we're so curious to hear from listeners on this who
Speaker 1: might deal with this in their lives and in any
Speaker 1: type of way. If you would like to share your experience,
Speaker 1: you can email us mom Stuff at how stuff Works
Speaker 1: dot com. Um. You can also tweet us at mom
Speaker 1: Stuff podcast or message us on Facebook. And we got
Speaker 1: a couple of messages to share with you. So I
Speaker 1: have a letter here from Katrina on our podcast a
Speaker 1: while back on Women in Construction um, and she writes,
Speaker 1: I apologize that I'm just not getting around to writing
Speaker 1: this email in response to her Women in Construction podcast,
Speaker 1: but I often listen to them weeks behind, and I
Speaker 1: also listened to two other podcasts from housewark dot com.
Speaker 1: And side note, Katrina, no need to apologize it is
Speaker 1: it's hard for me to keep up with my podcast,
Speaker 1: que um. So she goes on to say, I just
Speaker 1: wanted to say that I think you did a fabulous
Speaker 1: job really covering what women go through in a highly
Speaker 1: male dominated field. I am an entertainment rigger in Las Vegas,
Speaker 1: which is an extremely male dominated field due to the
Speaker 1: nature of the work. I've only ever met four other
Speaker 1: ladies who rig and only two of them are on
Speaker 1: the same level of capability, certification, or general knowledge as
Speaker 1: I am. I did want to say that I know
Speaker 1: of one thing. It's been very difficult for me. Although
Speaker 1: I can personally say I have never experienced sexual harassment,
Speaker 1: my boyfriend has at my expense. See, my boyfriend and
Speaker 1: I met while working the same place rigging and went
Speaker 1: on to work in multiple venues for multiple companies together
Speaker 1: with the understanding between us that it was easier for
Speaker 1: me to be respected and garner respect for my physical
Speaker 1: capabilities by not letting our coworkers know we were a
Speaker 1: couple at work. We were just two co workers and
Speaker 1: were able to keep this up for over a year.
Speaker 1: The entire link of that year, however, my boyfriend often
Speaker 1: came home upset and telling me he had to put
Speaker 1: up with listening to our coworkers talk about trying to
Speaker 1: hit on me, sleep with me my breast, et cetera.
Speaker 1: And he felt he couldn't say anything without jeopardizing the
Speaker 1: respect I had worked so hard for, and without hurting
Speaker 1: his own job. For reacting. I always thanked him. It
Speaker 1: made sure he knew how much I loved and appreciate
Speaker 1: the sacrifice from him. And when we moved, we were
Speaker 1: finally able to be in a work environment that allows
Speaker 1: us to be a couple publicly and let our work
Speaker 1: stand for itself individually. That being said, as women are
Speaker 1: so from the targets of such behavior and sexual harassment
Speaker 1: and how it affects a woman is so typically the
Speaker 1: topic discussed. I just wonder how many other loving boyfriends
Speaker 1: and husbands are out there suffering the expense of trying
Speaker 1: not to hurt the respect and career paths of the
Speaker 1: women they love who may be in the same line
Speaker 1: of work. And I will say that with that like,
Speaker 1: kudos to your boyfriend for for dealing with that, absolutely,
Speaker 1: But I think I think that guys, whether they are
Speaker 1: romantically in relationships with women on the job or not,
Speaker 1: have it like so much power, arguably even more power
Speaker 1: than women on those job sites to say, hey, that's nonsense,
Speaker 1: let's shut it down, because as we all know, guys
Speaker 1: can and do lead by example as well. So curious
Speaker 1: to hear from fellas about that, because I'm sure that
Speaker 1: there can be risks associated with being the one calling
Speaker 1: out that kind of inappropriate behavior too, So let us
Speaker 1: know your thoughts. But thanks so much Katrina for writing
Speaker 1: in and and Rigging, which sounds like quite a job. Well,
Speaker 1: I have a letter here from Ariel who says I
Speaker 1: absolutely love the podcast, though I don't get to listen
Speaker 1: as often as I like. As such, I am currently
Speaker 1: catching up on past episodes and just finished enjoying your
Speaker 1: interview with Nina McLaughlin, which made me think about my
Speaker 1: self image as something of a handywoman. Though my husband
Speaker 1: and I do fall into stereotypical gender roles and that
Speaker 1: he is the breadwinner and I am the main caregiver,
Speaker 1: we also have something of a role reversal and that
Speaker 1: he is the main man in the kitchen while I
Speaker 1: do most of the household repair work. As a fiercely
Speaker 1: independent person, I've never been one to wait on another,
Speaker 1: whether it be male or female person, to do something
Speaker 1: for me, and so have enjoyed learning how to take
Speaker 1: on handy type projects myself. I even have my own
Speaker 1: toolbox set apart from the general toolbox that houses the
Speaker 1: basic hammers and screwdrivers, and if the threatened the men
Speaker 1: in my house broken fingers should I ever go looking
Speaker 1: from one of my tools and find it missing. I
Speaker 1: love my husband dearly, but the man has lost the
Speaker 1: power word for drill, the drill bits, and more than
Speaker 1: a few other odd tools. Over the years, as a
Speaker 1: young driver, my father taught me basic car maintenance and
Speaker 1: I often helped with minor repairs when he would work
Speaker 1: on my car. Now, I am usually the first to
Speaker 1: notice something amiss in our vehicles, and with the Haynes
Speaker 1: Manual a k a. Mechanics Bible as my dad called it,
Speaker 1: can often troubleshoot the problem even before I call the
Speaker 1: auto shop. My mechanic loves the fact that he can
Speaker 1: talk to me about my vehicle and technical terms and
Speaker 1: doesn't have to sugarcoat the problem. I love hearing from
Speaker 1: women who live and work in a man's world while
Speaker 1: retaining their sense of femininity, bucking against perceived gender norms,
Speaker 1: will still proudly holding true to the ones they hold. Dear,
Speaker 1: thanks for another amazing podcast, and thanks to you, Ariel.
Speaker 1: I read this email and was immediately like I have
Speaker 1: to do some learning, Like I need to learn how
Speaker 1: to do things that are technical and mechanical, and I
Speaker 1: don't know anything about my car. And here at my
Speaker 1: way friend changes his oil aerial and he can like
Speaker 1: fix his brake pads. I don't even know where your
Speaker 1: brake pads. You know what, Caroline. I bet he'll teach you.
Speaker 1: He's offered, so you just have to say yes. Just
Speaker 1: say yes to the dress. Wait, no, that's different, So
Speaker 1: yes to the brake pads, Caroline, Yes to the brake
Speaker 1: pads in the oil change and I will just have
Speaker 1: to wear raggedy clothes when I do it because he
Speaker 1: always gets the dirty. But where is this is nice? Genie?
Speaker 1: You get some cover rolls. I knew, I know you know.
Speaker 1: I get some fancy cover alls. So basically, arial, what
Speaker 1: I'm trying to tell you is that you're an inspiration
Speaker 1: and I appreciate your letter, and we appreciate all of
Speaker 1: your letters. Mom. Stuff at how stuff works dot com
Speaker 1: is where you can send them and for a links
Speaker 1: to all of our social media as well as all
Speaker 1: of our blogs, videos and podcasts. With our links to
Speaker 1: our sources, you know where to go. It's stuff Mom
Speaker 1: Never told You dot com For more on this and
Speaker 1: thousands of other topics. Is it how stuff works dot
Speaker 1: com