Ep. 3 - Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a serious psychiatric illness that can be especially challenging for loved ones suffering from this disorder. In this episode, we share insights from the BPD literature to understand what this disorder is and how it develops in the first place. This episode features a special guest speaker, Dr. Zachary Rosenthal from Duke University who is an expert on treating BPD and will share tips on how loved ones of people with BPD can manage these relationships.

• Transcript

  Speaker 2: Hello everyone. Today we are talking about borderline personality disorder. Kibbe and I are both really excited to talk about this because it's an area of research for both of us. Kibbe treats people with BPD and we also have some special features for this episode. We have a firsthand account of what it's like to have BPD from one of my very good friends. She wrote out an interview. She's a little bit worried about her identity being exposed, but I'll go ahead and read you what she wrote. I think it's really beautiful and helpful. We also have an expert guest on our podcast today, our advisor, Dr. Zach Rosenthal. He is a borderline personality disorder expert. He's done a lot of research in this realm and he also has a lot of helpful tips for people who have loved ones with BPD and how to help them seek appropriate treatment. There's a lot of misinformation out there that he'll help us clear up. So let's start out by talking about what borderline personality disorder is. So this is an incredibly difficult disorder. It is really difficult both for the person suffering from it and for the loved ones surrounding them. The first thing to know about BPD is that they have a lot of emotional difficulties. Their emotions are extremely intense. They are frequent and they're hard to manage. It's really hard for them to calm down. They also have a lot of unstable interpersonal relationships and this makes sense if there's a lot of emotional intensity, right? So there's a lot of ups and downs. There's a lot of intensity. There are a lot of breakups. There's also self-destructive behavior, a lot of impulsivity. So you might see drug use, you might see unstable employment, some dangerous behaviors, and it also looks like self-harm and suicidality. And another interesting part of BPD that we'll go into is this idea of identity diffusion. So people with BPD often have lots of changes in their interests, their social networks shift, and they kind of they can tend to go in different directions in life. There's a sense that they don't know who they are. Also a lot of feelings of chronic emptiness. So you can tell by listening this, this is a really difficult disorder. This can be really challenging for partners, family, and for therapists. It can be challenging because it can be hard to watch somebody with so much to give, with so much love, be so down on themselves, be so destructive. It can be difficult to watch them lose jobs. It can be difficult to watch them hurt themselves. You can get hurt by.

  Speaker 0: This behavior. We've heard from people who have loved ones either dated or married to or have family members with BPD. It could be super challenging and confusing, right? Because without knowing what this is, it's just looking at just lots of chaos, a lot of fights, a lot of closeness and intensity. And it could be it could look really unpredictable. I think that people who have loved ones with BPD tend to really resonate with the experience of this intense closeness. Like you, you two are super close, super attached. They might really idealize you or think the world of you one minute and then you have the flip side, intense fights, devalued, suddenly you're the worst person ever. So a lot of emotional intensity could feel like a roller coaster, right? Which can be exciting and can be, it can draw people in and feel like the most intense connection they have in their life. On the other hand, the downside is there's so much unpredictability and, and fear involved. Another thing to that I've noticed recently when talking to clients and talking to family members who bring in their kid or their spouse for treatment for BPD is that the whole system, the whole family system has to cope with someone like this. I mean, it's they might deeply love that person, but it's really challenging to figure out what to do when that person, you know, has really like intense anger or something like that. So it really is such a systemic challenge for not only the person suffering from it, but the people around them. And I've noticed that sometimes people cope with that in different ways, right? Some people are also chaotic, also have a lot of anger issues, or they tend to be people who like control, right? They like order and rules and structure because they crave so much of that structure outside of that relationship. So kids of people with BPD can sometimes manifest in those two different ways, kind of like substance abuse and think about it. So that's just something I've observed. I haven't really read the literature on that. But anecdotally and clinically, I've seen that too. And it would be really helpful to for for people with loved ones with BPD to really understand what's going on. Like, what is this disorder? What does it look like from the inside? So, you know, we would love to hear that firsthand account from your friend.

  Speaker 2: Yeah, so I have a good friend who has pretty severe BPD. She also has a lot of self awareness, and she's been in treatment for a long time. And so she really kind of understands this and is able to communicate it well, and understands, I think, her impact on other people. So this is a I'm so grateful for her for writing this down for me. I think it's a really helpful and illuminating interview. So I first asked her what it's like. She said it's complicated to explain. So I'll try my best. I started having major feelings of emptiness at a young age. I didn't have the words to explain it back then. But as I grew up, it became a bigger and bigger void. It's like there's this black hole inside you and it sucks and everything else. There's really no better word than emptiness because that's exactly how it feels like you are nothing and there is nothing. I feel like I'm strapped into a roller coaster that I can never get off of. Some days are great. Some days are too great. And then I can feel the depression come back. The emptiness feelings will never really go away. Every single feeling good or bad feels like a tsunami slamming into me and taking me with it. When I'm angry, I tend to black out in rage. When I'm happy. I know I'll later regret everything I say or do. There's no winning. I feel like I can never control how I react and like I'm always a backseat driver to my own life. regulating my emotions feels impossible. It's like every cell in my body feels on fire. You're also rarely sure about what feelings are correct or true or appropriate for the situation because everything is so intense. It makes it hard to sense reality and understand how you're affecting the world around you.

  Speaker 0: Yeah, I think that's a really beautiful firsthand account of what it what actually emotion regulation, dysregulation feels like. So emotion dysregulation, we understand is the core one of the core parts of BPD. And what that means is difficulties managing intense emotions. So motions come on super strongly. And normally what we can do things to help us calm down, right, talk to a friend, go for a walk, you know, do things to help us go from really, really angry, really, really upset to a little bit calmer and able to handle things. But people with emotion dysregulation can't it's like a bomb exploding in their in their body as they described. So I love that your friend gave that description because it could be really hard to understand from the outside, right?

  Speaker 2: I got a description once it's a little bit like when she said every cell in her body feels on fire. Another person once told me it feels like their skin is flipped inside out so that all the nerve endings are just right there exposed to the world. And so everything just hits them so much stronger and so much more immediately. Just imagine trying to navigate the world like that, without being able to modulate anything with everything hitting you so intensely. Okay, so now she starts talking about how this has affected her relationships. She said, I've always had trouble making and especially keeping friends. It became harder as I grew up as the impulsivity began to get stronger during the teenage years. I doubt every word and action I take when I interact with others for fear of getting it wrong. I don't know how to connect with people and my mood swings and extremes can be too much for people to stick around very long. Dating has always been really hard. Relationships come with too many unknowns and too many emotions for a regular person. But for me, it can just be too overwhelming. I'm terrified of being alone. Hello, abandonment issues. I struggle so much to connect that I either pull too much and the other person feels tends to feel overwhelmed or keep people at an arm's length. I don't truly believe I deserve to be loved. I have too many issues and can be too unpredictable. So it's easier to not allow people to get close than to suffer closeness and then lose them again. People don't tend to stick around once they realize how unpredictable and uncontrollable I am. The funny part is the harder I try to keep people in my life, the more I lose people and the lonelier I am.

  Speaker 0: I just even just listening to that my heart goes out. I mean, this is this is one of the things that really gets me people with BPD are just often such lovely, sensitive, like deeply caring, emotional people. And they often really do want connection and crave that so much that it's that's their area where it's like a hot button topic where they want the closeness, but they have so such a hard time maintaining the relationships that that feel that important to them. So I just even just hearing that it's like my heart is aching.

  Speaker 2: Yeah, I also I mean, I've experienced some of this from her, but she's such a wonderful friend. It I mean, just from a personal level, it breaks my heart to hear this. I'm someone who feels a little bit blunted when it comes to like intense connectedness to other people. So I mean, part of me admires how strongly she feels and cares for others. But I mean, it comes with that other side that she's talking about of just the intense fear of losing and, and what happens when you try to hold on to something too close. She says every field every day feels like a huge struggle. I fight self destructive urges on a daily basis. I've never had a clear sense of self and it's something I've wrestled with every day for as long as I can remember. I've never been able to clearly understand who I am. It's constantly shifting, which itself brings a lot of self hate. The lack of self concept clarity has led to a bunch of other issues including a major eating disorder and addiction to both substance and self harm. I don't know that any of these issues will ever go away, which is not only exhausting, but brings a lot of suicidal ideation and intrusive suicidal thoughts, since life just feels like it's not meant for me.

  Speaker 0: Yeah, I think that that's another beautiful example of how painful the identity diffusion, not knowing who you are not having a strong sense of self, and all that emotional difficulties. If you don't know how to regulate or manage all those on your own, well, not on your own, but in ways that are healthy. A lot of people will be turned to whatever works, whatever helps them calm down, whatever helps them comfort themselves feel grounded. Often those things can be really destructive, right? Like impulsive sex or eating, you know, eating behaviors or drugs like that. So I mean, yeah,

  Speaker 2: I also appreciated how she said that life just feels like it's not meant for her, which is probably how it feels to not have a strong sense of identity. Because identity means who am I? Where do I belong? And she's in a world where she doesn't maybe feel like she has that kind of home, that kind of natural sense of belonging. Okay, I asked, what do you wish people understood about it? She said, I wish people knew that I'm trying my best, that I didn't ask for this, and that I'm not doing it on purpose. I don't mean to be awful, that when I am, it comes with a lot of self hate afterwards, pretty much everything does. I don't mean what I say when I'm out of control. And I usually come right back when I calm down and apologize. I also wish people would understand what it's like to have every single emotion feel like burning lava. I'm often told to treat myself well, think positive thoughts and all that crap. I'm not saying those things don't work for people. But for me, it feels so far away and impossible. Easy fixes don't exactly change anything and only make me feel more inadequate when they don't work. She said, I also wish people understood the self destructive tendencies. I feel like self harm isolates me the most. People are afraid of it. And I've lost a lot of people because of it. Also, the exhaustion that comes from fighting suicidal ideation on a daily basis is very misunderstood. So what I want to talk about that I feel is misunderstood is this concept that people with BPD are manipulative. Some people with BPD are manipulative. Some people with anything going on can be manipulative. But I think there's something special here because a lot of behavior can be interpreted as manipulative. And that's justified because it can feel really manipulative. For instance, they may threaten suicide when you try to leave them. They can use they can use self harm to modulate really intense emotions that are brought up when you're having a difficult encounter, a breakup or some kind of conflict and that can feel really, really manipulative. I do just want to kind of talk about the stigma of BPD for a second because the reality is is that people with BPD are often genuinely feeling extreme emotion and genuinely feeling that suicidality. And so it really might not be that they are actively trying to manipulate and maybe that they are doing their best to regulate the emotion that is so extreme in that moment. And then lastly, I said, How have your friends and family been able to help? She says, I feel very lucky to have been born into my family. My parents have always been my number one supporters, even when they didn't understand anything that was happening to me. And they've always done everything in their power to help me fight this. They've saved my life many times and I could not do any of this without them. I think what was extremely helpful was the way my parents dove into helping me. My mother joined family groups and we did a lot of family therapy and family group DPT. Involving my family in my treatment helped us work through a lot of our issues and helped me make huge strides in my treatment. So that's the end of that interview. If you're listening, my wonderful friend, thank you so much for being so honest and giving us that.

  Speaker 0: Yeah, it was wonderful. Yeah, I think that it's even just by listening to her account, it sounds like one of the more painful aspects of having BPD is that people around you don't understand what it is, right? They, they try to give suggestions they try they or blame or they get upset. Fundamentally, they just they, it's hard to know what it is. And I think we're lucky that lately, there's been a lot of research, a lot of scholarly work on trying to understand what BPD is. I think we've made a lot of strides in that in that field, which helps us understand and take kind of take the stigma out. I can explain a little bit about how the literature is talking about how what like BPD is how it develops. I think that most there's many different perspectives on how BPD is like what BPD is and how it develops, right? So there's many different researchers have their own different approaches to it. But most of them seem to converge on the idea that people with BPD or at risk of developing it are born with an emotional sensitivity. So as you said, there, they feel emotions more intensely, they react with intense emotions more frequently, and they have a harder time calming down from emotion. So it's just this swell of emotions, and they're born like that. You could kind of tell like some kids are just more emotionally sensitive than others. And another part of why someone like that might be at risk for having BPD is that they might have grown up in an environment that doesn't really support their emotions. So either it's just not a right fit, and then it doesn't teach how to cope with those emotions well, or it could be destructive or abusive or chaotic. So it's just a really upsetting, stressful environment anyway. So just for that perspective, there's no, it doesn't assign blame to anyone. It's not the mother, the father, the caregiving environment, the school, and it's not the person, it's the mixture, right? And it's many, many different factors over long periods of time. So it's, it's really hard to point the finger at this is why that person's like this. It's really there's, there's no one person at fault. It's just, it's an interaction between, you know, environment and genes. So one of the main theories out there is put out by Marsha Linehan, who's a brilliant psychologist, she developed dialectical behavior therapy, which we talked about over and over again, because she herself has BPD and developed that treatment with an understanding of what it actually is, which is, in her view, BPD is a disorder of emotion dysregulation. And in her bio social theory, she explains it as, you know, kids who grow up with this, who are born with this emotional sensitivity might be in an environment might grow up in an environment that invalidates those emotions, meaning treats their emotions as not real, or dismisses them, or basically doesn't teach them to learn, understand, feel compassionate and cope with their own emotions. So that could look like a lot of different things, it could look like an abusive environment where the kid cries, and they get hit or yelled at or verbally abused. Or it could be just an environment that doesn't understand that that kid like, oh, just calm down, we'll be fine. So it could be a family that is not a right good fit, because the rest of the family doesn't feel those intense emotions. They don't know how to tell the kid to calm down or help them. So they might say things that dismissively then invalidates that kid's emotions without meaning any harm. So there's all these different ways that an.

  Speaker 2: Invalidating environment could look like. One thing that can happen to is, you know, when kids steps their toes, and the mom just says, Oh, calm down, it's no big deal, is that the kid starts to learn that more extreme displays of emotion will get more attention. Because if the if the parents or the caregiver or the teachers aren't validating sort of smaller shows of emotion, they're not noticing their kids, they're not noticing the body language,

  Speaker 0: The facial expressions. And they want to and they want people to understand everyone wants their emotions to be understood by someone else, right? So the kid will start learning, when like, when I'm really upset, then I'll get attention, and I don't get attention any other.

  Speaker 2: Time. And so and so they get rewarded for these magnified emotional expressions. And those expressions, you know, also feel really real to them. But they just sort of.

  Speaker 0: Start communicating in different ways, right? So you can see that there's like a back and forth over time, right? A kid who has emotional sensitivity, will try to express their emotions to their parents or teachers or whoever, they say, Don't worry, calm down, it's not a big deal. And then they have to amplify and just show that, that distress even even in bigger, bigger expressions. So over time, that's in the bio social theory, that's why they think that people with BPD tend to show their emotions with these big, dramatic expressions like self harm or screaming or something that's kind of it seems like larger than life, right? Another thing that happens when these emotions aren't validated is it can be hard to see inward can be hard to know, is this an appropriate emotion to feel in this environment or in this context? Am I seen by other people? How do people experience me? I'm not getting information that's useful to me. And so you stop seeing who you are. And this can lead to a lot of identity.

  Speaker 2: Confusion. Another thing that can happen is that when you don't kind of have that sort of internal guide telling you like, this is who I am over time is you start putting extra emphasis on outside external sources of information. So if someone's mad at you that day, you don't necessarily have this sort of internally maintained identity that can say they're mad at me today, but I don't know, they won't be tomorrow. I'm a good person, I can fix this. Instead, everything can kind of boil down to that exact moment and that exact interaction and it can be it can expand into I'm a terrible person. The information I'm getting from the outside world is that I'm bad, I did something wrong. And I make people angry. And so when you're going that moment to moment,

  Speaker 0: Your identity shifts constantly. Yeah, just imagine what it would feel like if you didn't trust anything that's going on inside. Like when you like someone when you feel sad or angry, when you are drawn to something, if there's another part of you that's like, no, no, no, that's wrong. People have told me all my life that that's wrong. It's not a big deal. And that kind of internalized and validating response to your own internal experiences, you're not going to know who you are, right? Yeah. So I mean, the, as I said, there's different perspectives on what BPD is. And there's perspective that I'm learning right now, my internship called Transference Focused Psychotherapy is more psychodynamic approach. And they really focus on the identity piece, which I find fascinating. So they say that a normally developing identity is one where you get a sense of yourself and others and your relationships through your relationships, right? Your relationship with your mom, your dad, with your siblings, with a teacher, with a best friend, all of those relationships come together and integrate into like a full sense of you like, oh, I'm, I'm a caring person here, but I can be really strong or angry or sometimes you know, so you have this really complex sense of self through kind of combining all those relationship experiences together into one sense of like, here, this is Kibbe, this is Jacqueline, right? But for people with BPD, or other people who've had this kind of chaotic environment growing up, is that they don't have that same integration, they don't integrate the all those relationships in one coherent sense of self, they might split them off into different parts, right? And they might split it off into all good or all bad, right? These very one dimensional ways of seeing yourself. So if someone's mad at you, they might think, I'm the worst, I'm terrible, I'm this is, you know, I'm the victim, they will go into this really, like, not complex, but very simplistic reductionist way of seeing themselves that could be overwhelming, right? So instead of if someone's mad at me, I might think, oh, that's really hurtful, I feel upset. And also, I know that that person loves me, and I'm a caring person. So not that bad. No, they just have like this one view, one way of seeing themselves and aren't integrate the other other parts of them. So that's, that's how, in the TFP perspective, they understand identity fusion, which could lead to a lot of the other symptoms of BPD. So I thought that that was cool, just to just to think about how we all develop our sense of self and the way we regulate our emotions and things like that from our relationships.

  Speaker 2: That's super fascinating. I know nothing about TFP, but I'm super excited to learn more about it. I've always wanted to my last, my last boss was a TFP therapist.

  Speaker 0: Cool. Yeah. Yeah. And there's, there's other perspectives to call a mentalization based therapy, who some perspectives who look a little more closely on how those kids with emotional sensitivities relate to caregiver figures like their mom, and how they feel safe with them, how do they get their needs met. And if they haven't gotten their needs met appropriately from that person, then they will feel super distressed, don't have that sense of safety, don't have that sense of secure attachment. And that can lead to the issues seen in BPD. So there's many ways to think about it. I think that the common thinking is people who have this emotional sensitivity from birth, you know, naturally a little more emotionally sensitive. If they don't get their emotional needs met in their environment, they don't learn to cope with their own emotions, they don't learn to feel safe when they have them that don't learn to validate them. That's, that's what would lead to BPD. So we are so excited to invite our advisor, Dr. Zach Rosenthal on our podcast to talk about borderline personality disorder. He is an expert in all things emotion regulation. So focuses on personality disorders, also misophonia, and we are really happy to get your perspective, Zach. Thank you so much for coming on. And we were hoping you could start out by telling us how you think loved ones and friends can navigate the challenges of borderline.

  Speaker 1: Personality disorder. Thank you, Jacqueline. And thank you, Kibbe, for having me. Let me first, just if I may say two things. One is I'm so excited and proud of the both of you for starting this podcast. And I think that this is going to be just really terrific for for people to learn about all sorts of things they can do to improve how they manage relating to people who can be at times challenging to relate to. So I just want to say, awesome work. I love you both. And I'm really excited about this. Thanks, Zach. Yeah, yeah. He's the best mentor. He's great. Okay. Not me trying to pull for that. But I appreciate that. The second thing I want to say to your audience as we get going is that this is an incredibly difficult and an incredibly emotionally charged topic to wrestle with. And I will say, just from my own personal experience, having a mother with borderline personality disorder, who I've talked about in a number of different forums, and being someone who was raised, you know, with a mother who I love dearly, and who has struggled for a long, long, long time with borderline personality disorder and related problems. I know firsthand how difficult this can be. And I really am happy to do what I can to help share with your audience any information that will help them feel like they, you know, they are empowered and have a sense about what they can do. So I think, you know, with that kind of intro aside, your question to get started was, what are some of the common difficulties that loved ones of those with borderline personality disorder or BPD, what are the difficulties that they struggle with? There can be a lot. So the short answer is, boy, there can really be a lot of different challenges. I mean, a lot of times families or loved ones of people with BPD will talk about how their experience, their experience is that they are not sure what they have done, but they're maybe being accused of something that they, that the person with BPD is saying that they have done. So they may be told, you know, they may be blamed or told that they did something wrong, or maybe there's something from the past that gets brought up. And it's sort of a, I don't know, verbal aggression is maybe the right way to put it. So, you know, feeling like, gosh, I don't really, I don't really understand or see how, what this person is saying I did. I don't really see it. It's not mapping onto my reality in this moment. I'm being blamed angrily for something that I don't actually think I did, or that I did something different, but they're interpreting it as a, as something that was dangerous. And that really can put the loved one in a bind where they feel like they feel scared and they're worried that they have to take on responsibility for the physical safety of their loved one when that's not really something that they can actually do, but they get sort of stuck thinking that somehow they're the ones that are responsible fully for what the loved one with BPD does. And that can just feel like an incredibly heavy weight, an extraordinarily heavy weight, and really just not a very, it's not tenable. It's not a long-term tenable weight to carry as a loved one of BPD. It's very difficult. I can imagine that would feel so helpless and scary and confusing of what to do. Like, what, do I take responsibility? What, how can I help? How do I step back? How would you, you know, to speak to that, what would you say to those people, the loved ones of BPD? Like, how to manage those difficulties? What do you do? What should they say? There's a couple of things. One is, is you can really try in the midst of being validating and kind, yet not taking responsibility for changing the person, to help them find the kind of treatment that is likely to help them. So rather than taking on the burden of trying to tell them what to do, rather than taking on the burden of trying to be the person who's going to keep them safe and keep them alive, keep them off of drugs, keep them from losing their job, keep them from impulsively behaving in ways that get them in trouble, you know, you can't be that person full-time. So rather than sliding into that space where you now have taken on that role, I would recommend helping the person from a scientific evidence. And there are treatments, we'll talk about them in a few minutes, but there are treatments that work for BPD that when I got into the field years ago in the 1990s, those treatments were just not there yet, or were just beginning to be born. And now we do have some treatments that have shown promise and some that have been around for decades. So there are treatments that work for BPD, and I would help try to get them to those providers who can help them with that. And by the way, counseling, as usual, supportive counseling, where you come in and talk and kind of just get things off your chest each week to a therapist who's very kind and supportive, that, it turns out, is not a treatment for BPD. So counseling, as usual, with any therapist who is kind of going to listen and give you advice and be a sounding board or a event, that's probably not the type of structured approach. It's probably not the type of targeted approach that someone with BPD needs. So it's not just the case that the loved one needs to get them on board with treatment with anybody. It's really treatment that's backed by scientific evidence as.

  Speaker 2: Much as possible. So I have experienced this problem where people will come to me and say, I think my brother has BPD. How can I help him? What kind of treatment can I find? And I'll start looking up DBT resources, and I have a feeling you'll speak to this. But the problem is I'm not always able to find what I think of as like a full-service DBT, like real DBT. And instead, I see a lot of people going to individual therapists who, on their psychology today, say that they do DBT. And I'm wondering, A, kind of what it means when you just see a psychologist say that they do DBT, B, what DBT really is, and C, what you should do if the place where you're living doesn't have the best resource available. Well, Jacqueline, you've just asked many good questions. Those are all really, really good questions. I'll try to answer them quickly. So it is true that dialectical behavior therapy, DBT, as you were labeling, DBT is, at this point,

  Speaker 1: Probably, not probably, it is the most studied, the best studied treatment to psychotherapy. And it's been shown to work in a number of trials across the world, really since the early 1990s. This is not the only treatment for BPD, but it is the most well-known. It's the most well-spread throughout the world. It's many places throughout the world. And it is the most evidence-based. So you're right, that's probably a specific direction to try to channel people towards. You're also right that it is challenging to do that because when you, as a said, you will likely find, well, if you're in a rural area of the country, you might find nothing. But what you can do is you, as a loved one, can either coach your loved one with BPD, or you can yourself do some homework about the provider. What is their training in DBT? Were they trained? And can they tell you about that training? Can they put that on their website, or can they just tell you how they were trained? And were they trained in a hands-on way at a place where DBT is trained, or did they read a book on their own? So you can start by what is the training of the provider? You can also look to see are they providing DBT the way it's been evidence-based, which is a one-year-long treatment. It's a psychotherapy. It is weekly individual therapy with weekly group skills training, and also with weekly consultation for the therapists to get together to support each other. And it also includes telephone consultation to help apply the skills that they're learning in the group, and the skills that they're being motivated to use with their individual therapists. They're able to use the telephone to reach out to their individual therapists when they need to in between therapy visits to try to implement these skills. So DBT uses a skill-based approach where in the groups they're really learning a lot of life skills, and those life skills then are to be applied and practiced. So when talking to somebody who says they do DBT, you'd want to assess do they do all of this, or do they only do a part of it? And what's most common is that places that only do a portion of DBT are likely to only do the group skills training. They will, you know, they will say they do DBT, and they do. They only just do part of it. They don't do the whole thing. Now that may not be the end of the world if it's a place that is providing DBT from a trainer or trainers who have been well trained in DBT, and they're providing it, but they are not DBT as a whole. So if that's all that was available, I would probably feel good sending my loved one to that. If what was available was that or somebody who does full DBT, I would be inclined to, you know, try to direct my loved one over to the place that does full model DBT. But if you can't get that, and you can only get group, I would feel comfortable.

  Speaker 0: Starting there. Thank you so much. It's been really helpful to really understand what good treatment for BPD looks like. My last question is how it must be really emotionally draining and taxing for loved ones of BPD, right? There's like the lots of ups and downs, the emotional intensity, the fear involved, the helplessness. How would you recommend the loved ones take care of themselves? What are some tips that they can help cope, help them get through life and maybe grow up or be able to handle their own emotions and experiences.

  Speaker 1: In healthy ways? I think that, you know, the first thing that can be done is to try to do exactly as your audience is doing right this moment, which is to get educated, and to get educated in a way that is as best as possible driven by the science. And the science can be the science of borderline personality disorder, and the science can be the science of things related to borderline personality disorder, like emotions and difficulties regulating emotions. There's a lot of science there, and that's a really big ask for a loved one to try to do. So it's not that I'm suggesting loved ones need to become experts. But there are great materials. There are really good books and materials and information online that, in fact, are driven by scientific evidence and can really be helpful in guiding loved ones to learn about BPD. And so there can be, you know, many different ways in which BPD can present itself. And so it can be really hard to get educated on it because it can look different for different people. But that's part of getting educated about it is that it doesn't always look the same. So learning about this so that you can get it from an educated perspective, you can learn what you're looking at and what to expect. And I think that's starting point is get educated as best as you can. And again, part of getting educated is about understanding these treatment options and how they work and what they are and what they're not. That's clearly a huge part of getting educated. I think the second thing beyond getting educated as best as you can is to self-validate. It's really to have self-compassion to recognize that it's very difficult to relate to these loved ones and you still can love them. You can love someone with BPD and you can also be really frustrated with them. You can be extraordinarily frustrated with them. You can be angry with them at times, but you can still love them. And those two things can be hard to sit with simultaneously. So learning how to have self-compassion and to self-validate that it really is difficult. It really is. And it really is difficult in moments where you may be emotionally ambushed, caught off guard. And that's a moment to self-validate. It's not a moment to beat yourself up and blame yourself. It's a moment to figure out what can you take responsibility for in a non-judgmental way? And what can you let go of? So in other words, a third thing is to not blame yourself, but at the same time, see your role and responsibility in helping. So that's really difficult, but that can look like identifying and maintaining limits. Limits. So limits. So having kind of a sense of what's off limit and what's not with this person. What are you willing to tolerate and what's appropriate? And what are you not willing to tolerate? And really thinking carefully about what those limits are. And then observing them. Observing them, maybe they change over time a little bit. Maybe they stay the same, but observing how your limits shift and observing when you need to assert your limits.

  Speaker 0: Can you give us an example of a limit?

  Speaker 1: For example, if I'm talking to a loved one with BPD, a limit might be that I may have a limit where I'm not willing to talk with them about all of the things that are going on in that moment with them when they're having suicidal thoughts. Like entertaining suicidal ideation and arguing with them about whether and how they might harm themselves. That's just a limit. That's beyond my limits. That's not something I'm willing to do. So I know that. And so what I might do in that situation, if that were to come up is be kind, be validating, be loving, but at the same time, set a limit and say, this is not something that I'm willing to really try to solve for you right now. I really want to help you get help right now. And I think we need to, what I am willing to do is to help you get the help you need right now. And if we need to call a suicide crisis line, or if we need to call the police or 911 or mobile crisis unit, I am going to help you with that. I need you to get the help you need, but I just don't think right now I'm able and willing to be the one that helps you get through this crisis. So it's kind of knowing, I don't know if that's helpful. It's very helpful. It's knowing what those limits are. It might be that your loved one with BPD sometimes talks about, in a disparaging way, other people in your family, and tries to kind of pull you into the drama around that. And I don't mean that in a judgmental way. They may not be trying on purpose. They're not trying to manipulate the situation. They're doing the best they can do. They just need to learn to do better, but they're doing the very best that they can do. And so I mean that very non-judgmentally. And it may be they're kind of the things they're saying, you know, to you might feel like they're pulling you into drama. They're pulling you into family drama. They're pulling you in to say something negative about someone in your family. You can have a limit there, and you can just stick with that limit. Your limit might be, I'm not going to talk about or talk negatively about certain people in my family. I'm just not. That could be the limit that you set. And then when you notice that you're being kind of inched closer to that limit or pulled across it, you can notice that and then kind of assert the limit that that's not something I'm, you know, that's not something I'm going to talk about. Or you can just change the topic of conversation. You can just assert your limits by redirecting the conversation without having to literally say, I'm not willing to talk about that. You can just change the topic. That's another way to shift and stick with your limits. There's lots of ways to stay within your limits. But the key there in managing this is you need to know what your limits are. And then you need to be mindful and be aware of when you notice that they're relevant at any given moment. And if you need to, to assert them.

  Speaker 0: Yeah. No, I love that. I think that you give us hope, and you give the audience hope for being able to love and have the relationship with someone with BPD, which is often someone very important to you, through staying validating, staying compassionate to that person and yourself, understanding what BPD is, and knowing your limits and setting them compassionately in that relationship and helping them find treatments with evidence-based. So I love that. That's the.

  Speaker 1: Message that we have hope here. I think so. I think that's right. Yeah.

  Speaker 2: Okay, Zach, well, thank you so much for coming on.

  Speaker 0: Yeah, thanks, everyone. Thanks to Zach for being such a wonderful guest and giving our audience those tips. If you want to dive more into this topic and really need more help, want a better understanding of how to cope with someone in your life with BPD, I really recommend the book. It's called Loving Someone with Borderline Personality Disorder, How to Keep Out of Control Emotions from Destroying Your Relationship. It's written by Sherry Y. Manning, M-A-N-N-I-N-G. Fantastic book. We recommend it to a lot of our patients, a lot of our patients' family and friends. So that's one resource that could be really helpful for you. And there are plenty of others online. So I really congratulate everyone for digging into this topic.

  Speaker 2: Okay, thank you all for listening to this episode. It was a really important one for all three of us, and we hope you found it helpful. So we will see you next week. By accessing this podcast, I acknowledge that the hosts of this podcast make no warranty, guarantee, or representation as to the accuracy or sufficiency of the information featured in this podcast. The information, opinions, and recommendations presented in this podcast are for general information only, and any reliance on the information provided in this podcast is done at your own risk. This podcast and any and all content or services available on or through this podcast are provided for general, non-commercial informational purposes only, and do not constitute the practice of medical or any other professional judgment, advice, diagnosis, or treatment, and should not be considered or used as a substitute for the independent professional judgment, advice, diagnosis, or treatment of a duly licensed and qualified healthcare provider. In case of a medical emergency, you should immediately call 911. The hosts do not endorse, approve, recommend, or certify any information, product, process, service, or organization presented or mentioned in this podcast, and information from this podcast should not be referenced in any way to imply such approval or endorsement.