BPD: Why It's Not Manipulation, It's Emotional Pain (Part 1)

Stop the stigma. Sage Nestler, MSW, an LGBTQ+ mental health specialist and leading educator on BPD, joins the podcast to pull back the curtain on one of the most misunderstood mental health conditions. Often villainized or confused with narcissism, Borderline Personality Disorder is actually defined by intense emotional pain and a desperate search for relief. Sage shares his personal journey of being diagnosed after a mental breakdown and how he transitioned from fearing he was "evil" to becoming a specialized advocate for the BPD community.

Find mental health and addiction treatment near you: https://recovery.com/

In this deep-dive episode, Sage explains the fundamental characteristics of BPD, including mood dysregulation, an unstable sense of self, and the pervasive fear of abandonment that often sabotages relationships. We explore the specific nuances of "Quiet BPD," where emotional turmoil is turned inward through self-harm or eating disorders rather than external outbursts.

Sage also breaks down the power of Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) in managing daily spiraling thoughts. Whether you are living with a diagnosis or supporting a loved one, this conversation offers essential tools for de-escalation, communication, and radical self-compassion. Learn more about Sage Nestler’s work and advocacy by visiting the National Education Alliance on BPD.

⏱️ Chapters: 

00:00 – Introduction to Sage Nestler, MSW 

01:38 – What is Borderline Personality Disorder? 

02:36 – Understanding BPD Mood Dysregulation 

03:29 – How BPD Impacts Sense of Self 

04:30 – The Reality of BPD in Relationships 

07:59 – BPD vs. Narcissism: Ending the Stigma 

19:25 – Is it Dangerous to Self-Diagnose BPD? 

20:45 – Quiet BPD vs. Traditional Symptoms 

27:11 – Supporting Someone with BPD in Crisis 

36:06 – What Causes BPD: Genetics vs. Trauma

❓ Questions the Video Answers:

1. What is Borderline Personality Disorder? 
2. How do BPD mood swings feel on a daily basis? 
3. Is BPD the same as Narcissistic Personality Disorder? 
4. What is "Quiet BPD" and how is it diagnosed? 
5. Why do people with BPD have a fear of abandonment? 
6. What is "splitting" or black-and-white thinking? 
7. Can BPD be treated with medication? 
8. How does DBT help with emotional regulation? 
9. Why is BPD often misdiagnosed as Bipolar Disorder? 
10. What causes BPD: is it genetic or trauma-based? 
11. How should you support a partner with BPD during a crisis? 
12. Why is BPD more commonly diagnosed in those assigned female at birth? 
13. What is a "Favorite Person" in the context of BPD?
14. How can someone with BPD manage impulsive behaviors? 
15. Why is there such a heavy stigma around BPD in the media?

#BPD #MentalHealth #QuietBPD

Transcript

SPEAKER_02 0:00

Because of the emotional intensity, people with BPD have a lot more situations that can lead to a crisis level.

SPEAKER_00 0:08

Sajan Estler is an LGBTQ mental health specialist and a leading educator on BPD.

SPEAKER_02 0:13

If you are a support person for someone with BPD, being able to understand ways to de-escalate, that is the most important thing.

SPEAKER_01 0:22

How are relationships most impacted by BPD? Welcome back to Recoverable. I'm your host, Terry McGuire. Today we continue our exploration of borderline personality disorder, or BPD, a diagnosis frequently cited as both one of the most difficult mental health conditions to live with and one of the most misunderstood diagnoses by both the general public and mental health professionals. Our guest again is Sage Nestler, a mental health specialist who lives with borderline personality disorder. Sage, welcome back.

SPEAKER_02 1:01

Thank you for having me.

SPEAKER_01 1:03

Borderline personality disorder is one of the most misunderstood and stigmatized mental health conditions that there is. As somebody who lives with it, if you could change one thing about the public understanding of borderline personality disorder, what would it be?

SPEAKER_02 1:19

That BPD is not narcissistic disorder, or people with this disorder are not sociopaths or psychopaths. I hate how it gets paired in with all of those because we live with so much emotional pain with this disorder that a lot of the behaviors can come off as manipulative when it's really an escape to get away from that pain. We're villainized a lot because of that. But yeah, that's the biggest thing I think I want people to understand.

SPEAKER_01 1:51

So as we attempt in this discussion to reduce the amount of stigmatizing and misunderstandings, let's start with the most searched internet question on the topic, and it's a foundational one. What is borderline personality disorder?

SPEAKER_02 2:07

Borderline personality disorder is it's a personality disorder that was identified in the 1930s. Um, and it came about with patients who would not respond to different forms of therapy. Um and they came up with the term borderline because they uh couldn't figure out if it was more a neurosis or a um psychosis type of disorder. Because borderline has the mood dysregulation, but also issues with identifying like yourself and like having these patterns that impact your relationships. It's a disorder that pairs mood concerns with the personality concerns.

SPEAKER_01 2:59

Let's divide those two things out and talk about them. So let's talk first about the moods.

SPEAKER_02 3:04

Moods are impacted in every possible way with BPD because there are different brain structures in those of us who have it. We experience emotions to a much bigger degree than people without the disorder. Dysregulation happens a lot where we have like extreme sadness, extreme anger. Little things can make our mood shift drastically. And so pretty much every day there's spiraling because you experience these moods constantly shifting. And unfortunately, it's not something that medication can help. Therapy is like the biggest thing to help you regulate your moods, but the emotional pain is the biggest hallmark of BPD.

SPEAKER_01 3:56

So let's talk about the personal identity portion of it and your s your sense of self. How is your sense of self impacted by BPD?

SPEAKER_02 4:06

Yeah, so sense of self is one of the biggest things impacted by BPD because people with BPD tend to have lower self-esteem due to invalidation and like criticism in youth. We tend to have an unstable sense of self where we're constantly changing who we think we are, what we are passionate about. Um, and because of the low self-esteem, we constantly struggle with professional relationships or personal. And it's just very painful because we don't see ourselves the way other people see us, like if we're successful or something, because we're very hard on ourselves based on a lot of criticism that many of us have experienced.

SPEAKER_01 4:55

We're gonna dive into all of this more, but I just want to hit the three key characteristics that you brought up. And the third was relationships. How are relationships most impacted by BPD?

SPEAKER_02 5:07

The biggest thing that impacts relationships with BPD is the fear of abandonment that we have, as well as splitting or the black and white thinking. So when we're in a relationship with someone, whether it's romantic, professional, whatever, our brains can like see someone's expression. And if it shifts slightly, um, we might think, oh, they're mad at me, they hate me. Um, and then because of the fear of abandonment, we might push them away, or things of that nature. And with romantic relationships as well, there's the idealization where we might really idolize the person we're with. And then if a little thing happens, then it tanks and we might think they're the worst person. And so there's a lot of conflict that can happen because of little things that we think are important or may have happened, whereas the other person didn't mean something a certain way. Yeah, it's the fear of abandonment that is the biggest issue because we don't want to be abandoned, so we'll push the other person away first.

SPEAKER_01 6:19

You can't fire me, I quit.

SPEAKER_02 6:21

Yeah.

SPEAKER_01 6:22

When I don't know if I should call them misunderstandings because they're not from your perspective, but when you have a different sense of the situation than the person you're interacting with, are you able to communicate? Is someone with BPD able to communicate like, I think that you're mad at me right now, or I think you're judging me, or or whatever it might be, or is that a difficult thing to do?

SPEAKER_02 6:45

That's a very difficult thing to do. Um for me personally, DBT, dialectical behavior therapy helped me a lot to be able to identify my emotions and like work on interpersonal skills. But before therapy or learning these skills, the emotions become so intense that it's almost feels like your brain is screaming at you and you can't like communicate to the other person, I think you're mad at me or whatever. You might just say, you hate me, you did this, and it really hurt me, and I just want you to leave, or say hurtful things to push them away. And it's such a difficult thing because if you don't have the skills, like through DBT or other forms of therapy, the emotions take over and the impulsive behaviors of like pushing people away or assigning intent to them, which may not have been the case. And I think that's just the hardest thing for people to understand is if we act out with anger or things like that, it's not planned to try to manipulate another the other person. It's in response to what we feel happened or experienced in a relationship.

SPEAKER_01 8:09

When people who don't fully understand, and I don't that would probably be most of us because it's a difficult thing to understand, BPD is is manipulative the word that is most often used or assigned to somebody? It's like she's just, he's just, they're just manipulative as opposed to in pain.

SPEAKER_02 8:27

Yes. Manipulation is thrown around all the time. And it just breaks my heart because of because of the highs and lows of our extreme emotions, people think that we're trying to manipulate them by pushing them away or saying that they did this or that. And I think the biggest thing people need to understand is that manipulation does require intent and planning. And BPD is very impulsive, and because of the low self-esteem, there is not a lot of mental capacity for manipulation of another person. Um, but because it's clustered in with other personality disorders like antisocial personality disorder or narcissism, people equate it to that it's just trying to escape the pain while trying to function day to day, and it causes a lot of turmoil in almost every area of a person's life.

SPEAKER_01 9:28

Can you describe what emotional pain means in the context of borderline personality disorder?

SPEAKER_02 9:35

Yeah. So one of the best examples that I love using for this is with BPD, because we experience emotions that are so strong, a small change in someone's expression can make us feel like, oh, they're mad at me, they hate me, I did something terribly wrong, I'm just a terrible person. Whereas someone without the disorder might not notice a change in expression, or our emotional pain is very much connected to our interactions with other people and how we perceive how they see us or interacting with us. And that is why interpersonal relationships and that turmoil is one of the biggest things that people have issues with as far as trying to understand how to support somebody in their life with BPD, because it can cause a lot of turmoil for the other person as well. But that is something that I see a lot is people trying to figure out how I can have healthy relationships without having so much turmoil or being successful professionally or having friends and not losing or pushing them away.

SPEAKER_01 10:59

Or the reverse, correct? Over being overly clingy, being making them your the center of your life.

SPEAKER_02 11:06

Yeah. And that goes back to the idealization. So there is the concept of the favorite person with BPD, where we will really idolize somebody. And it can be really difficult because you put them on such a high pedestal that if something little happens, then it turns into this person hates me, I wish I never met them, or I wish they never met me. And then it goes in that black and white thinking cycle. And it's very hard, I know, for people who are in that favorite person position because the person with BPD might rely on them completely for all of their emotional needs. And I know because I also work with people who are in that position and don't know how to handle being someone's everything with the BPD while managing the idealization and then the constant turmoil. So that is just one of the most difficult parts of this disorder because you want to have relationships and be successful or um get married, and it just causes so many issues that it's hard for the other person to be able to understand what we're experiencing inside without also being impacted by the impulsive behaviors.

SPEAKER_01 12:35

Let's talk about the role of gender in borderline personality disorder.

SPEAKER_02 12:40

Yeah. So people who are assigned female at birth are generally more likely to be diagnosed with BPD. And usually the diagnostic age is between 18 and 25. And unfortunately, it doesn't usually get diagnosed until somebody is admitted into a psychiatric ward or hospital. But it's also very stigmatizing for people who are assigned female at birth because women are seen as being overly emotional or the stigma with that. And so because of the emotional piece with BPD, doctors are more likely to be like, oh, you just have BPD because you're experiencing these strong emotions and you're having all these interpersonal issues. And it's also harmful for men or trans people as well who do have it because they're often not diagnosed, or just the concept of not being allowed to cry, or you have to be a man. And so a lot of times that just ends up being flown under the radar. And unfortunately, that does connect with uh suicidality because if men feel like they aren't allowed to express their emotions, you know, get hope for this possible disorder, then unfortunately there is the issue of falling through the cracks. And there's just so much diagnostic issues with this disorder. So people who are assigned female at birth are generally the ones who end up with this diagnosis.

SPEAKER_01 14:25

When and how were you diagnosed with borderline personality disorder?

SPEAKER_02 14:29

When I graduated with my master's in social work, I had had a lot of mental health issues my entire life, but I pushed through school and everything. I didn't have a family who was supportive with therapy, and so was kind of the concept of pulling yourself together and not needing that. Um, so when I graduated, I ended up having a mental breakdown and was admitted to the hospital through the emergency room. And I was diagnosed in the psychiatric unit at this hospital with BPD about two months after I graduated. And it was so painful for me because throughout my schooling, we spent one day learning about cluster B personality disorders, which BPD is part of. And with people I'd interned with, I had heard about how evil people with borderline personality disorder are, or the inappropriate term of borderlines. And absorbing that stigma and then getting diagnosed with it afterwards caused so many issues with in me because I was just terrified that I was this evil person that I had been told people with BPDR. But it was right after that that I started to specialize in this disorder and show people this is not the stigma that surrounds it.

SPEAKER_01 16:00

I would think that a lot of people watching this when you whatever idea they have of borderline personality, someone with this disorder is not thinking of you. Right. So how when you were diagnosed and you were scared, thinking, oh, am I all the things that that people think people with borderline personality disorder are? How has your understanding of it changed personally? Like, you know, uh-oh, I have this horrible thing and I'm a horrible person to what you now know about both the disorder and yourself.

SPEAKER_02 16:32

It has been a long journey. Um yeah, because I just spent so much time hating myself after getting that diagnosis and kind of reflecting on my symptoms and like interpersonal relationships and thinking I just destroyed people's lives because of how I had treated them. But the more I learned about the disorder, connected with people who also live with it, and professionals who don't hold the stigma, because I had been through extensive programs for dialectical behavior therapy that helped me learn skills, how to better manage this. But it's still hard because even though it's been six years since I started specializing in this, I just still see the stigma all the time. And I have issues where even in professional situations, I can't say that I have BPD because I have lost professional opportunities when that has come out. It's just such a struggle, which is why I focus on the emotional pain because people demonize those of us with this disorder while not realizing how much pain we harbor each day, but also we can lose relationships, professional opportunities, different things because of the stigma surrounding it. And that just infuriates me.

SPEAKER_01 18:01

You've brought up DBT dialectical behavior therapy several times. I know it was designed for treating borderline personality disorder. I'm not asking you a lot of specifics about it because we just did two episodes with Dr. Kiki Failing about it, and so anybody who wants to learn more about it, those uh episodes are available. But what DBT techniques or skills do you use on a daily basis to keep yourself where you want to be?

SPEAKER_02 18:28

The emotional ra regulation skills 100%. Um because there's so much spiraling in my brain with thoughts and like putting intent on other people's actions, I really love the skills of like just imagining your thoughts as clouds floating by and not attaching to the thoughts or the concept of being non-judgmental of what you're feeling or thinking and just watching those thoughts go by instead of absorbing them. But I also do use the tip skills, um, like the temperature ones specifically, if I'm really struggling with impulsive behavior, like putting cold water on my face, yeah. Um, or like if I have urges for self-harm, smashing ice in like the bathtub or intense exercise, because it helps to get all that emotional energy out. And DBT I really liked because it does give you the skills and it's not just talk therapy, which is effective, but for managing these emotions every day, and especially understanding how to connect with other people and interpersonal relationships. It's helped me with my relationships as well.

SPEAKER_01 19:53

So another of the most asked questions on the internet is about YouTube. Is there a danger in diagnosing yourself based on YouTube videos or other social media criteria?

SPEAKER_02 20:05

Aaron Powell There absolutely is. Um, and I've seen this a lot, especially with like TikTok, with not only BPD, but other diagnoses, people will share their stories or like criteria for different things, and then people will be like, oh, well, I have this now. And the issue with this, especially with BPD, is that YouTube videos or TikTok, it can help you to kind of identify if you might have this disorder. But if you diagnose yourself, it's very easy to convince yourself that you have this. There's not a lot of very accurate information by everybody who posts these videos, and it can contribute to the stigma, or if people say, Oh, I have this, but they haven't been properly diagnosed, they won't have access to treatment that they need as well.

SPEAKER_01 20:58

While we're talking about the diagnosis, there are sort of two kinds of borderline personality disorder, and one is called quiet, and that's the variety you have. Can you tell us how that's different from the traditional presentation?

SPEAKER_02 21:13

Yeah, quiet BPD is very difficult because it is so underdiagnosed, because the stigma or the stereotype of people with BPD is like screaming or throwing things or these impulsive behaviors, whereas with quiet BPD, you experience all the same emotional turmoil and struggles with interpersonal relationships, but it's very internalized. So, for example, growing up, invalidation is a big issue with BPD and how it develops. Um, in my family, I wasn't allowed to be angry. So I internalize that anger, and while I'll experience anger to such a degree that other people People with BPD do, I don't act out, I act inward, which means I have self-medicated before or self-harmed to try to just get rid of those emotions. And then everyone else says, you know, you look so calm, recollected, but inside you're experiencing all the same things, but nobody else sees it, and that can be very invalidating and continue the cycle of people don't understand what I'm going through because I don't fit the stereotype.

SPEAKER_01 22:32

Is there more self-medicating, substance use disorders, other addictions, those kind of behaviors with the quiet BPD because it's being turned inward?

SPEAKER_02 22:42

There are, yeah. Um binge eating disorder and bulimia are very common with this type of BPD. Um I actually am in recovery from bulimia, and that as well as like shopping or using impulsive behaviors like sexual things or self-medicating, they're ways to numb yourself from the emotions. And so, like with binge eating disorder or bulimia, it's that release or like trying to fill the emptiness.

SPEAKER_01 23:20

So, in terms of really common symptoms, the fast and intense mood swings are sort of w one of the things that I think people without it think of most. Why does that happen? And and tell me a bit about that experience.

SPEAKER_02 23:34

With the mood swings, this also does get confused with bipolar disorder because of the highs and lows with bipolar. Whereas with BPD, you experience a lot of these mood swings, but it's constant every day. You don't have these periods of like depression or mania, but each day you experience extreme anger, extreme grief, extreme happiness, even. But because your brain is so sensitive to outward stimuli, your emotions can just change rapidly. And for example, like in my personal life, it's hard for people who I have relationships with because I will be really happy one moment and then something will happen, and then I'll just be in tears. It's just very hard to have like these intense emotional experiences every day, um while managing just your life.

SPEAKER_01 24:35

Absolutely. So while you're working, while you're socializing, while you're living all that's going on inside, yeah.

SPEAKER_02 24:54

Yeah, absolutely. Um, especially like with quiet BPD, because I feel like it's all inside, and I have to be really careful of managing my personal relationships and managing all my responsibilities while managing the emotions, but sometimes there are days where I just can't manage everything I have to. One of the things that I really like that people do focus on is that when we feel sadness, it's not just sadness, there's intense grief. Um, and it can be over even what people would consider little things. But for example, like I recently lost a friendship and I've just been grieving that deeply. Um it's just hard because with the other person, they aren't grieving to the extent that I'm grieving, which happens a lot with BPD, and then it just causes more of the emotional turmoil. Like, why didn't they care about me as much as I cared about them, etc.

SPEAKER_01 25:57

What advice do you have for partners, family members of people with BPD in terms of maintaining a positive relationship with all of this going on?

SPEAKER_02 26:07

Communication. Communication is key. Um if a person in your life has BPD, they're going to be experiencing all these emotions and may have like outbursts or things of that nature. If you can get to a point where you're able to talk to this person with BPD and let them talk to you about what they're feeling or experiencing without invalidating them. So if they say, I'm really mad that you did this, try not to say things that will shut them down, like, oh, I didn't mean it that way, or something that sounds kind of like the gaslighting type of thing.

SPEAKER_01 26:50

I'm sorry you feel that way.

SPEAKER_02 26:52

Yeah. It's one of my least favorites. Because that will definitely make someone spiral even more with BPD. Um, but yeah, and also validating a person's emotions. So if they say, I felt really mad that you did this, say, I see how upset you are about this. And from my perspective, this is how I was feeling. Using I statements is important. And just opening the dialogue and not shutting down their emotions. Because even though people with BPD experience emotions, deeper does not mean that they're wrong. Right. And I think that's the biggest thing people need to understand is it's a different emotional experience.

SPEAKER_01 27:39

They're intense but not invalid. When someone with borderline personality disorder is struggling or in crisis, what kind of support is actually helpful and what sort of a reaction would make the situation worse?

SPEAKER_02 27:52

This does again go back to invalidation. So because of the emotional intensity, people with BPD have a lot more situations that can re lead to a crisis level. Um, so if someone with BPD is in that state where they might be saying things that sound like threats but are not, because it goes back to that manipulation piece, like I want to kill myself, or um, if they're doing self-harm, um, it's very important to have the crisis numbers. Like there's the 988 one, but just to be able to have support for someone with BPD who is going through these crises and very intense emotional experiences. And if you are a support person for someone with BPD, being able to understand ways to de-escalate the situation, um, such as the crisis skills, being able to help guide them through paced breathing, like counting to four while breathing in, counting to four while breathing out, um, but also removing anything that might be dangerous if there is a history of self-harm or abuse, self-abuse um in any other way. Um but again, just listening and getting the other person giving them space to talk about what they're experiencing without shutting down what they are feeling, that is the most important thing.

SPEAKER_01 29:39

Now I'm gonna say something that I hope doesn't sound mean, but as as somebody who might be in the support role, I do not have that diagnosis. Got plenty of others, but I don't have that one. If someone was behaving in a way that I found maybe threatening, whether to myself or to to themselves, I think I'd be afraid. And I think that the thought of saying, let's breathe in for four seconds, I I don't think that's where I'd go. So so how does I guess it's two parts. How does someone stay calm enough to do something like that? And where's the line when they should be dialing 988 or doing something more de-escalating?

SPEAKER_02 30:19

So that's definitely something that I see a lot as well. Um, because it can be scary if a person with BPD is in a place where the other person feels threatened. So if it gets to that point, the paste breathing, those things are not important. It is vital to call the 988 number. Um and that one is really helpful, especially if you're somebody who is taking care of somebody with BPD or has someone in your life who has it, because with the 988 line, they will be able to provide you with skills on how to de-escalate the situation, talk to the other person, and then determine if it's important to seek higher level care, like go to the emergency room. But it is also very important that the person taking care of somebody with BPD or supporting them feels safe because there can be outbursts like throwing things or um threats. And it's just so important that as someone supporting someone with BPD doesn't feel like they are in jeopardy as well, because I do know that that can be very difficult. But the crisis lines, those are just so important because they do have the skills to be able to help guide a support person on what is best for the person with BPD.

SPEAKER_01 31:52

And one of the things I learned about 988 when I was working in suicide prevention is that it can really help to make that call on speaker. Because, you know, if you're just sitting there having this private conversation with the person who's, you know, you're talking about me while you're having this, and to say, like maybe you don't want to have this conversation right now with a crisis worker, but if I start having it and I say something incorrectly or you want to add, all of a sudden we're in a three-way dialogue, and that that can help. Is that something you've experienced or seen too?

SPEAKER_02 32:21

Yes. Um, it is so important to have that call on speaker because if the person with BPD is in crisis, they may think that you're trying to control them, or they don't have their own control in their life. Um, and that's something through the National Education Alliance on BPD that I've been helping with, where we're trying to educate 988 operators on how to de-escalate situations with people who have BPD or to kind of know acknowledge if the person might have those symptoms while also providing sort support people with the skills to be able to handle the situations.

SPEAKER_01 33:06

So when we're talking about crisis, it seems to me that crisis and stigma almost go together in this diagnosis because I think the stigma is you're always in crisis. And that's the way borderline personality disorder is portrayed in the media. Um, movies, of course, and shows, but also social media. And that there's even a new uh movie out, which you said is called Borderline, which I did not realize was uh even a way that people are described with just that one word, which makes it worse.

SPEAKER_02 33:33

Yeah. So there's a movie that came out recently called Borderline, and it's about a person who's described as being a sociopath but has a diagnosis of BPD and kidnaps a woman and tortures her, and it's so stigmatizing. And the term borderlines is so offensive because it equates a person with this disorder to their disorder, or the stereotype fits it. It has been used as a scare tactic in the media, like with these movies. Like people with BPD are evil, they're gonna ruin your life. The truth is that there is a lot of the emotional pain and the crises, but it's not constant turmoil like that. So I think it's so important that people separate the stereotypes seen in the media with the reality of what this disorder is. And it is a brain illness, like other mental disorders, and it's not something that is used to manipulate other people or to harm other people purposefully. And yeah, there's just a lot of guilt that goes with this disorder if we like reflect on how we might have treated somebody in a time of high emotion. And so that's why I'm just very passionate about fighting the stereotypes and the stigma in the media, because that movie is just disgusting.

SPEAKER_01 35:03

Sorry. So after I don't know what word to use here, is that outburst? Is it an emotional situation? What what what's the best way to say after something happens that involves other people and you say you feel guilt and shame, how is that reparation made? Are you able, does it is there a calm and then you can go back and revisit it, or or what has your experience been?

SPEAKER_02 35:25

Yeah, my experience has been that there are outbursts sometimes if I'm feeling extreme anger or sadness. And then once my emotional state reaches a more manageable level, I'm able to reflect on what happened and then feel this immense guilt over what I might have done in a time of really high emotion. And that leads to a lot of the interpersonal issues with overapologizing and then people thinking, well, you need to not do that anymore. And these highs and lows are very hard to manage and it's a constant cycle. And it just breaks my heart how much guilt those of us with BPD have, because we do feel deeply, so we feel very deeply for those in our lives, and we don't want to hurt them, and that is so important to understand that it's hard to control the emotions sometimes.

SPEAKER_01 36:25

So, what causes borderline personality disorder? Is it considered genetic? Is it a trauma response? Is it both?

SPEAKER_02 36:34

Originally, um it had been believed that childhood trauma was the main factor in BPD. But what it actually is is there are differing brain structures, and not everybody born with these brain structures will develop BPD, but it can become more apparent if there is like environmental issues as a child, such as invalidation, um, abuse, trauma, um, neglect, but also it's just a mix of both the environmental and the genetic. And for example, a few other people in my family do have this disorder as well. And so when you have the genetic factors, you are more likely to develop it. It just doesn't always turn into BPD, if that makes sense.

SPEAKER_01 37:31

You have mentioned a couple times DBT dialectical behavior therapy. Um, as I said, we've done some other episodes on it, but I want to dive into it here a bit because if that is designed for treating borderline personality disorder, what are some of the things that you know from your own experience and from the people you've supported, the ways that that therapy helps? And are there others that also help?

SPEAKER_02 37:54

Yeah, so DBT, like I had mentioned, is so skills-based. And so it gives you the skills that you need to be able to manage your emotions and interpersonal relationships, but also acceptance and commitment therapy is very helpful because a lot of times those of us with BPD have trauma. And so that therapy particularly helps with being able to examine things that have happened to us and to radically accept them, even if they still hurt us, but to be able to make sense of what has happened to us and how to manage the emotions around that. And while DBT is the primary care for BPD because it has been most effective, a lot of times like acceptance and commitment therapy help us to be able to examine our emotional states and how it also differs from the emotional states of other people and how it's okay that we don't feel the same way that other people might feel, which can be hard, but they kind of work together to help us work through our past the past while the DBT skills help us manage day-to-day emotions and the symptoms of this disorder.

SPEAKER_01 39:24

Can you give me an example where you personally were in a state where you were having symptoms and you used a combination of those therapies to regulate yourself?

SPEAKER_02 39:38

Yeah, so a good example would be a recent one with this friend who I lost, because I had a moment where I had seen kind of the fallout in hindsight of what had happened. And his perspective of what had happened was different from mine, and the acceptance and commitment therapy helped me to be able to accept that he had seen things differently than I did, had experienced different emotions. And even though that's still very hard for me, that he didn't feel the same depth, it helps me to be able to radically accept that this is just the way things played out. That was his experience, this was my experience, and it's okay that they're different, even though it still hurts. Um, and then using the DBT skills, like self-soothing, um, with imagery, like meditation, that helps a lot to keep my emotions and grief from that at a manageable level.

SPEAKER_01 40:41

It's hard for me to imagine someone having the level of self-control and self-awareness to be able to use those techniques at a time where their self is being volatile. How do you do how how does this ever catch up to this?

SPEAKER_02 40:53

Yeah, so with this, it's a lot of hindsight. So during like the turmoil in this situation, I did have some outbursts and a lot of things happen where I wasn't able to control them in the moment. But afterwards, kind of looking in hindsight about what happened, and then talking with this person again about my experience, and then I did apologize for the way things played out because I didn't have the skills in the moment to, like you said, you know, have the mental capacity to focus on like managing these outbursts. Um and it's very hard because a lot of people will be hurt by what happens in these situations if we do have outbursts as a person with borderline personality disorder. I've had to radically accept that a lot of people can accept your apology but still won't want you in their life. And it's hurtful, but I also can see like how hard it is for the other person when they have to witness kind of these outbursts or experiences that the person with BPD has to their actions. And so it's just a lot, a lot of having to accept the way that our outbursts impact others while acknowledging that we do have that emotional pain, but sometimes you just have to move on, do the best you can to continue working on these skills and self-compassion and trying not to beat yourself up constantly, which is something I struggle with all the time.

SPEAKER_01 42:53

Well, I think that that most humans do.

SPEAKER_02 42:56

Yeah.

SPEAKER_01 42:57

So that's where we will wrap up this episode. We're gonna come back next week and continue this discussion, and we'll start with how borderline personality disorder is diagnosed. And we're sort of moving that to the second episode because there are nine criteria, and we're gonna go through each of them so that you can better understand what it is and how it's diagnosed. Thank you so much for your time. I really appreciate you sharing your own personal experience and your expertise.

SPEAKER_02 43:25

Thank you.