BPD: The 9 Diagnostic Symptoms You Need to Know (Part 2)

Living with Borderline Personality Disorder (BPD) often feels like being "screamed at by your brain" while trying to navigate everyday life. In this deeply personal and educational episode, we go beyond the "scary" stereotypes to reveal the intense emotional pain and interpersonal turmoil that defines this condition.

Joining us is Sage Nestler, an LGBTQ+ mental health specialist and a leading educator on BPD. Sage is a member of the advocacy committee for the National Education Alliance on BPD (NEA-BPD) and provides a rare perspective as a clinician who also lives with the disorder. He explains that for those with the quiet version of BPD, the struggle is often internalized, making their experience invisible to the outside world. They share how the "Favorite Person" (FP) phenomenon and black-and-white thinking can create a constant cycle of idolization and fear of abandonment in relationships.

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

Sage clarifies the common confusion between BPD, Bipolar Disorder, and PTSD, explaining why he believes focusing on symptoms rather than labels is critical for proper care. They also address the most searched questions on the internet: Is there a specific medication for BPD? (The answer might surprise you) and can the disorder truly be "cured"?. Whether you are a "support person" for a loved one or someone seeking clarity for your own experience, they offer the validation and insight needed to move forward with compassion.

For more resources, check out the National Alliance on Mental Illness (NAMI) and the Family Connections Program through the NEA-BPD.

⏱️ Chapters:

00:00 – Defining Borderline Personality Disorder (BPD)

01:21 – Common Stereotypes vs. Reality

02:55 – What Living With BPD Feels Like Internally

05:31 – Advice for Loved Ones and Support Systems

08:56 – How to Know if You Have BPD

10:02 – Resources: NEA-BPD and NAMI

15:08 – The "Favorite Person" (FP) Concept Explained

22:52 – Breaking Down the 9 Diagnostic Criteria

46:02 – Best Medication and Treatments for BPD

48:53 – Can Borderline Personality Disorder Be Cured?

❓ Questions the Video Answers:

1. What is borderline personality disorder (BPD)?
2. What does BPD feel like on the inside?
3. What are the 9 diagnostic criteria for BPD?
4. What is a BPD "Favorite Person" (FP)?
5. What is "Quiet BPD" and how is it different?
6. Can BPD be cured or treated effectively?
7. Is there a specific medication for BPD?
8. What is "splitting" in BPD relationships?
9. How does BPD affect the fear of abandonment?
10. Is BPD often misdiagnosed as bipolar disorder?
11. Why is BPD so heavily stigmatized in mental health?
12. How do you get a professional BPD diagnosis?
13. What is identity disturbance in BPD?
14. How can I support a partner or child with BPD?
15. Does BPD cause chronic feelings of emptiness?

#BPD #BorderlinePersonalityDisorder #MentalHealth Awareness

Transcript

SPEAKER_02 0:00

And it is a very painful condition because the emotions we experience are so intense. Sajan Esler is an LGBTQ plus mental health specialist and a leading educator on BPD. There is the stereotype of the person who has all these outbursts and throws things, but that's not the case.

SPEAKER_00 0:19

Can borderline personality disorder be cured? Sage Nestler, welcome back. Thank you. If someone did not listen last week or if they just need a refresher, if you could start by just describing to us what borderline personality disorder is and how it affects people who have it.

SPEAKER_02 0:42

Borderline personality disorder is a disorder that deeply impacts a person's mood and ability to regulate themselves as well as causing a lot of interpersonal turmoil. And it is a very painful condition because the emotions we experience are so intense that it causes a lot of impulsive behaviors and issues in interpersonal, like I had mentioned, our relationships throughout our lives.

SPEAKER_00 1:13

If we have someone in our life with borderline personality disorder, but we might not know that, what would it look like? What would we be seeing?

SPEAKER_02 1:21

That is one of the hardest things to answer because there is the stereotype of the person who has all these outbursts and throws things or makes threats, but that's not the case. A lot of times people with BPD will have highs and lows throughout each day and experience all these intense emotions. And if you have someone in your life with BPD, you might experience a lot of emotional turmoil if those of us with the disorder we feel the fear of abandonment, like we're going to be left. And so we want to push the other person away. And then there's the black and white thinking of really loving and idolizing someone and then disliking them or hating them. And it goes in this constant cycle. It's just a lot of ups and downs.

SPEAKER_00 2:14

Why does it matter that people understand borderline personality disorder and the fact that it reflects deep emotional pain as opposed to just really difficult or scary behaviors?

SPEAKER_02 2:26

It's so important to understand because the symptoms that those of us with BPD have can deeply impact other people in our lives. But a lot of times it's the experience of other people and how they view those of us with BPD and what has happened to them based on our symptoms that were often misunderstood, and especially being equated to sociopaths or narcissists. And that's just not the case.

SPEAKER_00 2:56

You not only have studied and specialize in borderline personality disorder, but you live with it. What's it like to live with?

SPEAKER_02 3:05

Say, like what a day in the life of living with BPD is like. A lot of times I will wake up and immediately have strong emotions about whatever I'm anticipating that day. I might be going about my day, and someone will make an expression, and then I'll think, oh, they're judging me or they hate me. If I don't hear back from a friend or a professional person, then I think that I've immediately done something wrong. Um, I will have periods of being very like sad or distraught, and then it can change in a flash where I'll feel really happy, or something will happen, and then I'll feel a lot of rage. And because I have the quiet version, it's all very internalized. So on the outside, a lot of people don't see what I'm experiencing, but I'm having to deal with these emotions constantly cycling inside of me. And it feels like being screamed at by my brain while having to navigate each day in all my relationships. And while I have studied and practiced DBT. Dialectical behavior therapy. Yes. It's not always possible to use all those skills constantly to keep myself stable because it costs a lot of mental energy on top of everything else I'm trying to navigate throughout the day. So if that's what it feels like from the inside, what does it look like from the outside?

SPEAKER_00 4:37

Just instability? Unpredictability?

SPEAKER_02 4:40

Yeah. So there is a lot of like instability with my personal image of myself or how I feel about myself. And I might have issues in my personal life with relationships where I will just crumble and be really upset, like I failed, or um this other person hates me. And it's hard for the other people in my life to be able to see these highs and lows and to see me a certain way, but I don't see myself the way other people see me. And that causes a rift in how I see myself because of that personal identity that is a big concern with people who have BPD.

SPEAKER_00 5:31

So we probably have two different audiences watching, right? There's going to be people who have, I think they might have this disorder, and people who want to learn about it because maybe someone in their life does. So let's talk to both of them. And for the people who are like, I kind of wonder if my whatever partner child uh has borderline personality disorder, what do you have to say to them or what advice can you give them about moving forward and either having a diagnosis or navigating being in relationship with somebody with the disorder, possibly?

SPEAKER_02 6:06

If you feel like someone in your life might have BPD and you have or see these outbursts or just constantly changing emotions and have all these interpersonal issues, it is very helpful to talk to a professional, um, such as a therapist or even the different mental health organizations like NAMI, the National Uh Alliance on Mental Illness, to navigate what you're seeing in the person in your life who you think might have this, while also learning how to take care of yourself. Um, especially with adolescence, because BPD shows up very early, usually. Um, a lot of times with adolescence, it gets written off as just hormones or things of that nature when it is actually BPD and can be dangerous if there's self-harm or outbursts that impact the support person.

SPEAKER_00 7:11

So in the first episode you mentioned in a crisis situation calling 988, um, now you're saying something like NAMI, National Alliance on Mental Illness, there would be Mental Health America as well, other uh mental health organizations. Play for me like what that conversation would be. If I've got somebody in my life and I'm like, I don't know what's going on. You know, one minute they're this, one minute they're that, whatever the experience might be, and I call that organization. What would be a healthy way to have that conversation that would lead you to a better understanding of next steps?

SPEAKER_02 7:41

So if you are concerned about someone in your life who might have BPD, like you had mentioned, contacting Nami or the Mental Health America or the National Education Alliance on BPD, um, bringing up the symptoms you're seeing in your loved one, making sure that you don't mention that they're in crisis if they aren't in crisis because you want more information on what might be going on. There are lots of different support groups, especially through NAMI, um, with people who have people in their life with different conditions, such as BPD, who can help share their stories with you and tell you like this is what I experienced with my loved one, and then kind of help navigate ways to get your loved one help or to find help for yourself on how to manage taking care of this relationship with this person.

SPEAKER_00 8:46

So then the other audience, and this goes to one of the most searched questions on the internet about this topic, how do I know if I have a BPD?

SPEAKER_02 8:55

Yeah, that is such a hard question, too, because again, like with a lot of mental disorders, symptoms overlap. So, like with PTSD, especially complex PTSD, a lot of those symptoms overlap with BPD.

SPEAKER_00 9:14

And bipolar disorder.

SPEAKER_02 9:16

Yes. It's very important not to self-diagnose. There's so much information online, such as YouTube or TikTok or Instagram of people sharing their stories. And if you relate to people who do have the diagnosis who are talking about their experience, it would be best to talk to a professional, if possible, or these pre organizations organizations about the symptoms you're experiencing to figure out ways that you might be able to receive a diagnosis or help with managing them to help better understand yourself.

SPEAKER_00 9:55

So when you talk about the organizations now, me and MHA, I'm very familiar with. Can you say again the other one that you are involved in advising?

SPEAKER_02 10:02

Yes, it's the National Education Alliance on BPD, so the NEA BPD. And it's an organization that's national and it's purely for borderline personality disorder. They do a very important course called the Family Connections Program, which helps families navigate how to support loved ones with BPD. And I'm actually in the advocacy committee, and we work a lot on destigmatizing this disorder, helping people self-advocate for themselves. Um, I'm the leader of the self-advocacy committee, and we're working on tip sheets on how to navigate what do I do if I think I have BPD? Is it safe to tell a professional that I have this? Um and that organization is so important because there's no stigma within it because everyone involved for the most part has BPD themselves as well. And sometimes in AMI or the MHA, um, there are people who might hold the stigma. And so the NEA BPD does a lot of nonprofit work on trying to help people support not only themselves, but loved ones as well.

SPEAKER_00 11:30

So you said one of the questions um that you're putting together, and I love like getting the scoop before it's out in self-advocacy is is it safe for me to tell somebody I think I have this? What's the answer?

SPEAKER_02 11:42

The answer is you have to gauge the situation very carefully. Um like I had mentioned previously about losing professional opportunities while coming out with that I have BPD or even just relationships, friendships. Um, because of that, it's important to gauge what the situation is. So if it's a professional situation, I would say to navigate that very carefully because of the stigma and the stereotype of people with BPD being unreliable or erratic. Um but these tip sheets, so they're going to help people ask professionals who are knowledgeable in BPD. Like if I saw this video or something online and I related to these symptoms, does that mean I have BPD? And then the clinician can help guide you through that instead of coming out and saying, I think I have BPD, say I am experiencing these symptoms and I related to the something I saw online, and then opening the discussion that way.

SPEAKER_00 13:03

But I can see a lot of reasons that that's a better way to open it, because if you say, I think I have BPD and they go through their diagnostic criteria and say, Nope, now what? You know, but if you say I have these symptoms, it's like, oh, that could be either this, this, or this, and and some more options are open in terms of exploration. Is that am I reading that correctly?

SPEAKER_02 13:23

Yes. Um, because focusing on the symptoms over just the label or the diagnosis is so important because of the overlap that we've talked about, especially with bipolar and PTSD. Um and while BPD and bipolar can co-occur, sometimes they are just misdiagnosed. And like with bipolar disorder, there is the medication piece, whereas with BPD, there's not. Um, and it's mostly therapy. Um, so it's important to talk about the symptoms and with a professional who knows the different diagnoses and can help guide through what might feel like it fits best, and then pursue different treatments.

SPEAKER_00 14:10

We keep bringing up the stereotypes and you know, they're with every mental health diagnosis, but I think even more so with something like borderline personality disorder. So I don't even know how to ask this question, but it's like we don't want people to think we're blank, and a lot of that blank are actually symptoms that we might be exhibiting. So, how do you sort of wed those two? It's like I don't want you to think I'm erratic, but I might be.

SPEAKER_02 14:38

That goes mostly to not defining a person by these symptoms. So, for example, I have BPD, but I'm not erratic or have these outbursts or all these interpersonal issues all the time. Whereas the stereotype is this is just what you are like constantly all the time. So it's just not equating someone, their entire being to this label or diagnoses.

SPEAKER_00 15:08

Okay, thank you. Diagnostic criteria or traits of borderline personality disorder, the one we hear about most is fear of abandonment.

SPEAKER_02 15:17

That is probably the most common trait with people who have BPD. Um, in my experience, that's one of my main symptoms. And with a lot of the people I've worked with, that's also one of their main symptoms. And it's because of our strong emotions, we get very attached to people. And like the favorite person concept. Because we put so much of our emotional needs and support on another person, that fear of abandonment comes in that if they leave, we won't be able to manage our emotions or our mental state. And so the fear of abandonment shows up a lot in the black and white thinking with people. Um, really loving them and thinking they're the most amazing person in the world. And then something happens, and then we think that they hate us or we hate them. And so there's a lot of push and pull where like trying to push someone away before getting hurt ends up leading to abandonment. But that is yeah, the most common and one of the most hard to manage symptoms I've noticed in myself as well.

SPEAKER_00 16:33

When you say favored person, I hear that somebody without this disorder, and think, oh, I have a favorite person. But when I was researching this, I saw it's like FP. And the minute there's a letters attached to it, you know that it's part of a diagnosis. So it's it's much more than just like, oh, you're my favorite person. Can you describe that?

SPEAKER_02 16:53

Yeah. So the favorite person concept in BPD is difficult because we have a favorite person, we feel like they're our entire world, they're our everything. We want them to fulfill all our emotional needs. We idolize them and go to them for everything. Um, whereas somebody without BPD might be like, oh, this is my favorite person, and it's quote unquote normal relationship, but there's so much more intensity with the favorite person because of the idealization. Um, for example, just with friends, I've had quite a few people who ended up being my favorite person, and it's hard because of the attachment and getting so attached to them. And then the fear of abandonment can come in, and they don't want to push them away. And so it's like this intensity where they can't fulfill all of our emotional needs, but then because they're our favorite person, we want them to fulfill all the roles, and it's very constantly push and pull in my own brain because I can see it happening. Um, whereas if you don't have the diagnosis yet and you're experiencing this, like before I was diagnosed, it caused a lot of issues in my friendships, particularly. Um, because I would just attach myself to somebody and it would become kind of a toxic, unhealthy friendship or relationship, because one person can't be your whole life, but your brain like wants them to be.

SPEAKER_00 18:36

And I understand how you end up abandoned or alone by saying, forget it, you know, I'm gonna push you away. But I'd have to also think that a lot of people are like, hey, I'm out. This is just too much. Does it happen both ways?

SPEAKER_02 18:52

Yeah, absolutely. Um in my personal life, I have had people who just can't handle the ups and downs understandably. And so they will push me away or relationships will end. And unfortunately, that is one of the very difficult parts about BPD, is that it does and can hurt other people in your life most of the time, unintentionally. And it's important that we understand how this is a painful disorder to live with, but it's also very difficult for our loved ones to manage as well. Um so that's kind of one of the hardest pieces because the fear of abandonment can also lead to being abandoned if there are the ups and downs and pushing them away and pulling them back.

SPEAKER_00 19:48

Let's speak directly for a second to family members, friends, people who are in relationship or have been in relationship with somebody with BPD and were hurt.

SPEAKER_02 19:59

Yeah, that one's a very hard one for me to answer because I just know that the people I have unintentionally hurt, it had a lasting impact on them. And I think what I would like people to know who have been hurt by those who have BPD is that we feel a lot of guilt and remorse over how our actions or symptoms have impacted other people. And even if it feels like we discarded somebody or um intentionally hurt them, we do feel that remorse and pain over losing them. And I hope that people who have been in relationships with or have known people who have BPD and have been hurt by them also know that most of the time we do not intentionally want to hurt people.

SPEAKER_00 20:57

And I'm sorry if it's hard for you to answer that question. I didn't mean to put you in a position of remembering that. So unstable and intense relationships, is that just hand in hand with the fear of abandonment?

SPEAKER_02 21:09

Yeah, they usually go together because again, the favorite person concept kind of comes into that as well. And so when you have these strong emotions for somebody, there is a lot of times like in romantic relationships where you will break up and get back together, break up and get back together, or friendships, family. Um and so fear of abandonment does go in with that because of the self-sabotaging behaviors that can lead to pushing the other person away or these symptoms impacting them in a way where they don't want the person with BPD in their life because of the impact has on them, which is understandable.

SPEAKER_00 21:57

And unstable and intense relationships is that. Heading under which splitting comes in. What is splitting?

SPEAKER_02 22:05

Splitting is kind of what I talked about with like black and white thinking. So it goes between really loving or idolizing somebody or just having these really strong positive emotions about something or somebody splitting where something will happen and we'll just think that they're the worst person in the world or they hate us and we don't want them in our life anymore. And or if they did something wrong, it's like we had put them on a pedestal, and then it was too high of a pedestal for them to fulfill. And so those negative emotions will come in, and the concept is that there's no gray area. So we see things in good or bad.

SPEAKER_00 22:51

Okay. So that's what the word splitting means. That we that's that line: black, white, good, bad, love, hate. Yes. Okay. I wasn't sure if it was psychological. I guess it kind of is. Yeah. Okay. So the third most common or the third of the nine diagnostic criteria is identity disturbance.

SPEAKER_02 23:12

Yeah. So that goes into having the low self-esteem and not knowing who we are a lot of the time. Because invalidation is such a factor in especially growing up and developing this disorder, where if we really love somebody or something, and somebody else was like, well, that's stupid, or you shouldn't be into that, then you start to lose the sense of yourself. And that's where the personality part of the disorder comes in because of these parts in our brain where we struggle with knowing who we are because of the constantly changing emotions, constantly changing relationships, and a lot of times changes in profession. Um it just goes to the low self-esteem and that identity disturbance because we have a hard time understanding who we really are.

SPEAKER_00 24:17

See, those sound different to me because when I hear low self-esteem, I'm like, I gotta kind of raise my hand over here. When I read distorted or unstable sense of self, that sounds so much worse to me.

SPEAKER_02 24:31

Yeah, that is a good point. Um because when we think of the low self-esteem, like it can apply to anybody. Whereas not knowing who you are, or your sense of self is so much deeper and intense. And that is why there's the constant changes in relationships or professions or what we love or are passionate about because we don't know who we fully are. And it takes a lot, if you have that accessibility to therapy or things like that, to work through it. But because there's not a lot of access to therapy and it's expensive, that can lead to these very intense feelings of emptiness because a person isn't able to fully work through who they are, what their values are, what they're passionate about. And that can be very difficult to live with.

SPEAKER_00 25:36

I was gonna ask a follow-up about, you know, without prying, like what that's like. It's so it's not just uh, am I a good person or am I a bad person? It's I don't even know what I care about. I don't know, I mean, not knowing who I am. What is that, what is that experience? And then I have to ask myself, do I know? But but I'll I'll deal with that when the cameras go off. But but what is that like for you? What is that like for somebody with borderline personality disorder to not know who they are, what they are passionate about, what they tell me more.

SPEAKER_02 26:19

Yeah, so for me personally, uh my entire life, I've just switched different passions or interests or professions, things that I wanted to do. Um, and it was very connected to invalidation by family members and trauma growing up. Um that I felt this deep sense of emptiness. And like when you don't have this sense of self, you're constantly trying to find things to fill, like what will make me happy, or but because of the rapidly changing emotions, too, that impacts what we're passionate about or what we think we're meant to be, or if we're good or a bad person. And so it is a very complex thing to work through and I still struggle with it. Um, while I know what I'm passionate about now, I do go through periods where I feel like I just don't know who I am. Um, and that's something that also impacts my relationships as well. Because when a person with BPD struggles with knowing who they are and what they're passionate about, it impacts your relationships. And if you connect to the other person in the same way. And so that it's just such a complex thing to work through.

SPEAKER_00 27:46

It just sounds so hard.

unknown 27:49

Yeah.

SPEAKER_00 27:51

I really have depression and I don't care for it one little bit. But BPD sounds so hard. It is.

SPEAKER_02 27:59

And I really appreciate you saying that because there are all these factors. Well, we've talked about the stereotypes and the stigma, but there's so much you have to manage each day. And because therapy is expensive, because there's not a lot of accessibility, a lot of people with BPD don't receive the help they need. And unfortunately, that does contribute to the suicidality piece because of the intense emotions, not knowing who you are, these struggles with relationships, and it can lead to these feelings of just despair. And that is something that I see a lot with people I work with, and it breaks my heart. Is there a higher rate of suicide with people with BPD? Yes. It is the mental disorder with the highest rate of suicide attempts and death.

SPEAKER_00 28:55

I did not know that. Yeah. Okay. The fourth criteria for diagnosing BPD is impulsivity. We have talked about it in other ways, but can you explain impulsivity in BPD?

SPEAKER_02 29:08

Yeah, so that's definitely connected to things such as self-harm, gambling, um, sexual relations, spending money, um, substance abuse, things of that nature, where again, it's connected to the emotions. And so you're trying to self-medicate in all these different ways. And impulsivity can also be self-sabotage. So it's also connected to the fear of abandonment. So if you feel like you're going to be abandoned, you might do something impulsive to try to push the other person away.

SPEAKER_00 29:45

Is there an unawareness of consequences or a disregard of them or both?

SPEAKER_02 29:50

In the moment, it's very hard to identify what the consequences might be because it's about that self-medication kind of piece as well. And trying to get out of the negative emotion. And that's when a lot of the DBT skills come in where you want to stop and take a step back before acting on impulsive um behavior. And it can be very difficult to do that in the moment without like a therapist or assistance. But um, yeah, those impulsive behaviors, you aren't thinking about the consequences in the moment. And usually, again, it goes back to that hindsight piece that if you do this and then rethink about what happened, then it turns into that spiral of guilt and like sometimes self-hatred because you feel like you can't control these impulsive behaviors.

SPEAKER_00 30:52

Is there a higher rate of substance use disorders or and or addictions with BPD?

SPEAKER_02 30:59

Yeah, it is one of the most common co-occurring conditions, um, especially with alcoholism, um, because of the self-medication piece. Um same with eating disorders as well, like the binge eating disorder, bulimia, um, because it does feel like self-medication in the moment.

SPEAKER_00 31:23

Okay, we have touched on this a bit, but uh another one of the nine criteria for diagnosing BPD is recurrent suicidal behavior or self-harm.

SPEAKER_02 31:34

And this one is one that's difficult for some people to understand that doesn't always have to be part of a person's experience with BPD. Um, it is very common because again, the feelings of emptiness, the high emotions can lead to those thoughts of wanting to just escape the pain. Um, and it does have the highest rate of suicide attempts or death by suicide. And it is one of the most common criteria, just like with fear of abandonment, but it's because of those high emotions that lead to crisis a lot of the times. And that's why it's so important to have the 988 number or the other crisis numbers, or safe people who you can talk to, and understanding if you're supporting somebody who has BPD, that there might be constant times where they do feel suicidal and it's not manipulative. It's not like trying to punish another person by saying, well, I just I'm gonna try to commit suicide. Um, but that is not what usually happens. It's just to escape the pain and it's not manipulation.

SPEAKER_00 33:01

So I'm gonna ask a question, although I don't want to like turn this into a suicide episode. But if someone brings up suicide, threaten suicide, whatever verb you want to use there, often it seems like one of two things happens. Either you're like, I heard this before and you sort of ignore it, or each time you know, you'll call the police and all the things that can happen after that happen. What what's the what's the correct way to respond to not an imminent threat, but a common threat?

SPEAKER_02 33:36

Like a verbal threat. Yeah. Again, communication. If you have someone in your life who's constantly saying like these suicidal things, or I'm going to commit suicide, sit them down and try to talk through what they are feeling or what they are experiencing. And the important thing is to know if there's a plan or if it's just a threat. And a lot of the times it's hard to know if the other person is going to be honest with you about a plan. But because it's so common to have multiple instances of either attempts or these threats of committing suicide, to understand that it's not always going to lead to an attempt. Um, and usually it's a way to escape the pain. And so either supporting someone with suicide or with BPD who has the suicidal ideation, um, knowing ways to help soothe them, um, or if you are the person with BPD and you're constantly feeling like you're suicidal, understanding ways that you can help to soothe yourself and identify what emotions you might be experiencing and what can help, um, like the crisis skills like dunking your face in cold water, intense exercise, things like that to get the energy out and before acting on anything.

SPEAKER_00 35:17

So another of the diagnostic criteria for BPD is effective instability. What is that?

SPEAKER_02 35:24

So that means when you are just unstable as far as your relationships, your emotions, your ability to manage these ideas in your brain that things are a certain way, if they aren't really that way, or um when you have this instability of not being able to differentiate between reality and what's in your brain and what you're experiencing, um, because they might not match up. And that's when that comes into play, because other people might not understand why you're seeing things a certain way or acting on certain things. Um and it's just very difficult for people with that disorder to have this symptom because it isn't one that is one of the more common ones, like the fear of abandonment. Um, and usually it just relates to the personality side of things where your brain has these ideas of yeah, the way things are, and it may not match up with reality.

SPEAKER_00 36:46

The way it was described and the source I saw it was intense and unstable moods, often with periods of deep sadness, irritability, or anxiety that can last for a few hours or a few days.

SPEAKER_02 36:59

So that relates again to the emotional um intensity and that connects to the personality piece because you can have those intense moods that lead to the unstable license of yourself and the way you go about the world.

SPEAKER_00 37:18

There are three more of the diagnostic criteria. And again, it's five or more that a professional would be looking for to make a diagnosis. So just in terms of somebody watching or listening, if you happen to say, like, yeah, that's me or that's them or whatever, um, don't diagnose yourself, but these are good things to know. Um, the seventh is chronic feelings of emptiness.

SPEAKER_02 37:43

Yeah, and that is definitely connected to the sense of self as well, um, where you just feel empty, like you're not fulfilled, um, either in relationships and professional and your the way you view yourself and the feelings of emptiness. I relate it a lot to like that deep depression where you just feel like you have no purpose, you don't know why you're here, um, you don't think anyone will understand you. And that is kind of where that chronic feeling of emptiness comes from.

SPEAKER_00 38:18

And that leads to or can lead to, a constant search for external validation. So you're like, you make me feel good about me, is that yeah.

SPEAKER_02 38:28

And that's connected to the favorite person piece as well, because if you can't fulfill yourself or have those feelings of emptiness, you want somebody else or something else to fulfill you. And that connects to the interpersonal issues as well.

SPEAKER_00 38:48

Another of the diagnostic criteria for BPD is intense, inappropriate, or uncontrollable anger.

SPEAKER_02 38:55

And this one is probably the one that goes with the stereotype the most because with all the strong emotions, anger quickly can turn into rage. Um, and so if a professional experiences this person with a lot of anger, and sometimes it can lead to breaking things or throwing things or that kind of anger, or the quiet version where I don't externally express anger, but it leads to self-harm or has in the past. Um that one is probably the symptom or criteria that is the most stigmatized because people with quiet BPD can fall through the cracks because they don't have the outward expression of anger, but they're feeling on the inside.

SPEAKER_00 39:53

And then the last. So the last trait or criteria that a professional would be looking for in making a diagnosis of BPD is stress-related paranoia or dissociation.

SPEAKER_02 40:04

So this one is one that is one of my main symptoms as well. Uh paranoia definitely goes into how you perceive the way other people are reacting with you or what situations are. Or if you have trauma, you might be paranoid that you're gonna get hurt again, or this person's doing this or that because it happened in the past. And then dissociation is also very connected to trauma and stress, and they constantly say it's like watching yourself from outside of your body. Whereas the way I experience dissociation is it feels like I'm kind of in the back of my mind, and my body's just talking and moving and doing its own thing. Um, and that is one criteria that often is difficult because it can overlap with PTSD or even things like dissociative identity disorder or other dissociation um type disorders. So that is where that symptom comes into play.

SPEAKER_00 41:19

So having just gone through the nine criteria and traits that a professional is going to look for to diagnose BPD, how have you seen that diagnosis go for yourself or other people?

SPEAKER_02 41:30

For myself, um the psychiatrist who diagnosed me was very much under the influence of the stereotype and the stigma surrounding the disorder. And because I had been diagnosed after being admitted following a suicide attempt after losing a fiance, um as soon as I had mentioned that to the psychiatrist, he had said, Oh, you have BPD because of this unstable, intense relationship with your previous fiance. And unfortunately, that's very common that because of the intensity of relationships, if psychiatrists see this or other professionals, usually in an impatient setting, they'll just diagnose a person with that. Whereas if you're not inpatient and you are seeing a professional, it usually takes a lot longer to identify this disorder because you have to see the client's emotional state, their changes in relationship, if there's paranoia or delusions. Um, and then the anger piece as well. And unfortunately, while there are the nine criteria, there is still the stigma. And a lot of clinicians don't like to diagnose BPD because of the stigma surrounding it, which can cause a lot of issues with people not being able to receive the care that they need.

SPEAKER_00 43:13

So, given the stigma around BPD, how does it feel to get a diagnosis? Is there some relief that, like, oh good, I have a name for it? Is it like, oh, not that name?

SPEAKER_02 43:23

For me, it was definitely the latter after having been in school for my master's and social work and hearing how evil people with BPD are. And then to receive that diagnosis after believing that stigma, I felt like I was just the worst person in the world if I had this disorder. And a lot of times there's not a lot of care around it. Whereas I've noticed when I've been diagnosed with other things or seen other people diagnosed with other things, there's a lot more compassion. Whereas with BPD, I've seen so many times with clients where they have said, when I've told people I have this diagnosis, they just tell me that I need to do the therapy and I need to manage myself and my emotions so I don't impact other people instead of their experience being validated, which just increases the intensity of the symptoms if you aren't being validated.

SPEAKER_00 44:27

So it's the difference between saying your behaviors affect me, get them under control, and oh, I'm so sorry you're feeling that way, and experiencing those deep emotions. And I hope that you're able to get them leveled, managed, regulated so that you don't. Is that the difference?

SPEAKER_02 44:47

Yeah. Or just validating the person and especially if there is history of suicide attempts or behaviors or self-harm, letting them know and understand that a clinician or another professional sees the pain that they're experiencing, or loved ones, instead of your behaviors are impacting everybody else, you need to fix yourself. Um, just understanding that the person with BPD needs to be validated as well. And then being able to help them understand how the symptoms might impact other people, but it's not all about how it impacts other people. The person with BPD needs to be shown compassion as well.

SPEAKER_00 45:42

Get yourself better because I find it really uh disturbing that you're disturbed.

SPEAKER_02 45:47

Yeah. Yeah. In a nutshell.

SPEAKER_00 45:51

So so so much empathy. Okay, two more of the most searched questions on the internet about BPD. One is what is the best medication for someone with borderline personality disorder?

SPEAKER_02 46:02

Fortunately, there are no medications for borderline personality disorder, which is incredibly difficult because then it puts a lot of pressure on the person with BPD to pursue therapy to better themselves, they don't impact other people. Whereas there are co-occurring conditions with BPD. So depression, for example, I'm on antidepressants as well. Um that can help some of the mood stabilities issues or um anxiety medication as well, but there isn't a specific medication for BPD at this time.

SPEAKER_00 46:47

So I'm hearing them thinking if I had all of the symptoms that we've been talking about for two days, and then I was told, hey, when it gets really bad, you're gonna need to find therapy or call on whatever you've learned in therapy. You're gonna have to practice all those techniques. And like I I just, I just, but in comparison, it feels like just right now, have depression. And when I'm in it, I'm not like, I know what helps. I need to get some sunshine, I need to move my body, need to reach out to a for I'm just in it. So it sounds to me like it would be really hard to uh access and use the tools, if you even develop them, to deal with something while you're in it.

SPEAKER_02 47:35

Yeah, a hundred percent. Um it's so frustrating because while DBT is very effective as far as skills go, like you mentioned, when you're in these emotions or states or symptoms, having all those skills in your mind aren't always going to help because the emotions are gonna over or flood. And it is definitely a struggle because there isn't a medication that can just help stabilize. And so people with BPD are often told you have to do all these things all the time while also managing your life. Right. And that just adds to the stigma. And I think a lot of compassion needs to go a long way with how difficult it is to be in these intense emotional episodes and not be able to constantly use these skills if you don't have the mental capacity in the moment when you're flooded by these emotions.

SPEAKER_00 48:44

Another of the top-searched questions on the internet is can borderline personality disorder be cured?

SPEAKER_02 48:53

Unfortunately, it cannot be cured. Um, there have been studies that have shown if a person receives early intervention, like with DBT or other care through a therapist, um, they can better manage their uh condition. Um, and a lot of times by the time people reach their 40s, if they had an earlier diagnosis, they might have lessened symptoms. However, I don't like mentioning that so much because I received so many messages from people saying I'm 50 or 60 years old and I was told I would be cured by the time I was 40. What's wrong with me? Why am I a failure? And the answer is you're not a failure. It's a lifelong chronic condition, and it takes steps each day to manage.

SPEAKER_00 49:47

Okay, so we're gonna wrap up these two episodes here, but I want to ask you if somebody listening or watching recognizes themselves in this conversation, what would you like to say to them?

SPEAKER_02 50:00

I would love to tell them that I see your pain, I see the emotional turmoil you might be experiencing, the issues with relationships. You may might not have people who understand you or have these poor feelings about yourself if you have chronic emptiness and the I see you. This is a very painful disorder. People love to talk about how painful it is for other people, but there is hope for this. And even though it is a painful illness, it's possible to work through the emotions and have a success successful relationships and develop yourself and your personal experience. And people who know you and who you really are are not going to put these stereotypes on you.

SPEAKER_00 50:58

Thank you. I appreciate your expertise. I appreciate you being willing to share your own personal experience and just showing kindness for symptoms and a diagnosis that's really misunderstood and stigmatized. Thank you. And we'll be back next week with a deep dive into another topic.