338. The psychology of borderline personality disorder (BPD)

Borderline Personality Disorder (BPD) is one of the most misunderstood mental health conditions, clouded by stigma and misinformation. In this episode, we take a compassionate, research-based look at what BPD really is, where it comes from, and how people living with it can find healing and stability. From exploring the biological underpinnings and role of trauma, to the impact on relationships and the remarkable effectiveness of treatments like DBT and SCM, we look at both the challenges and hope. We’ll explore: • What BPD feels like and the key symptoms • The biosocial model: how biology and the environment intertwine • The impact BPD has on relationships and attachment • Stigma, myths, and gendered assumptions around diagnosis • Why loneliness is high, and support is essential • How DBT and Structured Clinical Management help people adapt • The encouraging truth about recovery and long-term prognosis If you’ve ever wanted to learn more about this misunderstood condition, this episode is for you. ORDER MY BOOK https://www.psychologyofyour20s.com/copy-of-book Follow Jemma on Instagram: @jemmasbeg https://www.instagram.com/jemmasbeg/?hl=en# Follow the podcast on Instagram: @thatpsychologypodcast https://www.instagram.com/thatpsychologypodcast/?hl=en# For business: [email protected] mailto:[email protected] The Psychology of your 20s is not a substitute for professional mental health help. If you are struggling, distressed or require personalised advice, please reach out to your doctor or a licensed psychologist. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:04Jemma Sbeg?

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• 3:44Jemma Sbeg?

  Hello, everybody, and welcome back to the Psychology of Your 20s, the podcast where we talk through some of the big life changes and transitions of our 20s and what they mean for our psychology.

• 4:03Jemma Sbeg?

  Hello everybody, welcome back to the show, welcome back to the podcast. New listeners, old listeners, wherever you are in the world. It is so great to have you here back for another highly requested episode as we break down the psychology of our twenties. So guys, today we're going to talk about borderline personality disorder or BPD. Maybe you have seen the term thrown around online, especially recently. Maybe you have seen it used to describe people who others think are manipulative or dramatic or even dangerous without really even knowing the whole story or what BPD actually means. Maybe for some of you listening, you know, this is a term that you've encountered more personally.

• 4:47Jemma Sbeg?

  Maybe this is a diagnosis that you've received. Maybe you grew up with a parent who had BBT and didn't really understand it until recently. Or maybe you are hearing it for the very first time on this podcast. What I really want to do today is give a proper and real introduction into the world of people with BPD, into what this condition actually means. And probably more importantly, what it doesn't. Because I think, as is the case with a lot of mental health disorders or personality disorders, the truth gets rather twisted. And I think it gets made smaller until it becomes a bit of a stereotype.

• 5:32Jemma Sbeg?

  This has definitely happened with borderline personality disorder. At its heart, this is a condition, this is a disorder of emotional regulation and attachment. Meaning it massively affects how someone feels, their mood, their relationships, how they see themselves, how they view love, one of our core human experiences. Some of the ways that I've seen people describe it is basically like a lack of identity. You get such intense feelings of anger and nihilism that you feel.

• 6:07Jemma Sbeg?

  Completely empty and then the next day or the next minute, you will be filled with like such an intense ecstatic joy that you feel like the world could never be an evil place again. It's scary kind of not knowing how you feel about the same situation and therefore kind of not knowing who you are. Others have also described this emotional pendulum by saying it's like having so much emotion that you don't know what to do with it, but also at the same time feeling so empty and having both of these things exist at the same time. You can go from loving a person so deeply, you think, you know, you might die and then

• 6:46Jemma Sbeg?

  suddenly hating everything about them. It is the disorder, it is a roller coaster disorder. That's really like the best way to put it. And what actually is behind this emotional intensity? Because I think you may know the symptoms, you may know the general character profile of what people assume people with BPD look like, but do we really know the origins? Do we know how this disorder impacts the mind, why it is so linked to attachment? I think a lot of people don't. So I really want to talk about it today. I really want to reduce a little bit of the stigma and just talk about some probably unknown facts

• 7:27Jemma Sbeg?

  and some unknown research about BPD that you might not see presented on TikTok and that you might not see in everyday discussions about this, about this condition. As always, I say this every time with these specific episodes that we do on mental health disorders, this is not a diagnostic tool. It's not a diagnostic tool for yourself or to be used um for someone else, nor is it a substitute for therapy or real life intervention. We're also going to be talking about some sensitive topics today to do with suicide, suicidal ideation and self harm. So if that's something that you are sensitive towards,

• 8:07Jemma Sbeg?

  just consider whether this episode is what you need to hear today. It will be here in a month, it will be here in a year. You can always come back to it when you feel more prepared. I will leave you some links in the description for further resources. So if you or someone you know may be experiencing borderline, if you think they may be experiencing borderline, if this episode has left you distressed, hopefully those help you find the help that you need in your local area and for what you're going through. So I just want to give that little disclaimer before we get into it. It probably will be a more heavy episode than we're used to, but take care of yourself. And without further ado, let's dive into the psychology of borderline personality disorder.

• 8:58Jemma Sbeg?

  So I want to begin with a little bit of like an imagination exercise to really get across even just a small part of the experience of someone with BPD. This is how people describe it. Imagine for a moment that every emotion that you have felt today or in the last week, you are currently feeling right now, all at the same time. You know, you don't just feel happy, you feel ecstatic joy. You don't just feel sadness, you feel bottomless despair. Every moment of rage, every moment of laughter, every moment of hatred from the past week of your life, you're experiencing

• 9:40Jemma Sbeg?

  it right now. These visceral emotions that I think are only usually available to us for a tiny portion of of our lives and of our days, people with BPD, they feel them all the time. They feel them much more often in much, much higher definition.

• 10:00Jemma Sbeg?

  Now imagine that these emotions get split into positive and negative. And now, instead of just feeling all your emotions at once, you're feeling all or nothing. You're feeling either entirely good and loved and happy, or entirely miserable and depressed and angry. And that rapid, effective, or emotional instability can be triggered by something that many of us would consider really, really tiny, really, really miniscule. You know, a delayed reply to a text message, a certain facial expression, a certain slight or perceived rejection.

• 10:42Jemma Sbeg?

  Not only is the depth of feeling amplified for people with BPD, and there have been studies that have shown that people who have borderline personality disorder may actually have access to a more nuanced emotional scale, but the rate at which these emotions is changing within someone with borderline personality disorder is also accelerated. This is what people often mean when they describe BPD as emotional instability. And in fact, that's exactly what some diagnostic manuals call it. This is a really important caveat before we get any further in the episode. If you are listening from somewhere outside of Australia or outside of the US,

• 11:25Jemma Sbeg?

  you might know borderline personality disorder as something entirely different. In the UK, in parts of Europe, in parts of Asia, you might hear the term emotionally unstable personality disorder, or EUPD, rather than borderline personality disorder. Now, the reason I'm going to go with BPD for this episode is, obviously, I am in Australia, and if you couldn't tell from my voice. But also, it is the term that is used by the DSM, which we've spoken about before many times on the podcast. It is the Diagnostic Statistical Manual of basically every single mental disorder known and categorized. So, you know, if I was to start saying emotionally unstable personality disorder.

• 12:12Jemma Sbeg?

  Instead of borderline personality disorder, I think I would kind of slip up. So you may have heard this as a different term, as a different, in a different way. They do mean the same things. There is a reason, though, that they are labelled differently. The term or the preface of borderline comes from kind of an older way of thinking. Um, back in the day clinicians believed that people with BPD with this condition were on the borderline between psychosis and neurosis. Neurosis is also known as anxiety. Today, most experts agree that that is not actually what's happening. That description is outdated. We don't really use terms like neurosis anymore.

• 12:56Jemma Sbeg?

  Emotional, emotionally unstable, I should say, gets closer to the reality. What is really happening with this disorder is a nervous system that has been caused or forced to react intensely and unpredictably to emotional triggers. Let's talk about prevalence here for a little bit. BPD is estimated to be prevalent in anywhere between 0.7 to 5.8% of the general population. Uber specific numbers right there. Um, and I'll tell you why those numbers are so specific. They're so specific because that is the minimum and the maximum that researchers believe this condition could be present.

• 13:36Jemma Sbeg?

  Um, when considering factors like, um, a lack of diagnosis, especially in certain population groups like men or in certain countries with underdeveloped mental health systems where there isn't di- as much, I guess, like, knowledge of this or opportunities for diagnosis. They're also considering if there is an overrepresentation. So sometimes when people try and find these estimates of like, how common is a disorder in the world? They like to go as small as possible and as big as possible. So when you hear 5.8%, I don't want you to think that anytime you go into work, anytime you're walking down the street, one in every 20 people have borderline personality disorder.

• 14:19Jemma Sbeg?

  Again, it's just like the max of all maxes. Now, let's talk about more, more deeply. Let's talk about what this disorder actually contains. What are the hallmark symptoms of BPD? So according to the DSM five.

• 14:38Jemma Sbeg?

  If you want to be diagnosed with borderline personality disorder, a couple of things have to be true. Firstly, you have to experience a certain number of the following symptoms. An intense fear of abandonment, unstable relationships and unstable self-image, so feeling amazing one minute, terrible the next. Impulsivity, recurrent suicidal behaviour or self-harm, emotional instability, rapid intense mood changes, chronic feelings of emptiness, intense anger inappropriate to the situation, and at the extreme, stress-related paranoia or dissociation.

• 15:19Jemma Sbeg?

  I think that as of today, as of right now, as I'm recording this, you need to have five or more of these symptoms present over a significant period of time and across various contexts. So you can't just feel emptiness, impulsivity and intense rage when you're around your family and your family only. Or you can't just experience that when you're at the job that you hate. It has to be something that unfortunately isn't purely environmental or context-based, but which sits with you throughout all social, physical, emotional contexts. That is kind of the hurdle that you have to jump over to be diagnosed with BPD. We're going to talk about a couple of the other hurdles later on. Don't worry, we'll get to it.

• 16:04Jemma Sbeg?

  So clearly, when we talk about instability, this isn't just having a few mood swings. It, these swings are full body. They affect identity, relationships. They affect our relationship with ourself, even sometimes how we see reality. One of the most devastating aspects of BPD is the way that it heightens risk for self-harm and suicide. And this is kind of a known, very sad secret of the community of people who endure and suffer from this condition. I saw this statistic the other day that as many as

• 16:46Jemma Sbeg?

  70%, I believe, of those with BPD will attempt suicide at some point in their lifetime.

• 16:54Jemma Sbeg?

  That makes borderline personality disorder one, if not the most high risk psychiatric diagnosis when it comes to mortality. I would assume it would be second only to anorexia. That statistic isn't necessarily meant to shock you, although it definitely shocked me. Seventy percent is a ridiculously high number. But it's meant to just highlight how intense and painful this disorder can be for those who are living with it. Whereby the only response many of the people who are enduring this condition believe they can have the only appropriate response is a drastic devastating and permanent one.

• 17:37Jemma Sbeg?

  Another key complexity to do with BPD is that it actually rarely exists alone. We talked about those hurdles you need to get across. This is the second biggest hurdle. Getting the diagnosis is actually quite difficult because for someone with BPD, it is highly likely, in fact, it is more probable than not that they will also be experiencing another co-occurring mental health condition. The research in this is a little inconsistent, but in terms of the rate of co-occurrence with other mental health conditions, anywhere between sixty-three to ninety-five percent of people with borderline personality disorder will also have another diagnosis at the time of their diagnosis.

• 18:23Jemma Sbeg?

  Now, that number, the sixty-three to ninety-five percent, that was found in a very well-known two thousand and nineteen Swedish population study, which looked at almost two million people with BPD. So I think that we can say that number is fairly accurate. Two million people. I think that is the largest sample size of any study we have ever mentioned on the podcast before ever. Some of the most common co-occurring conditions are the ones that are obviously most common in this, in society in general, so depression, um, anxiety disorders, bipolar

• 19:04Jemma Sbeg?

  disorder, but then also PTSD, complex PTSD, CPTSD as it's called for short, substance use disorders and eating disorders. This one especially, eating disorders and BPD are incredibly common, especially bulimia and binge eating disorder. Now, this overlap obviously can make things quite tricky. Imagine going into a doctor's office and, you know, really all your symptoms are coming from a large tumor, but instead of treating the tumor, they start treating a gash on your leg and they start treating you for a vitamin deficiency and they start treating, they send you to the dentist to get like dental treatment and

• 19:48Jemma Sbeg?

  all along you have this big tumor that all of this stuff is coming from. Like that's how some people describe BPD. It's like you're treating, you go into, I don't know, the medical system, specifically the mental health system, and you have this big thing that is really bothering you, that you can't figure out. And as, in order to get a final diagnosis, all these other little things get treated or get labelled first, when the big thing kind of goes undetected. I've heard so many stories of this from listeners, um, of people who, you know, they had not even heard of the term BPD until they were in an inpatient treatment for an eating disorder, five years after they first developed said

• 20:33Jemma Sbeg?

  eating disorder. Or they've been treated for depression and anxiety for years before suddenly someone sits down and says you might have this and it's like the key that unlocks the door. I think that's similar for, you know, late-stage diagnosis for ADHD and for autism, often.

• 20:51Jemma Sbeg?

  People don't get the label that they need and that they would would really give them an answer until a little bit later in in life. So where does BPD actually come from? Psychologists, researchers, they will often turn to the biosocial model to explain the origins of BPD. Now, the biosocial model was originally proposed by Marsha Lyman in the nineties, I think, and she also is the creator of dialectical behaviour therapy, DBT, which you have probably heard about on the podcast before. We're going to circle back to that in a second. But according to this biosocial model, BPD develops from

• 21:34Jemma Sbeg?

  a combination of a couple of things, almost like a perfect storm. It is not a singular thing that creates it. Firstly, there must be a biological vulnerability, meaning a person is born, naturally born with a heightened emotional sensitivity, a certain specific kind of temperament, or heightened emotional dysregulation. An individual basically is seen, in this case, to have had a predisposition for either hyperarousal or hyperreactivity. So their nervous system reacts more strongly to emotional stimuli and takes longer to return to a baseline because of their genetic blueprint. It has nothing to do with environment

• 22:15Jemma Sbeg?

  yet. There's a lot of different theories and pieces of research and looking at the specific biological basis behind this hypoarousal or hyperreactivity. And what a lot of people typically come back to is this one structure in our brain, one of the smallest structures, which is the amygdala. Now, the amygdala sits right in the centre of what we call our old brain. It is responsible for detecting threats and for triggering an emotional response like fear or anger, which will in turn also trigger a physical response. Now, in people with BPD, when they do FMRI scans of these people's brains, what they tend to find is that the amygdala is hyperactive, meaning that

• 23:01Jemma Sbeg?

  When a rather ubiquitous or small emotional experience occurs, it reacts in a disproportionate way compared to a so-called, and I hate saying this, a so-called normal brain or a control brain. The brain's alarm system in this case goes off at the slightest sign of rejection or criticism because it cannot distinguish between something that requires a 2% reaction and a 200% reaction. That is part of the intensity behind this disorder. Now, on the other side, we have the prefrontal cortex. Now, the prefrontal cortex and the amygdala often get talked about together a lot because they are like, how do I describe it?

• 23:46Jemma Sbeg?

  They're like on two sides of the balance beam. The prefrontal cortex, she is logic, she is regulation, she is the thing that provides reason, executive functioning and helps calm us down. Now, if the amygdala shows heightened reactivity, the frontal lobe shows reduced activity or reduced connectivity in people with BPD. Basically, there are less roads, less fast pathways running around the frontal lobe. So messages are a little bit slower. So you've got a brain where the emotional accelerator is extra sensitive and the braking system is less responsive slash doesn't really work. That's a hard mind to control for anybody.

• 24:31Jemma Sbeg?

  Of course, this does have a genetic component. If you have a parent, if you have a sibling, if you have an immediate family member with BPD, the chances of you then developing that disorder sits around the 40 to 60% mark. It's about 40 to 60% heritable. Now, it's kind of hard to, um, kind of hard to detach whether it's because you've been raised in an environment where someone has a disorder that causes them to be quite polarizing and reactive, or whether it is purely genetic. The best way we can figure it out is through twin studies. And it does seem to be that there is both a genetic and an environmental.

• 25:18Jemma Sbeg?

  Context here. The genetic aspect of having a family member or having a certain genome or whatever it is that has been primed for BPD is that that vulnerability can actually lay completely dormant for somebody's whole life or for many, many years until something triggers it. And this is where we get to talk about the second part of the biosocial model, which is the role of an invalidating environment. Meaning that a lot of people who go on to develop BPD from a young age probably existed in a world that didn't teach them how to manage their emotions,

• 26:03Jemma Sbeg?

  didn't give them a safe space to manage their emotions, and who probably experienced something very severe and extreme during their childhood that they couldn't grasp, they couldn't control, they weren't supported to understand as a child. And so from that point on, all of their emotions were at level a hundred. You guys know, my guilty secret is that if I'm researching an episode where I want, I want to know more about lived experience, I love going into Reddit and reading through all like the, um, I guess like the support boards. And in one of the ones for BPD, I found a lot of people talking about this experience of a before and after.

• 26:47Jemma Sbeg?

  Like a moment where they felt their brain, this new brain, their BPD brain like switch on.

• 26:56Jemma Sbeg?

  And this is exactly what we're talking about. There's a biological vulnerability, a light switch that is suddenly switched on by an environmental experience. Now, what might that environmental experience be? Well, there are a lot of options, a lot of really actually terrible options, but it's often trauma, um, either subtle or overt that adds to these effects and that creates the personality disorder or personality type we now call borderline or emotionally unstable. A two thousand and eighteen study published in the Journal for Personality and Mental Health looked at a sample of adolescents from thirteen to seventeen who were at an inpatient unit

• 27:40Jemma Sbeg?

  as a result of their BPD. And then of these people who, of these children who had BPD, they also matched them with a sample of people of the same age who didn't have BPD. And then a further two hundred and ninety adult inpatients with BPD. And they just got every single group, the teenagers with BPD, the teenagers without BPD, and the adults with BPD, to answer a few questions about their childhood, specifically experiences of abuse or neglect. What the study found was that adolescents with BPD described significantly more abusive experiences than their psychologically healthy peers.

• 28:26Jemma Sbeg?

  But often, they did so in quite a detached way. Oh, you know, I don't really know why I'm like this, but then they would go on to explain something that was just like absolutely psychologically crushing.

• 28:40Jemma Sbeg?

  What's even more interesting is that that recall of those events and I guess that rate of trauma and emotional or childhood neglect was very similar in the adult group as well. And a lot of these people found that the impact of their childhood adversity was almost more pronounced in adulthood. Perhaps due to the prolonged effects of early trauma and the fact that the inability to regulate themselves through those experiences had meant that the impact of those experiences had just been allowed to. Compound.

• 29:21Jemma Sbeg?

  Trauma, especially when it's relational trauma to do with how your caregivers treated you, to do with maybe a death in the family, to do with social rejection or social pain or grief, it also heightens a fear of abandonment. And it makes trust in relationships a lot more difficult. And it reinforces that hyperreactivity to emotional stress, which is another core element of BPD. Now, trauma doesn't have to be this huge, major thing that you can point to and reflect on and say, this is where it began. For a lot of people with BPD, they actually say, you know, my childhood was pretty good. They don't recount having an abusive childhood.

• 30:05Jemma Sbeg?

  But as we said before, when you ask them to describe it, it's, you know, parents who are physically present, who put food on the table, but are deeply dismissive. Parents who themselves had BPD and because that's the only caregiving and parental love the child or the person has ever known, that felt normal to them. Or it's just not being valued. It's environments that just didn't match the child's sensitivity, where they felt like they were too much or too dramatic, where they felt like every time they said, "Don't abandon me," someone would, or someone would think that it was funny to play into these insecurities.

• 30:50Jemma Sbeg?

  Really what we are pointing to here is how trauma interacts with biological vulnerability, which then interacts with emotional invalidation or environmental invalidation. That is the trifecta that creates BPD. And I would say 99% of cases, and it's what shapes emotional regulation, self-concept, and of course, our attachment pattern. Now with that in mind, we are going to take a short break. But when we return, let's really talk about how this impacts our relationships, because I think this is the space where people are most curious about BPD or often first introduced to BPD. So stay with us.

• 31:40Jemma Sbeg?

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• 36:19Jemma Sbeg?

  Something really critical and key with BPD, as I mentioned before, is the role of relationships. They carry so much of the disorder's weight and a lot of the times, I think it is where BPD becomes most visible in everyday life, especially to others. If you have watched Girl Interrupted, Fatal Attraction, Silver Lining's Playbook, these are like pop culture references that I actually think are pretty good at explaining or showing the intensity of this experience to people. I personally, I love Silver Lining's Playbook. It is one of

• 37:00Jemma Sbeg?

  my all time favorite movies, but if you've seen it, you will feel, or you will notice that the movie has this weird way of making you feel stressed and making you feel on edge, especially from the main character, like his interactions with people are so, they've become so volatile at times and you can feel that through the movie. And I apparently, see, I don't have BPD, but I've been told it is a very good depiction of how this feels inside the mind of someone with BPD. Like, things are rising, things are like just spiraling and it's all joy in the next one moment and it's all disappointment or anger or hate the next. Psychologists often frame this through the lens of, obviously, attachment

• 37:44Jemma Sbeg?

  theory. Many people with BPD show what's called an anxious preoccupied or a disorganized attachment style. That means that they desperately crave closeness and connection, but at the same time, that intimacy, because it is something they desire so much, feels deeply threatening. When closeness for them has so often been paired with pain, rejection, or inconsistency, love becomes both the thing they need the most and the thing they fear the most. They fear the loss of that love. They fear that someone is just inevitably going to leave them.

• 38:29Jemma Sbeg?

  And they fight very, very hard internally and externally to prevent that from happening. This plays out in what we sometimes call a push-pull dynamic. On one hand, they're craving this bond, they're craving intimacy. They are pulling it closer and on the other hand, they're so fearful of being hurt that they push away and that's what the withdrawal and the anger looks like. There's a very famous phrase used to describe this, which is, I hate you, please don't leave me. You've probably heard of it. It is actually the name of one of the most well-known books on B P D. And it's exactly as it sounds. I hate you, please don't leave me. I actually love you. What we sometimes realise is that

• 39:14Jemma Sbeg?

  love for them feels so intense um that sometimes it just gets confused with all other intense emotions. Or you start to anticipate the pain of someone leaving before it happens and so you're reacting or you are acting out this future imagination that you have of how it's gonna feel when this all comes to an end. Relationships really do feel like, as they described, a pendulum swing between extremes of idealising one's partner and then devaluing them. At one moment, you know, your partner is perfect, they're the best thing that's ever happened to you. They are gorgeous and beautiful and kind and everything you've ever wanted. And the next, after some perceived slight or disappointment,

• 40:00Jemma Sbeg?

  that same partner might be seen as cruel or untrustworthy. And in that moment, it feels like you never wanna see them again, it's ruined. It's not that the person with B P D wants to see things in this black and white way. It's that their emotions are so overwhelming that it's hard to hold both the good and the bad in one mind at the same time. This has a name, it's known as splitting and it's basically the inability to hold opposing thoughts, feelings or beliefs all at once. Obviously, no one is ever perfect, you know, even if someone is literally our soulmate and the love of our life and we've managed to find them, things do go wrong.

• 40:43Jemma Sbeg?

  But for someone with BPD, often to survive the internal emotional volatility, they do find it easier to make outright categorizations, like this person is evil or this person is an angel. And when someone sits in the middle, sits in the gray area, they cannot just be a normal person with flaws, with inconsistencies, with normal human reactions. That's what makes everyday relational conflict, disagreements, disappointments so difficult for someone with this disorder. I read a few reports of what this felt like for people with BPD and what some people describe is this inability to detach the bad feeling about the situation from the person in the situation.

• 41:27Jemma Sbeg?

  Obviously, having arguments in a relationship is uncomfortable. But also, there's this whole rupture and repair idea of you do need to sometimes have friction and conflict in order to build the muscle and build the volume of your relationship and to move forward. And so it's kind of just a normal part of things, even if it feels bad now, you can move forward. Someone with BPD sees that situation and is like, well, that's just all the evidence I need that this person is going to treat me poorly in the future, that our relationship is doomed. And so of course they react accordingly, they react defensively or from a place of of pain. You know, you have this fight with a friend, right? It's heated, it's rough, it's hard.

• 42:11Jemma Sbeg?

  And if you have BPD, sometimes you might feel like afterwards, okay, well, that friendship is over, I guess, like that's that's dumb, that person is a terrible person, they never want to see me again. So I'll be the first one and never want to see them again, first, if that makes sense. And then three days later, you know, they'll text you wanting to grab a coffee or wanting to hang out and talk it through. And it's this confusion of like, what do you mean people can be nuanced? What do you mean this wasn't the end? You know, I'd already emotionally prepared to cut you off. What, what is this? Why doesn't everyone think the same way as me? One account I read that was really profound was this person who again was on Reddit and was like genuinely seemed confused

• 42:52Jemma Sbeg?

  that someone who she had had an argument with wanted to repair the relationship. She was like, what do you mean? Surely this is all the evidence we made and that we required to know that this friendship isn't going to work out. Conflict is part of a relationship, but if you have this emotional instability in these previous experiences of being hurt or being let down. Well, of course, it's going to be a lot harder to tolerate. People who are actually the romantic partners of people with BPD often report really struggling sometimes with this cycle of closeness and conflict. Feeling deeply loved one moment and painfully rejected the next.

• 43:34Jemma Sbeg?

  There was a two thousand and fourteen study that looked at this specifically, the partners of people with BPD. And what they found was that a lot of these romantic partners reported um an increased sense of hurt in the aftermath of arguments and an increased sense of caregiver burnout or caregiving anxiety. When you feel deeply personally responsible for someone else's emotions all of the time, and that person is also, you know, a little bit difficult or impossible to predict. That takes its toll. It takes its toll on the other person. It takes its toll on the structure of the relationship as a whole. Parents of uh young adults or teenagers with BPD

• 44:17Jemma Sbeg?

  also report this feeling. There was another study, I think in twenty twenty one, that looked at them as the main relationship in the life of someone with BPD. And again, it's this weird. It's this weird difficulty of feeling helpless and guilty, but also angry, wanting to set boundaries, but also wanting to let this person be in control because that might be the best way to manage the situation. As a result of this, um which again, a lot, a lot of these people, actually all of them. They cannot control this amplified emotional reaction, but as a result of it, there is a huge link between BPD and loneliness. Because of how individuals with this condition relate and interact with others,

• 44:59Jemma Sbeg?

  it is really common for people with BPD to self-isolate as the only appropriate reaction to these behavioral patterns that, number one, they don't want, but number two, they find themselves being unable to control. They don't actually want to hurt people. They don't actually want to have this repetitive relational pattern of loving someone intensely, trusting someone in intensely, and then one thing going wrong and feeling like the world is splitting open. And so because they find it difficult to manage the emotional consequences of relationships, they just avoid relationships in general.

• 45:40Jemma Sbeg?

  Research shows that not only are people with BPD more likely to be lonely compared to the general population, but their social networks are often much smaller, much less diverse, also less satisfying. And maybe we could even trace this back to what we were talking about before with the suicidal ideation and behavior. Loneliness is of course going to be another factor. Not only can you not control your emotional state, you also don't get that same support socially that maybe you really need and that other people do receive. You know, I just, I can't imagine how isolating that would feel. To want love and to want to be around people so badly and to really love the depth and

• 46:25Jemma Sbeg?

  the intensity and beauty of relationships, but also know that there's a part of you that just can't handle it and just deciding to opt out. Like, that's a crazy sacrifice and a crazy decision that people have to make. And this is the thing, for people with BPD, there is this stigma that their capacity to love. Is kind of broken, that they can't do it normally. That's not true. It's simply tethered to fear in a way that I guess a lot of us don't really understand, unless of course, we're in it, unless we're experiencing it. Let's talk some more about the stigma around BPD since we've kind of gotten started on that now.

• 47:08Jemma Sbeg?

  Because I do think it's one of the most stigmatized mental health diagnoses out there. Part of the stigma comes from a misunderstanding about the behaviors associated with BPD, particularly the intention of these behaviors. Outwardly, someone might appear to be doing things to get attention, to be manipulative, to be dramatic. A partner might, you know, this person might frantically call you or have these very intense emotional outbursts and you might think that that's a control tactic. The I hate you, don't leave me experience, it, you know, it might not be manipulation. It actually rarely is manipulation in a calculated sense.

• 47:51Jemma Sbeg?

  It is just the only panicked way that someone with BPD can respond to a situation. They do not have the same emotional and interpersonal regulation skills that the, again, average person has. So they are not sitting there and thinking, well, if I react this way, I'm going to get a certain response. And even if they are, it's not because they want to necessarily hurt someone. They're just doing anything to get back to a place of emotional safety within the relationship. It's a survival strategy, that push-pull, that I, the I want to let you in, but I don't know

• 48:32Jemma Sbeg?

  how to, or I don't want to be disappointed. It does cause them to do things that outwardly might seem really strange, but for them make perfect sense, or don't make sense, but they feel like they have no control. Of course, I do think cultural representations only make matters worse. We've talked about some good representations. A lot of the stuff we see these days with the characterizations of people with BPD online are less educational, less informative. And, you know, when you see social media or TV or movies frequently portray people with BPD as toxic exes or dangerous individuals, it reinforces um this fear and this sense that they don't have empathy, when that's totally not what's going on here.

• 49:16Jemma Sbeg?

  I will say caveat here, in some ways I do understand sometimes why people want to talk about it that way, um, because that's their perception and that's their truth. Their truth was that they were in a relationship with someone who had this this condition and they experienced things that really hurt them and they experienced behaviours that maybe left them feeling very unstable and could be interpreted as dangerous. Two things can be true here. Someone can be experiencing a personality disorder they really don't have a grasp of, um, and that's might not be entirely their fault. And someone else can equally be suffering from that same condition on the, on the other

• 49:59Jemma Sbeg?

  end, on the kind of sharp, pointy end of the behaviours that the person with BPD is using to protect themselves. So again, it's complicated, it's nuanced, I think it's hard to talk about because you want to validate someone's experience of what is again, um, diagnosable mental health disorder, but you also want to understand that, yeah, it, people do get hurt by these behaviours, whether intentionally or not. The thing is, is that people with BPD are not sociopaths, they're not narcissists, they don't have those same, the same lack of empathy as you would maybe expect from someone who is deliberately manipulative. Maybe they have comorbidity, but it's not a significant

• 50:44Jemma Sbeg?

  level of them. So they get the shame, they understand it, they understand their erratic behaviours, they don't want to be like this. And that's really hard because that self-criticism and these misconceptions actually make them feel more isolated and hopeless, less likely to get help. Another thing we need to talk about, another layer of this actually comes from gendered assumptions around PPD. So something you may not know is that historically BPD has been diagnosed significantly more often in women. Some estimates suggest it's about seventy-five percent of diagnosed cases are female.

• 51:24Jemma Sbeg?

  And if we look back, this has basically reinforced this cultural stereotype that emotional intensity, volatility, relational sensitivity is inherently feminine, or that women who express strong emotions are somehow hysterical, overly dramatic borderline. These stereotypes are really dangerous because they don't just influence some random person on the streets judgment, like they shape clinical perception as well. And, and we know this because of, again, those diagnosis rates. A woman who is emotional, anxious, having issues in their relationship, prone to self harm, they may be more quickly labelled as borderline, whilst

• 52:05Jemma Sbeg?

  a man with the same underlying issues and patterns might be seen differently. And that's probably what's resulting in men being under diagnosed, even when they meet the criteria for BPD. Why? Partly because the, the same way that um autos- an autism diagnosis has been set up to catch more young boys due to their socialisation, a BPD diagnosis has been set up to catch more women because of how they have been socialised. Men tend to externalise distress in ways that society and clinicians would interpret differently. Instead of expressing sadness or fear, they might display anger, or impulsivity, or risk-taking behaviours, or substance use. These expressions can lead clinicians to assign very different

• 52:49Jemma Sbeg?

  diagnoses, as we talked about before. A lot of people with BPD get a lot of different labels before they find this final one that really does describe them. So for men, it might be antisocial personality disorder, anger management issues, conduct disorders. And that means that the treatment they receive only addresses the reactions or the outbursts rather than the cause. The result is, you know, what we know as a gendered blind spot. Women are overrepresented in statistics, so that means that we have a very limited way of seeing this disorder that has been influenced by gender, and it means that the disorder has often been stigmatised for just meaning that someone overreacts, or is labelled

• 53:31Jemma Sbeg?

  as manipulative, not to be trusted, whilst men are under recognised and they go without support entirely. Here's the thing that we have not mentioned once, which now I'm realising I probably should have mentioned it earlier, but BPD is treatable.

• 53:47Jemma Sbeg?

  For a long time clinicians believed it wasn't. Patients with BPD were seen as too difficult, too resistant, too uncooperative. We now know recovery, or what they call remission from this disorder, is not only possible, it is incredibly common. More so than what you are thinking. Incredibly common. So we are going to take a short break now. But when we return, I want to talk about that. I want to reveal why therapy for BPD is actually becoming incredibly effective. So stay with us.

• 54:27Jemma Sbeg?

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• 55:10Jemma Sbeg?

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• 55:52Jemma Sbeg?

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• 56:33Jemma Sbeg?

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• 57:17Jemma Sbeg?

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• 57:45Jemma Sbeg?

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• 58:29Jemma Sbeg?

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• 59:05Jemma Sbeg?

  So let me throw some statistics at you here from the National Institute of Health from 2012. These results have been reaffirmed. Later on, I think in 2024, they did a follow up study. They found that this hasn't changed a whole lot. In the study, they wanted to see if someone with BPD was put into an appropriate treatment environment, how would they do and could they quote unquote recover? What they found was that 60% of borderline patients will achieve a recovery from borderline personality disorder if they go through treatment. That number, maybe even higher.

• 59:48Jemma Sbeg?

  There was one such intervention where there was a 99% remission rate, showing that of almost all of the mental health disorders out there, this one is actually. One that responds to treatment very well and how they, how they kind of categorize remission is a lack of of symptoms that create distress or cause problems socially, psychologically or physically. A lot of people will find that the older they get, the more symptoms will and can ease through getting therapy and through having good therapeutic approaches to what they're experiencing.

• 1:00:31Jemma Sbeg?

  The gold standard here is dialectical behavior therapy or DBT, which we mentioned earlier. I promised that we would come back to it and here we are. What makes DBT so effective is that it was designed specifically for what you might call an under controlled personality type. Now, before this therapy, people really couldn't figure out what to do with BPD patients. And then this amazing woman came along and and she invented this. And what she really realized was that people whose emotions are intense, whose emotions are quick to flare, hard to regulate, who are kind of maybe a little bit more socially abrasive at times.

• 1:01:15Jemma Sbeg?

  They need a different approach to therapy compared to the the traditional methods of doing it. And so the key thing about DBT is that it meets people with BPD where they're at. It doesn't try and force them to control or suppress their emotions or try to over explain them or reappraise them the way that maybe other therapies do. It actually asks for people to live within and with the emotions in a way that people talk about as being highly, highly effective. So it's built around four key skills or pillars. The first is mindfulness. Um, you might hear the word mindfulness and be like, oh, my God, can we not talk about that anymore?

• 1:01:58Jemma Sbeg?

  And I get it, like, I feel like mindfulness is this thing that gets thrown at any mental health problem. And it's like, well, have you tried mindfulness? Have you tried exercise? Have you tried this or that? And it's like, okay, I don't think sitting in a room and thinking about my thoughts for an hour or so is gonna help me. But really what it's about is being grounded in the present moment. And that's something that you can control. And it's also about observing feelings without judgment. This is a very hard skill to develop. A lot of the time, we will feel a feeling and we either put it in the good or the bad category. Now, if you're someone who has these very polarized emotions, as is the case with BPD, where that's an even more sharper contrast, being able to just respect an emotion

• 1:02:43Jemma Sbeg?

  and not force your way or push against it or try and force your way through it is incredibly helpful. Then there is distress tolerance, so supporting the individual so that they can survive a crisis without worsening a situation, learning how to cope with pain without acting impulsively. Then comes emotional regulation, identifying patterns, learning strategies to reduce our vulnerability to extreme emotional swings. Um, there's this one strategy I heard of that's like the zoo strategy, uh, so or the aquarium strategy, I can't remember what it's called. Either the aquarium or the zoo strategy and it's like watching your emotions like they're behind a glass window pane and you can stay there for as long as you want and you can watch

• 1:03:28Jemma Sbeg?

  how your emotions want you to react or where they're moving in your body and then you can just walk away when you're done observing and when you get bored of that emotion. And finally, there's interpersonal effectiveness, learning how to communicate needs clearly, set boundaries, maintain healthy relationships, not lash out, um, not immediately assume abandonment. That's something that a lot of people with BB, uh, with DBT have not always, sorry, with BPD, oh my God, so many Bs, Ts and Ds and Ps. That's something that people with BPD haven't always been taught. This is a really, really powerful therapy. I feel like I've said that a million times. One of its unique strengths is the emphasis on validation. So it really acknowledges the

• 1:04:13Jemma Sbeg?

  reality of someone's emotional pain and it's not sitting there and being like, it's not asking someone to change overnight, it's not asking someone to not have these feelings, it's just asking for them to. Interact with them in a different way, in a way that's actually maybe not going to work for everyone, but for people with BPD, it really does. Another approach, another evidence-based approach, I should say, is structured clinical management, or SCM. This was developed in the UK. As you can imagine, DBT, incredibly time-intensive, incredibly expensive. And basically, they wanted a more generalist alternative to such a therapy. Research has shown SCM is that effective alternative.

• 1:04:57Jemma Sbeg?

  At its core, this is about structure, consistency, and support. As we've heard today, many people with BPD experience chaos in their relationships and in their daily lives. So, having a reliable professional who provides clear expectations, who is there as a consistent contact, who can literally just provide you with practical guidance, can be profoundly stabilizing. It's like having a buddy. It offers really regular, reliable support, psychoeducation, and basically someone who is like a sounding board when your emotions are making your thoughts very loud, or making it, making you think that a certain reaction is appropriate when it just might not be. Really, what this provides is predictability.

• 1:05:42Jemma Sbeg?

  For people whose early environments were unpredictable or invalidating, simply having like a clinician or a trusted individual who consistently listens, who provides guidance, who doesn't withdraw in moments of crisis, can be, just like the, can be it. That's can be the thing that you need. It's incredibly affirming. Although like the skills these kinds of treatments teach are so valuable, it's really about how they can start to create that consistency for themselves and how they can basically learn in a non-avoidant way that someone leaving them, someone being mad at them, a relationship not working.

• 1:06:25Jemma Sbeg?

  Is not the end of the world. They can trust in themselves to survive. Again, the prognosis is really, really good. And that's what makes it hard to hear about the high rate of distress and the high suicide rates and the high self harm rates to do with BPD. Because it is so misunderstood, because people don't get a label, because they perhaps don't know this information. There is this whole like suffer in silence. If I talk about it, someone's going to immediately characterize me as this kind of person. This is just something I have to get over kind of mentality. And I hope this episode is kind of lessened that for someone a little bit.

• 1:07:07Jemma Sbeg?

  So they understand that actually um with the right people, there won't be stigma and you it's really like building a skill. You put the time in, you put the effort in, you can experience a different way of relating to people that you really want to love and be close to and of relating to yourself. What looks like chaos for a lot of people in these situations is usually just pain. What looks like manipulation is usually just desperation. And what looks like hopelessness is in reality, like something that you can help yourself with. Like there is, there are so many stories of change and transformation in this space. I will say, if you are a romantic partner of someone with BPD,

• 1:07:51Jemma Sbeg?

  maybe that's why you're listening and I'm sure you can understand all this. You can have empathy and compassion for this person and still realize you may not want to be with them. I've kind of circled this matter cautiously throughout this episode. Abandonment is such a big issue for people with BPD. But something I've always believed is that no one is owed a relationship just because of what they're enduring or going through. And you aren't obligated to stay with someone when things are dysfunctional and when they haven't perhaps gotten the help that they need yet and it is available to them. Even if they have limited control over this reaction, it doesn't mean that you have to be there to bear the brunt of it. You know, this is what we define as a personality disorder

• 1:08:33Jemma Sbeg?

  after all. And regardless of all the really positive statistics we have about remission, maybe at the end of the day, your personalities just don't align and the condition is just part of that. They might just need to find their person the same way that we all do. So if you are also listening to this thinking, how do I manage this incredibly emotionally complex relationship with someone who's afraid of being abandoned, but I don't want to be with them anymore, approach it with a lot of kindness, see if you can maybe get them some help. Um, maybe this isn't the right time, maybe they do need to get treatment and know that the reaction they have is not always a reflection of you and that you are allowed to make the best

• 1:09:18Jemma Sbeg?

  choice in your situation. You know, this is a very complicated condition that's confusing, even for those who have been experiencing it and living it for decades. So I just want to say, um, there are still a lot of things we don't understand about this. Perhaps there will one day be a whole manual and guidebook for navigating this kind of like maze that is operating in the mind of everybody, but specifically the maze in the mind of people with BPD. But until then, I think it's just good to have empathy for the things that we don't understand and the things that we don't know. And empathy for you, if you're experiencing BPD, for living in a brain that is probably very different to everyone else's. And I can imagine it's kind of confusing

• 1:10:00Jemma Sbeg?

  sometimes to really want to be able to respond or behave in the way that others are and just not knowing how. So I'm sending you a lot of love. I hope that this has been informative. I hope that you've gotten a good introduction. Um, yeah, and that things change for you if you want them to, and that you find some kind of hope at the, at the end of the tunnel. Thank you again for listening. If you have made it this far, leave a little emoji down below. What am I going to do my emoji of, guys? I always get this far and I, and I forget. Maybe like a little star. I don't know. I'm feeling, I'm feeling a star emoji today. So I know that you've made it this far. I want to thank our researcher Libby Colbert for her contributions to this episode. As a reminder, there will be resources down below.

• 1:10:46Jemma Sbeg?

  I highly advise that you go and check them out if this episode resonated with you and if you want to learn more, or if you just need some additional help. Make sure you're following us on Instagram at that psychology podcast. I almost forgot my own Instagram handle. That's embarrassing. And that you are following along on Apple, Spotify, iHeartRadio, Tidal, wherever you are listening. Um, and give us a five star review if you related or felt seen by this episode. Until next time, stay safe, be kind, be gentle with yourself and we will talk very, very soon.

• 1:11:23Jemma Sbeg?

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• 1:12:07Jemma Sbeg?

  And this product is perfect for that. I also find that Moisture Surge is a great lightweight base. If you like something under your makeup, it makes your skin look so plump and soft. Especially first thing in the morning when it's maybe not looking that way. Basically, I think it feels exactly like how you want a moisturizer to feel. Fresh, lightweight and deeply hydrating. Try Clinique Moisture Surge 100 Hour today at clinique.com. Feels like moisture surge.

• 1:12:38Jemma Sbeg?

  Sponsored by ADT. It's that glorious time of year again. We're back to school, we're back to work, we're back to our routines. ADT wants to help you get back to home. Enjoying the little moments with your friends and your family is a lot easier when you have one less thing on your plate. With their customizable systems that can be professionally installed, ADT has your home security covered. The ADT Plus app lets you access your whole system from your phone, so you can arm, disarm, even check live camera feeds, so you always feel safe and secure. Their technology enables first responders to locate you faster in an emergency, so you have one less thing to worry about.

• 1:13:19Jemma Sbeg?

  And you can spend all that time making memories with your loved ones instead, whilst ADT protects your home. Visit ADT.com or call 1-800-ADT-ASAP. When every second counts, count on ADT. No two journeys look alike. That's why Sky Miles is designed to move with you wherever life takes you. Fly. It flies with you on new adventures, family getaways, business trips, and the moments that matter most. Earn. It earns alongside your everyday life. It dines with you on special nights out. It streams alongside your favorite entertainment, rides through your daily routines, and helps turn everyday moments into something more. Redeem. It helps you redeem for what's next.

• 1:14:01Jemma Sbeg?

  From spontaneous weekend escapes to the trip that you have been dreaming about, to upgrading your next trip to a premium cabin experience, the miles you've earned along the way can help take you further. Access. And it unlocks access to exclusive, one-of-a-kind experiences and opportunities that make membership feel rewarding long before takeoff and long after landing. Because Sky Miles is more than a travel program, it is a membership that moves with you. Fly farther. Earn every day. Redeem your way and access more. Because when your membership is as unique as you are, there's no telling where your next journey will take you. Something that really frustrates me is when wellness brands greenwash their products

• 1:14:46Jemma Sbeg?

  to make them seem more clean or better for the environment when they are actually not. When you look into it, they are kind of just like the rest of them. Nature Sunshine, however, doesn't just talk about the planet. They do something about it. They sustainably source ingredients. They craft their supplements with 100% solar powered manufacturing and their products are incredible. I don't drink coffee and so Nature Sunshine Brain Edge gives me that kick I sometimes need with potent ingredients combining yerba mate with nootropics, adaptogens, botanicals to support mental clarity and focus. And you already know how much I love their marine glow and have for years. It is the only collagen that combines skin supporting marine collagen with the sun and

• 1:15:31Jemma Sbeg?

  blue light protection of luton to make your skin feel and look glowy and protected. Plus, I just really like that they have nature at the core of everything that they do. Try Nature Sunshine and experience the difference with supplements that are better for you and the planet. Go to naturessunshine.com today and use the code PSYCH for 20% off your first order plus free shipping. That's code PSYCH for 20% off your first order at nature sunshine.com.

• 1:16:02Jemma Sbeg?

  You know that feeling when your skin just needs a tall drink of water? That's what Clinique Moisture Surge 100 Hour Moisturizer is for. Moisture Surge 100 Hour Moisturizer absorbs instantly and hydrates for 100 hours for plump glowing skin. That's right, 100 hours. It is a lightweight, oil-free gel cream, safe for sensitive skin. It's allergy tested and fragrance free. I use this all the time. It makes my skin feel so fresh and plump and glowy. Even under makeup, I still see an amazing difference. It never leaves my skin oily or tacky.

• 1:16:43Jemma Sbeg?

  Try Clinique Moisture Surge 100 Hour today at clinique.com. Feels like Moisture Surge.

• 1:16:51Jemma Sbeg?

  This episode is sponsored by Gymshark. Gymshark has spent over 14 years obsessing over gym clothing and the people who wear it. And let me just say, I think we all know they are very, very good at what they do. No, seriously, their stuff is so good. Their everyday seamless collection is light, it's soft, it's stretchy. All of their stuff just looks good on and it's made for people who love to exercise, whatever exercise that is, lifting, cardio, Pilates, running around campus, maybe just doing errands. Discover Gymshark and find your new favourite gym clothing at gymshark.com.

• 1:17:28Jemma Sbeg?

  I've been really trying to prioritise my health in a realistic way this year and something that has kept me really motivated is my Whoop. I am such a data person, which is why I love Whoop, because I can genuinely see why my body feels differently depending on the day, why I'm running differently, why I'm maybe less focused. Whoop effortlessly tracks my sleep, it tracks my strain, my recovery, my stress, and most importantly, my overall health. And it just gives me all that data and all those patterns so I can make better decisions, which includes knowing when to go easy and knowing when to go hard. New members can try Whoop with a 30-day free trial before committing to a membership. That's join.whoop.com/psychology for your free month of Whoop.

• 1:18:13Jemma Sbeg?

  Hi, this is Jemma Sbeg. Taking care of yourself doesn't have to mean completely changing your routine. Naturewise Vitamin D3 is an easy way to support immune, bone and muscle health every single day. And because quality matters, Naturewise has one of the first NSF certified Vitamin D3 currently on the market. Plus, it's non-GMO, gluten-free and third-party tested. Visit naturewise.com to explore their Vitamin D3 options and find the one that's right for you. naturewise.com. This is an iHeart Podcast. Guaranteed Human.