6 Signs of Borderline Personality Disorder | What is BPD?

Hey there, everybody, and welcome to this video where we try to answer the question, what is borderline personality? I'm your host, Dr. Donnellice Snipes. In this video, we're going to define borderline personality. We'll identify the risk factors for borderline personality and explore how the symptoms of borderline personality, or bpd, which is what I'll call it from, from here on out, makes sense from a trauma informed perspective. It's important to start out by recognizing what we call personality disorders are inflexible, pervasive ways of thinking and behaving that often develop in childhood. Well, when you develop something that long ago, of course it's going to be difficult to change. If you had a habit for 20 years, it's hard to change it. If you've had a behavior for 20 years, it's going to be hard to change it. And those behaviors were formed at a time when the individual tended to be thinking in more dichotomous terms. Piaget calls it concrete reasoning. So they did tend to be more inflexible. Children view things as right or wrong, all or nothing. So personality disorders, and I really hate that term. If you've watched my other videos, you know, I hate that term because the behaviors that are encompassed within each one of these diagnoses make sense. It is the way the child learned how to survive a chaotic, dysfunctional environment. When people are children or even young adolescents, during this time in a healthy, secure relationship, the child learns, among other things, that other people will be there to help and not hurt them. Erickson. Eric Erickson called this the trust versus mistrust stage. They also learn how to identify and manage their emotions and how to problem solve and modify their skills schema, or the way they anticipate and perceive situations. Erikson kind of referred to this as autonomy and initiative. And they also learned that they're lovable and capable. They are able to do things and succeed and they're able to try things. And if they fail, okay, they fail. They are still lovable. So these are all things that children learn from within a secure relationship. They require a secure attachment because that secure attachment figure provides the support and the encouragement and the safety for the child to grow and take chances and step outside of their comfort zone. The secure attachment helps the child learn how to identify their emotions and develop skills and tools to manage those emotions. People with BPD often still think very concretely. Their reasoning is based on what is being experienced in the present moment. They see something, it makes them feel anxious, therefore they interpret it as there must be a threat. So it's very present, focused. Instead of being able to tolerate that distress and step out into their wise mind and look and say, okay, you know, let's look at the big picture. They are very focused on what is going on right now. I'm going to make all my decisions based on the evidence right before me. This happens partly because this is how the child learned how to reason, but also because of the ongoing stress and trauma and drama in the child's chaotic life. They became what we call emotionally dysregulated. When they start to feel stress or threat, they go into overdrive. They go into extreme fight, flee, freeze, fawn, or forget about it mode. And when you're in that mode, when you're being flooded with those stress hormones, it is difficult, if not impossible, but it's definitely very difficult to see clearly everything that's going on and to think clearly. Your brain is trying to protect you. So people with bpd, when they start feeling that threat, they instantly go into threat evasion mode, if you want to call it that. And they see things as all good or all bad. And they may take things very personally. And because of that flood of emotions, because of that flood of stress chemicals, they have difficulty stepping back and quote, logically looking at it. They have difficulty getting into their wise mind, which is why a lot of the behaviors of somebody with BPD seem very impulsive, seem very extreme. Well, their life has been one of extremes. The trauma from their childhood led to brain changes that resulted in that emotional dysregulation. It is not just a thinking thing that they can automatically turn off when they experience threat because they're emotionally dysregulated, their brain sends a tsunami of stress hormones and chemicals and hyperactivates that threat response system. When they were a child, they were little, they were a lot more powerless. So they had to respond a lot more strongly, potentially to fight against the hungry lion, if you will. When the person's dysregulated, they're stuck in that default emotion focused responding mode and are unable to identify, evaluate and modify their schema. When they're stuck in that mode, like I said, they have difficulty seeing the big picture and getting in their way into their wise mind. So their not able to modify their mental shortcuts. When they were a child and somebody became boisterous and angry and loud, for example, they learned that when that happens, it's a dangerous situation. So that triggers their fight or flight response. In the present, when somebody gets angry and boisterous and loud, they may not actually be in danger. You know, people get angry. However, they are so drowned in the stress hormones that were triggered from their expectation based on the past that they can't recognize that this context is actually different. They're actually safe now. It's unpleasant, but they're safe now. So they can't modify that schema, they can't change the way what they're anticipating when they're in that dysregulated state. Said another way, their default mode or their autopilot is just on full bore and is not letting up. The executive control or the higher order reasoning part of their brain isn't able to turn off the autopilot. So they're sticking with responding and perceiving things the way they always have. For people with BPD to recover, one of the first things they need to do is to start releasing that trauma from their body, healing their HPA axis so when they experience threat, they don't automatically dysregulate and start functioning in fight or flight mode, start functioning in threat evasion. They're able to tolerate that distress, but that is a whole lot easier said than done when they're at that point that any stressor that is triggering triggers the tsunami. So when you're in the middle of a tsunami, it's hard to say, okay, you know, let's step back and think for a minute. So there it is, a process of helping the person develop a sense of safety and start to heal their HPA axis by reducing stress and getting healthier as they are moving toward developing other skills. When the person with BPD is not dysregulated, they're freaking exhausted. Dysregulation is like running a marathon or a really hard sprint if it doesn't last too terribly long. But then when it's over, they are exhausted emotionally, physically, spiritually. However, they're exhausted. They're panting mentally, if you will, but they're also hyper vigilant. They're looking around, waiting for the next threat because that's what their family of origin was like. They are waiting to see, okay, I'm vulnerable because I'm exhausted. Who's going to take advantage of it or who's going to get angry at me for the way I responded. So being hypervigilant takes energy, which further drains them and leaves them feeling exhausted and vulnerable and powerless. And then another stressor comes and you see how it's just this ongoing cacophony of stress and terror. People with BPD often feel like they're walking on a tightrope on the borderline between safe and unsafe. Well, think about when they were a child. When they were a child, things were either good, safe, calm, or all hell was breaking loose. It was chaos. There was no middle ground. There was no family meeting where people were going to have a stern discussion. It was either safe or unsafe. They walked that borderline between love and hate. Their caregivers often were emotionally unavailable, were struggling with their own mental health or addiction issues or anger management issues. So their caregivers were often only sporadically there. Well, to a child who personalizes everything, if they don't give me attention, if they don't want to spend time with me, they must hate me. If I do something wrong and they get angry, they must hate me. If I'm good and I fly under the radar, then they love me. But it's going back and forth between those two extremes. Same thing with acceptance and rejection in this family. They were either approved of and they did something right or they were a complete screw up. There was no middle ground. A lot of people with BPD have a certain set of core symptoms. Now, as with everything in mental health, there are a variety of symptoms and you don't need every symptom to meet the diagnosis. So not every person with BPD has all of the same symptoms. But let's just take a look at each one of the symptoms and figure out how does it make sense? The person with BPD often has unstable sense of self and chronic feelings of emptiness. They grew up in a household in which they were told to don't talk, don't trust, don't feel, fly under the radar, do as I say and maybe you'll be safe. So they weren't ever able to explore who am I? They were told to, you know, don't be heard and maybe even don't be seen. So they never figured out what they liked, what they were capable of. They didn't have a secure attachment to support them, so they felt safe stepping out of their comfort zone and trying new things to figure out what am I good at? They never had somebody to support them in exploring what they feel or care about. They never had someone to help them identify emotions. A lot of people with BPD struggle to really identify their emotions, if they can identify them at all. It's usually the big ones. Angry, sad, scared, maybe happy sometimes, love sometimes. But they have difficulty with the nuances like irritability, rage versus anger versus resentment versus jealousy. That all starts to get really muddy because they were never helped to define those things so they don't know what they feel about certain things. They may talk about their feelings in terms of bodily or somatic experiences. It makes me feel icky. It makes me feel tired. It makes me feel like giving up. Okay, that says helpless, that says hopeless. And they don't know who loves them. Our sense of self. We learn to love ourselves, but we also see learn what's good about ourselves in some respects from what other people love about us, especially our primary caregivers. In a secure attachment, the caregiver says, I love you for you. You may not be good at football, you may not be good at art, you may not be good at math. Whatever it is you're not good at, okay, you're not good at that thing, but I love you for you. And that helps the child start internalizing that they are a person that is worthy of love, irrespective of their weaknesses. Frantic efforts to avoid abandonment. And I mentioned this earlier, that people with BPD very often grew up in chaotic environments in which they felt unsafe and disempowered all the time, which is the hallmark of trauma. They grew up in a traumatizing environment, traumatized environment. Their caregivers may have been there physically all the time or may not, but they also were often not emotionally present. Their caregivers were so caught up in their own stuff that they couldn't be there for the child. They were so caught up in their own stuff, they couldn't be supportive and they ended up lashing out and being rejecting of the child. So now the child is terrified. As an adult, they grew up getting the message that they're not good enough, people are not going to stay around, nobody can be trusted. Did so of course there's going to be a fear of abandonment. And we are wired to not be alone. We have oxytocin, the bonding hormone, for a reason. People want to be loved. People who grew up in households in which there was chaos often still crave and cling to that hope that one day they're going to get into a relationship where they feel safe and secure. Now, not everybody, some go to the avoidant attachment side, but a lot of people with BPD have what we call anxious attachment. They so desperately want to feel safe, they so desperately want to feel loved that they are trying to find somebody to do that. They don't know who they are, so they can't be there for themselves. They can't tell themselves that, you know, I'm a good person. They rely on other people to say you know what, you're a good person. You deserve to breathe the air. So if these other people abandon them, then guess what? They don't have anybody telling them that they're okay. And that's terrifying because if they don't have that external reinforcement, then they feel like they're going to kind of disappear. They may have unstable, intense, dichotomous interpersonal relationships. It makes sense because emotionally they go from being flat, you know, having difficulty feeling much of anything to furious or frantic that it makes sense that their relationships are going to be the same way. If they feel loved, if they feel safe, then things are, things are okay. But they are going to do whatever they can in that relationship. If you help me feel loved, then I'm going to cling to that because I really desperately need that. I am parched and need that thirst quenched. However, if they start feeling like the other person is going to abandon them, then they go from 0 to 250 like that and may become very rageful and angry. And that anger is a response to threat. All of a sudden they felt threatened. They felt like what they'd always experienced was getting ready to happen again. So they went into threat evasion mode. They may have self, self damaging impulsivity and this can be in the form of non suicidal self injury or addictions. And I'm not going to go deep into detail on those things, but they make sense. The child and even the adult when they start feeling these overwhelming emotions that they can't hardly even label, let alone deal with because they are so incredibly intense and so incredibly powerful, it just feels like they're drowning in their own emotions. These behaviors may help the person numb or escape that tsunami and or may give the person a sense of control. I may not be able to control what's going on inside me and it's just agonizing to feel and to focus on. But if I can turn my attention to this out here, whether it's gambling or NSSI or something else, something that I think I can control, then that takes my mind. I don't have the energy, I don't have the need to focus or notice what's going on inside me. So it gives me some relief for the moment. They experience emotional dysregulation and inappropriately intense anger. We've talked about that one already, so I'm not going to spend a lot of time there. And transient stress related paranoid ideation. Well that is a really flowery way of saying when they get stressed they start feeling like people may be out to get them. Like people may not have their best interest at heart. Well, think about what they grew up with. Think about the environments they've been in. Think about how people have reacted to them because they haven't understood why this person goes from 0 to 250, why this person is so incredibly intense and extreme. Well, they start to notice these things in people and they start to expect the worst out of people. It makes sense. Once you understand what caused the behavior to develop, they make a lot more sense. Once you know the cause or the function of the behavior, then you can start identifying ways to address it. Mindfulness and self esteem are really important to start out with. Helping the person start to get in touch with what they're thinking, what they're feeling. Secure attachment with self and others. This goes along with self esteem. It's important for them to be able to connect with themselves and figure out what it is they like, what it is they're good at, and why they're lovable as individuals. And that is almost incomprehensible for a lot of people with BPD because they feel so incredibly unlovable. So this part takes time. It's not something you're going to do in a week or sometimes even in a month. It takes time. Once they develop a secure attachment, they are mindful of their thoughts, wants and needs and they respond appropriately to their thoughts, wants and needs in the moment. Then they can start working on secure attachments with others and starting to become accurately aware of other people's thoughts, wants and needs. And accurate is the key. I mean, they never learned how to be accurately aware of their own feelings. You wouldn't expect them to be accurately aware of others or know how to respond to that. So moving on to helping them develop secure attachments in the present and develop the ability to evaluate situations like anger in the present context and say, okay, this feels really awful. This is bringing up memories of the past. However, in this context, at this time, am I in danger? People with BPD need to develop distress tolerance and vulnerability prevention skills in order to start helping them heal their stress response system or their HPA axis in order to help them start connecting with their emotions instead of being afraid of them saying I don't want to feel or I can't tolerate that. Recognizing that, yeah, this is an unpleasant feeling, but it's not going to overwhelm me, it's not going to overcome me. Fact based problem solving and reasoning is so important. As a child growing up in a chaotic environment, they often learn to function and perceive the world from an emotion focused perspective. I feel scared, therefore there must be a threat. So I need to scan and try to figure out what the heck that threat is. Instead of saying I feel scared, let me check and see if there's a threat. So fact based problem solving helps them move from that emotion and recognize that emotion not as fact, but as a smoke alarm or a warning sign that there might be a problem and that they need to get up and figure out if there is. They need to work on stress management for HPA axis recovery. And I mean stress management in all of its permutations. Not just cognitive, not just taking a week off from work, I mean physical stress, lifestyle stress like drinking, smoking, poor sleep, bad health, anything that is causing stress on their body or their mind or their heart is stress and it's going to trigger that HPA axis or that threat response. So it's going to be important to start trying to whittle away all of those, as many of those stressors as possible in order to help the person recover. And I make the analogy that HPA access recovery is often like trying to catch your breath after a sprint by jogging. You know, after a sprint, I don't know about you, if I run really, really hard after that, I just want to stop and catch my breath and I recover a lot faster. If I do that, my heart rate goes way down real fast. But that's not always possible. And HPA access recovery is the same way. Most people can't say, hey, I think this is important. So I'm going to take three months off from life and go stay in a cabin or go on a cruise somewhere where, where I'm completely unplugged and I can rejuvenate. That sounds great, but who really has the time or money to do that? So you can't completely stop. You've got to keep going, you've got to maintain that jog. So recovery takes a little bit longer. It's not impossible, but it's important to help people recognize that it is a process. And as they strengthen their HPA axis recovery by reducing stress, they can also work on strengthening their vagal tone or the ability of their parasympathetic nervous system, their relaxation response to kick in and tell the default mode network or the autopilot, hey, I got this. We don't need to operate in fight or flee. We can start relaxing. Strengthening the vagal tone helps the person more effectively trigger the relaxation response even in the face of stress.