Ep 145: Borderline Personality Disorder with Dr. Jerold Kreisman

What is borderline personality disorder and what causes it? How does it affect familial and romantic relationships? What does treatment look like? What can people with loved ones who have BPD do?

On this week’s episode Effy and Jacqueline take on one of the most elusive mental health struggles that predominantly show up in the relational context with the help of psychiatrist and the author of I Hate You, Don't Leave Me: Understanding the Borderline Personality and Sometimes I Act Crazy: Living with Borderline Personality Disorder Dr. Jerold Kreisman. They discuss the characteristics of this disorder, how it impacts relationships and strategies for those who have loved ones with BPD.

To learn more about Jerald
Dr. Kreisman graduated from Cornell University Medical College and concluded residency in psychiatry at The National Institute of Mental Health in Washington, D.C., and at St. Louis University.

He is board certified in Psychiatry and is an Associate Clinical Professor in the Department of Psychiatry at St. Louis University. He is past president of the Missouri Psychiatric Association and has been designated a Distinguished Life Fellow of the American Psychiatric Association. 

Dr. Kreisman has lectured widely in both this country and abroad, and has appeared on many media programs, including The Oprah Winfrey and Sally Jesse Raphael Shows.

He has been listed in “Top Doctors,” “Best Doctors in America,” and “Patients’ Choice Doctors.”

He is the author of:
I Hate You, Don't Leave Me: Understanding the Borderline Personality
Sometimes I Act Crazy: Living with Borderline Personality Disorder
Talking to a Loved One with Borderline Personality Disorder

Connect with us on IG and more:
Curious Fox @wearecuriousfoxes
Effy Blue @coacheffyblue
Jacqueline Misla @jacquelinemisla

Email us: listening@wearecuriousfoxes.com
Join the conversation: fb.com/WeAreCuriousFoxes

TRANSCRIPT:

Dr. Jerold Kreisman

You know, if you understand what their background or what they're going through, it becomes understandable. It's, it's all it's their way of trying to exist in the world. It's very confusing.

Effy

Welcome to the curious Fox podcast for those challenging the status quo in love, sex, and relationships. My name is Effy Blue.

Unknown Speaker

And I'm Jacqueline Misla. And today we're talking about borderline personality disorder or BBT, and the ways in which this condition impacts individuals and relationships.

Effy

On this podcast, we've taken deep dives into conversations about mental health, trauma and attachment because these have direct impact on our relationship with ourselves and others, with so many labels and diagnoses pointing apparently in different directions, but sounding very similar when you take a closer look at them. We are curious to explore the Venn diagram between these conditions such as ADHD, anxiety, bipolar, depression, disorganized attachment, narcissism and so on, and their impact on our connections. Today, we wanted to understand borderline personality disorder. So we reached out to the person who wrote one of the best selling books on the subject.

Dr. Jerold Kreisman

I injeel Kreisman, a psychiatrist in St. Louis. I've had particular interest in a number of areas, particularly in personality disorders, especially borderline personality disorder, where I've written a number of books and articles.

Dr. Jerold Kreisman

When we think about BPD, we likely think about instability, unstable moods, unstable emotions, unstable behaviors, but they're actually nine traits that characterize BPD fear of abandonment, unstable relationships, unclear or shifting self image, impulsive and self destructive behaviors, self harm, extreme emotional swings, chronic feelings of emptiness, and explosive anger.

Effy

As you can imagine, this difficult and destructive tornado of emotions, perceptions and behaviors have a significant impact on the familial and romantic relationships. In our conversation with Dr. Kreisman. We wanted to understand more about the disorder, the effect it has on relationships, and the way in which individuals and the people who love them

Jacqueline

can seek help. Dr. Kreisman is a board certified psychiatrist and associate clinical professor at St. Louis University, and has been designated a distinguished life fellow of the American Psychiatric Association. He is the author of I hate you don't leave me understanding the borderline personality. Sometimes I act crazy living with borderline personality disorder, and talking to a loved one with borderline personality disorder.

Effy

We started our conversation with Dr. Kreisman by asking what exactly is borderline personality disorder and what causes it.

Dr. Jerold Kreisman

Borderline Personality Disorder is one of the 10 defined personality disorders that are is accepted in the DSM that's the Diagnostic and Statistical Manual that is mostly accepted in this country and variations around the world. And it's a disorder that is characterized by significant mood changes that are environmentally induced impulsivity, tremendous struggles with relationships, the impulsivity is usually destructive. The there's a concerns about abandonment, like all of the really most medical disorders altogether, it's defined by a number of criteria. In the situation of borderline personality, there are nine defining criteria. And in order to endorse that as a diagnosis, one has to have five or more of those defining characteristics. And they include the things that I've mentioned, particularly the difficulties with with boots and impulsiveness, anger, relationship issues, self destructive behaviors, and sometimes suicidal feelings. In particular, it's it's characterized by a tendency to undergo what's called splitting a person with BPD tends to see the world in extremes of black or white right or wrong, good or bad, one or the other. Such that a person is wonderful, and his love beyond reason, but maybe rough While without any limits with in the next minute depending on on how they're

Effy

affected, and then do we know what causes it,

Dr. Jerold Kreisman

it appears to be a combination of nurture nature. We do know there are some genetic predispositions in which a person might be vulnerable. Many people, in fact, most people with borderline personality disorder, have a history of trauma and childhood, or sometimes abuse, neglect, sometimes pretty terrible. And we also know that it's twin studies, when you have twins, identical twins that are separated at birth, there's a higher prevalence to for both to have borderline personality, even though they have different environments. We also know that first and second degree relatives of people with a diagnosis of BPD have a higher tendency to also have BPD. So it seems there are some genetic connections, probably it's a 5050 kind of thing. And then, depending on the exposure in one's environment, and what one's background is, that may unleash the characteristics.

Effy

And are the characteristics kind of what age is kind of onset, like what age? Are you seeing the these characteristics? Or are they sort of later on in life? Do they show up in specific situations, are they triggered by relationships particularly or just going about your day,

Dr. Jerold Kreisman

will usually, one begins to observe borderline characteristics in adolescence and in the early 20s. There's a difference between normal adolescence and borderline adolescents, some people feel

Unknown Speaker

even 11 year old and some of what you described, happens in my household just because of you read it. Yeah,

Dr. Jerold Kreisman

I believe the phrase borderline adolescent may be out redundancy. But there is a difference. And the difference is a normal adolescent, gets mad yells at his parents and slams the door, a borderline adolescent, pulls the plugs out of a wall, throws dishes in the kitchen, storms out of the room and goes find some drugs. One of the other characteristics, of course that comes up is they have a facility to become almost chameleon like, because part of the problem with with this, and this is a part of the problems in adolescence and early growth is developing a sense of identity. And for some of BPD, there is not an established identity, they sort of change depending on where they are, who they're with their, their Republican when they're with Republicans or Democrats when they're with the Democrats. But when it's two o'clock in the morning, and they're by themselves, they're not really sure who they are, what they are sort of become sort of a zealot character, like from the old Woody Allen film. So they develop there. And as time goes on, some of the anger outbursts that are characterized some of the difficulties establishing identity, some of the difficulties in relationships sometimes mature out so that over the decades, many people with a diagnosis of BPD that is flagrant, and HC 20 or 25. By the time it's 35, May these characteristics have mellowed down. And by the time they're 45, or even 55, they may no longer fulfill that five of the nine criteria. So technically, they would no longer satisfy that diagnosis as they age for many people. Interesting. Why is that the case? I think it's a either a burning out or a maturing kind of thing. People with BPD when they're young and the impulses are really severe will do this destructive behavior. Cutting is a common thing to see with people in borderline personality where they may cut on themselves. And some of them as they get older, they have a better control of that. They may become disaffected with the tendency to run out and be promiscuous, pick up somebody at a bar or turn to drugs as they get older, that they may establish themselves in ways that that that kind of destructiveness becomes less of an issue. And they may start to establish some sense of who they are with a if they're able to find a job if they're able to find a reliable partner. And so they can begin to monitor some of these things. And that happens with or even without therapy.

Unknown Speaker

You had referenced that there are some things in the environments that can trigger outbursts. Can you talk a little bit more about that?

Dr. Jerold Kreisman

It is usually an interaction with an individual or person for example, a man may be walking out the day of work and maybe get stopped at the door by his boss who praises him says he's doing a great job is going to give him a promotion and a raise and he feels wonderfully euphoric. And he walks into the garage, he walks to the garage and he finds He locked his keys in the car. And he starts beating his head against the wall saying I'm stupid, I'm hateful, I'm an idiot, I hate myself, it's that those kinds of just different situations can cause an extreme reaction, and it can whipsaw it from one to the other. And that particularly affects relationships. Because of the concerns of the insecurities in about abandonment, and relationships, someone with BPD may be constantly testing the relationship, sometimes putting the other person in a sort of damned if you do damned if you don't, kind of situation, it's a sort of question that one partner may see the other, something like, Which dress makes me look fatter? Either way, you're gonna get in trouble. And whatever you answer, it's gonna, it's going to tick off an outburst. If things are going wonderful. It's wonderful, but just one little screw up, Chad kind of just changed things, you're gonna leave me you don't love me anymore. This is never going to work.

Effy

I mean, it's fascinating. The whole structure of I find fascinating. And the thing that I'm curious about is, like, for example, with anxiety, or at least the way that I think about sort of personality disorders, and some of the mental health issues is the kind of they seem to have a narrow, like a background narrative that define them. So for something like anxiety, I feel like it's like the impending sense of doom, like feeling of an impending sense of doom, it's kind of defined anxiety, right? So I'm curious if there is a, like, a narrative that defines and summarizes the BPD experience? Is it like, I don't know who I am, like what you mentioned a minute ago, about like a 2am. When they're on their own, they don't know who they are. That is a really sad image for me like that, that got me like that. It sounds really painful for the person. And I'm just curious, what if there was like something that defines that the experience?

Dr. Jerold Kreisman

I think, when you look at the specific criteria, I haven't really enumerated each one specifically, but they're out there. One of those criteria is a sense of emptiness or boredom. And that goes along with the poor sense of identity, there is this and, and that in turn, connects to that desperate fear of abandonment, that my existence exists only in relationship to somebody else. I'm somebody stomping somebody's husband, somebody's employee, somebody something. And it's only in in trying to relate it to something else. So there is, as you said, an insight, sort of an existential anxiety of basically the question, basic question of who am I.

Unknown Speaker

And the irony of the fact that there there exists such a focus on relationships and identifying themselves via relationships, but then the behavior that can really damage relationships, and so there's a desperate need for connection, and then there's behavior that damages that connection, can you talk a little bit about the effect on relationships, you talked about this black and white way of doing thing of seeing things, and also damned if you do damned if you don't, or there are other ways in which having BPD impacts relationships, either familiar or romantic.

Dr. Jerold Kreisman

What you will hear all the time is everybody's first wife was a borderline. And it usually refers to the sense of this first relationship man or women starts off very attractive and very appealing and very, very praising. And then the demands Come on, and the testing comes on, even though it is felt that genetically. And in the general population, the TED, the prevalence of BPD, that is thought to be expressed in the world is about 5050 men or women. But 75% Of all people who are diagnosed with BPD are women. So why not? Why should that be? Well, I think there are a couple of reasons for First of all, in general, women have a more demanding role, particularly when it comes to identity in terms of, Am I a mother or my work? Or am I a spouse, when the school cause because the kids are sick, they call mom more than they call dad. And so the whole issues are more Women also tend to seek help more much more often than that as well. So I think there are reasons why there is this artificial kind of difference. I wonder if

Unknown Speaker

socially to there, there may be an expectation that men will lose their temper, and they'll say things they don't mean, but women are supposed to be kind and nurturing. And so if a man fits into the personality type of the nine criteria of BPD, we may just say, you know, he's just a mean guy. But if a woman does we say that's not characteristic, women are not supposed to act like that. And so then she may be called out in a different way.

Dr. Jerold Kreisman

That is exactly right. If you had a scenario where you had a person say, get in a fight with with their partner, go to bar drink a little too much, pick a fight and jump in the car and speed and get stopped by a cop. If it's a woman to burst into tears, and starts talking, the policeman will take her to emergency room and say she has borderline personality. If it's a man, he'll say he's a sociopath. He's an antisocial personality disorder, and they'll take him to jail. So there is I think, very much a social distinction because many of these, these characteristics that are defining such as anger, such as self destructiveness, are seen more, more typically a female kind of thing. For a male, it's more antisocial, he's doing it on purpose, as opposed to borderline personality, although they can seem very angry and can really cause a lot of upset in another person. You know, if you understand the what their background or what they're going through, it becomes understandable. It's it's all it's their way of trying to exist in the world. It's very confusing.

Effy

Yeah, I mean, I can just slipping into that like not not knowing who you are not having any control over your mood, swinging hard from one, like black to white, white, the bag, just those symptoms are alone that just confuse you and detach you from from reality as well.

Dr. Jerold Kreisman

Yes, and that is one of the other defining one of the nine criteria is in extreme areas of extreme stress. There can be short term, and intermittent and transient episodes of really losing touch with reality, usually a sense of depersonalization or feeling like things aren't real, sometimes really active hallucinations, hearing voices, or a sense of paranoia. The people are after me, usually end it for all once and for all, the world can look like an episode of significant psychotic illness like schizophrenia. The difference though, is once that stress is gone, and they've been able to get some rest and the stress is sort of settled down, it all dissipates?

Unknown Speaker

Is this something that you would be able to see if you were dating someone, you know, you made the joke of you know, the first spouse or the for the ex wife? But that means that during the dating period, imagine you didn't see anything, you didn't see any of those characteristics? And it wasn't until you got married? Is that the case? Or are folks ever able to mask it? Or is it that the relationship hasn't become turbulent enough, or there hasn't become enough problems in the household for the outburst to arise? Would you notice this while you're dating somebody?

Dr. Jerold Kreisman

Not necessarily. I mean, obviously, dating is a period of getting to know somebody, and individuals with BPD can be very sensitive, very intelligent, very empathic, very attractive in a lot of different different ways. You know, the steady, extreme and unrealistic stereotype of the borderline personality is the old movie from 30 years ago. So feel attraction to Glenn Close character is this lovely, attractive, powerful, interesting woman who when she senses she's being abandoned, you know, really goes off the deep, the deep end, and the classical relationship. That is, it begins to be the perfect relationship, but that ends up going asunder is the matching of the borderline woman and the narcissistic men. They just glom together, because the borderline woman who can be very attractive, and such as looking for someone who appears to be powerful, this is person who's never going to leave me, who's wonderful, who's always going to take care of me, and protect me from all the bad things that have happened in my life. The narcissistic man finds a woman who praises Him, who reinforces all of his need for constant idealization. And so that it's perfect in the beginning. But then once things start to get too much, and the warmth begins to feel to control, and begins to rebel against it, and the man begins to start finding that he isn't always going to get praised, and she starts picking away and then things really blow up.

Effy

Yeah, we were actually talking about this prior to this, this conversation, like how do people with borderline end up in relationships in the first place when when they can show up so explosive? And I think one of the things we're talking about is that I don't think that people was full blown BPD end up with sort of healthy regulated, you know, non trauma, thriving people, I think they do end up with people who are also struggling in their own way. Right.

Dr. Jerold Kreisman

Well, I think certainly in the beginning, often that's the case. I mean that all the time. I mean, I think sometimes because people with borderline personality can be very appealing, and intriguing and interesting, and certainly can be can attract a lot of people that if they do attract someone who is healthy and can persevere and can begin to understand the situation. And if and if the the the individual with borderline personality can also begin to recognize what's going on, and possibly get help with it, that things can certainly work out. But it can be a turbulent time for a while. That's certainly true.

Unknown Speaker

Yeah,

Unknown Speaker

I imagine, and particularly to if you have, we're talking about in partnerships, but if a parent has borderline, I can imagine how challenging that is to for a child who's trying to understand and navigate the world and their own emotions and their own identity, and are looking to their caregivers to role model that how challenging that has to be to be able to witness that and how confusing that must be.

Dr. Jerold Kreisman

Well, it's very true and oftentimes borderline mothers have borderline children because one of the issues that seems to be associated frequently in the childhood of people who develop borderline personality is a mothering process that is extreme is extreme one way or the other, a mothering process that is, for example, so insecure that she won't allow that she holds the child so close, that he's unable to separate at all, or at the opposite, and one who is so involved in her own stuff, or his own stuff that if it's a fathering figure, that pushes the child away and is unable to allow any kind of rapprochement and connection there. So that kind of mother child interaction tends to end up predicting a lot of borderline issues.

Effy

We recently spoke to Julie manana about disorganized attachment style. And when I hear you talk about borderline, I'm definitely hearing some parallels. Can you speak to a little bit more if those things are the coexists? Or are they the same thing? Does one exists in the other? Can you speak a little bit about what the attachment style model fits into the borderline personality disorder?

Dr. Jerold Kreisman

Why I think as I was saying, the ideal paradigm of childhood is an attachment that also a lot that also encourages and individuation phase, that a period when the child starts to crawl starts to walk, there's encouragement to wander off, but also encouragement to come back and get a hug. Whenever Whenever you need to. And developing an attachment that's a healthy attachment. And when that's disrupted for a lot of reasons, because of some of the things we've already talked about, or some form of not just neglect, but even abuse, where trust is hindered. Where there's physical abuse, or sexual abuse, which is common with with people with BPD. Attachment is always fraught with distrust, and confusion. So that it's hard to make links and couplings that feel healthy.

Effy

So am I right, in understanding that people with borderline personality disorder tend to have disorganized attachment style? But But is it the other way around? Also, if you have a disorganized attachment style? are you likely to also have borderline personality disorder? Are they interchangeable?

Dr. Jerold Kreisman

Well, not interchangeable, but it certainly could work both ways. Yes. Okay.

Unknown Speaker

interested in why this is not discussed more often. You know, why?

Unknown Speaker

Why is it I think that there, there's a lot of different personality disorders that they're in conversation. And I think maybe people use BBT and talk about it in ways that to self diagnose or diagnose a partner or mean, boss. But why overall, do you think that there's some misinformation that exists about people or an ex wife? Yes,

Dr. Jerold Kreisman

exactly, or thanks? Yeah. I think one of the, one of the main reasons is there's tremendous stigma attached to BPD, along with, you know, the stereotypes. And it's kind of understandable, I guess, in ways because when you think about such people exhibit a lot of drama. I mean, just about any female in a Tennessee in any Tennessee Williams play has borderline characteristics. I mean, it makes for great drama. So it's in the movies, usually a woman but it can certainly can be a man, but usually it is a woman that's portrayed who's impulsive and dramatic and histrionic and usually in ways that are uncontrollable and difficult. So I think there's, there's tremendous stigma about it. And there's also been for many years of feeling that the prognosis was terrible, that there's nothing you can do. These are these are people who are just going to continue to be destructive. There's no treatment, there's nothing you can do, they'll never get better. And for a long time, that was the stereotype that was associated with it. Now we know that's not true. We know that over time. 90% or more, will significantly improve over long periods of time. I mean, 10 plus years, or shorter depending on a situation but the vast majority get significantly better. And that wasn't understood until really more recently.

Effy

I feel like borderline in general is not understood? Well, I think that's probably why it's not. So, you know, for example, with things like depression and anxiety and narcissism, I feel like they those terminologies are popularized, and sometimes mistakenly used for, you know, people, when they're sad, they'll say, I'm depressed when they're worried, they'll say I'm anxious in or I have anxiety, or, you know, if their partner is selfish, you know, they say they're narcissistic. So a lot of these sort of diagnostic terminology has been popularized, but I don't I don't hear BPD as like, as sort of like, thrown down card is like, yes, it is. But it's not as much as the others. And my guess is that it's just generally widely not understood well, and then it's just stigmatized, like you mentioned.

Dr. Jerold Kreisman

I think that's true. I think, as people understand more about human behavior, there's a greater acceptance, I think, nowadays, compared to maybe 80 years ago, the idea of Oh, depression, yeah, that's a disorder. It isn't like, pull yourself up by the bootstraps and quit feeling sorry for yourself, like would have been the feeling of 100 years ago, and 50 years ago, someone with a substance abuse problem says, for God's sakes, just stop drinking. What's the problem? It's not a big deal, instead of recognizing this as addiction as an illness, and I think more recently, it's been with obesity, you know, just stop eating, you know, that's, that's all you have to do. You're overweight and just exercise and eat more, it'll be fine. Not understanding that's a disorder. I think, all those things become a little more accepted over time as people understand it better. And there isn't the same understanding about borderline personality, it's still more of a sense of sort of swept the a couple of times and shape up and quit act that up like, like,

Unknown Speaker

calm down. Yeah. Yeah. Can you talk a little bit about the treatment that that folks can seek out?

Dr. Jerold Kreisman

Yes, there is. Unlike the cheese and the farmer in the dell, borderline personality rarely stands alone, there's usually an accompanying disorders. So most people with borderline personality also usually have symptoms of depression, anxiety, many eating disorders, substance abuse problems. So there are medical treatments for those kinds of symptoms. And even when there isn't depression, some of the antidepressants help in terms of stabilizing some of the impulsivity. And other medicines sometimes are helpful, although there is no specific treatment. But other medicines additionally, such as mood stabilizers and anti psychotic medicines, usually in very small doses can kind of help even things out. But the primary treatment for BPD is forms of therapy. And that was the other concern until maybe 20 years ago, there really wasn't any organized treatment program. And now there are several that have been shown to be really helpful. Probably the one that's most commonly referred to is dialectical behavioral treatment. DBT, which is a behavioral treatments, sort of tries to teach skills, how to handle things. Another one that's been shown to be really useful is mentalization based treatment, which has to do with trying to mentalize about why they're feeling what they're feeling, as well as trying to understand more with the other person in the environment at the time, what their reactions are trying to mentalize trying to think about. Another accepted form is transference focused therapy, that has to do with which is more of a psychoanalytic procedure, where the relationships are focused on and it starts with the relationship with the therapist, himself or herself, and how that extends to other kinds of relationships, or schema focus therapy, all of these have been shown to be really helpful, but there isn't one size fits all, you really have to individualize some people do much better with a behavioral kind of system. So something like DBT would be really good, others would do better with more of a psychoanalytic type program. And so it becomes a matter of finding what kind of therapy treatment would be best for the individual.

Effy

What about the environment? So and I would say environment and also the type of relationships that maybe people with BBT might find easier than the not so for example, on the show, we talk a lot about monogamy and non monogamy or kind of as relationship options. Do you have any idea of sort of what kind of relationships what kind of environments that can support that that treatment versus what can maybe triggered or exacerbated

Dr. Jerold Kreisman

because there is constant questioning of oneself and such a there is a tendency to have to kind of be traveling around a lot to be uncertain about relationships. So there often is a history of promiscuity, there's a history of even gender confusion in terms of still trying to figure out who they are sexually as well as socially, after a period of time, ideally, there begins if there can find some consistency, then some something can can develop. But that can take that can take a period of time. So that often it takes a while to develop some more consistent and reliable relationships with reliable people. Sometimes, the choices of people are poor, either because they're looking for persons looking more for adventure, or maybe they're even looking to be self destructive. So they, they're purposely going after people that they know are harmful. And that's something you see a lot too is, you know, again, the stereotype of the woman who keeps going back to her partner who keeps beating her and keeps abusing her. But I love you know, you keep going back and you keep getting beaten up, like eat like it's gotten to, like, it's not gonna happen again. It's kind of hard to find something's consistent like that.

Effy

Yeah, it sounds rough. It sounds like a rough ride. I'm not gonna, I'm not gonna I'm not gonna lie.

Unknown Speaker

Yeah. And also, it sounds like the there's a journey towards getting better. Because to your point, like, imagine you have to work with someone and figure out, is it bipolar? Is it depression? Is it borderline personality? Is it? Is it this? Is it that that there's so many kind of what sounds like, is it adolescence? Right? There's some overlapping things that you really need to start peeling apart and figuring out what particular treatment is going to work? Is it important to be able to nail down, for example, if it's borderline personality is important for that diagnosis to be determined? Or if someone is, for example, misdiagnosed with bipolar and depression and anxiety or something else? Will those treatments still support someone who really does have borderline? Or is it really important to be able to find what exactly is the cause?

Dr. Jerold Kreisman

I think it is really important to try to distinguish because what happens is, one disorder can camouflage the other. I mean, if someone with borderline personality also has an eating disorder, they're gonna go to an eating disorder unit, usually, and they're going to focus on that. And they may get frustrated, because the person doesn't seem to be responding the way that most people do. And, and that's usually a sign that things are more complicated. treating somebody who whose chief complaint is, is depression, and doesn't seem to respond still seems acting out. And then the doctor has gone through all sorts of antidepressants and things and they don't seem to be getting better. That often suggests they're missing something, because the other disorder is camouflaging, that there's a personality disorder here, too. And if you don't address it, you don't start saying, you know, we've got to start looking at this stuff to it isn't just going to be in a depressants, and, and getting better rest and some of the usual kinds of approaches, we have to look at what's going on character illogically to, and that often gets covered up, oftentimes, when there is a failure to improve the way that one expects you to begin to start thinking about there's something underlying here as well, that we haven't seen yet.

Effy

I have one quick question about the diagnosis. Is something like borderline on a spectrum? Or is it an on off thing? So I know, for example, something like bipolar it's like, on or off, right? You either have it and you're having manikin and depressive episodes, but something like, you know, I know, something like anxiety is somewhat on a spectrum, right? Some people have really severe anxiety, and some people have it less severe. Is it like that with borderline? Or are you just like you have borderline and your full blown experience at all times?

Dr. Jerold Kreisman

Well, the way we define these disorders is in a categorical way, there's so many spectrums, if you have those symptoms, you got it, if you lose one of the one, you ain't got that sense, it's really artificial, but realistically, is on a dimensional water level. And actually, the DSM, the way we define it is starting to evolve to more and we currently are in DSM five, I'm sure the DSM six is going to begin defining it different because there is as all things there really is a spectrum along the line of some people function at a more primitive level, much more than others. And I think, you know, when when does depression, not be grief, not be quite what it is. So there, so there really realistically there really are degrees of these disorders, and of course, bipolar disorder, you have periods of mania, you have periods of depression, and they have periods where it's neither one of one of the distinctions between bipolar and borderline is At borderline, you're always whipsaw back and forth there. There usually is one or the other. And it's going from one to the other as opposed to these periods of sort of quiescence.

Effy

Okay. All right. Okay. So what about people with loved loved ones who have BPD? Either family, parents, or they find themselves in a relationship? You know, it started great. And, you know, a few months in, they're now discovering the other person is struggling for BPD? What can they do? Is it like just, you know, Exit Through The Gift Shop? Or if you can, you can't really do that with no with well with family? Or what can they do to one be, well, them to stay while themselves and to try to support the relationship?

Dr. Jerold Kreisman

Well, the kinds of things that really I described in my books, in terms of communication systems, I think, understanding that that's a disorder and persevering, you know, committing to sort of stay him is because they're always going to be tested, I know, you're gonna leave me I know, you're gonna leave, or you're gonna leave, and be able to kind of communicate that as important. But I think the communication system, at least what I found to be helpful that I described in more detail in the in the books, is being able to convey in communication, three primary areas, one of support, it's an if statement that says, I'm here, I care about you, I want to be with you an empathy statement that accepts that you're, you're suffering. And I understand that this is hard for you. And then a truth statement, that's what I call set. The true statement is just reality is we got to set some limits, you know, there's only so much I can do. And, and when you do this, there are there consequences. If you cut your wrists, I'm gonna take you to the hospital, I know, you don't want me to take you to the hospital. But it you know, it's again, it's a damned if you do and damned if he does, I got to do what is a result of your behavior. And so it's sort of balancing the carrot that the if statement that you statement, and the reality statements that will be tested over time,

Unknown Speaker

in your books, either. So the three of I hate you don't leave me sometimes i Crazy in talking to a loved one with borderline personality disorder, you via your books kind of share that journey of first understanding it and living with it, and then living with someone who has it. Are there areas that you feel like you want to continue to explore? Is there another book in the works, if you will? Are there pieces of the borderline personality, story and journey that you think are left to be explored?

Dr. Jerold Kreisman

I think what will be coming next? I don't know about more books. But I think what, what we're beginning to understand more is some of the neurology, the biology of it all and some of the interactions in the brain that seem to be associated with that. And if we can understand a little bit more about how the how the brain works, and and the connection between mind and brain, and the physiology as well as how that's impacted by what's going on in life. I think that's where the exciting areas are going to be. In all of medicine. Really.

Effy

Yeah, there's definitely more research that's done on trauma. And I think at the root of a lot of these personality disorders and mood disorders, there's trauma, and I think there's a lot of neurological biological research being done in kind of what happens to the brain, when experiences trauma, both developmentally or as an adult. Right. And I think a lot of new information is coming from that. And I imagine what you talked about at the beginning of this conversation, that borderline tends to happen, you know, half genetically and half environmentally, often around abuse or neglect and early years, which I assume it's kind of experienced as trauma. Right? And it feels like a lot of this is trauma, you know, in the context of, you know, personality disorders is person getting borderline trauma, in the context of attachment is disorganized trauma in the context of attention as ADHD, there seems to be these like correlations where you start with trauma, and depending on which area that you're, you're discussing, we just seem to give it different names. But at the root of it all, it just seems to be trauma, and especially developmental trauma. Does that sound right to you?

Dr. Jerold Kreisman

Yes, I think I think we're all all humans have have certain predispositions and vulnerabilities that may be expressed depending on where the environmental issues are, and they may be expressed as major depressive and they may be expressed as ulcers, it may be expressed as some autoimmune disease are inflammatory disease. So many disorders seem to be really autoimmune in that sense that there's always some sort of inflammatory problem that always frequently, there appears to be discovered. an inflammatory process in when the body isn't working the way it's supposed to. So yeah, I think this combination kinda is extant in all of functioning humans.

Effy

Sure, yeah. No, that makes sense. And I am super excited about this new research and what that tells us, and what are some of the things that we can do to heal from some of these traumas, and maybe even sort of, you know, figure out how we heal from these particular disorders as well. So it's super interesting.

Unknown Speaker

I appreciate the conversation today, I think, you know, I mean, certainly read the books, you give us some resources, but I think also via this dialogue, have been able to connect the dots between some of what people may be feeling and experiencing within their bodies, or within their relationships. And I think the biggest thing that I'm walking away with is I I came in with that assumption that you shared early on that myth of it is what it is, and there's not much that can be done and recognizing now that there are ways in which relationships and individuals can get better, I think is really helpful.

Unknown Speaker

Thank you much appreciation.

Effy

Thank you. Thank you so much for your time. And thank you so much for sharing your wisdom with us.

Dr. Jerold Kreisman

Why joy being with you.

Jacqueline

You can find Dr. Gerald crossman's books on borderline personality disorder on our reading list at we are curious foxes.com backslash reading list. On our website, you'll also be able to find blog posts and past episodes that can help you indulge your curiosity around love sex and relationships you can visit us at WWE are curious foxes.com If you want to weigh in on this topic, or connect with other foxy listeners, Head to facebook and join our Facebook group at we're curious foxes. If you found this episode to be interesting or helpful. Please share our podcasts with a friend quickly rate the show, leave a comment and subscribe on Apple podcast or follow us on Spotify or Stitcher to support the show. Join us on Patreon at we are curious boxes, where you can find mini episodes podcast extras that couldn't make it to the show, and over 50 videos from educator led workshops. And finally, let us know that you're listening by sharing a comment story or question. You can email us or send us a voice memo to listening at we are curious foxes.com

Effy

This episode is produced by Effy Blue and Jacqueline Misla. With help from Yağmur Erkişi. Our editor is Nina Pollock, whose personality is in perfect sync with ours. Our intro music is composed by Dev Sahar, we are so grateful for their work, and we're grateful to you for listening. As always, stay curious friends. Curious for Fox podcast is not and will never be the final word on any topic was solely aimed to encourage curiosity and provide a space for exploration through connection and story. We encourage you to listen with an open and curious mind and we look forward to your feedback. Stay curious friends. Stay curious, curious curious, curious. Stay curious.

Still Curios?