hi my lovelies today I am here as
promised with dr. Ron day dr. grande
specializes in personality disorders
trauma sexual trauma drug and alcohol
use just to name a few things now in my
video a week or so ago I asked you guys
if you had questions for him
and I got loads of questions so today
I'm here to ask him them my first
question for you someone's asked is it
typical for someone diagnosed with BPD
to alternate between finding some kind
of solace in the diagnosis and accepting
that you do meet the criteria etc to
being in total denial believing you
haven't really got a personality
disorder that's an excellent question so
I would say yes that's a fairly common
experience and I would say it's most
common with personality disorder as I
see it with sometimes a few other
disorders but if you think about the
nature of a personality disorder and
specifically the nature of a cluster B
personality sorter of which borderline
is is one of those there's an insight
component that's compromised it's an
insight deficit so somebody can be in
treatment they can be seeing a counselor
they can have the symptoms of borderline
and through that relationship they can
kind of believe at least in session that
they do meet the criteria and it looks
like they may have this disorder but the
way the disorder manifests because it's
a disorder of personality what I find is
that later on when clients are away from
the counselor and they're on their own
during the week they start thinking like
angry thoughts like no no that's I don't
have this diagnosis that counselors you
know making this up and my feelings are
real I know they're real and it becomes
like an emotional reasoning and then
when they go and see the counselor again
sometimes it goes back to oh yeah I
might have the diagnosis so it's a it's
actually I think one of the worst parts
of borderline and I think again have all
the cluster based antisocial histrionic
narcissistic is you can look at
objective Abbadon
but those emotions are so strong they
can convince you that you're the victim
and that you're being kind of conspired
against this a little bit of paranoia
so I actually look at that as a fairly
normal and reasonable consequence of
borderline I am I was in denial myself
for a long time with her thinking my
suppose it's with the black and white
thinking when people around me I was
thinking badly of them I would then
think oh yeah the problems not me it's
you you're the bad person because I'll
be thinking by my perception of them
would be different yeah I need to think
about the unstable relationship pattern
we see with borderline that has kind of
the same feel to it or somebody that's
the splitting you're talking about
that's the love Hey
so idealize somebody and then later on
maybe a few minutes later or a few days
later to drastically devalue that person
I mean so there's a lot of changing of
opinion yeah again it's it's it's rooted
and I think it's rooted the emotions and
probably that lack of insight yeah okay
the second question I have is oh well
actually I've meant to ask you this
first are you related to Arianna I you
know I saw that question on there and I
recognize that was probably some sort of
celebrity but I have no idea
yeah no no no relationship she's been in
the news recently Christian was dating
Pete Davidson and he has borderline
personality disorder and they got
engaged after a month and that
relationships all over now couple of
months later surprised yeah I guess I
guess being in Hollywood is a tough life
you know I don't I don't know but yeah I
think I don't know the origin of her
last name but the origin of my last name
is actually Italian so a lot of I don't
know if the origin of her last name is
like Hispanic or not but a lot of times
and you see grande you'd think Spanish
yeah in my case it's Italian okay
next question is it common that I have
almost zero BPD symptoms when isolated
and don't interact with people but when
I choose to or have to be around people
my BPD starts up again yes I would say
that I would say that is sometimes
common for some people with borderline
personality being isolated and being
alone is actually when the anger starts
to ramp up because they think about
interactions they had earlier but for
others they can engage in other types of
work and engage other content and
they're not thinking about those
relationships that are not seeing those
relationship behaviors play out in front
of them and if you look at the symptoms
of the disorder
they're very tied to relationships right
fear of abandonment unstable
relationship pattern even you could even
argue the identity disturbance
fluctuates based on who they're with
what kind of relationships they have so
yeah I think it makes perfect sense
the anger as well it's right people
right yeah it's usually not an anger
like a globalised anger you're right
it's more of a specific anger at the
behavior of other people yeah so in the
absence of people yeah I think the
symptoms could temporarily remit and
then they'd be reactivated when when
you're back with other people makes
sense okay my next question sorry I've
lost it
what helps people with BPD that hear
voices of people they know from their
past and present yeah okay well the one
of the tricky things with borderline
person is where and really all the
coaster base is that they are comorbid
with a number of other disorders and to
make it even more confusing
borderline personality order has a
symptom criteria that's actually symptom
criterion 9 which is paranoid ideation
or severe dissociation
and a lot of people who deal with the SM
wanna counselors are very critical of
that being one of the symptom criterion
because there's other disorders that
have really more of a focus on that like
the SOSI of a dinosaur yeah so what
you'd have to know to really answer that
question is does that individual have
only or line personality sorter and what
they're experiencing is really
dissociation and not really
hallucinations or delusions or do they
have a comorbid illness that could
better explain that experience and you
know of course I wouldn't know pretty
specific case but in general if you're
hearing voices if you're if you're in
voices other people can't hear or seeing
things that they can't see that's
usually not directly attributable to a
personality disorder we see a little bit
of that with like skits a tipple they
call it perceptual distortions but but
really that moves into the old axis one
classifications right so psychotic
disorder major depressive disorder
psychotic features gets a funny animal
something that that's more anchored with
hallucinations and that type of like in
delusions and those type of reality
testing elements okay yeah cuz I I
suffered with intrusive thoughts
paranoia catastrophizing which I suppose
could fall under their the only time I
had like psychotic episode where I was
hearing voices was actually only a few
weeks after having my first baby and so
I think for that it was down to that as
opposed to being anything to do with the
BPD right yeah cuz strictly if you if
you strictly look at personality
disorders they're just extreme levels of
personality that occurs in everybody I'm
technically I don't favor her the five
factor model but the big five traits
kind of explained personality in a
compact way and every personality
disorder can be put on that model it's
just with personality sorters the levels
are really pushed up or down right so
example with with borderline we
expect to see more neuroticism which is
one of the big five traits so that's you
know with that explanation it you
wouldn't really see room for
hallucinations or delusions directly in
personality okay my next question okay I
have quiet borderline and I really
really struggle with talking to my
partner about how I feel when I am upset
to the point that I am physically unable
to speak and this can last for awhile I
completely shut down dissociate and
sometimes I'm even unable to move is
there a word for this
I've heard of selective mutism but I
don't know what this is
yes selective mutism is a disorder in
the DSM we usually think of that
disorder as affecting children
it doesn't exclusively have to but it
would be unusual for that to carry into
adulthood again it can probably what's
more likely in a situation like that is
some other again co-occurring comorbid
disorder something that nature the
dissociative component indicated there I
could could be borderline or it could be
something else so it just becomes a
matter of you wouldn't really know
without a thorough assessment so in a
situation like that whether the
borderline was a quiet manifestation or
or an external izing I would say you
really have to see a counselor and have
them kind of sift through what disorders
are operating and you know what's
maintaining and triggering these
different symptoms okay do you think it
could be um like the fight flight or
freeze response where she's just
literally freezing up right it could be
fear right could be Norman had fear that
turns into extreme fear yeah because
there's a lot at stake so you could kind
of catalog that under like anxiety so it
could be like a panic attack or
something similar to a panic attack
yeah what's interesting about panic
attacks a lot of people don't know is
they're not a mental disorder so if
somebody has panic attacks that's all
they have there's no diagnosis available
panic attack is a specifier that you can
meaning it's a elements you can add to a
diagnosis
it's a specifier for every other
diagnosis except for panic disorder
because panic disorder is when somebody
has panic attacks because they're afraid
of panicking so somebody can have
borderline personality disorder with
panic attacks that's actually a
diagnosis so there's a lot of
possibilities when it comes to to not be
able to speak into being afraid and yeah
fear is definitely something it could be
operating there okay my next question
okay I'm not diagnosed with a
personality disorder yet but I'm going
to start an evaluation next month with a
psychologist the - I can relate to and
see I have a lot of symptoms of a BPD
and avpd with that said I was wondering
what counts as extreme mood swings is it
how often it happens or how extreme the
emotions are right so when we look at
symptoms and we try to catalog how
damaging or painful or harmful they are
we usually think of three terms severity
frequency and duration and really any
one of those properties taken to an
extreme could result in a symptom being
catalogued so somebody frequently had
mood swings that that could do it if the
duration was a long time so if the mood
swings kept going for hours and hours
and of course if they were intense
usually though it's a combination and
the truth is it's quite subjective right
so if somebody has mood swings and they
go and see a counselor or a psychologist
or whatever and they say it's really not
bothering me but it happens every day
and it lasts for an hour it could be
that the professional would say well if
it's not bothering you then we're not
gonna worry about it at at the same time
somebody could have mood swings once a
week for 15 minutes but that could
really bother them so I think probably
one of the best anchor anchors we use is
the idea of clinically significant
distress
meaning is the distress rising to a
level where it's having a negative
impact on a person's development their
functioning whether it's Social Work
school something like that so all the
more reason to talk to a counselor and
try to try to figure out you know how
how severe those symptoms are and before
I move on can I just ask you what is a
VPD did I say oh yes avoidant
personality disorder
oh wait am i a so that's an interesting
dichotomy to set up comparing borderline
personality where they're in different
clusters right so bored lines cluster be
dramatic erratic emotional yeah and
avoidant is a cluster see so it's an
anxious fearful disorder person I
disorder so it would surprise me that
those two would kind of be up as the two
possible diagnoses for any particular
set of symptoms it could happen right I
mean somebody could potentially going
into therapy you know all 10 personality
sorters are available and any number of
other disorders but avoidant is
oftentimes conceptualized as extreme
social anxiety okay it's deeply felt
it's an intense anxiety that's not based
on like a performance fear but a fear of
being rejected so kind of has that in
common of borderline but other than that
the commonalities and pretty quickly
because borderline has again kind of
that idealization devaluation the
frantic efforts to avoid and iment
suicidal behavior impulsivity things we
just wouldn't see with avoidant
avoidance more of a a softer disorder in
terms of how it looks to an outside
observer hey if that makes sense both
cause suffering but if you knew someone
with avoidant and you knew some of
borderline you'd probably be able to
pick out the person would whirl a lot
easier because the behaviors are
relational yeah okay good tonight okay
so my next question is quite long
basically she has a one person a
favorite person and she finds emotionals
of her emotions are all over the place
if they are apart even if it's for a
small amount of time
I'm constantly wanting approval
validation from her wondering why hasn't
she picked up the phone etc how would
this person gain emotional stability
when she wasn't around this person okay
good question
right so this this again speaks to one
of the properties we see with borderline
personality
from moment to moment there can be a lot
of changes in moved and there can it be
an evaluation of evidence like so when
you're with somebody you have a close
relationship with it's easy to believe
they like you they're not gonna reject
you because you can get reassured
constantly right you can just directly
ask them do you still like me are we
okay
yeah and that those affirmations can
kind of sustain a person but then when
they're away from the person that they
have this intense relationship with
these other thoughts start to creep in
this other this fear of abandonment
right and I think this just comes down
to I mean emotional stability is
actually relatively complex but to try
to give an answer this question one
thing it comes down to is do you have a
way through therapy have you gained a
way to apply reason right well they call
it cognitive behavioral techniques to
apply it in the absence of other people
so internally can you can you analyze
the situation say well they weren't
rejecting me this morning when they left
for work
they haven't rejected me for the last
week two weeks month years whatever it
is so it's unlikely that something new
has happened or I'll now be rejected all
right so it's good checking the facts
yeah it's a reality testing and kind of
just a logical cognitive behavioral
strategy and this is the type of
strategy like with a counselor
especially somebody who's well-versed in
CBT which is actually very popular in
United Kingdom right cognitive therapy
is the dominant therapy there that
particular skill is something they could
could teach an individual and that's how
I really see it being applied quite
often as is in those periods where the
reassurance isn't there and you're
looking to kind of anchor sometimes I
call it grounding and those techniques
can help okay brilliant
okay my next question what do you do
when a loved one with BPD
is splitting on you right so this is a
good question
oftentimes we do hear from people that
are with people with the disorder and
they wonder how to deal with live the
different distortions and that's what
splitting really is right it's a type of
cognitive distortion it's also called
black and white thinking dichotomous
thinking a lot of different names for it
and it's really the lack of a continuum
right so it's as if you had a ruler and
everything you've measured was either no
length or one foot right so if the ruler
was one foot long there's no six inches
there's no eight inches it's just
extremes and I think for individuals who
tend to think when a continuum that's
very frustrating to deal with so when
you see somebody reacting to you you're
all good or you're all bad it's hard to
argue it becomes exhausting I would say
I mean there's no great advice for this
splitting is one of the symptom criteria
because it is indicative of the disorder
and it is difficult symptom I mean it's
it's a focus of treatment probably the
best idea there would be to if the
personal board like person I thought it
was Amina Bowl attend therapy and bring
this up to the counselor and say you
know what specifically can I do to deal
with the splitting to de-escalate to put
distance in between or whatever the
potential goal is because the splitting
can also present in a number of
different ways and you really have to
know what's going on so that would be
one of those things where if you can get
into the therapy not to like hog all the
time and take it away from the client
but just to help navigate that
relationship might be a good idea make
sense okay the second question is my ex
with BPD became emotionally abusive
manipulative and was gaslighting me she
has left with no explanation and is
engaging in dangerous behaviors sexual
violence binging drugs alcohol self-harm
it's
how do I deal with the now PTSD anxiety
low self-esteem codependency etc after
this relationship and friendship has
ended and what can I do to show I still
care as I'm worried about her safety
yeah so I'll treat these as two separate
issues the still caring and in that
component that probably has to be left
until these symptoms are dealt with
primarily right because somebody's
having traumatic reactions and other
difficulties that's not a great time to
try to mend fences and intervene at some
point you have to go and get treatment
for the symptoms you have regardless of
where they're caused by somebody the
board line person is order or you don't
know the cause or whatever so that
becomes kind of a more immediate crisis
that that individual has to deal with
for their own their own safety
right I mean PTSD can be dangerous in
and of itself once that's you know once
that individual finds some sense of
stability and symptom relief I think
then you can explore mending fences or
repairing relationships but that's a
that's a long process
borderline personality order all the
cluster B's are considered relatively
stable over time especially you know in
a short time like a five year time
period it's not something that it's not
a disorder that turns on a dime right
that doesn't pivot quickly so I wouldn't
necessarily look for some sort of
fulfilling or dramatic positive
resolution right but more kind of a
daily slow continuous effort I hope that
person gets help you know a lot of those
behaviors they're talking about the
sexual promiscuity and suicide behavior
very dangerous and very tragic but we
have to as people in relationships with
people with disorders may have to take
care of ourselves too it's like they say
on an aeroplane to parents always put on
that mask before because if you before
your children because if you're not well
you're not going to be able to help it
anyone else yeah at some point those
become about survival
right which which might sound a little
cold but you have to have an orderly way
to to look at these different symptoms
and treat them and and trying to engage
in the chaos while you're feeling
symptoms and they're feeling symptoms is
likely not going to lead to a lot of
improvement yeah okay my next question
when I haven't seen my therapist for two
weeks I usually have three days where
I'm very sensitive and get angry at
people for no good reason can I do
something to prevent this right so I
think we kind of touched on this before
with the emotional dysregulation
constant anger is one of those
cornerstones symptoms I see with
borderline personality
it's defined in DSM is inappropriate
intense anger but I found that it tends
to be trait anger so so most people have
what's called state anger where they
they kind of get angry and then it fades
but with borderline we see trait anger
where angers part of the personality so
it stays doesn't matter yeah it tends to
be stable yeah and and very consistently
triggered so if the counseling was
helpful and then a few days pass it kind
of makes sense that trait anger is gonna
sneak back in I would say kind of the
same thing about the cognitive
behavioral techniques there's a point
where you have to evaluate the
consequences of your behavior and you
have to really look at it in an honest
way and say I know I'm feeling anger and
and I understand that feelings can be
legitimate but the consequences of the
anger could get me in trouble it could
it could harm a relationship I mean I've
seen examples where people have acted on
anger and arrested and go to prison and
you know there's a lot of bad things
that happen with with what we call
reactive anger so borderline personality
sword has a strong association with
reactive anger so it's it's anger that
happens in the moment directly because
of a stimuli and a way of perceiving as
opposed to kind of planned criminal
activity or anything it's not that type
of anger usually so yeah there has to be
some sort of grounding counting to 10
taking some time and applying a
cognitive behavioral technique learned
in therapy and and just trying to
understand that it's a win if you avoid
the consequences of the anger even if
you experience the anger and I think
that's what a lot of people struggle
with because if they're feeling the
anger if it feels like something's very
wrong but what people sometimes forget
is you can make things a lot worse by
acting on those angry feelings that's a
really good point to make I would have
done good hearing that like a few yeah
okay next question someone's just come
out of treatments they're doing DBT they
understand and accept they have
borderline they're currently taking
medication and trying to use skills when
triggered but is there hope they will
ever come off those meds considering
when you start coming off so many of the
meds they have side effects and a lot of
them are negative okay that's a good
question so important to keep in mind
that I'm a a PhD not a physician so my
area of specialty isn't medicine or
medications when working with clients of
course we see a number of clients on
medications I'm not aware of any
medications that are approved to treat
borderline personalities or because it
again it is a it is extreme levels of
personality traits so it's not something
that would respond to medications but I
have seen people with aura line on
medications for the related symptoms
right so if they're having anxiety they
might be on anxiolytics if they're
having depression they might be on
antidepressants the the medications
oftentimes are taken until the symptoms
of bait and then sometimes psychiatrists
will try to back off on the medications
and see if the symptoms come back and
other times medications are taken for
life even though there might be some
changes that occur as new medications
come out or somebody becomes tolerant of
the medication so having the goal of
getting off medications altogether I
think is certainly understandable
because the side effects can be awful
with lattes medications but I don't you
know I don't know what the probability
of that would be in any instance it
really depends on what's come orbit with
the disorder and what that psychiatrist
is thinking in terms of you know what's
the long-term plan or these medications
for symptoms in the short run and
there's a hope of getting off them or
are some of these disorders more chronic
so it really becomes hard to know but I
can certainly appreciate that the
medications are unpleasant and probably
this is a good question you know to
bring up with the psychiatrist or with a
counselor and express concerns over
prolonged taking of medications again
with a personality disorder the
medications don't directly affect that
so likely they were prescribed for some
other type of symptom and my final
question for you dr. Grande is how do
you cope with feelings of guilt when
you're feeling so guilty but you have no
reason to feel guilty how do you cope
with that right this is an excellent
question and I think this by again
potentially speaks to some of the
comorbidity we see with poor line person
I swear so borderline is heavily
comorbid meaning it tends to occur at
the same time as depressive disorders
like major depressive disorder and one
of the key symptoms for that disorder is
inappropriate guilt so it's feeling
guilty when there's no logical external
reason to feel to feel guilty so it
could be that there's some depression at
work or it could be this is just a
symptom and isolated symptom the person
is experiencing and they have borderline
personality so to answer this question
is kind of poor to understand that guilt
is different than shame and a lot of
times when we think of borderline
personality we think of a a
characteristic called shame proneness
which is the tendency to experience
shame so somebody's high in shame
proneness they're more likely to
experience shame than somebody's love
and shame promise and shame is about
feeling bad about yourself
right so you do something that violates
society's norms and you say to yourself
I'm a bad person
that's shame guilt is when it's about
the
object so you do something to violates
the norms and you say I shouldn't have
done that that behavior was wrong so I
think the first thing would be to make
sure that what you're really dealing
with is guilt and not shame because it's
a totally different way of approaching
it and if it is guilt you'd have to make
sure that you weren't dealing with
depression you'd have to go to a
counselor and make sure that you didn't
have a separate disorder or even some of
the symptoms of depression if it's shame
shame ties in pretty closely with
depression too so there's still that
danger and of course for poor life
person is order and a lot of times this
would be treated as part of the
emotional dysregulation treatment
they're like cognitive behavioral
therapy and also the identity
disturbance those two symptoms to try to
address you know why you think why do
you think you're a bad person and and
does the evidence really support that or
does the evidence support that you may
have done things that violate the norms
of society so inappropriate guilt and
shame can both be very destructive and
what I found with these to construct it
gets in the way of treatment because it
blocks out all reason you know if you if
you don't like yourself if there's a
self-hatred you're not gonna be really
open to receiving ideas about logic and
reason how to solve problems that's a
really dominating emotional component to
not like oneself it's a it's it speaks
powerfully so I would say you know
figure out what it is work with a
counselor to figure out what it is and
then watch out for the depression and
then try to attack that symptom like you
would may the symptoms we see were
borderline brilliant
well that is all my questions thank you
so so much for coming over too much
light thanks for having me this has been
great guys please head over I'm gonna
put a link down below subscribe to dr.
Grande's Channel there's so many
different videos on mental health and
you'll benefit so much from watching
them so thank you again dr. Grande
absolutely any time take care bye guys