Today I had the opportunity to chat with Dr Grande and ask him all of the questions that you requested me to ask.
Dr Grande specialises in the field of cluster B personality disorders, as well as trauma and drug and alcoholism just to name a few!
His channel is covers everything from mental health, human behaviour, psychopathology and research. Please head on over and check out his channel and don’t forget to hit the subscribe button and the notification bell so you can get notified when he uploads new vidoes, which he does weekly! There is a wealth of information on his channel so please do go check it out! The link is below:
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
This transcript was auto-generated and therefore may contain mistakes.