Borderline Emails #2

Hey deserve listeners. So in this episode I'm going to continue reading your emails about borderline. So let's get to it. This next email is from patron Aurora. Uh I'll summarize the email. They are basically saying, "Hey, I've heard you talk about how borderline and narcissistic personality disorders can happen within the same person, but they seem completely incompatible. So how can that be? " So, I'll answer that paraphrased question, which is to say that yeah, I get it. I can see why it would be confusing, and it is. But let me give you the following profile as uh one possible uh presentation that I might conceptualize as someone that has both borderline and narcissist and narcissistic personality. So you have someone who uh has the same uh has both the traumas that are involved in both. So with narcissistic personality, the way that the early child is interpreting the world is that they're being neglected, maybe abused because they are inferior, because they don't matter, because they don't really exist, maybe. And so to offset that, to defend against that, when they're very young, they decide not only do they exist, but they're superior. And they don't need other people because other people only remind them that they're inferior. And so they're defending against this trueism to themsel. They absolutely believe that they are nothing. And the solution to that is to prop up this belief that they have to construct and live that they are not only worth something but they're superior at the same while you know they're desperately trying to get love and attunement and acceptance and compassion but at the same time they know that's not going to happen because other people don't care. So they prop up this like image of themsel to themselves and others that they're superior as a way to stave off that abyss of nothingness and inferiority while never actually trying to have contact with other people in a meaningful way because they're sure that other people are going to reject them and see them for what they are which they believe to be nothing that they're worthless. Okay. So uh that's what's happening with a classic narcissistic individual some with borderline um or the same person. So take that person with classic narcissistic personality and also involve abandonment and abuse uh that that's also happening. So the child let's say um uh in addition to being neglected is also uh occasionally having a parent or a caregiver or an older sibling or something physically harm, sexually abuse or something. And in that experience, the child interprets it as betrayal and abandonment, you know, because they're being neglected as well. And so they believe that they are abandonable and that people will always abandon them betray them while also again desperately seeking closeness because they've never had it. They've never been given even that primal attention and attunement and security that everyone needs and and will crave. And so they emerge into adulthood with both defensive structures that to uh constantly be looking for evidence that they are worthwhile and lovable and secure but at the same time uh sure that other people are going to reject them and abandon them and betray them. And when uh things are going well, when they're able to prop up their grandiosity, and have maybe fake relationships that seem close but aren't really close, then they are living within what might look to be a sort of calm narcissism. You know, the thing about narcissistic personality is that when these individuals are getting their defensive needs met and they believe that uh they can sort of rest and say, "Okay, I've established that I'm superior to myself and other people. I don't need to put that much effort into it anymore. " The narcissistic supply has been supplied. And they can kind of relax because no one wants to be constantly active in their defense. So for those people, they can kind of relax a little bit. And in those moments, they're uh they're doing okay. And they also will engage in relationships that reassure them that they're not going to be abandoned. That's hard to do when you're narcissistic because you want to issue relationships in general. You want to believe that you're independent. You don't need other people. But, you know, under what I always say is underneath every narcissistic person is a borderline person. Underneath every avoidant attached person is a preoccupied person. It it doesn't work in all angles, but it's a good general reminder that narcissistic people and avoidant attached people are not devoid of needs and emotion. They're just dealing with the same problems that preoccupied and borderline people deal with, but in a way that looks from the outside and even to themselves that they don't care, that they're stable, everything's fine, they're strong, but they're not. You know, so with this narcissistic borderline person and their supply is happening, they can kind of kick back and coast a little bit and they frequently will not be triggered by abandonment because they don't allow themsel to get close. But let's say that they go through a bad day and they can't meet their narcissistic supply or someone does abandon them or they interpret things as abandonment in the borderline manner and they plummet and they try to engage in the narcissistic supply game but it's not working and they plummet and underneath the surface for both borderline and narcissistic people is annihilation. They both share the emptiness and the abyss and the terror when the defenses are no longer there. To the narcissistic person, the defense is the grandiosity. To the borderline through the chase or through testing another person. Are you for real? Do you really love me? And the other person passes that test. And you can have both. It can look weird. Now, it's not a common presentation to have both, right? Because how can you both issue relationships but constantly be preoccupied and pursue them? And it's complicated is the thing. And uh but I hope that I laid out how they can coexist. When you hear these disorders described in a simplistic way on the internet, it might seem like impossible for the two to coexist, but when we're talking about actual human beings with messy lives, you know, no two narcissistic people are the same. No two people with borderline are the same. Also, no two clinicians are the same in terms of the way we look at it. Uh, you know, someone that I would describe as having both narcissistic and borderline, another person might use one or the other or something or not even like the whole idea of personality disorders at all. So, it gets a little messy, but you know, I hope that I laid it out. But I it's a good question because uh in some of the simplistic ways that even I present these two disorders, it doesn't make any sense. Like when we talk about working models of self and other and attachment theory for people with narcissism, the working model of self is good and a working model of others is bad. With borderline, the working model of self is bad. The working model of others is good. So how can you have a working model of others and yourself of both good and bad? Doesn't make any sense. But it's more uh nuanced than that. Uh when I use that good and bad framework, it is a way of bluntly looking at it. But you know, looked at a different way like a narcissistic borderline individual can uh at times be in a mode of seeing other people as inferior because that's what they need to be doing in the time. But other times they might be seeing other people like it's really common for uh well let me give you another aspect of the combination. So you could have someone that absolutely is in a very frequent activity of making sure that they believe that they are superior and they see themselves that way and they make others that way while at the same time, you know, that they're trying to signal to others, special and, you know, they're frequently bragging or building a life where they can say that they're superior or something and putting other people down. At the same time, they are maybe going home to their spouse and pursuing them in a very extreme preoccupied attachment way. And you know, that can be a pretty toxic mix, right? But um so at home, they're trying to recharge their attachment battery by forcing their spouse to be the perfect or compliant or close or non-abandoning or something. and those defenses and those projective identifications are coming up. But when they're at work, they are constantly uh recreating their childhood by asserting their specialness and you know those you know can exist and there's different presentations. I will say in my own descriptive language I typically will choose one or the other. Like in the uh examples that I've gave that I have given I would probably label them as narcissistic with vulnerability underneath you know uh in that they fit a certain profile of narcissistic personality where they're actually exhibiting their uh relationship vulnerability in a way that for some narcissistic people they don't have access to or they don't get triggered in that way because like I And underneath every narcissic person is a desperate, lonely, sad, hurt child. Like profoundly hurt. And that profoundly hurt uh inner child is much more on one's sleeve if you are borderline, right? So they can share that very hurt child. Right. Anyway, let's uh take a break and listen to or not listen but read another email.

All right, we're back from the break. This next email is related because it involves BPD and NPD. Middle tier long-term patron. They write in to say, "Hello, Kirk. I was wondering if you could describe the dynamics that occur when a person with borderline personality disorder and a different person with narcissistic personality disorder interact with each other. I've always heard that the combination of a person with BPD and NPD can be intense and that they can trigger each other, but I have never really heard an explanation of the dynamics that occur. As a therapist with BPD, I noticed that I have gotten triggered and activated a few times when I've worked with clients who I suspect may have been somewhere on the MPD spectrum. I'd be curious to hear more during these types of interactions so I can understand both myself and my clients better. End of email. Yeah. Well, um I could go on and on, but there's a lot of emails to get to and it's a great question and the topic sentence or the thesis that I would have if I were to go on and on about this is that you can't really generalize about this sort of thing. There are um some obvious incompatibilities between people with borderline and narcissic. You know, like the person with uh borderline will pursue the person with narcissism and will reject and push away and distance. Right? So that can create a runaway train of pursuing distancing. But that's a simplistic way of looking at it. Um there's also some compatibility between the two because depending on their awareness level or their ability to see each other kind of they share a lot of history of trauma and neglect and abandonment and harm and they might understand each other in a way that other people don't or something. You know it or because the borderline person pursues the narcissistic person might actually benefit from that because most people don't push past their walls and the borderline person just falls head over heels in love and narcissistic person feels gratified regarding their uh superiority but also they need someone to push that hard. So it it's really different. But for you, Raquel to experience being triggered by people with narcissistic personality, that's really across the board. I don't know if that has anything to do with you being borderline. People with narcissistic personality are going to trigger people. In fact, I will often say that one of the ways that I assess for early indicators of a personality disorder in general is how much fear I feel, how much adrenaline I feel. you know that sort of inner chest flutteriness and anxiety and nervousness that uh I when I feel that with a client and I don't have any discernable reason why and but even sometimes when I do have a discernable reason why but usually I don't then it's an immediate question as to whether or not this person might have a personality disorder. It's not an indicator of a diagnosis, but it's an alert that there's something threatening about this individual. There's something that I'm picking up on that is scary to me. There's a subtlety to the threat or to the danger or the anxiety or the amplification of something. And I will feel that in my chest. And sometimes I'm just having counter transference that has nothing to do with the client. Sometimes I'm just having indigestion, but other times it's a picking up of the subtle ways in which people with narcissism or borderline are worried about relationships and they have this um this sort of underground hostility that is showing through of vulnerability, a worry that they have. And it's manifesting in these little ways that they're framing things and little uh nonverbals and things that they attend to and things with the ways they respond to me. Especially in therapy that will feel like I'm not standing on solid ground. And then I start to freak out and then I notice it when I'm at my best. I notice it and then I say, "Oo, I wonder if this is a personality. " And what it'll do for me immediately is remind me to slow down because I have forged ahead with some clients who have narcissism or borderline and you know like a common scenario is I'm working with a client that doesn't know that they have a personality disorder and they are engaging in therapy for some other reason and I'm starting to pick up on it or I'm not noticing it and I just start forging ahead and one of the first thing especially if the client you know I can think of an example where a client came to me about parenting. they were wanting some parenting advice and um naturally as they were just you know presenting their scenario that they're having with their kids I thought that I was tasked with evaluating that and giving them feedback and there were pros and cons to their approach and I was saying okay well this is good but you know we might look at this and in that process I stepped on a landmine by criticizing them and for narcissistic people and borderline people they're very sensitive to criticism and they turned on me and started to defend in a subtle ways in the beginning and then I started to reiterate. You know, I'd say, "Oh, well, I'm not saying I know for sure what's going on, but you know, based on your description, it just sounds like this is what you're doing well and maybe this is something to look at. " You know, I'm pretty careful when it comes to parenting feedback. I would never say you're doing it wrong because parenting is too weird for that. So, I I'm usually pretty tentative and I was in this scenario. that even the suggestion that I was criticizing, which I would even call it criticism, I would call it doing my job because that's what they're hiring me to do. And what I did is I ended up u triggering something in them and they fired me as a therapist. And how much good am I going to do if I don't detect that landmine and step on it and the therapy blows up? like I I'm not doing the therapy any favors. client any favors by not uh having that caution. Whereas with clients that don't have a personality disorder in this way, then it would be bad for me to tiptoe around things because I would be slowing therapy down so greatly that it wouldn't be very useful to them. So I have to be able to detect that early. Now, later on in my career, I started to formally assess for this in subtle ways in the beginning of therapy instead of just forging ahead and waiting for my heart to feel scared, you know. But anyway, let's read another

email. All right. Next email is from middle tier patron Jen from Pennsylvania. She says, "My husband is a big Philadelphia sports fan, and our tradition is that if the Eagles make it to the Super Bowl, we watch Silver Linings Playbook the night before. " All right, just chiming in. Well, Jen, it must be nice to have your Eagles going to the Super Bowl with such regularity that you have a tradition having said, you know, the Hawks just won the Super Bowl. But, uh, if the Eagles are going to the Super Bowl, that means that they might have even beat us in the playoffs leading up to it, you know, because we're in the same convers. So, uh, but yeah, that sounds like a nice tradition. So, uh, going on. It's a great movie, Silver Linings Playbook, and I remember you mentioning Jennifer Lawrence's character in a BPD episode, but I was wondering what your thoughts are on the other characters. All right, just chiming in. Yeah, it might have even been in a Borderline deep dive that I was talking about different movies that depicted people with borderline and Jennifer Lawrence's character presents it pretty well, and that she gets overreactive to things. I don't know if I would characterize her, if I did have her as a client, as pretty high in the spectrum, particularly because in the end of the movie, they seem to repair and move and ride off into the sunset and they seem to be telling us that everything's fine moving forward. But, you know, it's Hollywood. Whereas in reality, if she actually did have borderline, it might be actually uh just a matter of getting worse in the future because as she becomes more attached to uh Bradley Cooper's character, she would be more vulnerable to the kinds of syndromes that borderline people suffer from. But um but I do remember thinking that of the debate I there's also a character on the Sopranos. Now, you know, these characters are cartoon versions and just one profile and they're stigmatite. You know, these it's arguable that especially the character on the Sopranos. If you ever watch the show, there's a woman that has a relationship with Tony Soprano who is a car salesman and she becomes really demanding and possessive and jealous and emotional and it gets uh pretty dark eventually, but you know, anyway. And yeah, uh would I characterize that person as possibly suffer from borderline? Yeah, but it's just one type. And if we always assume that people with borderline are toxic and a problem, then we're missing really the vast majority of people with borderline. But anyway, going on this time watching it, I noticed that each character seems to represent a different mental illness. The father played by Robert Dairo definitely gives off OCD vibes with his compulsive sports betting and odd beliefs that different compulsions would affect his life in different ways. Just jump in. Yeah, Robert Dairo. I don't know if I read the author's take on this, but it seemed pretty clear that the author either knew or looked up what OCD is, what bipolar is, cuz Brad Bradley the Cooper has bipolar pretty I would say his uh depiction of bipolar is, you know, it's not a the movie isn't like here is what the disorder like, but if you're gonna have a disorder in a movie, in a 90minute movie, then I would say that the bits that they show us about Robert Dairo and OCD and the bits they show us about Bradley Cooper and bipolar, the stuff that they show about Jennifer Lawrence's character and borderline is good, you know. Uh but then you go on Jen from Pennsylvania, you say beyond that, there's Julius Styles character who seems to be a bit of a satist and even display some Machavelian tendencies and spending a lot of time plotting and planning to cause other people's lives to fall apart even when it won't affect her. I'm curious if you saw this and what you would think overall. Uh, just chiming in. I don't remember her character doing those things. I barely remember what her character did in the movie. In fact, until your email, I forgot she was even in the movie. It's been a while since I've seen it. So, I I can't really comment on it. Um, yeah. So, that's that email. Let's read

another one. All right. This next email is from YouTube member K from Green Bay. She wrote in an email. I'll summarize it. She is saying that she thought she had autism 5 years ago and so she went to a psychiatrist and within 20 minutes the psychiatrist she told Kay that quote you don't have autism because people with autism don't have enough self-awareness to know that they have autism and instead I think you have borderline personality disorder. And then for Kay, this was very invalidating and very hurtful and she decompensated emotionally. She started having suicidal thoughts because of this dismissal from the psychiatrist. And then years later, she went to a different clinician and was diagnosed with autism. And so Kay is wondering if she should reach out to the She also Kay also tells me that when she looks at the doctor's reviews online that they're all one star reviews saying that the psychiatrist, you know, the first one is very dismissive. So uh first off, yeah, that individual if that's close to what happened, that first psychiatrist is completely incompetent. That's a nonsensical statement. I it's not even something that I've heard people say. You know, there's certain things that I will hear clinicians say that are wrong. You know, like all border lines [snorts] are going to sue you is one of the things that I used to hear. You know, never work with a person with borderline because they will they're going to sue you as a therapist. And uh if I heard you telling if you emailed and said, "Yeah, I had this therapist that said that to me. " I would say, "That's ridiculous, but I've heard it before. " This is ridiculous what you're telling me. The psychiatrist said, and I've never heard anything like people with autism don't have enough self-awareness to know that they have autism. What are you talking? Maybe they're only referring to profound autism and that's their only vision of autisens. You know, plenty of people with autism know they have autism and have the self-awareness around it. Um, and then to jump from that to borderline, like yesesh. Anyway, and then you ask, should you reach out to them? And what I would say is, yeah, if you want, I don't know what good it's going to do. It sounds like she's already gotten a lot of negative feedback in the form of her reviews. So, you could add to that or send a letter. It's more humane, I suppose. And you know, if you're trying to make a difference in the world and help this psychiatrist improve their competence so they don't harm people in the future, yeah, send a letter, but it's certainly not your

responsibility. All right, just quickly, this next email is very much related to the previous one. So, I thought I would include it in this episode. Super long-term patron Thor from Denmark. He says, "Hello, Dr. Honda. I hope you and the rest of the team are doing well. " Well, chiming in. We are. Thanks for asking or thanks for hoping going on with the email. For quite a while, I have been wondering how mental health professionals approach clients who reveal that they have been self-dagnosing themselves or that they recognize some sort of psychological concept from their own thinking or behavior. I. e. if a client says, I think I have borderline personality or I real I realize that I have rigid thinking or when I first heard of passive aggression, I realized that I have a tendency to be passive aggressive. So for you, Kirk, do you inquire about this? Do you trust their self-evaluation or are you immediately skeptical? Would you evaluate the client in the first example for BPT for borderline straight away? What are the ethics? How does it affect therapy in general? And how do you approach a client who has done a self-ruling out meaning you know that they have decided they don't have something i. e. a client who says, "I have researched complex PTSD and I am confident it does not fit me. " Since your podcast contributes to the awareness of psychology and mental disorders, I find it likely that it also contributes to a tendency to self-evaluate among clients as it gives them the opportunity to recognize them themselves in your descriptions and deep dives. End of email. Yeah, I have recognized that as um a minor risk to educating the public directly about disorders and that some of individuals will uh irresponsibly self-dagnose, you know, erroneously. But so in the past uh the vast majority of lay people didn't understand anything in the DSM. They might have understood depression kind of, but certainly they wouldn't be confident in diagnosing themselves. with the advent of the internet and dstigmatizing therapy and psychology and people like me educating the public and this kind of stuff. um the information that's out there and and one of the things that we always know about you know uh you know in the '9s when I was taking psychopathology and learning about these disorders uh we all started to diagnose ourselves as students of like oh I have this I have that and then our professor my friend Ned Farley said by the way if you're diagnosing yourself that's normal and you're probably wrong it's just normally that you know I I don't know if in the medical field this happens as Well, but there I could go into the speculations as to why we do that, but we do that. And sometimes we're right though, you know, like when I learned about panic disorder, I diagnosed myself with that disorder right on the spot because I did have panic disorder at the time. So, and that was very helpful to have that awareness. But anyway, so for the lay public to learn about disorders and start to compulsively and erroneously diagnose themsel, that's normal that we all did that too. Um, so what's what do I do with it? Well, uh, one, I try to accurately describe these issues in my podcast, not only the disorder itself, but also the cautions about self- diagnosing. But the other thing I do if someone comes to me having self- diagnosed and I think that they're wrong or something, I don't know. I I think it really depends. It's not a common thing that I will get. Um, but there are versions of this, you know, like even midstream years into therapy with a client, they might come in and say, "Oh, I read this self-self this self-help book and like one example that comes to mind is I was working with a couple and they were talking about sexuality and the wife had read a self-help book about the differences between men and women when it comes to sexual turnons. " and um sexual energy. And I'm trying to be vague to protect privacy, but the book basically said this very reductive thing about men and women that is simply just not true scientifically. And although uh my client, the wife, it really resonated with her, which is fine, but it also painted men in this opposite way as if men and women are always completely different in this fundamental way when it comes to sexuality. And you know, it's not diagnosing themselves, but it's an outside source that they are confidently applying to their lives. And um so when I see that I have to evaluate whether or not it's going against their goals in therapy or it's neutral or it's going with their goals in therapy, you know, like if they came across a self-help book that was wrong, but it actually assisted in what they were asking me to help them with, then maybe I wouldn't touch it, you know? Um uh I don't know. I could Anyway, so uh that's the foundation. Now, sometimes I might just push back on something for the sake of trying to help them understand uh I don't know if that's exact even if it doesn't match up with the goals. But like in that instance that I was telling about the couple, for her to read the book and have it help her with her sexuality in a way that I thought was helpful to her was a plus. But to uh also read in this self-help book that her husband was something that he's not cuz the book was declaring that all men are this and all women are that. Well, and the goal of therapy was one to work on reduce conflict, two to increase intimacy, and as a part of that improving their sexual life, their sex life that I found that self-help book, that wrong notion needed or at least half of to be addressed by me because if she walks away thinking that one, that's a scientific fact, and two, that I kind of endorse it passively by not saying anything about it, then her goal of improving the her sex life with her husband is going to be hindered greatly. Um, and you know, never mind how her declaring that couple therapy affects him, right? Da da. So, uh, so that's what I'm always thinking. I think there's this general tendency to push back against self- diagnosing as irresponsible and silly and um childish or um a product of stupid people today or something like this. And it just depends and a lot of the times people are right. Uh like with the previous emailer, she was self- diagnosing with autism probably because she had educated herself on it and had taken a lot of time to think about it for herself. She goes to a psychiatrist and the psychiatrist tells her the opposite, but also exhibits she doesn't, you know, I'm guessing that, you know, Kay from Green Bay knew enough about autism to know that first psychiatrist didn't really know what they were talking about, you know, and so um are we supposed to think that lay people are completely unqualified in these areas and all clinicians are qualified in these? you know it it depends on what's happening right so if someone u now I will tell you that just uh I don't know vibewise if I just as a citizen when I see a Tik Tok video of something of someone declaring that they have ADHD and they you know share their symptoms and you know nine out of 10 of the symptoms have nothing to do with ADHD it you know it annoys me But why does it annoy me? You know, what what's the difference really? It's just like I don't like it when I, you know, when a flatearther talks about how they know the Earth is flat and they give all the evidence. It annoys me. Why does it annoy me though? Like what difference does it make if someone thinks the world is flat? It's weird. But as long as those people aren't harming anyone, then I don't know. They're wrong. The Earth is not flat. It's an old blate spheroid and for that person that is declaring they have ADHD and nine of the 10 symptoms are rattling off and have nothing to do with ADHD uh from the outside it doesn't look like that person has ADHD but what's the difference right so it depends on where the rubber meets the road which is clinical diagnosing so when someone comes to me um you know what are the goals is the point that's why earlier when I was talking about the psych in psychiatry if someone comes to them claiming they have ADHD and they've self- diagnosed, there's a bigger reason I think I talked about this or I might have just thought it, but uh for a psychiatrist to have a client saying, "I've pre-diagnosed myself with ADHD. " There's a bigger incent or there's a bigger reason for the psychiatrist to p push back on that because the client is coming to psychiatry in all likelihood at trying to get drugs for their disorder and for their self-dagnosis disorder because with ADHD you can be prescribed stimulants right and uh to be prescribed those uh those drugs it can cause a lot of side effects that are completely unnecessary because the person doesn't have ADHD. Whereas someone coming to a psychiatrist saying they have autism. There is there are no drugs for autism. So you don't have to push back if you disagree with it. Plus that first psychiatrist doesn't seem to understand autism at all anyway. So you know what are you going to do? All right. The next

email is from annual middle tier patron Jen from Texas. She wrote in and I thought I would just summarize by saying she's talking about her husband in the email and how there was a lot of ups and downs and he has borderline and claimed that u certain volatile periods in the past he was experiencing the psychosis that is involved in borderline. Okay. So, let me talk about that. That uh is a confusion, but I'm guessing for all y'all listening, you don't have that confusion. So, sometimes people think that borderline is a version of schizophrenia or psychosis or something. And there have been periods of time in our clinical history that did play around with that. In fact, the reason why it's called borderline is because the or originators of the term found that there were some patients who exhibited what looked to be delusions but were borderline schizophrenic. They weren't schizophrenic and they found that their delusions were only regarding relationships. So if you look at the world through schizophrenia and through severe mental illness as these people do, then that's the way you would frame it. In my world, you'd frame it as a distortion or projective identification or a relational trauma that's being triggered, right? So, like uh when I have borderline clients that are totally convinced that I'm going to leave them and I repeatedly tell them I'm not know that there's no evidence that I'm going to leave them and yet they're certain that I'm going to fire them and I manage to convince them in one session and in the next session they're totally convinced again and it dictates their behavior. This kind of thing. Well, if you don't know what a personality disorder is, you know, schema- based issue or relational trauma being triggered is, then as a clinician, you see that as a delusion. You know, you believe something that is clearly not true. And people with schizophrenia who have delusions will occasionally have delusions kind of like this. You know, you're out to get me. You're working for the FBI. But people with borderline, it's completely different, right? they're convinced of something because it was true growing up and they're very worried about it happening and they're testing and all this kind anyway and so um it's not psychosis. It's a completely different ballax. Now some people will argue that it's similar and maybe it is neurologically and there is some models that suggest that it is but anyway without getting into those weeds. Now, what can happen with some people with borderline is that when they're severely triggered, if they have a severe case of borderline and they're severely triggered, they can become unglued and can become fairly distorted in their point of view such that in that crisis they can look like someone with schizophrenia or bipolar or something like this, but that's just in that state, right? So, that's another thing. Um, so when you uh Jen from Texas write in, you ask the following question. Okay. Um you so your husband is apologizing for the past when he was very toxic with you, abusive even, and your husband says, "Oh, well, don't regard that because I was having transient psychosis that is described in the DSM regarding borderline. " And therefore, I'm not responsible for what I did to you, Jen, because I'm I, you know, I was I have borderline and I was experiencing that thing that they described in the DSM. Okay. And then you go on to say, part of the reason why I think he was lying is because he didn't say scary stuff around other people who weren't me and he didn't have functional decline in work and social life, but he was only transiently psychotic for a brief period with me. So, how does that make sense? All right. So, just chiming in. Yeah, generally speaking, when someone is having a psychotic break, they have it in all uh arenas of life at work, at home, this sort of thing. But not always, even if we're just talking about schizophrenia, some of those folks will have increased symptoms under certain circumstances of stress or something. Anyway, but yeah, so with borderline uh as you're observing, he depended on you more for attachment security and therefore his relational traumas were being played out with you and not with anyone else. And that can be true. Now, borderline people can transfer their traumas onto their spouse. Often it will happen that way, but sometimes it won't. Sometimes it won't be with their spouse. Sometimes it'll just be at work and not with their spouse, which is kind of interesting, right? So, it just depends on what sort of, you know, current circumstances trigger their issues. Anyway, so he was doing a kind of classic thing whereas at home his relational triggers were happening and in outside it just wasn't being triggered and he was able to regulate everything was okay with him. Right? So, uh, one way of describing that is that he was experiencing that kind of borderline psychosis with you in that he had beliefs that you were against him, that you had wronged abused him, or that you were inherently betraying, and you know, all the craziness that happens, right? And then at work, he wasn't being triggered, so he didn't have any of that quote unquote transient psychosis. And that's why the term transient psychosis is um misleading because it has the word psychosis which is very particular unless you understand how it's being used and the history of it being used. Um now you're saying that he's making an excuse and trying to get forgiveness or something or wanting you to move on saying, "Hey, I'm not responsible for what I was doing in the past. " Now the question of responsibility is weird, right? Because if he was truly psychotic, you know, thought that you were a devil or, I don't know, a monster from out of space and he was treating you poorly, then yeah, you know, you're not you're insane at the time of the crime. Does that apply to the kind of massive distortion that can occur in massive borderline personality? It I don't know. It depends. Uh it depends on the question. But for you, Jen, uh you don't have to uh even if you go with his explanation that his previously very harmful behavior to you was involved in the transient psychosis, that doesn't mean it didn't happen. And it also doesn't mean it might not happen again. And so, um regardless of how he frames it, you can still see it however you want to see it. you experienced it, you know, and um uh so yeah, and also I will say that, you know, people with borderline um especially at higher ends, you know, they're suffering greatly. And can we say that their perspective is under their control? No. Can we say that they're responsible for getting the help that they need? You know, like if someone has borderline, they probably know they have something going on. And if they refuse to get help, then at that point do we say, well, you know, you're not responsible for the abuse you went through. your reactivity, but you are responsible for trying to address it. And if you're doing nothing to address it, then morally speaking, you're to blame for flying off the handle when you do. Even though that's related to your childhood trauma, you're also not doing anything to address it. Now that gets weird because for some people it's you know part of getting triggered is going to treatment or the idea of going to treat. So, you know, I don't know, you know, it but for uh people in your position, uh I think a lot of exploration and support has to occur. And you know, one of the things that people will walk away from listening to me talk about borderline or any mental disorder or any personality disorder is, oh, I now have more compassion for these people. And then people will extend that thinking that I'm communicating that if you're a spouse that you should forgive these people automatically because they're not to blame necessarily for their reactivity. And I am not [ __ ] saying that. For me personally, I choose to work with these people in my office where I have control and I don't have to live with them 24/7. Whereas in my personal life, people like this I distance myself from depending on the scenario. You know, I I have friends that have borderline that know they have borderline, they get treatment, that sort of thing. But if these individuals don't have awareness and I see the signs um then you know like there have been times in my life when I have entered into a social circle and I will pretty quickly recognize that one of the people in this circle has borderline or something and I won't be sure because I'm not their therapist but I'm like oh I see signs and I catalog that away and I say, "Watch out for that person. " I don't deal with them differently, but I, you know, I just sort of say, "Well, be careful. You know, don't don't let your guard down necessarily around that person. " And then if they explode on someone else in the circle, which is usually the case cuz, you know, they don't trust me well enough to explore explode on me yet, then I will have confirmation or not of my speculation as what their problem is. And then once I have a more confident conceptualization of that person, then I will do a lot to distance myself from that person because if I'm not their therapist, I have no control over what they're doing. And if I get into their inner circle and they start to transfer on to me, they are going to get me. They're going to attack me and I won't have any ability to push back, right? They're not going to listen to me if I'm going to say like, "Hey, you're borderline. " You know, u and also when I'm socializing outside of work, I'm letting my guard down. My heart is open. You know, I'm relaxed. I'm not at work anymore. And uh so I if I had a spouse or friend or an acquaintance my and you know everyone can have their own personal policy around this but if someone's toxic and they have a personality disorder I will take measures to protect myself which can involve basically me figuring out a way to get them out of my life. Now, for those of you who have borderline or narcissism or something out there, uh, you know, depending on your scenario, if you have awareness and you're addressing it and you're not inherently toxic and hostile and unbridledly mean to people, then I wouldn't necessarily distance. I might pro I probably wouldn't even detect it in you. You know what I mean? So, I'm just talking about the people that are pre-awareness, pre-treatment or very early on and they are uh you know just a walking time bomb harming people around them. And so if you Jen from Texas uh are like you know I care about him and he's saying that he was he did all those horrible things because he was experiencing some symptom that's described in DSM and I don't know what to do with that. Okay, you know, you can choose to conceptualize it however you want. And then from there, the question of responsibility is still kind of up in the air whether you see it as psychosis or not. Uh, in all likelihood, it involves some sort of triggering that's happening from him. And even if it was quote unquote involuntary from him, you still have the right, you know, once you differentiate, really look at it, get support from people to say, I don't I don't care if this is involuntary or not. I have one life to live and I'm not going to live it in this person's crosshairs. Or I don't see them doing enough to get help around it. Or they are going to therapy but they're not working hard enough in therapy and so I'm leaving or something like that. So, you know, I don't I don't you weren't asking me for information on all that, but that was sort of the implied question in your longer email. All right. This next email

is from long-term patron IVR. She says, "Hi, Dr. Honda. I was studying structural dissociation and I saw that both complex PTSD and borderline personality disorder are grouped into secondary level of dissociation. " So, I'll just cut to the chase and say that the theory of structural dissociation I'm not that familiar with. So, I could kind of bastardize it, but I think I won't today. And what I'll say is that uh the model has uh I so I'll just say I just don't know it and it it's probably a great question and maybe other people know the answer and maybe one day I'll look into it. I'll add it to the list. But I just wanted to say long-term patron IVR, I hear your question. It's a good one, but I don't know the answer to it. But you do ask if dissociation in general is a part of only borderline or is it part of other personality disorders. And what I'll say is I what I don't know because I don't know what you learned about structural dissociation and all but that there's a possibility that their definition of dissociation is broader cuz anyway and that there's a confusion of terminology there but anyway the other thing is that uh dissociation in the classic sense in the DSM sense is something that is developed seemingly due to a lot of terror experienced when one is very small. That can be from abuse, sexual, physical, but it can also be from severe neglect. Right? If a child is left alone for a long period of time, they might be in such utter tear that they will dissociate and then that mechanism that's protecting them at that age of 18 months becomes uh overutilized in their later life uh under circumstances that don't really call for it, right? You know, they're at a meeting at work and their boss is in a bad mood and then they dissociate, right? So, that's not helpful and that you don't need to do it. you're you're physically safe, but it feels to the body that you're not. And so it causes these problems anyway. And you're asking if other personality disorders have that. And I would say that all personality disorders, uh, you know, except for psychopathy and antisocial, which is its own kind of thing. I mean, obviously those people can be very traumatized, but if I if we're not if we're just talking about all the other personality disorders, they all come from early childhood extreme difficulty. And everyone who goes through extreme difficulty in early childhood has a greater likelihood of developing a dissociative defense at that early age that gets overutilized when they're older. And so um the association of actual dissociation like DSM dissociation with personality disorders is there obviously um and that people with borderline might be sometimes described as inherently having dissociation but they don't always is the point. Um so yeah I don't know I feel like that's not a great answer Ivy but that's the one I've got. And that's the last email that is within that section. So, uh, that all those emails that I did in this episode and last episode had to do with diagnosing and conceptualization and that sort of thing. So, I feel like I completed that portion and the next number of episodes have to do with relationships and then there's a bunch of episodes about what it's like to be in therapy and a therapist and D. So, tune in then and everyone out there, please take care of yourself because you deserve it. You really, really do. —