Episode Transcript
WEBVTT
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This is Rachel Armor Cover. We've
got a special guest here. He's here
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to tell us a little bit about
himself and then he's you're going to ask
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him some questions. This M Jerry
is going to tell us. Tell us
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a little bit about yourself. Well, good morning, Rachel. DELIGHTED TO
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BE WEAKIA Today. I'm Joe Christman. I'm a psychiatrist located in St Louis.
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My interest has been in number of
areas, but primarily in areas of
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borderline personality disorder, and I've been
interested in for a long time. Actually
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been interested in when I was in
training, even before it was really defined,
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which really wasn't standardized until the DSM
came out for the third edition,
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came out in the s buts,
and during this time I've written number of
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articles and in books in the area. The most popular, I guess,
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is a book called I hate you, don't leave me, which is kind
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of characterizes the struggles that people with
borderline personality disorder have. It's now in
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its third edition, most recently came
out a couple months ago. My other
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books in the area is is a
borderline personality what is called sometimes I had
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crazy and then when they came out
a couple of years ago which, unlike
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the other two, which are devoted
towards a general public, that are also
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well referenced and are used in by
professionals. My third book that came out
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a couple of years ago, talking
to a local one with borderline personality disorder,
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is year just to the general public
in terms of people who are living
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with someone or dealing with someone with
poorderline personality and determining ways that it may
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be helpful. Some years ago we
develop one of the first, I think
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it was probably the first, unit
at a hospital here in St Louis that
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was meant to be a short term
program specifically for borderline personality. Nowadays there
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are several around the country that are
helpful through this diagnosis. Okay, all
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right, general we're going to ask
you some questions. What are you working
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in the mental field? How did
you get into this home mental hull field?
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In medical school you rotate the different
specialties and what I found in treating
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I really liked several, including pediatrics
and arology internal medicine, but when I
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rotated for psychiatry I found that was
the one specialty where I was really able
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to sit down and spend time with
them, with an individual, really get
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to know a person. I found
that more treating more interesting to me.
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So I kind of hear in that
direction in medical school at Cornell that one
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of the professors there was starting to
work with with adolescence that he labeled borderline,
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even though this was before the term
was even acknowledge, and I found
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dealing with some of these kids was
very interesting and when I did internship I
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rotated through several different specialties, including
the country, and that's sort of solidified
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it. And from there I went
on a training at the national intud mental
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health in Washington for psychiatric training and
then came back to St Louis for more
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and have been stay of working years
since then and that's been my interest.
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I got interested in borderline personality because
it was an area that wasn't well understood
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and it was a group that signified, a group of patients who other professionals
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really did well. I take it
back then, these are patients who had
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a reputation of being difficult, demanding
and way back years ago, we're thought
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to be really not very treatable,
but I found them to be interesting,
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intelligent, triguing challenging but kind of
exciting to kind of work with, and
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that's when I became more interested and
more involved and began seeing more and writing
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more about about this group. Okay, what are some difference with dealing with
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avoidant attachment style, avoidant attachment disorder
for end, versus bpd, and is
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it is there a lot of differences
or is there a lot of overlap as
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well? Avoided, when you when
you say avoid attachment, you're talking about
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kind of a diet either attached or
avoid and that's sort of does describe the
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kind of I hate you, though, and leading persona of people with borderlings
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personality very there is a tendency to
clean one of the one of the concerns
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and people with this disorder is fears
of abandonment. So there's a ten attendency
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to kind of want to grab onto
people, but at the same time there's
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also a fear of being overwhelmed,
being gobbled up, and a lot of
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it is felt to be precipitated by
experiences with attachment issue growing up and sometimes
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involved with trauma issues in the past. But borderline personality disorder is named reaffined
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dig else is an attachment avoidance is
more of a general term for they really
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don't correlate that well, okay,
well, I mean I know there's a
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there's an actual avoidant attachment personality disorder
which is different than like a generic avoidant
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attachment style which can be used commonly
among people that just have an insecure attachment
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style. Well, that's not actually
a depotit. There are ten personality disorders
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and attach, the Avoidan it's not
one of them. It's that the term
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that gets grown around and meaning some
I think, different things different people.
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Okay, you mentioned there's a lot
of trauma related to BEPD. Is there
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some evidence that's kind of troversal,
that bpd is not related to trauma?
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Many people with bpd have a history
of trauma and their childhood. But it's
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not. But there are many,
there are many others that aren't and it
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gets kind of confusing sometimes because back
about thirty years ago there was a movement
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that was saying that basically borderline personality
disorder was really a form of post dramatic
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stress disorder and they years now a
guy concept. And again it's not a
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it's not a defined disorder or a
defined personality disorder. But some people talk
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about what's called complex post traumatic stress
disorder, where there's a specific abuse in
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childhood that has the same symptoms,
basically borderline personality, tendency that to hurt
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oneself and auls of mood changes,
poor sense of identity, difficulties of the
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relationships. But genetically it's been shown
that post dramatic stress disorder and borderline personality
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are are genetically different. They are
the symptoms can be could be differentiated.
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So they're they're not, they're not
the same and not everybody with borderline personality
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has history of trauma. Now,
some other people have argued to get think
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a look at it. Another direction
is that many of the people who are
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not aware of a sense of trauma
in their background really do have a sense
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of trauma, but they've either blocked
it out or they've that's domed. It's
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just a matter of well, everybody
goes through everybody has a father who boats
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them up every once in a while
or takes out their belt, or has
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a mother who drinks all the time
and and they don't acknowledge that there's a
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sense of trauma. But although history
of trauma in the background of someone mortaline
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personality disorder is common. It's not
a requirement for the defining the diagnosis.
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In some people do not acknowledge that
a trauma. Okay, I was really
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interested in your information about Adhd and
borderline personality being related. Can you elaborate
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on that, I think. What
are the realities of poorderline personality disorder is?
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It rarely presents by itself. When
someone would be PP asked for help,
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there's usually in an accompanying a comorbid
disorder along with it. Most commonly
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it's depression. Often it's anxiety.
Sometimes it's even bipolar disorder, which is
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different than poorderline personality disorder, and
sometimes attention definity disorder occurs Comorbidly, and
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sometimes it can be a little difficult
to tease out the difference because in both
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disorders there's a tendency. People with
borderline personality and add can be impulsive.
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They often have racing thoughts, they
also can have issues of anger. They
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also can self medicate with alcohol or
other substances. So they have a lot
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of things in common and it is
it. There have been some studies showing
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that a significant in a percentage of
people who have a childhood diagnosis of adhd
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later on also fulfill criteria for a
diagnosis of borderline personality disorder. So they,
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like which some of the other syndromes, they not infrequently do occur together
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and do have similar kinds of symptoms. There are differences, though, of
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course, in adding or Adhd,
which is basically say there's not usually a
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symptom of self harming. Very usually
isn't the same kind of issues with the
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identity. There may be some of
the interpersonal difficulties, but there are obviously
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distinctions between those two disorders either,
though they may or co occur well,
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because, I mean Adhd you can
see in the brain as well. Well.
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There are some indications of that,
although I don't think that's been totally
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determine in the same kinds of ways, in the same ways that we can
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do some of the other things in
your book. I hate you, don't
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leave me. You mentioned a lot
of things that happen, that are happening
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in the world that are causing an
increase in bbd. Can you tell us
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a little bit about that? I
think in some ways a lot of our
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culture is kind of a borrow in
a borderline functioning. The most obvious is
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the recent pandemic. I think the
tendency for isolation and adjustment in life has
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had a significant impact people who have
been limited at how much they can get
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out and do the things that they
can. I think exactlybate some of the
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tendencies and some of these symptoms that
we see in bpds, such as concerns
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of being alone, concerns of being
abandoned, difficulties with relationships, a tendency
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to self medicaid with drugs or alcohol. So it's really kind of worse than
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but I think also our culture tends
to be, when we look at politics
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and when we look at so many
areas of culture, a tendency life happens
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in boiling personality is is a tendency
to be extreme. One of the characteristics
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of bpd is a tendency to see
things in extreme. They love beyond measure
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people who the next day they may
hate without reason. You're my best friend,
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but then you did want little thing
that kind of pissed me off and
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so now I hate your guts.
That it's either things are either black or
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white, good or bad, right
or a long extreme, and I think
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we see that a lot in politics. I can people tend to sometimes and
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to act an extreme in that borderline
kind of way. In the legal system
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you're either you'll be or your I
feelthy there's no kind of easy between.
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The biggest problem with borderline personality is
a difficulty of seeing the gray zone in
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between sort of accept that there are
people that I care for who have characteristics
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that I don't like. But in
borderline personality you're good or your bad,
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and I think a lot of times
in our culture we see things in those
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extremes. What are your thoughts about
the controversial issues of CPD and being missed
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diagnosed as PPD? I'm sorry swiping
this. Controversial issues of CPD being misdiagnosed
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as bpd? I'm sorry. CPD, CPDSD, like complex postponec trust art.
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Yeah, yeah, I think it
becomes a matter of lumping or splitting.
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The welcome together is splittable part.
As I said before, PTSD,
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complex P POSD is different from borderline
personality disorder, although they both have often
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have a history of trauma. People
with be with the complex PPSD do have
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some of the same problems with relationships, but I think basically they kind of
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melt into each other and I think
it becomes kind of a false distinction because
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if the someone who's had that trauma
and is having the symptoms of borderline personality
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disorder, I think it's just less
complicated to identify it as borderline personality disorder
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with with the history of trauma and, as I said before, true PTSD
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has been determined to be, to
be genetically different, to be biologically different,
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and are our distinction. I guess
here's another question. It like mean
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your own personal experience? Would you
say most bpd patients that you work with
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are due to trauma? The majority
do have a history of trauma, usually
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in childhood, which usually results in
some sense of lacking. What has been
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identified by professionals is what's called object
constancy and ability to see some consistency in
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people are opposed to feeling like things
are changing all the time, and I
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think that's that and some of the
attachment that is that it is consistent and
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Aly Ale. Mothering experiences that are
consistent and reliable are often disrupted for one
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reason or another. I think you
see that in the majority but, as
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I said before, not in all
of them. At what age do you
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feel like? You mentioned your book
about bpd starting to mellow out with a
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lot of their emotions. But like
when do you usually see that? If
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you see it, well, you
first begin to see although I've had pediatricity
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tell me they they see signs in
young kids. Most often you don't really
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see the beginnings of bpd until late
adolescents are already that the s and when
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at the first generally presents itself,
although you know, some people fail that
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adolescents in general is an expression of
borderline issues because indeed a fifteen year old
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is dealing with issues of identity,
of moodiness, of impulsivity and so forth.
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So some people feel almost being a
teenagers redundant of big borderline. But
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the truth, the true borderline that
gets interfering comes up in early but when
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it's defined officially it's on a categorical
area. In other words, to make
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the definition, to make the the
true diagnostic definition of line personality. There
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are nine symptoms and you have to
Indorse five of those nine symptoms. But
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over time for most of these patients
those five dissipate and so starting even the
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s and usually by the forty most
of these patients are getting significantly better.
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Some of the maybe self harming has
gone away, some of the substance of
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the use has stopped, in which
case they no longer satisfied five of those
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nine criteria. Maybe they have two
or three of them, so it's officially
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they're no longer borderline. So that
you most of the the vast majority,
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and by then I mean ninety percent
or more, over time, starting in
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around the S, sometimes earlier,
sometimes later, get significantly better and most
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get better to the sense that they
no longer would fulfill the official criteria for
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for borderline personality. Now that's an
that's not a great way to define it
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because it's sort of artificial, because
really it's more a matter of degree.
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It's more a matter of it's not
like suddenly your borderline and then now you're
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not because this went away. It's
more a matter of just how how much
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is it interfering in your life?
And but for most people they do mature
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out of it over period of time. What do you feel is the most
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helpful tool for those in relationships with
individuals with borderline personality? Well, I
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think, and that's what the third
book talking to a local foorderline personalities about
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it. Looking at some of the
symptoms that you see in someone you interact
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with, such as the sort of
kind of damn if you do, dam
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if you don't, kind of situation
where someone with fourline personality a lot of
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time will put the person in a
situation where there's no good answer. You
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know, do you like me better
in this outfit of that out that?
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Oh, you don't like me over
here. Oh, no, matter what
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you say, you're going to get
in trouble with and I think learning to
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first recognize that that person just isn't
being an evil, nasty person. The
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person is someone who's really struggling with
the disorder. So I think person recognizing
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that a person you're with has some
symptoms of a personality disorder helps and then
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and then being able to be patient, being able to see what sort of
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traps that can sometimes walk into that
you don't want to get, that you
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want to kind of avoid, and
they're there's certain approaches that I describe my
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book that are sort of way of
just being able to be supportive and empathic
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with the person but also not being
pulled along to exacerbate their symptom, being
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able to have some boundaries with them
but also being able to show you that
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you care about this individual and then
you understand that they're going through a difficult
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time. I mention your book that
electric shock therapy was no good for those
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with DPD, but have you heard
of much research with dealing with amd are
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neurow feedback to deal with trauma that
could reduce symptoms of bpd? Well,
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there's certainly some literature that Mbr,
which has to deal with eye movement,
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is has been helpful in dealing with
with trauma in some people. It's very
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variable. I mean some studies have
shown some help. Those studies have shown
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not as much child that has been
shown in some cases. There have also
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been some small studies showing that TMS, transcranial magnetic therapy that's usually been used
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for depression, has been helpful for
that. In general, though, physical
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treatments, including medication and shock treatment
and tms have generally had less effect in
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impacting bpd. The most successful approaches
have been treatment approaches and there's a number
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that have it formalized in sort of
manuals that you can present, and those
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are treatments probably most wellknown as dialectical
behavioral treatment, which is a form of
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kind of behavioral treatment. That's helpful, but there are other such a Schema
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related therapy, memalization based therapy that
has to do with kind of working on,
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kind of empathizing and understanding the feeling
transferred focus therapy, and there's a
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there's a therapeutic approach called just good
psychiatric management, which is basically sharing with
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the individual who struggling with DPD what
bpving is how you deal with it.
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How you do is simple ways to
deal with emotional impulsiveness, emotional changes,
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recognizing when there are struggles and working
on techniques to counteract it. But the
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physical treatment are not particularly helpful,
accept for coexisting issues. In other words,
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there are no medicines currently available,
and it isn't that pharmaceutical companies have
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not tried at hard non medications that
are available at specifically treat borderline personality.
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But many, but most people would
borderline personality, as I mentioned before,
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have the coexisting disorder, such as
depression. I call with disorder anxiety.
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Substance of use and medicines can be
helpful to treat the coexisting symptom and things
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and emb are can be helpful for
treating the trauma part of things and tms
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can be helpful for treating the depression
part of things, but generally they're not
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specific for the DPD is at least
a targeted as just these different psychotherapeutic techniques
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are all right, Um, I
guess. Do you have anything else you
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would like to add? Oh,
I think the good news is unlike years
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before we win when borderline personality was
was a disorder, that people that professionals
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didn't want to deal with, had
a bad reputation, that had a stick,
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but that these people were impossible,
we now know that the prognosis is
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very, very good. Most of
these people are going to get better.
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We also know there are specific and
targeted treatment program for people like this.
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They are not hopeless, they are
not a pain in the neck, they're
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people who are suffering and who can
who can get better, and we'll get
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better over time and I think,
hopefully, our society has been more accepting
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of seeking treatment. Our biggest problem, I think today, especially since with
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the pandemic, has been the shortage
of professionals that are available to treat the
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various forms of mental illness that in
the country. Okay, well, I
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guess that's it. Thank you for
your time, dared Gerald, and I
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hope to have you come back some
time. All right, guys, thanks
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for listening. Tune in next Thursday. Always, follow us on your favorite
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platform, first podcast, social media, and if you have any questions,
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00:25:37.000 --> 00:25:47.720
you can always contact us on Rachel
and Recoverycom. All right, guys,
