Episode 103: Borderline Personality Disorder (BPD): End the Stigma with Alyssa Scolari, LPC
Episode 103: Borderline Personality Disorder (BPD): End the Stigma with Alyssa Scolari, LPC
Borderline Personality Disorder, or BPD, is arguably the most misunderstood and widely stigmatized mental health disorder. Alyssa is here this week to set the record straight on what this disorder looks like, how it is related to trauma, and why we need to fight the stigma.
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Alyssa Scolari [00:23]:
Hey everybody. Welcome back to another episode of The Light After Trauma podcast. I am your host, Alyssa Scolari.
Alyssa Scolari [00:32]:
Welcome back, settle in because we have another good episode for you today. I am trying to get settled in as well, trying to get ready to chat with you all about borderline personality disorder, but I hope that everybody is enjoying their summer. I feel like we’re at that point in the summer where everything just flies by and make the most of it because I’m already hearing talk about fantasy football and I’m like, “Oh God already, please no.” Now summer’s not my favorite season by any stretch. I don’t love the heat, but I’m also just not quite ready to talk about fall football and all things pumpkin spice flavored. I’m just not, I’m not ready for that at all. So just hold on to every second because summer is flying.
Alyssa Scolari [01:34]:
I feel like I’ve been working so much this summer and it’s really just on a lot of like future things. I have a really exciting project that I am going to announce in just a few short weeks that we’ll be launching in the fall. And then I’ve just been working on my website stuff and client stuff, and kind of mapping out the future of where I want my practice to go on the podcast. So I feel like it’s just been a summer where I’ve been so busy, and when I’m not busy with work, I have been really busy with EMDR. As many of you know, I’m going through that process. And I know I’ve said in the past that it has been kicking my butt, but man, I mean it more than ever, I feel like I’m now really in the depths of it, of just going through my memories chronologically and reprocessing them.
Alyssa Scolari [02:32]:
And I think particularly the last week or so has been really, really difficult. My brain is, and this is what is to be expected, honestly, this just means that I’m doing it right. I mean, if you can do EMDR, right. But this is really what’s been happening it feels like my brain is on fire and I’m hypersensitive to everything. So even more so than I was before, every noise, every sound, I’m almost overly reading people’s emotions and their facial responses. And this is something that I used to do when I was little because I had a person in my life who was really hot and cold. I never knew what version of them that I was going to get. And so I find that I’m like that even more right now, as I’m reprocessing everything,
Alyssa Scolari [03:28]:
I’m looking at people like, who are you today? Are you safe today? Are you going to hurt me today? And none of that is even about the present, right? Because I don’t have people in my life that are going to hurt me. So I’m really just kind of, not I’m disassociated, or maybe emotional flashbacks. And I’m also having a lot of new memories surface. In the car yesterday we were driving, something was said. And of course, what was said was harmless, but whatever, it did trigger something in me. And then I started having new memories and the memories were auditory. So I could hear things. And it was one of those just really bad PTSD episodes/attacks is what it feels like, where I’m just like, I almost want to put my hands over my ears to stop what I hear, but that’s not going to work because the flashbacks are just, it’s my brain.
Alyssa Scolari [04:33]:
And I found myself in EMDR this week while I was reprocessing a memory feeling so much dread because there’s so much, I don’t remember, but I know is in there. And I found myself almost feeling like, “Oh, this is a movie I don’t want to watch.” Almost like I was watching a horror movie. I hate horror movies and I will cover my eyes because I’m very scared of them. I have enough anxiety. I don’t need a movie to give me more anxiety. So I will always put my hands over my face when I’m watching a horror movie. And this is what that felt like I wanted to just stop and I didn’t want to see the rest of the movie.
Alyssa Scolari [05:24]:
But the movie is reality and there was just so much grief that came with it. And there was a lot of self-compassion, which I think is pretty new for me. I’m not used to having a lot of compassion. I’m used to intellectualizing things and I’m used to finding ways where I was at fault for what happened, but I’m just really developing a lot of compassion for myself. And it’s been a beautiful, painful, agonizing thing. And it’s also been exhausting.
Alyssa Scolari [06:05]:
So I’m definitely a little withdrawn. I’m a little isolated and it’s really to protect myself. I don’t even think it’s a bad thing. I think that it’s probably best right now if I don’t have a ton of contact because I’m already so depleted from this process. So it’s taking me a while to respond to people. And really all I want to do is read books because I get to escape that way and play really nontriggering video games and cook good food and do some really slow yoga.
Alyssa Scolari [06:45]:
That is kind of where I’m at. I’m at how can I do the bare minimum? And I think that’s okay. I’m okay with that. I’m okay. I’m okay with that. You know, I say maybe I’m trying to convince myself I’m okay with it because I’m one of those over-functioners, so it is a little bit hard for me to be still in my grief, but I’m doing my best to just let it wash over me. And it is, and it’s so random, right?
Alyssa Scolari [07:16]:
Sitting in the car yesterday, this was a completely separate incident. We’re in the car. My husband runs into the store to grab something. I stay in the car and when he comes back in five minutes, I’m sobbing. I am hysterically crying and shaking. And he was like, “What is wrong?” And it was just like I got hit with this wave of grief.
Alyssa Scolari [07:39]:
And I have to say, I’m really proud of myself because I’m not running from it anymore. And normally I would run from it. I would pick up my phone and maybe go on social media to try to distract from feelings or turn on the radio. And, and I did for a second, I turned on the radio when I felt all those feelings creeping in. And I was like, “Nah, let me listen to music. I don’t want to feel this.” And then I was just like, “Alyssa, you don’t have to run from this. It’s not going to kill you.” I actually said that out loud to myself and I just let the tears come and I sobbed and it moved through me and then I was able to manage the rest of the day.
Alyssa Scolari [08:27]:
So I’m hanging in there. This is, I think, one of the best things I’ve ever done for myself, as hard as it is I know it’s exactly where I need to be right now. So I am so proud of myself for all of the work that I am doing. I’m just so proud. I’m really proud that’s all I can say. I’ve worked so hard and it’s going to make me a happier human being and it’s going to make me an even better therapist and yeah, yeah. That’s where I’m at. So that being said, we will close up the corner on my life updates and now let’s just dive into what we’re talking about today because we’re talking about borderline personality disorder.
Alyssa Scolari [09:16]:
It’s also often referred to as BPD, and maybe you have been diagnosed with this and if you haven’t been diagnosed with it, then I’m sure you’ve heard of it because it’s one of, well, I think it’s the most highly stigmatized of the mental health disorders in existence to the point where a lot of therapists refuse to work with somebody if they even utter the words BPD or the acronym BPD or the words borderline personality disorder, not every therapist, but a lot of therapists.
Alyssa Scolari [09:51]:
And I can even recall so much stigmatization when I was learning about it, even as a grad school student. So the stigma is quite literally in the system, right? I was taught the stigma. I was taught to believe the stigma when I was a grad school student. And, I definitely had, again, not every professor. I had amazing professors where I went to school, but I did have one professor who I specifically remember was like, “You are going to really have a hard time ever having successful treatment with somebody who has this kind of disorder.” And quite honestly, I know now that is not true. And I wish I could go back and tell that professor that they were just projecting their own frustrations. Perhaps they’ve been diagnosed with this disorder, or perhaps they worked with people in their practice who were diagnosed with this disorder and didn’t have a good outcome, but I will continue to talk about that a little bit.
Alyssa Scolari [10:53]:
But first, you might notice the term personality disorder, right? And it’s like, “What does that mean?” Because it’s much more clear what anxiety disorders and depressive disorders are, but what does it mean to have a personality disorder? Basically, there are personality disorders, and then there’s everything else. That’s kind of how it’s separated in the DSM, which is the book that has all of the mental health diagnoses.
Alyssa Scolari [11:23]:
What makes a personality disorder different is that this is thought to be like a lifelong long-term pattern of behaviors that cause distress and dysfunction. This person’s behaviors deviate outside of the cultural norm and it’s typically something that starts either in adolescence or very early adulthood. And it’s kind of thought that personality disorders are much more difficult to treat because these patterns of behavior are much more inflexible. It’s just deeply rooted in who somebody is.
Alyssa Scolari [12:06]:
So that is what kind of separates personality disorders versus mood disorders, anxiety disorders, what have you. Now borderline personality disorders specifically, because there are a few, right? Borderline’s not the only one there’s, narcissistic personality disorder, there’s an obsessive-compulsive person of personality disorder, and OCD, basically obsessive-compulsive personality disorder, which this is just an interesting little fact is having OCD but not seeing a problem with the OCD and therefore not wanting to change. That is one of the biggest differences between somebody who has obsessive-compulsive personality disorder versus obsessive-compulsive disorder. So I find that very interesting and I don’t know if I buy into that totally because I have people who technically meet the criteria for OCD or for obsessive-compulsive personality disorder, right? They have OCD tendencies but they don’t really see a problem and don’t want to fix it, but it’s not really causing a whole lot of distress.
Alyssa Scolari [13:23]:
I don’t know. I don’t know. That’s a topic for another time. We’ll talk about it later. I have to give it some more thought, but going back to BPD. So BPD is basically characterized by having to meet at least five of the following requirements. So first we have chronic feelings of emptiness, and then there’s emotional instability in the way that you react to regular day-to-day events, maybe having major episodes of sadness or rage or severe anxiety. Next is frantic efforts to avoid real or imagined abandonment. So you spend so much of your time trying to avoid feeling any feelings of possible abandonment, a disturbance in your identity or an unstable sense of self or an unstable self-image.
Alyssa Scolari [14:26]:
There’s impulsive behavior in at least two areas that could be self-damaging. So this can include substance abuse, driving recklessly, binge eating, and having risky sex. I’m not, not just having sex, but, risky sex, maybe sex with multiple partners or having sex a lot with no protection. Spending lots of money. So if you’re just living paycheck to paycheck, or maybe you’re gathering a bunch of credit card debt, those kinds of impulsive behaviors.
Alyssa Scolari [15:02]:
Intense anger, anger that is so intense that it doesn’t necessarily match the situation at hand or issues with controlling your anger, explosive anger, getting into fights a lot, whether physical or verbal. Having unstable interpersonal relationships. So unstable relationships with the people in your life. Difficulty keeping friendships. Difficulty with family members, difficulty with maintaining healthy relationships. Suicidal behavior, suicidal gestures, self-harming, threats, threats of suicide, and usually severe dissociative symptoms. So dissociation is a form of disconnection. It’s a form of almost checking out mentally so that you don’t have to be present.
Alyssa Scolari [16:02]:
Dissociation is typically a trauma response. And I know we talked about this a few episodes ago, how sometimes dissociation can be a healthy thing in very moderate amounts, but this is more like dissociative symptoms as a reaction to trauma, or as a reaction to something, some kind of intense situation.
Alyssa Scolari [16:26]:
Another thing that I think ties into all of that is folks who have borderline personality disorder will often engage in something called splitting. And basically what that means is you see the world in a very black and white manner. So it’s things are kind of all or nothing. People are either amazing or they’re absolutely horrible devils. An experience you had was either the best thing you’ve ever experienced in your entire life, or it was so bad it was absolutely the worst ever. And so there’s really just no middle ground for people who experience borderline personality disorder.
Alyssa Scolari [17:06]:
So all of those symptoms that I just read off to you, right? You have to meet five of them in order to meet the criteria to be diagnosed with this disorder. Now, if you meet these criteria for two weeks, and then you no longer meet this criteria, you don’t have borderline personality disorder. This is a pattern of behavior that stretches over a long period of time, if not lifelong. So in fact, borderline personality disorder and all of the personality disorders, you typically can’t get diagnosed with one of them until you’re about 18 years old because your personality is still developing. I kind of think that’s a little bit of bullshit and I think that it should be at least 25 years old until you’re diagnosed with a personality disorder because our brains haven’t even fully developed until that age. So when you’re diagnosing somebody at 18 years old with a personality disorder, know their brains aren’t even fully developed.
Alyssa Scolari [18:15]:
So how do you know? How, how do you know, right? The criteria for BPD is, one of them is, impulsivity. Well, guess what? At 18 years old, your prefrontal cortex isn’t fully developed and your prefrontal cortex is what governs impulsivity. It’s what helps stop impulsivity. So I sort of feel like it’s stupid, but what do I know? I’m just a low old therapist over here. But here is where I start to get really worked up about borderline personality disorder and it is because of the stigma.
Alyssa Scolari [18:52]:
You can Google this any day of the week and you will find several articles about how borderline personality disorder is one of the most stigmatized, misunderstood, mental health disorders in the profession. And it isn’t just misunderstood among doctors and regular society. It is misunderstood by therapists and it is a diagnosis that is handed to people, very haphazardly by therapists and professionals who truly don’t know much about this disorder at all.
Alyssa Scolari [19:35]:
And it infuriates me. And this has been my experience with BPD. So I’ll talk a little bit about the stigma, just that I’ve experienced through my own journey of health.
Alyssa Scolari [19:47]:
So when I first started out in an eating disorder treatment center, I met with a psychiatrist. I met with him probably for 20 minutes, and it was my first time ever meeting with a psychiatrist. And he asked me a few things. And then he looked at me, he didn’t make eye contact with me the entire time we were talking. And then at the end, he looked at me and he went, “You have borderline personality disorder and you need to be on this, this, and this medication. And do you have any questions?” Now I had no clue what he was talking about. I had loosely heard of the term, but I don’t even think I was in grad school yet, or maybe I had just started grad school. So I really didn’t know much at all.
Alyssa Scolari [20:44]:
So I kind of was labeled that. He didn’t know me. He had no clue about my history of trauma. He was just like, “Oh, okay. This is what you have.” And I didn’t know then the stigma of that disorder. And honestly, I had just kind of forgotten about it. I hated where I went to treatment. So I just got through it. I kind of wrote the whole place off. Looking back at that now it infuriates me that somebody could talk to you for 20 minutes and give you a personality disorder. You have no clue what that person’s patterns are, their behaviors. How could you diagnose somebody with that after 20 minutes?
Alyssa Scolari [21:37]:
But I do remember that there was one instance where I was with one of the employees who worked at this place and this person was talking about borderline personality disorder and this person said, very matter of fact, “There’s no treatment for it. You can’t get better. All you can really do is manage it. You’ll have this forever. And it’s really hard to ever have any kind of good relationships with this disorder.” And she’s just said it very flat. And so I remember thinking like, “Oh my God, if I really do have this, I’m going to be alone forever. I’m never going to be in a marriage. I’m never going to have friends. Holy crap, this is awful.” And I kind of almost, not made it a self-fulfilling prophecy, because that didn’t really happen for me. I was able to sort of see over time that was such a horrible thing and a very hurtful thing that she said, but it really brought me down. And it really made me question my future for a while.
Alyssa Scolari [22:54]:
So moving on, then eventually I graduate from treatment and I find a regular outpatient therapist and I am going to see her and I like her, and she’s cool. And about a few months in, this therapist, I noticed, starts talking more about herself than me. And she talks about the other people that she sees and doesn’t give me specifics but tells me way more than is actually appropriate. And she works with sex offenders and she’s talking to me about them and how a lot of people can’t do the work that she does. And then she goes, “But at least I don’t have to work with the borderlines because as you’ll see in grad school, they’re a nightmare.” And I was horrified that a therapist could say that about humans, absolutely horrified. First of all, the borderlines, like so nasty, just that language. It was awful.
Alyssa Scolari [24:10]:
So eventually I fell away from that therapist and I found myself with another therapist and this therapist and I had spoken extensively about the diagnosis of BPD. And this therapist had sort of like told me, “Yeah, I really don’t see that in you. You really don’t have any of that.” And I was kind of like relieved because there was so much stigma that was surrounding this diagnosis, that it almost became this game of how can I not have this disorder as opposed to how can I fix my trauma? And so this therapist was like, “Yeah, you really don’t have that.” And one day I went in for my appointment and the person who was ahead of me, there was like a little waiting room, and the person who was ahead of me opened up the door, stormed out and slammed the door.
Alyssa Scolari [25:17]:
And my therapist at the time came out and pointed at that person and went, now that is a borderline, a borderline, first of all, like the level of inappropriateness, it makes my skin crawl. And then we kind of talked about it a little bit. And she was talking about how people who have borderline personality disorder are super treatment-resistant and they always fail in therapy. And they always drop out because they can’t respect anybody’s boundaries. And they’re highly manipulative. And I really looked up to this therapist. So I’m just like, “Oh, oh, okay, I guess that’s how people are then.” So you can kind of see here this pattern, even from my own experiences, of hearing people talk about borderline, like they’re the worst people on the face of the planet. First of all, they’re people with borderline personality disorder, they’re not borderlines.
Alyssa Scolari [26:20]:
And for people to talk about them like, “Oh, they never do well in treatment.” It’s such bullshit. And over time I had new therapists who really helped me see folks who have borderline personality disorder in a totally different light, right? I had different therapists. I had a supervisor, all of whom have been fantastic and who have truly helped me understand that this diagnosis is not something to be afraid of.
Alyssa Scolari [26:56]:
There are therapists that will outright reject people who have that diagnosis. Therapists will still talk about people with that diagnosis saying that they’re impossible to treat. They are not impossible to treat. And as I’ve learned, I actually really enjoy working with people who have borderline personality disorder. People who have BPD are not fucking evil. And if you’ve ever been made to feel like you are, I am so sorry. And I am here to tell you that is fucked up and that is not about you. That is about your therapist’s own projections of their own issues. If it was your therapist who said that, or who made you feel like that?
Alyssa Scolari [27:43]:
If you go back and you look at the diagnosis, the symptoms for BPD, so many of them, in fact, all of them can also be symptoms of complex trauma, hello. People who have BPD do not have issues with their brain. They have been fucking horribly traumatized. How can you expect somebody, right people, therapists love to say, “Ah, people with BPG they don’t know any boundaries and they’ll, they’ll manipulate you all day.” How could you expect somebody to know what boundaries look like if their whole childhood was full of their boundaries, being violated. If somebody comes into therapy and their whole lives, they’ve had to use manipulation as a tactic to get their needs met. Why would you think for two seconds that they won’t try to manipulate you?
Alyssa Scolari [28:49]:
Manipulation in itself is not evil and we need to stop treating it like it is. People come to therapy with the same patterns and behaviors that they learned from their trauma. And if you want to call it a personality disorder, go right ahead. But I, for one, just feel like using that, almost just as “Hey, you’re fucked up.” Now don’t get me wrong. For some people having this diagnosis is hugely validating. And for those folks, I’m like, “Yes, do it.” If it’s validating, then it’s validating. And that’s great. But for people who have battled with being diagnosed with this disorder over and over again and stigmatized as a result of it, if it doesn’t feel like it fits you, it’s okay to let that go. You don’t have to say, “Oh, I have BPD, Oh I have BPD. This is going to be the rest of my life. I’m going to struggle for the rest of my life.” No, you’re fucking not. No, you’re fucking not.
Alyssa Scolari [29:55]:
It infuriates me, as you can tell, because I have worked with people with BPD and I have watched them recover to the point where they don’t meet the criteria for that disorder anymore. BPD is a result so often of complex trauma. And if we start treating the trauma, right, there’s a treatment for borderline personality disorder. It’s called DBT or Dialectical Behavioral Therapy. And it’s really something that was created for people with borderline personality disorder. And it’s great. It teaches so many wonderful skills. If we use that and we treat the trauma that is underneath it, I have seen people that no longer meet the criteria for that diagnosis. And more importantly, I have seen people that are successful and live happy and healthy lives, and they can be self-harm free and they no longer feel suicidal. And they are in functioning relationships. It doesn’t mean all their problems have gone away. Absolutely not, but it can happen.
Alyssa Scolari [31:08]:
There is so much hope if you have BPD. And again, if you’ve ever been made to feel like your mental health is hopeless because of this diagnosis. I’m so sorry. And that is part of why I wanted to talk about this today is because I wanted to fight the stigma because this stigma, I’ve experienced the stigma firsthand, I’ve been thrown out that diagnosis. And what I know now about myself is no, I don’t have BPD. I have trauma. I have a crap load of complex trauma that I have been working through. And I have gotten to a place where it’s just like, yeah, no. For me, that diagnosis felt more harmful than validating and I think that’s because I’m so acutely aware of the stigma.
Alyssa Scolari [32:04]:
Now, again, if this is something that feels good for you, if it helps you to have this diagnosis, please don’t let me talk you out of that. Because despite the stigma that I’m talking about for every bad therapist out there, there are a million great therapists who would never stigmatize people. And there are a million people out there who have this diagnosis and have found it super validating and helpful.
Alyssa Scolari [32:34]:
But I’ve also talked with plenty of people who have had this diagnosis used against them, haphazardly given to them. I’ve had 10-year-olds that have come to me and told me that previous therapists have given them a diagnosis of borderline personality disorder. Their parents come to me in disarray, frantic about what this is going to mean for the future of their child. And it’s just not like that. There is hope. There is hope. No matter how you feel about the diagnosis, there is, there is hope. And that’s my message today. You have hope. I believe in you. I know you can do it. I love you. And I am holding you in the light.
Alyssa Scolari [33:19]:
Thanks for listening everyone. For more information, please head over to lightaftertrauma.com or you can also follow us on social media. On Instagram we are @lightaftertrauma and on Twitter it is @lightafterpod.
Alyssa Scolari [33:36]:
Lastly, please head over to patreon.com/lightaftertrauma to support our show. We are asking for $5 a month, which is the equivalent to a cup of coffee at Starbucks. So please head on over again. That’s patreon.com/lightaftertrauma. Thank you. And we appreciate your support.