Episode #131

Borderline Personality Disorder (BPD) & CBT

The highs and lows of Borderline Personality Disorder (BPD) can be challenging to deal with, whether you have BPD or a loved one lives with BPD.

What are the symptoms of BPD?

What therapy modalities can help?

How can you use CBT tools to help you live with BPD?

Join me, Dr Julie Osborn, as I share with you how you can use CBT to cope with Borderline Personality Disorder.

Click to listen now!

Full Episode Transcript

Hi, it's Dr. Julie, and I'm a doctor of psychology and a licensed clinical social worker specializing in Cognitive Behavioral Therapy. I'm here to help you bring the power of CBT into your own life.

So thanks for being with me. I hope everyone's doing well. I'm going to start off with a message I received on my Instagram page after my last podcast that came out, which was behavior and CBT, and I talked about underlying assumptions and how that affects your behavior.

So one of my listeners shared that,

“Changing habits has always been a difficult task for me. A couple of years ago, I started vaping, for instance, and I've been meaning to leave it as a weekend-only activity, but it's so hard. Also for 10 years now, I've been familiar with anxiety and obsessive personality traits. For me, it's always been really helpful to jot down my thoughts. It's not on a daily basis, but at least on a weekly one. But I always end up making excuses not to set aside the time to do so. For some reason, it always feels like there's something better to do. Looking forward to listening to this episode. Your podcast meant the world to me during the pandemic years.”

So thank you very much, Ivan, for sharing that. And a couple of things I wanted to say that came to mind when I read this was when he shared that there's always something better to do and he always feels like doing something better. That goes into my mantra, right? Is make decisions based on his best for you, not how you feel. And that it's really normal when we want to make changes, that it's not going to be one and done. It's not simple. It's a process. Sometimes we take three steps forward, two steps back. The most important thing is you keep going forward, you create a plan, and you start using your tools. So writing things down on a daily basis is great. Creating a schedule. I recommend a lot of my clients to use their phone to put notifications in, like O to do with all record, or if you're using the mindovermood book, my clients use depression, anxiety inventory, and having to do those once a week, the depression one and the anxiety one, is always a good reminder because I understand life gets busy and it's like, Oh, another day went by, another day went by, another day went by.

I didn't do anything. I didn't do any reading. I didn't write a thought record. So you really have to create some structure at first to really learn the tools. Eventually, the goal is that it'll just be automatic. When you're having a negative mood, you're going to be in your thoughts a lot quicker. But I love what he shared is that it has been difficult. He does try to write down his thoughts, but he sees it. Sometimes it's a back and forth thing. So we all need to give ourselves some grace, not about beating ourselves up, but it's about having a plan and taking one step at a time. So again, as always, please share. I love getting your emails, your comments on, again, my Instagram or my Facebook page. You can email me as well. I'll go over all that stuff at the end of the podcast, but I'm very easy to reach, and I always respond back. I appreciate you guys taking the time and letting me know how the podcast is helping. So today, based on a couple of requests, I'm going to talk about borderline personality disorder. I know back in my catalog, I did a podcast on all different personality disorders, and then recently, I did one on just a narcissistic personality disorder, and that one was requested also.

It's very common. And borderline can be pretty common, too. But a lot of people don't know about it. But I think once you listen to this podcast and you learn, it might relate or resonate with you or somebody in your life. I would say the experience that stands out to me is I've met a lot I have people coming in saying, I'm dating this person. They're all over the place. They scare me. Things are great or they're terrible, and I'm not really sure what's going on, and they blame themselves. And once I get more information, a lot of times I can tell them that the person they're dating Maybe I have borderline personality disorder. They also call it BPD for short, and to understand, and then they can make a decision whether they want to address that with their partner or they want to move on. So that's how it's come up in my therapy office a lot. I have worked with some people with borderline personality. There's also another therapy that overlays with CBT, which is called DBT, which is Dialectical Behavioral Therapy, which is really highly recommended if you have borderline personality disorder.

So as always, I'll talk about some referrals at the end so you guys can get the help you need if you want to. So let's first talk about what is borderline personality disorder. So it is a mental health disorder, and it's characterized by patterns of instability in your mood, your behavior, your self-image, and your interpersonal relationships. And people with BPD AD often experience intense and rapidly shifting emotions. They have difficulty regulating their emotions, and they struggle with a strong fear of abandonment. And that fear really feeds into that instability of their moods. So the term borderline originally referred to the belief that individuals with this disorder were on the borderline between neurosis and psychosis. But this is super outdated and misleading. So If that's what you look, if you look this up, that is not what we're talking about anymore. So let's talk about what some symptoms are and different features if you have BPD. So the first one is intense and unstable emotions. That's the one that I think is most easily to see, especially if you're in a relationship with someone or if it's you, that you just feel really unstable and your emotions are all over the place because they can be so intense, but they rapidly change.

And this could be feeling angry, feeling anxious, feeling sad, feeling irritable. The emotions are often disproportionate to the situation and are really difficult to regulate. So if you're like, Okay, why am I freaking out over something that seems small, that's where it's disproportionate. Or if you're with someone going, God, you're making this much bigger than it is, and the person is freaking out, again, it's hard to regulate their moods. They may be getting triggered about their abandonment issue. So there's a lot of things that cause the instability in their emotions. And because of the fear of abandonment, which is one of the symptoms, it's very pervasive, and they're very fearful of being abandoned by loved ones. So this can really lead to these frantic efforts to avoid real or perceived abandonment. It's really important to remember the perceived abandonment because when your mood is not stable, your perception is going to be off, and you may see others' behavior as abandoning, they're going to leave me or they're thinking about it, when it's not true whatsoever. And then having this fear, it can manifest in a really clingy behavior, extreme reactions to separation, and a really hard time trusting others.

Very difficult to trust other people. Another characteristic is having unstable relationships. So people with borderline personality disorder often have really tumultuous and unstable relationships. And some of the characteristics are this idealization and devaluation. So this is where I say they either idealize you in one moment and then they can demonize you the next. This leads to really frequent conflicts and difficult maintaining relationships. I've had this when I worked in psychiatric hospital years ago, and I really wasn't trained with this, and I wasn't sure what was going on until I got some more education and my supervisor helped me out. But I remember having a client that just thought it was the greatest thing in the world, and I didn't do what she wanted. She hated my guts, so I would pound on my door. Again, this was a psych hospital, so people were trying to get stable. But I remember thinking, what is going on? So they either think you're the greatest thing or they think you're the most horrible. And that's why if you're in a relationship with someone who has BPD, it can be very difficult and very hard to know how to even work with this person's personality.

You don't want to make things worse, but you can't just feed into it. And you don't want to just put a bandaid and make things better. But it's important to understand like, whoa, this isn't about me. This person is really unstable. They need some help. And we need to talk about this. I might need to leave the relationship. If you're the person with borderline, it's important to get some help so you can learn how to regulate your moods. You're not stuck this way. That's important. Another characteristic is a distorted self-image. So people with borderline personality disorder have a distorted sense of self, and they really struggle with identity issues. So they may experience feelings of emptyness and uncertainty about who they are and what they want in life. Also, they can have really impulsive behavior. They can be impulsive and even risky. These are really common with people with BPD. Some examples would be substance abuse, reckless driving, binge eating, and self harming behaviors like cutting. So these behaviors often serve as a way for them to try to cope for dealing with all these intense emotions or relieving these feelings of emptyness. So you can see it's not just about, Oh, no, if I have someone in my life like this, but Someone with BPD, you really are going to struggle and a lot of turmoil, and it's really hard to know what to do, and you don't even understand what's going on.

So again, I'm hoping if you're relating to any of this, it will start having some clarity on what direction to go to get some help. Another symptom is dissociation. Some individuals with BPD may experience episodes of dissociating where they feel disconnected from themselves or their surroundings. So this can range from feeling this mild attachment to more severe episodes. So it's like to explain what that is, is if you're outside your body watching what's going on. So you feel very disconnected to yourself, which can feel really scary, as you can imagine, right? And then one more characteristic is this chronic feeling of emptyness. So many individuals with BPD report feeling chronically empty or devoid of a sense of purpose or meaning in life. So just imagine, right? You got all these emotions, highs, lows. You're feeling empty. You're afraid of being abandoned. Your relationships are up and down. It's a lot to deal with, right? Just talking about it out loud, you can hopefully have a lot of empathy for people that are struggling with this to understand how difficult it is. And it's important to note, though, that everything I mentioned, not every single symptom, everyone with borderline will experience this, and the severity of them will vary greatly.

It's not black and white, but I'm just giving you guys a baseline here. People with borderline personality disorder can significantly impact functioning in lots of areas of their life, including work, relationships, and obviously overall well-being. But again, with good therapy and good support, people with BPD can learn to manage their symptoms and really have fulfilling lives. So normally with treatment, it's therapy, like I said, CBT, as I mentioned earlier, to the DBT, medication, if the person is also dealing with depression or anxiety. And then again, other support from family, loved ones, and maybe support groups and other professionals. So if you're going to reach out for help, you want to ask somebody if this is something that they work with, they even specialize in, I would recommend, and see what type of resources that they have for you as well. So now that we know what borderline personality disorder is, I want to talk to you guys about why do people even develop this? Because you're not born with personality disorders. They are developed based on life situations. It's really complex, and it's influenced by a lot of different things, which include your genetics, biology, environmental, psychological factors.

While the exact cause of BPD is not fully understood, I'm going to just share some factors that could contribute to it developing. So one, again, is genetic factors. So there is some evidence to suggest that Genetics play a role in the development of BPD, and individuals with a family history or other mental health disorders might be at higher risk of developing this within themselves. However, having a genetic predisposition doesn't guarantee that you're going to have BPD because environmental factors play a huge role also. But there could be some genetics, so there's just some evidence that's not seen as black and white. Another factor is brain structure and function. The research shows they found differences in the structure and function of certain brain regions with people that have BPD. It's pretty interesting, right? And particularly those involved in emotion regulation and impulse control. So the part of your brain that's involved with emotion regulation and impulse control, they have found a difference in the structure. So these differences, they say, may contribute to the emotional dysregulation and the impulsivity seen in BPD. So having the brain scans is pretty It's interesting when it can show us, right?

Another huge one is early life experiences. And adverse childhood experiences such as abuse, neglect, trauma, or inconsistent caregiving are commonly associated with people that have borderline personality disorder. So your experiences can disrupt the development of the emotional regulation skills, which then leads to this insecure attachment and shape negative beliefs about oneself and others. A couple of podcasts ago, I did a whole podcast on attachment styles and CBT, so that can be connected to someone that might have BPD. So this is a big one. When I do meet people with borderline personality disorder, my first conversation with them is asking about childhood experiences such as, as I mentioned already, abuse, neglect, trauma, inconsistent caregiving, what was their childhood like, what happened in the home, all of those types of things. So that's a huge factor. They also said there's some biological factors. So imbalances in the neurotransmitters, these are the chemical messengers in your brain, such as serotonin, dopamine. These have been implicated with people that have borderline personality disorder. And the neurotransmitters play a role in your mood regulation, your impulse control, and your stress response, and Normalities in that functioning can contribute to the symptoms of BPD.

You can see there's a lot of stuff going on. It's not just one thing, but it's good to get educated about what are some factors that might be playing a role here. Another is your environmental factors. What stressors were in your environment when you were growing up? Were you under chronic stress, unstable family environments? Did you have significant life changes? All of these can really exacerbate regulate the symptoms of borderline personality disorder, or they can also trigger their onset in vulnerable individuals. So high levels of stress can further dysregulate your emotions and definitely contribute to impulsive and maladaptive behaviors. So what's like a chronic stress is if you're homeless, if you're living in a home where there's alcohol or drug addiction, domestic violence, any environment where as a child, there's just instability. You don't know what's going to happen next. You don't know if you're going to be able to eat the next day. Those huge chronic stressors can definitely be the environmental factors that play a role. And then one last element here is personality traits. There's certain personality traits, just as like someone who's highly sensitive to rejection, really intense emotions, someone who's really impulsive.

They may predispose these individuals to have borderline personality disorder. These traits, when they're combined with the environmental stressors and the genetic vulnerabilities, as well as the life experiences, these can really increase the risk of developing the disorder. As you can see, I know I'm giving you a lot of information, but BPD is really complex and multifaceted. Not everyone with risk factors are going to develop this personality disorder. There's lots of people that have gone through the things I'm talking about and never develop a personality disorder. I want to say also that individuals with BPD can and do recover when they get good treatment and support. As I was saying earlier, there's different therapies, there's lots of support out there that have really shown to be effective in helping people to manage their symptoms and really improve their quality of life and change things around. So where does CBT come into play with all this? That's what we're here We're talking about, Cognobaveral therapy, and how can it help with borderline personality. So we already know that CBT is one of the most widely used and researched forms of therapy for treating borderline personality disorder. I'm among many other things.

So one of the aspects, I should say, with CBT is understanding your thoughts and your emotions. I teach you guys to understand what are you thinking, And how does that create your emotions? So cognitive behavioral therapy can help individuals with borderline personality disorder understand their thoughts, their feelings, and the behaviors, and how it's all interconnected, as I talk to you guys, as well as your physical symptoms. And I would teach somebody with borderline personality disorder to learn to identify and challenge their distorted thoughts and their beliefs that contribute to this emotional distress. And it's a really important tool because as I was saying earlier, people that have BPD, their emotions swing very rapidly. So it's going to be even more challenging to be able to stop and say, Okay, what am I thinking right now? When you feel like your emotions going up and down backwards all the time, you're just reacting, reacting, reacting. So having the structure of CBT can be so helpful to be able to just stop and, Hey, let's walk through a thought record together. What was the situation that was happening before you started to feel this way? Let's write down what are these moods and rate them.

And let's start figuring out what you're thinking so we can start challenging them. And once, hopefully you guys have experienced this already using the tools, is that when you can start figuring out what you're thinking, you start to just feel like you have some control over what's going on and the choices you're making because you're not just reacting off your moods. And that dysregulation that people with borderline feel is it's really hard to be able to feel like you have any control because you're just reacting off your moods. The thought record is just one main tool. There's lots of others that can help, but you can understand how that could be a really good starting point for you if you're struggling with this. Also, just as I mentioned a minute ago, the emotion regulation is super important because people with borderline personality disorder experience such intense and fluctuating emotions. It can just be so overwhelming, which is a mood in itself. So the cognitive behavioral therapy can teach you skills to recognize and manage the emotions in a healthier way. Other than the fall record, this can be using mindfulness techniques. Again, being able to identify your emotions.

A lot of times people don't even know what... It's like, I don't even know what I'm feeling. I'm just all over the place. So we work a lot on being able to identify what are the feelings you're having and really get to the underlying feelings, not just I'm anxious, I'm depressed, I'm worried, but all the other ones. We have hundreds of moods, and a lot of times we get stuck on a couple and we don't really look at the bigger picture, which can help us identify our thoughts better. And then teaching relaxation exercises. So I teach people all the time breathing, muscle relaxation. I recommend people to do meditation, to listen to guided meditation. So whatever can really relax and just calm your system down when you're in that moment of just feeling frantic and just reacting to your environment and your emotions and that fear of abandonment. As I mentioned earlier, this personality disorder is really associated with difficulty in relationships. So the cognitive behavioral therapy can help you improve your communication skills. I teach people how to set boundaries. I teach people how to navigate their interpersonal conflicts more effectively by teaching specific communication skills.

Even being a good listener is part of having good communication skills, being able to listen to what the person is saying so you're not just being triggered and jumping jumping into being reactive. Again, going back to that fear of abandonment as an example. So it's really important to not to communicate. If you're someone that has BPD, to be able to say, You know what? I'm really feeling dysregulated right now. I got too much going on. I need to take a break and I need to get back to you. I'm going to go relax. I'm going to go breathe. I'm going to go do a thaw record. That is a really good tool and a better way to cope. And these are things that you can use so you're not just reacting and affecting your relationships and making it more difficult. I teach people coping strategies all the time. That's part of CBT, to deal with the stressors in your life and the triggers. You want to know, what are my triggers? So it's not just happening all the time. Just say, for example, a trigger could be a really violent movie. If I know that's a trigger for me for whatever reason, if there's any abuse that's going to happen in the movie, I'm not going to go see that.

So I'm going to maybe watch the trailer, read about the movie before I go, instead of just assuming it's going to be okay. That can be a trigger for people. There's lots of triggers that happen. Songs, some things we just can't see coming. But if we can identify the triggers, we're going to be better able to see them coming, avoid them, or how to cope with them when they do happen because they are going to happen. And then everyday stress, we all have stress. We need to know how to work with that. So I teach people how to use problem solving skills, distraction techniques. I tell everybody, distraction, it's not a long term solution, but it is a tool that you can use when you need to. Just go distract yourself. Go turn on a funny show or just go listen to some music you like or go take a walk or call a friend. You don't always have to be in the moment figuring everything out. And definitely building a support network. If this is something you're struggling with, you want to have a really good therapist, you want to be able to share with people you really trust and are loving and understanding, if you can own this is going on, that's going to make a huge difference in your life.

A lot of people... It's very sensitive to tell somebody you may have borderline personality disorder. People are offended sometimes. They're like, No, I'm not. That's a horrible thing. So you have to be able to, as a professional, how to communicate this to someone and help them accept it. Because once you accept, this is true for anything. Once we accept what we have, what we're dealing with, then we can get better, right? Because then we can own it and say, Okay, what can I do to make this less of an issue in my life? How can I cope better? So building a support the work of people that will support you and not make you feel bad because you're dealing with this, or not make you feel bad when you're not having a good day or you do overreact and you're not using your tools. So that's really important to feel safe. Another part of CBT that can be helpful is changing your behaviors. So with CBT, I focus on modifying people's behaviors that can be harmful or counterproductive. So people with borderline personality disorder can learn alternative ways of responding to situations, breaking the harmful patterns, especially if you're doing cutting or any harmful things to yourself, and building healthier habits.

So instead of cutting, what can I do instead that can help me feel calm, keep me present in what's going on, and not use that to feel pain in a different way or even dealing with that dissociation as I was talking about before. So changing your behaviors, obviously, can make a really big difference for all of us, and that's part of the whole CBT. It's also common with having BPD that you most likely have very low self-esteem. So with learning the CBT tools, I can help you challenge your negative thoughts, look at your successes, create ways of seeing yourself in a different way, identifying your core beliefs and changing those, and building up your self-esteem so you can start feeling good about yourself and not just focusing on the negative or the negative that everybody else is pointing out to you, right? Or looking at things that haven't worked or feeling like a failure because of relationships. So it can be Challenging. Like any mental health issue can be challenging. But if you are open and aware and accepting, you can really make big changes and live a very happy, fulfilled life. None of us have to be stuck with anything.

Having borderline personality disorder, it can be very complicating, and you have to take it one step at a time because there's so many different factors that can affect your life. Again, not all of these. You How can you affect your life. It might be one or two. Maybe it could be all. But really do some self-evaluation, have some insight. If I'm relating to any of this, if this is something someone's told me before and I've just reacted really negatively because it sounded so terrible or whatever my impression of what it might be. You might have had half thoughts that that means I'm a terrible person or no one's going to love me or no one's going to want to be with me. I can't manage my emotions. I can never get just like maybe one of my parents or whatever that is or blaming your parents because this happened. I bring up a lot with my clients that I'm not here blaming your parents. Were we just evaluating and assessing what was your environment? It is what it is. We were affected by our environments. I was affected by my environment. All of us are.

That's just the way it is. Our parents, how they parent us, we are affected. And sometimes we have more sensitive personalities, and we take things in a different way than somebody else might. So it's not about blaming anybody. It's just understanding how did this develop? Based on that, what are the things I need to work on? I need to work on my issues of abandonment because I keep creeping up in all areas of my life, right? And I'm not being able to create the life that I want and deserve because I have this personality disorder that has just probably ruled your life. So I'm asking you to give yourself a little bit of grace, some self-love, some self-care, and reach out. There's lots of help out there. Again, seeing somebody who specializes in cognitive behavioral therapy like myself, there's lots of us out there that want to find someone who specialized in it, but also looking for a dialectical behavioral therapist. That's a real specialty with borderline personality disorder. So looking for that. They even have treatment programs that specialize for people struggling with this as well. Some people need some inpatient, some people might just need some intensive outpatient, and some people might be okay just meeting with their therapist once a week.

So go and get evaluated and take suggestion and do what's best for you because you deserve to be happy and have a loving relationship and feel good about yourself and feel successful in your life. You didn't create this. This is something that's happened based on all the things that I talked about, lots of different factors. And it's not always like, why exactly? But what can I do to move forward? We can all figure out why things happen to us, and we don't always have to even figure that out. But we can say, This is how it's affecting my life today. How can I move forward? That's one thing I love about CBT, right? Is that I can spend time trying to figure out my past, or I can say, This is what's affecting me today, and what do I need to do differently to make things better, and use the tools. I practice what I preach, use the tools I teach you guys all the time to make the positive changes in my life so I can be happy as well, and I can manage the stressors in my life. So thanks for listening. I hope this was helpful.

Again, it's just 30 minutes, so there's more to this. Do your own research. If you're looking for a cognitive behavioral therapist, a referral, this is on my website as well, but if you look up feelinggoodinstitute. Com, and you just click on Find a therapist, you put your zip code, you will find somebody in your area. All of us on this referral platform are all specialists in cognitive behavioral therapy. I'm always willing to find you referrals if you need somebody as well. You can always reach out to me on my website, which is mycognitivebehaviouraltherapy. Com, and send me an email. I'd be happy to reach out and give you some direction. I've done that many times. Again, you can follow me, myCBT podcast on Instagram and or Dr. Julie Osborne on Facebook. So please share with anyone that you may think would benefit from this podcast. Keep sharing your thoughts, your concerns, your questions. I love hearing from you guys and getting feedback to you as well. Please hit the subscribe button to make sure you don't miss another episode. And remember, on my website, mycognitivebehaviouraltherapy. Com, I now have a store where you can look at some fun products with my Mantra and other CBT logos.

They're all designed towards your therapy goals. And you can also find that just looking up mycbt.store. On the internet, it'll take you straight there. There's free shipping.

As always, make decisions based on what's best for you, not how you feel.