Borderline Personality Disorder / ep50 show notes

Updated: Mar 27



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EPISODE MAP -

  1. main topic

  2. Announcements

  3. A homework assignment

  4. A request of you


A few disclaimers:

  • Put yourself first. I keep every episode as safe as I can, but just by the nature of the topics, you may experience some stuff come up. Take a break if you need to. This one doesn’t go into trauma details of course, but it’s a pretty hefty one as far as the depth we’re going to go.

  • This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of depression, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider.

  • And these are my personal conceptualizations about how the PVT connects to the DSM. I’m not suggesting you think the same way. In reality, these diagnoses are often very different between providers. And even when agreed upon, they’re potentially understood in very different ways. So this is how I am viewing them in general. As a starting point.



BORDERLINE PERSONALITY DISORDER & THE PVT


A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:


Key words already: “instability of interpersonal relationships” and “impulsivity” as well as themes around confidence or self-esteem

  • disorder may be rooted in development of the self, which suggests a layer of shutdown; “self-image” is also a key word here

  • Impulsivity may have something to do with energy returning, from shutdown into sympathetic or the stuck sympathetic freeze energy getting triggered. Either way, a layer of sympathetic activation here potentially.

  • Impulsivity will have something to do with a weaker vagal brake, especially considering the social impairments of BPD

Being with the self in the present moment is impaired

  • Same for all these “disorders,” there is a lack of being in the present moment


“Present in a variety of contexts”... why not all?

  • Same issue as with ADHD and neurocepting safety


1. Frantic efforts to avoid real or imagined abandonment.


“Frantic” - there is an element of energy, a sympathetic charge to it

  • But the word “frantic” seems very chaotic to me, like there is fear mixed in to the sympathetic charge

  • Not just flight energy, not just fight


If it was “just” those energies, they could be directed at what they need to be directed at, like running away from a predator

  • But when those energies are thwarted, or not allowed to complete what needs to happen to get to safety, then fear combines with it and changes those defensive bodily impulses into something else


The primary autonomic sympathetic state does not involve fear, it involves bodily instincts and impulses that are acted upon to run or fight. When the energy is not able to complete through an action like running or fighting, then the fear comes in.

  • And that’s where that more frantic energy is going to come from


But this also relates to trauma - the sympathetic energy can’t discharge and the body is immobilized while charged, keeping the energy stuck inside

  • This is the Freeze mixed state - the Freeze energy being triggered is very chaotic or frantic

  • Not just flight energy, but panic

  • Not just fight energy, but rage

  • Both are more chaotic, both are frantic; there is less control of the self and less control of the real world; heightened danger and a perception that one’s life is under threat if some action is not taken; something, anything


“Real or imagined” - unhealthy neuroception detects risk when there might not be any there


Neuroception is the unconscious detection of safety or danger cues in the environment - can be healthy or unhealthy

  • When we’re stuck in a flight/fight/shutdown/freeze state, we see danger where there is none and we amplify danger that isn’t needed to be amplified

  • This unhealthy neuroception is going to pick up on danger cues - triggers to the freeze energy - that may or may not be based in actual danger cues

  • One of those danger cues could be loneliness, isolation, being left alone, rejection, abandonment…

  • The other person is the safety, there’s a dependence on that person. So when there’s a perception of them leaving, it’s a significant danger cue connected to abandonment.


“Abandonment” - probably due to unhealthy attachments

  • There is a definite higher rate of hx of trauma and abuse from childhood in BPD

  • Is it actual abandonment or a story follows state? Is the person actually leaving them or is there a shift in the autonomic nervous system, which then gets translated into a story of abandonment?

  • The story could very well be accurate. It could very well come from past history of actual abandonment. But it might also be the brain’s best attempt at explaining what is happening in the ANS state shift, which is of course based on the past and applied to what is currently happening.


Now combine the frantic energy - the rage or panic energy - with a perception of being abandoned and everything that comes along with that

  • I think this nervous system - of the individual dx’d with BPD - clearly recognizes that connection and safety are biological imperatives and a must in life, but lacks the sense of self to be themself and bring themself to a safe connection with safe others

  • We all need connection, but to be a full part of a relationship we need to bring our full self; we need to have the self love first, the connection to our self in the present moment, then we bring our self to someone else’s self, who is also in the present moment = healthy relationship

  • How often does this actually happen? Probably actually very seldomly.


Peter Levine uses the word “vortex” to describe how trauma lives and stays in the body, I like it for conceptualizing the relationships being described here. It’s a swirling vortex of disconnection from others and from the self:

  • something in the real world or a perception of something happening in the real world → then experienced as a danger cue, which triggers the stuck Freeze energy from prior actual abandonment and/or abuse → then an impulsive action that stems from that frantic energy as a way to channel the stuck freeze energy → then feelings of shame and guilt for having acted on the frantic fear of abandonment, on the rage or panic → then real life consequences for whatever might have happened during those actions which come from the frantic fear of abandonment → then seeking the comfort of others as an attempt to regulate the underlying ANS… but this person has extreme difficulty with recognizing safe relationships due to probably some early life unhealthy attachment and trauma → then you can probably guess where this goes next… It repeats.

  • It’s a swirling vortex of disconnection from others and from the self


2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.


In defensive states, critical thinking is compromised, like I discussed with OCD in episode 49

  • As someone said in the comments - it’s an issue of being able to hold two truths at the same time, to be able to think in black and white, not black or white

  • “And” indicates two truths at the same time - to see where you’re coming from and also where the other person is coming from; being able to see another’s perspective and acknowledge that both are potentially valid

  • But to do so requires we have access to our safety system

  • Not having access to the safety circuitry leads to the “idealization and devaluation” - either the person is all good or they’re all bad

  • versus they’re just a person who messed up or they’re just a person and I messed up or they’re just a person and not the right fit for me or we’re both just people and not right for each other

  • But i can still love myself, i can still maybe love them but not be with them or i can forgive them but not be with them…

  • Being able to see these more balanced potential truths requires access to a calmer way of thinking which is only in the safety state


An “unstable and intense interpersonal relationship” sounds like a hefty level of sympathetic energy to it

  • There’s a chaos to it, a frantic energy - a panic or a rage or both, specifically

  • Fighting, breaking up, blaming, withdrawing, obsessing, jealousy, wondering, impulsive sexuality, self-harm - all require sympathetic activation

  • There’s blame in the idealization or devaluation, there’s aggression, an assignment of value.

  • Very sympathetically charged thinking

  • The black or white thinking is still there, the person is idealized, they’re all good

  • Very sympathetically charged thinking


Could the “idealizing” be stemming from flight energy?

  • Being saved, being safe, being protected

  • Someone else hurt them and this new person is the one they’re running to


Could the “idealizing” be stemming from a return of the fight energy from shutdown?

  • The other person is again the savior, bringing them connection

  • They aren’t actually fighting, but there’s a return of energy, from shutdown into sympathetic intensity


Could the “devaluation” be stemming from fight energy?

  • Lots of blame and judgment toward another; it’s aggressive and accusatory

  • Could this be a fluctuation between flight and fight energy toward that person?

  • More or less moving up and down the sympathetic rungs on the polyvagal ladder?


Or could this be the freeze state?

  • Ideally, it needs to slowly thaw, warmed by the social engagement system. But when the freeze energy is triggered, it’s more like the ice shatters.

  • I wonder if this is what we’re seeing with the intense and unstable interpersonal relationships


It’s ultimately on an individual basis, but these are some possible paths


The other person is bringing them some level of relief or distraction from their own inner pain. But that’s not the same as actually reaching the top of the polyvagal ladder and accessing the safety state and being able to connect with the self and with the partner in a relationship


3. Identity disturbance: markedly and persistently unstable self-image or sense of self.


1 and 2 had a sympathetic charge to them, probably a Freeze mixed state

And here in number three is where we see the shutdown evidence of the Freeze equation


A key piece of BPD is the inability to define their own identity and being dependent on another to do so

  • The unstable self-image or sense of self sounds like shutdown to me

  • Disconnected from the self, from the deeper emotional experiences, connective experiences, personal values, fuller range of thoughts and the underlying bodily sensations

  • Very much a disconnection

  • Not a full on dissociative thing, but there is very much a disconnection and ability to simply be with the self, like with OCD


This disconnection from the self combined with the intense frantic sympathetic energy is a scary thing because it results in dependency on another for emotional well-being

  • This is not co-regulation or inviting assistance or seeking support from another, this is dependence


4. Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).


  • PVT concept of behavioral adaptations, similar to the compulsions of OCD

  • Intense, frantic, panicky, rageful energy that is directed toward “potentially self-damaging” impulsive bx


“Impulsive” - no thought behind it, no planning, just sympathetically charged action

  • But toward what? Why is this happening?

  • These reckless bx are avenues for the sympathetic energy

  • But there’s no mindfulness or ownership over the underlying sensations

  • So it’s just impulsive, chaotic action which probably comes from the chaotic freeze energy stuck within

  • There’s no ability to sit with the energy and be with the inner self


These might be the person’s best attempts at coping, at seeking relief, seeking feeling grounded or discharging the energy...

  • This is a behavioral adaptation that Dr Porges talks about. The energy is too much, so they alter their behavior to discharge it

  • But it fails, then reinforces the stuck state with blame, guilt, shame and consequences from their choices


These are also all outward attempts to deal with the intense stuck freeze energy… but what if this intense stuck freeze energy were directed inward?...


5. Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour.


“Between 60% and 78% of patients with the disorder have shown suicidal behaviours, with more than 90% engaging in self-harm.44,45” -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494330/


This is very much a Freeze thing or a shutdown thing

  • With freeze, the intense stuck sympathetic energy doesn’t just disappear on its own

  • It’s either going to be directed outward or inward when the ice shatters


That’s why we need the social engagement system, the safety circuitry to strengthen and slowly warm the freeze state

  • I think suicide and self harm is what we see when the intense stuck freeze energy is directed back toward the self (Peter Levine)


With shutdown, the returning intense sympathetic energy doesn’t just go through the self without the person being able to handle it

  • They’re going to direct it outward or inward


The trick, at the deepest levels, is not to direct it outward or inward through action, but to simply be with it and witness its process

  • It’s imperative we not wait for a crisis to be mindful, can’t simply rely on coping skills when there’s a problem

  • Do the work ahead of time, in moments of non-crisis

  • This is going to result in greater capacity to handle the crises, more sense of self, more feelings of connection and reduction in intensity of feelings...


6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).


“Affective instability” - rapid and intense mood swings that are difficult to control

Sound like sympathetic?


But instability = chaotic freeze energy, which we see in this next piece -


“Reactivity of mood” - reactivity being the key part here.

  • Intense mood that has a Freeze undertone to it

  • Weaker vagal brake; less ability to tolerate distress

  • The freeze energy is easily triggered due to a weaker vagal brake, resulting in a chaotic level of sympathetic energy when triggered


Need a stronger social engagement system

  • b/c there is a significant social impairment with BPD

  • They seek social regulation, but don’t have the system to actually accept co-regulation


All of this = Chaotic freeze mixed state feel to the affective instability; that intensity feels like the tenseness of freeze to me, like walking on ice


7. Chronic feelings of emptiness.


The feeling of emptiness is very much a shutdown thing

  • Foggy, grey, numb, disconnected


It’s the conscious emotional experience of the stuck shutdown state, like in depression

  • I can see an underlying, chronic feeling of emptiness along with the freeze energy since shutdown is a piece of the freeze equation


But it’s the emptiness plus the stuck chaotic sympathetic energy


8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).


“Intense” - Sounds like the rage associated with the freeze mixed state


“Inappropriate” - the individual is experiencing and filtering the world in a much different way then those around them potentially

  • Triggered easily and can be very intense


When in defensive states, our thoughts change as well and we become very good at rationalizing our choices

  • It’s dangerous to admit fault in these states, to be vulnerable

  • Have to be in the safety state to actually feel sorry or take responsibility


9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Dissociative sx stem from a shutdown state or a mixed freeze state

  • When in shutdown, we dissociate or go numb

  • Benefit to the potential survivability of the prey

  • Chronically = Disconnected from the true self

  • Depersonalization - detached from the self

  • Derealization - detached from reality


BPD and Trauma

“Subjects with borderline personality disorder had significantly higher rates of physical abuse in childhood/adolescence than subjects without borderline personality disorder, with gender controlled (52.8% versus 34.3%; χ2=5.43, df=1, p=0.02), but the groups did not differ in their rates of sexual abuse (29.2% versus 19.4%; χ2=1.46, df=1, p=0.23) or of other types of trauma in childhood/adolescence.” https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.160.11.2018


Borderline personality disorder was not significantly associated with physical assault, sexual assault, or any other type of trauma in adulthood...

Stems from childhood trauma


Subjects with borderline personality disorder had a significantly higher rate of PTSD than subjects without borderline personality disorder (25.0% versus 13.0%).


  • Though this does not include CPTSD

  • I’d anticipate higher levels of trauma that the person has dissociated from.

  • Trauma memories can lay dormant for a long time.

  • There is a big focus of the individual dx’d with BPD on the outside world and a clear deviation from the internal world

  • Who knows what’s going on inside?


ANNOUNCEMENTS -

  • I’ve got a few segments with Mercedes that have yet to be published for everyone. Members exclusive and podcast listeners.

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  • Make sure you’re caught up btw. I’ve had mini episodes on art therapy and Mercedes’ and my first impressions of each other recently.


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