The heavy price you'll have to pay to have a healthy relationship (with David Burns)
Kayla Spicer discusses Borderline Personality Disorder, its symptoms, and the challenges of diagnosis and stigma. She shares her personal journey and effective strategies like Dialectical Behavior Therapy (DBT) for managing BPD traits and fostering healthier relationships.
Deep Dive Analysis
18 Topic Outline
Introduction to Borderline Personality Disorder and Stigma
Kayla's Personal Journey and BPD Diagnosis
Rejection Sensitivity and Attachment in BPD
The Concept of a 'Favorite Person'
Impact of BPD on Identity and Self-Worth
Emotional Intensity and Risk-Taking Behaviors
Splitting as a Defense Mechanism
Understanding Anger and Big Reactions in BPD
Challenges with Diagnostic Labels and Categorical Models
Advice for Partners and Friends of Individuals with BPD
The Role of Boundaries in BPD Relationships
Dialectical Behavior Therapy (DBT) as Treatment
Core DBT Skills: Distress Tolerance and Interpersonal Effectiveness
Self-Compassion and Broader Benefits of DBT
Overlaps and Distinctions with Other Personality Disorders
Quiet BPD, Self-Harm, and Emotional Reasoning
Giving Criticism and Seeking Help for BPD Traits
Supporting Loved Ones and Reducing BPD Stigma
7 Key Concepts
Borderline Personality Disorder (BPD)
An enduring pattern of rigid, inflexible thoughts, behaviors, and emotions emerging in adolescence/early adulthood, pervasive across life aspects. It is often described as a disorder of attachment and perception, stemming from a fundamental feeling of being inadequate or unlovable.
Dialectical Behavior Therapy (DBT)
The gold-standard treatment for BPD, developed by Marsha Linehan, which combines individual psychotherapy with weekly group sessions. It teaches specific skills in distress tolerance, emotion regulation, and interpersonal effectiveness to help individuals manage intense emotions and improve relationships.
Splitting (Defense Mechanism)
A tendency to view people, situations, or oneself in extreme all-or-nothing terms, lacking complexity or gray areas. This often stems from childhood trauma where it was difficult to reconcile good and bad aspects of a person or situation, leading to a need to categorize for safety.
Favorite Person (BPD)
A concept within the BPD community referring to a person an individual with BPD depends on almost fully, idealizing them and feeling unable to function without them. This hyper-dependence is an adult recreation of seeking security from primary attachment figures due to an insecure attachment with oneself.
Biosocial Model (BPD)
Marsha Linehan's conceptualization of BPD, suggesting it arises from a combination of biological vulnerabilities (like high sensitivity) and social/environmental factors (like chronic invalidation) that reinforce extreme emotional reactions and behaviors.
Emotional Reasoning
A cognitive distortion where one perceives an intense emotion as reality, believing that because they feel a certain way (e.g., angry), the external situation must objectively reflect that feeling (e.g., the other person wronged them). This is common in BPD due to difficulty understanding and regulating one's own feelings.
Quiet BPD
An informal term describing individuals who experience BPD symptoms more internally, 'acting in' rather than 'acting out.' Key traits include people-pleasing, unhealthy boundaries, self-sabotage, shame, and a strong desire to avoid conflict, often directing intense emotions inward.
12 Questions Answered
Therapists may be hesitant due to the perceived emotional volatility, unpredictability, and rigidity often associated with BPD, as well as the high rates of suicidality and self-harm attempts among individuals with the disorder, which can be emotionally heavy for clinicians.
A 'favorite person' is an individual with BPD depends on almost fully, idealizing them and feeling unable to function without them. This person serves as a source of security and self-worth, compensating for the individual's insecure attachment to themselves.
Without a 'favorite person,' individuals with BPD often experience an increase in maladaptive coping mechanisms, such as self-harm, suicide attempts, and substance use, as a response to feeling completely alone and emotionally distressed.
Childhood trauma can destabilize a child's ability to form coherent mental models of the world, leading to a lack of a clear sense of self. This wound is carried into adulthood, making it difficult to establish an independent identity.
Splitting is a defense mechanism where individuals with BPD perceive people, situations, or themselves in extreme all-or-nothing terms (all good or all bad). It often originates from childhood trauma, where it was too difficult to reconcile conflicting good and bad aspects of significant figures.
Intense reactions can stem from a combination of factors: learned behavior where extreme emotional displays gained attention, the immense pain caused by perceived slights due to high sensitivity, and projecting impossibly high standards onto others.
Men with BPD may express symptoms as chronic anger or compensate with substance use, rather than the more commonly recognized self-hatred or emotional lability seen in women. This can lead to misdiagnosis due to a clinical bias viewing BPD as a primarily female disorder.
The prevalence of BPD is estimated to be anywhere from 1% to 6% of the population, with some estimates closer to the 6% mark, making it one of the most prevalent personality disorders.
Partners and friends should prioritize self-care, set firm boundaries, validate the person's feelings without validating ineffective behaviors (only 'validate the valid'), and encourage the individual with BPD to seek professional therapy.
DBT is an evidence-based treatment for BPD that typically involves weekly two-hour group sessions teaching specific skills (distress tolerance, emotion regulation, interpersonal effectiveness) paired with one hour of individual psychotherapy per week, usually for a full year.
Self-harm serves as a coping mechanism for intense emotional distress, providing an emotional release and physiological relief by releasing endorphins. It can also be a way to feel something when experiencing chronic emptiness or an act of self-punishment due to feelings of worthlessness.
When giving criticism, it's helpful to first ask if the person is receptive, offer reassurance and appreciation, use 'and' rather than 'but' language, and frame the feedback as a request for mutual benefit, while remaining calm and loving.
12 Actionable Insights
1. Reduce BPD Stigma & Foster Compassion
Cultivate compassion and open-mindedness towards individuals with Borderline Personality Disorder (BPD), understanding it is a painful condition stemming from sensitivity and past experiences, not a choice. This approach helps reduce stigma and fosters empathy for those struggling with the disorder.
2. Seek Professional Help for BPD
If you experience traits like emotional dysregulation, mood swings, or high sensitivity, seek therapy from a comfortable and supportive therapist. This can help you understand your experiences and determine if Dialectical Behavior Therapy (DBT) or a diagnosis is beneficial for maintaining healthy relationships.
3. Commit to DBT Therapy
Engage in Dialectical Behavior Therapy (DBT), the gold standard treatment for BPD, which typically involves weekly two-hour group sessions on distress tolerance, emotion regulation, and interpersonal effectiveness. Pair this with one hour of individual therapy for a full year to effectively manage BPD traits.
4. Prioritize Self-Care as a Supporter
If you are a partner or friend of someone with BPD, prioritize your own self-care and consider seeking therapy for yourself, as these relationships can be emotionally draining. Remember you are not their therapist and they need to do their own work.
5. Establish Firm Boundaries
Be firm and consistent with boundaries when interacting with someone with BPD, validating their feelings but never their ineffective or harmful behaviors like self-harm or name-calling. This teaches secure attachment and prevents reinforcing maladaptive patterns.
6. De-escalate Emotional Storms Calmly
When a person with BPD is highly emotional, remain a stable presence by not getting swept into arguments. Calmly state your love and commitment, suggest a break to cool down, and return to the conversation later, modeling that temporary disconnection does not mean abandonment.
7. Use DBT’s TIP Skill
Utilize the DBT “TIP” skill (Temperature, Intense Exercise, Paired Muscle Relaxation, Breathing) to physiologically regulate your nervous system during intense emotional distress. These bottom-up techniques help calm the body when reasoning is ineffective.
8. Apply DBT’s DEAR MAN
Employ the DBT “DEAR MAN” technique for effective communication and making requests: Describe the situation factually, Express your feelings, Assert your request, Reinforce the benefits, stay Mindful, Appear confident, and be open to Negotiating. This structured approach helps achieve better outcomes without emotional reactivity.
9. Practice DBT’s Check Facts
Practice the DBT “Check the Facts” skill to de-escalate intense emotions by objectively identifying verifiable facts of a situation, distinguishing them from assumptions, and then examining fears and worst-case scenarios to gain a more realistic perspective.
10. Develop Self-Compassion
Cultivate self-compassion by learning to “reparent” yourself and develop a secure attachment with your inner self. Be mindful of your suffering, acknowledge it as part of the human experience, and offer yourself kindness and validation (e.g., “you’re doing your best”) without false reassurances.
11. Offer Criticism Carefully
When offering criticism to someone with BPD, first ask if they are receptive to feedback, then provide reassurance and use “and” instead of “but” language. Consider using a fictional scenario to illustrate the point before relating it to their specific behavior to reduce personalization and feelings of defectiveness.
12. Build External Support Networks
If a person with BPD is in an unhealthy relationship, encourage them to build a support network outside that relationship, such as through volunteering, work, or friends. This helps them feel they belong to something bigger and provides a lifeline if they choose to leave the relationship.
10 Key Quotes
I would say borderline personality disorder is very heavily stigmatized, for those that know about it, to the point where I've even heard of therapists refusing to work with people because they told them that they had it.
Spencer Greenberg
It's because we have this sense of not being good enough fundamentally. So criticism can feel like a form of rejection or abandonment. And that's why sometimes moods get so dysregulated.
Kayla Spicer
It's really always looking for a threat. And sometimes creating that threat for ourselves, because we in some weird way feel the most secure in feeling abandoned, because that's all we know.
Kayla Spicer
If you don't know who you are, and the only worth that you attribute to yourself is negative, then you need other people to tell you your worth in the world.
Kayla Spicer
I think that the numbness can coexist with the intensity in emotions. And to some degree, you could even make the argument that this emotional reactivity is a way of compensating for the fact that you feel chronically numb.
Kayla Spicer
It's not something that's done intentionally. It's just this knee jerk reaction to being so scared of being abandoned.
Kayla Spicer
When we're dealing with situations that are so intense or can be so intense, it's really easy to feel burnt out, to feel completely drained, to lose a sense of who you are as a person, even sometimes leave those relationships, not feeling so trusting anymore of others or not feeling so securely attached anymore, because it can be traumatic to have to bear witness to someone self-harming and feel as though you're responsible for those things.
Kayla Spicer
We can help you before it happens. But you also need to be able to put in your skills and healthy, effective coping mechanisms once the thing has already occurred. And they need to learn how to do that without relying fully on others.
Kayla Spicer
It's not abandoning them. But it's also showing them that people can leave and still love you and come back and be true to their word, because that's probably something that they've never had. And what a gift that is to offer it to them.
Kayla Spicer
I think everyone could benefit from learning DBT. To be quite honest, whether or not you even have traits of BPD, I think these are just life skills that people should have.
Kayla Spicer
4 Protocols
DBT Phone Coaching Rules for Self-Harm
Kayla Spicer- Clients are allowed phone consultations/coaching when they feel they are about to engage in self-harm behavior.
- If a client has already engaged in self-harm behavior and calls their therapist after, the therapist will hang up.
- The client is not allowed to call for 24 hours after engaging in self-harm and calling the therapist.
- The purpose is to set boundaries and not reinforce self-harm, encouraging clients to use skills before or cope effectively after.
TIP Skill (Distress Tolerance)
Kayla Spicer- Temperature: Use cold exposure (e.g., cold water on face) to regulate the nervous system when dysregulated.
- Intense Exercise: Engage in vigorous physical activity (e.g., running, push-ups, jumping jacks) to regulate emotions.
- Paired Muscle Relaxation: Intentionally tense up parts of the body and then relax them progressively.
- Breathing Exercise: Exhale longer than you inhale.
DEAR MAN Skill (Interpersonal Effectiveness)
Kayla Spicer- Describe: Objectively describe the situation (the facts, what a camera would see).
- Express: Express your feelings about the situation.
- Assert: Clearly assert your request or opinion.
- ReinfoRce: Explain the positive consequences or benefits for both parties if the request is met.
- Maintain: Stay mindful of your objective during the conversation.
- Appear: Appear confident and effective in your communication.
- Negotiate: Be willing to negotiate and find a middle ground.
Check the Facts Skill (Emotion Regulation)
Kayla Spicer- Identify the facts of the situation (what a camera would objectively record).
- Identify your assumptions about the situation.
- Based on assumptions, identify your fear and the worst-case scenario.
- Determine how you would deal with the worst-case scenario.
- Go through the exercise to help de-escalate feelings and connect with reality.