Borderline Personality Disorder
Episode Description
Like other personality disorders, borderline personality disorder is a commonly misunderstood and stigmatized mental illness. In this episode of Mind Your Mind, host Tim Unsinn talks with Lucas Mitzel, a therapist at Dakota Family Services, about what BPD is, how it affects someone’s behavior, and where to seek treatment if your child has been diagnosed with BPD.What to Expect
- Symptoms of BPD
- The importance of therapy
- Advice for parents
Resources: Learn More
- “I Hate You, Don’t Leave Me,” by Jerold Kreisman, MD, and Hal Straus
- Dr. Bruce Perry’s Child Trauma Academy
Things to Think About
- When your child is struggling or lashing out, it’s important to maintain your own emotions and be a rock that can support them.
- Dialectical Behavior Therapy, or DBT, is a highly effective therapy for treating borderline personality disorder. Dakota Family Services offers the only comprehensive DBT group in the state of North Dakota, but there are other DBT groups around the country as well.
About the Hosts
Lucas Mitzel provides therapy for children, adolescents, and adults, ages 5 - 30. He believes building relationships with clients is the most important piece of successful therapy. He loves what he does, because it allows him to walk next to people he would never have met had he chosen a different profession, as they work to make amazing life changes. He has the honor of meeting people at their worst, all while watching them grow into the people they’ve always wanted to be.
Transcript
Borderline Personality Disorder
Featuring Lucas Mitzel, LCSW, Dakota Family Services
Tim Unsinn:
Welcome to Mind Your Mind, a podcast presented by Dakota Family Services, an outpatient behavioral health clinic located in Minot, Bismarck, and Fargo, North Dakota. In this podcast, I will talk with our experts about understanding and nurturing our mental health and wellness. I'm your host, Tim Unsinn. Join me each episode as we explore the intricacies of our minds, decrease the stigma of mental illness, learn practical tips for managing our mental health and wellbeing, and recognize when it's time to ask for help. Join me now to mind your mind. Welcome to this episode of Mind Your Mind. Our guest is Lucas Mitzel. Lucas is a therapist on the Fargo campus and provides outpatient therapy for children, adolescents, and young adults. Lucas, it's great to have you on Mind Your Mind. Our topic is borderline personality disorder. However, before we get to the topic, there's always the question at the beginning, and that is, why do you do what you do?
Lucas Mitzel:
I enjoy doing what I do because I just, I love working with people and helping them become who they want to be.
Tim Unsinn:
Borderline personality disorder, that is a big, big name. What is it?
Lucas Mitzel:
Yeah, borderline personality disorder is really interesting. It's got a really bad rap and stigma attached to it, and I think that's mainly because there's a lot of confusion and misunderstanding surrounding it. Borderline personality disorder is a mental health disorder that impacts how you view the world, interact with the world around you and how you handle your emotions. When we talk about personality disorders, we tend to talk about them a lot of times in clusters. So there's cluster A, cluster B, cluster C, and it's kind of a way to categorize them. And so cluster A tends to be people who struggle with suspicion or lack of interest in people. Cluster B often are seen as dramatic, overly emotional or have unpredictable behaviors. Cluster C is often viewed as overly anxious, so borderline personality disorder falls into cluster B and symptoms become more of a personality disorder when it becomes kind of just who you are as a person.
Lucas Mitzel:
So when we look at borderline personality disorder, there's nine symptoms. So the very first one is fear of abandonment. Somebody who really struggles with the idea that somebody might abandon them or they might perceive that they're being abandoned. It's gonna cause intense emotional distress in them. There is gonna be patterns of unstable and intense relationships. So relationships might falter between really, really bad or toxic to feeling like they're the best person in the world for them. And that could switch honestly between hours. And so they go through these really intense periods of just all or nothing when it comes to the people that they're with, whether that be parents, boyfriends or girlfriends, teachers, anybody they might come in contact with. There's also a bunch of impulsivity that is oftentimes self damaging and that does not count self-harm, we'll get to that one in a second.
Lucas Mitzel:
But driving really fast or intense spending or having lots of sexual partners, these are all sorts of things that come up with borderline personality in regards to the impulsivity. So then we have struggles with suicidal behavior, gestures or threats. So somebody who has a borderline personality disorder has really, really big emotions and it's really hard for them to handle those things. And oftentimes because of that, the thoughts of suicide or self-harm or threats can come up as a way to deal with those stressors or a way to pull people in or handle relationships if they feel like somebody is maybe pulling away from them, they might use suicide as a means to get them to come close or to find comfort. And we'll get to why people do that in a second. But another big struggle somebody with a borderline personality disorder might have is identity disturbances.
Lucas Mitzel:
So having a really hard time knowing who they are as a person. So they might be switching between sexual identities, gender identities. They might even just struggle with like who they want to be as an employee or going to college and not knowing what major they want to be or switching from different hobbies and different groups in high school. So one month they might be really into like anime and the next month they might be considering themselves a jock or maybe they get really involved in religion, and they're just hopping between groups 'cause they're not really sure who they are. They might be considered chameleons or social chameleons because they can blend in with whoever they're with because they want to be who people want them to be, if that makes sense, rather than who they want to be. Moving on, I've mentioned this a few times, but they have large emotional reactions to things.
Lucas Mitzel:
So oftentimes people who have a borderline personality disorder are described as emotional burn victims. So just like with a burn victim, the slightest touch can cause a large amount of pain. So any sort of sleight or thing that might go wrong or be perceived as wronging them could cause intense emotional pain that maybe you and I wouldn't experience with that, but it's really hard for them to handle that. And then the last two would be intense or inappropriate anger, or just difficulty controlling their anger. And then stress-related paranoid ideation or severe dissociative symptoms. So when they're under a lot of stress or having a really hard time, they might become a little bit more paranoid or even dissociate at times. So those are the nine diagnostic criteria that we look at. You only need five, so that means not everybody's going to have every single one of those, and they're all on a spectrum. So just because you might have somebody with a borderline personality disorder doesn't mean that they're going to have the same amount of identity disturbances as somebody else. For example, the way I view it or I've conceptualized borderline personality disorders symptoms is that they're ways that they've learned how to cope with the world in order to get needs met. The coping mechanisms are maladaptive, which is why it's called a disorder, but it's often a response to trauma in their childhood or intense invalidation and/or abandonment that happened in their past.
Tim Unsinn:
You're listening to Mind Your Mind. Our guest is Lucas Mitzel, and Lucas is a therapist and we're talking about borderline personality disorder. So that was a lot of information. Now that I have myself or a child of mine have been diagnosed with borderline personality disorder, now what?
Lucas Mitzel:
So the, I mean, number one thing that I always tell people is we need to get into therapy services as soon as possible. That's the number one treatment for a borderline personality disorder. I'm not a med provider, just throwing that out there right away. But there isn't really a medication to specifically treat borderline personality disorder. So we need to look into therapy. And the best known therapy treatment for borderline personality disorder is called DBT, which is the acronym for Dialectical Behavioral Therapy. And it's considered the go-to treatment for individuals who suffer with this disorder. And it was literally made for this disorder. So there's four modules or main components of DBT and I don't know if we've done a podcast on DBT already. We should <laugh>.
Tim Unsinn:
There you go. That's, that's one to put into the back of your mind, and that'll be on our topics list.
Lucas Mitzel:
<Laugh>. Yeah. But so the four, the four main modules are mindfulness, which is paying attention to this current moment intentionally. And the second one would be distress tolerance. So that's handling hard situations without making things worse. The third one is emotion regulation, which is our long-term stability and managing our emotions so that we don't need to use as much distress tolerance because we're handling it ahead of time. And then lastly is interpersonal effectiveness, which is a really fancy way of saying making relationships and keeping them. And if you look at each one of those four modules, each one of them has, they fit all of the diagnostic criteria in them. So the intense interpersonal relationships fits with the interpersonal effectiveness aspect. The intense emotion regulation or difficulty with that goes with the distress tolerance and emotion regulation. The anger outbursts is distress tolerance and so on and so forth.
Lucas Mitzel:
So it was very much tailored for this disorder. And for people who aren't in our area, if you can find a DBT program that would be really great, that involves an individual therapist who is also your phone coach. So the client will have a phone number that they can reach out and that helps with the generalization of the skills that they learn in group therapy, which is the other part of it. And then to have a true DBT program, the therapy team also needs to have their own little group of like therapy consulting and making sure that they're doing everything to fidelity as it's called or following the model if you do live in the area. Our clinic has a DBT program that's been up and running for a little under a year now. It's been super successful and we just are graduating our second batch of people, which is really, really awesome.
Tim Unsinn:
And the area in which Lucas is talking about is the Fargo Moorhead area and Dakota Family Services. You can Google that. Look it up, check it out. It's probably a part of this podcast at some point at the beginning or the end too as well. So now that we know that every person is unique, but do you have any general tips for someone either parenting a child with a diagnosis or suffering from this themselves?
Lucas Mitzel:
Yeah, I mean, like Tim just said, it's important to make sure that you're talking with your therapist about really specific interventions for you and your child because everybody is unique. And so there's not just like a blanket tip list or intervention list, but there are some general things that are pretty universal when working with somebody who has this disorder as a parent or even just for yourself. So for parents, when your child is struggling, it's really, really important that you are managing your own emotions. Sometimes things can get explosive and loud and your child might be saying things that they don't actually mean that are really hurtful. And if you are getting escalated yourself, the whole situation is gonna get outta control real quick. The best thing that you can do is be a rock for them and just try and remain calm.
Lucas Mitzel:
The analogy I like to use for parents is your child is like a kite in the wind. And if they're blowing and the wind's going really hard and they're having a hard time, it's not good if we just tie another kite to that kite and be escalated with them. 'Cause Now we're gonna crash into each other and fall down on the ground. We need a rock or somebody to reel them back in and hold steady. So that's number one. Modeling the skills that you want them to use. So the big part of DBT that I love is that parents are involved in the group as well. So you're learning all of those skills that they need in order to help regulate. And so use them in front of them, use them too. Start talking about those skills with them and just model when you're having big emotions, how to use those things so that they're seeing it happen.
Lucas Mitzel:
And you guys can keep each other accountable too. And that's been really awesome for a lot of our families. Self-Harm and suicidal ideation is common for this diagnosis, but it's really important that when that stuff is happening that you remain really calm. So judgment and anger is only gonna make things escalate. Now obviously if your child is having any suicidal ideation or self-harm, it's important that you reach out and you get some help. Go get them assessed at a hospital or follow the safety plan that's been set up by your individual therapist. But when it's happening, no matter what, we just need to make sure that our emotions, again, are under control. 'Cause It's only gonna make things worse. Again, going back to the kite in the wind analogy, if we are up there with them.
Tim Unsinn:
So one final question before we wrap up. I'm thinking here as a parent, so you know your child's been diagnosed. Is there therapy for the parent to sit in on so they can learn how to help their child? How does that work?
Lucas Mitzel:
Yeah, I often recommend that families go and get their own individual therapy as well. This is a really difficult diagnosis to parent, so processing through your own emotions and your own experience is gonna be important as well. But I also really encourage my families that I work with, I have frequent conversations with the children's parents and giving them tips and obviously with consent from the child because they have confidentiality as well. I'm not talking about what's going on in therapy, but just what might work well for their individual case and what's happening there. Maybe how to say things to their child. It's all very specific. So making sure that you're having conversations with your child's therapist, but then also getting your own because there's a lot of things to process through at times.
Tim Unsinn:
A lot of great information. Lucas, thank you as always. You're listening to Mind Your Mind. Our guest, Lucas Mitzel, he's a therapist on the Fargo campus of Dakota Family Services. And before we wrap up, there's always that final question because we all have a lot on our plates, we do a lot of things. How do you Lucas, mind your mind?
Lucas Mitzel:
Yeah, I think one of the most important things that I tell people is obviously I'm a little biased in this, but have a therapist and go talk to somebody. Having somebody to share ideas with or just what's going on, an objective third party that's not really involved in the situation has always been super helpful.
Tim Unsinn:
Perfect, thank you so much. Thank you for joining us for Mind Your Mind, a podcast presented by Dakota Family Services. You can't have health without behavioral health. Remember to mind your mind. For more information, links to additional resources, contact information, and much more, go to Dakotafamilyservices.org.
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Humans are hardwired for social connection, but it can be difficult knowing where to fit in as unique individuals. In this episode of Mind Your Mind, host Tim Unsinn and therapist Christy Wilkie talk about the importance of using your strengths, interests, and relationships to figure out where you belong. They also touch on signs that you might not be staying true to yourself, as well as how to handle feelings of being left out.;
PTSD: Signs, Symptoms, & Treatment (Community Chat Series)
While often perceived as only relating to those who’ve experienced warfare, Post-Traumatic Stress Disorder (PTSD) can affect anyone. In this special Community Chat episode of Mind Your Mind, Psychologist Dr. Hannah Baczynski and therapist Lucas Mitzel explain what trauma is, how it affects each person differently, and when to seek treatment for trauma-related symptoms. They also discuss different treatment options for PTSD, touching on the pros and cons of each.;
Autism in Children & Adolescents (Community Chat Series)
Though autism is one of the most commonly discussed mental health diagnoses in the community, it is often one of the most misunderstood. In this special Community Chat episode of Mind Your Mind, therapists Lucas Mitzel and Falan Johnson discuss what autism is, how it appears in children and adolescents, and how it may look different between individuals. They also touch on how autism can show up differently in boys than in girls and offer intervention tips for parents and caregivers.;
Autism in Adults (Community Chat Series)
Autism is sometimes perceived as a disorder that only affects children and adolescents, but it is actually a lifelong diagnosis. In this special Community Chat episode of Mind Your Mind, psychologists Dr. Hannah Baczynski and Dr. Megan Spencer explore the symptoms and nuances of autism in adults, touching on the history of autism spectrum disorder, the research surrounding it, how autism commonly presents in adults, and more.;
Spirituality & Mental Health
Though spirituality is often associated with religion, it can mean much more than simply attending religious services or praying. In this episode of Mind Your Mind, host Tim Unsinn and psychiatrist Dr. Wayne Martinsen define spirituality and discuss its relevance in daily life, touching on ways people experience, express, and cultivate spirituality. They also talk about the link between spirituality, religion and meaning in life.;
Setting Healthy & Realistic Goals
Setting goals is easy. Working towards them is hard. In this episode of Mind Your Mind, host Tim Unsinn talks with Dakota Family Services therapist Christy Wilkie about how to set healthy, realistic goals, as well as the importance of managing your expectations and staying persistent. Whether you’re starting an exercise routine, writing a book, trying a new diet, or building your career, keep these tips in mind when setting your next big goal.;
Facing Your Fears
Fear is powerful. It can cause us to avoid problems, people, and even opportunities in our life. But it can also be overcome. In this episode of Mind Your Mind, host Tim Unsinn speaks with Falan Johnson, a therapist at Dakota Family Services, about the function of fear and how to face it. Learn where fear comes from, how to identify it, and how to calm down and build confidence when you’re feeling afraid.;
The Three R's: Regulate, Relate & Reason
In this episode of Mind Your Mind, our host Tim Unsinn talks with Dakota Family Services therapist Jessie Mertz about the “3 R’s”—Regulate, Relate, and Reason. They discuss what each term means, how they build upon each other, and how this approach can help you calm others who are experiencing distress.;
What is Schizophrenia?
Schizophrenia is a chronic, complex mental health disorder that affects around 1% of people in the United States. In this episode of Mind Your Mind, host Tim Unsinn and psychiatrist Dr. Wayne Martinsen discuss the symptoms and implications of schizophrenia, touching on its many effects on individual and family life. Learn about how schizophrenia is treated, how it affects physical health, when it tends to develop, and how it is perceived between cultures.;
How to Have a Conversation About Mental Health
Although the stigma surrounding mental health is gradually disappearing, it can still be tricky knowing how to talk about it. In this episode of Mind Your Mind, host Tim Unsinn and psychologist Megan Spencer explore how to have a conversation with someone about their mental health, including signs that you should talk to them, how to start the conversation, and some possible reactions to expect from the other person.;
The Benefits of Being Outside
Are you feeling cooped up indoors? Join host Tim Unsinn and therapist Lucas Mitzel in this episode of Mind Your Mind as they discuss the importance of getting outside on your mental health. Learn about the benefits of green and blue spaces, activities you can do while outside, and how being outside can help improve symptoms of different mental health diagnoses.;
Dealing With Burnout
In this episode of Mind Your Mind, Tim Unsinn talks with psychologist Dr. Hannah Baczynski about the signs of burnout, how to prevent it, and how to know if your burnout is related to general life stressors or a mental health disorder. They also talk about the difference between fatigue and burnout, as well as how to support yourself and alleviate burnout when you’re experiencing it.;
Living with Chronic Illness
Many of us know someone who has been diagnosed with a chronic illness, or have been diagnosed with one ourselves. In this episode of Mind Your Mind, host Tim Unsinn talks with therapist April Morris about how chronic illness can impact daily living and mental health, as well as how to seek support if you have been diagnosed with a chronic illness.;
Bipolar Disorder: Understanding the Highs and Lows
Although the term ‘bipolar’ is sometimes used as slang to describe someone who is moody or indecisive, true bipolar disorder is a complex and sometimes severe mental health disorder that affects the way a person thinks, feels, and behaves. In this episode of Mind Your Mind, host Tim Unsinn discusses bipolar disorder with nurse practitioner Amanda Daggett, touching on what the disorder is, what its symptoms look like, and how it can be treated.;
Social Media: Managing Emotions & Setting Boundaries
How much time do you spend each day looking at your phone? An hour or two? Multiple hours? In this episode of Mind Your Mind, host Tim Unsinn meets with therapist Christy Wilkie to discuss how social media use can impact our mental health, relationships, and behavior. Learn tips for monitoring your child’s internet use, as well as how to manage your own time spent on social media.;
Understanding OCD
While OCD is sometimes perceived as simply a desire to keep things neat and organized, it can actually have much more severe symptoms for those who experience it. In this episode of Mind Your Mind, host Tim Unsinn meets with psychologist Dr. Megan Spencer to talk about who Obsessive Compulsive Disorder affects, what its signs and symptoms are, and how to seek help if you or a loved one has been diagnosed with OCD.;
Breaking Bad Habits
Bad habits can be easy to start but sometimes very difficult to stop. In this episode of Mind Your Mind, host Tim Unsinn and therapist Falan Johnson talk about breaking bad habits, including where habits come from, how to know if a habit is bad, and steps you can take to stop it.;
Finding a Therapist
Are you looking for some help on your mental health journey? In this episode of Mind Your Mind, host Tim Unsinn and therapist Jessie Mertz talk about how to find a therapist, including what you should know when searching and what questions to ask when you meet a therapist for the first time. They also touch on what the letters after a therapist’s name mean, and how they apply to the type of services or treatment you might be looking for.;
Coping with Rejection
Whether it’s from asking someone on a date or applying for a job, we all experience rejection at some point in our lives. In this episode of Mind Your Mind, host Tim Unsinn talks with therapist April Morris about how to cope with rejection, including the common coping stages, the importance of acceptance, and how rejection can impact people differently.;
Psychological Assessments: What to Expect
Do you think you might be suffering from an undiagnosed mental disorder? If so, a psychological assessment might be able to help. In this episode of Mind Your Mind, psychologist Dr. Hannah Baczynski and host Tim Unsinn talk about what to expect from a psychological assessment, including what an assessment might include, what information you might receive from the psychologist, and what you should communicate with your psychologist before and after receiving an assessment.;
Supplements in Psychiatry
In this episode of Mind Your Mind, host Tim Unsinn and Amanda Daggett explore the topic of using supplements for mental health. In addition to talking about some of the most commonly used supplements like melatonin and St. John’s Wort, they also discuss the benefits, the risks, and the research surrounding various supplements.;
Seasonal Affective Disorder (Community Chat Series)
Feeling like you’ve got the winter blues? If you’re noticing symptoms of depression with the change of seasons, it may be a sign that you’re suffering from Seasonal Affective Disorder, or SAD. In this special Community Chat episode of Mind Your Mind, therapists Christy Wilkie and Lucas Mitzel discuss the common symptoms of Seasonal Affective Disorder, how it can affect other mental health disorders, and some useful tips, tricks, and resources for managing symptoms of SAD.;
Trying New Things With Confidence
Join Christy and Lucas, therapists at Dakota Family Services, as they share practical tips for building confidence when trying new things. From managing self-doubt to building resilience, this episode will empower you to approach new experiences with a positive mindset.;
Relationships are Hard
In this episode, Christy and Lucas explore why relationships can be so hard. Join them as they discuss the characteristics of both healthy and toxic relationships, talk about the difference between normal conflict and abuse, and help you discover your love languages so you and your partner can best express your love to each other.;
Is Everybody Anxious?
In this episode, Christy and Lucas explore anxiety. Join them as they discuss the signs and symptoms of an anxiety disorder, what you can do to decrease your anxiety, and how to best help loved ones struggling with anxiety.;
Is Everyone Feeling Sad
In this episode, Christy and Lucas explore depression. Join them as they discuss the signs and symptoms of Major Depressive Disorder, what you can do to help yourself feel better, and what you can do to help your loved ones. They will talk about coping strategies, therapy interventions, and ways to help you identify when your child might need extra help.;
Change is Hard
Change is inevitable. Join Christy and Lucas as they explore big and small changes and how they impact you. Learn why change can be so hard, even good change, and discover ways to manage it effectively.;
We Need to Talk About Suicide
In this episode of "Is It Just Me," Christy and Lucas discuss the very important topic of suicide. Listen to learn about risk factors, warning signs, and what you can do to help a loved one who is struggling. Remember, you are not alone. If you need immediate assistance, call 911. If you need to talk to someone, call the Suicide and Crisis Lifeline at 988.;
Do We Need to Get Outside?
Join Lucas and Christy as they explore the power of spending time outdoors on mental and emotional well-being. Discover practical tips, personal anecdotes, and expert insights on the benefits of getting outside and reconnecting with nature.;
Exploring ADHD
In this episode of "Is It Just Me?" Lucas and Christy discuss ADHD, shedding light on its prevalence and impact on daily life. Learn practical strategies for managing symptoms and understand why your friend or loved one with ADHD does the things they do.;
Internet Safety and Mental Health
In this episode of "Is It Just Me?", join our hosts Christy and Lucas as they delve into the complex relationship between the internet and mental health. With the digital age bringing information and social connections to our fingertips, it also presents unique challenges and opportunities for our safety and psychological well-being.;
Boosting Self-Esteem: From Marathons to Daily Triumphs
In this episode of "Is It Just Me?", Christy and Lucas discuss how common it is for people to see themselves differently from others. Using their own personal triumphs and challenges as examples, they outline the things that shape our self-esteem. Additionally, they share simple daily practices to help listeners recognize and celebrate their own personal victories. This episode is filled with tips and engaging stories aimed at encouraging listeners to undertake challenges that foster self-growth and personal confidence.;