Transcript

Selects: BPD: The Worst Disorder or Not a Disorder at All? | STUFF YOU SHOULD KNOW

From Stuff You Should Know · Episode page · Watch on YouTube

· 51 min · 8,995 words · 170 timestamped sections

This is the full, timestamped transcript of "Selects: BPD: The Worst Disorder or Not a Disorder at All? | STUFF YOU SHOULD KNOW", an episode of Stuff You Should Know published January 18, 2026 (51 min, about 8,995 words). It mentions 4 people, works and ideas, including Marsha Linehan, Dialectical Behavioral Therapy, Adolf Stern, Otto Kernberg.

What this episode is about

This discussion explores borderline personality disorder (BPD), examining whether it is the most problematic mental health condition or if it should be viewed differently. The conversation highlights the complexities of BPD, its impacts on individuals, and the broader societal misconceptions surrounding mental health disorders.

Key takeaways

  • Borderline Personality Disorder: it's like living in a world of emotional tsunamis—consistently overwhelming, rarely understood.
  • BPD’s perception issues differentiate it from bipolar; it’s less about mood swings, more about emotional dysregulation.
  • Surprisingly, clinicians often shy away from BPD patients, perpetuating a cycle of misunderstanding and isolation.
  • Compassion is scarce for BPD, yet those struggling crave understanding more than ever; ignorance truly isn't bliss.
  • BPD's trigger-happy emotional responses can make everyday life feel like navigating a minefield—dangerous and exhausting.

Who speaks in this episode?

What is discussed, and when

  1. – 10:00: Adolf Stern, Otto Kernberg
  2. – 15:00: Marsha Linehan, Dialectical Behavioral Therapy
  3. – 50:00: Dialectical Behavioral Therapy

Notable quotes from "Selects: BPD: The Worst Disorder or Not a Disorder at All? | STUFF YOU SHOULD KNOW"

  • Yeah. And that goes back to a jerk named Adolf Stern who really jerked it up back in 1938.
    about Adolf Stern · at
  • It was Otto Kernberg who was the serious jerk in this situation.
    about Otto Kernberg · at
  • Criteria if you do you got BPD right and we'll talk about the criteria in a second but we do want to sort of reintroduce Marsha Lahan who like I said was a real pioneer for her…
    about Marsha Linehan · at
  • Examine and change how you interact with the world externally. And it's basically the gold standard for treating borderline personality disorder right now.
    about Dialectical Behavioral Therapy · at

Who and what is mentioned in this episode?

People

  • Marsha Linehan — Person · Referenced expert · 1 mention · first at
    Cited as a pioneering clinician/researcher who developed Dialectical Behavior Therapy (DBT), described as the gold-standard treatment for BPD, and who later disclosed her own history of BPD.
  • Adolf Stern — Person · Referenced expert · 2 mentions · first at
    Credited with introducing the term/idea of “borderline” (1938) as being on the border between psychosis and psychoneurosis, providing historical context for the diagnosis name.
  • Otto Kernberg — Person · Referenced expert · 1 mention · first at
    Mentioned as a key figure in the 1970s who described borderline pathology (unstable personality/disorganized self), tied to BPD’s growing clinical recognition and DSM inclusion.

Concepts & topics

  • Dialectical Behavioral Therapy — Concept · Strategy · 2 mentions · first at
    Highlighted as the gold standard treatment for Borderline Personality Disorder, focusing on skills to manage emotions and relationships.

Full transcript with timestamps

Hey, good morning everyone. This is Chuck here on a Saturday with a curated selection of one of my favorite episodes. This is BPD colon the worst disorder or not a disorder at all. This is all about borderline personality disorder and it's pretty fascinating stuff and I hope you guys enjoy it. Welcome to Stuff You Should Know, a production of iHeart Radio. Hey, and welcome to the podcast. I'm Josh and Chuck's here, too. It's just the two of us, and that's cool, cuz this is stuff you should know.

Yeah, Jerry's got the week off and she said, "Press on, dudes." Yeah, party on, dudes.

Party on, Wayne. Uh, that was also from Bill and Ted's Excellent Adventure, wasn't it? Party on. Oh, was it?

I think so. I can see George Carlin saying it. Yeah, I'm probably wrong. I'm probably wrong. So, Chuck, we're talking today about something we've kind of touched on before, but when we touched on it, we were like, well, this is something that deserves its own episode for sure.

Yeah, we're we're talking this is another in our suite on uh mental health conditions. And boy, we've got a lot of them, but we still got more to go.

Yeah, we do. You know, and I think these are important shows. And every time we do these, I feel like we get good feedback on people who who suffer from these conditions and and say, "Thanks for uh either educating me and or getting the word out to people who may be a little uh what's the word? Ignorant about some of this stuff."

As Michael Jackson would have said, you're ignorant about this. What's that from? He just used that word a lot.

Oh, really? Yeah. But regardless, that has nothing to do with anything. when you mentioned just now that um people like kind of wrote in or write in when we do episodes like this when we did our emotional pain episode and we mentioned um borderline personality disorder a lot of people wrote in well I don't want to say a lot but some people wrote in and they said you know thank you for treating it compassionately because when most people talk about it they talk about it like they despise it or they despise people with BPD and the more you look into it the more you realize like wow this is may be one of the hardest um mental illnesses that you can possibly have. Uh and I think we kind of said that in the emotional pain episode, but if I didn't know it before, I definitely do now after doing this research.

Yeah. And it's also clear that it's one that somehow seems to garner the least amount of empathy,

right? Uh not only among just people who, you know, may or may not know much about it, but even clinicians and therapists. uh as that stuff you sent me like a lot of times try to avoid uh or or severely limit the number of patients they have that they treat with BPD

uh which makes it even more sad because it is a really tough one. Um, I guess we'll just define it kind of off the bat and you know, a lot of this episode will kind of be defining it in different ways because it's it's fairly complex, but it is a what's known as a cluster B personality disorder.

Uh, which is in the antisocial personality disorder category along with histrionic personality disorder and narcissistic uh, personality. I'm just going to start saying PD.

Yeah, PD's. it will make it sound like you know you're talking about even more narcissistic PD but um it seems like a lot of what it can be is sometimes a disorder of perception uh and while there are very real things that that do um that can trigger people with BPD um a lot of times it's the way things are perceived incorrectly either about themselves or about others or others actions.

Yeah. And I saw um a lot of people confuse um borderline personality disorder with bipolar or at least think they're similar, I guess, because they both start with B's or something like that. But no, they're not similar. Bipolar has much more of a um a brain and central nervous system basis. Whereas while um borderline personality disorder has a a component of that the executive function of the person in their prefrontal cortex either didn't develop in in a fully normal way or it um it's not functioning uh up to snuff.

I guess more than anything and the thing that differentiates it from bipolar is it's a an um an assignment of meaning. It's psychological as much if not more than it is um physiological.

Yeah. And also bipolar is characterized and we we did a a good episode on that quite a while ago, but um it's characterized by like these highs and lows

and then in between those periods they can be relatively stable. Uh whereas with b uh borderline personality disorder, it's it's sort of always there. Um, this one thing you sent me had to really kind of really nail it on the head at the end. Those with bipolar may have a hair trigger kind of response during an episode,

whereas when you have borderline PD, you have a hair trigger response all of the time. And I can't imagine how tough that must be.

Yeah. So, that that kind of um calls out one of the big hallmarks of BPD, which is um it's emotional dysregulation.

Yeah. Things that would affect other people. a little bit, maybe not at all. Stuff that most people that let roll off their back,

right? Could set somebody uh with BPD off into a rage that could last days potentially.

Um they also might use self harm um what's called non-suicidal self-injury uh to kind of externalize the pain because they're the emotional dysregulation is so profound. They don't know what they're feeling. They just know they're feeling everything all at once. And it's kind of like standing in a in an ocean and a huge wave hits you

and you're just you're as profoundly enveloped by emotion at that moment as you are when a by a wave when it just completely knocks you off your feet and sweeps you away.

Yeah. There was another um and we'll talk about her in great detail. Her name is Marca uh Linhan

or is it Linhan? I'm going to go with Lahan. Yeah, she, as we'll see, is a uh someone who not only suffered from BPD, but um kind of pioneered the the treatment uh of BPD, but she said it's like having thirdderee burns on 90% of your body uh metaphorically. So, you're lacking emotional skin and you feel agony at the slightest touch or movement. Mhm.

Um, and since you did mention self harm, uh, non-suicidal self harm, it also, uh, people with BPD have a suicide rate of, was it like 50 times higher than average in the population.

Mhm. Yeah. So, this is, um, this is no joke. This is a very hardcore disorder that bears more empathy and understanding.

Yeah, for sure. Let's let's uh go back to the beginning, shall we? Because borderline personality disorder is one of those terms that has taken on its own meaning in the general population, but if you stop and think about it, it doesn't really reveal much about what it's describing. It's just one of those, you know, frustratingly so.

Yeah. And that goes back to a jerk named Adolf Stern who really jerked it up back in 1938.

Yeah. He was a psychoanalyst and he basically I mean if you if you didn't know what it was and I didn't even fully know what it was. I always wondered what borderline meant and it very simply meant and means uh this is Stern saying you're you're not quite on the psychotic level and you're not quite uh psychonurotic. Uh you're basically on the border between those conditions while encompassing a bit of each. So we're just going to call it borderline.

Yeah. And psychosis is what we would still consider psychosis, but under psychoanalysis, um, psychonurosis is what we call like anxiety, depression, that those kinds of mental illnesses. So, I guess Adolf Stern wasn't really that big of a jerk because he really kind of did combine them appropriately.

It was Otto Kernberg who was the serious jerk in this in this situation. Okay, so he was a psychoanalyst in the mid 1970s. So that's, you know, like 40 something years later.

And um he described it as an unstable personality and disorganized conception of the self. And this is just when it was sort of starting to become more and more um kind of talked about and officially I think 5 years after that was uh in the DSM version three.

Yeah. I mean, that's pretty quick for something you just started to identify and five years later makes it in the DSM because they don't churn those DSMs out like, you know, every few months. It takes years to put one together. So, Kernberg seemed to have stumbled onto something that was worth um looking at very very um very quickly.

Yeah. And isn't there a a sort of movement or belief now that it's a lot of people think it's something that it's like a diagnosis you shouldn't even give right?

Yeah. There's we'll talk about that. I think we can kind of pepper it throughout, you know. Okay. But I but yes, there is um a school of thought that basically says BPD is not a personality disorder. It's not even a mood disorder. Although some people say it would better be characterized as a mood disorder. They say it's it's a cluster of symptoms that overlap with a bunch of different actual disorders.

And that the problem with that, you say, "What? Who cares? you're identifying people, a group of people whose um rate of suicide is 50 times the general population. That alone is worth like identifying and helping those people out.

But they're what they're saying is number one, BPD has gotten such a bad name in the general population that you

literally stigmatizing somebody when you give them that diagnosis. It is an enormously um heavy weight you put on somebody when you say, "I am a trained psychiatrist. I know what I'm talking about. And you have borderline personality disorder. Everybody step back basically.

Yeah. I mean, it's it's almost in line with saying someone is a sociopath. It's different things, but as far as like the stigma goes,

very much so. Yeah, for sure. That's a great analogy actually. So, so some people are like, okay, it it's stigmatizing, but even more than that, just the science isn't necessarily there. Like we were saying, it's a it's symptoms rather than an actual disorder. And then apparently the working group for personality disorders for the DSM5, that's the most recent one.

They actually said um we're not sure that this should be a categorical disorder, which is the type that you either have it or you don't. They they suggested it should be dimensional, which means that it exists on a spectrum,

right? So you can have a little bit of BPD, a lot of BPD, or right in the middle or whatever. um and that got rejected and now so it's a categorical um diagnosis where if you don't have BPD you don't have BPD if you don't fit the criteria if you do you got BPD

right and we'll talk about the criteria in a second um but we do want to sort of reintroduce Marsha Lahan who like I said uh was a real pioneer for her work uh in the treatment and recognition of BPD

uh very late in her life um revealed that she suffered from BPD uh after, you know, patients and friends encouraged her to come forward. Uh and she said basically, you know, I'm going to do it. I'm not going to die a coward is what she said. Um but for the longest time, uh was not out with that information. um was born in Oklahoma uh in I guess the 50s and in the 1960s in high school was diagnosed with schizophrenia uh drugged up um given electroshock hospitalized uh was in was was practicing self harm uh of all kinds and then had it sounds like a not a moment of clarity but a pretty profound uh religious experience.

Yeah. The only thing missing was a visit from St. Michael. pretty much I mean she's Catholic and uh after this religious experience she was able to uh which you know had a lot to do with self-love but after this she was able to still have these emotions that she had before but managed it uh to the point where she wasn't practicing self harm and did she come up with the term radical acceptance or did she just buy into that?

I don't know if that was a descriptor of hers or not. Okay. I don't think she came up with that but basically is you know radical acceptance is like hey listen this is how things are with me this is how things are with the world uh I accept this and I'm not going to compare this uh to what I think the reality should be or what other people think it should be.

There's a huge butt that follows that though. But but um I am going to do what I can to change those things about myself.

Right? So that is the basis of um a type of cognitive behavioral therapy that she came up with called dialectical behavioral therapy. And it is it's based in radical acceptance and the desire to examine and change how you interact with the world externally. And it's basically the gold standard for treating um borderline personality disorder right now.

Yeah. And it seems like it really works. I saw that it was um kind of the only proven treatment to reduce um suicidal behavior,

which is, you know, the at the the tail end of um what a lot of people experience with BPD. And the good news, and we'll we'll talk about treatment later, but the good news is if if you have BPD or know someone that does, you can get better. And they have they have proven and shown time and time again now that through the treatments that we'll discuss later, it is it is absolutely something that someone can get a hold of in most cases,

right? Which is great. It is great. I mean like as for as as bad of a stigma as BPD has, the idea that like it has a very high success rate of treatment is pretty encouraging.

Yeah. So, um, Lahan's basis of of or her understanding or her definition of borderline personality disorder is that it it's bioscial that people who have BPD are either genetically or biologically predisposed to having BPD. But not everybody who has that predisposition is going to be triggered into developing BPD. It takes basically a a biological substrate for BPD. Usually your prefrontal cortex hasn't developed in a certain way and so your executive function isn't functioning like an executive should.

That gets joined together with a trigger. um usually mistreatment uh whether it's abuse, neglect, invalidation by your parents as a kid and you put those things together and very often it results in what you be diagnosed with later as BPD.

Yeah. And man, one thing I really took away from this and this is something that you know Emily and I and and most parents that I know our way into is uh boy, you got to validate your kids.

Yeah. That's new, which is crazy. But it's it's you Yeah. You got to validate their emotions and validate their experiences and their feelings.

Even if it's something that you don't think is uh uh like has the most relevance or whatever, or even if like the kid is wrong about something or like emotionally wrong, like you still have to validate that and then talk them through it. What you can't do is just discount a kid's feelings cuz that that's like telling them that their truth isn't real and that's damaging.

I know. And doing parenting right sounds like a waking nightmare to me. Doing what? Parenting right?

Parenting correctly. Yeah. No, I can't imagine the exhaustion along combined with the fear of just misststepping once or twice and then there you go. You screwed your kid up for life.

Yeah. What you got to do is in my experience is like you can't beat yourself up too much because parenting fails. You can really go down a rabbit hole of your own

I'll bet depression if you if you screw up. Uh and you can't do that because kids are resilient and you just got to like you got to prove to them that you can like pick yourself up and move on and do better, you know.

Yeah. And I I I don't think Lahan's um idea is that it just takes one or two missteps. It takes like a parent who is a genuinely bad parent. Very frequently they have BPD themselves. Yeah.

And um that is a real challenge to parenting well in and of itself. But you don't have to have had a a parent with BPD to develop BPD. But typically it's a a parent that is not at all meeting your needs,

especially emotionally. And um I say we take a break and we'll come back and talk about how you would be diagnosed with BPD. What do you think?

Let's do it. Okay, Chuck. So, we said that BPD is in the DSM5. It's a personality disorder. And just to differentiate real quick, a mood disorder um describes patterns in in feelings like you have mood swings in that um you know highs and lows and it's pretty reliable that you're going to have it one way or another. Personality disorder focuses more on how you relate to others. And that definitely makes sense to me that you would consider BPD a personality disorder then. Yeah, that seems to be a really key thing is uh that it's a it's it really disturbs your relationships.

Mhm. Um so, uh to be diagnosed, you fit at least five out of the following nine that we're going to read for you. Uh chronic feelings of emptiness,

and that's emptiness, feeling like isolated or lonely or hopeless. Sure. Um emotional instability uh and reaction to day-to-day events. Um, that's the thing we were talking about earlier, like u saying mountains out of mole hills seems slightly reductive, but that's kind of a basic way to say it.

Okay. Uh, frantic efforts to avoid abandonment, uh, whether or not they're real or imagined.

Each one, yeah, as we'll see, abandonment issues and and this very very much includes emotional abandonment, uh, is a really big um precursor.

Yeah. Uh, unstable self-image or sense of self. Uh what else? Um impulsive behavior is usually a big one and you have to have impulsive behavior in at least two areas that are um harming your day-to-day life

like an eating disorder and gambling addiction or something like that, right? Um, another one is this is based on and so this is where some psychiatrists would be like see this is not this is this is a symptom that we're talking about here but it's um unstable and intense interpersonal relationships

meaning like you're really really close to somebody for you know a couple of days and then they do something you don't like and they're the worst person in the world

and it can happen very very quickly with people with BPD. Um, and if you stick around and stay in that person's life, you can find yourself walking on eggshells very quickly because you don't want them to turn on you all of a sudden right?

Um, so that's a huge one. If you have a lot of unstable, intense relationships with people, that's just kind of the MO. That is usually a big giveaway with with BPD.

Yeah. Um, the last three, uh, recurrent suicidal or selfharming behaviors. We've talked about that a little bit. um stress related paranoia or dissociative symptoms like feeling like the self or the world isn't real.

Yeah. Uh that's it feels like that's probably at the far end of the spectrum or the most severe end.

Uh and then one we u missed earlier was uh inappropriate and intense anger or difficulty controlling anger.

Well, I didn't miss it. That was purposeful. Okay. Wanted to end with that big one.

Okay. All right. Speak to it. Well, there's a lot of um I I always hate saying those qualifiers. It's just so easy to say, but I think it perks people's ears up like, "Oh, this person doesn't know what they're talking about." So, let me rephrase that. I have seen that there are schools of thought regarding borderline personality disorder that it is a a rage response to trauma.

Okay? That that is your response to unresolved trauma. It's how you learn to deal with those feelings and those emotions is to rage at people because rage is as much a hallmark of BPD as fear of abandonment is.

Right. And um that's why some people are critical of including it as a categorical diagnosis in the DSM5. They're saying you're pathizing rage. No, you just need to teach people how to identify their emotions and how to express them in a more appropriate, less hostile manner. And then that's how you would treat somebody with BPD or not even with BPD, somebody with a rage disorder. But some people think that that is what what people are mistaking for BPD.

Oh, I gotcha. Okay. Interesting. Uh you're going to to be diagnosed, like I said, five of those nine. Um it'll probably be, you know, like you'll be talking to a psychologist or or someone in an interview. You might fill out a questionnaire or something.

Interesting. They may click click click click. uh or they may speak to your family or something like that. Uh it can be difficult to diagnose. Um and there like you said there's there's a lot of overlap between you know things like anxiety and depression and things like PTSD and eating disorders, a lot of comorbidities. So I get why people can have issues with like this diagnosis rather than it's like a cluster of symptoms of other things. But I don't know if you group that all together then it and call it its own thing then I don't know. I'm not sure I see the harm in that.

Uh again I think it's the stigma and then also it might be distracting from treating the other underlying stuff.

Maybe because they there also isn't and we'll talk about um pharmaceuticals but there isn't a specific pharmaceutical for BPD.

That's another clue that some people point to that it's not it's it's it's we're mistaking it somehow. And I don't want to like overstate the um that school of thought. It is widely considered like a an accepted um diagnosis right?

Borderline personality disorder is. So I don't want to make it seem like oh the cracks are in the facade. It's about to chromal any day. Now my point is

people make some pretty good um points about how well we understand it or how well we're defining it and we're possibly missing some component of it. Yeah. And isn't that stuff debate usually or I guess it should be and I hope it's couched in how to best treat people and help people, right?

Yes. Rather than just like poo pooing ideas. Yeah. No, I I think that's exactly right. But I mean again, if we come to this place where even if if a BPD is the center of a giant vin diagram of a bunch of different disorders

Yeah. Yeah. And we're mistaking that center overlap of all of them as its own thing.

If you if you zero in on that group and they have a 50 50 times higher rate of suicide than the general population, again yeah

that is worth zeroing in on, you know, as its own thing. And like you said, um dialectical behavior uh therapy is focused initially on individual sessions that are that are that are aimed to control that that behavior. Suicidality.

Yeah. Yeah, for sure. Um, you did mention earlier as far as causes go that sometimes there is a genetic link. Um, but it seems that it's not really the disorder that is like maybe passed from parent to child, but some of those traits and maybe that's because it is sort of a cluster. Um, sometimes you can, you know, you can have BPD and come from like, uh, a pretty good, you know, um, stable upbringing, but that seems to be the outlier. And it seems to be that like most people that end up suffering from this had a pretty lousy childhood.

Yeah. So, they were either neglected or just kind of um saddled with emotionally unavailable parents who just weren't really there for them. Didn't go to their dance recital kind of thing.

Never went to single one. Um excessive control. I It sounds very Freudian, but I saw one um classic example is a an absent father and an a doineering mother, and it's like how many times have you guys trotted that one out? But apparently it really does have a screwy effect on people as a kid.

Um, and then also if your parents um or parent had a mood disorder themsel or um misused substances that would probably have affected their parenting as well.

Yeah, it this also made me think about like parenting of old versus parenting now. and and parents can there there are still of course a huge uh range of bad parents these days. I'm not saying that everyone's doing it right now,

but it definitely seems like things turned a corner and parents are trying a lot harder these days and like sort of the old days of like, oh, you know, kids raise themselves and you can ignore them and blah blah blah. And like I'm sure that I mean I know that still happens but it just seems like that happened a lot more

back in the day and and maybe in the future things like this will be less and less.

Yeah, that's the hope for sure. I know that's sort of a basic uh sort of an elementary way of looking at it, but I just feel like parents are more aware of stuff these days and

like you know people of our generation and certainly the generations before that was even worse as far as parental involvement and parents who either one or the other you know fathers a lot of times you know historically the ones that were like no we're we're not going to parent because we're doing the work and we're going to bring home the paycheck and

so uh like I had a I've talked about it before I had a dad that wasn't very involved, but it it wasn't like the kind of thing where he I ended up with BPD because of it, you know.

Yeah, for sure. If that makes sense. You raised a question though in my mind. I wonder what percentage of boomer grandparents are allowed to see their grandchildren.

I'll bet it's higher than you'd think. Are allowed to or not? Are not allowed to like just don't have contact with their grandkids.

Yeah. Or it's very limited and supervised. And so actually though a lot of those grandparents all of a sudden are the most doing

and it's kind of like I know some parents are like oh okay well this is great where was that when I was a kid

right yeah for sure but also I' I think in some of cases the the more they don't they're actually also undermining the parenting of their kids under their

Yes. and imagine it can be very painful for a parent who had a unattentive parent to now have that parent be a very intentive grandparent.

If you have BPD, I would guess that would be a rageinducing trigger. I imagine it would be.

So, um, there are plenty of other ways that you could probably develop BPD. Another very classic one is any kind of abuse emotional sexual physical abuse, at the hands of your parent or a caregiver. Um, and they say that about 80% of people with BPD experienced some level of childhood trauma, whether it was emotional neglect, um, or some sort of abuse. It is a it's a huge factor, a huge risk factor in developing BPD. For sure.

Yeah, absolutely. Uh, and it it seems to be exacerbated if you're a kid who is um maybe you're just innately a little more unsure of yourself or a little more vulnerable as a person and then that is reinforced with a parent who is not uh validating your experience and your emotion as a kid. So, you're you're already starting back sort of behind the eightball and then your parents are making it worse and uh so that can definitely you know ease you toward that condition. Well, it's like a that's a chicken or the egg question though. Like were you like that, you know, already and your parents just reinforcing it or did you get that kind of did you learn to do that because of your parents behavior? It's like a not chicken or the egg but parent or the disorder,

right? You know, but we said earlier that there's also believed to be a biological component to it too that it's not all psychological and it does seem to um have something to do with executive function in the brain. One of the big things that executive functioning does is it helps you control your emotions. Not just in accepting things and dealing with them and moving on, but also your outward display of emotions. Um, if you don't have executive function, your emotional dysregulation uh is more likely to include explosions of anger, uncontrollable anger. Um, and then one of the thing, it's not just BPD that has that. There's plenty of other um disorders that have it, but one of the one of the key traits of BPD is it can last a really long time, too.

Can we make a t-shirt that has a chicken that says parent across the chicken's chest

and then next to an egg that says mental disorder. Love it. And just that's the shirt. No explanation. Figure it out or don't.

How about this though? On the back of the shirt, Mor is coming out of the egg. Okay.

All right. To really confuse people. Uh-huh. Yep. Oh, wow. That just really changed things. I like it.

Okay. So, as far as the number of people who experience BPD, um it's kind of a wide range like all this stuff because it's one of those disorders that is uh a lot of people don't admit it or seek treatment. So, it's really hard to to nail it down. But um Livia helped us out with this one and she said.5% to 6% um and they find it about four times more in women. But they've also found other studies are like no it's the women who are brave enough to come forward and seek treatment and it happens just as much in men. I also saw that it's a um that's an indictment of clinicians who um basically have to figure out for themselves whether the person has BPD and that they're more likely to assign it to a woman than a a man, a male patient.

Oh, interesting. Yeah. So, regardless, it is very frequently diagnosed more than you would think. It's one of the more common serious mental illnesses. Apparently um people receiving impatient mental health treatment uh one in five of those people are diagnosed with BPD. So it is very prevalent at least in inside the the the clink.

Yeah. The mental clink. Yeah. The mental clink. Um one other aspect is um a very black and white thinking. Um you kind of talked before about uh splitting which is um you know really revering and idolizing somebody and then very quickly despising them.

Uh and this can happen very very frequently and like several times throughout a day even or it can be like just a switch that is permanent. Um like someone you used to really like and idolize all of a sudden it just no more. You despise them and they're they're on the the bad person list forever.

Yeah. And that's that falls under the larger category of black and white thinking. It's not just applied to people. It's right events, things, anything. A dandelion can be entirely evil or the the fully good.

And because you see things and people and events as entirely one way or the other,

you set people up for unrealistic expectations. If you're like you're 100% pure and kind person and I love you, that person is inevitably going to let you down in some way, shape or form because no one's 100% pure and kind. Similarly, no one's 100% evil.

Uh and most people that uh you would label evil as if you have BPD probably aren't evil at all. They just did something you really didn't like. But now to you, that person is evil. not not to be trusted, not um you know, they did something wrong. At their core, they're evil. And that's another huge um hallmark of BPD as well.

Yeah. I mean, even Darth Vader was was once a young boy. Yeah. Just trying to learn the ways of the force.

But boy, did he get pale as he aged. Uh he sure did. Um this can also this splitting can happen uh with yourself. um you you may vacasillate wildly from feeling like you're you're okay and that you feel good about yourself and you have a little bit of self-confidence to really loathing yourself and um that's when like things like you know self harm can come into play. Um your sense of your own personality can really change. uh you're you know you could very much switch like kind of do these wild switches between um your goals in life or or how you want to present yourself to the world or like your values and ethics and things like that. And it this I'm not really sure but it kind of seems like almost like uh sort of auditioning yourself kind of over and over sometimes like oh let me let me try this new me or whatever or auditioning or trying out a new thing that you think might help. Um,

does that make sense? Yeah. No, totally. It's also circumstantial, too. They might act different ways to different people depending on what they think those people want from them.

Um, or yes, to impress like a a friend or a new person or something like that. They might adopt that person's um like hobbies and interests. But I saw it explained as um people who have BPD and do that that they they don't understand where they end or the other person begins because

they have no idea what they believe in. They just don't know. So they're kind of open for suggestions basically.

Interesting. Yeah. Um should we take a break? Oh jeez, that came out of left field.

Sorry. Sure. All right. All right, I think it's a good time to take a break and then we're going to come back and talk more about uh personal relationships. All right. Uh we're back and talking about um borderline personality disorder. And one kind of hallmark um with someone with BPD is what's called like a favorite person or just a a person in their life that they have um have not necessarily even chosen who they've hooked up with. Could be a spouse. It could be a partner. It could be a friend or co-orker. Anyone that you really have latched on to as someone maybe the only person that you really really trust with yourself.

Yeah. And I don't think you even trust that person. You just that's the person you've come to find you can lean on the most, I think.

Okay. But yeah, the FP for those in the know, the favorite person um is very frequently somebody who is willing to kind of go along with this at least for a while. There's a ton of flattery and admiration and praise and all of your greatest points are pointed out all the time.

Um, but you're also in real danger of letting that person down and facing that wrath of rage or anger or hostility. Um, and if you come back for more, you're going to find that you as the favorite person might start altering your behavior to fit the person with BPD's behavior. So, you might start considering them when you're making plans like, "Oh, we can't go out of town this weekend because um this our friend with BPD was going to, you know, wanted us to to come out for their Sunday picnic or something like that, right?"

Like, you would be afraid to not go to their picnic. Um, and you generally end up feeling like you're walking on eggshells. And it's a codependent relationship that evolves. Um, the favorite person seems to be the person who's willing to take it the longest or the most. And that it's not a permanent thing. Typically, people get burned out on it and eventually abandon the person with BPD, which is again at the root of what they're fearful of. They're fearful of rejection or abandonment. Mhm.

The the tragedy of the whole thing is that their behavior almost inevitably guarantees that they will be rejected or abandoned by the people around them.

Yeah. That sort of self-fulfilling feedback loop. Um yeah, I mean it's it's a it's a big burden for an FP. Um and if you are a spouse or partner of someone and you are the FP, like that's a lot to manage. And so a lot of empathy goes out to those people as well. uh when you're altering your own behaviors, like literally things like I saw people are like, you know, I had to I've had to step out of like really important meetings just to answer a text within 10 minutes because I knew that that would set them off. And just little things like that can really add up um to someone's burden.

Um one of the other things that uh is difficult to deal with when you're an FP is uh that person wants you all to themsel. They're threatened very much by other people. So, they will try to isolate you from your other friends and your family so that they have you all to themselves. Not just for time. I'm sure time is a big part of it, but also to cut down on any um I guess rational explanation or rational points from those other people like what are you doing? Why are you putting up with this? Um isolating them would help cut down on that too.

Yeah. And you know, if you're an FP, there's always the um sort of sad and scary possibility that there could be a split um incident that all of a sudden you go from being the FP to being the most despised person. Um I I would imagine that's something that has is probably comes over time and is not like a a quick thing.

It can be. Uh but it can be. All right. For sure. It it can happen. It can turn on a dime.

Wow. And the other the other problem with it as well, Chuck, is that um the person with BPD almost invariably immediately regrets doing that, right?

And so they'll make every effort to try to win the person back, which probably feels pretty gross for the FP.

Um and they'll say things like, "I'll never do that again." Like they know what they've just done is worth regretting, is worth feeling horrible about because they've just been abandoned or rejected. They just did it to themselves. So now they're trying to fix it or mend it, but it's all just kind of built on, you know, shaky ground because it's it's going to happen again because it's impossible for that person not to let the person with BPD down again.

Yeah. I mean, I get the impression that people with BPD generally don't have any illusions about themselves because it is such a struggle. Well, that is a big problem with not only getting treatment, but seeking treatment. Because when your brain is structured in a certain way, and ever since you were a little kid, you've just responded a certain way to things, even if people around you are telling you that is messed up or that you're being hostile or whatever, to you, that's normal. That's natural. So, it's really, really hard to interrogate your own behavior, let alone change it, because it seems normal and natural to you. It's not that you need to change your behavior because you you chase somebody away. It's that that person left you and now you need to go get them back. Um, so even if you have people around you telling you it's going to take a lot of emphasis repeated

constant emphasis that what you're doing right now is abnormal and harmful and you need to go get help for this. Um, that's yeah, that's one of the curses of it. They can't see it. They at least if they can see it, most of the time they can't. Well, and this is I mean all the mental health disorders require a support system, but this one really seems to to sort of be at the top of the list of needing a really solid uh vast support system.

Um for treatment, uh like we said, the good news is is that treatment um works. Um they used to think that personality disorders were uh untreatable and that you were just kind of stuck with it. um they have found that um about half the people who are treated uh who seek treatment and are treated no longer meet the criteria after 5 to 10 years. Amazing.

It doesn't mean that they're, you know, they're perfect and awesome and fixed. It means uh they can still have some symptoms, but they have it under control enough to where they don't meet that five out of nine criteria. And that's what it's really sort of about, I think, is managing um something that that like you said that that you might have had since you were like a baby

um to live a productive, you know, healthy life. Yeah. And that's kind of what you're going to learn in DBT um which again is the gold standard for treating uh BPD is that you're going to be taught these skills, how to deal with

disappointment, with um being let down, with somebody not responding to your text. you're going to learn a different set of skills on how to deal with that both internally and externally. And one of the things that um that kind of differentiates DBT from other kinds of behavioral therapy uh is that there's group sessions, but it's not a group session that you know you've seen in a movie like my niece Mila was in a movie called No Exit and it featured a couple of group sessions. I think you can still see that on Netflix.

I think so. But it's not like that. It's more almost like a classroom instead and then people get up and practice these skills in front of others and with others, but it's not like a a group therapy session in the traditional sense, but that's a huge component of it is a is group work.

Yeah. And it's, you know, if it sounds a little bit like cognitive behavioral therapy, it is sort of based on that in part because it's a real and and I get how it works. It seems like a real sort of rubber meets the road practical ways of learning new behaviors rather than um and and therapy is is a huge part of it. But it's not just let's therapy and talk about your past until you're blue in the face. It's like all right, we we we know what's going on and we think we know where it came from generally. Now, let's really talk about putting this into daily practice, like literally doing things and having a checklist and and putting stuff into practice, which I think is just I mean, not only for DBT, but stuff like that is so it so speaks to me as a a good way forward when you have any kinds of problems. Um, because it's it's just a practical thing. It's learning new behaviors. That's another

um criticism of of BPD as its own disorder that DBT can be used to treat all sorts of different symptoms of all sorts of different disorders. It just makes sense like that.

Yeah. No, for sure. But um there's also another type of therapy that supposedly works really well for DBT called psychonamic therapy and it is talking about what you went through as a child. until you're blue in the face. But it's more about relating to relating that to how you deal with people in your current life, people in situations. It's relating it back to it so that it's not just one big confusing blob. You understand your own behavior better um

as a result of interrogating what you went through as a kid. And I guess it smells a lot like it it believes um borderline is a a like a a a response to trauma using anger rather than anything else.

Yeah. I mean, if you can sort of build out your emotional life map, I imagine that's a very helpful thing to do, you know.

Yeah. And then one other thing that really kind of underscores how difficult dealing with people with borderline personality disorder can be, one of the main components of dialectical behavioral therapy is um what's called a therapist consultation team,

which is basically a group of therapists working with patients with BPD having like a a like a blowoff steam session about them, right? and reminding one another like these are people suffering and we need to have empathy for them. That's how hard it can be to treat people with BPD.

Yeah. And like I said at the beginning, there are therapists that will refuse treatment because uh all the reasons that we talked about, uh they say the National Alliance on Mental Health basically says if you have BPD and you recognize that and you want to seek treatment, um whether it's, you know, DBT or any other kind, you uh well, first of all, seek out someone that specializes in DBT. But if there's no one in your area that does that, then like you you have a right and this this goes with any sort of emotional or mental problems that anyone has, they're working for you. So you have the right to advocate for yourself and to find somebody who works for you and who um who will not stigmatize you and like really like it's okay to question them and make sure it's a good fit for you.

Yeah, for sure. I think people just I don't know. It's I think part of the problems with a lot of these disorders is people can't be advocates for themselves and and that might be part of their problem. So, they're not going to advocate for themselves when receiving treatment and they'll just take whatever they can get and it's not all therapies are created equal and therapists are created equal.

Definitely not. I think one of the problems with BPD is that they might over advocate for themselves.

Oh. And like chase a therapist off basically, right? But the the thing is, Chuck, is like you said, people take what they can get in part because there's a huge shortage of um psychiatrists in particular in the United States

and people will just take whoever can get them in within a year or less. Um like the waiting lists are crazy.

It is crazy. Yeah. Well, if you want to know more about BPD, uh there are a lot of articles and resources all over the internet to help you. Um and uh since I said that, it's time for listener mail. Uh, I'm going to call this uh, well, let's just call it listener mail. Hey guys, uh, one day I will write the email that I've been formulating in my mind for years, trying to put into words what the show has meant to me. I'm tearing up just writing that sentence, which provides you with a hint of why that email hasn't been written yet. Wink wink.

Uh, in the meantime, I want to let you know that uh, both of your names are listed on my big thanks to portion of my bachelor thesis. Nice.

Uh it's customary in my country to thank your college coach for their support during your graduation year and your thesis forward. Um I have felt it was only right to also thank the other people who have supported me to the same extent as my coach and this includes you guys. Uh I don't feel the least bit dramatic when I say my thesis would not have been written if it wasn't for you guys keeping me sane. It's what you've done for me over the years. Uh but this year I really needed it more than ever. So thank you. all caps, double exclamations. Uh, I've added a picture of my forward where your names are mentioned. And since I'm Dutch, I'm afraid it won't make much sense to you, but I figured it might bring you some joy to see the proof.

There are some rando J's scattered throughout those words. Yeah, totally. And uh, Chuck has a little null sign through it. That's weird. I'm not sure what that means.

That means watch your back. That means I don't count. Uh, and that is with much love and immense gratitude from Suzanne. Uh, oh, I'm going to do my best here, Suzanne. Uh, Chris.

Let's hear it again. Chrysilic. I like the K R Y S W I J K. You like the second one? Crystal.

Yeah. Thank you, Suzanne. I'm going to call her Suzanne. Thank you very much, Suzanne. That was very kind of you. Thank you for tearing up. Uh, I think you did just write that email if you ask me. Don't you, Chuck?

I'm tearing up. Uh, if you want to be like Suzanne and let us know what we meant to you, we always love hearing that kind of thing. Or you can just write in and say anything you want. We're at StuffPodcast at iheartradio.com. Stuff you should know is a production of iheartradio. For more podcasts, iMheart Radio, visit the iheartradio app, Apple podcasts, or wherever you listen to your favorite shows.

Questions about this episode

Who speaks in "Selects: BPD: The Worst Disorder or Not a Disorder at All? | STUFF YOU SHOULD KNOW"?

Josh Clark (Host), Chuck Bryant (Host).

What is "Selects: BPD: The Worst Disorder or Not a Disorder at All? | STUFF YOU SHOULD KNOW" about?

This discussion explores borderline personality disorder (BPD), examining whether it is the most problematic mental health condition or if it should be viewed differently. The conversation highlights the complexities of BPD, its impacts on individuals, and the broader societal misconceptions surrounding mental health disorders.

What is mentioned in this Stuff You Should Know episode?

4 people, works and ideas are mentioned, including Marsha Linehan, Dialectical Behavioral Therapy, Adolf Stern, Otto Kernberg. Each one on this page links to its own page with every episode that mentions it.

How long is "Selects: BPD: The Worst Disorder or Not a Disorder at All? | STUFF YOU SHOULD KNOW"?

The episode runs 51 min; the transcript is about 8,995 words in 170 timestamped sections.

More from Stuff You Should Know

About this transcript: the episode's spoken words as captioned on YouTube, split into timestamped sections. Reclip.Me locates every person, work and idea in the text, keeps the time it is first named, and quotes the words around it verbatim. Last updated January 24, 2026.