Psychiatric Interview: BPD (Borderline Personality Disorder) | Part 1 | Dr. Lois Choi-Kain

i wanted to start by asking you what brings you in to talk to me today it's like i'm kind of embarrassed because i don't really know what to say other than like well rebbe asked me to you know and that sounds like so like flippant and it's and it doesn't i don't want to sound that way you know what i mean sure but i mean ravi has like filmed me previously and um like the footage that she has is is pretty some of it's pretty intense like she has me like right after i tried to overdose so i was like i threw up in a bucket and like it was like should we call like poison control and she has another one where like i had like this angry episode and i broke it um i broke my laptop i just threw it on the ground and it was completely demolished and like ripped off like a van cleef necklace and um so she has like stuff like that and then it's not like i've made so much progress but i've made i've made some progress i've had my laptop for a little while now my new one good for you i haven't broken a phone in a while and um and so i guess in one way it's like good for people to see that you can't make progress and then on the other hand i just want people to know that because i don't talk to even my boyfriend doesn't know that i was diagnosed with bpd and he'll never see any of this but how can you be social i don't i can't and i really am worried about it but i'm just gonna hope he doesn't um well i find this fascinating because the way you're sitting here with me today is that i can't imagine that happening exactly and that's my point because i want people to see that like they have this idea of what what bpd is or what mental illness is and all of these things and it's actually sort of i struggle with that because then when someone meets me they have no idea right and and i think that's there's the misconception of what it looks like and it doesn't always look like what people think it looks like you know and i really want people to know that it doesn't fit into a box well it sounds to me like part of your reason for being here is that you are telling a story of your own self-improvement in the face of these really difficult and volatile moments right i mean i didn't actually like think about that until later and only because my boyfriend pointed it out but yes i'm gonna take that okay take a little bit i'm gonna take that yeah yeah so can you tell me how that exactly happened for you how you went from being in a place where you're overdosing and breaking your computer to holding on to things a little longer without taking your feelings into action like that what do you think's worked i mean i think when we get older the borderlands not to not to call us borderlands but borderlands when we get older we sort of have a better grasp of our emotion regulation and that's been the case for me and then also just i've been and i said this before like i before i was a turtle without a shell like quite raw quite vulnerable quite susceptible to anything and it was just like everything was so painful and now i have a shell and i don't know if that's age or experience or maybe just like a little bit of both um like one thing i'm proud about with myself is that before anger was just like my go-to like i didn't really have any other way to process emotion so i would just be angry in fact i was always angry anyway and then but now i can like my and like now i can like cry and like feel sad and before it was like just anger just like this so much anger and i would like break things and scream and yell and like tear at myself and like um and then i would cry and feel sad you know but now i can feel sad like initially which i i think is an improvement so too yeah i think that is improvement in the sense that you went from feeling these strong feelings that you didn't have a good grasp on that would just turn into kind of angry action and now you have a bit more ability to feel your own vulnerability yeah definitely and some different ways in which that vulnerability feels to you like sadness or yeah maybe regret or anxiety or fear or guilt or something along those lines yeah yeah yeah that is i think you're right there's some maturational process about it but it seems to me there's also some effort on your part and i did to dbt so that helped um but i i wouldn't give myself that much credit honestly i do think age has a lot to do with it like my mother was definitely a borderline and she's so much um she's not you know like how so was she borderline what happened how did you know i mean i didn't know and i i don't think there's any way that i would ever know but she was just like extremely vicious and very um i don't i mean i don't want to say these negative things and like and make them like these attributes of borderline but she was such a vicious woman and like instead of like hugging she would like hurt you know what i mean so it's like it's like kind of like i hate you don't leave me that kind of thing or whatever and then like all of those all of those like cliches like walking on eggshells but she was just such a vicious vicious woman and um she was horribly mean and that's a terrible thing to say about i mean i don't i feel bad saying that that's how i knew she was borderline no but really though she was just she was it makes sense she was horrific like just horrific like just such a horrible horrible mother and she never she didn't have any ability to process her emotions and anger was definitely what she went to like there was no there was no ability to anything else it was just anger all the time and so you could recognize that like you on some level she was mostly feeling all her intense emotions through anger so that she would express so there was this i was in japan i was in tokyo and um there was like this and i'd never heard of borderline personality disorder because i actually think it really hasn't really been understood until and this was in 2007 i believe so this was a long time ago and there was a time article which i don't even read time now i think i've graduated to like a little bit higher vocabulary but um and it was talking about borderline personality disorder and then there was this one sentence in there and it was talking about how instead of hugging they claw something along those lines and i just teared up because i recognized my mother so much like in this article and that's like when i knew that she i mean you can't really diagnose someone else right well you can't but i can't um that's when i knew that like that was probably what was going on with her and so then when i was hospitalized for the first time um and i had brought that up like i don't know if that's like how quickly they connected the dots but they connected those dots so the first time you were hospitalized was that when you tried to overdose or was it before that there were so many so many overdoses so many one of the for everyone one of many so the first time it was like it was so like i wrote this thing about it or whatever it was like basically like children's benadryl and like that was like how i was gonna like that's how i was gonna go like that's how i was gonna tell everybody how much i condemned life like children's been a drill which weirdly like was effective at like making me super sick but um how old were you i was 20 30 i was 30 yeah i was 30. so not young but you had children's benadryl well of course i mean i guess not of course i don't know why i had it actually you're right yeah i know i had children and then after that it was like then because i had this in new york i had this doctor that would prescribe anything i wanted so then it was like adderall xanax whatever it was whatever it is that i wanted i had it and so um that was just like an ongoing thing and then i would like research how to do it and like it actually has like a pretty low like ability of like working it's usually like 11 of the cases and i was like this is gonna take forever and so i like figured out like how high a bridge needs to be if i need to jump off of it which is 250 feet and then what kind of gun and like it's just stuff like that like i was obsessed with it so you were kind of honing your skills over that period of time like you started with something like children's yeah which kind of now you're like what was i thinking that's but none of it worked anyway but yeah exactly like that one was just sort of like so it was just so it was so dramatic like in a cheesy way i remember just like telling my boyfriend on the time i was like you're gonna watch me die on children's benadryl like i'm like adding that last part but it was so awful and i feel bad for him for having to go through that well i wonder if you can remember why you took the overdose though aside from wanting to die it was the holidays which i don't typically do well around and um i was having an interpersonal conflict with him so i don't remember what it was that happened but like and it didn't help that honestly like i've been out drinking and doing coke and stuff so like that didn't help obviously that makes you like more vulnerable and susceptible to like whatever and then um i mean it wasn't it wasn't it wasn't my best moment clearly clearly and then i had to you got a lot better at these overdoses but these overdoses i think that there are a statement you want to be dead there it sounds to me correct me if i'm wrong they're also a statement someone's hurt me or i'm hurting yeah yeah yeah and is there always someone there when you do this no i mean there was one time towards the end towards the like last ones that were happening um i took like limit was like pretty much impossible to overdose on but like like i don't i don't know if you know this or not but you lose like your ability like your motor function and i couldn't like so i did that and something else and i don't remember what the other one was but nobody was there and i didn't tell anybody and i had this playlist that i would play whenever i was going to like get myself like revved up for this like suicide session it's just like the like it's so not opposite to emotion it's so like i'm going to dive into this depression you know it's actually called like avec cigarette so it was like basically just sad like i think i even had like les mis on you know what i mean like oh wow i know it was it was so ridiculous is it though well because les mis is like the dad dies and like you know and i went to go see that musical with my you know i just i've seen it like three times and like when the dad dies it's like it always is pretty acute like it's like a very um very yeah it was so but it's kind of i mean i shouldn't have deliberately put it on anyway so i put that on and that was probably the only time where i didn't where i know where you're going with this where like i would reach out and ask for help right or tell somebody what happened because i never actually called 9-1-1 but i would always tell a friend or something but that time we didn't and vijay actually somehow he just knew what was going on and he came over and i hadn't locked the door which is i don't know but i was on the ground and i couldn't move and um and i remember like when i because i couldn't move because i didn't have any like motor abilities i didn't have like i couldn't i didn't have anything the strength to like open up the door or call or ask for help or anything and i remember just being there like incapacitated and being like this is not what you want like this is not what you want and i don't think i overdosed again after that when was huh maybe 2000 and 2011 was one of the majority of them happened so i want to say 2011. i don't think i did it again after that it's a blurry blurry recollection but i really don't think i did yeah so it's been about eight years since you've overdosed right and how did that happen in 2012 2012 so it's seven seven seven this year yeah yeah a while yeah yeah so in that moment you decided to stop doing it because it was yeah it was scary scary to you yeah and how did you manage well i went to the hospital obviously they took me in and then i was there for it's usually like a one-week stay i'm pretty sure that was a one-week stay um and then i got out again and then i wasn't better but eventually you just get better i guess right don't people just get better a little bit or do they just avoid as i've learned from my last session a little bit of both yeah i think there is something about the natural course of borderline personality disorder where you're right that people i don't know a kind of generic word is mature and how much brain development goes into that how much life experience goes into that and how much just the emotion regulation that you said gets better over time we don't know yeah but i think that there is also sometimes some avoidance that goes into why people stop exploding in the way they do so it sounds like the suicidal explosion stopped about seven years ago and is that when these kind of outward moments of destroying your computer or doing something else angry got worse or was that going on all the time that would have been like a really just pervasive issue throughout like i wasn't allowed to be angry when i was a child and i think that that actually is probably why it got to be so bad so i wasn't allowed to have like emotions or feelings or my mom would say things like children should be seen and not hurt and so like even if i were to like like i just remember once like she just like beat me up in the car and i didn't know what i had done but basically like i hadn't clapped correctly or something and it was just sort of like all right yeah it was that we've gone to the symphony and like i hadn't like done it correctly like maybe i went like this and i should have gone like this something just really ridiculous and um but i wasn't allowed to be angry and i wasn't allowed to have like emotions that i think like children should be able to have so maybe when i was like on my own then i and like it just got worse i'm not sure i'm not sure i'm actually not really sure but that was always a problem you are on to something so back then how old were you at that time um that was like my whole childhood right yeah but that memory it seems specific you know i was probably i was a teenager so do you remember how you felt yeah i always remember that just like like trapped and like weak and incapable of like defending myself and just sort of like yeah just like something like that like just like that like there was nothing i could do i could really literally nothing i could do yeah defenseless yes how does that link up to the problems of anger eventually you weren't allowed to express anger but eventually you were expressing anger in all these ways that's that being yeah yeah there's something empowering about it yeah definitely you're right definitely and it's not good that it's like linked with that but yeah definitely and i was like is it not good that's a judgment i know but it's not good i think i know okay you just said a minute ago that you thought that it was kind of bad for you that your mother didn't let you express anger because a child in that situation should normally be able to express anger or just an emotion yeah i don't i mean just emotions but yeah i know you're right it's there's got to be like a healthy balance there but is there something adaptive about the fact that you would let loose about this anger thing because i think feeling angry and acting angry there's something pretty liberating about it oh definitely like everyone likes to break [ __ ] once in a while do you i do when have you broke okay sorry we don't have to but like you know actually one exercise i do with patients is that you know these painted ceramics that kids make i have about a hundred of them okay and i bring them in and i bring in hammer and we whack them to death well it is therapeutic what do you think is therapeutic about it i'm not sure there's a what happens when yeah release of what i don't know endorphins i'm not really sure like feelings feelings yeah another thing i like to do is take glass jars and throw them into dumpsters when they shatter all over the place so what is it about phones like i feel like i'm not the only one who has like this like it's always a phone that i'm breaking okay so tell me no it's not just me though like i've been in like anger management classes and like they broke phones too like is it what the phone represents like this communication tool like is that what it is i've gone through so many phones so many phones i mean i just don't even get like a nice phone anymore that's pretty adaptive but i do think you're right about it is that there have been many broken phones in the program that i run yeah and oftentimes more probably more often than not the thing that people break that's not the object i've given them to break on purpose is the phone yeah but i want to sort out with you what what are the kind of maybe functional or positive ways in which breaking things helps you emotionally and where's the problem with it well it's a release like we talked about right it's a release and it's empowering and it's like a way to get back control maybe yeah i think that's right i mean there's something about putting force into something and watching it transform yeah it's like having an impact yeah and i do think it's true that a minute ago when you're talking about this situation with your mother you felt like you didn't matter defenseless you know and you need to kind of protect yourself in a way and i do think that sometimes the lashing out is this kind of available force of empowerment but there are downsides clearly clear um first of all the temporary lack of access to your phone or your computer it's crippling yeah yeah but what else about it is not working for you um i mean it's i mean it puts like a barrier in between relationships right and it's this is what i said before like it's so hard to like fix these things once i've done this to them you know what i mean like not i'm talking about the phone or the computer or anything else that i've broken like it's just hard to fix the relationship because this person typically the people in my lives have like almost like this like they they see me the way that most people see me and then all of a sudden they turn into um this is gonna sound like a judgmental statement but a monster and then all of a sudden it's like it's all then it's all broken and then they'll say things like you're not the person i thought you were or like that you turned you were scary now or just things like that and then it's sort of like i understand that things are fixable at that point but it's hard and it's almost like i don't want to you know what i mean and then it's like i have to get them to understand like things i don't want to have to get them to understand does that make sense yeah it does about this issue of the transition between the the version of you that they think they know and then the monster that comes out what is it like for you living between these two halves of yourself like what happens for you when you're the kind of um i don't want the person yeah yeah i don't want to be that person but this other side that's so kind of pleasant and lovely and apologetic slightly self-effacing slightly what's it like for you in that state this is how i want to be is that yeah definitely i don't want to be like i don't want to be it's not like i need to be perfect but i don't want to be like i don't want to be the person who like breaks relationships or breaks phones or like it's not like i know that no one is perfect and i know that no one is as like as and i know that we're all just sort of struggling and you know just barely making it i know that that's true about everybody but [Music] sometimes it feels like i struggle with it a little bit more than other people and i i kind of just want to be someone who doesn't struggle with it as much i can understand that wish but you are someone who has to work harder to manage your emotions and how you express them and what impact they make on your relationships and you know there is this divide between this side of you that's so um appealing but kind of hidden yeah i know it's true and then this transition to what you call the monster but a more like kind of naked expression of how you feel so what happens when you actually aside from the release and all these internal benefits of the destructive tendencies tendencies what is it like for you to be seen as that person that it's horrible and i don't want it to happen what is horrible about it for you i understand that it's horrible but what exactly is it for you that bothers you most well i feel like i'm disappointing the other person i really do and i it hurts a lot when they say things like you're not the person i thought you were you know that kind of thing hurts a lot and they're not wrong so but then if i was just like go into every conversation and just like be transparent and talk about like at the same time i have cuts all over my arms so i just kind of feel like people should automatically know that there's probably something a little not to say unhinged but like a little bit more um unhinged i don't know i just feel like i just try not to be that person and i don't want to be that person i don't want to disappoint other people and i don't want to have to like i don't want to have to like i want to be that way i know that you're trying to get like something out of me and i'm sorry that i'm struggling but i just don't want to be that way i don't blame you but i do think there's something about not being what other people want you to be being disappointing it's kind of like clapping the wrong way at the symphony that really is painful for you but it's the way you really are yeah and i think that's the difficulty is for you to be yourself you feel at risk you know at the mercy of someone else's hand that you can't quite control or do you think it's like that for everybody to a certain extent i'm not i mean i don't know i'm just asking like do you think it is for everybody like everyone who has bpd or everybody everybody yeah i'm just asking i honestly don't know it's like a genuine question that's a good question is everyone like that in the sense that they try to hide their true selves to be more acceptable to others yeah i think everybody you know yeah i think there's some variation on it but i think like you're saying it's harder for some people because the gap between who you really are and who you want people to see you to be is bigger yeah i mean if i were to go around being as like dysregulated as i probably am or like like i have such bad anxiety and it's already hard enough to like be around people like to wear like even my friends are like you're a little off you know like because i i start like i just say weird things sometimes and people are like oh my god like just stop talking um it's true but like if i if i were to be that way i would never be able to get a job i would never have like any friends and i would i mean i just yeah that's what i think i think that those things would happen and then i wouldn't be able to function if you didn't have friends you wouldn't be able to function if i didn't have it like if i weren't able to like be like able like i interview pretty well and like i typically do well at work unless like things have like crashed and burned or like and i mean i don't i don't think i would be able to be a functioning adult i really don't i need to be a functioning adult i mean i need to you get an a plus on that i don't think i do but we need to be a function the desire is there yeah i can see that i can see that i think that part of what makes you so interesting is that you have these different aspects to yourself you are a very likable person and there's a side of you that becomes unhinged it's this side that makes you more than what other people want you to be and it makes you the individual you are and that's your emotional life yes it's true you don't always manage your emotional life in a way that's optimal for others but that doesn't mean you have to always make yourself optimal to others true but okay and i don't mean to interrupt you but like i mean i i think anyone who has borderline personality disorder can relate to this but i've lost friends and i've lost relationships and i've like alienated people because of my inability to be this perfect person you know what i mean and i don't want that to happen you know what what me too oh that's that's nice that makes you feel better yeah we all do that to some extent and i think you're right you're on to something about how people with bpd have the kinds of problems other people without bpd have but more extreme magnify because i can tell you yeah i've sometimes had to say things or do things for myself that weren't acceptable to other people in my life and sometimes you lose those relationships yeah but it's a matter of feeling more like maybe decisive and in control about it rather than it just happening to you yeah that's how i feel like it is for me but you're more in control of it sometimes i'm giving you credit here you give me a lot of credit when you don't give yourself credit well because i because i've lived me i've lived me i have pretty much i have all the experience with me that anybody could ever need i definitely don't want to like continue to lose like relationships and even like if the relationship i'm in isn't healthy like i would like to be the one who takes that step to be like this is an unhealthy relationship i'm going to separate myself from this relationship in a healthy balanced manner but it very rarely happens like that it's usually just like chaos and i really just don't want it to be that way anymore so if i act this way and i'll be honest like if i act this way maybe eventually it'll just always be this way it's got better it has to i mean i think you actually have some real understanding of these things for yourself and it has gotten better but i think you are right that you have a ways to go yeah of course because i do think it is a kind of lifelong goal for all of us to be able to decisively say this isn't healthy for me and then kind of like package it up and tie a bow on it that's the dream it rarely happens that way but um i i think the the thing i want to ask you um before we end is in light of the this progress you've made going from overdosing to not overdosing breaking things at your own expense and driving away people that you actually need to not doing that for for a while yeah as much yes what do you still think you need to work on what is the biggest problem in your life right now i mean i want to say anger because i just i didn't realize this as much until we had these sessions not you and i but the last two like pathologically avoiding it is that the right way to say that like i am so scared of being angry that i will do anything to make sure that i'm not going to be in a situation where i get angry so what is that anything you do to make sure you don't get angry people pleasing or like just avoiding certain conversations or topics or um not asking questions about certain things or just like letting myself think certain things because i don't want to know the answer um not yeah definitely not having conversations that i find to be um likely to make you yeah exactly well i think that when people realize something's a problem like anger sometimes the most brutish way to manage it is to avoid it yeah and that's a step in the right direction it's just like if people have a problem managing alcohol use they avoid it all together now for someone who's emotionally sensitive who hasn't been allowed to express emotions openly this rarely works for the long run yeah so i've heard yeah yeah and some people do things that kind of look normal to the naked eye like sleeping a lot taking naps drinking using benadryl actually benadryl is a big thing you're like why would you i was like yeah of course i have it like that new drill makes everyone a little delirious yeah of course i have it i didn't even think about that as being weird yeah of course i have children's benadryl yeah i know do you still use it no no so what do you do in addition to these actions to manage all that emotion you're not expressing um well probably i mean i don't know i mean um i don't know i really don't know i mean i know that if i'm depressed i'll sleep and if i need to like if there's definitely like if i feel like i have done something wrong or i haven't done something to the best of my abilities like i definitely will sleep as much as i can do you ever use medications more than you're supposed to or yeah how about alcohol yeah i mean i feel like we've discussed this in the last session but yes alcohol too but only when i'm like with people that i don't like only when it's like a social situation because i don't drink by myself and like when i'm with my boyfriend i don't drink that much at all and like i'll just have like we'll just have like one or two and then like that's it like it doesn't matter like where we are or what we're doing like i have no desire whatsoever to be excessive about it but like when i'm with people that like my friends or a social situation i'm definitely going to be drinking too much and it's not like too much it's not a purpose yeah too much how do you know well i think the blacking out would probably be a big indication what do you mean by that blocking out just like not remembering that mostly hope happens in social situations it only happens in social situations yeah why is that because i have anxiety yeah i have some fear anxiety so anxiety about the people yeah like it doesn't even if they're like a really good friend like i get anxiety about hanging out with them um yeah that sounds really uncomfortable yeah i mean it is but that's just i think i think a lot of people have that a lot of people have social anxiety i think mine is probably a little bit worse but um than your average person but i think that's something that a lot of people suffer from yeah i do think that you will reach a fuller potential for yourself if you work out something about your fears about others and how you come across to them whether or not they find you acceptable i never that's that's a connection i never thought about that but you're right okay sorry was that torture or was that helpful oh my gosh i just thought i had social anxiety because i have social anxiety i had no idea that that's like the connection there well of course it is well i mean not of course do you wanna know how much therapy i've had well this one was for free i know exactly thank you rebbie thank you lois yeah thank you yeah sorry i'm like thinking the wrong person i apologize sorry thank you yeah well i am very impressed by you don't be but thank you for saying that and fine for the record that's another thing i think you need to work on is is uh kind of deflecting credit from yourself because i have a feeling this thing that your mother instilled in you through her volatility is fear of having pride in yourself yes you didn't allow that yeah and that's probably getting in the way of your asserting yourself in a way that would feel more satisfying to you yeah i think you're right definitely so um i found this a very um satisfying conversation me too i've gotten to know you and i feel like i was fortunate to do so that's kind thank you and i hope this kind of helps you carry on yeah sorry yeah i know thank you that was super helpful and i um thank you i mean that genuinely thank you you're quite welcome thank you all right okay yay what do we do now thank you okay before we finish up let's just roll a little room tone which is good everybody stays quiet and we record for 10-20 seconds you

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Published: Tue Feb 02 2021