 The main victim of the borderline patient is herself Yes, yes, or himself Gender pronouns are interchangeable and I say she Simply replace it with he and I say he guess what you can replace it with she I'm gonna use she throughout this text throughout this video so the greatest victim of the borderline patient Is herself She torments herself. She hates herself. She loathes herself. She considered her considers herself a bad object She tries to keep people away From finding who she truly is She has a very negative Self-image is unworthy bad corrupt hopeless and very often helpless Her aggression is compensatory and this is the topic of today's lecture My name by the way is some buckney. Yes, still and I'm the author of Malignan self-love narcissism revisited then as bazillion other books about personality disorders economics philosophy and so forth I'm also a former Visiting professor of psychology Yes, and today we're going to discuss secondary issues in dialectical behavior therapy issues that elucidate through light on the borderline Dynamic when I say borderline, I mean of course borderline personality disorder or BPD how borderlines abuse first and foremost themselves In dialectical behavior of therapy. There's something called secondary targets and what I want to do. I want to read to you something that Linehan has written Marshall Linehan is written. She's the she's the one who developed Who developed a DBT dialectical behavior therapy? the main therapy used in borderline personality disorder so so she identified basically several dimensions of behavior that are Problematic in borderline active passivity and I'm quoting Marshall Linehan active passivity the tendency to approach problems passively and helplessly rather than actively and determinately and this results in a compensatory mechanism known as apparent competence the tendency to appear Able to cope with everyday life and resistance to seeking help or accepting it when it would be effective and wise to do so The second diet is emotional vulnerability and self-invalidation emotional vulnerability high sensitivity to emotional cues emotional intensity and slow return to emotional baseline self-invalidation adopting characteristics of the invalidating environment as fact Not acknowledging true thoughts and feelings about self others or the situation and the third diet is Unrelenting crisis and inhibited grieving unrelated crisis repetitive stressful events coupled with an inability to recover fully from any one stressful event inhibited grieving Has to do with not inability to fully experience and or resolve These the aforementioned traumatic or painful events. These are the three diets. We're gonna I'm going to Expand a bit on each and every one one of these are patterns extreme patterns experienced by the way both by clients and Sometimes by therapists via transference and Both the clients and the therapists remain stuck in these patterns makes it very hard for therapy to be Effectuated and for clients to reach their goals. These are known as secondary targets Let's start with inhibited grieving In the next edition of the diagnostic and statistical manual edition six, we're gonna have a diagnosis Known as prolonged grief disorder It's an encapsulation of what liner hand called inhibited grieving inhibited grieving is Active or passive ways that people avoid or escape their emotions Particularly emotions related to loss or grief And so when do we grieve? When do we experience loss? When do we mourn? When we lose something we lose someone Who or which are significant to us? So it's not always the loss of the person It's not always the loss of an object In animate object. It's not always the loss of a position reputation place language you name it it's sometimes The perception of the loss Sometimes the grief is sometimes not over the loss itself But over the experience of the loss the perception of the loss It's an attempt to avoid the emotions attendant upon the loss Upon the grief upon the morning The grief is prolonged Precisely because we don't confront these emotions We don't process them We don't live with them. We don't get habituated by avoiding them actually end up perpetuating them and so Loss and grief a very dominant in cluster B personality disorder, especially narcissistic and borderline. I've suggested many times that NPD and BPD these personality disorders actually types of prolonged grief Grief reactions grief over what could have been grief over lost potential When we lose something when we lose someone when we think of tragic Regrettable things our past nostalgic and even when we live a life That we disown that we feel estranged from a life that is not our own life that we hate Life that we never wanted We feel sad feel sad We feel grief grief Because there is a loss there and it is a loss of a hypothetical It's a loss of a future a counterfactual future There has never happened but could have in short Prolonged grief is about lost potentials much more than about lost actualities We grieve What could have been and we grieve the idealized image of the past These losses are all in our minds And this is especially true in borderline personality disorder borderline personality disorder is a form of Solipsism an escape from reality by handing over Important internal processes and their regulation to an outside agent outsourcing them For example to an intimate partner so Grief and sadness and mourning they're painful They're overwhelming In the case of the borderline, they're intolerable And so the inhibited grieving comes in To prevent the borderline from decompensating disintegrating and acting out. It's a defense against the ocean of sorrow And suffering that constitutes the borderline's experience of herself escaping such feelings is understandable avoiding them is a reasonable rational strategy and so The borderline actively Tries to distract herself She becomes a alcoholic She develops obsessive compulsive rituals like cleaning the house cleaning the house all the time Trying to get work done. She keeps her mind busy all day and many many borderlines abuse alcohol and drugs They develop addictions and all these things are intended to prevent the borderline From having an internal experience or shall I say experience of in an interior It's as if the borderline lives on the surface On the one hand the borderline has no skin separating her from reality reality impinges border touches her Directly and super painfully on the other hand it is there on the in the on the interface with reality that the borderline exists She has no depth Because she's empty There's nobody there exactly like the narcissist But the narcissist solution is to pretend That reality is a figment of his own fantasy Reality in the narcissist case is always internalized and interjected The borderline solution is very different It's to say I am going to avoid reality By keeping busy I am going to avoid reality by demolishing and eradicating my mind With drugs and alcohol I'm going to divorce my own body via Depersonalization Derealization Amnesia Dissociative defenses. I'm going to divorce my own body So that anything and everything that happens to me is not happening to me actually. I'm not there This is the borderline solution the narcissist solution the world is me the borderline solution I am not in the world so The borderline spends an inordinate amount of time Suppressing her thoughts and feelings Not expressing how she really emotes Hiding the true extent of other people's impact on her Some of this avoidance is actually very functional and necessary. It gets her through the day It allows her to function at work or some other activities, but Over time She gets addicted to avoidance to escape She develops phobia fear of being engulfed and enmeshed in reality not only with the intimate partner She loses the opportunity to experience things and And so she's devoid of an internal experience It's as if her life the borderline's life was some kind of dream a dreamscape Very often nightmarish, but not necessarily. It's very surrealistic in the neutral way It's as if she everything that's happening to her Could have happened otherwise It's just a narrative choice a script a movie and so The prolonged grief the inhibited breathing the experience of loss of the borderline Is there But it's very superficial Because it's mediated via numerous defense mechanisms Cognitive distortions serve deceptions and so on and so forth the borderline Mourns Potentialities her losses are possibilities It's as if she lives she inhabits the past and the future, but never the present and so this is inhibited inhibited grieving What about unrelenting crisis? This is the flip side of inhibited grief Inhibited grieving involves avoiding reality escaping emotions Unrelenting crisis is actually inhabiting the chaos The internal chaos of the borderline. It's as if you're immersed the borderline immerses herself immerses herself in her own Disregulated overwhelming drowning emotions It's as if she is a puppet a Mindless marionette Driven by her emotions emotions dictate to her what to do and she ends up in very difficult stressful dangerous situations she ends up being in these situations because Because she abrogates Personal responsibility choice and decision-making. She says I can't help it my emotions have driven me to do this and so Most borderlines go through in an unusual crazy number of stressful events In a single week the borderline can use drugs and alcohol Then get raped Then get evicted because she hadn't paid the rent then break up with her partner then get into a car accident Get arrested for an assault of the other driver and all this in five days The avalanche of tsunami of stressful events in the borderline's life is What line of them called the unrelenting crisis a prolonged and repeated crisis state? That engulfs the borderline is intense and provokes a disregulation of emotions in the end Another reason for the unrelenting crisis Is the fact that borderlines Misperceive reality. They have very poor reality testing Their judgment is impaired But they have like a weak radar for dangerous situations risky people and so on so forth and sometimes They do realize that some people are predators Some situations a bed for them, but they get into the situation anyway Why? Because it's exciting It's risky. It's thrilling Borderlines are reckless and defined when they are in a secondary psychopathic state So sometimes it's a lack of discernment a lack of judgment gallability naivete or whatever and Sometimes it's just the f you factor on the hell with it I'm gonna go along with it because it sounds fun It sounds exciting. It sounds irresistible. Let's go to the next diet active passivity Active passivity Is the opposite of apparent competence, which we're going to discuss momentarily Apparent competence is when you when the borderline appears more competent and capable than she is So people don't recognize that she's suffering They don't recognize that she's falling apart and needs help Because she displays amazing competence. We'll come to it a bit later Active passivity is what is called in other schools of psychology land helplessness In active passivity the borderline actively seeks help from other people But she's passive in helping herself She doesn't take care of herself She ignores her own emotional needs She neglects things that need to be done. She procrastinates But not because she's a perfectionist, but because she is needy and clinging similar to a codependent So She has a hard time Managing her life and she fully expects other people to do it for her She relies on them. She's entitled exactly like the narcissist She doesn't have the confidence of the skills. She believes she's afraid. She's anxious She feels more comfortable and less alone when people around her Do everything for her Helper in her lingo So people help her and in the borderline's mind Anyone who helps her loves her Cares for her. There is an over-perception similar to the histrionic so It's a kind of test or testing The borderline pushes people around her to serve her to cater to her needs to take care of her of her life To manage her life for her because this is the only way she could ascertain That these people love her that they're there for her that they care about her that they want Her well-being So it's it's not only Over dependency. It's also a form of testing Borderline doesn't do things for herself Even if she could do them instead She actively recruits other people to help her and this is active passivity. It's like sitting on your hands While asking someone to help you to stand up Active passivity is very problematic There's over time the borderline develops a self-perception Which is essentially Helpless Borderline develops learned helplessness. She becomes anxious Incapable of helping herself. She starts to view herself as defective, deformed, impaired disabled, unable to accomplish anything and The more she relies on other people to do things for her The more she sends the message to herself That she is doomed finished hopeless Over time She begins to believe this She takes this message to heart and she thinks I'm incapable. I'm inadequate I'm unworthy. I'm a failure. I'm a loser. Sounds familiar? That's the bad object Active passivity Encourages the expression of the bed object and its dominance over all other internal psychological processes puts a lot of pressure on the borderline on the one hand and on other people who are expected to do things for her Expected to conform into a beggar, friends, lovers, I don't know, therapists They find themselves doing way more for the borderline than they would for other people In short It's an unboundary situation Both the borderline and everyone around her lose their boundaries and over time This leads of course to resentment and burnout Everyone around the borderline gets exhausted. Don't wanna be don't want her around anymore People become reluctant to help the borderline. They find themselves Rejecting her and shunning her and she on the other hand escalates. She ups the ante She demands things more intensely. She begins to threaten to stonewall passive aggressively Manipulate people to do what she wants them to do passive activity active facilities Bed for self-esteem, but also detrimental when it comes to relationships This is why many borderlines choose the solution of active apparent competence Apparent competence is when the borderline pretends to be more capable More emotionally put together more stable and more competent than she actually is she fakes it fake it till you make it She seems to be okay She seems to be reasonably competent. So people say, you know, she's she doesn't need help People don't realize how much she's suffering How much how much she needs suck or an assistance people don't understand or don't grasp How near the verge she is on the verge of falling apart and disintegrating So she can she ends up being alone Having to deal with her problems in a solitary fashion feeling disconnected or alienated from other people some people suffering from mental health problems they use apparent competence because They're incredibly smart and they're very capable in certain situations. So these people are good at work Oh, I don't know in their jobs or hobbies or volunteer activities But when they're back at home in intimate situations or alone, they fall apart They can't cope with loved ones and intimacy and so on so forth and we this is called contextual competence Contextual competence is when you're good in some situations capable and competent in some in some environments But a disaster in others People appear more competent than they are because there's a disconnect Between how they present to others and how they are feeling or functioning. It's a lie. It's a facade. It's a deception But you know, other people have their own problems They're happy to pretend together with a borderline that everything is fine and so Borderline sometimes avoid Presenting the real case avoid avoid being truthful about how suffering and how How disintegrating they are because they don't want to be a downer They don't want to express how they really feel because it makes other people miserable Nobody would want to spend time with them So they put on they put on a cheerful facade. I'm happy. Go lucky. I'm joyful. I I joke around I make people smile and laugh. I'm jovial. I'm Companionate I'm sociable and all this is fake All this is intended It's a desperate attempt to avoid abandonment and rejection by other people It's deep inside the borderline is a shambles is a ruin There's nothing there It's like some ancient archaeological site of trauma and pain and suffering putting on Happy face is exhausting spending time with others Starts to seem like a major chore in the start to avoid people and these compounds, of course the depression Let's go to the last diet, which is emotional vulnerability versus self-invalidation Emotional vulnerability is A core characteristic of borderline personality disorder and it has three different aspects emotional sensitivity emotional reactivity and slow return to emotional baseline Let me enlighten you about each one of these People with borderline personality disorder have a low threshold for emotional responses They've they have a her trigger response It doesn't take much to bring a bpd person to extremes of emotional response and emotional stone A borderline can Look at someone Listen to something or someone Watch a sad movie Be frustrated in a minor way and All this can throw the borderline into a complete emotional Tentrum She just is all over the place often aggressive and violent and so on so forth While other people who are not borderline They would seem completely oblivious to these triggers and this is emotional sensitivity Emotional reactivity is the tendency to experience very strong emotional responses Research suggests that people with borderline. They tend to have overpowering Emotional reactions particularly when the emotional figures are interpersonal or related to rejection Both intimate rejection in person a social rejection Borderlines do abandonment and they do rejection very badly People with borderline when they have these strong emotions Everything these emotions consume everything There are no resources left The entire energy Economy of the borderline is consumed and subsumed by these emotional Hurricanes and tsunamis It's very hard and takes you a huge effort and skill to manage these emotions And so most borderlines fail in doing this intense emotions interfere with borderline's ability to think To plan to problem-solve to see reality for what it is to compromise To consider other people's perspectives in short to do anything It's as if the borderline becomes the emotion It's transformed into this into this title wave of feelings It's hard to control behavior when we experience strong emotions It's doubly so for the borderline There were quite a few studies that demonstrated that when emotions are intense The main priority even in healthy people is to escape these emotions Even through behaviors which might cause us problems So for example overeating Drug abuse substance abuse Becoming aggressive or violent There's always all all these are all ways to avoid emotions that threaten to Kill us literally and Then the third element in borderline is slow return to emotional baseline People with borderline often have difficulty to get back to what is Called physiological baseline arousal These are logical baseline arousal is like arrest or arresting emotional state Rest emotional state at rest think of it as zero So there's the emotional baseline most people all people naturally Go from the emotional baseline to emotional arousal emotional arousal can be ten out of a hundred twenty out of a hundred and so the borderline Goes from the emotional baseline of zero to eighty and ninety There are no Stations in between it's from zero to hero from zero to a hundred and sixty seconds and Cannot return to zero She remains stuck at 60 or 70 Baseline is How you feel when nothing emotional is happening you go to a walk for walk I don't know when you sit quietly reading Non-fiction book financial statements That's baseline Borderlines are never a baseline never and they always find it very difficult to even get close to baseline Probably the biological reasons for this I don't want to go into this there's a physiological stress response system Differences in parasympathetic and sympathetic nervous system brain differences which have to do with emotions of regulation We'll leave it some other time But it's a fact that people with borderline personality disorder not only depart from the baseline very often and Are not able to get back to it. They also ruminate About emotional events and this amplifies emotions make it impossible literally to get back to baseline People with borderline don't have the skills They don't know how to regulate emotions. They don't know even how to self-soothe In order to get themselves back to back to baseline and there is a strong element of displacement the slow return to baseline Render the borderline chronically vulnerable to emotional situations So a borderline can have an emotional response at work she shoots up from baseline to 90 zero to 90 Then she goes back home and she's still at 60 or 70 because she can't beg get back to zero She's still at 60 or 70 and then a tiny thing tiny problem tiny frustration cause her to erupt and Aggress against her intimate partner who has done nothing to her But she's still at 60 She is not overreacting to the frustration She's just unable to get back to baseline after the incident at work. So she takes it out on her intimate partner aka displacement Emotional vulnerability Leaves the borderline Renders her makes her feel Helpless out of control of her own emotions thoughts and actions and she despises herself She loathes herself for this She's very self-critical. She has a harsh inner critic And she feels consumed By her own emotions and unable to see a way out Marshall Linehan Describe people with high emotional vulnerability as Emotional burn victims sensitive to the slightest touch And the other side of this is self-invalidation Self-invalidation is when the borderline rejects or invalidates her own emotions When she's stuck in emotional vulnerability She's caught up in her emotions and then she moves on to self-invalidation Judging herself rejecting herself for having had these emotions in the first place She goes from being sad and devastated and depressed and anxious and unhappy and and so on so forth because she has been Rejected she's been abandoned either what she goes from this Telling herself that it's stupid to feel this way something's wrong with her She's mentally ill. She's acting out. She needs to get a hold of herself. She needs to snap out of it And so She learns to invalidate herself Because she's grown up in an invalidating environment She was surrounded by people who invalidated her emotions in early childhood Parents caregivers society itself sometimes therapies can be invalidating outright rejecting people struggle with mental health problems and other people around them Her their friends the neighbors their colleagues the spouses their children their therapies Church you name it other people around them tell them You know, it's nothing serious Maybe we'll go through this. Why can't you just snap out of it? Why don't you just move on and This is very invalidating and It adds to the borderline's internal self-invalidation She internalizes these voices She interjects and they become a way of coping with her emotional dysregulation because She devalues the emotional dysregulation and she devalues the emotions She says nothing bad. It's nothing big. It's nothing serious Why are you reacting like this shame on you? There's a genetic there's a vulnerability which seems to be even genetic maybe But to tell you right the borderline Constantly self-criticizes constantly self-invalidates And if you if the borderline gets caught in this dialectic between emotional vulnerability and self-invalidation She's swept away By this she feels like a victim of the storm of her own emotions. She self-victimizes She's engulfed by self-criticism self-judgment and shame about her emotions If the borderline is comorbid With psychopathy or with narcissism. She would then Project these feelings She would develop alloplastic defenses and rather than self-victimize She would accuse other people of victimizing her She is harshly invalidating harshly self-critical and This sometimes works sometimes it jolts her out of unwanted emotional experiences, but the costs especially in the long term a huge Personal suffering shame guilt self-hate inwardly directed anger and so one of the main solutions of the borderline is to transition from the self-state of a borderline to the safe state of a psychopath secondary cycle and then grandiose narcissistic reckless reactant and defiant She blames everyone around her for her own self-victimization