In this MedCircle LIVE Event, clinical psychologist and personality disorder expert, Dr. Ramani Durvasula discusses relationship tools for an array of personality disorders.

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Personality disorders discussed during this event and in MedCircle original series include:

• Narcissism / Narcissistic personality disorder (NPD)
• Borderline personality disorder (BPD)
• Avoidant personality disorder (APD)
• Paranoid personality disorder (PPD)
• Obsessive-compulsive personality disorder (OCPD)
• Antisocial personality disorder (ASPD)
• Histrionic personality disorder (HPD)
• Dependent personality disorder (DPD)
• Schizoid personality disorder (SPD)
• Schizotypal personality disorder (STPD)

Kyle:

I’m very excited for this, Dr. Ramani. This is our first ever MedCircle live event.

Dr. Ramani:

I love it.

Kyle:

We can see people joining us right now. Welcome.

Dr. Ramani:

Awesome.

Kyle:

We posted one Instagram post on our Instagram, and I thought, “100 slots, that’s plenty.” It was sold out in a couple hours. It was done, and so, we had to open some more slots.

Dr. Ramani:

That’s so crazy. Oh, good.

Kyle:

So, I hope we get a lot of people.

Dr. Ramani:

Good, good, good. I hope a lot of people get their questions answered, because information is power.

Kyle:

Yes, yes. Well, as people start to log on, thank you for being here. I know a lot of you are brand new to MedCircle. Maybe you’ve seen a couple of Dr. Ramani’s videos on YouTube. Maybe you’ve gone to the MedCircle site and seen some stuff. But, we’re going to go in depth, and I want to make sure that the majority of our time today is spent answering your questions, the questions you have specifically related to personality disorders and how you can be a better supporter in your relationships, a better supporter for the individual who has a personality disorder, is living with one, and if you’re someone living with a personality disorder, perhaps some self-help strategies from Dr. Ramani on that, as well.

Kyle:

Well, we’re almost at 86 people. I’m going to give people a couple minutes. I know it’s quarantine. My computer is on a pile of sheets right now, so I’ve got my own little home-set office, so we’ll give people a little bit of time to get in here. Naomi, thank you so much. Dr. Ramani, people are chatting in the chat, so people are very excited to see you. You guys are more than welcome to chat using the chat button at the bottom. If you have a question for Dr. Ramani, however, use the Q&A button at the bottom. You can submit your question from there, and we’ll get to as many as possible. I’m going to give them one more minute, Dr. Ramani. But, as people are coming in, what are you hoping to accomplish when we talk about personality disorders, today?

Dr. Ramani:

Well, a couple of things is that, number one, as we know, my work is very much on narcissism in general. Today, I think, is a special focus specifically on personality disorders, so we really are talking about people who … you’re seeing someone might … a person you’re in a relationship with, family member with who has been getting therapy for this, because, odds are, they wouldn’t know they have a personality disorder unless they’ve been formally diagnosed. And, if people do have questions like, “What’s the difference? How do I know if they have a disorder or not?” I’ll talk about that. But, I think that what ends up happening is that personality disorders are very unique in the relationship space because there’s such a risk of people personalizing what happens in this.

Dr. Ramani:

Imagine you are in a relationship with somebody who was living with a substance use disorder, okay? So, they may wake up, wake up very late and be very irritable until they’re using again. A lot of people wouldn’t personalize that irritability. They’d say, “Oh, they’re an addict. They got to get their drugs and they’re not getting their drugs,” and they wouldn’t blame themselves. Interestingly, with the personality disorders, people blame themselves when they’re in those relationships because, again, personality disorders, by definition, particularly the ones … I shouldn’t say all. The ones, the narcissistic, borderline, those kinds of personality disorders have associated with them a fair amount of interpersonal instability.

Dr. Ramani:

Interestingly, the other people in those relationships, the person who may not have a personality disorder tends to blame themselves. And so, that piece of it is why I want people to understand the boundary between you and them, what responsibility lies with them, and to be very realistic about what it is you can do and how to take good care of yourself in one of these relationships so you can be there with someone, but not get lost in the relationship and not get harmed by it [crosstalk 00:03:59]

Kyle:

Yes, yes, okay, well, I’m going to turn off my air conditioning since it’s a little loud. I think we have a lot of people in our first live event, so excited. I woke up like it was Christmas, today. Thank you for putting in your questions. There’s a Q&A box on the bottom. Put in your questions there. And, if you feel so inspired right now, I’m going to do it. Dr. Ramani, you can; you cannot, whatever you want. I am going to just take a picture of myself and put it on social media. One thing that MedCircle is doing, of course-

Dr. Ramani:

Like, picture of the screen? You are talking-

Kyle:

I’m just going to do one of these, like a selfie.

Dr. Ramani:

Oh, all right, I’m going to take it of the screen because I don’t have such capabilities. You always don’t quite understand how limited I am. Look, they’ll even have the words then, see?

Kyle:

There, I’ll get Dr.-

Dr. Ramani:

I guess I’ll try that other thing you just told me to do, but that just feels like a lot to me. Uh, yeah, that’s … I look a little crazy, but my kids would say, “Why don’t you know how to do this?” but there we go. All right, I got it.

Kyle:

And, mental health can be a personal journey. It can be one you share with family and friends. I, by no mean, want to pressure anybody to share what they’re doing here, today. But, for those of you who do feel comfortable sharing that you took time out of your day today to get educated on mental health, that is a really courageous and proud thing to share, I think. So, if you feel strongly about that, tag me; tag Dr. Ramani. Tag MedCircle, and we’ll connect on social media after this. But, let’s get into this discussion about personality disorders. What types of relationship issues do you see in your practice, Dr. Ramani, treating personality disorders in regards to how that affects the relationship?

Dr. Ramani:

So, I work predominantly with survivors of relationships, people who were in relationships; either they’re, if not full-blown personality disorders with relatively difficult personality patterns. These are often high-conflict and antagonistic, dysregulated, manipulative kinds of relationships. And, many people have been in these relationships for years and have been second-guessing themselves and been confused and assuming it was them and wondering what they’re doing wrong for years. My goal has often been, in working with clients, is to educate them ab these patterns. Because, sometimes, that actually clears up most of the other thing. “Oh, I didn’t even know this was a thing. I thought I was doing something wrong.” Especially when … and, again, I talk about this word a lot, so we might as well get it out right in the beginning, so I’ll use it, is gaslighting.

Dr. Ramani:

Gaslighting is a classical part of any relationship with somebody who has a lot of personality stuff going on, and gaslighting is the denial of another person’s reality. It can take several forms, including literally denying reality: “I never said that. I never did that,” and yet, you literally have the text message in your hand where they said that. It might be things like, “You’re being too sensitive. You have no right to feel that way. You’re the one who has a problem.” It’s either a deflection. They’ll minimize it. There’s, “You’re making too big a deal about this,” and that tends to be the landscape of a relationship with somebody who has, really, personality issues, particularly narcissistic personality issues.

Dr. Ramani:

And so, it’s helping clear the air and help them understand that’s what gaslighting is. Your reality is being played with. That’s why you’re so confused. And, for most people, Kyle, these are what we call legacy issues. They’re issues that started in childhood. They either had one or two narcissistic or other high-conflict difficult personality parents, and that can set a person up for thinking this kind of relationship manipulation is normal. In fact, abuse = love, the trauma bonded kind of a situation. So, it’s helping people understand that history. In addition, people who do have histories of trauma are actually more vulnerable to entering these relationships with people with high conflict personalities and getting stuck in them as though, “Love is supposed to be confusing and upside down,” and, “I feel bad about myself,” and all of that. All of those things are almost equated in this toxic stew of love. It’s helping a person create a new paradigm of what a loving relationship is supposed to look like.

Kyle:

When we talk about personality disorders on MedCircle, narcissism seems to be the most sought out topic of the personality disorders. After that, we have borderline personality disorder. Very briefly, what is that?

Dr. Ramani:

Which one, narcissism or borderline personality?

Kyle:

BPD, borderline.

Dr. Ramani:

Okay, so, borderline personality disorder is a personality disorder characterized by instability, instability in emotion, instability in mood, instability in behavior and instability in relationships. The person experiencing borderline personality disorder really, really suffers with a sense of internal chaos almost at all times, and all of this is very much fueled by a chronic fear of abandonment. In classical pure borderline personality disorder, the person is not only terrified of abandonment, but, really often, very much devalues themselves. There’s a lot of despair in there. So, there’s the assumption of, “I’m no good. I’m worthless. Of course people are going to leave me. What do I need to do to keep them close?”

Dr. Ramani:

And, because of that, there can sometimes be a sort of desperation in their communication, and that can put other people off. Many people may feel manipulated in these relationships, and, more often than not, it’s not intentional on the part of somebody with pure borderline personality disorder in the sense that they don’t know how to appropriately reach out to someone because, imagine, they’re in a sense of panic. That’s the best way I can describe it. A person with borderline personality disorder often feels so much panic that they feel like they’re drowning. So, when they go to be with their supporter, the supporter feels like they’re going to do down with them, although they’re trying to rescue them from drowning.

Dr. Ramani:

Anyone knows that. Drowning 101 is like you have to get a person in a kind of a hold and get them out of danger. But, the borderline individual, the person with that personality disorder often feels like they’re drowning, and they feel panicked, and they feel, in a chronic sense, a psychological pain. It’s an incredibly, incredibly difficult pattern and difficult legacy to carry. So, it can be very confusing for supporters of a person with borderline personality.

Kyle:

Dr. Ramani has a few series on borderline personality disorder. At the end of this stream, if you’re watching live, I’m going to provide some discount codes if you do not have a MedCircle membership so you can access those series and more. If you’re watching this on replay, you can fast-forward if you want to get there. Otherwise, it will be at the end of this video. I want to go through avoidant personality, Dr. Ramani, paranoid personality and obsessive compulsive personality disorder. Could you talk about, very briefly, what those are, and maybe some of the relationship struggles that can come with those disorders?

Dr. Ramani:

So, those are all very different kinds of personality disorders. I most often speak about, for example, narcissistic personality disorder, a little less about borderline. But, narcissistic and borderline personality disorder sort of live in the same section of the diagnostic world, again, very much characterized by instability, dysregulation, that sort of thing. When we talk about paranoid personality, we’re in a different area of the personality and the personality disorder kind of world. People with paranoid personality disorder literally do always feel like people are out to get them, that people are watching them; people are talking about them. They’re very suspicious. They’re very mistrustful to a degree that it’s getting in the way of being able to establish any kind of meaningful relationship, collaboration, anything like that with anyone. You can imagine a relationship with someone who has paranoid personality disorder. It’s all but impossible.

Dr. Ramani:

The person with paranoid personality with seem very almost victimized. They always feel people are out to get them, and, as a result, people can experience them as very combative and oppositional like, “They’re out to get me. They’re talking about me. You’re out to get me and your friends are out to get me,” and you’ll feel like, “I can’t.” It’s almost like it feels impossible to integrate a person with that kind of a personality into your life. And, as you can imagine, close relationships are not going to be the strong suit of someone with paranoid personality. My guess is actually that people may run into this more in a family member, so, in other words, not a relationship that they chose, but a relationship with someone who’s already built into their life like a sibling or potentially a parent.

Dr. Ramani:

That lives in a part of the personality disorder world that almost tends to be a little bit more odd and unusual behavior. It almost feels on the low end of psychotic, but it’s not. Again, it’s just this incredible suspiciousness. What’s interesting is that suspiciousness and almost paranoid suspiciousness can carry through narcissistic personality. So, some people might be saying, “How do I know the difference between the two?” Because, the person with paranoid personality won’t have the grandiosity, the entitlement. They won’t have those things. But, many people with narcissistic personality styles or narcissistic personality disorder can be incredibly sensitive to criticism to a level that it looks paranoid. And, because they are so insecure … people with narcissism are so insecure. They think everyone’s out to get them, out to steal their ideas.

Dr. Ramani:

They literally want people to sign nondisclosure agreements when they walk in their front door like, “What are you talking about? This is going out to dinner,” so, that’s also seen in narcissistic personality, too. Now, when we jump the rails to these other two disorders, you’re talking about avoidant personality and obsessive compulsive personality. Avoidant personality disorder is more of an anxious presenting personality style. People with avoidant personality disorder actually look a lot like they have another kind of a mental illness called social anxiety disorder. People avoidant personality very much want to be with other people, but they’re so afraid of negative scrutiny, that they’re going to look foolish, that people are going to criticize them. They’re so afraid of that, that they either don’t put themselves into a social realm, or they avoid the situations altogether, thus the name avoidant.

Dr. Ramani:

But, the trick … and, I don’t like the name of that because, actually, people with avoidant personality want to spend time with other people, but they feel so socially unskilled, that they hold back. Or, when they do engage, there’s a sort of an awkwardness about it, and they may even agree to do things that they’re not necessarily comfortable with just so they could feel like they could fit in. People with avoidant personality may also have a greater risk, for example, of using alcohol to lubricate social situations so they feel a little bit looser and more comfortable. Now, for people with avoidant personality, relationships can be difficult, but I don’t think impossible. I think a person experiencing them is very slow to warm up, very socially anxious, may regularly seek reassurance like, “Is this a good idea? We’ll do anything you want.”

Dr. Ramani:

So, it has an almost dependent feel to it. But, what a person in a relationship with someone with avoidant personality may see is that it’s very difficult to bring this person into a larger social group. You’re like, “Hey, let’s go to this party.” They’ll be like, “Oh, no, no, no, no thank you,” and so, it might be the kind of thing where you may get into a relationship like this, but helping this person into larger social situations and issues like that might be harder. And then, going to the last personality pattern, you talked about obsessive compulsive personality. First of all, I want to distinguish that from obsessive compulsive disorder. They’re actually pretty different. Obsessive compulsive disorder has more of an anxiety feel to it, people who have intrusive unwanted thoughts and engage in behaviors to help ease their anxiety such as washing their hands or checking a lock, or ensuring that there’s a lot of symmetry in their world. People with obsessive compulsive disorder also seek out reassurance a lot, and they’re very plagued by doubt. That’s very different than obsessive compulsive personality disorder, again, a very unfortunately named … all the personality disorders, by the way, are badly named.

Kyle:

I know.

Dr. Ramani:

I don’t know if the DSM people were out to lunch or what the heck was going on, but they’re all badly named. But so, if I named them, I would call obsessive compulsive personality disorder pathologically rigid or something like that because that’s what it is. It’s characterized by rigidity, perfectionism, self-righteousness, hyper high levels of morality and a judgemental quality. Probably the thing that is most common in people with obsessive compulsive personality is they’re workaholics. They work all the time. They derive a lot of their identity from working. They judge people who don’t work as hard. They work to the detriment of their family, their relationships, everything. And so, people with obsessive compulsive personality are really stingy with money. If you go and get two cups of coffee with them and maybe you got a large and they got a small, they’ll expect you to give the extra 50 cents for the large coffee. Really, really, they get into the minutia of those things. They keep records of all that stuff. Again, there’s a mean, miserly almost quality to them, and so, not exactly very easy to have a relationship with because there’s a lot of judgment.

Dr. Ramani:

There is this miserliness. There’s this … they’re cheap, but I don’t mean cheap money, just cheap with everything: cheap with their time, cheap with their affection, cheap with their warmth. It’s just this kind of … I don’t know how to describe it, this holding back and restrictive quality, and they’re very, very rigid. If you have a date at 6:00 and you got stuck in traffic, they’ll say, “Well, I’m canceling the date because I said 6:00, so no date.” So, it’ll feel really, really rigid and uncomfortable. They’ll give you a gift and they’ll say, “Well, we decided to spend $50 gifts, so please don’t spend more than that. Oh, this year, I spent $75 on your gift, so next year, I’m only going to spend $25 on your gift. They’ll go there. They will go there … not an easy relationship to have. People with narcissism can have overlaps into that obsessive compulsive space.

Kyle:

Yes, okay. So, we’ve talked briefly then, today, about narcissistic personality disorder and the traits of narcissism, borderline personality disorder, avoidant, paranoid and obsessive compulsive personality disorder. Bridget is on this chat, as well. She’s our producer. She’s going to throw a poll up in front of you guys. If there are any personality disorders that we would like to talk about that we have not talked about, please vote very quickly so we can give some attention to the one with the highest vote. You should see that on your screen. While that’s going on, Dr. Ramani, somebody asked a question on the differences between avoidant personality disorder and social anxiety.

Dr. Ramani:

Okay. It’s a very difficult differential. In fact, each year, I always put my students in my abnormal psych class to help discern that difference. I actually think the main difference would be what we call pervasiveness and severity. People with avoidant personality, it’s a much more severe kind of a presentation. They’re more limited by their social anxiety. It cuts across more different kinds of situations, and so, because of that, because of that pervasiveness and severity and, frankly, stability of it, I think people with avoidant personality, it looks more severe. People with social anxiety will actually do pretty well with small groups, so they might do well with their closest best friends, with their brothers and sisters, even with a partner they get to know. People with social anxiety will struggle when they’re in maybe a larger group. A lot of people with social anxiety only have it in performance situations like if they have to give a speech.

Dr. Ramani:

A person with avoidant personality, it’s almost like it’s hard for them to ever get out of that. And, in fact, for some people, actually, a bigger issue with the differential is avoidant personality versus autism spectrum, because we will see that sort of discomfort sometimes in social situations. Because a person on the spectrum is going to have many, many other social processing and potentially other issues that differential becomes clear, but, in some cases, it’s not always clear, particularly a person who is on the spectrum but is functioning in workplaces and all of that.

Kyle:

So, by a landslide, most people chose borderline personality disorder for us to discuss further.

Dr. Ramani:

Ah, interesting, okay.

Kyle:

So, you talk about this more than anybody. You probably don’t even need to be asked the questions. What do people need to know when they are in a relationship with somebody who is living with BPD? How can they be a great person for themselves and their partner?

Dr. Ramani:

A couple of things. One thing I want to say, because this is actually a — I’m going to be frank with you Kyle — a very angry email I’ve gotten more than a few times, and so I want to open with this point because I think that there are people living with borderline personality who think I don’t understand this correctly. And, I apologize because I think I didn’t articulate it correctly. One of the biggest struggles is how to understand empathy in a person who has borderline personality. Here’s the bottom line. People with borderline personality have almost too much empathy most of the time. They break themselves in trying to be there for other people and listen to them, and really will actually put themselves at risk and harm to be there for other people. Where it gets problematic is when the distress for a person living with borderline personality becomes so overwhelming. They’re so despairing. They’re so fearful. They feel so worthless and they feel so awful about themselves.

Dr. Ramani:

At those times, they’re terrified, and it feels like their empathy has gone away. It hasn’t really gone away. It’s almost like it’s being eclipsed by this internal pain that this person with borderline personality is feeling. Then, the person with borderline personality feels intense remorse at not having been appropriately empathic at the time they were distressed, and then they feel even more worthless. You see how that cycle plays out. So, to anyone that has heard that and has anyone on this call, I do want to be ensured that that got heard properly because I may have said it quickly once and it may have come out insensitively, so I apologize because I work with clients who live with borderline personality. I know how despairing they are, how much pain they are in. It is incredibly difficult for them, so I think let’s start with that. Number one, this person is in a tremendous amount of pain, okay? And so, I can’t explain it. It’s as though they’re drowning and these voices in their head are saying, “You are no good and everyone’s going to leave you,” and it feels real, okay?

Kyle:

Well, but, I interviewed someone with BPD and they told it to me like this. They said, “Imagine trying to feel whole, to feel full, but no matter how much you filled yourself up, it was like shoveling dirt into a bottomless pit. They never feel full. They’re craving that their whole life.”

Dr. Ramani:

Yes, craving that, and often, rare, so kind, almost too kind. Here’s the paradox of a person with borderline personality classically. I am talking about pure borderline. Some people call it quiet borderline, and there’s a variant of borderline I can get to in a moment that can sometimes get more challenging. But, in the case of the pure, quiet borderline, the person is in so, so much pain, and they will be so kind, almost too kind to other people. They give the best of themselves to other people. They have so much empathy for other people. I work with people who are borderline personality who are healthcare providers and who are teachers. When I tell you they don’t go the extra mile, they go the extra thousand miles, but then they exhaust themselves. And so, I think that’s the struggle, is helping them find that balance of … I tell any borderline client, person living with borderline I work with, “Can you be as kind to yourself as you are to me and everyone else? If we could even get you there, we’d be so good.”

Kyle:

And, you guys, that’s a moment. There’s 165 people watching this live right now. Every single person who just heard that … I don’t care if you’ve never been told you were even close to BPD. Why wouldn’t we all take that advice? Remember that. Be [crosstalk 00:25:02] kind to ourselves.

Dr. Ramani:

And, people living with borderline personality, they’re so unkind; they’re cruel to themselves. So, I think, that if somebody’s living with someone with borderline personality, you’ve got to stop, be mindful, and catch yourself and recognize: this person is in pain. And, before you start yelling at them and getting impatient with them, no more than you would scream at anyone who’s … like somebody who’s bleeding in front of you, you wouldn’t yell at them and say, “Stop that bleeding!” You would say, “How can I help you?” and you would get down and you would help them. So, I say to people who are supporters of and love people and care for people who are borderline personality, breathe and understand they’re not acting this way to ruin your day. They’re hurting. That’s number one.

Dr. Ramani:

Number two is it’s absolutely essential that you encourage and support their attendance and treatment. I would say if you’re supporting someone whether this is your partner, your friend, a family member, please read about it. There’s some magnificent books out there about borderline personality. There’s one, I think, The Essential Family Guide to Borderline Personality. Read it, because, if you could understand this, then it may be an opportunity to say, “Ah, I get this, and this is what’s happening, now.” I was recently talking to someone with borderline personality, and she said, “I am about to get really angry at you and yell at you, and it’s because I am falling apart inside, and I’m in so much pain. I don’t know what to do with the pain.”

Dr. Ramani:

I actually thought that was great because I’ll tell you, what ended up happening for me was I was prepared and I understood she was in pain. So, while it wasn’t easy to listen to, I knew it wasn’t targeted at me. I happened to be the human being in front of her right now, and I thought: from a loving place, instead of making it personal, let me just reassure and say, “It’s okay. Is there something else we could be doing? Would you like a little time and space for yourself, and I’ll just be in the other room?” kind of thing to let them know, “You can be safe. I’m not going to abandon you. I’m not going to run away from you, but what would help you? How can I help you now?” watching your tone of voice and all of that to understand, again, there is a lot of despair. But, on the flip side, Kyle, you also need to take care of yourself because it can be difficult taking care of somebody or loving somebody who may, at times, lash out at you.

Dr. Ramani:

And so, you want to be a good supporter. How are you a good supporter? You take care of you just as I want the person who’s living with borderline personality to learn to take care of them. But, that’s going to be a requirement of any person. So, I noticed that somebody made the comment about the book Walking on Eggshells. That’s also another important book because it really does deconstruct how to communicate with someone who’s living with borderline personality without personalizing it, because that’s the key; it isn’t personal. They are struggling with something, and so it is not about you. It’s about them.

Kyle:

Yes, I love that. It’s not about you. It is about them, that [crosstalk 00:28:07]

Dr. Ramani:

It’s their journey. It’s their experience, yeah.

Kyle:

I want to go right into our questions. I want to get into as many as we can. Our first question comes from an anonymous attendee. “How do I tell if you’re gaslighting yourself, and how do we recognize the difference between our own anxious or paranoia, if you will, versus someone gaslighting us? What if we’re so far gone that you now lose trust in everyone and yourself and become as hypersensitive as a narcissist?”

Dr. Ramani:

Catch yourself. Catch yourself. The first time you say to yourself, “I think I’m being too sensitive. I think I’m making too big a deal of this,” stop, pay attention, and ask yourself the question … sorry.

Kyle:

Aah, hi cat!

Dr. Ramani:

Sorry about that.

Kyle:

I love it.

Dr. Ramani:

But, maybe take a step back and say, “Okay, let me break this down.” Because, the minute you say, “I think I’m being too sensitive,” there’s a real strong likelihood you are gaslighting yourself. So then, break down the situation in front of you and say, “What is happening here? What was the stimulus? How well am I reacting to this? Do I have all of the information?” So, it’s all of those things to be aware of. How are you reacting in a situation? But, take every gaslighting statement that’s ever been said to you. “You’re being too sensitive. That never happened. You’re making too big a deal.” And, if you’re saying things like, “Maybe I’m being too sensitive. Maybe I’m wrong. Maybe that never did happen. Maybe I am making too big a deal out of this,” odds are you are gaslighting yourself.

Dr. Ramani:

And, at that moment, catch yourself. Stop and ask the question, “How am I reading this situation?” It’s really about learning to be present with yourself. I tell people that one of the most sacred parts of yourself is your reality. Don’t let anyone take that away. And, here’s the thing. To say, “I’m being too sensitive,” is to judge your own reaction. It’s to judge your own reaction. So, to me, that’s a judgment, and that’s not healthy. Who is to say? There’s no sensitivity leader in the world. There really isn’t. So, once you say, “No, I am feeling. I am having a feeling.” If you can change, “Maybe I’m being too sensitive,” into, “I’m feeling hurt, now. I’m feeling anxious, now,” turn it into the I-am-feeling statement. Now, you’ve brought yourself back into your reality. And, instead of judging your feeling, you’re naming your feeling. I think that’s a great way to push back on gaslighting.

Kyle:

Good!

Dr. Ramani:

Felt self-gaslighting.

Kyle:

I get it. You told me that, once. I’s on YouTube, a live therapy session, you and me on my issues. You go, “Kyle, you’re judging your own feelings and your own emotions.” I go, “Oh my God, I totally am. I’m totally doing that.” Great question, thank you for doing that. Let’s go to our next question. Guys, when you thumb up a question, it goes to the top, so if you see a question that you really like, give it a thumbs up. “Why are psychopathic and sociopathic people and people with BPD attracted to each other? And, what are the longterm effects likely to be on the children of such a couple?”

Dr. Ramani:

Okay, so, let’s first start by talking about the trauma bond, because I think that the idea of the trauma bond gives people a tool to understand a lot of these kind of relationships, okay? The trauma bond is what a person learns early in life. A person who’s had early relationships in life characterized by chaos, invalidation, manipulation and confusion or abuse will then, because their early relationships during childhood conflate or confuse those kinds of things, invalidation and manipulation with love, because that’s your earliest depiction of love. Then, as you get into adulthood, relationships that have those qualities of invalidation or abuse or chaos get equated to love and are almost impossible to break.

Dr. Ramani:

Just as when you were a child, you made justifications for that person’s behavior, for their invalidation and all the rest of it, you’d make the same kinds of justifications as an adult, and that trauma bond can feel almost impossible to break. Well, as you can imagine, a person who has a very vulnerable and fragile and unstable personality style, as we might observe in a person living with borderline personality or who has borderline traits who may then fall into a relationship with somebody who is very egocentric, who is very manipulative, who’s invalidating and cruel. You could see how that could replay an earlier narrative, create a trauma bond, and the person with borderline personality, who maintains such a severe fear of abandonment will stay in that relationship not understanding it, and the person who might be more psychopathic or narcissistic will take advantage of that knowing, “This person ain’t going anywhere,” and that will sustain, so sadly, that cycle.

Dr. Ramani:

This is why people understanding the trauma bond … and, this is where some people say, “But, the other kind of relationship doesn’t feel as interesting to me.” That’s okay because, in your case, interesting and those bonds are not healthy. That may very well be that not very interesting initially is healthy, and so it doesn’t have the same kinds of old, evocative, nostalgic sparks, to be honest with you. So, those are the things to keep in mind on why those personality styles may be drawn. The psychopathic, sociopathic, narcissistic people tend to exploit a person in a relationship. A person with a more fragile personality style is very easy to take advantage of, and that’s how that terrible partnership can take place.

Kyle:

Well, this is on the same topic. An anonymous attendee asks, “Is there even a remote possibility of having a healthy romantic relationship with someone diagnosed with BPD with the help of therapy?”

Dr. Ramani:

Absolutely. I truly believe that. I think that this is where we know that people who are living with borderline personality, the treatment of choice is called dialectical behavioral therapy. DBT has a very strong mindfulness component to it, and helping the black and white of borderline personality turn into better tolerance of the gray. There is no two ways about it. A person in a relationship with somebody with borderline personality should join well-run support groups or group therapy with people to have those conversations about what works and what doesn’t work. Because, I think that what you’ll find then is, to the degree that a person is in a relationship with someone with borderline personality, to understand that, yes, there will be a need for reassurance; there will be a need for how safety is set up, that, “I’m going out. I’ll be back at such and such a time.”

Dr. Ramani:

So, if you say to your partner who’s living with borderline personality that, “I’m going to be home at 6:00.” Now it’s 5:30 and you’re not close to home, say, “I want to call you. There was a crisis at work. I just wanted to let you know that. It’s probably going to be closer to 8:00. Everything’s okay.” You don’t just roll up at 8:00. That’s not going to work. And so, you love so many other things about the … we all make compromises for love, Kyle. We all do. Nobody we fall in love with is perfect and none of us are perfect, either. We all have our thing, and I believe that, with communication, with understanding, and also for the partner to understand that there are moments in a person’s life who’s living with borderline personality that they are despairing, that they may feel chaotic and out of control.

Dr. Ramani:

That’s not about you, and it’s not always your job as that person’s partner to fix it. I highly recommend that somebody who is in a relationship with borderline personality get educated about the techniques of DBT. And, if anything, maybe even figure out … work with a couples therapist who has a DBT background who then can guide you to how to be a good supporter for that. I absolutely think it’s possible, but it’s a commitment from both partners. It’s work, and I actually do think that couples therapy on a regular basis would be an essential part of a relationship being healthy in that way.

Kyle:

On MedCircle, if you do not have an all-access membership, at the end of this, I’m going to give you guys a discount code that you guys can use to try it out. But, you can also start with the free trial. In our all-access library, Dr. Ramani has a full series on what borderline personality disorder is. She has another series that’s targeted to the family members and loved ones, and it’s strategies for living with someone or being in a relationship with someone who has BPD. We also have great patient spotlights on that, as well, so make sure you look that up if you’re interested in BPD. In the chat, Dr. Ramani, people were asking, “But, what if my partner with BPD is not going to get any therapy? What is the likelihood of me having a healthy relationship with them?”

Dr. Ramani:

Yeah, if your partner with BPD is not going to get therapy, I don’t see it. I really don’t, because I do think that the very qualities of borderline personality, which can make relationships very fraught spaces, that, first of all, that shows a lack of commitment to the relationship, because that’s something that’s going to be healthy for the relationship, and this person saying, “No, I’m not going to do this thing,” that’s respectful of the other person in the partnership. So, this has nothing to do with BPD. This has to do with: if you’re in a relationship with an addict, if you’re in a relationship with anyone who says, “Yeah, no, I’m not going to get help for what I’m struggling with,” then no, that’s showing a lack of commitment to this thing called a relationship.

Kyle:

And, I think it’s probably worth mentioning what we’re discussing here are people living with BPD, not somebody who watched a video on YouTube and diagnosed their partner with BPD.

Dr. Ramani:

No, no, no, no, yes, [crosstalk 00:37:41]

Kyle:

There are so many people who go, “I think my girlfriend has BPD,” so you can’t … unless you’re a therapist or a psychologist, you can’t really [crosstalk 00:37:50]

Dr. Ramani:

And even then, we really can’t. I would not diagnose someone I’m close to, yeah.

Kyle:

Let’s go to our next question. “What advice do you have for someone moving forward when they’ve cut off their family due to toxicity/emotional abuse? I’m in DBP, which is dialectical behavior therapy for BPD and PTSD, and I feel a bit overwhelmed by all the work I need to do moving forward to have a healthier relationship and to unpack what happened to me growing up.” She also says, “Thank you, Dr. Ramani, for helping destigmatize BPD, because things do get better.”

Dr. Ramani:

Good. First of all, that’s the most important thing of all. But, I think that question is important on so many levels, which is: this is a lot of work. Yeah, it is a lot of work. However, you know what, Kyle, I don’t think a lot of people are doing all the work they should be doing in therapy. I’ll be honest with you. A lot of people out there are walking around thinking that they ain’t got nothing going wrong with them, and there’s a lot of challenges they’re encountering. My read on that question was: initially this person has said that they have created some distance between them and their family of origin as part of working through this process. A part of DBT and any form of therapy is to give yourself permission to create safety in any way that you need or want. Listen, some families are open to it and some aren’t. It sounds like the person who wrote this is saying, “This is not going easily. This is not easy. I feel that my family of origin system was toxic, and I had to create a boundary.”

Dr. Ramani:

The idea of creating safety for yourself is a big theme in borderline personality. A lot of people living with borderline personality don’t feel safe, and a big part of the issue is learning how to keep yourself safe, and that means setting a boundary. Her family of origin may not like it, and they may even be being very difficult with her as a result of it, which can also be replaying out all of this trauma. I’m really happy to hear … and, her question raises something very important. People living with BPD should also always being trauma-oriented work. Dialectical behavior therapy, in and of itself is not necessarily designed to deal with trauma. It’s not a trauma-oriented therapy, per se. It’s a very mindful in-the-moment-oriented therapy, and its real gift is also managing some of the dangerous suicidal crises we see in borderline personality as well as the black and white thinking and all of that. An enhancement of DBT with trauma-oriented therapy, whatever form that takes … it could be EMDR. It could be something else. That, to me, is the perfect pairing. Yes, it’s a lot of work. But, on the other side of that can be a very, very productive, mindful, healthier life living with personality. It’s work. It is.

Kyle:

When you mentioned the EMDR, our next question was, “Can EMDR …” I lost the question, I think. I think she asked, or the user asked: EMDR, is there any evidence on EMDR being used for somebody who has suffered the abuse from the narcissist?

Dr. Ramani:

That’s a really great question. So, for everyone to know, EMDR is a very particular, specific form of trauma therapy that focuses on using a present-focus event, in this case, how you focus on eye movements, and then being able to use your traumatic and focus on traumatic experiences in a way that they’re not as paralytic. I’m simplifying it to a fault. It’s obviously much, much more nuanced than what I’m saying, here. I think that EMDR can be used for any kind of traumatic experience. What an EMDR therapist is probably going to work on with you is not just the trauma from the narcissistic relationship, but it’s going to go on into earlier trauma from early in life that may have been the foreshadowing of entering into this relationship and help you understand how you might have even gotten stuck in this traumatic space. So, yes, it could help you with that, for sure. But, I think, in addition to a trauma-focused therapy like EMDR to help with narcissistic abuse, you would also need to work with someone. Or, if the EMDR therapist gets it, getting educated about narcissistic abuse, how it specifically played out in your case, and how to ensure that it may not happen, again.

Kyle:

Excellent. Naomi, hi, welcome to the MedCircle live event. She asked, “Can personality disorders be connected to various forms of childhood abuse? And, if I go through the work of dealing with my childhood abuse, will my avoidant personality disorder get better or even go away?

Dr. Ramani:

That’s a great question. The fact of the matter is much of the research suggests that nearly all personality disorders do have an origin into childhood experiences and, in many cases, yeah, childhood abuse. They tend to be very developmental in their arch. They reflect disruptions in attachment, in something that tended to happen in childhood. However, Kyle, more and more research is coming out all the time showing some level of a biological temperamental vulnerability. In the case of borderline personality and certainly in psychopathy, we definitely are seeing that there might even be genetic involvement. There’s definitely brain areas that are involved in terms of dysregulation, and so we know that there’s a biological piece. In fact, Marsha Linehan’s model for understanding borderline personality is called a biosocial model where she looks at biological vulnerability up against parental invalidation.

Dr. Ramani:

But, that parental invalidation piece is really, really important. So, just about all personality disorders have their origins in childhood. It’s interesting. I was just writing a lecture on avoidant personality yesterday, so this is fresh in my mind. One thing that we know is that for people who have avoidant personality disorder, some of the origins of that may be if you come from a family where shame was used as a method of discipline or control, that there’s this sense of, “You’re a shameful person. Your social interactions are shameful.” And so, for I think you said her name, Naomi. Naomi’s question is that absolutely doing some of that deep dive into childhood issues can definitely sort of help you understand where some of these early schemas and narratives came from. And, once you start understanding some of that, you can start dismantling them.

Kyle:

Awesome, well said. Naomi, thank you, great question. Remember, if you go to the Q&A section at the bottom, you can vote up your favorite questions so they go to the top. Next up is Steve. Steve, thank you for being here. Steve says, “Dr. Ramani, in your opinion, are there any personality disorders which have not yet been formally identified, but may be in the next 10 or 15 years?”

Dr. Ramani:

That’s a really, really, really interesting question. I actually think that, to Steve’s question, what we’re going to see, it’s less of what hasn’t been identified, but rather the subtypes of the existing personality disorders we have. Does that make sense? So, we have personality issues we know about, all of which need to be renamed. But, within those, there’s likely subtypes. Theodore Millon is a … was: I think he’s passed away. He’s a well-known personality researcher, and he was somebody who had already started on that path. For example, when it came to borderline personality, he identified subtypes of borderline personality: discouraged, submissive, [crosstalk 00:45:30] and so on. So, that subtyping is where we’re going to start seeing. For example, in the narcissism world, we talk about covert narcissists, grandiose narcissists, malignant narcissists. I think the subtyping is really where the money’s going to be.

Dr. Ramani:

But, to Steve’s question, there are other personality disorder types that have been floated that have not landed in the DSM. I don’t think they ever will land in the DSM, but people like Theodore Millon’s framework and others like that have talked about things like negativistic personality, and that’s more of a self-defeating passive-aggressive personality style. That style can often be a little overlapping with narcissistic, but it doesn’t fully capture it. We may also see more of what we call a self-defeating personality style, a person who actually consistently almost gets in their own way through negative ideation. And then, there’s also been talk of the more malignant side of a truly sadistic personality style, somebody who gets pleasure out of deliberately asking harm … I’m sorry, creating harm to other people. So, these are subtypes that already exist, but never fully land. So, there’s always new ones being development. Getting the research substantiation can be hard, but those are some of the other ones that are floating out there.

Kyle:

Tiara says, “My daughter is 11 years old, diagnosed with dissociative identity disorder. How can I find her the appropriate help? All counselors in our area only work with teens or adults.”

Dr. Ramani:

That’s a tough one. So, when you have an 11-year-old who’s having dissociative symptomatology, I’m going to guess that … this is the majority if not almost all individuals living with dissociative identity disorder, which, by the way, is not a personality disorder. It’s a separate cluster of mental illnesses, which I actually think should belong alongside trauma-related disorders because almost everyone with dissociative symptomatology has endured trauma … that her daughter has endured trauma. And so, I would say that in that case, if she can’t find someone who’s specifically DID-focused that she would do well working with someone who has tremendous expertise in working with childhood trauma and understands the dissociation that occurs in people living with childhood trauma.

Dr. Ramani:

So, just simply trying to find a specialist in DID might keep ending up on a dead end because very few of us specialize … I can think of one person who’s ever been brought to my attention who does work in that area. It’s pretty rare. However, finding a very, very, very good pediatric child trauma therapist … because, people do a lot of work in that area. They should be able to understand the dissociative symptomatology that her daughter is experiencing, as well, and I really wish her strength in that journey because that is not an easy journey to be taking to watch that happening for your child.

Kyle:

Absolutely. Leah is here. Leah, thank you for being here. She asks, “How can someone access emotions and get them out? I hold my emotions in and struggle to feel them.” Leah, it’s like you’re asking my question. “I have so much built up, but I’m scared to let them out.”

Dr. Ramani:

So, I guess the first question would be, if she was sitting in front of me, I’d be like, “What are you afraid of?” I would love to direct her to some of the wonderful work out there on acceptance and commitment therapy. Because, a lot of the work of acceptance and commitment therapy, there’s all this stuff happening, and it’s good. It’s all good. There’s no feeling that’s going to break us. It may make us uncomfortable, but that discomfort is okay. You can accept that. That’s simply part of being a human being. But, I think the question would also be for her is: what is the message she got early in her life about what emotion means? What does it mean to show emotion?

Dr. Ramani:

A person may very well have been taught as a child, “Don’t show emotion. Emotion is shameful. How dare you?” She might have very well seen people being published for showing emotion. So, it’s also: what were the earliest teachings on what emotional expression means. And, for some people, they feel like: once I open up this floodgate, I’ll never be able to stop. Trust me, again, back to acceptance commitment therapy, you will be able to stop. It’ll hurt, but you will be able to stop. Letting it go will actually set you free. Unfortunately, though, Kyle, I really want to let her know we live in a society where everyone’s uncomfortable with feelings. Imagine you go to dinner with someone and they say, “I want to talk to you about how I’m feeling. I’m really despairing and I’m in a lot of internal pain,” and the other person’s answer is like, “Well, I just wanted to find out what movies you’ve been seeing.” We don’t want to talk about pain.

Dr. Ramani:

We don’t want to talk about it, and yet, to me, that’s the problem, because it’s as though it’s shameful to talk about pain. Your pain isn’t shameful. Your pain is beautiful. It’s part of who you are, and if we could just get out of our own way, questions like hers wouldn’t be something that so many people are struggling with because somehow we think it’s untoward. And, if somebody does talk about their feelings, they’re labeled as odd or weird or something like that. We stigmatize people who talk about their feelings, so we need to catch that, that again, it is these difficult experiences. There’s that Rumi quote. Rumi is a poet who wrote, “The wound is where the light enters you.” Your pain is your magic. Your pain is your power. Own it, harness it and don’t let anyone else tell you it’s ugly.

Kyle:

Oh, wow, excellent. I’m so glad you mentioned acceptance and commitment therapy. I just listened to our series on that two days ago. I was even talking about it on Instagram, and my big takeaway from … I think it was in the first or second session in that series was: when I have the feeling I’m a bad son or I’m a bad brother, or, “That person doesn’t like me,” instead of that thought putting the, I don’t know what you call it, but a segment before it that says, “I am having the thought that nobody likes me. I’m having the thought that I’m not a good son,” and that separation allows you to work from or to that thought I guess rather than from this thought that may not even be true. It’s a great series. ACT, love it.

Kyle:

Okay, we got seven minutes. I’m going to ask … some people were asking questions. There will be a recording that sends out to members who signed up for this MedCircle live event, thank you. There will be no way we’re got to get to all of these questions. There’s a few coming in every single minute. However, we will be doing more of these. In fact, I’ll just give everybody right now … we’ll do one more question from Dr. Ramani, and then we’ll wrap up. But, we are doing another one of these tomorrow. Our MedCircle live event tomorrow is for our all-access members only. It will be a smaller, more intimate meeting. Dr. Ramani will be here. It will be on personality disorders, communication styles and relationship tools, and also another chance for you guys to ask her your questions.

Kyle:

If you already have a MedCircle all-access membership, you’re good to go. You can register, all good. If you do not have an all-access membership but would like one, you can start with a free trial. You get seven days for free. You can even just go sign up for the free trial. Then, you’re an all-access member. Come to our even tomorrow and you will get in. We also want to provide you with a code for 25% off your first month. Just use RAMANI25 at checkout for your monthly membership, RAMANI25. We’ll have Bridget put it in the chat, here. This code is time-limited. I actually don’t know how long they’ll be good, so, but I would say a couple days or so. So, make sure that if you are going to do it, do it sooner rather than later. There it is, RAMANI25.

Kyle:

We also have a brand new MedCircle app. You can download it for free. There are free series available on the app. There’s also Dr. Ramani’s entire video library on the app, as well, and you can start there. Melanie asked, “How much is the all-access?” Monthly membership is $20 a month. It’s a seven-day free trial. Or, you can do $120 for the year. It’s the best deal. You pay it all upfront as $120, but make sure you use RAMANI25 at checkout for those monthly memberships. Let’s go to another question. Dr. Ramani, thank you for all of your time, today. Anonymous, hello. Anonymous asks, “Can you talk about high-functioning BPD? What does that really mean? A psychiatrist once told that to me because I was in grad school at the time and I have a career, but still struggling with BPD.”

Dr. Ramani:

I’m so glad she asked that question because here’s the thing: so many people say, “Oh, I have BPD. I’m not going to be a functioning person.” The heck you’re not. If, look at Dr. Marsha Linehan, who has been very public about the fact she lives with BPD, and Dr. Linehan, herself, has sort of revolutionized how we manage borderline personality disorder. I work with colleagues who live with borderline personality. I have clients who have borderline personality, have amazing careers. So, I think this idea is that I think many people … I’m not going to say all of any of us, but many people living with borderline personality definitely have that opportunity to be a person who’s high functioning and living with borderline. But, it is also understanding that there is often a struggle. There’s a depletion that comes from some of that internal despair and some of that internal dysregulation and the negative feelings that are constantly coursing in some of … again, the fears that can really sap a person of confidence, that could lead to second-guessing in a workplace situation, that may even contribute to sometimes there being some difficult interactions with colleagues who may or may not understand where you are coming from.

Dr. Ramani:

So, I think that that question raises the absolute critical issue of treatment and access to treatment. If everybody out there living with borderline personality had access to longterm consistent DBT as well as enhancements including trauma therapy and support groups, we wouldn’t be viewing this as this big clinical morass. We’d be viewing this as a manageable mental health issue. We’ve managed to manage lots of physical health issues in our world. But yet, mental health still remains this very marginalized space. This is about access. This is about everyone who’s living with any mental health issue. Right now, we’re talking about borderline. You absolutely … of all the personality disorders, I’ll be frank with you; borderline personality is the one that’s been subjected to the most evidence-based clinical trials and has shown real promise in terms of treatment. So, I think anyone on this call who’s living with borderline, please understand that, in some ways, it’s lifelong work. But, I’m convinced everyone’s mental health is lifelong work.

Kyle:

Absolutely!

Dr. Ramani:

Everyone of us should be doing the longterm work on our mental health. I think we view it as a one-off, and I think that’s an amazing question to end on because this idea that somebody … it sounds like she has an incredible career, and yet she’s acknowledging some days are harder than others, but she’s doing the work. I think if you do the work, there is tremendous, tremendous possibility.

Kyle:

Dr. Ramani, wonderfully said. I just want to let everyone know in the chat I have linked to Dr. Ramani’s MedCircle page. You can get her books there, learn more about her. In fact, she has a great Meet the Doctor video that’s never been publicly released. It’s just sitting on that website, so a little secret Easter egg there for you. Dr. Ramani, always wonderful to see you. I hope we can see each other in person very soon, and I’m very excited to see you tomorrow for our all-access MedCircle live event. Hopefully, we’ll do a lot more of these. We take your feedback very seriously, MedCircle members, so, when you email support@medcircle.com, that goes to me. I read every email. We go through it. We do not just reply and move on to the next thing. We track it.

Kyle:

We want this to be valuable to you. I really appreciate everybody showing up here. I really appreciate all of you that share MedCircle with your family and your friends. You guys are working to destigmatize mental health, to make this conversation normal, to make mental health a part of our everyday dinner conversation. And so, thank you for showing up and doing this. We sold out in a few hours. It was amazing. You guys are great, and we’re going to keep doing these. Awesome, awesome, Dr. Ramani, you’re the best, and remember-

Dr. Ramani:

Thank you.

Kyle:

Whatever you’re going through out there, you got this.