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walkitoutThe APA has a phenomenal podcast series called “Speaking of Psychology”. I’ve recommended the recent episode about perfectionism to a number of people, and more recently, I listened to an episode about Borderline Personality Disorder. It does a great job of explaining the evolution of how Personality Disorder in general is conceptualized (on the “borderline” of psychosis and neurosis, the many, many, many distinct personality disorders, and the new to DSM-V alternative section in which it is a general personality disorder with a list of specific symptoms). It touches on standard therapies for Borderline Personality Disorder in the US and around the world, and also its heritability. The clinician scientist interviewed for this episode is part of the general vibe of the community, in that she doesn’t blame parents for “causing” psychological problems like personality disorder, while simultaneously making fairly onerous and specific suggestions for how parenting styles can connect with underlying personality / genetics / wtf to trigger a disorder.
This feels unhelpful.
I mean, she’s already noted that burnout for therapists who treat people with borderline is a real problem, and that the disorder is highly heritable, and therefore the parents being asked to do this extra work are themselves probably personality disordered and may or may not be diagnosed themselves and may or may not have been effectively helped.
NOT mentioned in the podcast is the tendency of people with personality disorders to choose partners on the autism spectrum. There are a bunch of reasons for this. Notably: people with autism don’t necessarily notice or understand what they are encountering in a person with a personality disorder, and won’t necessarily immediately run away; also, people with autism themselves have pretty limited choices for partners. Most importantly, a person with a personality disorder may find hanging out with a person with autism to be extremely calming and relaxing and un-triggering and so forth. In any event, I have personally noticed that a lot of people with autism tend towards the blunter end of the communications spectrum, so if the kid with the personality disorder is going to need a bunch of softeners and validating and so forth, and the not-personality-disorder having parent does have autism, that’s _really going to be a much bigger lift than the therapist is imagining_.
I’m really sorry to say that I don’t have a nice, tidy suggestion for what to do instead. I think this suggestion is a total non-starter. I applaud the high degree of realism reflected in the observation that personality is pretty set and stable even in toddlers (I have all kinds of additional observations to add along the lines of “or even earlier”). There’s a lot to learn from this episode and a lot to think about, but the industry continues to suffer from disproportionate resources being diverted to people with borderline personality disorder while simultaneously accomplishing absolutely nothing. Well, okay, they might be making it worse.
This feels unhelpful.
I mean, she’s already noted that burnout for therapists who treat people with borderline is a real problem, and that the disorder is highly heritable, and therefore the parents being asked to do this extra work are themselves probably personality disordered and may or may not be diagnosed themselves and may or may not have been effectively helped.
NOT mentioned in the podcast is the tendency of people with personality disorders to choose partners on the autism spectrum. There are a bunch of reasons for this. Notably: people with autism don’t necessarily notice or understand what they are encountering in a person with a personality disorder, and won’t necessarily immediately run away; also, people with autism themselves have pretty limited choices for partners. Most importantly, a person with a personality disorder may find hanging out with a person with autism to be extremely calming and relaxing and un-triggering and so forth. In any event, I have personally noticed that a lot of people with autism tend towards the blunter end of the communications spectrum, so if the kid with the personality disorder is going to need a bunch of softeners and validating and so forth, and the not-personality-disorder having parent does have autism, that’s _really going to be a much bigger lift than the therapist is imagining_.
I’m really sorry to say that I don’t have a nice, tidy suggestion for what to do instead. I think this suggestion is a total non-starter. I applaud the high degree of realism reflected in the observation that personality is pretty set and stable even in toddlers (I have all kinds of additional observations to add along the lines of “or even earlier”). There’s a lot to learn from this episode and a lot to think about, but the industry continues to suffer from disproportionate resources being diverted to people with borderline personality disorder while simultaneously accomplishing absolutely nothing. Well, okay, they might be making it worse.