All right, hello everybody. I'm really glad to give you another side dish video and in this case one of the questions some of you were interested in was the issue of borderline personality disorder, what it's about and how to interact with somebody who might be suffering from it. So a very lucky one of my colleagues, Anthony Rucco here at University of Toronto Scarborough is considered a world expert on the disorder and does a lot of research on it in his day to day life, so he's willing to come in and chat with us. So, thank you, Anthony, appreciate it very much. >> Thanks for having. >> Maybe we could just start by you giving us a sense of what the disorder is and how you would maybe recognize it in somebody. >> Okay. So borderline personality disorder, like other personality disorders, is characterized by symptoms in four main domains. So they are in the area of emotion regulation, impulse control, identity or self concept and interpersonal relationships. So, people with BPD tend to have difficulties in some, and oftentimes all of these areas of functioning. So the, don't know if we talked about the average person with BPD, we tend to see difficulties with emotion regulation. So people with BPD will say that they experience emotions more intensely than the average person and have difficulties regulating those emotions. And related to that, they will talk about difficulties with impulsivity. So. Especially when they're experiencing a really disturbing or distressing emotion, they might do things that are not characteristic for them. So, maybe binge eating to the point that they have to throw up or their stomach's hurt, or they, and this is another symptom of the disorder, they may actually physically harm themselves. Another area of dysfunction, I talk about self-concept and identity. People with BPD have a really unstable and difficult, they have a hard time knowing who they are, we see it in lots of different ways. So for example ,they might say they don't know how to act in different situations, and they'll be a chameleon depending on the situation. Or they really don't know what to do in their lives, and who they really are. And then the other area of functioning that I talk about was relationships. So people with BPD will say that they have a hard time relating to other people in the sense that their relationships are intense and stormy, with lots of ups and downs, and they're very sensitive to interpersonal rejection. So it's this combination of a number of different symptoms, but most people will say that the key, or most prototypical symptoms of BPD are in the areas of emotion disregulation and impulsivity. >> Right. So I have this stereotypical notion in mind, which could be just that. It could be a bad stereotype, so I'm going to throw it out there and let you tell me if I've got this right or wrong. But sometimes in some of the write-ups I've seen, the story they like to tell, let me say it that way, is that people who end up suffering from Borderline often experience abandonment as a young child in some way. So a major parental figure maybe or whoever abandonment and they've become a little they're, I'd say fixated, on that worry of being abandoned. And so very often when they start a new relationship with somebody, they will, as you say, over express the positivity they feel. They will feel they will feel rescued perhaps or something to that extend, which sometimes can lead to a self-fulfilling prophecy in the sense that this other person perceives it as a little too quick, a little too fast, a little too strong. And may react with a little bit of pushback, which then feeds the abandonment kind of worry, and again, with an overactive emotional response, this person could take that very hard. Is that sort of stereotypical endo-play that somebody might see? >> Yeah, I mean, it's a great question, I mean, the stereotype is that BPD is more prevalent among women, which it is somewhat more prevalent, but men are also affected with the disorder. And if we're thinking about potential causes of the disorder, one of the causes that is frequently been sighted in the research order term, is a history of abandonment, usually they talk about it as a history of trauma, such as physical abuse, sexual abuse, verbal abuse, or neglect. And when we think about potential causes of BPD, we tend to view BPD as a result of, just like other disorders, mental disorders, of an interaction between the environment, genetics, and neurobiology. So one theory is that maybe at least a subset of people who have BPD, they may actually have certain genetic predispositions. And in the presence of those genetic predispositions, if there is some type of an invalidating environment, an environment in which a person is told that their emotions are not good, that it's bad to have emotions. Or that the person experiences some trauma or abandonment, then we might see some type of really an unleashing this developmental process that leads to the development of BPD. We think that might be related to things like stress hormones, and chronically elevated levels of cortisol for example, that might actually then affect how the brain is functioning. And there's also some research that suggests that perhaps these high levels of stress hormones are even impacting the structure of the brain. And so it's a really complex thing, and abandonment and trauma is definitely considered one of the potential causes of the disorder. But I do want to highlight that, because BPD can be quite different from one person to the other, by that I mean that because there are nine different potential symptoms of the disorder, and in order to be diagnosed with the disorder you actually need five of them. It's possible to have two people with BPD that actually only share one common symptom. So BPD is probably not one disorder, but a combination of multiple causes and multiple ways in which those causal pathways lead to people who present with symptoms of BPD. So, it's a complicated thing and not everybody has a history of abandonment, not everybody has a history of trauma, but it is definitely something that's more prevalent in people with BPD. >> Cool, yeah, and that's probably true of just about any mental disorder where we could say that largely similar story. Can you tell us a little bit more about your research? What's it like to work with these people? And what kinds of research questions are you tackling? >> Yeah, so the research that I do on BPD focuses mainly on brain functioning. So, how does the brain activate differently in people with BPD versus people who don't have BPD? And I use brain imaging to better understand how it is for example that the people with BPD process emotions. So for example showing them pictures of emotional faces, happy or sad or angry faces, and looking at whether the systems that are involved in regulationg emotions activate differently in people with BPD. And one of the main findings from my research is that the parts of the brain that were involved in representing how strongly or intensely people with BPD experience emotions, and feel emotions is actually more active in people with BPD. And on the other hand, the parts of the brain, especially toward the frontal areas of the brain, that are involved in regulating emotions, those are under active in people with BPD. So this research helps us better understand what might be some of the Neural underpinnings of the disorder, and we may be able to use this research to maybe even intervene. So for example, research that I'll be starting very soon is actually using a brain stimulation technique that's a technology at the Center for Diction and Mental Health here in Toronto. We might be able to actually improve symptoms of depression and suicidality in people with BPD, by directly stimulating both parts of the brain that I talked about. So there's some interesting research being done, and definitely, one of the things that people talk about when they meet me and they hear that I study Borderline Personality Disorder is, how do you do research with people with the disorder because, unfortunately, the disorder is highly stigmatized. Many mental health clinicians intentionally, purposely refuse to treat people with BPD because they see them as manipulative, and difficult to work with, maybe, don't get better in treatment. But, we know, today, that people with BPD actually do get better with treatment, and that stigma actually impacted how well they do in treatment. And treating people with BPD as everyday people who occasionally go through difficulties, personal difficulties, emotional difficulties is the best way to look at these people. Because the more that we can be kind to them and involve people in BPD research, the more we can understand it and hopefully better treat it. >> Yeah, cool. I had this analogy in my mind when you were talking about stronger emotions, but less emotional regulation. I have dogs, and one of my dogs is tricky to control at the best of times, but I was imagining somebody who had a dog that was particularly difficult to control, mixed with poor abilities or dogsmanship, if you will. That's sort of the deadly double whammy these guys are getting. >> Yeah, and everybody has difficulties at some point in their lives, and on a day to day basis when you're feeling emotional it may impact your ability to control yourself. It's that people with BPD it may be that much worse. The good news is that we get access to people, certain access to treatments for people with BPD, we've actually shown in recent research that parts of the brain that are involved in controlling behavior, actually increased their activation through one of the most common treatments for BPD. So there's hope, just because the brain may activate differently doesn't mean that you can't change that, including using a psychotherapy. So the brain does change, and is plastic, it changes through therapy, and so people do get better, which is contrary to some of the stereotypes about the disorder. >> Yeah, very cool. Excellent, I think I just have one more question for you, which is, it could be that some of the people watching this video feel some of the symptomatology themselves, or it could be that they know others and come into contact with others who may be suffering from this disorder. Any words of wisdom about what such a person might do? >> Yeah I mean,I think the best advice is first of all if you are a loved one, sorry, a loved one actually has the disorder, the important thing is to be supportive and understanding that the person is definitely most likely going to be going through ups and downs in their lives. But if they're not in treatment, it might be a good piece of advice to recommend that they see a counselor. Again, it's a difficult disorder to understand and actually diagnose because many people don't usually, believe it or not, assess the disorder when someone goes in for depression, for example. A mental health professional doesn't always ask about Borderline Personality Disorder, because it is a complex disorder, and there aren't as many people who are expert in identifying the disorder. So, if somebody does see these types of difficulties and they haven't seen a mental health professional, it's probably a good piece of advice to go in and see a counselor. And again, if a loved one has the disorder being understanding and supportive is always a good way to move forward. >> Excellent, well listen Anthony, I appreciate your time, thank you very much, and I think will want to speak for others and say, we also appreciate your work. Especially with respect to helping a population of people that may find it difficult to find allies at times. So thanks for what you do as well. >> Thank you. >> All righty, see you later, man.