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BPD Empathy and Quiet BPD: Low empathy or high empathy?

  • by Imi Lo
BPD Empathy: High or Low Empathy? Imi Lo &Kayla

 

BPD Empathy Paradox, Quiet BPD, and more…

I love, love, love this conversation 

Kayla is a Youtuber and psychotherapist in training and has a beautiful channel called On the Line on YouTube. After receiving her own diagnosis, she set out to educate others about this often misunderstood mental disorder 

There are many psychologists and experts who talk about BPD, but I was drawn to Kayla and wanted to talk to her because she is so open and clear in how she presents the information, and because she has had a unique journey of having BPD and is now on her way to becoming a therapist!!!!

We talked about many topics that are not often discussed publicly, such as

– What is quiet BPD? What are the subtypes of BPD?

– Is Borderline Personlaity Disorder a diagnosis or an identity?

– Can you become a therapist if you have had BPD?

– BPD empathy paradox – I think it’s a misconception that people with BPD lack empathy, why is that?

You can tell I was really engaged throughout the whole conversation, I feel blessed to be able to share Kayla’s journey with you. I hope you will get something from this!!

Thank you. 

Kayla’s Channel: https://www.youtube.com/@ontheline8561

 

 

 

FULL TRANSCRIPT

 

Imi: Hi, Kayla. Welcome so much. It’s lovely to have you.

Kayla: Thank you. Thank you for having me this morning.

Imi: Yes. So I saw you on YouTube and I thought that I admire how open you are and you talk about things about especially borderline personality disorder that not a lot of people talk about. You also talk about it from a very unique, dual perspective because I know you had it and you share very openly about your personal experience, which we will talk about, but you also have the clinical knowledge as someone in training. Yeah.

So if that’s okay with you, can you introduce a bit more of yourself to our audience and tell us a bit more about you and personality disorder and what propelled you to do this work?

Kayla: Sure, yeah. Essentially, I am finishing up my master’s. I’m actually done in a couple of weeks and then I’ll be-

Imi: Oh, wonderful. Congratulations!

Kayla: Yeah, thank you. So I’ll be a psychotherapist here in Canada.

What propelled me? I think for the longest time I’ve always had an interest in helping people. Originally, I was thinking of being a teacher, and throughout my teacher training, I just had the thought that, “You know what? What I enjoy the most is spending that one-on-one time with students and so how can I transform that into a career?”

I think that along the way when I got my own diagnosis, I realized really the importance of being in this field and helping others. Because with BPD, it can feel very alienating at times and to have a therapist who has firsthand experience, what a wonderful gift. That’s what propelled me to go on this journey of creating my YouTube channel, of getting my master’s degree so I could be a therapist in the domain. And it’s led me to incredible opportunities along the way, to meet a lot of interesting people, to learn so much more about myself and I’m really grateful for where life has taken me because of all of this.

Imi: And I bet it’s so rare that you get someone who will openly say, “Yes, I’ve experienced it too.”

Kayla: Yeah, exactly. And it can be tricky.

Imi: Have you met anyone who admitted to that, apart from Marsha Linehan?

Kayla: Yeah. There was one other person in my program, doing my master’s program, but we didn’t have any classes together. So once I had posted, we had a shared Facebook group and I had posted my first YouTube video on there to get the message out there. Someone else commented on it saying that they also had BPD.

But I’ve never actually met anyone in person who has had an open dialogue with me about being a therapist but also having dealt with disorder in the past. I know anxiety and depression are things I hear all the time because they’re not as stigmatized. But with BPD, really, I have yet to meet someone that we can talk about it openly.

Imi: Exactly. Yeah. I think all mental health is a little bit stigmatized, but yes, BPD and personality disorder as a spectrum particularly.

Kayla: Yeah.

Imi: So thank you so much for your courage and openness, what a gift to the world.

Kayla: Of course.

Imi: I do believe the level of your reward is proportionate to the level of risk you take.

Kayla: Yes.

Imi: So I have no doubt it’s worth it in the end.

Kayla: Absolutely. And like I said, I’ve already noticed so many benefits in my own life, and I can only imagine where things are going to take me and the impact that this will hopefully have on others’ lives.

Imi: It’s actually really amazing to be able to live so congruently, isn’t it? Just to come out as who you are rather than to hide a past of your past.

Kayla: It was really scary at first and I think it was something that I thought about for quite a while. Just knowing the field that I’m going into and putting myself out there so publicly, there’s definitely a fear of, “How is this going to impact my career? How will I be perceived by other professionals, by potential clients who run into my channel?”

But having weighed the risk, I think that ultimately I decided there was more benefits that would derive from this than not.

Imi: Yes.

Kayla: So that’s what led me. But it’s definitely still scary and something I think about at times, the repercussions, the negative ones, that it could have on my life.

Imi: Out of curiosity, do you volunteer that information or do you just naturally let client come or do you particularly work with BPD clients?

Kayla: Right now where I am, I’m actually working in a clinic that focuses on eating disorders. So I was doing that for my practicum. I’ll be staying there once I graduate as well.

I’m not working per se with BPD clients. It’s something that I’ve communicated that I want to do and are in my future plans. However, I will say that there are people that I see that maybe have more of sensitive traits that I can relate to and it’s easy for me to help them.

With my classmates at school and my professors at university, I have communicated that openly. It’s not something that I’m shy to talk about. In my professional setting I think that given that I haven’t been there for that long, it’s not something that I’ve addressed head on, I would say. It’s in my future plans.

It’s also a weird thing because it can be strange in the sense that, “Why do I need to disclose this thing that it puts us in a box almost?” I don’t even like using the term BPD and I think that putting it in this closed box, it really closes off the fact that there’s a variation, there’s spectrums, there’s multiple combinations of traits and how they present themselves and the length and et cetera, et cetera. It goes on. So simply saying, “Oh, I have BPD.” It can be hard for people to conceptualize that. It’s so much more than what it is set out to be in the DSM.

Imi: Which is what I want to come on to. Thank you for very smoothly bridging into my first question. I’m still so interested in your story and how you do your practice now, but I think we’ll cycle back to that when it comes to it.

Kayla: Yeah.

SUBTYPES AND QUIET BPD

Imi: I really want us to start talking about the subtypes of BPD. I would like us to focus on quiet BPD, which I think is what you identify with? Yeah, yeah.

But if you can quickly run through the subtypes, how they come about, maybe tell us a bit more about each of them. Then maybe we can have a more focused discussion about quiet BPD, which I think is getting more attention now, but it’s still very quiet.

Kayla: Exactly. The four subtypes are not officially recognized. They’re not part of the DSM. It was something that was conceptualized by Theodore Million. Throughout looking at different researches and seeing patterns coming up, he invented these four subtypes. So there’s two that I would say that are more externalizing and two that are more internalizing.

So the two externalizing one, we have the impulsive BPD, which is really the classic BPD. When we think about BPD, we think of someone who has extreme rage, maybe breaks things, throws things, very impulsive, very hot and quick. That’s what we think about. So the impulsive one is more of this classical connotation that we might have of BPD.

The second one that we have is the petulant one. With personality disorders, I’m sure that you know, but there’s three different clusters and BPD falls in cluster B. Within cluster B, we also have antisocial personality disorder, narcissistic, and histrionic. The petulant subtype really has different components or traits from narcissistic as well as histrionic personality disorder. So we see this as more of this grandiose self of entitlement. We see this as this sexual promiscuity, this attention-seeking patterns, which often, again, like the impulsive one is really associated with this classical notion that we have of BPD, someone who is attention seeking, someone who is impulsive, who doesn’t things through who might have risky sexual relationships. That’s what we think about.

Then when we shift to the two internalizing subtypes, we have then the self-destructive, which is a lot of self-hate, self-blame. It does share similarities with quiet BPD, but I would say that the main difference is that there’s an ongoing depressive state. So folks who have this more self-destructive subtype, you would see them as having some of the BPD traits, but also categorically being depressed, having a really hard time holding down a job, doing some of the basic things like getting out of bed, taking a shower, brushing their teeth. It’s more in combination with depression.

Then finally, we have quiet BPD, which is again, internalizing.It’s really known as acting in rather than acting out, as I’m sure that you know. With quiet BPD really, also we know it as high functioning. The reason being is that oftentimes with those who have quiet BPD, by just looking at them, we wouldn’t really know. We wouldn’t know because they’re not throwing things around, they’re not having huge fits. They’re not maybe doing some of the things that are known as the classical BPD. So the traits are more about this people problematic people pleasing. There is difficulty setting boundaries. There is a low assertiveness. There is persistent shame, self-hatred. All of these negative feelings are really directed towards yourself internally, but not necessarily something that others can see.

Imi: Yes, yes. I really admire the way you present information. It’s so systematic. I can just see boxes and categories in your brain and they’re so nicely, neatly laid out. Thank you. I think that really explains very well.

Why do you think some people have learned to internalize rather than externalizing their anger?

Kayla: Like everything else, I think that it’s very individual, and I think that we do have genetic predispositions to having certain personality traits.

When we look at the big five personality, you might have a predisposition to being more sensitive to being more anxious. Those things, paired with interpersonal skills that you learn from your primary caregivers, is, I think, the way that we develop into specific subtypes at BPD.

For example, taking my own experience, because I think that’s the most relatable and easiest way to describe this, but I really learned not only was I sensitive from the start, and also I learned from my interpersonal environment that it was actually good to suppress your emotions and to put others’ needs before your own and to people please and not to speak up and to withdraw when you were feeling any “negative emotions.”

So over time, I picked up on those social cues to internalize all my own things. And I think that, paired with also trauma that I lived growing up, I really learned that it was good to keep everything inside and that the only way to be loved was if you were overly performant. Honestly, that’s what I see with not only myself, but a lot of my clients who have these traits, that they’re perfectionists. That they’re overachievers and high functioning because they have learned from their environment that having these very normal emotions are not acceptable and not welcomed.

Imi: What might that environment be?

Kayla: Environment?

Imi: Well, you said they learn from the environments that their normal emotions are not acceptable. And I guess this is a leading question because off the top of my head, there are some examples of these so-called environments. For example, would be if you grow up with a very narcissistic parent or someone in the family is already very volatile, leaving you with no space to be emotionally expressive.

Kayla: Exactly. So having parents who have their own trauma, maybe some of their own variants of personality traits that make it so that there’s no room for children to express themselves. Kids who were abused whether physically, emotionally, sexually, whatever in what way you were abused, you could learn in those environments that it’s not safe to depend on others.

Imi: Exactly.

Kayla: And proximity and closeness to others is actually dangerous, which is a very normal thing. It’s normal to depend, it’s normal to ask for your needs. It’s normal to be sad and angry. But somewhere along the way, they learn that those things are unsafe. So proximity to others becomes a threat, asking for your needs becomes a threat.

Whereas in “normal,” again, because there’s no such thing as normal families, but maybe families who have more openness when it comes to emotions that have more stability and warmth and compassion, children will learn that it’s okay to be sad, and it’s okay to ask for something, and it’s okay to say no, and it’s okay… You don’t need to be performant and be the best at everything to have some praise and attention.

And you know what? Oftentimes parents do this unintentionally, they don’t even notice that they’re doing it. And you don’t even need big T Trauma like we call it, to develop a personality disorder. It could be small T trauma, which is just not getting your needs met in the way that you need as a child that you pick up on that and along the way you become this person who internalizes and who really believes that the only way that they are worthy is if they are this perfect person all the time who gets the best grades and has all the friends and is beautiful and whatever way perfection looks like for them.

Imi: And it was rewarded for the majority of their early life.

Kayla: Exactly, exactly, exactly.

Imi: Which reinforces a tendency again and again.

Kayla: Yeah.

Imi: Yeah, you’re right. It’s not that any parents intent… Some do. But it’s not always that the parents intentionally try to harm, but maybe they are themselves very perfectionistic and have very obsessive compulsive tendencies, which can then trickle down. Maybe there were transgenerational trauma. So we are not here just to blame the parents, although they very often contributed to that dynamic.

I was just thinking maybe it’s also partly cultural too. Some culture encourages internalizing a lot more and some cultures are more expressive and more tolerant of externalization.

Imi:   how many people with quiet BPD wouldn’t know they have BPD, do you think? I mean, obviously I’m not looking for a statistic, but in your impression or experience.

Kayla: That’s a great question. You know what? I think that a lot.

Most people, I would say at first probably don’t know because it’s not something that’s discussed and even when we learned about BPD at school, we learn about these classic externalizing types. So listening to those things, it could be difficult to then identify yourself in that.

Imi: Exactly.

Kayla: If you’ve never then heard of BPD, which is also common that some people just simply don’t know what it is. But you know what anxiety is. Anxiety is not a good representation of quiet BPD. So I think it could be really hard to tell, especially if you don’t even know how to make sense, and you don’t even really realize that there’s something wrong. You just think, “Well, this is the way I was brought up. There’s other people like me. Or I’m not doing anything abnormal externally, so there’s nothing ‘wrong’ with me.”

It could be really, really tricky at first to identify that, “Oh, it’s not normal to be so mean to myself all the time, and it’s not normal to not put boundaries and not say no and have anxiety and go in these self-hatred spirals.” When you start to clue in that other people don’t do that, then, that’s when you can start that process of, “Okay, let me do some digging. Let me check into this to see what’s actually going on.”

Imi: Yes. I mean, inherent as a part of this symptomology of quiet BPD is that you’re not allowed to acknowledge that you have needs, it’s shameful to need help to say you’re not all right. That counter-independence is a part of it. So not only that there’s a lack of awareness, even though if you sense something is wrong, it might be so hard for you to acknowledge it and reach out for help.

I had a question that slipped my mind. Oh, yes. I was echoing with what you were saying earlier about even the existing therapy models, like DBT, are very often geared towards a lot of the externalizing behaviors. I mean, self-harm is probably existing in quiet BPD too. But the impulsivity is not present in quiet BPD.

So I wonder if you think these therapeutic models, then, have limitations when it comes to quiet type? Or do you think they still can apply?

Kayla: They definitely still apply and I wouldn’t even go as far as saying that impulsivity isn’t a part to quiet BPD. Because once again, I think that it’s really important to move away from putting BPD and even the subtypes into these four neatly packed boxes. And to say that someone is really quiet? No, someone has some of these traits and also have other moments in their lives where they might have more externalizing tendencies, and that’s okay.

The beautiful thing with DBT is that I truly believe that it touches to all of those categories, for the reason being that we learn interpersonal skills, meaning we learn how to be assertive. We learn how to ask for our needs and what our needs are and figure out what those things are independent of others. We learn how to put boundaries, which is a huge part of quiet BPD. Another thing with DBT is that you learn emotion regulation. Oftentimes with quiet BPD because you’re still used to internalizing everything, it’s really hard to put a finger around what you are experiencing, what the feelings are, where they’re coming from, why those things are emerging. And so with DBT-

Imi: Chain analysis would be amazing, isn’t it?

Kayla: Exactly.

Imi: Tracing back.

Kayla: Exactly. And you’re learning to put words on your experiences. You’re learning of vocabulary for emotions, which is oftentimes not something people have with quiet BPD.

Imi: I mentioned chain analysis. Can you explain a bit more to our audience what that is, if you feel ready to? Putting you on the spot.

Kayla: Yeah, so chain analysis essentially… No, it’s okay. You’re taking an event and then you’re doing a systematic analysis of, “Okay, what were the triggers? Is there emotions? Is there thoughts? Was there external things triggering me? What was the outcome? What were the feelings that were derived from that? The behaviors?”

And it’s working your way through an experience to make sense of it and to understand where things come from, why they are emerging, where can we change the things in the chain analysis so that in future moments, if a similar occurrence happens, then we are more equipped to understand the process, where we can change some parts of the change to swap it out for things that are more effective.

So as a whole, it’s a process of understanding, from start to finish, the event, the emotions, the behaviors, the triggers, so that you can understand yourself better.

I think that’s beautiful to have for people who do have quiet BPD. Again, the mindfulness skills are amazing for everyone. Even distress tolerance, when you have this tendency to go into these shame spirals and you’re really in your head, distress tolerance skills are amazing because they get you out of your head and into your body, into activating your parasympathetic nervous system.

I always say that DBT, everyone, regardless of if you have BPD or not, could benefit from that because they’re fundamental basic skills that everyone needs to know. Everyone needs to know how to make a request effectively while being intentional and not harming the other person along the way. Everyone needs to have awareness and practice mindfulness. Everyone needs to understand their emotions and make sense of triggers to know themselves better. And everyone needs to know how to be able to calm down in moments of high stress because I don’t care if you have BPD or not, you will be faced in moments where you are completely overwhelmed and don’t know what to do with yourself.

So I do think that obviously there are areas that it could be improved. I know with the new DBT models that are coming out, they actually added self-compassion to it, so self-compassion is wonderful and I think really important for those who have BPD. So yes, there are areas that it can improve, but generally speaking, overall, I would say that it’s great if you have quiet BPD.

And especially if you compare that with other kinds of therapies, like schema therapy is awesome because it gets to the root of those core beliefs that you hold about yourself.

Imi: I’m a huge fan.

Kayla: I know that there’s a lot. Yeah, yeah. Schema therapy is amazing as well. So I think if you could do the DBT program and then in conjunction maybe your individual sessions are focused on the schema aspect of it and you really learn the skills with the group, but on your own you do more of this deep diving into yourself, that could be a great approach to tackling quiet BPD.

Imi: I think people can get quite lost in all these therapies. I mean, it’s shocking enough when you first realize you have this thing called BPD, and then it’s huge discovery to realize there’s a subtype that fits you even better. Then, you’re faced with all these different kinds of therapies. I think it could be so confusing for people.

I can tell that you’re a huge fan of DBT. There is a new model called RO DBT, which I quite like. Then I’m also a huge fan of schema therapy. Then there are some other ones that, for instance, in England, mentalization-based therapy treatments. Yeah, you know of it. It’s quite commonly used in the NHS. Then there’s some transference-based therapy.

I mean, can you speak to a bit of these models and do you have a recommendation or if not a particular type that you are preferring maybe what questions can people ask themselves to see what would fit?

Kayla: First of all with therapy, the thing that people need to understand that the most important thing is the therapeutic relationship.

Imi: I agree! I was going to say. Yes!

Kayla: So even through studies, the majority of the change happens by the simple fact of having someone who accepts you unconditionally, that you feel comfortable and open with, that you feel truly supported. So that’s number one. It’s not even about the modalities. If you find a good therapist, most good therapists will have an array of modalities and will pick and choose for the moments that you’re presenting them with.

If you’re showing up with a schema that’s popping up, they will address that using schema therapy. If you’re showing up with this really persistent inner critic, they might use compassion-focused therapy. So you’ll have someone who is flexible, who is open, and safe. Those are the main things to look for. That can be hard. And I know I’m giving these broad, general strokes

Imi: What do you mean by flexible, that’s quite-

Kayla: You need a therapist who’s flexible and able to adapt to your needs. Picking someone who’s rigid, especially because we know that there is a sense of rigidity with folks who do have BPD-

Imi: Can you illustrate that a bit more? So what would be something that they say or do or not do that would illustrate that they are rigid rather than flexible?

Kayla: So for example, if you have a therapist who is primarily CBT, just trained in cognitive behavioral therapy, that’s what they do. And every time that you go to therapy and you’re presenting them with a problem, they always go back to trying to change your thoughts. “Okay, well, how does this make sense?” And Socratic dialogue and walking you through this process of changing the thoughts. But meanwhile, what you need is just someone to listen to you, to provide you with compassion and warmth. And this therapist is so stuck in their theoretical model that doesn’t maybe include this more laid back, non-directive style, that it’s hard for them to be there and to truly just listen. That, to me, seems like a therapist who would be more rigid in their ways. “This is the way that we do this. This is the best way. This is the way that you will change.” No.

To have someone who’s more flexible, is open, who has different tricks that they can pull from different modalities to meet you where you are in that moment with what you actually need.

Imi: So when you have a hammer, everything becomes a nail and that’s not cool.

Kayla: Exactly. Exactly. Especially for quiet BPD. People are so used to being invalidated and to have folks not listen to them. You need therapists who are fundamentally compassionate, open, and will give you that positive regard.

Imi: Thank you, quite moved hearing that. And I do think you’re pointing out some very important things that I personally believe is beyond techniques. I think a lot of people go to therapies and things and asking for techniques and things they can do, which I can understand because you want to know what to expect and feel like you have got something that you’ve taken away. But I always think those are really not the most important game-changing things. Personally for me, I know the most game changing thing for me is really internalizing my therapist’s positive regard for me and beginning to see myself as he sees me.

Kayla: And using your therapist as someone that allows you to form a secure relationship so that you can develop a more secure attachment with yourself.

Imi: Exactly. Yes, it takes time, but it may not be as long as what people… For me, it took me more than a few years. But I think it’s totally worth it.

Kayla: 100% and it’s the best investment I’ve ever done in myself. It’s very expensive and I recognize it’s not everyone who’s as fortunate as me that I can afford these things. As time goes on, I think that we are getting more and more resources that are free or not as costly so that people have better access to mental health services.

Imi: As a side note, as I think you might agree with me, I always passionately believe all therapists should go through their own therapy.

Kayla: Yes.

Imi: I know that not all trainings require that. I’m quite shocked sometimes. I mean, I understand if you’re doing a highly manualized therapy where it’s very technique-based, although I think even then you should. When it’s relational, oh my God, it’s so important that we work through our own things. And yes, we will not be fixed and become completely perfect human, but it’s really powerful when you have personally experienced it and you truly believe in it.

Kayla: And you can share that with clients, to say, “I’ve been through this process.” When you sit down with them for the first time and you can really look them in the eyes and say, “I know how scary it is to be here. It’s uncomfortable to meet someone you’ve never met and now on top of that, you’re expected to divulge your biggest traumas. That’s a scary and courageous process.” And knowing from a first person experience, not exactly their own experience, because you can never really understand, but having this deep, empathetic understanding of, “I’ve been there myself.” And this is why I like to use acceptance and commitment therapy-

Imi: That’s it.

Kayla: … with my own clients because there’s this concept of a shared human experience that we’re all suffering. At the end of the day, we’re both in the same boat of being humans and suffering, and I’m here with you and I have my own struggles and I’m climbing my own mountain. Even though I am sitting in this cushy chair and you’re on the couch, that doesn’t mean anything. We’re equals.

Imi: Do you really have a couch for your clients?

Kayla: Yes. Yeah. Not one that they lay down, like the classical one.

Imi: The Freud ones?

Kayla: Freud… No, no.

Imi: Oh, yeah. So here’s another slightly controversial question, which again, not very much talked about. Of course, we don’t want to invalidate the suffering that comes with BPD, definitely not.

But do you think there are any “benefits” or even gifts to having this disorder?

Kayla: Yes, yes. And I think that most things in life that are difficult teach us important lessons. It’s important to not have toxic positivity.

However, at the same time, I do think that with BPD, the beautiful thing is that being sensitive makes you so much more empathetic and compassionate to others. And it’s a gift to be able to have this innate sensitivity to others, to also be very passionate in things that we do. Because when we love, we love deeply and profoundly and we let ourselves get carried away, whether it’s by the negative emotions or the positive ones of being in love, being grateful, is to feel things more deeply. And for that, I’m truly grateful.

And I think that with BPD, there also comes an innate resiliency that you’ve been able to overcome all of these challenges and you still are here today existing. That’s a gift that a lot of people don’t get to go through and never get to that point where they know so much about themselves and have experienced so much suffering, that you can take those things and become this extremely resilient, in-tuned, empathetic, compassionate, caring individual.

I think with BPD, there’s often an association as well with creativity and being spontaneous. So that’s the other side of being impulsive. I think that it makes for people who are go with the flow sometimes, who like adventures and make their lives really fun. That’s beautiful.

And once you start to look at the other side of the same coin for these classical BPD traits, you can start to see that, “No, this actually makes me outgoing and fun and deeply caring and resilient and sensitive and creative.” There’s a beautiful side, especially when you’re further along in your road to healing and integrate it.

Because I think that initially when we learned that we had BPD, there’s a tendency to shy away from those things and to hide and to say, “I don’t want those things. I don’t want to be that.” But when you learn to integrate your shadow, the things of you that you don’t like, that’s when the beautiful gifts tend to come out, because you’ve mastered both the shadow and the light.

Imi: Thank you for putting it so beautifully and in Jungian terms.

Kayla: Yeah.

Imi: Yeah, no, I agree. Obviously it’s a disorder, so in the symptoms are the shadows such as impulsivity. But then on that shadow there is a light side, which is spontaneity, being able to be playful. Obviously not everyone, but I really just know so many people with BPD are highly empathic. You mentioned sensitive and spontaneous, creative, artistic, and yes, resilience. But I think with the amount of trauma that they’ve been through for the fact that they’re still alive, it’s amazing.

Kayla: Its is.

Imi: Yeah.

Kayla: It is.

Imi: And despite carrying a death wish, you are still alive, you are a warrior, really, deeply. Even though if you self-harm every day and you want to kill yourself every day, the fact that you’re still here, it’s amazing and it’s such a gift to the world.

Kayla: It is.

THE BPD EMPATHY PARADOX

Imi: Yes. You reminded me of something that I am doing research into lately about empathy. So I think it’s such another controversial topic, which is BPD empathy. There would be many research and probably a lot of people saying horrible things in the forum to say people with BPD have no empathy. But then there are also another side where lots of people with BPD is highly sensitive and empathic. So no one know what that is about.

I’ve been thinking a lot about this and I found some answers. I know this is your interview, but I feel a bit excited about this so-

Kayla: Go ahead. Yeah, no, I’m curious to know what you found out.

Imi: I personally never really looked very deeply into it. I wrote an article before about the gifts of BPD and the BPD Empathy Paradox, and I do talk about them being empathic and things. But I didn’t have a lot of solid evidence apart, from one or two research papers. So I do get people saying, “You’re horrible. Why are you saying this? My wife has BPD. She’s got no empathy.”

So here’s the thing. I’m going to go on and for another five minutes.

You might know there are two kinds of empathy. One is emotional empathy, where it’s fired by our mirror neurons, where if you see someone in pain, you automatically feel pain. It’s hardwired into us. So that’s emotional empathy.

Then there’s one thing called cognitive empathy, which is related to mentalizing, which is perspective taking, where you think about why the other person is doing what they do.

Here is the thing I found and I need to find more research back up what I’m saying, but I saw one or two articles, and I think it’s so right, this hypothesis. A lot of people who ended up getting diagnosed with BPD have very sensitive nervous system and they actually are innately very emotionally empathic. So they catch on emotions very easily. They’re quite susceptible to emotional contagion. So if they see someone in pain, you’ll feel a lot of pain. It’s a spectrum. Some people will be like, “Ouch.” But some people, “Oh my God, I see animals hurting and I start crying.” So that’s what they call empath these days. And I think a lot of people with BPD probably have very high degree of emotional empathy.

However, I think when they are dysregulated, because mood swings is a part of it, they lose their ability to mentalize, which is the cognitive side. So they lose the ability to think through, “Oh, why is my boyfriend cold to me today? Maybe he has got something at work, maybe he’s not feeling very well.” They lose that ability to take the other person’s perspective and they become very concrete.

They talk about in mentalization where… Psychic equivalence, I think they have got a term for it, where things become very concrete. Which is like, “Oh, if he looks like he doesn’t like me because he has a cold, bitchy face, he must hate me.” And then that becomes the reality. So it would look as though they’ve lost the ability to empathize because they’ve lost the cognitive empathy, at that moment when they lose affect regulation. Sorry, [inaudible 00:37:41].

Kayla: No, no, no. But that seems very accurate and very true. I think that when anyone is dysregulated, you’re not able to mentalize anything.

Imi: Exactly.

Kayla: So why? It’s because our nervous system is activated and everything is firing, something is wrong, there’s a threat nearby. Why would you then be able to rationalize as to what is going on?

Imi: Exactly, yeah. And they deal with regret.

Kayla: I also think that…. Yeah. And there is a big overlap between narcissistic personality disorder and borderline.

So sometimes people, and I’ve heard this so many times, people will describe someone to me as having BPD, and when I’m listening to them, and then I need to correct them. “No, you’re actually describing N P D. This is not BPD.” There is a misconception in society that the two traits are mixed up, often conjoined together. And so then this adds to this fuel that folks who have BPD are not empathetic, are not compassionate, but they’re actually describing someone who has NPD. And as I mentioned, it’s not a clear box.

You could have someone who has different traits, different combinations from different personality. Especially that they’re all in the same cluster, it’s very common to have a sprinkle of this and a sprinkle call of that and a dash of this to make up this person who is way more complex than just BPD, NPD, histrionic personality disorder. No, there’s a bit of everything. So this makes it so that it’s hard sometimes maybe to be empathetic because there’s a stronger lenience towards narcissistic traits with underlying borderline traits. But when people look at this person, they see them as BPD.

Imi: What I also read about this whole empathy paradox is people with NPD, again, the myth, thanks for citing this, they don’t have empathy. So they’re psychopathic, they’re not able to emphasize. What some research found this that actually that’s not true. They have got a high degree of cognitive empathy, which means they can guess like, “Oh, what’s going on with the other person?” They can mentalize and then they may maliciously use it. And people with BPD is the opposite, in a way.

Kayla: Exactly, exactly.

Imi: Where they can’t help but they emotionally feel other people’s pain, but they lose the ability to cognitively perspective take. Whereas people with NPD can take the other person’s perspective and then they may do something with it, in a horrible way sometimes.

Kayla: Exactly. And if you have someone who displays a semblance of both traits, it could look like someone who is very emotionally empathetic. And when they’re not activated, then they have more of this tendency to be cognitively empathetic. But then if they have narcissistic traits will use that against others. So it’s very complex and I think that’s why the research… There’s so much contradictoral information out there. But you’re right to say that this model, this way of conceptualizing it, makes complete sense to me.

Imi: Oh my God. Thank you. I don’t have anyone to talk to about these things that I said. Yeah, yeah.

I want to be respectful of your time. So we may not be able to go through everything, but I want to cycle back to your personal journey and where you are at. I know a lot of people with BPD are also interested in getting on the same path, but many of them would get a huge imposter syndrome of thinking that, “Oh, that’s not possible for me anymore. I’ve got this highly stigmatized diagnosis.”

So if the question is whether not someone who has had BPD and have recovered can become a therapist… Or actually, if they do have an active diagnosis, what would you suggest for them?

Kayla: I think it’s very much possible, and even for me, it’s not to say… It’s a weird thing with BPD, also, even the term recovering from it makes seem that as though it’s a disease and that sometimes can be weird. I think that we have a long way to go in terms of terminology when it comes to BPD, whether that’s recovery or whatever the words that we use for it.

Because I definitely, as an individual, still have moments and traits and instances where I get into these shames spirals and all the things, and that’s okay, I’m human. And it’s not because I have BPD specifically, it’s just because there’s moments that are maybe amplified by the fact that I am more sensitive.

So I would say that if there’s individuals out there who are looking to go into this field, don’t be scared by this diagnosis. Don’t be scared by the labels and the stigma. And it’s really important to go through your own process of therapy so that you can acquire skills and understanding and more acceptance of who you are, to use those things.

As I had mentioned earlier, it’s in the beginning stages where we tend to shy away from this. That’s when it’s important to just go all in into it, lean into the discomfort, integrate those parts of yourself so that you can use those as a gift for your own clients.

When I started my program, my master’s program, I actually got diagnosed a month later. So it was during my whole master’s program that I was going through my own process of the DBT program, individual therapy.

I think that I do have an advantage because if you look at the spectrum, I wasn’t as far deep as some other people. So it was easier for me than maybe someone else who’s further along the spectrum of having BPD traits to acquire new skills and to change radically in my own life. I felt very well equipped and supported to be able to take on that endeavor.

So I would say it’s really important to know yourself. To make sure that you’re well-supported, because it’s impossible to do this by yourself. You really need people who love you and who can help to burden the weight a little bit because you’ve been doing it on your own for so long. Let others help you. Yeah.

The main thing is really just to go make sure that you’re going through your own therapy process to get the help that you need so that when you finally start to see clients, you’re at least better equipped and that you know yourself and your blind spots. Because the worst thing you can do is go into this profession blindly, having all these triggers, going into sessions, being really triggered, and then there’s transference that happens that you put that onto your clients, which is the last thing that they need.

Imi: Indeed. Yes, yes. Can’t agree more and thank you for encouraging statements. One thing I love, when I saw your channel, I think remember you saying something… Correct me if I butchered you, “It’s a diagnosis, not an identity.”

Kayla: Exactly.

Imi: So beautifully said. I would say that analogy to people like, okay, let’s say you have flu. You don’t just become a flu person for the rest of your life. You had the flu, you’ve recovered, so you don’t have to carry the flu identity forever.

Kayla: No.

Imi: It’s a bit more complex with PD, especially that it’s called personality disorder. But you don’t have to carry that forever.

Kayla: No. And you can start to see it as something beautiful.

I’m always going to be someone who is a bit more sensitive and probably anxious than someone else. And that’s okay, there’s nothing wrong with that.

Imi: Totally.

Kayla: It’s just about recognizing it, knowing it, and knowing how to be able to take care of myself in those moments where I need that extra boost.

But if you’re so scared of knowing those things about yourself and not willing to accept them, that’s where problems come in. Because then you’re fighting against yourself to just… Rather than saying, “You know what? I’m sensitive. That makes it so that I am more nurturing and compassionate in all those beautiful things.” And that’s thankfully where I am today. Like I said, I still have moments of being down on myself and that’s okay. And it is important for people to know that. I don’t want anyone to ever watch my videos or listen to anything that I say and think, “Oh, she’s doing so well, and look at her go and she’s living her best life.” No.

With BPD, there’s this black and white way of thinking. It’s not because I’m here today that my life is peachy in roses. What they’re not seeing is me striving every single day, waking up and making that conscious effort to be a better version of myself. And that’s what people who have BPD need to realize. It’s an everyday choice and process. It’s a moment to moment choice.

“Do I choose to go into these patterns that are comfortable and ineffective, or do I choose to go against this natural tendency and do something brave and courageous for myself?” That’s what we want to strive for.

I always tell my clients, “It’s not about the outcome, it’s about the process.” As long as you’re trying and you’re showing up yourself, that’s all you can ask for.

Imi: Thank you. And thank you for showing up. I am extremely passionate about helping people coming out as who they are. And if you are sensitive, yes, own that. You just move out of the diagnostic you’re no longer and manifesting… Going back to our conversation, the shadow side of your personality, but rather you can manifest the strength side.

Kayla: Exactly.

Imi: Still the same person. Yeah.

Kayla: Exactly.

Imi: It’s beautiful. Oh, thank you so much.

Kayla: You’re welcome.

Imi: I have really enjoyed this conversation and I talked more than you talked.

Kayla: So have I. No, I’ve learned a lot and definitely, you left me some things to think about, so thank you.

Imi: Thank you.

Finally, any particular resources that you would recommend to people? Maybe therapies that you would recommend or even just a website or books or your channel? Plug away.

Kayla: Yeah, definitely my channel. But I would say self-compassion is the best thing ever, so just checking out Kristin Neff. She has a website where she has a bunch of exercises, recorded, guided meditations. Self-compassion is a really good place to start. If you don’t know where to start today, you can do that. Everything is very comprehensive on your website and she has books and videos and everything that can help you to start that process of essentially re-parenting yourself so that you can feel more secure with yourself and in turn with others.

Imi: Thank you so much and I will certainly direct people to your channel.

Kayla: Yes, thank you.

Imi: Thank you. I hope we will speak again.

Consultant and Author at Eggshell Therapy and Coaching | Website

Imi Lo is a consultant and published author with extensive experience in mental health and psychotherapy across diverse international settings. She specializes in working with highly sensitive, intense and gifted adults. Her books, 'Emotional Sensitivity and Intensity' and 'The Gift of Intensity,' are internationally acclaimed and available in multiple languages. She integrates psychological understanding with both Eastern and Western philosophies, such as Buddhism and Stoicism.

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