Understanding Borderline Personality: Trauma, Brain Science, And A Path Forward

What if that sudden emotional storm isn’t manipulation but a nervous system crying out for safety? We dive into borderline personality disorder with open eyes and open hands, mapping the path from trauma to dysregulation and from stigma to skills. Drawing on clinical experience and brain science, we explain why BPD often feels like living with emotional third-degree burns: an amygdala that fires at shadows, a prefrontal cortex that goes offline when stress peaks, and an insula that amplifies empathy and pain. It’s a tough mix—high emotion, high sensitivity, low regulation—but it’s not a life sentence.

We get practical about what actually helps. Hear how dialectical behavior therapy teaches distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness in a way that builds the “wise mind,” the space where logic meets compassion. We talk about EMDR for trauma memory processing, attachment-based therapy for early wounds, and where medication fits for co-occurring anxiety or depression. We also get real about the work: progress is possible and common with consistent treatment, yet it takes time, repetition, and support. Along the way, we highlight the overlooked strengths many with BPD carry—fierce loyalty, deep intuition, and profound empathy—and how those traits become assets when paired with regulation skills.

If you love someone with BPD, your role matters. Consistency counters abandonment fear, kind boundaries protect both sides, and small wins deserve big celebrations. We share clear, usable strategies so relationships feel less like a battlefield and more like a safe place to grow. For those living with BPD, you are more than a diagnosis, and your brain can learn new patterns. Hope isn’t abstract; it looks like sessions, skills, steady people, and a growing sense of self that isn’t defined by the past.

Press play, bring your questions, and stay for the tools. If the conversation helps, share it with a friend, subscribe for more trauma-informed episodes, and leave a review to help others find their way to hope.

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Chapters

• 0:00 Welcome And Six-Year Journey
• 0:38 Focus On Trauma And BPD
• 2:36 Stigma And Misunderstanding
• 4:06 BPD As A Regulation Disorder
• 6:03 Real-Life Expressions Of BPD
• 7:42 What BPD Is Not
• 8:56 Brain Science Behind BPD
• 11:23 Emotional Burns And Hidden Strengths
• 13:34 Evidence-Based Treatments And DBT
• 16:00 Faith, Identity, And Hope
• 17:26 How Loved Ones Can Help
• 19:01 Direct Encouragement To Listeners
• 21:14 Closing, Resources, And Music

Transcript

SPEAKER_00: 0:00

Maybe you're thinking she sounds like a mess. But trust me when I say she's doing her best. Doing her best.

SPEAKER_01: 0:13

Hey everybody and welcome back to the Wednesdays with Watson podcast. If you have stumbled onto this podcast for the first time, allow me to introduce myself officially for the first time. My name is Dr. Amy Watson. For those of you that have been with us on this journey for the last almost six years, April of next year will be six years, you already know that this has been a journey. I finished my doctorate degree in traumacology, focusing on community care at the end of October. All of my life he has been faithful, guys. We will be coming back strong in the new year with episodes more frequently, back to the every two weeks, and we will continue to focus on trauma and how we can live with it and the things that it may cause in our lives. And today is an example of that. I had been asked to do an episode on borderline personality disorder a couple of times, and as I was walking through the end of my doctoral journey, I did not have the brain space for it. So this is the promised episode on borderline personality disorder. And so let's drop into this episode where we try to understand the connection, if there is one, between trauma and borderline personality disorder. For those of you that don't know, borderline personality disorder has an incredible stigma. Patients that are diagnosed with borderline personality disorder are often considered difficult to deal with. Often people who suffer with borderline personality disorder also suffer with addictions. All of them almost, and I have a friend that breaks this mold, but all of them have issues in relationships. And so a lot of times borderline personality disorder just kind of gets put as somebody as being difficult. And so today, I hope that this episode demystifies that in a sense. Let's talk about what borderline personality actually is. All right, guys, as I mentioned, welcome back to the Wednesdays with Watson podcast where we will continue to explore the intersection of trauma, mental health, faith, and also, guys, the incredible resilience of the human spirit. As I mentioned, my name is Dr. Amy Watson, and I am your host. And today, as I mentioned, we're going to walk into a topic that is often misunderstood, misrepresented, or even avoided altogether. I work with these patients, these borderline personality patients at work, and every time, I'll be honest with you, I've been part of the crew that just kind of takes a deep breath when we are going to be working with a borderline personality patient, because oftentimes these are some of the most difficult cases to therapeutically interact with patients with borderline personality disorder. Before you skip ahead on this podcast episode, and before you think, I don't have borderline personality disorder, and neither does anybody that I love. I'd like to invite you to stay around because borderline personality disorder is one of the most trauma-rooted severe mental illnesses. It is relationship-shaped, meaning borderline personality disorder at its foundation, when you rip it down to the studs, affect relationships and is affected by relationships. But as severe mental illnesses go, borderline personality disorder is hope-filled because there is healing, there is support when it's found in the right places. So today my goal is simple is to bring clarity about borderline personality disorder where there has been confusion. I'd like us to attempt to enter in some compassion where there has been judgment, and more importantly, hope where there has been stigma. Borderline personality affects about one to two percent of the population, though, like other things that are only effective of one to two percent of the population, most experts believe that it's underdiagnosed or even misdiagnosed. At its core, here's the thing we need to understand and how it's connected to trauma. Because trauma, remember, dysregulates the brain and the nervous system. And so at its core, borderline personality disorder is a regulation disorder, meaning that the brain struggles to regulate emotions, relationships, identity, impulses. So we see patients with borderline personality disorder, their emotions are all over the place, their relationships can be, it doesn't have to be. I have a friend who defies everything I'm gonna talk about today, but relationships who uh are affected by borderline personality, certainly the patient when they don't know who they are, their identity is affected, that their quality of life and and and then also impulses, lots of times addictions with patients with borderline personality disorder, and I mean addictions to everything from food to drugs to alcohol to relationships to success to performance to all of those things, whatever it is, borderline personality patients have a hard time controlling, if you will, for lack of a better word, impulses. So here's what that might look like in real life. A borderline patient may say, My emotions feel like a roller coaster. I didn't buy a ticket for this. A borderline patient in this might sync with some of you. A borderline patient may say, Oh, I love you, please don't leave me. Oh, I hate you. Please come back. That's why borderline patients get this stigma because their emotions are all over the place. That's a perfect example. I love you, please don't leave me. I hate you. Please come back. They may say, I don't know who I am unless somebody tells me. Their fear of abandonment, they may say that my fear of abandonment controls my whole body. But here is what borderline personality disorder is not. It is not them manipulating you. It is not attention seeking, it is not a character flaw. And hopefully, we know this, it is not a life sentence. Borderline personality disorder can be deeply tied to early trauma to include attachment wounds, emotional neglect, trauma in general, and remember our definition of trauma is anything that compromised your safety and took your choice. And so borderline personality disorder is deeply rooted in an event that compromised safety and removed your choice. People living with borderline personality disorder often developed survival strategies in childhood that once kept them safe, but they appear manipulative in adulthood. That's not someone being crazy, as oftentimes people like to say about borderline patients. That is purely somebody surviving. So let's talk about because you guys already know, I'm a little bit of a neuroscience uh geek. I am a doctor now, by the way. I'm not gonna lose opportunities to it to say that to you guys, especially those of you who've been with me since 2020. But let's look at what the brain of a borderline patient may look like. And so you've got the amygdala, which we've talked about often, your fear center, the emotional fire alarm, and so your amygdala is constantly scanning the environment for threat, and when it sees anything that is a threat or even sort of a threat, it's going to give you an emotional fire alarm. Well, in borderline patients, that amygdala, that that threat sensor that's always scanning, is super sensitive. So, for example, it may scan your environment and just the shadow of a threat, your the amygdala of a borderline patient is going to go haywire. And so their amygdala is often over-reactive and hyper sensitive. The prefrontal cortex, which is just the front of your brain where we uh stay say logical, where we're able to regulate our behaviors and our words and our actions. When trauma, and again, that working definition of trauma is anything that compromised your safety and took your choice. When we experience trauma, the prefrontal cortex goes offline. We call it flipping your lid. And so the the borderline patients don't have access to logical thinking or a regulated brain, and so they may uh make quick, impulsive decisions and be difficult to help them regulate things, and oftentimes this comes across as issues in relationships. The the insula part of the brain, too, interestingly, and borderline patients, this is the area that is connected to empathy, self-awareness, and emotional pain. With in patients with uh borderline personality disorder, this is also hypersensitive. And so these patients are often more empathetic, absorbing the pain of their environment, which just adds to the dysregulation of the nervous system. So put all that together with the amygdala, the prefrontal cortex, and the insula being affected, put it all together and imagine this. Having your emotional pain turned up to a volume of ten, your empathy is also turned up to a volume of ten, but your ability to regulate all of that, your emotional regulation, is turned down to a two. That's the brain of a borderline personality disorder patient. So no wonder relationships feel like life or death to them. They don't have an ability to keep it in between the navigational beacons and put relationships in context of where they belong. Everything is high pain and everything is high empathy, and these patients don't have any ability unless they learn to do it in treatment to turn down all of that. Their emotional regulation or their nervous system regulation is pretty much non existent. And so, like I said, no wonder relationships feel like life or death. When we understand the brain of these patients, compassion grows. And when compassion grows as we know, healing becomes possible. So, what is it like on the inside of a borderline patient? Let me share what so many borderline patients have told clinicians, friends, and therapists. And some of these are first hand accounts as I work with the patients in the hospital with borderline personality disorder. They will say things like, I feel emotions more deeply than anybody I know. Or I can go from zero to one hundred in seconds. I don't want to do that. They'll say I'm terrified that the people I love will leave. That is likely obviously connected to early attachment trauma and uh abandonment issues. Uh they may also say, I work so hard not to ruin relationships that mean the most to me. Or they might say something like, I'm exhausted from battling my own mind. Borderline personality disorder is often described as emotional third degree burns. Let's put that into perspective. When you have a third degree burn, it's burned down to the studs, basically, to the lower levels of your skin, and then you can imagine how painful that is. So when you think of that from an emotional standpoint, a borderline personality disorder patient often described as walking around with emotional third-degree burns. Everything hurts, everything feels intense, everything feels personal. But here is the cool part. That very same sensitivity that brings pain also makes people with borderline personality disorder deeply intuitive, deeply empathetic, they are creative, they are loyal, and they are capable of fierce love. Because there is a beauty in the sensitivity. We just have to help the brain regulate it. And so, how do we do that? There are treatments that work, there is real hope. If you've listened to this podcast for any amount of time, you've heard me say this your trauma is not your fault, but healing is your responsibility. But the hard thing with borderline personality disorder is that it's not easily fixed by just taking medication. Healing requires therapy and intense therapy at that. The best therapy that we know out there is dialectical behavior therapy or DBT. And DBT teaches patients with borderline personality disorder how to practice distress tolerance, how they can emotionally regulate, how to how to have interpersonal effectiveness in their relationships, how they can be mindful. DBT, I love this modality because it allows us to live in that tension of what we are what we call the wise mind in DBT, meaning if you look, if you consider a Venn diagram from the emotional brain, which only feels emotions and wants us to drive our decisions by emotion, or the logical brain, which is the left linear fact side of our brain, when we merge those two together, that middle ground, what we call as the wise mind and dialectical behavior therapy. And it takes it takes time, it takes intentionality to bring some in from the emotional mind and some in from the logical mind and share a little bit of that in that middle ground that we call the wise mind. That takes work, it may even take trauma therapy where you visit the traumatic event and so that it stops dysregulating your nervous system. Of course, you would do that under the care of a counselor. These are skills that can calm down that amygdala or that emotional fire alarm and strengthen that prefrontal cortex so it doesn't go offline as easily. Other helpful treatments might include trauma uh focused therapy like EMDR. I've talked about that on this podcast, attachment-based therapy, medication for co-occurring uh anxiety or depression, though medication is only part of the treatment here. Group therapy also can help, as well as skill skills coaching. So here's the hope for this. Over 80% of the people with a bipolar or excuse me, a borderline personality experience, significant improvement with treatment, and they may no longer meet the diagnostic criteria after consistent therapy. Let me say that again for the people in the cheap the cheap seats. Borderline personality disorder is treatable, and when you add Jesus to the mix, there is such victory. There is the opportunity for you to walk around on this planet whole and your relationships are whole. You're walking around with a regulated nervous system, and you are just moving forward with your life and saying, I'm not going to be defined by borderline personality disorder. I'm going to be defined by the hope that I have in the completed work of Jesus on the cross that will help me gain victory of borderline personality disorder. Because here's the thing: if you know somebody with borderline personality disorder, you too may live in a period of ground that needs to be healed. Because again, oftentimes relationships are affected by patients with borderline personality disorder. So if you love someone with borderline personality disorder, you play an important role. Here are a few things that you can uh do that would help both you and the situation. Stay consistent in your interactions with them because people with borderline personality disorder often fear abandonment. And so your reliability is a gift to them. Set boundaries, but do it with kindness. Boundaries say, I care enough about our relationship to protect it. So set those boundaries and move them if you need to, but they should be relatively concrete. Don't take the emotional storms of a borderline personality patient personally. Their intensity is not about your worth, it's about their wiring. I'm gonna say that again. Their intensity is not about your worth, but it's about their wiring back to that brain chemistry. Celebrate progress with them. Even small wins are big wins for a dysregulated brain. And I just want to make sure we've hammered home that is that patients walking around with borderline personality disorder have a dysregulated brain. That is likely connected to early childhood trauma. Not always. I am sure there's somebody in the sound of my voice who has borderline personality disorder and who did not experience trauma. But mostly trauma is what caused the dysregulated brain. Hear this loving someone with borderline personality disorder does not require that you lose yourself because your well-being matters too. On this podcast, we always come back to identity, and you noticed that one of the things that borderline patients struggle with is identity. Because trauma tries to rewrite identity, but Jesus restored it. And you know, I love that verse in Joel 225, I will restore all that the locusts have stolen. If you are the person listening to this episode and you have borderline personality disorder, let me speak directly to you. You are not your diagnosis, you are the precious child of the Most High God. You are not your emotional storms, you are not your fears, you are not too much, you are not broken beyond repair, you are loved by a God who does not abandon. You are worth steady relationships, and you deserve compassion, including compassion from yourself. This is a difficult diagnosis to be sure, but it is hope-filled because there are treatments that help it. And the hard part about borderline personality disorder is I mentioned earlier when I reminded you that your trauma is not your fault, but your healing is your responsibility. This is difficult, a difficult diagnosis because it's not easily fixed with a pill. And so if you are under the sound of my voice and you have borderline personality disorder, I hope that you would know that you are not that diagnosis, that you, as I mentioned, are the precious child of the most high God. I pray for healing for you, and I pray that as you consider what might be next for you, that you would reach out to those people who love you and sit in their support. And for those of us who are the support of people with borderline personality disorder, we have a job to remind our friends, our family, that they are not their diagnosis, that we love them unconditionally, and that we're here to walk this journey with them. Thank you guys so much for spending part of your day with me. I am recording this on a Wednesday and this is Wednesdays with Watson. Borderline personality is complex for sure, but it is also full of potential. Healing is possible and hope is real. If this episode helped you or someone you know who needs to hear it, please share it. And as always, if you're in a mental health crisis, please reach out to a professional or call your local hotline, including 988. We've got exciting things going on here at the Wednesdays with Watson podcast. We will uh walk into the year with brand new episodes and during the month of uh the rest of November and December, we'll be dropping episodes uh like this, which are topical in nature. We will get back to themed seasons in January of 2026. Until next time, this is Dr. Amy Watson, and these are your Wednesdays with Watson. You are seen, you are known, you are heard, you are loved, and you are so so valued. See you guys in two weeks.

SPEAKER_00: 22:28

What do you do when every morning the first thing you think is you just wanna stay in bed? I'm just asking for a friend. What do you say when all of your feelings are so overwhelming that you're too tired to pretend? I'm just asking for a friend. Maybe you're thinking she sounds like a mess. But trust me when I say she's doing her best, doing her best. We all need, we all need a safe thing. Someone told us in we all need, we all need a safe place. We don't have to defend I'm not asking for all the pain in all the end. I'm just asking for a friend. How do you come? Losing all you have. You are so afraid. You'll just lose it all again. Someone's got to be able to do it.