Dr. Christian Schmaal Discusses BPD, Brain Function, and Genetic Components

Here’s an interesting interview with Dr. Christian Schmaal about the “chemical” causes of Borderline Personality Disorder. Dr. Schmaal details his beliefs on some of the physiological causes of BPD, pain tolerance in relation to self-harm, and the ever expanding knowledge base clinicians have for treating those afflicted with BPD.

I actually find these scientific reviews of BPD a bit comforting, because it allows me to excuse some of my irrational behaviors based on brain chemistry. If, for example, you know that you’re prone to impulsive acts, it may be because of your genetics and neurology, versus some sort of moral/ethical deficiency.

This is especially helpful for educating those around you about BPD: if they know there is a chemical component (much like a chronic disease like Diabetes demands insulin treatment) they might be more forgiving and understanding when you have BPD flare ups.

Where does confidence come from?

I’ve struggled with this question for the better part of my life. For some people, confidence seems to be a natural thing. They feel self assured no matter what the situation, outcome, or consequences. These people have an innate belief in themselves that seems to constantly persevere no matter how negative or unexpected their environment is.

I don’t necessarily have this belief in myself. My sense of self confidence is shaky at best, mostly because I set out to do something in a confident manner, yet the opposite of I what I want to happen occurs. As a result, I question my level of confidence, because it would seem foolish to believe you could do something, when in fact you really could not. My manner of deriving confidence seems to work backwards. I take a positive result and build backwards to a positive sense of self, while negative results produce a negative sense of self.

Right away you’re probably thinking, “This guy bases his self worth entirely on achievement.” Well you’re partially correct, I do base about 95% of my confidence on achievement, because the bulk of my life has been spent in competitive academic, athletic, musical, and social situations. Therefore, I don’t feel good about myself unless I can recall a series of personal achievements; opposed to some people that naturally feel confident whether or not they excel in activities society tends to highlight.

Here are a few examples of what I mean.

Music Performance: I played the trumpet through college, but struggled with performances and performance anxiety. I would spend a lot of time practicing and concentrating on my music, making sure that I gave my preparation everything I could. When the day of the performance arrives, however, I tend to doubt myself. I can’t focus on what I’m doing, and feel overly nervous. The result: I choke and deliver a “C-” performance despite the fact that I gave the music a “B+” preparation. When I walk off the stage, I doubt my confidence, because I thought things were going to go one way, when in reality they go the opposite. I lose belief in myself. Moreover, I lose the extra focus and attention that confidence would otherwise give me.

Academics: I’ve studied for a major test for hours, carefully analyzing the material the professor has presented and crafting my responses to potential essay questions. When I walk into the classroom for the test, I feel like I should ace the test, because I’ve spent an appropriate amount of time preparing. When I get the test back, however, I get a “C+” when I thought I wrote “A “essays. Once again, I doubt my sense of self, because when I walked into the classroom, I was feeling like I was going to kill the test, but in reality my confidence was overblown and unjustified given the final grade I received.

Sports: I ran track through middle school into my first two years of college. I could hold my own in most races, but I never really delivered any unexpected amazing performances above and beyond what I thought I could do. I would practice at an “A” effort level, and then deliver a “C” race. My coaches always seemed a bit mystified, because they knew I did the work. To me, it seems easy to step to the starting line and say to yourself, “I’m going to win this race”, but when you end up placing 7th, those sort of “confident” thoughts don’t make sense.

Social: I see a pretty girl at a party. I muster my nerves and walk over, offering a polite “Hi” and “How do you know the host?” etc. smalltalk. Before I started towards the girl, I told myself I was going to get her phone number and really impress her. In reality, after I’ve had a conversation with her, she acts indifferent and blows me off. Guys have told me, “Just be confident”, but what does that mean when the result is almost always not what you expected?

In the sum total of all these types of experiences, my sense of self slowly erodes. I could set out to do something feeling very confident and prepared, yet deliver a completely opposite result. Thus, when I make an attempt at something again in the future, I can’t justify a feeling of confidence if past results have indicated that such confident feelings don’t bear themselves out in the results.

Essentially, I can’t ever feel confident, because it would be foolish to believe I could do something when I really can not. The result is obvious: I never rise to the occasion, nor perform at a peak level.

I also get discouraged when I see others perform at a peak level, based on nothing more than confidence. A classmate might study for an hour and then hit the bar the night before the test, while I shack up in the library for 4 hours. The next day, we both march in ready to get top grades. To my surprise, my classmate, who did cursory preparation and came in with an overblown ego earned a higher grade than me, who thought that studying for hours in the library would yield a top outcome. This experience teaches me not to believe in myself because despite my best efforts, I did no better than the cocky campus barfly.

So I ask again, Where does confidence come from? I honestly don’t know. Most importantly, not being confident is very detrimental to my recovery from BPD, because so much of BPD recovery falls on creating a positive self image in the face of feeling completely hollow. I honestly believe that if I had a completely blissful sense of confidence, that I would do things a hell of a lot better than I do now.

The problem is, the past has taught me that having confident feelings doesn’t necessarily produce great results. So, why would I ever try to feel confident? It seems to foolish to me to believe you can do something when in reality you can’t….

Thoughtful Youtube Video on BPD from BPDfamily.com

I found the following YouTube.com video about BPD by chance. It’s actually a very thoughtful summary of the illness, tempered with realistic commentary about how BPD affects family life. Most of the video is depicted in words, however, there are a few Picasso paintings used that are great visual aids.

Interesting side note: this video comments that some people thought Princess Diana had BPD. (This fact is unverified).