#21 Dr. Carla Sharp: Borderline Personality Disorder & Personality Pathology

#21 Dr. Carla Sharp: Borderline Personality Disorder & Personality Pathology

Carla Sharp, PhD, is the John and Rebecca Moores Professor of Clinical Psychology and Associate Dean for Faculty and Research at the University of Houston, where she directs the ADAPT Center and the Developmental Psychopathology Lab. She holds adjunct appointments at University College London and the University of the Free State in South Africa, and completed her PhD at the University of Cambridge. She has published more than 300 peer-reviewed papers and eight books, serves as an associate editor of Personality Disorders: Theory, Research and Treatment, and is a member of the workgroup updating the American Psychiatric Association's practice guidelines for borderline personality disorder. Dr. Carla Sharp has spent two decades proving two things the field resisted: that you can diagnose personality pathology in adolescents — as early as 12 or 13 — and that "borderline" may not be a separate box at all, but the clearest window we have into the core of personality dysfunction itself. We get into both, plus the question underneath all of it: what does it actually mean to have a coherent sense of who you are, and to make yourself understood by another person? Books by Dr. Carla Sharp * Mentalizing in Psychotherapy: A Guide for Practitioners (with Dickon Bevington; foreword by Peter Fonagy) — Guilford Press, 2022 * Handbook of Good Psychiatric Management for Adolescents with Borderline Personality Disorder (with Lois Choi-Kain) — American Psychiatric Association Publishing, 2021 * Developmental Psychopathology (with Amanda Venta, Peter Fonagy, Jack Fletcher) — Wiley Blackwell, 2021 * Growing Up Resilient: The Mediational Intervention for Sensitizing Caregivers (MISC) (with Lochner Marais) — Routledge, 2022 * Handbook of Borderline Personality Disorder in Children and Adolescents (with Jennifer Tackett) — Springer, 2014 * Social Cognition and Developmental Psychopathology (with Peter Fonagy, Ian Goodyer) — Oxford University Press, 2008 * Midbrain Mutiny: The Picoeconomics and Neuroeconomics of Disordered Gambling (with Don Ross, Rudy Vuchinich, David Spurrett) — MIT Press, 2008 Also referenced * I Hate You, Don’t Leave Me: Understanding the Borderline Personality — Jerold J. Kreisman & Hal Straus * The DSM-5 Alternative Model for Personality Disorders (Section III), and the dimensional approach in ICD-11 A note on a hard subject This episode discusses suicide and self-harm. If you’re struggling, you can reach the 988 Suicide & Crisis Lifeline (call or text 988 in the US). If you’re recovering from a relevant relationship that left you reactive, hypervigilant, or doubting your own memory of events — that’s an injury, not a character flaw, and it does fade. Always happy to talk. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit mitchellpenningroth.substack.com [https://mitchellpenningroth.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

#20 Dr. Aislinn Williams: The Dish on Schizophrenia

Aislinn Williams, MD, PhD is an Associate Professor of Psychiatry at the University of Iowa and Associate Director for Research at the Iowa Neuroscience Institute. Her lab uses transgenic mouse models and patient-derived induced pluripotent stem cells (iPSCs) to study how psychiatric risk genes (particularly voltage-gated calcium and sodium channels) alter neurodevelopment and behavior, with relevance to bipolar disorder, schizophrenia, depression, and autism. She is a board-certified psychiatrist who sees patients in the inpatient hospital and supervises residents in psychotherapy. She earned her MD and PhD (Neuroscience) at the University of Iowa, and completed psychiatry residency at the University of Michigan. * Williams Lab: williams.lab.uiowa.edu * Iowa Neuroscience Institute: medicine.uiowa.edu/INI (A note on audio: some source files were corrupted in production, so had to use lesser backups, apologies for the reduced quality. An infographics and animation pass is coming to visually unpack the science we cover.) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit mitchellpenningroth.substack.com [https://mitchellpenningroth.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

#19 Paul Abbott & Michael Lombard: Self-Currency

Paul Abbott is 60, raised on the move. His father’s career relocated the family every three years or so through Paul’s childhood. He attended Washington and Lee, started his career at Milliken & Company working night shifts in textile plants in the South, eventually built a “rollercoaster ride” of a career across real estate and finance. Today he’s based in Austin, and calls this stage of his life “Act Three.” He’s been married to his wife Lynn for thirty-nine years. People call him Chief. Michael Lombard, 36, is the great-great-grandson of Nicholas Lombard, who with his brother started Lombard Bros. in Waterbury, Connecticut, in 1923. It was one of the first motor carriers in the United States, and one of the largest in the Northeast before it was sold in 1984. Mike served in the United States Marines as a Fire Direction Controlman in the artillery, deployed to Afghanistan from 2010 to 2011. After the Marines he attended the University of New Haven on the GI Bill. In 2020, he moved to Texas with his wife, got his CDL, and became the first Lombard to drive a truck since the company sold. Today he is Partner Development Manager at Truck Parking Club, hosts The Lombard Trucking Show podcast, advocates for trucker health through the nonprofit Project 61, and has completed three Ironmans. He’s also seriously into history, especially Napoleon. We had no shared agenda going in. What emerged over two and a half hours was a conversation about identity and the cost of refusing the boxes you’ve been put in. Mike talks about losing a hundred pounds, the death of a fellow Marine that triggered it, and what it’s like to carry a family name that built and lost an empire. Paul talks about a nomadic childhood, the identity crisis he says he’s been in his whole life, and the framework that’s helped him navigate it — “you are the currency”: the idea that who you are is the thing you actually bring to a room, not the title, the résumé, or the credentials. Paul Abbott Instagram: https://www.instagram.com/chief_abbott [https://www.instagram.com/chief_abbott] Michael Lombard Instagram: https://www.instagram.com/lombardtrucking [https://www.instagram.com/lombardtrucking] The Lombard Trucking Show: Companion Substack Piece: https://mitchellpenningroth.substack.com/publish/post/198163382 Note: My first multi-guest episode in-person. Production quality is still a work in progress here. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit mitchellpenningroth.substack.com [https://mitchellpenningroth.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

#18 Brad Womack: Double Take ⚭

Brad Womack, 53, is a two-time lead on ABC’s The Bachelor (Seasons 11 and 15, 2007 and 2011, respectively). He grew up in Atlanta, GA, and later Livingston, TX, is an identical twin, worked the oil fields following high school, and eventually got into the bar business in Austin — before stumbling into the lead role of one of the most-watched franchises on television after a chance conversation. Five days later, he was in a room with the president of ABC. But this episode isn’t about The Bachelor. It’s about what it does to a person’s interior to become a national projection screen — to have millions of people think they know who you are. It’s about being a twin, and how identity works under pressure. Being the Bachelor is one of the most psychologically singular experiences a person can have. There is essentially no comparable template for it. You are simultaneously a private person, a romantic protagonist, and a public figure, all at once, for an audience of tens of millions. Most people never have to reckon with the gap between who they are and who the world has decided they are. Brad had to do it twice. That gap, and what it does to a person’s sense of self, is what I wanted to explore. I’m also a fraternal twin, from Tipton, IA — a town of about 3,000 people. Brad grew up in Livingston, TX, population around 6,500. There’s something specific about coming from a place that small that I don’t think you fully understand unless you’ve lived it, and the same goes for being a twin. That shared context made for an unusually honest conversation. The “Double Take” in the title refers to the dualities at play. Brad as The Bachelor twice; two twins talking to each other; two people from small towns; Brad as others defined him versus Brad defining himself; Brad under the national microscope versus Brad in retrospect. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit mitchellpenningroth.substack.com [https://mitchellpenningroth.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

#17 Dr. Lorenzo Leggio: GLP-1s & Addiction

Episode 17 — Dr. Lorenzo Leggio Note: At times, this conversation gets technical. I’ve tried to keep things accurate while also taking the time to explain what we’re talking about. The video version of this episode includes annotations that you may find helpful, along with links to relevant concepts, people, and ideas for anyone who wants to go deeper. Feel free to reach out in the comments or on social media — I’m happy to help. Dr. Lorenzo Leggio (MD, PhD) is among the most prominent addiction medicine researchers in the United States. His current roles at the National Institutes of Health: Clinical Director and Deputy Scientific Director of NIDA’s Intramural Research Program; Chief of the joint NIDA/NIAAA Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section (which he founded in 2012); Chief of the NIDA Translational Addiction Medicine Branch (founded 2020). He holds adjunct professorships at Brown University, Johns Hopkins, and Georgetown. His research sits at the intersection of addiction neuroscience, endocrinology, and the gut-liver-brain axis. His lab’s work on GLP-1 receptor agonists — the drug class that includes semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) — as potential treatments for alcohol and substance use disorders is one of the most scientifically and culturally relevant areas in addiction medicine right now. It bridges the Ozempic story with addiction treatment in a way that has genuinely caught the public’s attention, and mine — I’ve been following this space for several years. Dr. Leggio trained in internal medicine in Rome, completed his postdoc at Brown University’s Center for Alcohol and Addiction Studies, transitioned into a faculty role at Brown, and was then recruited to the NIH, where he has primarily worked since. A special thanks to Max Dennis for helping coordinate this episode and for lending a hand setting up when I arrived. Links Integrating Psychological and Pharmacological Treatments for Addictive Disorders [https://www.goodreads.com/book/show/35672113-integrating-psychological-and-pharmacological-treatments-for-addictive-d] — book co-edited by Dr. Leggio [https://www.goodreads.com/book/show/35672113-integrating-psychological-and-pharmacological-treatments-for-addictive-d] Concepts Referenced in This Episode GLP-1 (Glucagon-like peptide-1) [https://en.wikipedia.org/wiki/Glucagon-like_peptide-1] — A hormone produced in the gut and certain brainstem neurons that regulates appetite, blood sugar, and insulin secretion. The basis for the current generation of obesity and diabetes drugs, and the central molecule in Dr. Leggio’s addiction research. GIP (Glucose-dependent insulinotropic polypeptide) [https://en.wikipedia.org/wiki/Gastric_inhibitory_polypeptide] — A related gut hormone and the other major incretin. Tirzepatide (Mounjaro, Zepbound) targets both GLP-1 and GIP receptors simultaneously. Incretin [https://en.wikipedia.org/wiki/Incretin] — The class of gut-derived hormones, including GLP-1 and GIP, that stimulate insulin release in response to food. The incretin concept is the pharmacological foundation that all of these drugs are built on. Nucleus tractus solitarius (NTS) [https://en.wikipedia.org/wiki/Solitary_nucleus] — A brainstem region that serves as a primary relay station for signals from the gut, cardiovascular system, and lungs. GLP-1 is produced by neurons here, and it plays a key role in how these drugs affect the brain. Blood-brain barrier [https://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrier] — The selective barrier separating the brain’s circulation from the rest of the body. Relevant here because one of the open questions in GLP-1 research is exactly how and where these drugs act on the brain, and whether they cross this barrier directly or work through other pathways. GCG gene [https://en.wikipedia.org/wiki/Glucagon] — The gene encoding proglucagon, the precursor protein that gets cleaved into GLP-1, GLP-2, glucagon, and related peptides depending on which tissue is doing the processing. Gila monster / exenatide [https://www.nia.nih.gov/news/exendin-4-lizard-laboratory-and-beyond] — The origin story of the first GLP-1 drug. In the early 1990s, researchers discovered that the Gila monster’s saliva contained a peptide (exendin-4) structurally similar to human GLP-1 but far more stable. That peptide became exenatide (Byetta), the first FDA-approved GLP-1 receptor agonist, approved in 2005. Liraglutide [https://en.wikipedia.org/wiki/Liraglutide] — A second-generation GLP-1 receptor agonist (brand names Victoza and Saxenda) developed by Novo Nordisk. Once-daily injection; a major step forward from exenatide in terms of clinical manageability and efficacy. Ghrelin [https://en.wikipedia.org/wiki/Ghrelin] — A gut hormone often called the “hunger hormone.” Dr. Leggio’s lab has also studied ghrelin as a potential target in alcohol use disorder, making it part of the broader gut-brain axis story. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit mitchellpenningroth.substack.com [https://mitchellpenningroth.substack.com?utm_medium=podcast&utm_campaign=CTA_1]