Borderline personality disorder (bpd) is a mental health disorder that has garnered much interest over the years and has, for the most part, a hefty tag of stigma attached. This is quite unfortunate due to the fact that bpd is the personality disorder with the highest rate of remission, meaning no longer meeting diagnostic criteria, with remission rates ranging between 33-99%. Further, dialectical behavior therapy (DBT) is one of the most well-researched psychological treatments in use today and has been proven repeatedly through randomized-controlled trials to be an efficacious treatment for bpd. A person can meet criteria for bpd by qualifying for any 5 of the 9 symptoms:
Frantic efforts to avoid real or imagined abandonment,
A pattern of intense and unstable interpersonal relationships,
Impulsivity in at least two areas,
Recurrent suicidality or self-harm,
Chronic feelings of emptiness,
Inappropriate, intense anger,
Transient, stress-related paranoid ideation or severe dissociative symptoms.
Diagnosis is only appropriate in the context of professional assessment (meaning don’t diagnose your family member just yet!) and I like to point out that people struggling with bpd can look very different depending on which symptoms they are experiencing. I find it infinitely more useful to concern myself with whether a client identifies with the underlying mechanism proposed in DBT, namely the biosocial model, rather than whether or not they meet criteria for bpd.
The biosocial model has a biological piece and a social piece. The biological piece basically means that there is a biological emotional intensity that some people are born with. This biological piece has three parts to it:
Slow return to baseline.
What this means is that some people are born naturally more emotionally intense than other people. They are more easily set off, their emotions go higher, and they take longer to come back down. For example, an average person might wake up in the morning at around 0-5 of distress on a scale from 0-100. He then snoozes through his alarm, spills his coffee on himself, gets stuck in traffic, and his boss looks at him funny when he gets to work. Now he’s at a 50 of distress and he’s pretty upset. So, he gets a new coffee, listens to some music, vents to a friend, and takes a couple of deep breaths, and pretty much gets back to his 0-5. People who come to DBT often wake up at a 50. That’s a tough place to spend most of your time. And then they snooze through their alarm, spill their coffee, get stuck in traffic, and someone gives them a look, and then they’re at 100. And at 100, we are in a lot of pain. And nothing really happened, nothing so major happened, so we self-invalidate and say “I shouldn’t be so upset, what’s wrong with me?” which leaves us even more distressed. And at 100 of emotion, it’s kind of like having your hand on a burner. It hurts. Your reflex is going to be to just get your hand off the flame. And same with experiencing emotions at the 100 level. It hurts. And so, our reflex is to do whatever we can to get our hands off the flame. Even if that means self-harm, thinking of killing ourselves, using drugs, getting into fights with our loved ones, and generally speaking, things that make our lives worse in the long term. In the short term, these things often do work at reducing that arousal, and bringing us out of the 100, at getting our hands off the flame. The problem is that they do make our lives worse in the long-term.
Now, being born emotionally vulnerable or sensitive doesn’t necessarily mean that a person will struggle with issues with severe emotion dysregulation, like DBT clients do. There is a social piece that completes this theory. The social piece is that you take this emotionally vulnerable person, and you grow them in an environment that says, “hey, those big emotions that you feel, they are so big, they are too big, they don’t make sense, you shouldn’t feel that way, it’s wrong, stop it, grow up, get over it, chill out, what’s wrong with you??!!!” Over time, this teaches people not to trust their emotions, but rather to just shove them, shove them, shove them until they explode, so we end up with the shove, shove, shove, explode effect. So, you have an emotionally vulnerable person working super-hard to control their emotions and then exploding regularly and getting feedback that they’re too much, and ultimately getting feedback that the only way to get what they need emotionally is through explosions. Part two will explain this concept further.