Borderline Personality Disorder (BPD) gets its name from an early misconception. The intense emotional outbursts that accompany this disorder were once thought to be borderline psychotic episodes. Since these outbursts looked almost, but not quite, crazy, the sufferer was thought to be on the border between neurosis and psychosis. It is now known that the severe emotional dysregulation is the cause of these outbursts. Try to imagine the worst, most intensely emotional experience of your life, where the feelings seem like they will overcome you. The person with borderline personality disorder has that terrifying feeling frequently and will do almost anything to avoid it. It’s this strategy of deflecting painful feelings that leads to coping behaviors such as chronic interpersonal conflict, self harm, substance abuse and sex addiction.
The origins of this disorder are viewed by many experts as biosocial-i.e. a combination of genetic and social factors. The person with the disorder is seen as being unusually emotionally sensitive. Emotions such as sadness, anger, fear, and guilt are experienced with great intensity-they hurt more! This is the biological component. The social component comes from a resulting history of social episodes that invalidate emotional experience. An example might be frequent teasing from peers for strong emotional responses to things-e.g. being called a cry baby because they seem too sensitive in comparison to their peers. These experiences lead the BPD sufferer to doubt their own emotions and their ability to manage themselves.
As with any disorder, the intensity and frequency of the symptoms occurs across a spectrum from low to high intensity and frequency. People with a low level of these symptoms are said to have “borderline tendencies.” They do not meet the criteria for a diagnosis of borderline personality disorder, but are suffering from the same dynamic of emotional turmoil. Those with adequate symptomology to be diagnosed with BPD often view things in polarities, i.e. in black and white. They view everything as just fine in their lives until a real or imagined problem occurs, typically triggering a more intense response than is appropriate. The BPD sufferer then experiences an immediate flood of negative emotions that they can’t process or understand; they react to those powerful emotions impulsively, often acting out in destructive ways. This acting out then leads to increased levels of negative feelings and thoughts about themselves which they often turn outward onto others. This takes the form of conflict with the very friends and family members who most want to help. Through this conflict, the BPD sufferer effectively drives away the people closest to them. After they calm down, the BPD sufferer is often left feeling terribly alone and confused, despairing over their inability to manage relationships in a happy productive and satisfying way.
Though the goal of BPD treatment is often to help the sufferer better tolerate the grey areas of the emotional world-i.e. to accept that life is neither all okay nor all terrible-this is difficult to achieve. Unpleasant emotions can quickly reach an overwhelming intensity, automatically triggering reactive behaviors. Negative emotions can create a fight or flight panic response that renders logical thought virtually impossible. The sufferer fights with friends, family, coworkers and professional caregivers, or they attempt some form of escape.
Dialectical Behavior Therapy (DBT) is a therapy designed to address the challenges traditional therapies have faced in addressing this intense emotional disorder. Traditional therapies have relied on emotional introspection which is actually a trigger for most people with BPD. Not only do introspective therapies typically not help, they often make things worse. Therapists have discovered that very few patients with BPD can tolerate traditional therapy and stay involved.
DBT uses a highly structured approach to treatment. It involves the systematic learning of new emotional coping skills along with a gradual challenging of the negative, fallacious thoughts or beliefs that are the source of emotional turmoil. DBT is an empirically validated therapy that is effective in treating BPD. DBT, however, requires that the patient commit a minimum of one year to the therapeutic process, which is often best achieved in a residential setting. The emotional dysregulation experienced by people with this disorder requires repeated applications of new coping skills over an extended period of time. As emotions begin to stabilize, patients are able to gradually build an understanding of their interior world, allowing them to better tolerate and manage their emotions. In a sense, DBT allows patients with BPD to exercise their emotional muscles to build emotional strength. This takes practice, commitment and time!
J. T. (Tom) Kenneally, III, Psy.D., L.P., is a therapist for Fulshear Ranch Academy, a treatment and transition program located in Needville, Texas, for young women seeking a life of healthy independence.