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What is Borderline Personality Disorder

Dialectics, as summarized in this introduction, refers to a systematic way of reasoning between two or more people with opposing points of view, who seek to expose fallacy and elicit truth.

Merriam-Webster.com defines dialectics as the philosophy that provides a method of examining and discussing opposing ideas in order to find the truth, which incorporates Socratic techniques of exposing false beliefs and eliciting the truth.

Dialectical Behavior Therapy (DBT) is the art of critical thinking with a total acceptance of reality in the moment. Therapists and clients together, work to create an evolving dialogue. Clients with Borderline Personality Disorder (BPD) tend to use “Black or White” thinking. BPD clients, quickly and unconsciously, match their thoughts to their emotions, so that a high emotional moment for them determines their perceptions or beliefs about that event. Distortion is quite likely in this case. An example can be demonstrated when a teenaged girl tells her mother that she wants to go to the store. When the mother says, “No, not right now” the teen girl screams at the mother saying: “You don’t love me”  “You never take me to the store”. This distorted pattern is repeated in adult relationships, such as marriage, evolving and being solidified during her teen and early adult development. This distortion becomes generalized and can be identified in many life situations, like friendships and in workplace relationships.

Individuals diagnosed with BPD display a high sensitivity to emotional cues, and are extremely impulsive. These two features of BPD have a biochemical basis, which can lead to emotional dysregulation. Heredity and environmental elements are significant factors as well. Brain trauma and childhood brain development play a significant role in emotional regulation for these clients.  Children with low tolerance for stress or distress, and those who have not acquired self-soothing skills, are at a higher risk for emotional dysregulation.

The environment that the child is raised in makes a difference also. When caregivers invalidate the emotions of others; when they are ill equipped to model the appropriate expression of emotions; when their interaction style perseverates upon drama and emotional arousal; when the parent and child have incompatible personalities; all of these limitations point to the likelihood that a child will experience emotional dysregulation, and will be unable to self sooth.  In our sessions, we reassure parents that it’s not their fault. Children never come with a manual! We also explain that no parent anticipates having a child that is unable to experience soothing. Everyone has something to learn in this story.

Three family structures are most at risk for a vulnerable child: 

1.    the disorganized family (neglectful, maltreating)

2.    the perfect family (expression of negative emotions is discouraged)

3.    the normal family (where the child does not fit in the family system)

 

Part of the dialectics of this reality is finding the peace or acceptance in knowing that child and parent can overcome any of these obstacles. It’s hard work, but it is possible with our program support.

 

Emotional Dysregulation manifests in the following ways:

1.    Excess of painful emotional responses (no one to blame here)

2.    An inability to regulate intense arousal (cannot get back to balance or equilibrium)

3.    Cannot get attention off the emotional cue or trigger (perseveration)

4.    Cognitive distortions (belief that everything you think is true and correct—“It feels real so it must be true”)

5.    Uncontrolled impulsive behaviors growing out of positive or negative emotions (getting married after one week in the relationship)

6.    Cannot set goals without being in the “right” mood (thoughts and emotions linked)

7.    Freezing or dissociating in high stress situations (blanks out or shuts down)

Invalidating Environment –Individuals diagnosed with BPD have cognitive distortions. It is important to note that what is invalidating to one person, may have no impact on another person. Some BPD clients are correct when they say they are being invalidated. The primary role of emotions in humans is to serve as a rapid communication system. Invalidation of emotions in the brain sends the message that the communication was not received.  In BPD clients it is common to increase the intensity of the message by increasing the emotion.  The receiver is distracted by this new level of drama, and cannot hear the communication. They may also mistrust the message from the communicator. At this time, it is common for the receiver to invalidate the message from the communicator, due to the tone and high drama. This, in turn, causes the BPD communicator to increase the intensity of emotion again.  The cycle repeats itself until the receiver gives in to the dramatic communicator. As a result, a firmly entrenched negative communication pattern is established in this relationship. It is characteristic of BPD individuals to engage in self-destructive, angry, and disruptive outbursts in close relationships.

Maccabee, has determined that “the inhibition of action is the basis for the organization of all behaviors”. Strong emotion prepares an individual for action, like the fight or flight response. While this response is normal for mentally healthy individuals, in the BPD client their dramatic, overwhelming emotions escalate, often prompting self-harming behaviors. Inability to regulate emotion and behavior leads to maladaptive behaviors. Dialectical Behavioral Therapy (DBT) is designed to address this maladaptive behavior pattern. Cognitive Behavior Therapy CBT) has demonstrated much less success in this particular problem area.

BPD drawing

assessment

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Debra Meehl

Debra Meehl, DD Pastoral Counselor, DBT Trained Skills Trainer, Board Certified Hypnotist & President, Meehl Foundation Intenselevly Tained DBT Team

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Speaking Engagements
Texas TAAP Convention-San Antonio, TX
August 15, 2014 (11:00am-12:30am) www.TAAP.com
West Coast Symposium- Cape Cod
Bipolar Borderline & Substance Abuse
Sept, 13, 2014 (10:45am-12:15am) www.CCSAD.com
NAADAC- Seattle, WA
Radical Acceptance-Getting to the root of the problem
September 28,2014 (1:30pm-3:00pm) www.NAADAC.com
NASW-Texas State Conference
Bipolar Borderline & Substance Abuse
San Marcos, TX October 18, 2014 (2:30pm-4:00pm) www.naswtx.com
NASW-Atlanta, GA State Conference
Using DBT Therapy for Mood Disorders and SA October 23, 2014 (9:00am-12:15)
Radical Acceptance-getting to the root of the problem
October 24th, 2014 (1:30pm -3pm) www.naswga.com
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