Dialectical Behavior Therapy’s Bio-Social Theory
What makes some people able to manage life’s daily stresses and burdens with equanimity, while others experience an emotional rollercoaster when they hit even the slightest bump in the road? Are they simply built differently? Is it a result of a better childhood? Traumatic experiences? Our DNA?
People diagnosed with Borderline Personality Disorder (BPD) often experience some of the greatest struggles with everyday obstacles. They frequently describe themselves as having problems controlling emotions, being moody, getting angry quickly and feeling like relationships are out of control. Superficial cutting, over or under eating, drinking excessively, substance abuse, using physical violence and interpersonal struggles with friends and family members are common high risk behaviors. Negative emotions and problem behaviors seem ever present, whether they want them or not.
In her book Cognitive Behavioral Treatment of Borderline Personality Disorder, Marsha Linehan, Ph.D., explains her bio-social theory for understanding where these problematic emotions and behaviors originate. Linehan’s theory suggests that BPD is primarily a dysfunction in how our bodies regulate emotions. In other words, some people are hard-wired to be more sensitive to emotional stimuli than others. Those who are diagnosed with BPD tend to be highly sensitive and reactive to emotional events.
However, Linehan believes that most people with a vulnerability to extreme and intense emotions do not develop BPD. Particular environments are necessary in order for an individual to develop the disorder. The accompanying problematic behaviors are a result of an interaction between a biological vulnerability to extreme emotion and an environment that invalidates the person’s internal experiences.
Her theory suggests that a biological vulnerability to extreme emotion impacts how emotions are experienced. People with this vulnerability are:
- more sensitive than the average person to emotional stimuli,
- experience stronger and more extreme feelings, and
- take longer to return to a baseline of calm.
A small event that others might overlook or quickly move past is more likely to trigger emotion. Once triggered, the emotion tends to be extreme. Rather than experiencing mild frustration, affection, regret or hurt, these individuals will experience more extreme versions of emotion like fury, adoration, humiliation and hopelessness. For most people, emotions dissipate, but for an emotionally vulnerable individual, feelings linger for long periods of time. This leaves them in a high state of emotional arousal much of the time.
Children learn about themselves and their emotions from their parent’s correct labeling of emotional reactions. For example, irritability can be caused by such things as tiredness, hunger or being picked on by peers. Correctly identifying the cause of irritation increases the child’s ability to recognize their own internal state. In the best possible environment, external validation of one’s internal experience results in the development of stable identity.
In contrast, in the invalidating environment private experiences are responded to erratically and with insensitivity. The individual learns to mistrust her internal states and instead scans the environment for cues about how to act, think or feel.
Environments of abuse and neglect certainly qualify as invalidating environments. However, well-intentioned families can also develop into invalidating environments. A family that tends not to experience extreme emotion may simply not understand an emotionally vulnerable individual. As a result, this type of family may continually attempt to restrain an individual’s expression of emotion, use punishment to control behavior or trivialize or ignore the display of negative emotion. The ability to recognize and label emotions is left undeveloped and the person fails to learn to trust her own emotional experience.
The result of the interaction between an emotionally vulnerable individual and an invalidating environment is the behaviors exhibited by the adult with BPD:
- The individual has never learned to label and regulate emotional arousal,
- Tolerate emotional distress,
- Or to trust her own emotional responses as reflections of valid interpretations of events.
Behaviors such as overdosing and cutting help to control emotion and obtain help from an indifferent or punishing environment. These behaviors are inadequate solutions to overwhelming, intensely painful emotion. The challenge for the adult with Borderline Personality Disorder is to learn to understand and trust her own emotional experience and to employ adaptive responses to intense and extreme feelings.