# Dialectical Behavioral Therapy/Borderline Personality Disorder/Biosocial Model
## Biosocial Model of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is primarily a disorder of the emotion regulation system. BPD results from a biological predisposition to emotional dysregulation combined with certain dysfunctional (invalidating) environments which interact over time. The characteristics of BPD begin developing during childhood because the fundamental inability to regulate emotions is exacerbated by an invalidating environment. The vulnerable child fails to learn how to identify feelings or regulate emotional stimulation. She does not learn to trust her private experience as valid and real. BPD individuals fail to learn how to tolerate emotional distress.
As adults, BPD individuals adopt the characteristics of the invalidating environment in which they grow up. Looking to others for accurate reflections of reality and oversimplifying the ease of solving life’s problems characterize this self-invalidation.
Oversimplification of life’s difficulties leads to unrealistic goals. Those with BPD tend to have an inability to use reward instead of punishment for small steps toward final goals. When they fail to achieve these goals they are filled with self-hate.
Those with BPD are generally unable to self-regulate. Those with BPD have difficulty regulating arousal, for example going to bed (sleep) and getting out of bed (awakening). The usually have short attention spans and difficulty concentrating. They often feel overwhelmed when depressed and out of control when anxious. Self-esteem is especially vulnerable as they often feel that their self-esteem is on the line in every situation. Normally, those with healthy self-esteem are able to maintain positive feelings about themselves despite setbacks.

## Emotional Vulnerability

Individuals with BPD have difficulties regulating several, if not all, emotions. They have a very high sensitivity to stimuli – even small things set them off. They respond to even low levels of stress. And when emotionally aroused, they take longer to return to a baseline level of emotion. Thus, they are emotionally vulnerable. The more emotionally vulnerable a person is the more they need to be able to regulate emotion effectively. BPD individuals tend to regulate emotions by either shutting down (avoiding emotions) or escape (intense overreaction). Under the influence of intense (positive or negative) emotions, they are impulsive (unable to inhibit inappropriate behaviors). In other words, they are unable to inhibit mood-dependent actions.
Family members of BPD individuals often feel that they are “walking on eggs” because BPD individuals are so emotionally sensitive and tend to over-react.
Emotional intensity means that emotions are extreme and difficult to regulate. On the negative side, partings may precipitate intense feelings of loss, annoyance may turn into rage, and apprehension may escalate to a panic attack or out of control feelings of terror. On the positive side, they may fall in love at the drop of a hat, experience joy more easily, and be more susceptible to spiritual experiences.
Emotions affect thinking. Emotional arousal narrows the attention. The more emotionally aroused you become, the more pertinent and compelling emotion-relevant material becomes. Therefore, when emotionally aroused, emotions dominate perception, judgment, and behavior. For example, when angered, those with BPD find it hard to let go of thoughts and feelings that reinforce their anger.
“Slow return to emotional baseline” means that emotional reactions are long lasting. Basic normal emotions are fleeting and generally adaptive, lasting only seconds to minutes. For the borderline, emotions are long-lasting because they are amplified with sustained attention and reactivated with memories.

## Emotional Regulation Instead of Dysregulation

Emotional regulation and control includes these activities or abilities:
* Decrease (or increase) physiological arousal associated with emotion. Calming down with relaxation and breathing exercises when angry or anxious. Revving up with depression and sadness.
* Re-orient attention in the presence of strong emotion. To regulate emotions, you must be able to direct the focus of your attention (concentrate) and shift your attention from one thing to another.
* You must be able to inhibit mood dependent behavior. In other words, feel one way and act another. To keep life progressing forward, you must be able to coordinate action in the service of an external, non-mood dependent goal.
* Experience emotions without escalating or blunting. Inhibition of negative emotions serves to increase emotional avoidance. Emotions must be experienced to learn about them. Self-soothing is critical to tolerating intense emotions.

## Invalidating Environments

An invalidating environment is one in which communication of private experiences is met by erratic, inappropriate, and extreme responses. In other words, private experiences are invalidated. Personal expression is punished or trivialized. The environment disregards the experience of painful emotions. Neither are the factors related to expressed emotion appreciated. Also, factors that seem related to the expressed emotion (the person’s experience) are not appreciated. Likewise, the individual’s interpretations of the emotional distress are dismissed. Finally, the intentions and motivations of the emotional person’s behavior are not considered.
Descriptions of one’s self are not accepted by the environment as an accurate self-description. The invalidating environment does not appreciate one’s behavior as a valid response to events and often criticizes or punishes the individual. Behavior is attributed to socially unacceptable characteristics (e.g. over-reactivity, paranoia, lack of motivation, manipulation, lack of discipline, and failure to adopt a positive attitude).
Apparent calm and competence are valued. Emotionally invalidating environments are generally intolerant of negative displays of affect. Great value is attached to being (or appearing) happy! The message is to never “give in” to hopelessness. Most of all, the power of a “positive mental attitude” will overcome any problem.
Chaotic families may be oriented in this way due to limited resources (money, education, time, emotional or mental stability, etc.). Perfectionistic families overvalue intellectual or rational thinking and undervalue immediate experiencing. “Normal” families are sometimes inadequate for biologically vulnerable individuals.

## The consequences of invalidating environments include

* The child raised in an invalidating environment does not learn to label private experiences, including emotions, consistent with the larger social community for similar experiences.
* The child is not taught to modulate emotional arousal.
* Emotional problems are not recognized and the child is told to control her emotions without being taught how to do so.
* The solutions to life’s problems are oversimplified so the child does not learn to tolerate distress. Nor does she form realistic goals and expectations.
* Extreme emotional displays are often necessary to provoke a helpful response.
* By punishing communication of negative emotions and intermittently reinforcing displays of extreme emotions, the environment teaches the child to oscillate between emotional inhibition and extreme emotional states.
* An invalidating environment fails to teach the child when to trust her own emotional responses as valid interpretation of events. Rather, the invalidating environment teaches the child to invalidate her own experiences and to search her social environment for cues how to think, feel and act. Emotion Dysregulation tends to lead to Invalidation and vice versa.
A family which consisted of a slightly vulnerable child with slightly invalidating parents can over time evolve into a highly sensitive vulnerable child and an invalidating family.
A temperamental child, a distractible child, and the persistent child can overwhelm, threaten and disorganize otherwise nurturing parents. Over time, children and caregivers shape and reinforce extreme and coercive behavior in each other. In turn, coercive behaviors further exacerbate the invalidating and coercive system, leading to more, not fewer, dysfunctional behaviors within the entire system.
Understanding BPD reveals how other psychiatric disorders (depression, manic-depression, anxiety, post traumatic stress disorder, and attention deficit disorder) affect the development of one’s personality.