Day One: Biosocial Approach to Borderline Personality Disorder

DBT maintains the biosocial approach to understanding borderline personality disorder.  Biological and environmental factors directly affect behavior.  

"According to Linehan, BPD is primarily a disorder of emotion dysregulation and emerges from transactions between individuals with biological vulnerabilities and specific environmental influences. The dysfunction proposed by Linehan is one of broad dysregulation across all aspects of emotional responding. As a consequence, individuals with BPD have (a) heightened emotional sensitivity, (b) inability to regulate intense emotional responses, and (c) slow return to emotional baseline" (Crowell, Beauchaine, & Linehan, 2009, p. 495).


Emotional dysregulation. . .?

What does this mean?  One definition of emotional dysregulation is "a maladaptive pattern of regulating emotions that may involve a failure of regulation or interference in adaptive functioning" (Hilt, Hanson, & Pollak, 2011, p. 160).  What I like about this definition is that it describes these reactions as a pattern, not just a moment of strong, heightened emotions.  

What does this look like?  Let's look at self-harm.  For some individuals, there is a pattern of dealing with strong emotions by creating physical pain.  The logic may be that the pain moves from an abstract internal event to a concrete physical event; another view is that the emotional energy is channeled and controlled.  This cycle of a need for control and emotional release progresses with increasing distress.

For individuals with borderline personality disorder, their home environments are often invalidating, resulting in emotional dysregulation and the use of coping behaviors.  These coping behaviors could include impulsive decisions that are ultimately maladaptive and destructive but temporarily effective in emotional regulation.