Biosocial Theory in a Nutshell

The theoretical orientation of dialectical behavior therapy (DBT) is the biosocial theory.  Here, there is a biological component and environmental component to understanding behavior.

From genetics, we know that some people have more sensitivity, or predisposition, to triggers.  In borderline personality disorder, there is a biological side of the emotional reaction that starts with heightened reactivity that spikes faster than others and takes longer to go back to baseline.  It is physiological.  Individuals with borderline personality disorder may need 20% more time to return to baseline for most emotional reactions.

Having this heighten emotional response can be off-putting for people who are not as sensitive.  Some may draw comparisons to the reactions of others, which can be invalidating.  For example, "Your brother didn't even cry when his dog ran away, and here you are being a cry-baby about your dog being at the vet's office to have his teeth cleaned.  It's really not that big of a deal.  He'll be back to normal in soon, so just stop crying."

This sensitivity is not inherently bad or a signal that someone is "broken and just needs to be fixed."  The world is enriched by the passion and excitement of emotionally sensitive individuals.  Marsha Linehan is an intellectual example of this, as she too carries the diagnosis of borderline personality disorder.  It is true in art, music, writing, sports, science, and almost anything we do.  

In looking at problem solving, there can be an oversimplification of problem solving.  No one is born knowing how to regulate emotions.  We watch others and they show us how to regulate our emotions in a healthy way. 

Change is hard.  Change is gradual.  Change is a process.  Remember, one goal is progress, not perfection.  As the main dialectic in DBT, we have radical acceptance of the person and the need for change.  Change can definitely be worth the work.

The second part of the biosocial theory is the invalidating environment.  Invalidation is independent of the actual validity of the emotion or behavior (Manning & Hall, 2013).  Invalidation is not necessarily intentional or malicious, so this is not to blame others for the person's problems. 

In looking at invalidation, families can negate the person's private experiences. 

Parent: "How could you possibly be hungry?  You just ate!" 
Child: "But my tummy is growling and I am hungry."
Parent: "No, you just ate.  Ignore that.  You will be fine soon."

In this situation, the parent has invalidated the child's experience and has told the child what his body is really telling him.  Soon, the child will distrust his body's signals that he is, in fact, hungry.  

If the environment punishes emotions, the person may escalate the emotional response.  This results in dysregulation, meaning a disruptive emotional, cognitive, and/or physiological response.  Others may react to the dysregulated person and give them what they want.  Behaviorally, the problem with this is that the dysregulated behavior has been reinforced.  In reinforcing the behavior, this may become a pattern that increases over time. However, it is important to validate the person's emotional experience and not be judgmental or accusatory, in content, process, and tone. 

Others can label the internal experiences or exhibited behaviors as a pathological problem, such as calling the person lazy or selfish.  This, too, is invalidating.

The environment can teach unrealistic problem solving skills.  Examples of this include magical thinking and oversimplification.  "Magical thinking is thinking that one's thoughts by themselves can bring about effects in the world or that thinking something corresponds with doing it" (Colman, 2012).   

The discussion of the emotional vulnerability and invalidating environment is more of an explanation as to what has happened, what is happening, and what we can do about it.  The DBT skills are a part of how to regulate emotions, to tolerate distress, and to be more effective in interpersonal relationships.

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.