Recovery from Borderline Personality Disorder (BPD) may be possible, and the roots lie in understanding the biosocial model. This model originated with Marsha Linehan’s theory, arguing that there are both social and biological reasons that BPD develops.

borderline personality disorder is often considered one of the most difficult diagnoses with which to work. But in my many years of experience working with individuals with BPD, I found that there are reasons behind their actions that, when understood, can help lead to empathy, acceptance, and ultimately change.

According to the biosocial model, people with BPD frequently have differences in their neurotransmitter and neurological functioning. Research has shown that they many have neurotransmitter issues that make them more emotional, aggressive, or reactive to stimuli – making them more prone to emotionally intense experiences.

People with BPD have usually been invalidated throughout life, leading to emotional sensitivity. For example, imagine a child who is hungry or frustrated and is trying to communicate this to his or her parents but being told that their feelings don’t matter over and over again. The feelings may be cast aside with statements such as “there’s nothing to cry about”, or through cultural stereotypes such as “little girls don’t get angry”, or “big boys don’t cry”. And environments of emotional, psychological, and physical abuse are extremely invalidating.

Invalidation serves to demonstrate to children that their feelings are wrong and that somehow they need to look externally, to other people, to know what they are feeling and if their feelings have value. Being told their emotions were wrong led them to believe that emotions were bad things, to be avoided whenever possible. This creates a chronic, internal tension where the person feels that they have to live up to others’ expectations and not experience negative feelings. Yet they also feel anger and worthlessness for having those unavoidable negative feelings, or on a deeper level, for not being able to authentically express themselves.

This tension builds up and causes an emotional explosion. In fact, the individual who has had their emotions invalidated repeatedly growing up will feel that if they don’t demonstrate their emotions through large displays, that no one will believe them. They believe that their emotions are not worthy of being considered, so may in fact subconsciously overemphasize their emotional expression in order to ensure that other people “believe” that what they are feeling is real.

This is one reason BPD results in so many emotional outbursts. People with BPD have been invalidated for so long that they don’t trust what they feel unless their feelings are overflowing and taking over the room. It’s only then that the individual with BPD can relax and say, “see, I told you I was upset”.

Having emotions ignored by others for so long also leads to black and white behaviors and beliefs. For someone with BPD, behaviors may swing like a pendulum from distancing themselves from their emotions and other people to feeling needy and dependent on someone else. Although the individual looks for love and approval from others, they have difficulty accepting that love due to the low regard they have for themselves. Chronic invalidation has caused them to feel overwhelmed by distressing emotions. Sometimes their behavior becomes self-sabotaging and self-destructive when they can’t cope with these emotions. Frequently, social relationships merely reinforce these negative patterns.

As children, people with BPD learned these skills to survive in their dysfunctional environment. But these skills no longer serve them. Many people with BPD find the notion of “change” to be invalidating in itself because it implies that there is something wrong with them that needs to be purged. This is why the most successful and well-researched therapy for BPD, dialectical behavior therapy (DBT), focuses on balancing radical acceptance and non-judgment of oneself while recognizing the need for change.

The biosocial model reveals keys to recovery from borderline personality disorder and tells us that this diagnosis does not have to be the horrible life-sentence that many people and medical professionals make it out to be. Marsha Linehan, the inventor of DBT, revealed in a 2011 New York Times article that she had BPD when she was younger. Yet, she’s found ways to cope with and grow from the issues that at one point institutionalized her. If she can get through it, anyone can.

References

Carey, B. (2011). Expert on Mental Illness Reveals Her Own Fight. New York Times. New York.

Crowell SE, Beauchaine TP, & Linehan MM (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological bulletin, 135 (3), 495-510 PMID: 19379027

Linehan, M. M. (1993).  Cognitive Behavioral Treatment of Borderline Personality Disorder. New York:  Guilford Press.

Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.

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