The Little Things That Can Take Over in Borderline Disorder

Control over your emotions is key to maintaining your relationships, psychological well-being, and ability to function in everyday life. If you exploded in rage every time something didn’t go your way, not only would other people want to steer clear of you, but you’d undoubtedly compromise your success in major spheres of your life. As a result, you find ways to control your emotions, so that you don’t risk losing everything you have.

People with borderline personality disorder (BPD) are thought, at their core, to have what psychologists call “dysregulated” or out-of-control emotions that play out in the course of their everyday lives. Despite this generally accepted view, according to Boston University’s Nicole Cardona and colleagues (2020), there are surprisingly few empirical insights available from the literature that would help understand what the actual daily events are that prompt individuals with BPD to escalate.

You can undoubtedly imagine what some of these events might be, particularly if you know someone with BPD. Perhaps this person becomes enraged at you when you just happen to fail to say “hello” at a small family gathering. You were in the middle of a conversation with someone else, and so planned to make your formal greeting in a few short moments. However, this person storms away without waiting and you later learn about the outrage caused by that unintentional snub. People with BPD can take the most innocent of situations and turn them into perceived affronts to their very being.

According to Cardona et al., emotion dysregulation “can be characterized by emotion sensitivity, heightened and labile negative affect, deficits in adaptive regulation strategies, and overreliance on maladaptive regulation strategies” (p. 1). It is for this reason that some BPD researchers believe that the very disorder itself is, at heart, an emotional one. What's worse, the emotions that become dysregulated aren’t the positive ones such as joy, happiness, or pleasure. Instead, they are the aversive ones such as anger, jealousy, and fear. To avoid feeling the pain associated with these unpleasant emotions, people with BPD, Cardona, et al. maintain, engage in efforts to dampen them by escaping or suppressing them. It's these ineffective emotion regulation methods that ultimately take their toll on their well-being.

To drill down into the specific events that can prompt this type of emotional dysregulation, the Boston University team used what's called a daily diary approach. Their research strategy involved working with a small number of BPD participants who provided extensive information about their daily experiences, allowing for a detailed examination of emotion-laden events. Specifically, the researchers asked participants to record all of their emotion-arousing experiences in a 10-12 week period. The 8 members of the sample averaged 22 years old, were primarily Asian and female, and all were diagnosed with BPD.

You could gain some insight into this method if you think about your own daily experiences. When was the last time you felt frustrated by being unable, for example, to log in to an online shopping website? The site told you that you needed to reset your password but you didn’t have that much time, as you were trying to purchase the last item in stock in your size and color. As the seconds ticked by, did you decide to go through all those steps, even though you didn’t want to, or did you just angrily decide to forget the whole thing?

Now see how you would write about this situation if you received the daily diary prompt used by the BU researchers. Below are the first 5 questions that you would be asked to answer:

1. Since the last time you made an entry, how many times have you had a strong emotional experience?
2. Which of the following best describes the strong emotion you experienced since your last entry? (check “anger,” “sadness,” “anxiety,” or “guilt/shame”).
3. What made you feel ____?
4. Rate the intensity of the emotion (1-5 scale).
5. When you felt ____, what did you do?

In the final question, participants chose from a set of possible emotion regulation responses, as follows:

1. Purposefully tried to push the feeling away (e.g. used substances/alcohol, engaged in self-injury).
2. “Dug in” to the feeling (e.g. vented, paced).
3. Engaged in impulsive behavior (e.g. shopping).
4. Engaged in problem-solving (e.g. asked for what you wanted).
5. Allowed the feeling to be there and waited to react (e.g. did something productive).

As you can see from these choices (which weren’t mutually exclusive), the first three strategies would have particularly maladaptive consequences. The last two responses would not have quite such apparent impacts but, according to the authors, would still be maladaptive because they represented “change-based” rather than “acceptance-based” approaches to the emotion. The change, in this case, involves dodging or attempting to suppress an emotion. The healthier option is to find a way to experience the emotion and let it go, without becoming overwhelmed.

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The login problem may not seem all that consequential in the grand scheme of things as issues you face in your daily life. As it turned out, though, routine inconveniences actually made up 6% of all emotion-triggering events. Overall, the type of event that was most likely to trigger an emotional reaction was interpersonal in nature (54 percent of all events logged by participants). Some of these were very general and even as seemingly insignificant as “accidentally made eye contact with someone on the bus," much like the person becoming furious at that family gathering.

In addition to tracking events and emotions over the period of the study, the BU authors also introduced a brief skills intervention intended to help participants identify and potentially change their emotional behaviors. For example, instead of seeking isolation when becoming sad, a more adaptive response would be to reach out to a friend. This would allow the individual both to continue to experience the emotion while also seeking a way to reduce the emotion’s unpleasantness.

In analyzing their findings, Cardona et al. used what’s called both “nomothetic” and “idiographic” approaches. In the nomothetic, they compared participants both in triggering events and emotional reactions. Using this approach, the authors identified anxiety as the most frequent emotion reported across all participants. The most frequently used strategies in response to the emotion were the so-called change-based approaches in which participants attempted to push the emotion out of their conscious awareness.

Looking at the individual, the idiographic approach, the authors found divergence in the ways that participants responded to the same emotion as aroused by a given event. Some participants became better able to use adaptive strategies, particularly after the skills intervention. However, others stuck with their prior, ineffective, strategy use. Additionally, this within-person approach showed that not all participants responded with the same regulation strategy to a given emotion, and that participants varied within themselves in how they reacted to varying emotions.

In evaluating these findings, Cardona et al. note that although there may appear to be general patterns within BPD of emotion-triggering and emotion-regulating processes, there are also important individual differences. What sets off one individual with BPD may have no effect on another. Similarly, a strategy that helps one person cope with a negative emotion could fall completely flat when tried by another. Figuring out how to restore calm in someone who's starting to escalate may involve an approach that's unique to this individual rather than a one-size-fits-all approach. If you know the person well, you might be able to identify both the cues that lead to outbursts and the strategies that can help them regain their equilibrium.

To sum up, the study provides a detailed look into the emotional life of an individual with BPD, at least among this small but intensively-studied sample. The challenges posed to interpersonal relationships for people with this disorder may seem less insurmountable if you break them down into smaller and perhaps more manageable aspects of their daily experiences.

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