The 2 Major Challenges of Borderline Personality Disorder

The 2 factors that create emotional turmoil in borderline personality disorder.

Posted Mar 20, 2018

Goodluz/Shutterstock
Source: Goodluz/Shutterstock

Long thought to be a hallmark feature of borderline personality disorder, the inability to gauge the emotions of others and then regulate their own is what can make the lives of those with this disorder exceptionally challenging. Perhaps someone you care about has this diagnosis or seems to show some of the classic symptoms of instability, problems in attachment, and lack of clear-cut boundaries. What happens when things go wrong? How does this person react? You may find yourself in the position of having to be the voice of reason as you try to get the individual to calm down. The loss of emotional control seems to occur most often in situations involving other people, which often means you’re the target. As you’re berated, cajoled, and criticized for a supposed emotional slight, you wonder if there’s any chance of helping this person gain some self-control.

That extreme emotional reaction in people with borderline personality not only makes life difficult, but can also create its own set of negative consequences. People with borderline personality disorder often provoke anger and rejection in those they care about the most. However, they can also suffer when they’re in ordinary social situations, from family gatherings to chats around the water cooler at work. According to the University of Massachusetts Amherst Katherine Dixon-Gordon and colleagues (2018), there is inexplicably relatively little research on emotional regulation in the interpersonal situations that prompt this loss of control. As the authors note, “Interpersonal contexts are the most common and most potent triggers of emotions." Moreover, “difficulties in the ability to modulate or tolerate emotions is a transdiagnostic feature of psychopathology." Therefore, it would make sense that Interpersonal Emotional Regulation (IER), as the authors go on to clarify, could provide the key to understanding forms of psychopathology, including borderline personality disorder, where emotional turmoil plays such a central role.

In contrast to those who lack emotional control, when distressed, people high in IER are indeed able to engage in such stress-busting strategies as seeking social support and sympathy from the important people in their lives. They can tell people how they’re feeling in a calm and non-accusatory manner. Another adaptive IER strategy is the use of problem-solving to deal with an emotionally upsetting situation. Getting practical advice is yet another known coping strategy that can both make people feel better and resolve difficult situations.

By contrast, people with borderline personality disorder, along with those who are anxious and depressed, engage in maladaptive IER strategies that don’t reduce their distress, but only make it worse. Excessive reassurance seeking is one of those maladaptive coping strategies. Over the short term, seeking reassurance may alleviate your distress, which only serves to reinforce your use of it. However, as an interpersonal strategy, it is draining on those people who must constantly help to put you out of your emotional misery. A second maladaptive IER strategy is venting, in which you try to make yourself feel better by letting it all out in the form of shouting and yelling. However, people don’t like to be around you when you do this, so as an IER approach, it won't help, but will just make you more isolated and unhappy.

One of the reasons why people with borderline personality disorder become such poor regulators of emotions, Dixon-Gordon et al. note, is that they grew up in situations where their intense expression of emotions, as in venting, was reinforced by those caring for them. Although they may have been, or felt, largely ignored, their caregivers may have occasionally tried to soothe them when they got out of control. This intermittent pattern of reinforcement strengthened the venting behavior, leading these individuals as adults to continue their outbursts when they’re upset at other people.

The UMass Amherst researchers were particularly interested in what they call “intrinsic” IER, which is the process of regulating your own emotions rather than the emotions of someone else (which would be “extrinsic”). Further, they specifically aimed to examine maladaptive IER and the symptoms of borderline personality disorder, as well as anxiety and depression, based on the assumption that these conditions are all marked by the failure to regulate emotions effectively.

Turning now to the measure itself, Dixon-Gordon et al. devised the appropriately-named “DIRE,” or Difficulties in Interpersonal Regulation of Emotions. This was a scenario-based test, in which participants imagined themselves in three different interpersonally stressful situations. Read each of these, and then see where you think you'd rate in the responses:

1. You are feeling upset by a project you need to complete for school or work. The deadline is tomorrow, and you’re worried there is no way that you will be able to get all the work finished.

2. You and your significant other have been fighting a lot. You really care about the relationship and want things to work out. You’ve just had another fight.

3. You feel like your friends have been avoiding you. Every time you call one of them, they are busy. You want to have a social life and be liked. One day you hear that a bunch of your friends went out to dinner without you.

For each scenario, provide the following ratings (some of the wording varies according to the scenario, but these are the general items)

In this situation you would feel (from 0 to 100) not at all distressed to extremely distressed.

In order to feel better, how likely is it you would:

1. Raise your voice or complain to the person in charge.

2. Distract yourself from how you are feeling.

3. Complain to your co-workers or classmates about how unfair the situation is.

4. Simply notice your feelings.

5. Avoid feeling or showing your distress.

6. Keep contacting (texting, calling, etc.) friends and loved ones.

7. Keep asking for reassurance.

Ratings of emotional distress on that 0 to 100 scale show just how distraught you become when you’re interpersonally frustrated or rejected. The seven ratings of what you would do indicate your use of the following coping strategies, with the numbers corresponding to the above items: 1. venting, 2. avoidance, 3. venting, 4. acceptance, 5. avoidance, 6. and 7. reassurance seeking.

The DIRE scale breaks down into its four proposed factors; the maladaptive ones are venting and reassurance seeking, and the adaptive ones are avoidance and acceptance. The UMass Amherst researchers first demonstrated that these factors existed in their measure, and then went on in subsequent questionnaire studies to examine the relationships of the DIRE scales to depression, anxiety, and borderline personality disorder symptoms. Participants in one of the studies also rated their daily experiences of emotion regulation and coping to give the researchers a sense of how well the questionnaire would be related to reports of their actual interactions. The findings showed that, as predicted, both venting and reassurance seeking (the maladaptive IER strategies) were higher in people with borderline personality symptoms, as well as those of anxiety and depression.

The study did not focus solely on borderline personality disorder, and also did not specifically select people with this disorder as participants. However, the DIRE’s relationship with symptoms of self-reported borderline personality disorder and the feelings of distress that may accompany it (i.e., depression and anxiety) suggests that there are similar underlying process that can interfere with situations in everyday life that create havoc for these individuals.

The DIRE provides a useful prototype for other situations that lead you, or those you care about, to face emotional upheaval on a daily basis. There’s no way to escape emotionally challenging situations in life, but for people who feel they can’t cope, this measure suggests new ways to gain the emotional control that can help their lives become more fulfilling.

References

Dixon-Gordon, K. L., Haliczer, L. A., Conkey, L. C., & Whalen, D. J. (2018). Difficulties in interpersonal emotion regulation: Initial development and validation of a self-report measure. Journal of Psychopathology and Behavioral Assessment, doi:10.1007/s10862-018-9647-9