6 Ways Distress Affects People with Borderline Personality

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When things don’t go your way, it’s natural to feel a certain degree of distress. You’ve placed an online order, expecting it to arrive by a certain date. Perhaps it’s a present for someone close to you, some medication, or the materials you need to start a project you’re eager to begin. As you anxiously check the delivery service’s tracking information, you realize it’s going to be delayed. After a couple of days, however, the item shows up as “delivered.” You never received it. Now, what can you do?

You decide your best bet is to call the delivery service. After the third branch through the phone tree, you finally get to talk to a real person. By this time, you're so fed up that you explode in rage at how this terrible snafu could have happened. In the back of your mind, you realize that this individual on the other end of the line had nothing to do with the situation, but you still let your emotions take over.

These sorts of everyday frustrations happen all the time, whether they involve situations out of your control or perhaps your own failures (such as maybe you put the wrong address in on the order). You might not enjoy having lost your cool, but you realize it was a temporary lapse, and apart from feeling a bit embarrassed, don't let your reaction cause you undue worry.

According to Fordham University’s Christopher Conway and coauthors (2021), the ability to hold on and accept your feelings of frustration is part of a general tendency toward “distress tolerance.” Thus, the issue is not whether you let your anger get the better of you but whether you can even experience the emotion of anger. As counterintuitive as it might seem, your psychological health may actually benefit from getting in touch with your range of feelings, even those that are painful at the moment. You know you'll return to baseline soon enough after the episode has passed.

In contrast, consider the situation from the standpoint of people with borderline personality disorder (BPD). Inherent in their diagnosis is an inability to keep the range of their emotions in check. They can go from 0 to 60 in no time, unable to regulate their rage, anxiety, or sense of despondency. However, they can't just stand by and wait to get back to 0. Instead, they engage in various dysfunctional countermeasures intended to distance themselves from their negative emotions in what, as Conway et al. note, is an "amalgam of problematic reactions to negative affect" (p. 1060).

What is Distress Tolerance, and Why Should It Concern You?

The formal definition of distress tolerance, in the words of Conway and his fellow researchers, is “the tendency to persist in task- and goal-directed behavior while experiencing negative internal states” (p. 1050). As you can see from this definition, the essence of distress tolerance is on the “tolerance” itself, not the distress.

The Fordham-based researchers note that distress tolerance has some similarities with the related concepts of emotion dysregulation (the inability to control your feelings), experiential avoidance (shoving your feelings aside), and anxiety sensitivity (feeling anxious about feeling anxious). Additionally, people low in distress tolerance are just uncomfortable with frustration period. Indeed, the authors suggest that these related domains are “expressions of a broad dimension that captures individual differences in adaptive responding to internal discomfort” (p. 1051).

Given the nature of BPD and the well-established difficulties in regulating emotions for people who fit the diagnosis, Conway et al. maintained that an important test of the validity of the new measure was whether it would differentiate people with BPD symptoms from non-clinical samples or people with other psychological disorders.

How Do You Measure Up on Distress Tolerance?

Conway et al. tested their new distress tolerance measure on an undergraduate sample consisting of 1,525 university students (62 percent female; 71 percent White) whom they compared with the 225 members of an online survey site’s panel of adults (average age 48 years, 92 percent female) diagnosed with anxiety or depression. The third sample of 210 adults (average age 44 years, 50 percent female) received treatment for a substance use problem. All participants also completed measures of BPD symptoms along with other related scales, including measures of emotion regulation and ability to tolerate frustration.

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Turning now to the measures of distress tolerance, you can gain an understanding of where you might fall on this attribute by rating yourself on the following sample items using a 1 (strongly disagree) to 5 (strongly agree) scale:

1. My feelings of distress or being upset are not acceptable.
2. I can’t stand doing a job if I’m unable to do it well.
3. I take extreme measures to avoid being physically uncomfortable.
4. When I’m upset, I have difficulty focusing on other things.
5. When my thoughts seem to speed up, I worry that I might be going crazy.
6. My painful experiences and memories make it difficult for me to live a life that I would value.

Each of these items represents a different facet of distress tolerance, as follows:

1. Appraisal: Regarding feelings of distress as intolerable.
2. Frustration discomfort: Not being able to stand having your goals thwarted.
3. Avoidance: Deliberately pushing aside feelings of distress or frustration.
4. Difficulties in emotion regulation: Allowing emotions to interfere with goal-directed behavior.
5. Anxiety sensitivity: Feeling afraid of being anxious or worried.
6. Acceptance and action: Taking emotional experiences in stride.

Although the authors did not report on the mean scores per scale in their paper, by seeing how close your own ratings were to about a 3.0, you can get an idea of where your strengths and weaknesses are in terms of living with such negative states as frustration, worry, and anxiety. Just the act of rating yourself on these items that can come your way in the course of everyday life.

Statistically, these 6 categories of items fell into what the authors reported as a unitary factor. BPD scores, moreover, were most strongly related to distress tolerance scores compared to questionnaires measuring anxiety, depression, and even suicidality.

As the authors conclude,

"Distress tolerance might be part and parcel of clinically significant emotional problems. Indeed, prominent theories suggest that maladaptive response tendencies in the face of distress are a primary etiological feature—or at least the ‘phenotypic core’—of the full gamut of emotional disorders."

How People With BPD Can Benefit From Improving Their Distress Tolerance

You may be able to benefit personally from knowing your own levels of distress tolerance, particularly when it comes to soothing yourself while in a frustrating interaction, such as that botched package delivery. However, what about people with BPD? How would the capacity to increase distress tolerance fit into their overall treatment picture?

If, as the Fordham-U. authors propose distress tolerance is that "amalgam" of reactions to negative emotions. People with BPD could benefit from separating their inability to regulate their feelings from their fear that their emotions will run up from that 0 to 60 level in no time flat. Fleeing those emotions rather than acknowledging their existence will only separate them further from their ability to remain in touch with their experiences. A therapeutic approach that acknowledges this fear can help them learn to sit with those feelings and let them play out in a controlled setting where they are not in any real danger.

To sum up, the essence of distress tolerance lies in the idea that you can trust yourself not to get out of control should you find that things aren’t going your way. Feeling your goals are being interfered with is a natural part of life, and being able to accept this fact can help you move from frustration to fulfillment.

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