High-Risk Situations and Borderline Personality Disorder

High-risk fear

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Many individuals with borderline personality disorder (BPD) engage in high-risk situations as part of their maladaptive patterns to manage and control internal turmoil. These high-risk situations include interpersonal situations, negative emotions, life events, cognitive distress, and cues and urges. I talk more about these in The Borderline Personality Disorder Workbook. Let’s learn more about these high-risk situations to help you build your awareness and insight into each and help you find alternative behaviors to manage them better.

High-Risk Situations

High-risk interpersonal situations are those that include a lot of struggle and are often related to specific individuals that are connected to particular thoughts, feelings, or beliefs. Some of these may include people in your interpersonal circle, like your boss. For example, let’s say your boss has particular political views that you don’t share. She often makes statements that espouse this political view to you, which causes you to feel frustrated and see her as “ignorant and short-sighted.” The more you hear these statements, the more agitated you get, which makes it more difficult for you to engage with her appropriately. As this increases, the likelihood of you saying or doing something, directly or passive-aggressively, leading to you losing your job rises. If you have BPD, you are at an even greater risk of acting out when these interpersonal situations become related to thoughts or feelings that you’ve lost support, love, or a sense of security.

Negative emotions are absolutely included in high-risk situations, particularly for those with BPD. The most common negative emotions related to high-risk situations include anger, anxiety, stress, guilt, loneliness, helplessness, fear, guilt, shame, and feelings of being trapped. With BPD, these emotions tend to overwhelm you, causing you to have a hard time seeing anything adaptive or positive about yourself, others, and situations. For example, you send a text to your significant other and don’t get an immediate response. This situation causes you to feel an overwhelming sense of fear and helplessness as questions flood your mind. Due to this emotional and cognitive overload, you fall into old patterns and feel that all you can do is continue to text over and over until they respond. As you feverishly text, your emotions amplify, and other negative emotions seem to pile on, such as anxiety and despair. Now your abandonment fears have also been activated and your negative feedback loop is engaged. Adaptive options are pushed to the wayside and you spin in your loop until you get a response. When you get a response, it turns out not to be one of compassion and contrition, but of frustration and anger. This leads to an increase in the probability of an argument and subsequent relationship turmoil.

High-risk situations also include those life events that significantly impact your life and view of yourself and others. These include divorce, unemployment, death of a loved one, end of a relationship, personal injury, financial problems, imprisonment, or anything else that causes significant physical or psychological pain and discomfort. These are high-risk because of the increased likelihood that they encourage maladaptive beliefs, behaviors, and patterns that cause greater dysfunction and impairment in how you live your life and the decisions you make.

Cognitive distress is another high-risk situation as it involves the internal workings of your mind. Cognitive distress involves negative thoughts and memories you can’t get out of your mind that are related to fear, danger, past trauma, or stressful events. It causes intense anxiety, uneasiness, agitation, and so on. This level of distress can be so overwhelming that you feel incapacitated in your life and are stuck with whatever the world gives you; you feel powerless to control yourself, your world, or the people within it. It’s high risk because of the covert and overt reinforcement of inefficacy that bleeds into your beliefs, behaviors, and patterns that keeps your maladaptive coping strategies in place (i.e., substance abuse, aggressive responses, self-harm).

And lastly, cues and urges are high-risk because they involve those things in the environment that influence your thoughts, feelings, and memories. These can include drug paraphernalia, pictures of hurtful people from your past, items that you use to harm yourself, place of past loss or trauma, and so on. These are high-risk because they often ignite an internal psychological sequence of beliefs, behaviors, and patterns that adversely impact your interpersonal situations and life events, fueled by those negative emotions and cognitive distress.

How to Manage High-Risk Situations

Take a moment and think about each of these high-risk situations and identify people, places, and things associated with them. These are likely triggers that encourage maladaptive BPD beliefs, behaviors, and patterns. You may feel compelled to block them out, but blocking them out only encourages fear and strengthens your BPD. It’s time to refocus and challenges your BPD using the suggestions below.

It’s certainly not easy to manage high-risk situations, but it is possible. The more you try some of the suggestions below, the greater the probability of controlling them. This will give you the power and choice to determine the outcomes in your life.

• Don’t get into them, if you can help it. Work on identifying precursors to high-risk situations and avoid them. Do what you can to prevent them, or prevent yourself from interacting with them.
• Create a pros and cons list of the outcome of those high-risk situations. Try and see them objectively and be willing to recognize that there may be some positives or reinforcing components that cause you to engage in these over and over again.
• Identify, practice, and strengthen contrary behaviors. Many individuals with BPD have automatic responses when triggered; they behave without considering what they’re doing, the outcome, or impact. When you think about the people, places, and things associated with your high-risk situations, ask yourself, “What could I do differently, that is likely to give me a different outcome?” Write this down on a sticky note or on your phone and practice it every day.

Build your skills associated with adaptive coping strategies.