Pg. 60 Emotion Dysregulation and Impulsive Behaviors

The exact mechanism here is unclear, but it is common for borderline individuals to report substantial relief from anxiety and a variety of other intense negative affective states following cutting themselves.

Suicidal behavior, including suicide threats and parasuicide, is also very effective in eliciting helping behaviors from the environment-help that may be effective in reducing the emotional pain. In many instances, in fact, such behavior is the only way an individual can get others to pay attention to and try to ameliorate her emotional pain.

Pg. 61%u2026In our clinical population of parasuicidal borderline women, a majority report that the intent to change their environment is part of at least one instance of parasuicidal behavior.

%u2026It is a logical error to assume that if a behavior has a particular effect, the actor has therefore engaged in the behavior in order to bring about the effect. The labeling of suicidal behavior as manipulative, in the absence of an assessment of the actual intent of the behavior, can have extremely deleterious effects.

Pg. 61 Emotion Dysregulation and Identity disturbance

A tendency of borderline patients to inhibit, or attempt to inhibit emotional responses may also contribute to an absence of a strong sense of identity. The numbness associated with inhibited affect is often experienced as emptiness, further contributing to an inadequate (and at times completely absent) sense of self. Similarly, if an individual's own sense of events is never "correct" or is unpredictably "correct" -the situation in the invalidating family-then one would expect the individual to develop overdependence upon others. This overdependence, especially when the dependence relates to preference, ideas, and opinions, simply exacerbates problems with identity, and a vicious cycle is once again started.

Implications of the biosocial theory for therapy with borderline patients
Pg.62 General Aims and Skills Taught

Recognition of these emotion regulation difficulties, originating in both biological makeup and inadequate learning experiences, suggests that treatment should focus on the twin tasks of teaching the borderline patient (1) to modulate extreme emotionality and reduce maladaptive mood-dependent behaviors, and (2) to trust and validate her own emotions, thoughts, and activities. The therapy should focus on skills training and behavior change, as well as on validation of the patient's current capabilities and behaviors.

Pg. 63 Avoiding 'blaming' the victim
The process is tricky and requires an enormous amount of therapist tolerance, willingness to experience emotional pain, and flexibility.

Pg. 64 "Blaming the victim" has important iatrogenic effects. First, it invalidates an individual's experience of her own problems. What the individual experiences as attempts to end pain are mislabeled as attempts to maintain the pain, to resist improving, or to do something else that the individual is not aware of. Thus, the individual learns to mistrust her own experience of herself.

Chapter 3 Pg. 68
One of these borderline characteristics is continuing emotional vulnerability-that is, continuing emotional sensitivity, emotional intensity, and tenacity of negative emotional responses. Such vulnerability is, from my perspective, a core characteristic of BPD. When I discuss emotional vulnerability at this level, I am referring both to the individual's actual vulnerability and to her own simultaneous awareness and experience of that vulnerability.
There are four normal characteristics of frequent, high emotional arousal that makes matters particularly difficult for the borderline individual. First, one must keep in mind that emotions are not simply internal physiological events, although physiological arousal certainly forms an important part of emotions. As I discussed in Chapter 2, emotions are full-system responses. That is, they are integrated pattern of experiential, cognitive, and expressive, as well as physiological, responses. One component of a complex emotional response is not necessarily more basic than another. Therefore, the problem is not simply that borderline individuals cannot regulate physiological arousal; rather, they often have difficulty regulating the entire pattern of responses associated with particular emotional states. For example, they may not be able to modulate the hostile facial expression, aggressive action patterns, or verbal attacks associated with anger. Or they may not be able to interrupt obsessional worries or to inhibit escape behaviors associated with fear. If this point is kept in mind, then it is easier to understand the complexity of the problem facing borderline patients, as well as their tendancy to be at times inexplicably dysfunctional across a wide range of behavioral areas.
Second, intense emotional arousal typically interferes with other ongoing behavioral responses. Thus, regulated, planned, and apparently functional coping behaviors can at times fall apart when interrupted by emotionally related stimuli. The frustration and disillusionment when this happens simply makes matters worse. Furthermore, high arousal is associated with dichotomous, either-or thinking; obsessional and perseverative thought; physical distress, complaints, and illness; and avoidance and/or attack behaviors.
Third, high arousal and the inability to regulate it lead to a sense of being out of control and certain unpredictability about the self. The unpredictability stems from the borderline person's inability to control the onset and offset of internal and external events that influence emotional responses, as well as an inability to modulate her own response to such events. It is made worse by the fact that at unpredictable times the individual does succeed at controlling her emotional responses. The problem here is that the timing and duration of this emotional regulation is unpredictable to the individual (and to others as well). The quality of this experience for the borderline person is that of a nightmare she cannot wake up from.
Finally, this lack of control leads to some specific fears that increase emotional vulnerability still further. First, the borderline person fears situations where she has less control over events (usually new situations, as well as those where previous difficulties have been experienced). The borderline patient's frequent attempts to gain control of the therapeutic situation make perfect sense once this aspect of emotional vulnerability is understood. Second, the patient often has an intense fear of behavioral expectations from individuals she cares about. This fear is reasonable in light of the fact that she experiences dyscontrol not only of private emotional responses, but also of behavior patterns that are contingent on particular emotional states. %u2026.The patient can meet expectations at one moment, in one emotional state, that she may not be able to meet at another time.
An important aspect of this particular problem is the association of praise with expectations. Praise, besides communicating approval, also commonly communicates an acknowledgment that the individual can emit the praised behavior and an expectation that she can do so again in the future. This is precisely what the borderline individual believes she may not be able to do. Although I have presented the fear of praise here as cognitively mediated, such meditation is not necessary. All that is required is that the individual has past experiences where praise is followed by expectations; expectations are followed by failure to meet the expectations; and disapproval or punishment follows. Just such a sequence of behaviors is typical in the invalidating environment.

Anger and Borderline Personality Disorder
Pg. 70
%u2026.. In my experience, much of the borderline behavior that is interpreted as stemming from hostile motives and anger stems in reality to fear, panic, hopelessness, and desperation. (This is similar to Masterson's position that fear of abandonment underlines much of borderline psychopathology.) %u2026Although the panic response itself may stem from the initial, rudimentary experience of anger-related feelings, thoughts, or bodily reactions, this does not mean that the subsequent behavior is aggressive per se or hostile in intent. The overinterpretation of anger and hostile intent, however, can itself generate hostility and anger. Thus such interpretations create a self-fulfilling prophecy especially when rigidly applied.
Although problems with anger and anger expression may reflect more generalized emotional intensity and dysregulation, they may also be a consequence of other dysregulated negative affective states. Arousal of negative emotions and discomfort of any kind can activate anger-related feelings, action tendencies, and thoughts and memories. %u2026The basic idea is that as a result of various genetic, learned, and situational factors, negative affect and discomfort activate an associative network of initial rudimentary fear and anger experiences. Subsequent higher order cognitive processing of the initial aversive experience and affect may then give rise to the full development of the anger emotion and experience. According to Berkowitz, therefore, anger and its expression are likely consequences (rather than causes) of more generalized emotional intensity and dysregulation of negative emotional states. He reviews a fair body of data to demonstrate that negative emotional states and discomfort other than anger can produce angry feelings and hostile inclinations. In line with this position, Berkowitz has written that "suffering is seldom ennobling. It is the unusual individual among humanity in general whose character is improved as a result of undergoing painful or even merely unpleasant experiences%u2026When all people feel bad, they are all too likely to have angry feelings, hostile th