Good morning DBT adventurers. This is the last part of the introductory chapter describing Linehan's theoretical model of emotion dysregulation generally, and how it presents in BPD specifically. Hooray say all the people like @CheerBear who is busting to get to the doing bit. Thus without further ado, let's go...

The Consequences of Emotion Dysregulation

According to Linehan (2015), being able to regulate their own emotions is one of the most important skills that a child needs to develop because without good emotion regulation, the child (and later the adult) will struggle to engage in goal-directed and prosocial behaviours. This is because all of the person's energy and effort is going into dealing with their overwhelming emotions.

Reading this bit, I was reminded of how many times I've been told that I'm "behaving in an infantile manner" and that I need to "just grow up." I remember talking about this with my very first therapist more than twenty years ago. He said that telling someone to "just grow up" is about as useful as telling them to "just get taller." I found that super validating. I KNOW that I can't do some things that other adults are able to do. But guess what? Shaming me about it and telling me to just do it, doesn't make me any more capable of doing it!!! One of the things I super like about DBT is that through it I have learnt (and I am continuing to learn) HOW to better do those things that I'm not so good at. DBT is purely pragmatic, without any judgement or conveying any sense that I am wrong, bad or defective for not being so good at some things.

Self harm and suicidal behaviours.

I am guessing we probably all know that self-harm and suicidal ideation and behaviour is a key characteristic of BPD. All too often this is labelled as attention seeking and manipulative behaviour. However, according to Linehan (2015), self-injurious and suicidal behaviours can be thought of as maladaptive but highly effective emotion regulation strategies...suicide ideation, suicide planning, and imagining dying from suicide...can bring an intense sense of relief. Planning suicide, imagining suicide, and engaging in a self-injurious act (and its aftereffects if it becomes public) can reduce painful emotions by providing a compelling distraction (p. 9).

Reading this, I am again struck by how Linehan's attitude towards self-harm and suicidal thoughts/behaviours, differs so markedly from the attitude I have experienced from so many mental health professionals (and other people) over the years. When I engage in an act of self harm, or when I am talking about my suicidal urges to someone, I am doing so because I am trying to deal with overwhelming emotions and I am trying not to act on my urge to suicide. Does this make me demanding, manipulative and just attention seeking? If a person runs into the street screaming for help because their clothes have accidentally caught on fire, does this make them demanding, manipulative and just attention seeking? If a cancer patient in hospital is crying out for pain relief medication, does this make them demanding, manipulative, and just attention seeking? To me, in each of these examples the person is in extreme pain and crying out for help. They ARE seeking attention...but are they "just attention seeking." Why is it that in some instances when people seek attention they are attended to, whereas in other instances they are labelled as "just attention seeking???"

Poor sense of self.

Another key feature of BPD is a lack of a sense of self. According to Linehan (2015), this is due to chronic emotion dysregulation because emotional consistency and predictability across time and similar situations are prerequisites of identity development (p. 11). This is definitely something that I super struggle with - as evidenced by the fact that I am 40 years old and still don't know what I want to be when I grow up.

When I was at high school, we studied Shakespear's King Lear. There is a line in the play where Lear says who is it that can tell me who I am? I went to someone who I super trusted and told him that this line deeply resonated with me and that I didn't know who I was. He replied, "You are Phoenix_Rising, now go home." Two years later I saw my first therapist at the insistence of this same person. I still have a very poor sense of self - although it has definitely improved over the past few years. However, it still remains a big puzzle piece in the puzzle of where I might fit employment-wise.

Difficulties in relationships.

Again, I'm guessing that everybody is aware of the fact that any sort of interpersonal relationship with someone with BPD can be...er...interesting. According to Linehan (2015), difficulties controlling impulsive behaviours and expressions of extreme negative emotions can wreak havoc on relationships (p. 11). I think some of you are nodding so vigorously right now that I can see it through my computer screen.

I recognise that I do not have a strong sense of how challenging it can be engaging with...well...me. I only know that it is difficult, through what I have read. I don't have any lived experience of being in a relationship with someone with BPD. What I do know is that every person who I have ever loved, has left my world. I know that I've had four apprehended violence orders taken out against me, and I've had several other people threaten legal action if I didn't stay away from them. I know that I have never had a romantic relationship aside from the abuse stuff that happened when I was 14 and my "partner" was a 32 year old leader of the church youth group I attended. I know that my last friend walked out of my world in November, 2016. I know that my siblings and I parted ways after my mother died in 2004. I know that last year a psychologist refused to keep working with me, telling Victims Services that I had traumatized her. I know that if I was to die today, there isn't a person on the planet who would claim my body. So...I can't articulate to you exactly what it is about me that makes me difficult to be around, but I do accept there is SOMETHING about me that makes it that way. I am guessing that there are others around here (particularly carers) who have much greater insight into the challenges of being in an interpersonal relationship with someone with BPD than I do.

Well, that's it for me for today. I would be super interested to hear people's thoughts or comments, although I'm equally ok with people just reading along. Come to think of it, I'm also totally ok with having no one read along. For me, part of the magic of Forum Land is that I will never ever know who might be reading. I find that kind-of cool.