604 CHAPTER 13
Other behaviors exhibited by people with this disorder—including substance
use or abuse, binge eating, and parasuicidal behaviors—are more directly self-
destructive and are often instigated with the goal of feeling better after interpersonal
stress (Paris, 1999). Unfortunately, such maladaptive behaviors can be reinforcing
because they do temporarily relieve emotional pain. Because of such
temporary relief, these behaviors are negatively reinforced.
When highly emotionally aroused—by fear or anger, for
instance—all of us are likely to have cognitive dysfunctions: diffi cul-
ties in focusing attention and keeping long-term goals in mind, which
makes impulsive urges more diffi cult to put in a larger context. More-
over, when in such an aroused state, people are more likely to distort or
misinterpret what others say and do and to engage in black-and-white
thinking, overlooking ambiguities or subtleties (Fonagy & Bateman,
2008). Both of these problems are more severe for people with bor-
derline personality disorder. For example, when aroused, Reiland ap-
parently did not pay attention to the actual cues her husband provided
and would get so wrapped up in the emotions of the moment that she
could not think about what was best for their relationship. And when
aroused, Reiland interpreted her husband as not loving her, when all
he was doing was asking questions in order to understand the situation.Social Factors: Invalidation
Borderline personality disorder also involves interpersonal dysregulation—
relationships are typically intense, chaotic, and diffi cult (Robins, Ivanoff, & Linehan,
2001). One explanation for the interpersonal problems suggests that they arose in
childhood—that family members and friends were likely to invalidate the patient’s
experience (Linehan, 1993). For instance, a parent might tell a child “You’re too
sensitive” or “You’re overreacting.” During childhood, such dismissals may have
led to fear of rejection and abandonment, if not actual rejection. Such experiences
may have sensitized the child, leading him or her subsequently to overreact to the
slightest hint of being invalidated.
In addition, this interpersonal dysregulation may arise in part because of pa-
tients’ emotional and cognitive dysregulation (Fonagy & Bateman, 2008). When
people with borderline personality disorder meet someone who is positive or help-
ful, they often begin by depending on that person to help calm their emotions, as
Reiland did with her husband. But, paradoxically, once they feel dependent, they
fear being abandoned—which leads them to behave in ways likely to lead to rejec-
tion! Friends and family members may come to respond with caring and concern
only when the patient exhibits self-destructive behaviors (which, in turn, inadver-
tently reinforces those behaviors).FEEDBACK LOOPS IN ACTION: Understanding Borderline Personality Disorder
Linehan’s (1993) theory of borderline personality disorder rests on a series of feedback
loops (like those illustrated in Figure 13.8): Some children have brain systems (neuro-
logical factor) that lead them to have extreme emotional reactions (psychological fac-
tor), and their parents may have diffi culty soothing them (social factor) when they are
emotionally aroused (Graybar & Boutelier, 2002; Linehan, 1993). Either because the
parents create an invalidating environment (“It’s not as bad as you’re making it out to
be”; social factor) or because they engage in outright abuse or neglect (as occurred with
Reiland), the children may become insecurely attached to their parents. In turn, the chil-
dren don’t learn to regulate their emotions or behaviors (and cognitions) and elicit un-
toward reactions from others, which then confi rms their view of themselves and others.
This invalidating process, according to Linehan, leaves the person feeling pun-
ished for his or her thoughts, feelings, and behaviors—they are trivialized, dis-
missed, disrespected (Linehan & Kehrer, 1993). Such people therefore have a hard
time identifying and labeling their emotions accurately and coming to trust their
own experiences and perceptions as valid (psychological factor). They don’t learn
effective problem solving or distress tolerance.David Young-Wolff/Photo Edit
Although online message boards may provide
support for adolescent girls and young women,
they may also encourage or normalize the
self-harming behavior that is associated with
borderline personality disorder (Whitlock,
Powers, & Eckenrode, 2006).P SNP SN