psychopathology and different behavioral syndromes and etiological theories are
associated with the term. The disorder is characterized by disturbed emotional,
behavioral, and thinking patterns which cause enormous suffering and pain and often
danger to one’s life. Linehan describes a number of difficulties associated with this
personality disorder.
First, borderline individuals generally experience emotional dysregulation.
Emotional responses are highly reactive and individuals have difficulties with episodic
depression, anxiety, irritability, and problems with anger and expression of anger.
Linehan sees this emotional dysregulation as the core disorder. Second, borderline
individuals often experience interpersonal dysregulation. Relationships often are
chaotic, intense, and marked by difficulties. Third, borderline individuals have
patterns of behavioral dysregulations, as evidenced by extreme problematic impulsive
behaviors, such as attempts to injure and mutilate themselves, as well as suicidal
behaviors. Fourth, borderline individuals are at times cognitively dysregulated. Brief,
non-psychotic forms of thought dysregulation, including depersonalization,
dissociation, and delusions, are at times brought on by stressful situations and usually
clear up when the stress is ameliorated. Finally, dysregulation of the sense of self is
common. It is not unusual for a borderline individual to report that she has no sense
of a self at all, feels empty, and does not know who she is (Linehan 1993a:11).
Linehan stresses that unpredictable emotional lability leads to unpredictable
behavior and cognitive inconsistency, which interfaces with identity development.
The disorder often contributes 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 (Linehan
1993b:4).
Linehan sees a biosocial cause to the disorder. The disorder results from genetically
based irregularities combined with certain dysfunctional environments. Emotional
vulnerability is a biological disposition which, when combined with an invalidating
environment, can result in BPD. A main characteristic of an invalidating environment
is the tendency of caregivers or others to respond erratically and inappropriately to
various experiences of private or social meanings.
GoalThe goal of the path is described in the following terms. The general goal is to learn
and refine skills in changing behavioral, emotional, and thinking patterns associated
with problems in one’s life that cause misery and distress. The aim is decreasing
suicidal behaviors, and decreasing behaviors that interfere with the quality of life.
Another aim is the increase of behavioral skills, which is specified as increase in
interpersonal skills, emotion regulation skills, distress tolerance skills, and core
mindfulness skills (Linehan 1993a:144). This goal could be summarized in the
following way: decreasing crises and the danger to life and increasing the quality of
life, so that there is less suffering and less pain.
192 CHRISTA W.ANBEEK AND PETER A.DE GROOT