Date: Nov-2013Minutes: 13:09
The Dialectal Dilemma in BPD | Amy Tibbitts, LSCSW

In this 12 minute audio Amy Tibbitts, LSCSW discusses the day to day struggles of a person with Borderline Personality Disorder (pwBPD) and the basic principles behind Dialectical Behavioral Therapy. This is a very helpful presentation for anyone trying to understand the mindset and behavior of someone suffering with Borderline Personality Disorder.  It also helps with the understanding of how we, as family members, affect pwBPD.

Tibbitts explains that family members without mood disorders themselves  know that emotions are simply emotions and that they do not need to  responded to them. This is not so clear to a person with a mood disorder.

The speaker goes on to explain that family members also know that when they want to fulfill a goal, emotional responses need to be "put on the shelf" so they can continue with the task at hand. For someone with Borderline Personality Disorder this can be extremely challenging.

The Dialectal Dilemma - logic in the face of emotion is not helpful

Tibbitts describes what she calls the "dialectal dilemma". The dialectal dilemma is the invading feeling that results when applying logical thought to emotional responses at the time of the response. When this is done by the person having the response or by others it results in a very invalidating and very upsetting experience.

An alternative and the principle behind dialectical behavioral therapy is for the pwBPD to have cognition (recognition when an emotional reaction is in the extreme) and then substitute an alternate behavior - doing something different and more constructive with the emotional reaction.  The emotion is not denied.  The reaction to others is altered.

Three Characteristics Common with Borderline Personality Disorder

Three characteristics are common in people suffering with Borderline Personality Disorder are heightened sensitivity, extreme reaction/arousal, and slow return to baseline.

Heightened sensitivity - A person with Borderline Personality Disorder has a high sensitivity to emotions and feelings - both their own and of others.

Extreme reaction and high arousal - Extreme reactions and high arousal often makes it difficult to think through issues and act in an appropriate way.

Slow return to baseline - These reactions last longer and this in turn can the heighten the reaction to subsequent events and stimuli.

Biosocial Theory

The struggles with Borderline Personality Disorder are impacted by both biology and by the social environment.

Biological factors - Being tired, hungry, stressed, or under the influence are all conditions that exacerbate the struggles of Borderline Personality Disorder. This is why people with the disorder do not do well in crisis situations.

Social factors - Being in an environment that denies or minimizes emotional experiences (independent of whether they are valid or not) adds to the difficulties. Specific examples include indiscriminately rejecting the validity of feelings, punishing the pwBPD for their emotions, escalation of emotional situations, or oversimplification of the task of solving problems at hand.

When these factors become extreme it often leads to suicidal ideation, or parasuicidal ventures, or even suicide.

BAmy Tibbitts, LSCSW, is the founder and director of the Lilac Center in Kansas City, MO. She has been providing Dialectical Behavioral Therapy (DBT) in a private practice setting since October of 2000. Ms. Tibbitts is a 1997 graduate of the University of Kansas and holds a master’s degree in social welfare. She underwent clinical training at Wyandot Mental Health Center. Prior to opening her private practice, Amy provided clinical services at Johnson County Mental Health Center. She is currently authoring a book on Dialectical Behavioral Therapy.