Dialectical Behavior Therapy: Dialectical Dilemmas and BPD
The lives of people with Borderline Personality Disorder (BPD) can appear contradictory and chaotic. They are frequently highly emotional and have difficulty regulating the expression of their emotions, which leads them to feel out-of-control. However, they often don’t trust their emotional responses and have high, unattainable expectations for themselves. At one moment, they may be desperate for help and want to give up, while at others they are seemingly skilled and capable. Often, people with BPD experience constant stress with immediate and extreme emotional reactions, but they hold back the expression of grief and sadness.
There are many theories that have been developed over the years to explain the behavioral and emotional experiences of people with BPD. The dialectical dilemma’s described by Marsha Linehan, Ph.D., in her book Cognitive-Behavioral Treatment of Borderline Personality Disorder, are not considered universal. However, in her development of DBT, she found three common dialectical dilemmas experienced by people with BPD. These 3 dilemmas are each defined by their opposite poles. The process of investigating and synthesizing these apparently contradictory characteristics and behaviors often helps individuals with BPD understand problematic behaviors like self-injury.
The three dialectical dimensions include emotional vulnerability versus self-invalidation, active passivity versus apparent competence and unrelenting crisis versus inhibited grieving.
Emotional Vulnerability versus Self-Invalidation
Emotional vulnerability is an extreme sensitivity to emotional stimuli. This is the person who has strong and persistent emotional reactions to even small events. Emotionally vulnerable people have difficulty with such things as modulating facial expressions, aggressive action and obsessive worries. On the other end of the dialectical pole is self-invalidation. Self invalidation involves discounting one’s own emotional experiences, looking to others for accurate reflections of reality and over-simplifying problems and their solutions. The combination of these two characteristics leads to oversimplifying problems and how to achieve goals and extreme shame, self-criticism and punishment when goals are not met.
Active Passivity versus Apparent Competence
Active passivity is the tendency to approach life’s problems helplessly. Under extreme stress, an individual will demand that the environment and people in the environment solve his or her problems. Apparent competence, on the other hand, is the ability to handle many everyday life problems with skill. Often, people with BPD are appropriately assertive, able to control emotional responses and successful in coping with problems. These competencies, however, are extremely inconsistent and dependent on circumstances. The dilemma of active passivity and apparent competence leaves the individual feeling helpless and hopeless with unpredictable needs for assistance and fear of being left alone to fail.
Unrelenting Crisis versus Inhibited Grieving
With unrelenting crisis, repetitive stressful events and an inability to recover fully from one before another occurs results in urgent behaviors such as suicide attempts, self-injury, drinking, spending money and other impulsive behaviors. Inhibited Grieving is the tendency to avoid painful emotional reactions. Constant crisis leads to trauma and painful emotions, which the individual frantically attempts to avoid.
These three common dialectical dilemmas are intended to help the therapist understand and relate to the individual’s experience. Although the concept of these dilemmas was originally developed by Linehan in her work with people with BPD, DBT is currently used successfully with people with a wide variety of issues. It is likely that these dilemmas a relevant for a wide variety of people.
Linehan M. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press, 1993.
Matta, C. (2010). Dialectical Behavior Therapy: Dialectical Dilemmas and BPD. Psych Central. Retrieved on October 4, 2015, from http://blogs.psychcentral.com/dbt/2010/04/dialectical-behavior-therapy-dialectical-dilemma%e2%80%99s-and-bpd/