Why relationships can feel traumatizing to someone with BPD - and how the biosocial theory of BPD helps to explain this

The biosocial theory of BPD is described, and is used to help explain why people with BPD can sometimes feel like relationships are traumatizing.

Transcript

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Welcome to the Inner Solutions Podcast. We are your hosts, Donna Hughes and Jessica Heil. We own and operate Inner Solutions, a private practice clinic located in Calgary, Canada. We seek to understand and help our clients by providing empirically supported treatments and evidence-based practices with compassion and expertise. This podcast will provide you with information regarding complex psychological conditions as well as treatments that are available. One thing that I hear about quite frequently when my clients come to dialectical behavior therapy, which is the treatment of choice for borderline personality disorder, oftentimes if they've had a BPD diagnosis, they will say that they find relationships historically have been quite traumatizing to them. Whether that would be romantic relationships or friendships or sometimes family relationships, frequently people with BPD will say that some relationship within their history or multiple relationships have really severely impacted them in a negative way. And when we look at the data, yes, sometimes there can be, there certainly is a correlation with BPD and having objective traumas. We know that people with BPD have a greater likelihood of going through traumatic things such as sexual abuse. So that could sometimes explain why, of course, why relationships would feel traumatizing if something like sexual abuse or sexual assault has occurred. But that's not always the case. Frequently, people with BPD have had fairly typical relationships that have ended with uh what if it's a romantic relationship, sometimes there will just be a lot of conflict that has happened. There could be like yelling and that type of conflict that can occur. And that can certainly feel very impactful for many, many people. And sometimes we hear about relationships that are generally quite typical in the sense of like just not a ton of conflict, but it still felt very, very traumatizing for the person. So why would this be? It can be best explained by something called the biosocial theory, which is the theory of how borderline personality disorder develops. This is a theory that Marsha Linehan, the founder and developer of DBT, came up with to describe what happens, what is a person with BPD, their lived experience when it comes to their own biology as well as how people react to their biology around them. The biosocial theory is broken into two parts, the bio and the social. What we know through lots of research is that people with BPD are often born with a biological predisposition to experiencing more heightened emotions than the average person. It means that their emotions are just like really, really, really big. They're quite sensitive to the emotions that they experience. There's a lot of pain associated with those emotions. And somebody who has that biological sensitivity will frequently then have bigger responses to the things that happen around them because they're feeling those emotions so much more intensely. Now, what happens, the social part, is that when you have somebody who pervasively is reacting bigger because they're feeling things bigger, oftentimes the world around them, the people that they're interacting with, will have a response to them as well, because they're not necessarily expecting that a person's going to have as big of a reaction to the things that are going on, especially if they themselves have a more neurotypical brain where they don't experience emotions as being as intense as the person with the biological sensitivity. So the people around the person with that biological sensitivity may have an invalidating reaction to the person with the sensitivity. Invalidation meaning that they may, in an explicit or implicit way, say that the person is having uh that their emotions are not valid, that there's something about their emotional experience that doesn't make sense to the other person. And this could be said in words. Sometimes it could be things like uh people saying you're reacting too big for the situation. It could be said in a look rather than it being an actual verbal statement, it could be a nonverbal cue, such as like just kind of giving them a funny look when they're reacting. There's lots of different ways that a person can feel invalidated. But what we know is that when we have the combination of that biological sensitivity coupled with pervasive invalidation, meaning that the invalidation is happening over and over and over. Usually it needs to happen from a variety of different environments. It's not just from one person, it would be from all environments. And this happens quite early in age. So think about like a young person who is maybe feeling invalidated when they're at school and when they're at home and when they're with their friends and when they're at their sporting events, sort of happening everywhere. Over time, that pervasive experience of feeling invalidated, coupled with those bigger emotions, is the recipe that will eventually create borderline personality disorder. This biosocial theory really helps us understand what's happening in relationships at any age with a person with BBD. Because a person with BBD feels those emotions so much bigger, they're going to pick up on invalidating cues, again, explicit, like things that are said and also implicit, things that are just kind of implied or inferred, including different looks or body language. And when a person is feeling invalidated and they have bigger emotions, they're likely to react and they're going to do something or say something to indicate that they are feeling invalidated. And then that statement or that reaction is going to have an impact on the person who was doing the invalidating, again, whether or not they they actually intended to invalidate. And then that person may have a reaction back to the person with BBD. And we just go round and around and around almost in like a feedback loop. And that can create a lot of tension if there's this constant situation where one person is feeling upset with another, and then they react to it, and then that person's going to get upset with the other person, right? Round and around we go. And of course, there's going to be tension, there's going to be conflict, there may be silent treatment, there may be a whole bunch of different things. And ultimately, many relationships cannot sustain that over the course of time. And the relationships may end up deteriorating. Again, whether it's a romantic relationship or friendship. And some family relationships too. Some family relationships, people are able to sustain the tension and just kind of tolerate and still stay close despite that tension. And for other people, it's it can be enough where the relationships may eventually end, uh, even when they're family. So that this is kind of um, this it doesn't happen with everybody with BPD, but it is definitely something that we see as being fairly common. And it's it makes perfect sense when you just think about the fact that people are feeling these bigger emotions, and then they're, therefore, of course, right, they're going to be responding with a bigger behavior because of the way that they're feeling. Now, where the experience of feeling traumatized comes in is that when a person with BBD has been in these relationships where things keep on happening, there is this tension, this conflict, they're really suffering. They're feeling a lot of really negative emotions, very intense emotions related to what's happening in these relationships. And we know that for a person with BBD, the way that their brain will internalize those intense relationships will be often equivalent to how somebody with a neurotypical brain, so a more regulated uh limbic system, the part of the brain that houses emotions, uh, the person with BPD will have a response that's going to look similar to how a neurotypical person might have a response to something that was objectively traumatic. So, objective traumas, we consider those to be big T traumas. And these would be things that like any person would acknowledge as being traumatic. Things like war, things like car accidents, things like assaults. Uh virtually any person, if you were to poll them, would say, yeah, those are those are things that could cause trauma. So for neurotypical people, usually it takes an event like that in order for the brain to feel traumatized and start to have post-traumatic stress disorder symptoms, such as emotional arousal in the face of trauma cues, having really intrusive thoughts about the events, having avoidance behaviors, having it impact the way that you think about yourself, et cetera, et cetera. For people with BPD, we can see that they'll have PTSD symptoms, so post-traumatic stress disorder symptoms, over things that would be considered more of, I'm going to use the word small T trauma. So these would be things that the objective world wouldn't necessarily say is traumatic, and yet it still feels very much like a trauma for the person who is experiencing it. Regardless of whether it's a big T trauma or small T trauma, if it causes symptoms such as that emotional arousal, such as the avoidance, such as the intrusive thoughts, flashbacks, etc., then it is considered to be traumatic. And the person who is having these symptoms really is suffering and they are experiencing symptoms that are just really making their quality of life start to decrease. So we need to treat those symptoms regardless of whether they fall into that small tea trauma or big tea trauma category. And it's really imperative for everybody to understand that both types of trauma create just as much suffering. One is not a bigger type of suffering or more intense suffering than the other. They both can be really, really difficult to be enduring. So, how can loved ones help? If you have somebody in your life who has a borderline disorder diagnosis, then what can you do to help with the situation? You can learn about validation. That is the number one thing that loved ones can do for their person who has BPD. Learn about validation, practice it, and recognize that when they're feeling the way that they're feeling, they really are feeling that intensely and they're picking up on sometimes these very subtle cues of invalidation. You may not be meaning to invalidate, and it is possible that you still are doing something that is causing them to feel that the way that they are. So trying to really be non-defensive about that, hear them out and try to understand where they're coming from as to why they're feeling invalidated and practice validation instead. Doing that can go such a long way for a person with BPD and it can really help to regulate their nervous system. And then in turn, it's going to start to regulate the relationship. There's lots of books on validation that you can seek out just at your local bookstore. And Inner Solutions also has a course that you can access. It's available through our website all about validation. You can also look for a therapist that you can see who could teach you about validation. And then what can folks with BPD do to help themselves when it comes to the experience of feeling invalidated? You can remember to practice your distress tolerance skills when feeling invalidated so that you can do what you can to stay as regulated as possible despite the invalidation occurring. I think it can help sometimes to remember that usually loved ones are really doing the best that they can and they're not intending to invalidate. Sometimes invalidation just slips out and they had a different intention than the words that were actually used. And remembering that they want what's best for you can really help to buffer a bit of that invalidation. And then you can also teach your loved ones about invalidation, where you can provide them some information about how to validate and what you'd prefer for people to say when they are having conversations with you when you're feeling emotional. That's all for today. Thank you so much for listening and looking forward to having you back for next episode. Thanks so much for listening. If you found today's episode helpful, please go ahead and leave us a review, and you can also follow the show so that you don't miss out on any future episodes. For more information about us, you can check out our website, www.innersolutions.ca