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Section 9
Reactivity to Perceptions in Borderline Personality Disorder

Question 9 | Test | Table of Contents

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In the last section, we discussed counseling the spouse of a BPD client.  Three aspects of counseling the spouse of a BPD client that we discussed were avoidance and control, BPD reactions and fear and weakness. 

As you already know, the best way to adapt to stressful situations is to prevent such stressful incidences from happening. 

In this section... we will examine three steps to help your BPD clients prevent anger as a result of distorted perceptions. The three steps are identifying the problems, clarifying goals, and coping strategies.  As you listen to this section, you might consider the BPD client you are currently treating.  Could the steps to preventing anger benefit your client? 

Three Steps in Preventing Anger

♦ Step #1 - Identifying the Problems

The first step is identifying the problems. Obviously, everyone has anger triggers that can excessively irritate them. There are also certain stressors common among most clients such as work, interpersonal relationship conflict, financial worries, psychological problems, and health concerns. I ask each of my BPD clients to examine each of these categories separately, paying close attention to those categories in which angry episodes often occur. 

Work related stress includes, of course, the pressure to meet deadlines, to perform at the highest possible level, and to avoid being fired from the job. Financial worries are often linked to stress at work, such as achieving a raise. I am sure  you would agree that interpersonal relationship problems are frequent among BPD clients. Many times, clients have a difficult time in establishing stable relationships with other people because the fear of abandonment, as mentioned in an earlier section, conflicts with the client’s unintentional instability. 

Lila, a BPD client of mine, explained that interpersonal relationships caused the most stress in her life and often led to her outbursts.  Lila stated, "I have this boyfriend who I’m really in love with.  But I’m so afraid that he is going to leave me, that that’s all I ever think about.  I get so wound up that when we go out with other female friends of mine and he even talks to them, I get angry and lash out at everyone.  I guess it’s jealousy."  As you can see, Lila’s main source of stress was her need to feel loved, supported, and cared for coupled with a fear of abandonment.  Do you have a BPD client, like Lila, whose fear of abandonment results in an angry displays?

♦ Step #2 - Clarifying Goals
After the BPD client identifies the problem, the second step is clarifying goals.  I asked Lila to think of a specific situation during which she displayed anger toward another person.  Using a journal, I asked her to examine the situation using the following categories.  Who was involved; what happened; where it happened; when it happened; how it happened; and why it happened.  Lila wrote, "I was with Joey, Tina, and Diane at a 24 hour diner.  Joey was laughing with Tina and Diane, and I shouted at all of them, ‘Stop making asses of yourselves!’  It was late in the evening, and I just snapped." 

Next, I asked Lila to analyze her actual response using the following categories.  How you felt; why you did it; and what you wanted.  Lila wrote, "I was feeling jealous and self-conscious. I was thinking to myself, ‘Why isn’t he laughing with me?  Why do they get all the attention?’  I wanted Joey to be thinking of me.  I wanted him to laugh with me, and to act cheerful towards me."  I then asked Lila to fill out the following statements:  "In reality the problem isn’t __(blank)__, the real problem is __(blank)__" 

Often, this will include such statements as, "In reality, the problem isn’t what’s being done to me, the real problem is how I respond." or "In reality, the problem isn’t the situation, the real problem is why I responded."  Lila wrote, "In reality, the problem isn’t that Joey was laughing with Tina and Diane, the real problem is that I have abandonment issues."  Would you agree that the preceding statement was an indicator that Lila had begun to understand the source of her anger and stress?

♦ Step #3 - Coping Strategies
In addition to identifying the problems and clarifying the goals, the third step is to introduce coping strategies.  I asked Lila to make a list of strategies she could practice the next time she was feeling ignored.  Lila made up the following list.

  1. Tell myself that I can participate in the fun, and I won’t be ignored.
  2. Laugh along with my friends.
  3. Focus on the fact that my friends are fun people and not the distorted belief that my boyfriend is ignoring me.
  4. Tell myself that just because he is laughing does not mean he is going to leave me.
  5. Remember all the good times we share and how good he is to me. 

Lila decided to use these strategies the next time she began to feel jealous about her boyfriend.  At a later session, Lila stated, "They did work. I mean, I still felt jealous, but I didn’t lash out, and I even hid the fact that I was feeling upset. It passed, though, like it always does, and our relationship is much more open and happier now."  As you can see, by utilizing these strategies, Lila began to avoid lashing at those that she loved. 

Think of your Lila.  Could he or she benefit from this three step anger prevention?

In this section... we presented three steps to help BPD clients prevent anger as a result of distorted perceptions. The three steps are identifying the problems, clarifying goals, and coping strategies.

In the next section, we will explore cultivating interpersonal relationships.  There are three techniques for cultivating interpersonal relationships that we will explore.  The three techniques are Learning from Others, Remembering, and Engaging in Inner Work and Outer Play.

Peer-Reviewed Journal Article References:
Daros, A. R., Uliaszek, A. A., & Ruocco, A. C. (2014). Perceptual biases in facial emotion recognition in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 5(1), 79–87.

Pavony, M. T., & Lenzenweger, M. F. (2014). Somatosensory processing and borderline personality disorder: Pain perception and a signal detection analysis of proprioception and exteroceptive sensitivity. Personality Disorders: Theory, Research, and Treatment, 5(2), 164–171.

Sadikaj, G., Moskowitz, D. S., Russell, J. J., Zuroff, D. C., & Paris, J. (2013). Quarrelsome behavior in borderline personality disorder: Influence of behavioral and affective reactivity to perceptions of others. Journal of Abnormal Psychology, 122(1), 195–207.

What are three steps that are beneficial in helping BPD clients prevent anger as a result of distorted perceptions?
To select and enter your answer go to Test.

Section 10
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