Dialectical Behavior Therapy (DBT) proposes biosocial model for the development of borderline personality diosrder. The bio side of the model is explained in the page, "borderline personality disorder. " Here, the social side of the model is explained.
Role of the environment in emotional developoment
All babies are born with emotions but without names to describe them, or elaborate tools to communicate them. It is the people around them who give babies the names and tools to communicate their emotions. This learning coninues throughout individuals' life. When there is a goodness of fit between individuals and their environment, individuals can tolerate and meet the environment's behavioral expectations in each life stage. When one's behaviors deviate significantly from the norms and expectations of one's culture, on the other hand, those behaviors are deemed unacceptable and dysfunctional.
How does invalidation happen?
Well meaning parents, partners, co-workers, friends, classmates, and even us, mental health professionals, can inadvertently invalidate individuals' experiences. This happens usually when the environment fails to understand the individuals' private experiences, and respond to their communication by erratic, dismissive or punitive responses.
Imagine that a boy just finished an important presetation at school and said, "I blew it." Average responses from people around him can be like, "Oh it wasn't so bad," "I'm sure you did OK," "Don't be so hard on yourself, " or "Well, that happenes." If the boy is highly sensitive, he may feel that his heart-felt disappointment about his own performance was not taken serously. Instead of saying "thank you" to these words, as a result, he might frown, cross his arms and say, "what do you mean?" The other person reacts to the facial and body expression and say, "hey, I was just being nice, and you don't have to attack me like that." Imagine how the boy would react to the word "attack."
While the boy did not think he did well, the environment said he did OK, which made him quetion his own perception. But did the environment mean to criticise him? Most likely no. The person probably wanted to help the boy come out of his negative thought. There was no malicous intention in either side, and yet the conversation somehow escalted emotionally.
When these feedbacks are given repeatly over time, individuals get confused about their experiences, and learn not to trust their perceptions. The consequence is the extreme supression of their emotions at first to play by what seems to be the social convention, followed by extreme emotional outburst to get the wanted response from the environment.
Role of the family in particular
Since the personality traits start showing before the early adulthood, the family environment in which individuals grew up is a particular interest. Dr. Linehan's seminal book in 1993 suggested that individuals' childhood experiences of invalidation in families could be largely grouped into three types.
a) Parents were largely unavailable when the child needed emotional support.
b) Parents dicouraged or even prohibited negative emotional talks at home. Only positive sharing were encouraged and praised.
c) Parents' message was that growing up meant becoming more reasonable and less emotional. The child was told to regulate emotions by being reasonable.
Again, often families mean well. Many people who have similar childhood experiences do not develop borderline personality disorder either. As a result of transactions, however, slightly more sensitive child in slightly more invalidating environment can become highly sensitive to emotional stimuli.
What can we do to help?
As individuals learn new skills to regulate their emotions, we would like people around them to learn the mechanism of bordelrine personality traits and help them regulate their emotions.
In particular, we see valiation of each other's communication extremely effective to regulate emotions. Validation means communicating that you understand the other person's experience. Looking for what is valid in what they are communicating and acknowledge them. Validation is not agreement. Validation is not conceding. The only purpose is to encourage the individual to keep communicating so that they learn to understand their own emotions and communicate accurately. This is very important because as soon as the individuals stop commuicating, they loose the chance to learn and explore their emotions.
There are six levels of validation. I will write an example of how you can use each level of validation to react to "I blew it" example above in brackets.
Level 1: Stay awake. Don't multitask. Pay sincere attention to what the person is saying with kindness. [Stop what you are doing. Look at him. Nod.]
Level 2: Repeat what you heard by rephrasing and summarizing. Don't over do this, though. [You don't think it went well.]
Level 3: Put the words to observable facial and body expressions. Guess what emotions that they are trying to communicate. If your guess is wrong, don't push and probe. [You sound very disappointed. ]
Level 4: Show your understanding of the person's context, history, etc. Communicate that it is understandable that the person feels the way he or she does given his / her context or history. [You put so much efforts for this presentation, didn't you?] [You have bad experiences with presentation. The pressure must be big.]
Level 5: Normalize the person's feeling. [As this was such an important task, everyone wanted to perform his best.]
Level 6: Genuine interaction. When you use your full skills from Level 1 and 5 and when you know you have enough information about what the person is trying to communicate, only then, communicate your feeling, opinion, further questions and suggestions.
We all tend to jump to Level 6 without doing enough of Levels 1-5. Levels 1-5 are the foundation for the level 6 to work. You do not have to follow the order. In the conversation, you mix levels 1-5 accordingly. Validation can not only help individuals calm down, but also improve the relationship.
Linehan, M. (1993). Diagnosis and treatment of mental disorders. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.