How to Manage Emotional Cascades in Borderline Personality

Knowing what works can keep it from turning into a flood.

• People with BPD are known to have difficulties regulating their emotions, creating more stress in their lives.

• New research based tests one approach's ability to predict distress over a one-year period.

• Poor coping strategies, especially ones that are inflexible, can create a cascade that escalates over time.

A key feature of borderline personality disorder (BPD) is emotional dysregulation. People with this disorder have tremendous difficulty controlling their emotions, particularly when they are under stress. Their lack of emotional control can further contribute to stress by creating strife in relationships with others as well as generalized difficulties in navigating life’s obligations.

You may know someone with BPD and can attest to this problematic reverberation between symptoms and poor outcomes. This individual may lash out at a supervisor who they believe is treating them unfairly, only ensuring that they lose the very position that they’re trying to keep. In what is referred to as the “stress generation effect,” people with BPD actually make their lives more miserable over time and as a result, find themselves under constant pressure due to financial problems or loss of valued close relationships.

Emotional Cascades in Borderline Personality Disorder

According to Howard University’s Kapil Chauhan and colleagues (2023), BPD can be understood within the larger Alternate Model for Personality Disorders (AMPD) in the diagnostic system of DSM-5 as reflecting not only emotional dysregulation, but also lability (fluctuations between highs and lows), anxiety over the loss of relationships (separation anxiety), risk-taking, and constantly elevated levels of depression, hostility, and impulsivity.

Within the AMPD, personality disorders are viewed as longstanding adaptive disturbances that are distinguished from each other according to a set of underlying dimensions. BPD, in this system, reflects a particular pattern of elevations along these dimensions. Additionally, however, BPD can be “cross-walked” diagnostically by linking it to the traditional DSM-5 system currently in use that is based on categorical demarcations between disorders.

All of this may sound very technical to you, and of perhaps no more than academic interest, but the implications of moving from the categorical to the dimensional approach in diagnosing personality disorders are actually very significant. To put people’s personalities into bins based on whether they possess “X” number of symptoms could lead not only to inaccurate diagnoses but also failures in treatment.

Returning to the Howard U. research team’s investigation, its basic premise was that people with BPD not only experience emotional dysregulation, but that they also engage in a harmful tendency to ruminate over their out-of-control feelings. In what is called the Emotional Cascade Hypothesis, as the authors describe it, “individuals with BPD respond to negative affect with rumination, which further intensifies distress.” As the cascade progresses, these individuals may become self-injurious and suicidal, “because of more consistent associations with relief” (p. 2).

Testing the Emotional Cascade Over Time

Using a one-year longitudinal design, Chauhan and his collaborators tested the ability of the AMPD-BPD diagnosis to predict distress, rumination, and suicidal thinking. Their model rested on the assumption that one of the chief reasons that emotional cascades develop is due to an inability of people with BPD to use effective coping skills. The trajectory the authors proposed would be reflected in their data led from AMPD-BPD symptoms through to poor coping and ultimately higher distress scores as the year progressed.

The online sample of 107 individuals (from an original pool of 700) ranged from 18 to 57 years old (average age 31 years; 51 percent identified as women). They completed measures of personality disorder, symptoms of depression, anxiety, and stress, a rumination measure, and a coping checklist. Of the initial sample, approximately one-third dropped out over the course of the study, leading to a final sample of 67 tested at 9 months and 72 at one year.

Looking in more detail at the coping checklist, it was derived from a theoretical model used in treatment known as Dialectical Behavior Therapy (DBT). The coping-related skills that DBT teaches include mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. People who are unable to use these skills, according to the Howard U. researchers, should experience an increase both in rumination and distress.

Additionally, poor coping in this model would be reflected in a tendency to stick to one coping strategy (i.e. an ineffective one) rather than show flexibility in the way they adapted to stressful situations.

Consistent with the Howard U. researcher team’s predictions, dysfunctional coping at the 9-month point had the strongest effect on rumination at the one-year testing point. Additionally, looking at the AMPD-BPD diagnosis itself, later outcomes were more strongly predicted by anxiousness, depressivity, emotional lability, and separation insecurity. However, impulsivity, risk-taking, and hostility had negligible effects on outcomes, suggesting that these dimensions are less important from a diagnostic standpoint.

Turning Down the Emotional Cascade

Knowing now that people with certain BPD traits make their lives much worse by their poor use of coping skills should be of value in understanding how potentially to keep the cascade of emotions to manageable proportions. Interventions based on DBT are known to be highly effective in treating people with this disorder, and the Howard U. study’s findings are essentially a time-lapse approach to seeing how poor coping in people who are untreated can make their lives so much worse.

Even for people without BPD, though, there can be value in learning from the Chauhan et al. study. Perhaps someone has made you angry by criticizing you in a way that seems unjust. Maybe you parked in a spot you shouldn’t have in a crowded store lot. The owner comes out to chastise you and although in the grand scheme of things it shouldn’t bother you, it does and you mull over it for days. Knowing how rumination can create a cascade of negative emotions, you could practice your own functional coping and put it all behind you.

To sum up, an emotional cascade doesn’t have to turn into a flood if you are aware of the strategies needed to restore your own equilibrium. For people with BPD, these skills can make all the difference in helping them to keep their emotions more manageable as they navigate life’s many challenges.

Susan Krauss Whitbourne, Ph.D. - website

References: Chauhan, K., Donahue, J., & Thompson, R. (2023). The predictive validity of the dsm‐5 alternative model for borderline personality disorder: Associations with coping strategies, general distress, rumination, and suicidal ideation across one year. Personality and Mental Health. doi:10.1002/pmh.1580