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Section 2
Aggression in Borderline Personality Disorder

Question 2 | Test | Table of Contents | Borderline
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On the last track, we discussed three anger myths believed by BPD clients. These three myths are  anger is biochemical; anger is an instinct; and ventilation is healthy.  I also provided information that I have found helpful in dispelling these myths.

On this track, we will examine three sources of anger in BPD clients. These three sources are  learned responses in the amygdala; stress; and trigger thoughts.

Three Sources of Anger

Source #1 - Learned Responses in the Amygdala
As you know, one of the primary sources of anger in Borderline clients is learned responses in the amygdala.  This part of the brain is responsible for defensive reactions to stimuli.  However, the amygdala only responds with a reaction it has already learned in early development.  Each person’s reaction to a threat is different depending on what he or she learned in early childhood.  When a BPD client experiences a trauma, such as abandonment, early in life, and reacts in a certain way, the amygdala registers the emotions felt during the trauma and the reaction. 

Therefore, when, later in life, a BPD client experiences a traumatic feeling again, the amygdala reacts in a split second and favors the primary reaction it learned early on in development.  Because the amygdala reacts much faster than the neocortex, or the reasoning portion of the brain, the client, if their primary response was anger, acts angrily and without the information having been sorted through yet. This might account for the seemingly impulsive and unpredictable nature of BPD client’s anger.

Sybil was a 25 year old BPD client.  She related this experience to me, "I hate being late. I hate feeling that some aspect of my life is not in my control, I mean it drives me nuts. So this one time, I was at the bank during my lunch break.  I had ten minutes to get back to my office. I could have made it if the things had gone like they should have. Well, two of the five tellers closed their windows to go on break. Honestly, with people waiting during lunch hour, they take a break.  So incompetent.

"Then, some old bag is signing travelers checks and talking about her vacation in Florida. I’m thinking, ‘Nobody cares about Florida, good god, especially the thought of you in a bathing suit.’ Then some retard is counting his money like he’s a goddamn rainman. I was so pissed off, when I finally got to the window, I pushed the other patron aside and gave the teller a piece of my mind. I was late getting back to the office and so generally pissed the rest of the day."

Source #2 - Stress
As you can see, Sybil was reacting to stress, the second source of anger in a Borderline client.  Sybil was faced with a situation in which she had little or no control. This feeling caused her stress levels to rise, and as a result, her amygdala reacted in a response she had learned: anger.  This response was a defense against a threatening feeling. 

Confronted with this stress, the heart beats faster and hormones such as cortisol, testosterone, and adrenaline are released. Under certain circumstances and used properly, these hormones can act as a stimulant, pulling clients through difficult situations such as public speaking or a sporting event.  However, when combined with a learned behavior such as anger, BPD clients react impulsively with anger. We will discuss stress and anger in a later track.

Source #3 - Trigger Thoughts
In addition to the amygdala and stress, a third source of anger is trigger thoughts.  During an angry altercation, a BPD client has a conscious or unconscious monologue with him or her self.  These thoughts will push the client into reacting in a certain way to the threat, because they have convinced themselves that the situation is threatening. 

Sylvia, a 28 year old BPD mother of two, stated, "I can’t control my anger at my children. I scream, I shake them sometimes. It’s hurting our relationship.And down the line I think it will affect their self-esteem. With my eldest, I’m the worst. Totally nuts at times.I feel like slapping and slapping him until he shuts up." 

I asked Sylvia, "What are you thinking when you get so angry at your son."  Sylvia stated, "What a brat, what a selfish brat.  He’s trying to get back at me because I want a little order in my life. I feel like he’s trying to drive me to despair, like he wants to destroy me."  I stated, "Let me ask you a question. Suppose, after his misbehaving, you said something like this to yourself:  ‘He’s unhappy and he’s trying to get my attention. His behavior is unpleasant, but he’s just trying to take care of his needs.’ Remember, we’re speaking hypothetically. How would you react?" 

Sylvia thought for a few seconds and then answered, "I think I would definitely act differently.  First off, I’d give myself time to cool down, and second, I guess I’d understand him better." As you can see, by changing her trigger thoughts from "he’s a brat" to "he’s unhappy" changed Sylvia’s perception of her son’s behavior.

Technique:  Switcheroo
To help Sylvia even furthering her empathic exercise, I asked her to try the "Switcheroo" technique.  I asked Sylvia that whenever her son exhibits any kind of behavior, whether negative or positive, to ask herself These Questions:

  1. What needs influence him or her to act this way?
  2. What beliefs or values influence him or her to act this way?
  3. What aspect of his or her history influences this behavior?
  4. What limitations influence this behavior?

I asked Sylvia to practice this exercise for almost every action her son takes during the day.  This way, she conditioned herself to try and understand him better even before he began to misbehave.  I have found that conditioning her mind to switch from anger to understanding helped Sylvia to control her impulsive anger.

Think of your Sylvia. Could he or she benefit from the "Switcheroo" exercise?

On this track, we discussed three sources of anger in BPD clients. These three sources are learned responses in the amygdala; stress; and trigger thoughts.

On the next track, we will examine aspects that contribute to an angry BPD client’s sense of helplessness. These aspects are thought process; low self-esteem; and isolation.

Peer-Reviewed Journal Article References:
Mancke, F., Herpertz, S. C., & Bertsch, K. (2015). Aggression in borderline personality disorder: A multidimensional model. Personality Disorders: Theory, Research, and Treatment, 6(3), 278–291.

Scott, L. N., Stepp, S. D., & Pilkonis, P. A. (2014). Prospective associations between features of borderline personality disorder, emotion dysregulation, and aggression. Personality Disorders: Theory, Research, and Treatment, 5(3), 278–288. 

Scott, L. N., Wright, A. G. C., Beeney, J. E., Lazarus, S. A., Pilkonis, P. A., & Stepp, S. D. (2017). Borderline personality disorder symptoms and aggression: A within-person process model. Journal of Abnormal Psychology, 126(4), 429–440.

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