If you have a diagnosis of Borderline Personality Disorder (BPD) or Emotionally Unstable Personality Disorder (EUPD) it’s very likely that you feel unhappy more often than you feel happy.

Why is that?

One thing generally agreed upon is that people who experience BPD/EUPD have significant difficulties regulating their emotions. Marsha Linehan, PhD, the University of Washington psychology professor who developed Dialectical Behavior Therapy (DBT), the treatment deemed most effective for people with BPD/EUPD, describes some of the many consequences related to problems with emotional regulation:

“People who meet criteria for borderline personality disorder not only have at the core emotional dysregulation, but they have other patterns of behavior such as impulsivity. The impulsivity is almost always linked to emotional reactivity so that the person really cannot inhibit emotion-based behaviors, mood-dependent behaviors.”

Linehan notes other BPD/EUPD criteria are similarly related. “Their sense of identity, because your identity depends on stability of emotions. Who you are is a lot of what you like, what you gravitate to, what do you want to be near, what do you want to avoid, et cetera, et cetera, et cetera. And so as you go through all the criteria of which there are a number, almost all of them have to do with that.”

“That” is the fundamental problem– regulating highly reactive emotions. But how do emotions come about? And why can some folks regulate theirs while others cannot? Thanks to advances in neuroscience we are beginning to find out.

There is a well known neurotransmitter produced in the brain – dopamine – that triggers the creation of positive feelings such affection, exhilaration and awe. In other words, the sensations we get from seeing someone or something that makes us feel happy is associated with a boost in dopamine surging through our brains.

The positive effects of dopamine also help people cope with stress. Blunting the effect of stress induced hormones such as adrenalin helps bring emotions back into equilibrium. The effect of this is to increase a person’s resilience, that is, the ability to withstand or bounce back from adversity.

Unfortunately, for people dealing with chronic stress caused by emotional dysregulation, that’s not always the case.

It appears that long-term exposure to stress can decrease levels of dopamine and its moderating effects. In an effort to better understand the reasons for this, a team of researchers from University College London in the UK undertook a study that compared two groups of people, one group that has been exposed to acute long-term stress in their lives (as many people with BPD/EUPD have) and another group that has not.

Using an imaging technique called PETscans the research team compared the levels of dopamine production in the brains of 34 participants who were given an acute stress test in the lab. Two hours after this stress task, researchers injected each participant with a small amount of a radioactive ‘tracer’ that enabled them to visually monitor any changes in dopamine production.

The PETscans revealed that in those who reported low levels of chronic stress in their lives, dopamine production was proportional to the degree of threat that the person perceived in the study stress test. However, in the people who had greater exposure to chronic adversity in their lives, the perception of threat was much higher and their production of dopamine was much lower. This suggests that people who are chronically exposed to more stressful life experiences appear to have more difficulty regulating their emotions, the key diagnostic feature of BPD/EUPD.

That’s the bad news. The good news is that Dialectical Behavioral Therapy may be able to help boost dopamine levels through behavior changing techniques and in the process strengthen resilience. A number of skills that Dr. Linehan included in her DBT treatment were chosen for their ability to do that, e,g. i.e.?mindfulness meditation, expressing gratitude, social service volunteering, validation, self-soothing techniques and others.

According to Dr. Linehan, “We know that you can take a behavioral intervention, in other words, no drugs, no biological intervention. Just teach a person new behavior and their physiology changes and their brain changes. You can see it on imaging studies.”

You can read more about the study here

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