Disclaimer: Take everything I say with a grain of salt, I am not an expert in this field at all, so what I’m explaining is purely from my own understanding.
My new psychologist briefly introduced radically-open dialectical behaviour therapy (RO-DBT) in our session last week. Apparently RO-DBT for borderline personality disorder (BPD) is new-ish and almost unheard of in Australia. I’ve heard of DBT for my BPD and have tried going through a DBT workbook but didn’t really think it changed anything. I thought it’s because I skipped some of the advanced mindfulness section and it’s because I was doing it by myself, not with the guidance of a professional.
But when my psychologist explained that people with BPD could actually fall into different categories, it starts to make more sense to me. Sometimes I question my BPD diagnosis because I fit into some of the criteria but then I couldn’t identify with some other BPD’s common “presentation”. Health professionals are starting to realise that BPD patients could fall into two opposite temperaments, over-controlled vs under-controlled. Let me just focus on the emotion anger as an example. Under-controlled people would generally storm into an office, scream and curse at the person they’re angry at, throw things at them and kick chairs etc. They have little inhibition, so their anger is almost always public. Over-controlled people inhibit their emotions too much, their anger is more private, so when they’re angry at someone, the most they would do is something like avoiding the person they are angry at or just not say goodbye to them before they leave because they’re so angry. And then they will go home or a safe place, and scream, throw, punch, etc.
Now, the most presentation that I was more concerned with is me screaming at my partner, punching things while we’re arguing, etc. and that’s just the typical BPD outbursts that people know too well. But my psychologist has made me realised that I am actually over-controlled. When I am angry at my supervisor, I just avoid bumping into them, and then let it out when I am at home. Most people have never seen me angry even though I have been angry at them a million times. So my presentation is mostly over-controlled, but at home with my partner, when that’s the only place I feel safe, I’d behave in a way that would lead me to believe that I am terrible at self-regulation, that I cannot control my emotions, etc. In reality, me being “out of control” mostly ever happens when I’m in a “safe place” aka around my partner (I know, that’s unfortunate) and never at a workplace, etc. Plus, when people say things like binge-eating, spending money recklessly, etc. as one of the common BPD traits, I just couldn’t identify with it. Perhaps because I am too great at controlling my urges. But by inhibiting my emotions way too much, it would eventually lead to the outbursts and self-harm etc.
Typical DBT is targeted towards managing the under-controlled temperament, you’d want them to self-regulate, have a bit more inhibition, and display less of emotionally-driven behaviours, etc. You can see that the problem with treating someone with over-controlled temperament using techniques for under-controlled people, is pretty much a disaster. You’re basically providing inhibition skills to someone who are already too good at inhibiting themselves. RO-DBT for the over-controlled people would hopefully help them express their emotions, connect with people and learn more about social signals. Instead of just running away and deal with emotions themselves, they could actually be more open towards other people. They should be able to give some kind of signal to other people as to how they feel.
Back then in the office or lab, I often wondered why people just couldn’t tell that I wasn’t happy with their intrusion, in my mind I would go “Haven’t I made myself clear enough? Can they not understand that my short answers is an indication that I’m annoyed?” Perhaps I did feel extremely angry or annoyed but my outward presentation wouldn’t show it. That is why people could not get it and they would continue behaving in a way that would fuel my anger, because I somehow lack the capability to express my emotions verbally and even through my facial expression.
Understanding my temperament is truly an eye-opener and I hope people out there who have been diagnosed with BPD can identify if they lean more towards under-controlled or over-controlled, because not knowing that would most likely hinder your treatment. People with BPD are most often perceived as under-controlled, so it’s time to change that and acknowledge the other half of the BPD population, I think?
Darn, maybe I am just too excited with RO-DBT, hoping it would be the magical wand that could finally help me. Maybe my psychologist is too excited with the new things she’s just learnt and projected it onto me. Who can even tell anymore.