Borderline Personality Disorder

Emotions, the Nervous System, and Why Anger Can Feel So Intense Anger is one of the most misunderstood emotions, particularly for people who experience it intensely, quickly, or in ways that feel difficult to control. In clinical practice, anger is often labelled as a problem behaviour or a sign of poor coping, rather than understood as a meaningful emotional response shaped by biology, learning history, and current context. Dialectical Behaviour Therapy takes a very different position. Rather than asking how to eliminate anger, DBT asks why anger arises, what function it serves, and how people can learn to experience it without causing harm to themselves or others. This article explores anger through two closely connected frameworks. First, the DBT model of emotions, which explains how emotions are generated and maintained. Second, the role of the autonomic nervous system, which helps us understand why anger can escalate rapidly and feel overwhelming in the body. When these models are integrated, anger becomes less mysterious and less moralised. It becomes something that can be understood, anticipated, and worked with skillfully. The DBT Model of Emotions In DBT, emotions are not random or irrational. They arise through a predictable sequence of events. An emotion begins with a prompting event, which can be external, such as a conflict or perceived rejection, or internal, such as a thought, memory, or physical sensation. This prompting event interacts with a person’s vulnerability factors. These include things like sleep deprivation, stress, trauma history, chronic invalidation, or ongoing relational strain. When vulnerability is high, even relatively small events can trigger strong emotional responses. This is particularly relevant for anger, which is often activated in situations involving perceived threat, injustice, abandonment, or boundary violations. Once the emotion is triggered, it unfolds across multiple systems. There is an emotional experience, changes in thoughts, urges to act, and physiological arousal in the body. Anger, from a DBT perspective, often includes thoughts such as “This is not fair” or “I am being disrespected,” urges to confront, attack, withdraw, or defend, and physical sensations such as muscle tension, heat, increased heart rate, and narrowed attention. These components reinforce one another, creating momentum. If nothing interrupts the process, anger can escalate quickly and lead to behaviours that may later be regretted. Importantly, DBT emphasises that emotions themselves are not the problem. Emotions evolved to help us survive. Anger, in particular, is designed to mobilise energy, protect boundaries, and signal that something important is at stake. Problems arise when anger becomes too intense, lasts too long, or leads to behaviours that create further suffering. Emotional Vulnerability and Anger Escalation Some people are biologically more emotionally sensitive than others. DBT refers to this as emotional vulnerability, which includes heightened sensitivity to emotional cues, intense emotional responses, and a slower return to baseline. When emotional vulnerability is combined with an invalidating environment, where emotions are dismissed, punished, or misunderstood, people often learn to suppress or distrust their internal experiences. Over time, this combination can make anger particularly volatile. Suppressed anger does not disappear. Instead, it often builds beneath the surface until it is triggered suddenly and intensely. Many people describe feeling calm one moment and flooded with anger the next, with little sense of control. This is not a failure of character. It is a predictable outcome of emotional vulnerability interacting with chronic invalidation and stress. Understanding this model helps reduce shame. Anger is not evidence that someone is dangerous, broken, or manipulative. It is evidence that their emotional system has learned to respond strongly in the face of perceived threat or pain. The Role of the Autonomic Nervous System To fully understand anger, it is essential to look beyond thoughts and behaviour and consider the nervous system. The autonomic nervous system regulates arousal and threat responses automatically, without conscious choice. It has two primary branches that are relevant here: the sympathetic nervous system and the parasympathetic nervous system. When the sympathetic nervous system is activated, the body prepares for action. Heart rate increases, breathing becomes shallow, muscles tense, and attention narrows. This is often referred to as the fight or flight response. Anger is closely linked to this state. The body is mobilised to protect, confront, or defend. For many people who experience intense anger, this activation happens extremely quickly. The nervous system interprets a situation as threatening before the rational mind has time to evaluate it. Past experiences, particularly trauma or repeated invalidation, can sensitise the nervous system so that it responds to present day situations as though they are dangerous, even when the threat is emotional rather than physical. Once the sympathetic system is highly activated, access to reflective thinking is reduced. This is why reasoning, reassurance, or being told to calm down rarely helps in the moment. The body is already in survival mode. The parasympathetic nervous system, particularly the branch involved in social engagement and calming, helps bring the body back to baseline. Learning to activate this system intentionally is a key part of managing anger effectively. DBT skills are designed not only to change thoughts or behaviours, but to work directly with nervous system activation. Anger, Control, and the Illusion of Choice One of the most painful aspects of anger for many people is the belief that they should be able to control it through willpower alone. When anger feels uncontrollable, this belief often turns into shame and self criticism. From a DBT perspective, this expectation is unrealistic and unhelpful. Anger is not a deliberate choice. The initial surge of anger happens automatically, driven by the nervous system and shaped by past learning. Choice enters the picture later, in how a person responds to the emotion once it has arisen. This distinction is crucial. People may not have control over whether anger appears, but they can learn skills to influence how it unfolds and how they act in response. Recognising this distinction allows people to move away from self blame and towards skill development. The goal is not to eliminate anger, but to increase the window between feeling anger and acting on urges that may cause harm. Highlighted DBT Skill: Mindfulness of Current Emotion One of the most effective DBT skills for working with anger is Mindfulness of Current Emotion. This skill involves turning attention towards the emotion itself, rather than away from it, without judgement or suppression. For anger, this means noticing the physical sensations, thoughts, and urges that are present, while allowing the emotion to rise and fall naturally. When practiced consistently, this skill helps interrupt the automatic escalation cycle. Naming anger and observing it creates a small but meaningful pause. This pause can reduce physiological arousal and prevent secondary emotions such as shame or panic from layering on top of the initial anger. Mindfulness of current emotion also supports nervous system regulation. By staying present and grounded, the parasympathetic system is more likely to engage, allowing the body to settle over time. This does not mean anger disappears immediately. It means that anger is experienced as tolerable rather than overwhelming. This skill is particularly powerful when combined with validation. Acknowledging that anger makes sense given the situation reduces internal conflict and resistance. Paradoxically, accepting anger often allows it to pass more quickly. Learning to Work With Anger, Not Against It Anger becomes most destructive when people feel they must either act on it or get rid of it entirely. DBT offers a middle path. Anger can be acknowledged, understood, and responded to thoughtfully. Over time, this approach reduces fear of anger itself, which is often what drives impulsive reactions. Developing these skills takes practice and support. Anger patterns are rarely changed through insight alone. They change through repetition, feedback, and learning in a structured environment that prioritises safety and validation. DBT Anger Management Program Starting in April To support people who struggle with intense or reactive anger, our DBT Anger Management Program is commencing in April. This program is grounded in Dialectical Behaviour Therapy and is designed for adults who want to better understand their anger, reduce emotional escalation, and respond more effectively in challenging situations. The program focuses on building skills in emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness, with a specific emphasis on anger and nervous system awareness. Participants are supported to understand their own anger patterns, identify vulnerability factors, and practice skills in a structured and compassionate group setting. Anger does not need to define your relationships or your sense of self. With the right framework and support, it can become an emotion you understand and manage, rather than fear or fight against.

For many people seeking therapy, this expectation becomes a quiet source of shame. When change does not arrive on cue, it can feel like a personal failure rather than a reflection of how human change actually occurs. Emotional regulation, behavioural change, and identity development do not operate according to the calendar. They develop through repetition, practice, and time. Understanding this can be relieving. It allows space for change to unfold in ways that are realistic, compassionate, and sustainable. The Myth of the Fresh Start Symbolic dates are appealing because they offer a sense of order and control. They suggest a clean break from the past and a chance to begin again without baggage. This idea is deeply embedded in cultural narratives about self improvement and success. Emotionally, however, our nervous systems do not reset at midnight. The same habits, emotional sensitivities, attachment patterns, and stress responses continue into the next day. When we expect sudden change, we often set ourselves up for disappointment. The gap between expectation and reality can reinforce self criticism, hopelessness, or avoidance. In therapy, many clients describe cycles of recommitment followed by collapse. They may tell themselves that this time will be different, only to feel defeated when familiar struggles return. Over time, this can erode confidence in the possibility of change itself. How Change Actually Happens Meaningful change tends to occur gradually and often invisibly at first. It is shaped by small, repeated actions rather than dramatic decisions. Emotional regulation develops when the nervous system has repeated experiences of safety, containment, and choice. Behavioural change strengthens through practice in real situations, including moments where things do not go as planned. Identity development grows when people begin to see themselves responding differently over time. These processes are cumulative. Each time you pause instead of reacting, name an emotion instead of suppressing it, or return to a skill after forgetting it, you are reinforcing new neural pathways. This work is rarely linear. Progress includes setbacks, plateaus, and periods of frustration. None of these mean that change is not happening. Time matters because the brain learns through repetition. New patterns require consistent reinforcement before they feel natural or reliable. This cannot be rushed by motivation alone, nor can it be scheduled neatly around symbolic dates. Emotional Regulation Is Built, Not Decided Emotional regulation is often misunderstood as a decision to feel differently. In reality, it is a capacity that develops through experience. For many clients, intense emotions have been present for years or decades. These emotional responses were often adaptive at the time they developed. They may have helped someone survive, cope, or remain connected. Because of this, emotional patterns tend to be deeply ingrained. Regulation emerges when people learn to notice emotions earlier, tolerate discomfort, and respond with skill. This learning happens through repeated exposure to emotions in manageable doses, supported by skills and therapeutic relationships. Expecting immediate emotional change can inadvertently reinforce the idea that emotions are problems to eliminate. A more helpful approach is to focus on how emotions are met, understood, and responded to over time. Behavioural Change Requires Practice in Context Behavioural change is similarly shaped by repetition. Insight alone is rarely enough. Knowing why a behaviour exists does not automatically make it easier to change. New behaviours need to be practised in the same environments where old patterns occur. This includes moments of stress, fatigue, or emotional vulnerability. It also includes moments where attempts at change do not go well. Each attempt provides information. Over time, this information helps refine responses and build confidence. When change is framed around calendar milestones, there is often little tolerance for imperfection. When change is framed as a practice, there is more room for learning and adjustment. Identity Develops Through Lived Experience Identity is not something that changes through intention alone. It develops through lived experience and accumulated evidence. People begin to see themselves differently after they have responded differently many times. For example, someone may begin to identify as more resilient after repeatedly surviving difficult moments without collapsing or acting against their values. This shift often happens quietly and retrospectively. Clients frequently report noticing change only when they look back and realise they handled something differently than they would have in the past. This kind of identity development does not align neatly with symbolic dates. It unfolds as a byproduct of sustained effort and patience. Skill Highlight: Mindfulness Non Judgementally One DBT skill that strongly supports this process is mindfulness non judgementally. This skill involves noticing thoughts, emotions, sensations, and urges without labelling them as good or bad, right or wrong, success or failure. Judgement often accelerates emotional intensity. When experiences are judged harshly, the nervous system moves quickly into threat responses such as shame, avoidance, or self attack. Non judgement creates space. It allows experiences to be observed rather than fought. Practising non judgement does not mean approving of harmful behaviours or ignoring the desire for change. It means accurately naming what is present without adding layers of criticism. For example, noticing “I am feeling overwhelmed and wanting to withdraw” rather than “I am weak for feeling this way.” Over time, this skill supports emotional regulation by reducing secondary emotions such as shame and anger at oneself. It also supports behavioural change by making it easier to return to skills after setbacks. Instead of viewing a lapse as proof of failure, it becomes information about what was difficult in that moment. A Client Vignette Consider the experience of a client who came to therapy feeling discouraged after many failed attempts at change. Each January, she committed to being calmer in relationships. By February, she felt ashamed that she was still reacting intensely to perceived rejection. In therapy, the focus shifted away from dates and resolutions. Instead, attention was given to noticing emotional responses as they arose. Using mindfulness non judgementally, she practised naming her reactions without criticism. When she felt the urge to send multiple messages or withdraw completely, she learned to pause and describe the urge rather than act immediately. Over several months, there were many moments where she still reacted in ways she disliked. However, there were also moments where she noticed earlier, paused briefly, or repaired more quickly. These moments did not feel significant at the time. Later, she reflected that she no longer experienced herself as out of control in the same way. This shift did not occur at the start of a year or after a particular milestone. It emerged gradually through repetition, support, and patience. Letting Go of the Calendar as a Measure of Progress When change is measured against the calendar, it can obscure real progress. Subtle shifts may be overlooked because they do not fit the narrative of a fresh start. Learning to notice progress in how you respond, recover, and relate to yourself can be more meaningful than any symbolic date. Therapy is not about becoming a new person overnight. It is about building capacity over time. Each moment of awareness, each return to a skill, and each act of self respect contributes to change, even when it does not feel dramatic. Meaningful change is rarely sudden. It is steady, uneven, and deeply human. When we release the expectation that change should follow the calendar, we create space for it to unfold in ways that are real and lasting.

Most of us want to change something about our lives — to feel calmer, relate differently, stop repeating old patterns, or simply get unstuck. Yet, even when the desire for change is strong, something inside resists. Clients often tell me, “I know what I should do, but I can’t seem to make myself do it.” That gap between intention and action is where DBT does its best work. DBT recognises that change is not just a decision; it’s a process that unfolds against the background of our biology, emotions, environment, and history. When we try to change, we’re not fighting laziness — we’re negotiating with our nervous system, habits, and fears. DBT is built on the dialectic of acceptance and change. Both are needed. Acceptance helps us see things as they are without judgement. Change gives us the tools to move forward effectively. Without acceptance, we stay stuck in resistance; without change, acceptance becomes resignation. The Science of Resistance From a psychological perspective, change threatens predictability. Our brains are wired to prefer the familiar, even when it’s painful. The amygdala; the brain’s alarm system interprets uncertainty as danger, triggering avoidance or over-control responses. For individuals with heightened emotional sensitivity, that threat response can feel overwhelming. In DBT, we frame this as part of the problem to be solved, not a personal flaw. Resistance becomes data. It tells us that part of the mind is trying to protect us from discomfort, rejection, or loss. Change, in this light, means learning to approach discomfort rather than eliminate it. “I Want to, But I Freeze” During one group session, Emma (not her real nam) shared that she felt “paralysed” every time she tried to set boundaries with her partner. She understood the skill intellectually but said, “When I open my mouth, I freeze. My heart races, my brain blanks out, and I end up giving in.” Instead of focusing on the boundary itself, we paused to notice what was happening in her body- the tightening chest, the urge to appease. Together, we practised mindfulness of current emotion and the TIPP skill (Temperature, Intense exercise, Paced breathing, Progressive relaxation). Within a few weeks, Emma learned that regulating her physiological arousal first made space for skillful action. This is what DBT means by building mastery through small steps. We do not demand instant transformation; we teach the body and mind to tolerate discomfort in manageable doses. The Role of Willingness One of the central concepts in DBT’s Reality Acceptance module is willingness- the capacity to open oneself to what is, and to do what works in the moment, even when it’s uncomfortable. Its opposite, wilfulness, sounds like resistance: “I don’t want to,” “I shouldn’t have to,” or “It won’t work anyway.” Wilfulness is a natural human reaction to pain. When life feels unfair, wilfulness tries to reclaim control. Yet, paradoxically, it keeps us stuck. Willingness, by contrast, invites movement. It doesn’t mean liking reality, agreeing with it, or giving up; it means choosing to participate fully in the present moment so that change becomes possible. In therapy, I sometimes invite clients to practise “turning the mind” consciously shifting from wilfulness to willingness. We pause, breathe, and ask: What would willingness look like right now? This small question often opens the door to action. Skill Spotlight: Willingness vs Wilfulness Here’s how to practise this skill at home: Notice resistance. Pay attention to moments when you feel yourself saying “no” to reality. It might appear as tension in your shoulders, self-critical thoughts, or avoidance behaviours. Pause and breathe. Take a slow, mindful breath. Unclench your hands or soften your posture — physical willingness supports emotional openness. Name the wilfulness. Silently acknowledge, “I’m feeling wilful right now.” Naming it reduces its power. Turn the mind. Intentionally choose willingness: “I am open to doing what works.” Act effectively. Take one small, value-aligned step, even if it’s uncomfortable. Over time, this practice helps clients move from avoidance to participation, from rigidity to flexibility. “I’m Scared It Won’t Work” Another client, Renee, struggled with hopelessness. After years of therapy, she feared nothing would change. Early in DBT, she often said, “What’s the point? I’ve tried everything.” In one session, we used the “Pros and Cons” skill — a DBT strategy for increasing motivation by writing out the short- and long-term consequences of acting on or resisting a behaviour. Together, we explored the pros and cons of avoiding therapy homework versus practising one new skill per week. Initially, the pros of avoidance were compelling: less anxiety, less effort. But the long-term cons — feeling stagnant, disconnected, and self-critical — resonated deeply. By visualising both paths, Renee recognised that staying still was also a form of suffering. Her willingness to experiment with small behavioural changes grew from that insight. Within months, she began journalling daily and practising mindfulness for three minutes each morning. Her mood improved, not because the work was easy, but because she was no longer at war with herself. Balancing Acceptance and Change At the heart of DBT is dialectical thinking- the idea that two seemingly opposite truths can both be valid. You can accept yourself fully and still want to change. You can acknowledge pain and choose to act effectively. This balance transforms black-and-white thinking into a more flexible, compassionate stance toward life. Clients often describe this as a relief. Instead of asking, “What’s wrong with me?” they begin asking, “What skill could help me here?” That shift alone is profound. Why Small Steps Matter Change rarely arrives in grand gestures. It shows up in the moment you pause instead of reacting, the time you validate yourself instead of criticising, or when you attend group despite wanting to cancel. Each act of willingness strengthens neural pathways associated with self-regulation and hope. In DBT, we celebrate these micro-changes because they reflect real, lived transformation. The goal isn’t perfection, it’s effectiveness: doing what works in the service of a life worth living. Moving Forward If you find yourself stuck between wanting change and fearing it, you’re not alone. Every client who has ever walked into a DBT session has felt that same ambivalence. The work begins with acknowledging both sides: the part of you that hopes and the part that hesitates. Start small. Practise willingness once a day. Try a skill even when you don’t feel ready. Change begins in those moments of gentle persistence. You don’t have to believe it will work; you only have to be willing to try ~ that is the heart of DBT.

What is Catastrophising? Catastrophising is a type of cognitive distortion where the mind leaps to the worst possible outcome—regardless of how unlikely it might be. It can involve: - Assuming a situation is far worse than it really is, - Predicting total failure or devastation based on a small setback, - Reacting as though disaster is certain, even in the absence of evidence. For example: “I made a mistake at work. My boss is going to fire me. I’ll never get another job. I’ll end up alone and homeless.” In this thinking pattern, the emotional response is not to the situation itself, but to the imagined catastrophe. The brain responds to perceived threat—whether real or imagined—as if it’s actually happening. This can trigger a cascade of anxiety, shame, panic, and impulsive urges to fix or escape the situation. Why is Catastrophising So Common in BPD? People with BPD often experience intense sensitivity to perceived abandonment and rejection. This can lead the brain to treat any social rupture—no matter how small—as a threat to survival. If you grew up in an invalidating or unpredictable environment, it makes sense that your nervous system might now be wired to anticipate the worst. In this way, catastrophising becomes a (very painful) attempt at emotional self-protection. By preparing for rejection, failure, or abandonment, it can feel like you're trying to shield yourself from hurt. Unfortunately, this strategy tends to backfire, reinforcing emotional distress and leading to behaviours that may push others away—just as feared. The Impact of Catastrophising Catastrophising in BPD often leads to: - Intense emotional dysregulation – fear, anger, shame, despair. - Impulsive behaviours – self-harm, substance use, over-apologising, or cutting off relationships. - Difficulties in relationships – as others struggle to respond to disproportionate emotional reactions. - Self-fulfilling prophecies – where feared outcomes become more likely due to reactive behaviour. These effects can reinforce a painful cycle of suffering and disconnection, making everyday life feel unpredictable and exhausting. DBT Skills That Can Help Dialectical Behaviour Therapy offers a range of tools that specifically address catastrophising. Here are some that clients often find helpful: Check the Facts This skill invites you to slow down and assess whether your emotional response fits the actual facts of the situation. Ask: - What is the actual situation? - What am I telling myself about it? - Are there other possible explanations? - What is the most likely, and not the worst, outcome? By grounding your thoughts in observable facts, you begin to weaken the hold of catastrophic thinking. Mindfulness of Current Emotion Instead of trying to escape the overwhelming feelings catastrophising brings, this skill teaches you to *observe*, *name*, and *ride out* the emotion like a wave. This builds tolerance and reduces the need to act impulsively in response to fear or anxiety. Try saying: “This is fear. Fear is here right now. I can notice it without needing to fix everything.” When we catastrophise, our minds rush to imagined futures filled with rejection, failure, or disaster. In response, strong emotions like fear, panic, shame, or anger can flood our nervous systems. These emotions feel overwhelming and dangerous—something to *fix*, *escape*, or *avoid*. But in Dialectical Behaviour Therapy, we take a radically different approach: we learn to **stay with the emotion**, *as it is*, without needing to change it immediately. **Mindfulness of Current Emotion** is a core Emotion Regulation skill that teaches you to fully experience your emotions—without suppressing, judging, or acting impulsively on them. By turning toward the emotion with awareness, you build emotional tolerance and reduce the urgency to act in unhelpful or self-defeating ways. The Steps of Mindfulness of Current Emotion: 1. Notice the emotion in your body Where do you feel it? Is it tightness in your chest? A pit in your stomach? Heat in your face? Describe the sensations with curiosity, not judgment. 2. Name the emotion Give the emotion a label—fear, shame, sadness, anger. Naming an emotion activates the prefrontal cortex and helps regulate the intensity of what you're feeling. 3. Allow the emotion to be there Don’t push it away or try to “fix” it. Emotions are like waves: they rise, crest, and pass. Trust that this feeling, like all feelings, is temporary. 4. Avoid impulsive action The urge to *do something*—text, lash out, self-harm, or isolate is often a response to discomfort, not necessity. Pause. Breathe. You can choose not to act on the emotion. 5. Remember: You are not your emotion Say to yourself, *“This is just an emotion. I can feel it, and I can let it pass.”* This creates space between you and the experience, building the capacity to respond, rather than react. Why This Skill Matters In BPD, emotional experiences can feel all consuming, as if they define the self: *“I feel worthless, so I must be worthless.”* By observing emotions mindfully, you begin to decouple your identity from your emotional state. You learn that you can feel intense distress without being destroyed by it, and without needing to make decisions based on that distress. Practising Mindfulness of Current Emotion helps to interrupt the cycle of catastrophising by: - Grounding you in the present moment (instead of feared future outcomes), - Helping you tolerate discomfort without acting impulsively, - Reducing avoidance of painful emotions, which often prolongs suffering. This skill doesn’t make emotions disappear—but it does reduce their control over your behaviour and your sense of self. Like all DBT skills, this takes practice—but over time, it builds emotional resilience, clarity, and a growing sense of self-trust.

How Do Eating Disorders Start? Many individuals with BPD and eating disorders describe similar patterns of emotional distress that lead to compulsive eating behaviours. The onset of binge eating disorder often stems from: Restrictive Dieting: Cutting calories too aggressively can trigger intense cravings, leading to binge eating. Emotional Coping: Many people use food as a way to manage stress, trauma, or overwhelming emotions. Early Experiences: Childhood trauma, bullying, or growing up in a toxic home environment can contribute to food becoming a source of comfort. Guilt and Shame Cycle: The cycle of binge eating, followed by guilt and further restriction, reinforces unhealthy eating habits. These patterns can quickly spiral into an exhausting roller coaster of highs and lows, making recovery challenging without the right support. The Overlapping Traits Between BPD and Eating Disorders BPD is characterized by emotional dysregulation, unstable relationships, and an intense fear of abandonment—factors that often intersect with eating disorders. Here’s why they frequently co-exist: Emotional Dysregulation People with BPD experience extreme mood swings, often using food as a coping mechanism for overwhelming emotions. Impulsivity Impulsive behaviours, such as binge eating, purging, or restrictive eating, are common among individuals with BPD. Distorted Self-Image Low self-esteem and an unstable sense of self contribute to both BPD and eating disorders, often leading to extreme behaviours around food. Fear of Abandonment People with BPD often seek external validation, sometimes through controlling their weight and appearance. Trauma History Both conditions are linked to past experiences of abuse, neglect, or other traumatic events, reinforcing unhealthy coping mechanisms. Recognizing these overlapping traits can be the first step toward seeking appropriate treatment. The Feelings During and After Binge Eating Binge eating often provides temporary relief from emotional distress, but it quickly leads to guilt, shame, and exhaustion. The emotional process typically follows this pattern: 1. Before the Binge: Overwhelming cravings, often triggered by stress, sadness, or boredom. 2. During the Binge: A temporary escape, with feelings of excitement or comfort. 3. After the Binge: Intense shame, self-loathing, and sometimes further restriction or purging. 4. The Cycle Continues: These behaviours reinforce a cycle that can feel impossible to break. Many individuals with BPD and binge eating disorder report feeling powerless against their urges, making professional treatment crucial for recovery. The Path to Stopping the Cycle: Effective Treatment Approaches When BPD and an eating disorder co-exist, a holistic and integrative treatment approach is essential. Here are some of the most effective methods: Emotion Regulation Skills – Manage triggers & reduce emotional eating PLEASE – Take care of your Physical health, Lifestyle balance, Eating habits, Avoid mood-altering substances, Sleep, and Exercise to stabilise emotions. Opposite Action – If you feel the urge to binge out of sadness, do the opposite (e.g., go for a walk, call a friend). Check the Facts – Ask yourself: Am I really hungry, or am I trying to soothe an emotion? Distress Tolerance Skills – Cope without food as an escape TIPP – Use Temperature (cold splash), Intense exercise, Paced breathing, and Paired muscle relaxation to regulate urges. Urge Surfing – Cravings come in waves. Instead of acting on them, observe them like a passing tide. ACCEPTS – Distract yourself with Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations** instead of binging. Distress Tolerance Skills – Become aware of eating patterns Mindful Eating – Slow down, chew thoroughly, and truly experience each bite without distractions. Non-Judgmental Stance – Avoid self-shame. Instead of “I failed,” say, “I had a binge episode, and I can learn from this.” Radical Acceptance – Accept your emotions and experiences as they are, without resistance or self-criticism. Interpersonal Effectiveness – Set boundaries & seek support DEAR MAN – Communicate your needs assertively (e.g., asking for support, saying no to food pushers). FAST – Maintain self-respect when dealing with food-related guilt or judgment from others. Recovery is possible! ~ Using DBT skills can help you break free from the cycle of binge eating and build a healthier relationship with food. FAQs ❓ 1. Can BPD cause an eating disorder? While BPD doesn’t directly cause eating disorders, its symptoms—such as impulsivity, emotional dysregulation, and trauma history—often contribute to disordered eating behaviours. ❓ 2. Why do people with BPD struggle with food? Food is often used as a way to cope with intense emotions, self-worth struggles, and a fear of abandonment—common traits of BPD. ❓ 3. What is the best therapy for BPD and eating disorders? Dialectical Behaviour Therapy and RO-DBT are highly effective for both conditions, as it helps with emotional regulation, impulsivity, and mindfulness. ❓ 4. How can I stop binge eating if I have BPD? Developing emotional regulation skills, using distress tolerance techniques, and seeking therapy can help manage binge eating urges. ❓ 5. Can someone recover from both BPD and an eating disorder? Yes! With the right combination of therapy, support, and self-awareness, individuals can recover and build a healthier relationship with food and emotions.

The Deep Need for Safety - Understanding, Healing, and Finding Inner Peace Being safe, both mentally and physically, greatly impacts how we live. When we feel unsafe, our minds and bodies react with stress, anxiety, and survival-driven behaviours. But what happens when our lives are consumed by constant fear and uncertainty? It becomes a curse that robs us of joy, preventing us from embracing life’s beautiful moments. If you struggle with these feelings, ask yourself: What makes me feel this way? How can I break free when fear feels like an unshakable part of my life? And what steps can I take to cultivate a lasting sense of safety? Why Safety Matters Feeling safe isn’t just about avoiding physical danger, mental and emotional safety are equally important. Safety is the foundation of human well-being and performance. When we feel safe, our bodies enter a state of relaxation and recovery, allowing us to heal, build resilience, and thrive. On the other hand, chronic feelings of unsafety trigger stress responses, affecting our mental, emotional, and physical health. Consider how new-born babies flourish when nurtured in a stable, loving environment. They grow not only physically but also emotionally and cognitively. In contrast, individuals raised in chaotic or abusive environments often struggle with chronic anxiety, trust issues, and even long-term physical health problems. Their bodies and minds become wired for hypervigilance rather than growth. And if you were raised in a chaotic or abusive environment, I want to tell you: You are not alone, and this is not the end of your story. Ending your life is not the solution. You are not your enemy, be kind to yourself. It’s not your fault. Life is unpredictable, and we are all just human. Unresolved trauma and unacknowledged pain can leave individuals feeling isolated, burdened, and disconnected from a sense of normalcy. When those who should provide protection fail to do so, it can create lasting wounds. Breaking free from these cycles requires seeking support, acknowledging past pain, and working toward healing. The Impact of Feeling Unsafe on the Mind and Body When we don’t feel safe, our nervous system shifts into survival mode. This activates the fight-or-flight response, flooding our bodies with stress hormones. Over time, chronic stress can cause severe mental and physical wear and tear, leading to issues such as: Anxiety and depression Difficulty forming or maintaining relationships Chronic physical illnesses Self-destructive behaviours as a coping mechanism One of the most damaging effects of chronic stress is the feeling of being trapped. Whether it’s being trapped in an unhealthy environment, toxic relationships, financial instability, or even our own negative thoughts, the sensation of having no control can fuel anger, frustration, and destructive actions. Harmful Coping Mechanisms and Breaking Free When we feel unsafe, we instinctively seek ways to regain control. Unfortunately, many of these coping strategies can be harmful in the long run. Some common responses include: Substances, gambling, food, or even social media can become temporary escapes from feelings of fear and insecurity. DBT Skills to Cope: Distress Tolerance (ACCEPTS & Self-Soothing): Engage in healthy distractions, such as listening to music, going for a walk, or practising deep breathing, to reduce urges. Radical Acceptance: Instead of avoiding pain through addiction, acknowledge reality as it is and work towards healthier coping mechanisms. Mindfulness: Stay present and observe cravings without acting on them, recognizing that they come and go like waves. DBT Skills to Cope: Interpersonal Effectiveness (DEAR MAN, GIVE, FAST): Learn to assert your needs without resorting to control or manipulation. Healthy relationships are built on respect and balance. Emotion Regulation (Opposite Action): If the urge to control arises from fear, practice the opposite by letting go in small, manageable ways and observing the outcome. Checking the Facts: Challenge distorted thoughts that make you feel the need for excessive control. Ask yourself, “Is this truly a threat?” DBT Skills to Cope: Self-Validation: Practice recognizing your feelings and experiences as valid, even if others don’t acknowledge them. Building Mastery: Engage in activities that give you a sense of competence and accomplishment, such as hobbies, learning, or small daily achievements. Wise Mind & Radical Acceptance: Balance logic and emotions when evaluating self-worth. Accept imperfections as part of being human rather than as failures. By using these DBT skills, we can develop healthier coping mechanisms and create a genuine sense of safety, one that isn’t dependent on harmful behaviours or external validation. Building a Lasting Sense of Safety True safety comes from within. It’s about creating an internal environment where we feel secure, resilient, and at peace, regardless of external circumstances. Here’s how we can foster genuine safety: Emotional Vulnerability Real human connection is built on trust and vulnerability. While society often discourages vulnerability, it is crucial for healing. Suppressing emotions, especially anger, only fuels more stress and disconnection. Learning to express emotions in healthy ways can reduce anxiety and create deeper relationships. Dynamic Healing Rather than just “managing” stress, dynamic healing focuses on shifting our nervous system from a constant threat state to one of safety. This involves: Mindfulness and grounding techniques to bring awareness to the present moment Therapy and self-reflection to address past trauma and negative thought patterns Breathwork and relaxation practices to regulate stress responses DBT Therapy and Skills Dialectical Behaviour Therapy is an evidence-based approach that can be incredibly effective in helping individuals feel safe and in control of their emotions. DBT skills such as distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness help create long-term emotional stability. However, it’s important to note that progress with DBT is not an overnight success, it often takes months or even a year to see significant change. But the effort is worth it, as it leads to a deep and lasting sense of inner safety. Without committing to the process, you may constantly battle feelings of unsafety, missing out on the beauty and wonder that life has to offer. Creating Cues of Safety Our nervous system constantly scans for signs of danger or safety. By surrounding ourselves with positive environments, supportive relationships, and healthy routines, we can reinforce cues of safety and rewire our responses to stress. The Power of Positive Thinking One of the most important tools in creating a lasting sense of safety is the power of positive thinking. Thinking positively can help shift your mindset, making it easier to focus on what’s going well in your life rather than what’s wrong. Taking a moment each day to say something good about yourself, whether it's acknowledging your efforts, celebrating your achievements, or simply affirming your worth, can have a profound impact on your mental and emotional health. By regularly engaging in positive self-talk, you not only cultivate a sense of inner peace and safety, but you also rewire your brain to recognise and appreciate the good in your life. This simple yet powerful practice is key to building resilience, reducing anxiety, and ultimately healing from the inside out. When Feeling Unsafe Comes from Trauma or Life Circumstances Feeling unsafe may stem from a variety of sources, childhood trauma, toxic relationships, financial instability, or even personal fears. In these situations, it’s important to take a step back, breathe, and assess what you can do to resolve the issue. If you can solve it, take practical steps toward healing or improvement. If it feels overwhelming or beyond your control, don’t make the situation worse by allowing it to consume you. Instead, seek help. Reaching out to a trusted person or professional can provide you with the support and guidance you need to regain a sense of safety and peace. Final Thoughts Feeling safe is more than just avoiding danger, it’s about fostering a sense of internal peace and resilience. When we prioritize healing, embrace emotional vulnerability, and reframe our responses to stress, we create a life where we can truly thrive. The path to safety isn’t about control or avoidance, it’s about understanding, growth, and connection. By taking intentional steps and utilizing tools like DBT and positive thinking, we can move from merely surviving to truly living. Don’t let the fear of unsafety hold you back, life is full of beauty, connection, and joy, and you deserve to experience it all. FAQs 1. What does it mean to feel safe, and why is it so important? Feeling safe means experiencing a sense of security, physically, emotionally, and psychologically. It is essential for overall well-being, as it allows us to relax, heal, and function effectively. 2. How does chronic stress from feeling unsafe affect mental health? Chronic stress triggers anxiety, depression, and even physical illnesses by keeping the body in a constant state of fight-or-flight. Over time, this can lead to burnout and difficulty maintaining healthy relationships. 3. What are some common but unhealthy ways people try to feel safe? Many people turn to controlling behaviours, or perfectionism as coping mechanisms. While these strategies may offer temporary relief, they often lead to deeper issues in the long run. 4. How can I create a lasting sense of safety within myself? True safety comes from within and involves healing past trauma, practicing mindfulness, surrounding yourself with positive relationships, and using tools like DBT and self-affirmation to build resilience. 5. Can therapy help with feelings of unsafety? Yes, therapy, especially approaches like DBT, can help individuals regulate their emotions, reframe negative thought patterns, and build skills to feel safer and more in control of their lives.

In DBT, we see inhibited grieving as one side of a dialectic—a tug-of-war between avoiding grief to protect oneself from pain and, on the other side, the need for emotional processing, where we confront and work through our feelings to find healing. Finding a healthy balance between these two extremes is essential for moving forward in a healthy way. What is Inhibited Grieving? Inhibited grieving is when someone suppresses their emotional response to loss or trauma. This can happen for several reasons: fear of being overwhelmed by grief, social pressures to “stay strong,” or lacking emotional support. Some people may even believe, often unconsciously, that allowing themselves to grieve fully will be too painful or make them feel out of control. To avoid this pain, they might throw themselves into work, use substances, or distance themselves emotionally from others. While these strategies might work temporarily, they prevent natural grieving from happening. Over time, unprocessed grief can show up as numbness, irritability, or even physical issues, making it harder to find joy or connection in daily life. The Dialectic of Inhibited Grieving and Emotional Processing Dialectics in DBT teach us that two conflicting truths can coexist. For inhibited grieving, the tension lies between the need to shield oneself from emotional pain and the necessity of facing that pain to heal. Inhibited grieving involves holding back or avoiding painful feelings, which might seem helpful in the short term, allowing someone to function without becoming overwhelmed by sadness or despair. However, the long-term consequence of avoiding grief is that unprocessed feelings remain unresolved, leading to greater emotional distress later. On the opposite side is emotional processing, which means fully experiencing and acknowledging the pain of loss or trauma. Processing doesn’t mean being consumed by grief forever; rather, it’s about moving through it and eventually integrating the loss in a way that allows for resolution and peace. The Importance of Emotional Processing in Healing Emotional processing is critical to healing grief. It requires recognising and accepting the full range of emotions associated with loss—sadness, anger, guilt, or even relief—and finding healthy ways to express and release these feelings. While this process is painful, it’s necessary for long-term well-being. Inhibited grieving, meanwhile, often prolongs suffering, as the unresolved emotions continue to build over time. In DBT, I guide people to find balance through mindfulness, distress tolerance, and emotional regulation skills. These techniques help individuals approach their pain without becoming overwhelmed, allowing them to process grief in manageable steps. Strategies for Balancing Inhibited Grieving and Emotional Processing Mindfulness of Emotions: Mindfulness allows you to observe and acknowledge your feelings without judgment. In grief, this can help you notice sadness, anger, or fear without pushing them away, making room for natural emotional processing. Distress Tolerance: When grief feels too intense, DBT’s distress tolerance skills (like the TIPP method: Temperature, Intense exercise, Paced breathing, and Progressive muscle relaxation) can help you manage these feelings without resorting to avoidance. Staying present with emotions, even when they’re painful, allows healing to begin. Opposite Action: Sometimes, emotions like grief can encourage avoidance. Practising opposite action—doing the opposite of what your emotions urge—can help. For inhibited grieving, this might mean letting yourself feel sadness, talking to a therapist, or journaling instead of blocking those feelings. Building a Support System: Processing grief doesn’t have to be done alone. A strong support network of friends, family, or mental health professionals can provide essential validation and understanding, reducing the isolation often felt with inhibited grieving. Radical Acceptance: This DBT skill helps you fully acknowledge the reality of your loss, without denying or resisting it. Radical acceptance isn’t about approving of the loss; it’s about recognising it as real, which can make it easier to take steps forward. Moving Forward: Embracing Grief for Healing Finding a balance between inhibited grieving and emotional processing is essential for true healing. Though it’s natural to want to avoid pain, long-term healing only happens when we allow ourselves to experience and process grief fully. DBT skills like mindfulness, distress tolerance, and radical acceptance can help you face your grief, creating space for eventual peace and resolution. Grieving is a natural response to loss, and processing it honours what we’ve lost. By giving ourselves space to feel, we create room for growth and healing. Processing grief isn’t about “moving on”; it’s about integrating the loss into our lives in a way that allows us to live with strength and resilience.

At its core, the concept of unrelenting crisis highlights the interplay of heightened emotional vulnerability and the difficulties in regulating these emotions. Many people who experience these crises often feel trapped in a cycle of distress and avoidance, which can prevent them from making meaningful progress in their lives. In DBT, we understand this as one side of a dialectic—a push-and-pull between ongoing crisis and the need for acceptance. The opposite side of this dialectic is a concept that is central to DBT: Radical Acceptance. What Is Unrelenting Crisis? Unrelenting crisis can be described as a pattern of recurrent emotional or situational crises that feel impossible to escape. For some individuals, life becomes a series of intense challenges, and just as one situation seems to resolve, another arises. This cycle is often underpinned by both external factors—like unstable relationships, financial problems, or job insecurity—and internal factors, such as emotional dysregulation, impulsive behaviours, and deep-seated feelings of shame or worthlessness. In DBT, we see this state as a result of the interplay between heightened sensitivity to emotional triggers (biological predisposition) and a lack of effective coping strategies to manage distress. Individuals caught in this cycle may be unable to prevent emotional crises from escalating and may also have difficulty resolving these crises in a healthy way. Thus, they live in a state of emotional exhaustion, constantly feeling as though their world is collapsing around them. The Dialectic: Unrelenting Crisis vs Radical Acceptance Dialectical Behaviour Therapy teaches us to embrace dialectics—the idea that two seemingly opposing truths can coexist. In the case of unrelenting crisis, the dialectical tension is between the reality of constant distress and the need to accept this reality fully. Radical Acceptance is about recognising the limitations of our control and embracing life as it is, rather than how we wish it to be. This acceptance is not passive resignation or giving up; rather, it is the active choice to stop fighting reality. It is an emotional shift that allows individuals to accept the present moment and make wise decisions about how to respond, instead of becoming paralysed by anger, shame, or resistance. Radical acceptance can feel counterintuitive to someone in a constant state of crisis. The natural instinct might be to reject or fight against the hardships in an attempt to avoid further pain. However, this refusal to accept reality often perpetuates the cycle of crisis, leading to frustration and increased suffering. It is only through acceptance that we can stop being consumed by the crisis and begin to focus on what is within our control—our responses, actions, and future choices. The Role of Radical Acceptance in Breaking the Crisis Cycle The power of radical acceptance lies in its ability to transform the way we relate to pain and crisis. When we refuse to accept reality, we expend valuable energy fighting against what is. This can lead to behaviours such as self-harm, substance use, or avoidance strategies that, while providing short-term relief, often exacerbate the situation in the long run. Radical acceptance allows us to release this internal battle, creating space for more adaptive coping strategies. Consider this: a person caught in a cycle of unrelenting crisis may feel intense frustration with their inability to change certain aspects of their life, such as a partner’s behaviour or a traumatic past. Without acceptance, they may find themselves ruminating over their misfortune or trying to force change in ways that are unproductive. Through radical acceptance, however, they come to terms with the fact that they cannot change these external realities. What they can change is their approach to these situations, their reactions, and ultimately, their path forward. Acceptance does not mean liking or approving of the current situation. It simply means acknowledging it as real and as something that cannot be changed in the present moment. From this place of acceptance, individuals can begin to make mindful, deliberate choices that align with their values and long-term goals. This shift can break the cycle of crisis, helping individuals move from reaction to response. Practical Strategies for Practising Radical Acceptance Notice and Name the Emotion : The first step to radical acceptance is recognising the feelings associated with the crisis. By naming the emotion (e.g., "I feel frustrated," "I am scared"), individuals can begin to distance themselves from the automatic urge to react impulsively. Understand the Role of Resistance : Ask yourself, "Am I fighting reality?" Notice if there is tension between what you want to be true and what actually is. Recognising this resistance can help shift towards acceptance. Breathe and Pause : Practising mindfulness and grounding techniques, such as focusing on the breath, can create space between the emotion and the reaction. This allows time to reflect on what acceptance would look like in the given situation. Make a Choice : Radical acceptance is an active decision. It might be helpful to remind yourself, "I cannot change this reality, but I can control how I respond to it." Practice Self-Compassion : Acknowledging that acceptance is hard is crucial. It’s natural to struggle with accepting painful realities. Be gentle with yourself throughout this process. Moving Forward: Healing and Growth Balancing the dialectic of unrelenting crisis and radical acceptance is not easy, but it is a crucial part of emotional growth. The process of moving from crisis to acceptance is a journey—one that requires patience, practice, and support. Over time, individuals can learn to break free from the constant state of emergency and begin to build a life worth living, where they feel more in control of their emotions and choices. In DBT, we emphasise that acceptance does not mean passivity. Rather, it is an empowering tool that allows individuals to navigate life’s challenges with resilience and wisdom. Radical acceptance offers a pathway out of the suffering cycle and into a space where healing can begin.

In DBT, we identify three main dialectics: apparent competence versus active passivity, inhibited grieving versus unrelenting crisis, and self-invalidation versus emotional vulnerability . These dialectics represent the push and pull of emotional and behavioural patterns. Just as the ocean's waves are influenced by the moon and the weather, these dialectics are shaped by both our biology and our environment. Let's explore these dialectics and their secondary targets, using the metaphor of the ocean to guide our understanding. The Three Dialectics: Navigating the Tides Apparent Competence vs. Active Passivity: This dialectic can be likened to the waves that appear calm on the surface but conceal a strong undertow beneath. Apparent competence is the behaviour of seeming to handle everything smoothly, like a serene ocean, even when turmoil brews beneath. It's a learned pattern often developed in invalidating environments where showing vulnerability is discouraged. On the flip side, active passivity resembles being swept away by the current, feeling helpless and relying on others to rescue us. This vulnerability arises from a biological predisposition to intense emotional responses, influenced by the current environment's impact on our emotions. Inhibited Grieving vs. Unrelenting Crisis: This dialectic mirrors the waves that never seem to settle, crashing against the shore relentlessly. Inhibited grieving is like holding back the tide, refusing to let the waves of grief and loss wash over us. It often stems from past environments where emotions were dismissed or suppressed. Unrelenting crisis, on the other hand, is akin to a stormy sea, where the waves are constantly churning, and the person is in a state of perpetual crisis. This secondary target has a biological basis, with environmental triggers setting off intense emotional responses that feel overwhelming and unending. Self-Invalidation vs. Emotional Vulnerability: Picture the ocean during a storm—waves crashing against each other chaotically. Self-invalidation is like judging those turbulent waves, criticising ourselves for feeling as intensely as we do. This behaviour is often learned from environments where one's emotions were dismissed or minimised. Conversely, emotional vulnerability is being in the midst of the storm, feeling every gust of wind and wave of emotion deeply. It's a biological tendency to experience emotions intensely, influenced by how our current environment interacts with our emotional responses. The Fluidity of Waves: Switching Between Extremes Just as the ocean can change from calm to stormy in an instant, we can fluidly switch between these secondary targets in real-time. One moment, we might be the calm ocean, displaying apparent competence, and the next, we're caught in a rip current of active passivity. The same fluidity applies to the other dialectics. We may suppress our grief like the stillness before a storm (inhibited grieving) and suddenly find ourselves in the throes of an emotional hurricane (unrelenting crisis). The Impact of the Environment and Learning to Navigate Biological secondary targets such as emotional vulnerability, active passivity, and unrelenting crisis arise within us, much like how weather patterns can suddenly stir the ocean into motion. These responses are influenced by how our current environment interacts with our emotional sensitivity. Meanwhile, the patterns of apparent competence, inhibited grieving, and self-invalidation are often learned behaviours, developed over time in invalidating environments. These learned patterns are similar to how the ocean shapes the shoreline; repeated exposure to invalidation can carve deep grooves in our behaviour, leading us to question our emotional responses and suppress our grief. For many, this process of invalidation began early in life. They looked to others—parents, caregivers, or peers—to help make sense of their intense emotional experiences. But when their emotions were dismissed or not mirrored by others, they began to judge their own feelings as wrong or too much. Like a shoreline that learns to brace for the incoming tide, they learned to hide their emotions, pretend everything was okay, and feared being rejected as "emotionally weak." DBT Skill: Opposite Action One DBT skill that can be incredibly useful when addressing secondary targets is Opposite Action. This skill involves identifying an emotion and then taking action that is opposite to what that emotion is urging us to do. For example, if self-invalidation is causing you to withdraw and isolate, the opposite action would be to reach out for support or engage in activities that affirm your self-worth. Similarly, when dealing with inhibited grieving, rather than avoiding reminders of loss, opposite action encourages engaging in activities that help you connect with and express your grief in a healthy manner. This skill helps create new patterns of behaviour that counteract the extremes of the secondary targets, promoting emotional balance. Learning to Surf the Waves DBT teaches us to become skilled surfers of these emotional waves. Recognising these secondary targets and understanding how they manifest in our lives is the first step toward change. While everyone experiences these patterns to some degree, they can be more intense and frequent for those in treatment. By acknowledging the dialectics and the push and pull within us, we can learn to balance on the surfboard rather than being tossed around by the waves. Through DBT skills, such as mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness, and opposite action, we can learn to ride the waves of emotion without being swept away. Instead of suppressing our grief like an inhibited tide, we can allow ourselves to feel and process our emotions. Rather than judging our vulnerability, we can learn to embrace it as a part of our human experience. The ocean is ever-changing, and so are we . By understanding the dialectics within DBT and recognising the patterns of our emotional waves, we can navigate our internal seas with greater compassion and skill. In doing so, we can learn not just to survive the stormy seas but to ride the waves with confidence and grace.