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Section 8
Hostile Irritability in Borderline Personality Disorder

Question 8 | Test | Table of Contents

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In the last section, we discussed the effects of stress on BPD clients who react in anger.  Also, we included techniques for reducing stress, "Scanning the Body" and "Stop and Breathe".

As you already know, the best way to adapt to stressful situations is to prevent such stressful incidences from happening. 

In this section, we will examine steps to help BPD clients prevent angry outbursts as a result of stress and underlying causes. These steps are  identifying the problems; clarifying goals; and coping strategies.

Steps in Preventing Outbursts

♦ Step #1 - Identifying the Problems
The first step is identifying the problems. Obviously, everyone has certain situations or pet peeves that can excessively irritate them. There are also certain stressors common among most clients such as work, interpersonal relationship conflict, financial worries, psychological problems, and health concerns. I ask each of my BPD clients to examine each of these categories separately, paying close attention to those categories in which angry episodes often occur. 

Work related stress includes, of course, the pressure to meet deadlines, to perform at the highest possible level, and to avoid being fired from the job. Financial worries are often linked to stress at work, such as achieving a raise. I have also found that interpersonal relationship problems are frequent among BPD clients. Many times, clients have a difficult time in establishing stable relationships with other people because the fear of abandonment conflicts with the client’s unintentional instability. 

Joel, a BPD client of mine, explained that interpersonal relationships caused the most stress in his life and often led to his outbursts. Joel stated, "I have this girlfriend who I’m really in love with.  But I’m so afraid that she is going to leave, that that’s all I ever thought about. I think I get so wound up that when we go out with other guy friends of mine and she even talks to them, I get angry and lash out at her and them. I guess the specific problem would be jealousy." As you can see, Joel’s main source of stress is his need to feel loved, supported, and cared for coupled with a fear of abandonment. 

♦ Step #2 - Clarifying Goals
The second step is clarifying goals.  I asked Joel to think of a specific situation during which he lashed out at another person. 
--a. In his journal, I asked him examine the situation using the following categories. Who was involved; what happened; where it happened; when it happened; how it happened; and why it happened. Joel wrote, "I was with Tammy, Mark, and Dan at a pizza place. Tammy was laughing at Mark and Dan, and I shouted at them both, ‘Stop making asses of yourselves!’ It was late in the evening, and I just snapped."

--b. Next, I asked Joel to analyze his actual response using the following categories. How you felt; why you did it; and what you wanted.  Joel wrote, "I was feeling jealous and self-conscious. I was thinking to myself, ‘Why isn’t she laughing with me?  Why do they get all the attention?’  I wanted her to be thinking of me. I wanted her to laugh with me, and to act cheerful towards me." 

--c. I then asked Joel to fill out the following statements:  "In reality the problem isn’t ________, the real problem is ________"  Often, this will include such statements as, "In reality, the problem isn’t what’s being done to me, the real problem is how I respond" or "In reality, the problem isn’t the situation, the real problem is why I responded."  Joel wrote, "In reality, the problem isn’t that Tammy was laughing at Mark and Dan, the real problems is that I have abandonment issues." 

As you can see, Joel is now beginning to understand the source of his anger and stress.

♦ Step #3 - Coping Strategies
In addition to identifying the problems and clarifying the goals, the third step is coping strategies.  I asked Joel to make a list of strategies he would practice the next time he was feeling ignored. Joel made up the following list.

  1. Tell myself that I can participate in the fun, and I wouldn’t be ignored.
  2. Laugh along with my friends.
  3. Focus on the fact that my friends are fun people and not the fact that my girlfriend is ignoring me.
  4. Tell myself that just because she is laughing does not mean she is going to leave me.
  5. Remember all the good times we share and how good she is to me.

Joel decided to use these strategies the next time he began to feel jealous about his girlfriend. A few weeks later, Joel stated, "They did work. I mean, I still felt jealous, but I didn’t lash out, and I even hid the fact that I was feeling upset. It passed, though, like it always does, and our relationship is much more open and happier now."  As you can see, by utilizing these strategies, Joel could avoid lashing at those that he loves. 

Think of your Joel.  Could he or she benefit from this three step anger prevention?

In this section, we presented steps to help BPD clients prevent angry outbursts as a result of stress and underlying causes. These steps are  identifying the problems; clarifying goals; and coping strategies.

In the next section, we will examine trigger escalation and techniques to avoid it with BPD clients.  These techniques include  finding a pattern; self time out; and self-inquiry
Reviewed 2023

Peer-Reviewed Journal Article References:
DeShong, H. L., Grant, D. M., & Mullins-Sweatt, S. N. (2019). Precursors of the emotional cascade model of borderline personality disorder: The role of neuroticism, childhood emotional vulnerability, and parental invalidation. Personality Disorders: Theory, Research, and Treatment, 10(4), 317–329.

Harpøth, T. S. D., Kongerslev, M. T., Moeyaert, M., Bo, S., Bateman, A. W., & Simonsen, E. (2020). Evaluating “mentalizing positive affect” as an intervention for enhancing positive affectivity in borderline personality disorder using a single-case multiple-baseline design. Psychotherapy, 57(4), 580–586.

Hepp, J., Lane, S. P., Wycoff, A. M., Carpenter, R. W., & Trull, T. J. (2018). Interpersonal stressors and negative affect in individuals with borderline personality disorder and community adults in daily life: A replication and extension. Journal of Abnormal Psychology, 127(2), 183–189.

Nisenbaum, R., Links, P. S., Eynan, R., & Heisel, M. J. (2010). Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: Multilevel analyses applied to experience sampling methodology. Journal of Abnormal Psychology, 119(2), 433–439.

Scott, L. N., Stepp, S. D., Hallquist, M. N., Whalen, D. J., Wright, A. G. C., & Pilkonis, P. A. (2015). Daily shame and hostile irritability in adolescent girls with borderline personality disorder symptoms. Personality Disorders: Theory, Research, and Treatment, 6(1), 53–63.

Tomko, R. L., Lane, S. P., Pronove, L. M., Treloar, H. R., Brown, W. C., Solhan, M. B., Wood, P. K., & Trull, T. J. (2015). Undifferentiated negative affect and impulsivity in borderline personality and depressive disorders: A momentary perspective. Journal of Abnormal Psychology, 124(3), 740–753.

QUESTION 8
What are three steps that are beneficial in helping BPD clients prevent angry outbursts as a result of stress and underlying causes? To select and enter your answer go to Test.

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