BPD and Aggression: Managing Through Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) aims to teach people with Borderline Personality Disorder (BPD) that anger is a normal emotion that can be experienced without acting on the aggressive impulses that may follow. While anger and aggression often go hand-in-hand in people with BPD, anger is not necessarily the problem, according to Michele Galietta, PhD, a senior advisor at Treatment Implementation Collaborative.

During a National Education Alliance for Borderline Personality Disorder (NEA BPD) call-in lecture, Galietta explained that everyone experiences anger and aggressive tendencies from time to time, but those who suffer from pervasive emotional dysregulation have less control over their anger and frequently act out aggressively as a result.

“Aggression is behavior that is hostile, destructive, or violent, and has the potential to inflict injury to a person or object,” Galietta explained.

The first step to teaching people with BPD how to better manage their emotions is to understand what the root causes of their aggressive impulses are. It’s different for each person – for some, the behavior was learned in childhood, where aggression may have been a big factor in their home environment. For others, the root causes might be drug addiction, intoxication, psychosis, medications, or a manic episode. Only when a therapist understands the triggers for a patient’s aggression can they begin to help them reduce emotional dysregulation.

How DBT Helps Manage Aggression

Galietta emphasized that DBT therapists must make clear distinctions to their clients regarding anger versus aggression. It is not okay to conflate the two or imply that angry feelings are in any way “wrong,” but that it is aggressive behavior that’s the problem. Therefore, changing must be the focus of the therapeutic process. 

Many people with Borderline Personality Disorder come from backgrounds where they received little or no validation from family members, instilling in them the idea that their feelings didn’t matter or weren’t justified. In DBT, therapists use validation techniques to help demonstrate to patients that being angry in a specific situation may be a reasonable way to feel. In doing this, they do not dismiss a patient’s concerns or feelings.

Galietta also explained that DBT therapy uses the philosophical approach of dialectics to help fuse the opposing notions of acceptance and change. For patients to truly move forward with BPD recovery, they need to be able to accept things as they are while simultaneously working to change the ways they process negative situations and emotions.

Therapists are also there to point out to patients that the behavior they exhibit is not consistent with the healthier life that they seek to create through Borderline Personality Disorder treatment. In doing so, therapists help bolster motivation for patients to continue working toward positive changes.

In a follow up article on this lecture, we’ll further explore the methods employed by DBT therapists to assist Borderline Personality Disorder patients in their journey to a better life, and look at the “biosocial” theory about aggressive behavior and BPD.