Several theories have been proposed to help explain BPD. Some features of the disorder are rooted in biological and psychological phenomena. These include: 1) a lack of a normal attachment theory underlay and 2) a vulnerable sub-unit of the self, which leads to a pattern of behavior seen in narcissistic and antisocial personality disorders. BPD is also considered a disorder of emotional dysregulation. The problem is that impulsivity, the inability to delay future gratification, can cause emotional dysregulation. In toto, BPD seems to be the result of a dysfunctional neuro-developmental organization. The question for the psychologist and psychiatrist is “what can we do to change this?”
The central tenet of DBT is expressed in Gestalt, the “one thing” that distinguishes it from other psychotherapies. According to Linehan, gestalt therapy exists in other people, places and things such as a table, a meal, an animal, a car, a person, a dream and a “one thing.” Gestalt defines a problem as having many parts, each of which affects other parts. DBT uses gestalt therapy to focus on the parts of a problem, rather than the problem as a whole. The goal of DBT is dialectical because it involves the synthesis of opposites, such as what is happening and the meaning and/or the consequences of what is happening. The therapist changes the dyadic relationship between patient and therapist. The precise definition of DBT will be referred to later in this protocol document.
According to Linehan, self-in-context is the second concept that underlies DBT and distinguishes it from other therapies. Self-in-context goals are those that are part of the person, rather than something external to the person. The person’s focus is on how people view them, which change the person. Self-in-context goals involve learning to tolerate thoughts, feelings and behaviors that the person may not like or approve of. d2c66b5586