Interpersonal Hypersensitivity Model

Individuals with BPD may behave in ways that are self-defeating, confusing and challenging.

The interpersonal hypersensitivity model helps us understand the logic behind the thoughts, feelings and behaviors that cause individuals immense distress.

Vulnerabilities

Borderline Personality results from the interplay of genetic & biological predisposition and stressful life events & opportunities

• BPD is significantly heritable, with ~55% explained through genetic inheritance. We believe this genetic component relates to the hypersensitivity — in particular interpersonal sensitivity — discussed in the prior chapter.

• People who are more sensitive and expressive get more attention. Those that are more stable may be (frankly) more boring but are definitely more reliable. Neither is good or bad — there are trade offs! Problems arise when this hypersensitivity goes unattended, and maladaptive coping mechanisms are developed. Consider a Ferrari vs a Honda Civic. Both are good cars, but the Ferrari accelerator is a lot more sensitive and requires a greater expertise and attention to drive safely. Without that expertise, Ferraris are much more likely to go off the rails.

Interpersonal Hypersensitivity Model

• Connected: These individuals develop a coping strategy that depends on another person to feel OK and safe, feeling little sense of agency in themselves. They have an unrealistic expectations that this relationship can fill all their needs. So long as they feel connected in the relationship, the other person is idealized for meeting their needs. But because they feel helpless otherwise, the individual remains constantly on guard for any signs of rejection or separation.

• Threatened: If the individual perceives or experiences any separation (emotional or practical), they launch into a fight or flight response — a highly aroused “threatened” state. The other person has failed to meet their needs and expectations — and therefore may become devalued. In this state, the individual will start to flail and may insult and attack the other person, or may do things that make the other person feel the need to rescue them (like panicking, seeming helpless, or threatening self injury). If these behaviors work to increase involvement, the individual may safely return to feeling connected.

• Aloneness: In reality these actions are scary and unpleasant and frequently push others away. When others withdraw, this worsens the individual’s state — they feel deeply alone and empty. Symptoms usually become exacerbated in these conditions — either through impulsive behaviors (e.g. drinking, drugs, sex, eating, gambling) or the individual’s reduced ability to reality test (e.g. paranoia, dissociation).

• Despair: Finally, with sufficient withdrawal, the individual may become suicidal. Because the ultimate aim of these individuals is to be connected to others, often suicide attempts are “indifferent”: if someone cares enough to rescue them, then they want to live; if not, they would rather die. These individuals require and frequently elicit through their actions a “holding” environment — an institution (hospital, jail) or relationship they can fully depend on to meet their needs and keep them safe.

Lack of Agency

At no point in this process does the individual feel agency. Even in the connected state, the individual is fully dependent on the other person for their wellbeing. Because of this internal emptiness and external dependency, the individual relinquishes responsibility for their safety and wellbeing, placing the onus for their safety on those around them.