On the last track, we discussed 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.
I have found that in non-BPD clients, there is a certain chain of events, called trigger escalation that will eventually result in angry outbursts or violence. These escalations consist of behaviors that escalate the conflict and the anger of the people involved. In BPD clients, however, this escalation is much shorter and it takes much less to reach a point of violence.
On this track, we will examine trigger escalation and techniques to avoid it. These techniques include finding a pattern; self time out; and self-inquiry
Characteristics of Trigger Escalation
First, we will discuss the characteristics of trigger escalation. Specifically, trigger escalation is the exchange between two people in which certain words, sounds, or gestures are used that causes each person to rise to a higher level of aggression. Such triggers include verbal behaviors such as threatening, teasing, or complaining; nonverbal sounds such as groaning or sighing; voice tone or volume; gestures; facial expressions such as eye rolling and sneering; and body movements such as holding hands on the hips or pushing.
Certain people require more triggers than others to reach violent stages and some will stop the escalation altogether. However, I have found that BPD clients are often the ones to instigate trigger escalation and take it as far as physical violence. Also, because of their impulsiveness, BPD clients will jump from mild irritation to extreme aggression with just a few triggers whereas non-BPD clients experience a much more gradual escalation. Liz was a 23 year old client of mine.
She described a typical confrontation between herself and her fiancé, "I usually come in, sigh real loud, and slump down on a chair. Sometimes, I’m stone cold and quiet. After a little while, he’ll ask me what’s wrong, and now I’m angry that he didn’t ask me earlier. I usually just snap, ‘My boss is a bitch and so are my co-workers.’ He’s intimidated by then, and starts to challenge me, ‘They can’t all be bitches. I think you might be exaggerating.’ Then I get mad and shout, ‘why are you taking their side?’ And he’s still trying to keep calm, but I can tell he’s upset. I end up slamming something on the counter. One time, I even slapped him."
As you can see, Liz’s trigger escalation was extremely rapid, taking less than two exchanges to reach a high level of aggression. Think of your Liz. Does he or she have a rapid trigger escalation?
Technique: Finding a Pattern
To help Liz understand her aversive chain, I asked her find a pattern. I asked Liz to write in her journal any characteristics or actions she takes during a conflict that may escalate the altercation. I asked her to pay particular attention to her nonverbal and verbal behaviors.
Liz wrote, "First I usually sigh or groan, or some other nonverbal behavior. Then, Chris ignores me, and that is another of my triggers. When he does say something to me, I’m already mad, so I use profanity or something. He tries to be reasonable, and I start shouting. He tells me to calm down, and I think that he doesn’t care about how I feel. I end up hitting or throwing something."
As you can see, Liz has found a pattern in her arguments with her fiancé. Think of your Liz. Could he or she benefit from finding a pattern?
Technique: Self Time Out
Another technique I asked Liz to use is "Self Time Out". I asked Liz that when she felt herself getting angry to stop and isolate herself from Chris, not to irritate him, but to keep the conflict from escalating into something she will regret. As you know, this technique has also been successful with batterers. Even clients who are quick to escalate, like Liz, can stop themselves before they become too aggressive. Liz decided that when she began to shout, she would give herself a time out.
She stated, "I know that when I start shouting that the whole situation is going to snowball, I mean, without a doubt. He’ll get angry and I’ll get angrier. So now when I feel like shouting, I say, "Time out" and go into the bedroom or something. He understands and when I come out, I’m totally over it and I haven’t hurt him or our relationship."
Liz gives herself an hour to cool off and asked her fiancé not to leave the house. Liz stated, "To find him still there when I come back encourages me and lets me know that he doesn’t just love me when I’m not psychotic. I usually go for a walk which reduces the tension in my neck and back" As you can see, by removing herself from the situation, Liz kept herself from harming her relationship with Chris.
Technique: Self- Inquiry
In addition to finding a pattern and self time-outs, a third technique I find beneficial to BPD clients is "Self Inquiry". As you know, anger is a response to pain. Self inquiry is the opportunity for the client to stop and ask him or herself just why they are angry. Also, this works well when the other party inquires about the client’s motives. For instance, instead of contradicting Liz’s statements, Chris might have asked, "Why do you think they are acting this way?"
Also, when Liz began to shout at Chris, she might have taken the opportunity to ask herself, "Why exactly am I yelling at him?" She might have realized that she was feeling more hurt than angry. I asked Liz to work on asking Chris what the problem really is and start a dialogue instead of an argument.
Think of your Liz. Could he or she benefit from Self Inquiry? How about a Time out?
On this track, we discussed trigger escalation and techniques to avoid it with BPD clients. These techniques included finding a pattern; self time out; and self-inquiry.
On the next track, we will examine the characteristics of assuming behavior in BPD clients. These characteristic include ambiguous gestures; parataxic distortion; and warning signs.
What are three techniques to avoid trigger escalation with BPD clients?
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