What Does "Cause" Mean in Dialectical Behavior Therapy (DBT) ?

What is "cause"?  In Dialectical Behavior Therapy, one of the most effective treatments for those with Borderline Personality Disorder and other emotion dysregulation challenges, "cause" means that everything that has happened up until this moment helps explain what is happening in this moment.

In a very simple example, imagine that a plate falls to the ground in the other room. You're alarmed and think, "How the heck did that happen? I'm in the other room, and no one else is home."

You go into the other room to find that your dish rack is askew and other items are a mess on the counter. Upon further inspection it looks like your cat had gotten up on the counter and caused the dish to drop from the counter. There's the cause!

Another example is that a woman on Twitter this morning felt distraught that she sought out consoling from someone who rejected her. She felt devastated.  I can understand this, as I've experienced it before and traced it back to having a history of feeling invalidated and it feeling like the wound has been opened and salt has been poured in it when I experience or even perceive rejection in the now.

It's not always this easy to determine the chain of events that cause something. Even when we cannot readily identify the cause, I've found comfort in simply knowing that everything has cause, and that whatever is happening in this moment is a result of the cumulative moments that came before it.

Here's a more complex example.  Last night I was talking with a friend about how I feel that there must be something "wrong" with me because I don't desire one of the most natural of human experiences for a woman: to be pregnant.  Although I love and have always loved children and enjoy having them in my life, I have never wanted to become pregnant and have children of my own naturally.

I kept saying last night, "I don't understand why this is such a repulsive idea to me. Isn't it weird that I don't want something so natural?!"

Upon further thought, I was able to come up with a number of possible causes as to why I hold this perspective, for example:

*  I find the process of being pregnant -- carrying another human being in my stomach for nine months -- terrifying.  I always worried that it would feel like an alien was growing inside of me and that I'd want it out.  Who knows why I feel this way? I'd have to trace the chain of cause for this thought to try and discover more.

* I am very afraid of the process of being pregnant -- the changes to one's body, the stress on the organs, and in vanity, I suppose, how I would look afterward.

* I don't feel capable of committing to taking care of a child in the way that I believe I would need to commit.  I don't believe I am financially or emotionally capable of providing security to a child at this point in my life.

* Then there's the cognitive dissonance aspect -- my significant other also doesn't want children, and I am going to be 36 in a couple of weeks. My biological clock is ticking, and within a few years, it will no longer be physically feasible for me to have children naturally anyway -- at least not without great risk to a child (though many older women have had perfectly healthy babies, so this is not always the case).

* I have always been very mindful of how mental illness runs in  my family and do not want to be responsible for passing this along to another human being.  I realize that it's a combination of nature versus nurture, but I haven't been willing to take that chance.

So, I was able to discover a number of possible causes, singularly and combined, as to why I do not want to have a child, despite loving children and wanting them in my life (somewhat of a dialectic!).
I noticed lots of fear, a sense of responsibility, and cognitive dissonance. So there are reasons why I would not feel compelled or interested in participating something as natural as common as having a child.

There is always cause for what we are feeling or experiencing. You can try to map it out by honestly reflecting on your experience and coming up with possibilities, or you can just trust that there is cause and cope with any distress you're experiencing in the present moment as a result.

I hope this helps you better understand "cause" in Dialectical Behavior Therapy.

As always, your comments are welcomed and encouraged.

Thanks for reading.
More Soon.

P.S.  I am in total non-judgment of those who *choose* to have children. Your chain of events of cause may be different from mine and have led you to different choices. It's different for everyone. We each have very individual stories, and many people with mental illness are great parents.


  1. Thank you for sharing. While I would have loved to have a child, I also share some of your reasons for not. The thought of providing 24/7 care and support when I have enough trouble caring for myself sometimes!

    1. Hi Julia. Thank you so much for commenting and sharing your experience. I know what you mean. My two cats are my children. :) ♥ Debbie

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  3. Not until after my diagnosis I started to notice how my behaviour could have been affecting my child. The nature nurture issue still bugs me occassionally. Now I'm desperately trying to find resources to improve my parenting skilld with DBT. Any suggestions would be great.. Thanks. Awesome post by the way. I now understand the fear I had while pregnant. Lol

    1. Stephanie, I think it's wonderful that you want to find ways to be an even stronger and better parent than you already are! I'd check out Essence Happens (Teresa Lynn). I bet she has some excellent resources and ideas around parenting as a woman with BPD. ♥ Debbie

  4. Thank you for sharing. DBT is a therapy I have been practicing for 5 month. I suffer from OCD and PTSD, and by looking at the causes of the way I am being affected now I can open a new way to deal and comprehend what is going on now.

    1. Hi Anna,

      You're very welcome! How is DBT going for you? I also have the diagnoses of OCD and PTSD -- same as you. I am so glad that you are gaining a new perspective on how to effectively cope! ♥

  5. I think you are very courageous for saying exactly how you feel. I too, felt the same. I ended up getting pregnant and having a child (unplanned and entirely unexpected as several doctors told me my body couldn't handle carrying a pregnancy full term). Pregnancy was SO scary to me because, like life, everyone's story is different. Pregnancy ended up being the most balanced part of my life. I had friends tell me years before I got pregnant that if I ever got pregnant they'd stay away from me for fear of emotional instablility...some may feel offended but I laughed, as I'm sure I'd feel the same way being someone on the outside looking in. Having a child, though, has been the hardest thing I've ever done, which definitely validates every anxious thought I had before having my daughter. I feel absolutely blessed that her father gives me a break when I so desperately need one. I'm sure it is much more often than someone without BPD would feel necessary, I prefer an hour a day without her to get my own thoughts and emotions in order, without having to worry about what's she's doing) and my doctors have been a great help in making sure I get the emotional breaks I need to replenish my strength. Remember this: We are only given what we can handle; it's what we think we can't handle that gets in the way. It is my opinion (and everyone is entitled to their own) that you'd make an excellent mother simply because you are so mindful <3

    1. Oh, Stephanie! Thank you so much for your kind words and for sharing your own experience. Very insightful and honest. :) ♥ Debbie



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