DBT (Dialectical Behavioral Therapy) posits that there are three types of dialectical dilemmas that are commonly found in the behavioral patterns of those suffering from complex PTSD.
They are:
Emotion vulnerability versus self-invalidation
Active passivity versus apparent competence
Unrelenting crisis versus inhibited grieving
Each one will be addressed separately below.
When people experience trauma, it can often lead to a number of dialectical dilemmas. For example, people may feel like they need to be strong for others or that they need to ignore their own needs in order to cope. Alternatively, they may feel like they are inadequate because of the things they have done in order to survive. Trauma informed therapy can help address these dialectical dilemmas and navigate these difficult situations.
Emotion Vulnerability vs. Self - Invalidation
Emotion vulnerability refers to our innate emotional response system that is designed to protect us from harm. This system includes fight, flight, freeze, and submit responses which evolved to help us survive in moments of danger. When we experience trauma, this system can become dysregulated and lead us to react in ways that are out of proportion to the actual threat we face. For example, someone with PTSD may startle easily, have trouble sleeping, or become enraged when someone cuts them off in traffic. While these reactions may seem irrational to an outsider, they are actually our brain’s way of trying to keep us safe.
The other side of the emotion vulnerability dilemma is self-invalidation. This refers to the ways we invalidate our own experiences and emotions in an attempt to protect ourselves from further harm. We may do this by numbing our emotions with drugs or alcohol, dissociating from our bodies through disordered eating or sex, or by engaging in self-harm. These coping mechanisms may provide temporary relief from the pain we’re experiencing, but they ultimately perpetuate the cycle of trauma and prevent us from healing.
Active Passivity vs. Apparent Competence
The second dialectical dilemma is active passivity versus apparent competence. Active passivity refers to the ways we avoid taking action in our lives out of fear that we will fail or be rejected. We may stay in abusive relationships, jobs, or living situations because we’re afraid to face the unknown. We may also disengage from activities we once enjoyed because we feel like we’re not good enough. This can lead to a sense of powerlessness and despair.
The flip side of active passivity is apparent competence. This is when we put on a façade of being together and having our act together, when in reality we are barely holding it all together. We may overachieve at work or in school, be perfectionists, or people-please to the point of exhaustion. We do this in an attempt to prove our worth and avoid being seen as a failure. But this level of stress is not sustainable and eventually leads to a breaking point.
Unrelenting Crisis vs. Inhibited Grieving
The third and final dialectical dilemma is unrelenting crisis versus inhibited grieving. Unrelenting crisis refers to the ways we try to outrun our pain by constantly seeking distraction and stimulation. We may become workaholics, shopaholics, or engage in risky behaviors like substance abuse or promiscuous sex. We do this in an attempt to numb ourselves from the pain of our trauma but it only provides temporary relief. Eventually, the pain catches up with us and we find ourselves in an even worse place than we were before.
Inhibited grieving is the other side of this dilemma. This is when we stuff down our emotions and don’t allow ourselves to grieve our losses. We may bottle up our anger, sadness, and fear until they explode in uncontrolled outbursts or turn into chronic depression. We may also distract ourselves with work, food, or substances to avoid feeling the pain of our grief. But if we don’t allow ourselves to feel the full range of our emotions, we can never fully heal from our trauma.
Addressing In Therapy
Since trauma informed care is healing-centered, rather than pathologizing, it views individuals as experts on their own lives and experiences. This is in contrast to more traditional approaches which often view people who have experienced trauma as being damaged or dysfunctional. You may have even been arbitrarily diagnosed with Borderline Personality Disorder which supposes that who you are as a person is disordered, with your own unique set of dysfunctional traits, and that it's fixed that way forever. But the truth is, these dialectical dilemmas are experienced by all humans in varying degrees of intensity.
EMDR (Eye Movement Desensitization and Reprocessing) is a type of trauma informed therapy that can be helpful in addressing struggles with dialectical dilemmas. This therapy is based on the idea that left brain/right brain communication is impaired after a person experiences chronic developmental stress or traumatic events. The left brain is responsible for logic and reason, while the right brain is responsible for emotion and intuition. This can lead to a polarized thinking style, where an individual either relies solely on rational thought or solely on emotion. And if you look past the life contexts in which these dilemmas reside, it's evident that they involve a faulty balance between the use of emotion and rational thought in creating the experienced perceptual landscape. EMDR therapy can help you integrate these two aspects of your thinking, allowing for more nuanced and effective decision-making.
Dialectical dilemmas are common in people who have experienced trauma. Trauma informed therapy can help people address these issues and get the support they need. If you or someone you know is struggling with dialectical dilemmas, please reach out for help.
Sean O'Connor is a licensed mental health counselor (LMHC) at Peaceful Living Mental Health Counseling in Scarsdale, NY.
Sean specializes in sports psychology and trauma informed counseling to helps adults and athletes overcome anger, depression, anxiety, PTSD and stress.
Sean is available to take new clients!
We specialize in EMDR therapy and are Trauma informed therapists!
To keep track of your progress, you can purchase your own Journal Here: EMDR Therapy Progress Journal. Written by our very own, Dana Carretta-Stein, MS, LMHC, LPC.
Available in paperback, hardcover and E-Book.
