What are vulnerability factors in DBT?
Vulnerability factors are a core component of Dialectical Behaviour Therapy (DBT).
DBT is built around four key skill areas:
Mindfulness (noticing what's happening in the present moment, without judging it)
Distress tolerance (getting through a crisis or intense moment without making it worse)
Emotion regulation (understanding and reducing the intensity of difficult emotions over time)
Interpersonal effectiveness (asking for what you need and setting boundaries while keeping relationships intact).
Vulnerability factors fit into the Emotion Regulation category, and are a helpful, practical way to understand how physical and environmental conditions can increase our likelihood of experiencing intense emotions or impulses.
Traditionally, DBT posits that there are four primary vulnerability factors that many people find relatable. These are synthesised into the memorable acronym: HALT
H - Hungry
A - Anxious
L - Lonely
T - Tired
Although this is a fantastic start, and has a broad applicability to many populations more generally, it does not necessarily accurately capture the complexity and nuance of the neurodivergent experience. I have found when working with clients and considering my own lived experiences of AuDHD, that these factors only explain half the picture when it comes to exploring vulnerability to emotions, even meltdowns.
This isn’t to dismiss the use of HALT, or to discredit the work of Marsha Linehan, the founder of DBT. Instead, it intends to build on her incredible work. I have found use in modifying this concept to include vulnerability factors that encompass a neuroaffirming, inclusive picture of neurodivergent needs. This extends to the factors within our environments that interact with our specific ways of processing the world, which can contribute to overlapping, compounding layers of distress or susceptibility to emotional reactions. In order to understand this further, we must first have a grasp of The Window of Tolerance.
What is the Window of Tolerance?
Core to the idea of vulnerability factors is the idea that we all have a threshold of tolerance for distress/overwhelm in our environments. The optimal zone for tolerating the normal stresses of life is known as the Window of Tolerance, wherein we can effectively manage our emotions. When we cross the threshold of this window, however, we can enter a state of hyperarousal (fight/flight response that pushes us into a heightened state of nervous system alertness) or hypoarousal (freeze response that pushes us into a decreased state of nervous system activation).
Hyperarousal can look like angry outbursts, heightened anxiety, hyper vigilance, emotional overwhelm, panic attacks, irritability or feeling out of control. We can think of this as overt expressions of emotions.
Hypoarousal can look like feeling zoned out, lethargic/low in motivation, brain fog, emotional numbness, depression, feeling empty/flat, or passive. We can think of this as an internalisation of emotional expression.
What increases environmental vulnerability in neurodivergence?
This is where a new acronym can be a helpful tool for making space for these additional vulnerabilities that many neurodivergent folk face daily:
A - Autonomy Restrictions
M - Masking
B - Burnout
U - Unfamiliar Environments
S - Sensory Overload and/or overStimulation
H - Hormones (including PMDD)
I find the term “ambush” to be particularly fitting, as many of these situations can literally leave us feeling ambushed and overwhelmed by environments not designed with our needs in mind.
Autonomy Restrictions
When the world is not designed to accommodate our diverse processing styles, daily life can feel unpredictable and even chaotic. It is for this very reason that control and autonomy can be so important for neurodivergent people, because control can bring with it safety and stabilisation in an otherwise uncertain day. We may benefit from predictable daily routines, or having advance notice about social plans. Many neurodivergent people find benefit in working from home, as this can allow for ultimate control over their environment (including sensory options like dimming lights, taking breaks, stimming, minimal unexpected social encounters).
Without the capacity to enact autonomous decisions, the load on our executive functioning increases immensely, which can very quickly push us out of our window of tolerance. In doing so, we may be more likely to feel out of control and overwhelmed, often in a state of hyperarousal. Many people describe feeling angry, helpless or frustrated when they have little control or autonomy over how their day/week looks.
Masking
Further to the point of autonomy restrictions, the very act of masking can feel like a violation of our autonomy. Masking refers to the act of self-monitoring, or performing certain behaviours to appear neurotypical. We may fear social rejection or humiliation in appearing noticeably different, or alternatively, may use masking to cope with unfamiliar environments where we don’t feel safe to be our authentic, neurodivergent selves. The near-constant vigilance associated with masking can be exhausting, as it depletes our internal resources and consumes our energy at a fast rate. Having to suppress natural behaviours, such as stimming, or force other behaviours, such as eye contact, can contribute to a sense of powerlessness, frustration or anxiety.
With this in mind, constant masking can lead our window of tolerance to shrink, which means it can take less to send us into fight/flight/freeze. For this reason, masking is a huge vulnerability factor that is important to recognise in the neurodivergent experience.
Burnout
Continuing with the theme of masking, and the general exhaustion that is all too familiar within the neurodivergent experience, is the debilitating phenomenon of burnout. Whilst this can certainly be experienced by neurotypical populations after strenuous periods of intellectual, physical or emotional exhaustion, it tends to hit neurodivergent populations uniquely hard. The constant toll of managing the demands of daily life (such as life admin, work, caregiving requirements, parenting and self-care to name a few), can rapidly deplete our energy reserves.
Exhaustion of this kind can leave use feeling less resilient overall, meaning we may spend extended periods in a state of hypoarousal as we attempt to conserve the little remains of the energy we still have (think Spoon Theory). We can think of this as being comparable to a device operating on low-power mode. With low energy, we may be more susceptible to vulnerable emotions, such as shame, sadness and/or loneliness.
Unfamiliar Environments
New environments bring with them the requirement for the enormous mental effort of adjustment. These environments may have unfamiliar people, unfamiliar sensory situations, or unfamiliar layouts. When certainty and predictability bring safety for neurodivergent folk, unfamiliarity has the potential to destabilise our sense of control over our day. Adjustment places a huge load on our executive functioning, requiring us to synthesise new information, learn new names or faces, or in the case of heightened anxious, reassure ourselves that we are safe/that we can cope. When our window of tolerance is exceeded, we may have limited resources to draw upon to neutralise these intense emotions, leading to an increased vulnerability to emotion dysregulation. This may take the form of hyperarousal (fight/flight), which can heighten our nervous system’s alertness and exhaust us further. Alternatively, we may shut down into a state of hypoarousal (freeze), resulting in difficulty being present, mindful or connected to ourselves and those in our environment.
Sensory Sensitivities/OverStimulation
When we have sensitivities to sensory components of our environment (e.g., smells, sounds, textures, tastes, sights), it can make it virtually impossible to tolerate our day, let alone navigate it whilst in our window of our tolerance. Some sources suggest that sensory sensitivities can feel akin to physical pain for neurodivergent folk, which understandably can shrink our capacity to cope. We may feel irritable, even infuriated, with repetitive sounds or uncomfortable textures, or alternatively, may feel overwhelmed and nauseous by certain smells, tastes or sights. It makes sense, then, that sensory sensitivities increase our vulnerability to intense emotions and urges, particularly if we are unable to enact a sense of control/agency over the sensory situation.
Sensory sensitivities can lead to overstimulation, but are not always the underpinning of overstimulation. We can become intellectually or cognitively overstimulated by an influx of information with limited space to process it. As such, it is little wonder as to how overstimulation can make us vulnerable to emotional reactivity or emotional numbness as a way to cope.
Hormones
There is a documented link between neurodivergence and Premenstrual Dysphoric Disorder (PMDD) for women and girls (trans and cis). Neurodivergent brains can be extra sensitive to natural hormone shifts that occur within the luteal phase. This can amplify sensory sensitivities, and can ultimately increase our vulnerability not just to hyper/hypoarousal, but also to the cumulative effect of the AMBUSH factors in general. This can heighten susceptibility to difficulties with emotional control, as well as an experience called rejection sensitivity dysphoria (i.e., intense distress associated with real/perceived rejection , criticism or failure).
An important point on Meltdowns
It is important to note that intense emotional overwhelm can result in meltdowns for both adults and children. Meltdowns can happen when we experience total emotional, sensory or cognitive overwhelm. They are involuntary, and are a response from our nervous systems when we feel totally out of control, and can involve us losing control over our behaviours. Meltdowns can vary in the way that they manifest, but can often take the form of intense hyperarousal (i.e., crying, screaming, pacing, rocking, stimming) or hypoarousal (i.e., shutting down, trying to run away). Each of the AMBUSH vulnerability factors have the potential to contribute to meltdowns. As such, it is important to be aware of the individual indicators of our threshold having been crossed, to help us manage before meltdowns may occur.
Why is this useful?
Making space for neurodivergent specific vulnerability factors can increase self-compassion for our individual experiences of distress. As self-criticism is such a common experience for AuDHD people, a level of validation of and understanding for the factors that might contribute to our emotional experiences can be life changing.
If any of this resonates, you are not alone. The Felt Sense offers neuroaffirming trauma counselling online Australia-wide and in Melbourne. Feel free to book a complimentary 15 minute chat to see what therapy at The Felt Sense could look like for you at thefeltsense.com.au.
