Emotion Dysregulation, also known as Emotional Dysregulation, Linehan's Profile or Borderline Personality Disorder (BPD), is a serious and complex mental health problem. It’s the most common personality disorder. It’s like being born without an emotional skin; no barrier to ward off real or perceived emotional assaults.
People with BPD have difficulty regulating or handling their emotions or controlling their impulses and often have an intense fear of being abandoned. This combination of lack of emotional regulation and need for stable relationships can lead to trouble with maintaining healthy relationships, a positive self-image, and can lead to unpredictable behaviour, self-harm, and suicidal thoughts and/or actions.1 They are highly sensitive to what is going on around them and can react with intense emotions to small changes in their environment.
Onset is said to be in adolescence and early adulthood and may improve with age.2
The severity and the specific combinations of BPD symptoms may differ from person to person and may fluctuate over time. Common symptoms include:
As with other mental health disorders, the cause of Emotion Dysregulation (BPD) is not fully understood. Current understanding is that a person’s genetic inheritance, biology and environmental experiences all contribute to the development of the disorder.
Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly. Some factors related to personality development can increase the risk of developing borderline personality disorder.
Many people with the disorder report experiencing abandonment or loss of a parent in childhood, being sexually or physically abused, or being an emotionally sensitive child in an invalidating environment (exposed to hostile conflict and unstable family relationships).
Validate their experience and listen without judgment. Support their efforts to seek professional help, and educate yourself about Emotion Dysregulation (BPD).
Only a licensed health care professional such as a psychiatrist, psychologist or clinical social worker experienced in diagnosing and treating mental disorders can diagnose emotional dysregulation disorder thorough interview and discussion about symptoms.
Borderline personality disorder affects 6% of the U.S. population (~14 million Americans; 50% more people than Alzheimer’s disease and as many as Bipolar and Schizophrenia combined (2.25%)). Borderline personality disorder often occurs with other illnesses. This is called co-morbidity or having co-occurring disorders. This can make it hard to diagnose, especially if symptoms of other illnesses overlap with the BPD symptoms.
According to the largest national study done to date of mental disorders in U.S. adults—about 85% of people with BPD also suffer from another mental illness. Over half the BPD population also suffers from Major Depressive Disorder. When depression and BPD co-occur, the depression often does not lift (even with medication), until the borderline personality disorder symptoms improve.
Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, substance abuse, or eating disorders. In men, BPD is more likely to accompany disorders such as substance abuse or antisocial personality disorder.
In addition, one may have other mental health disorders, such as those listed below including the estimated percent of people with BPD who have them:
Historically, the term “borderline” has been the subject of much debate. BPD used to be considered on the “borderline” between psychosis and neurosis. The name stuck, even though it doesn’t describe the condition very well and, in fact, may be more harmful than helpful.
The term “borderline” also has a history of misuse and prejudice—BPD is a clinical diagnosis, not a judgment. Current ideas about the condition focus on ongoing patterns of difficulty with self-regulation (the ability to soothe oneself in times of stress) and trouble with emotions, thinking, behaviors, relationships and self-image. Some people refer to BPD as “Emotion Disregulation.”
Within the Health Care Community there is reluctance around labeling an adolescent with emerging BPD traits. This limits the introduction of coping skills and intervention to alleviate early symptoms. Eventually unaddressed symptoms may escalate requiring crisis intervention, and that treatment may not necessarily be effective or foster hope.
Some therapists are reluctant to treat people with BPD because they are seen as being resistant to treatment and because of their emotionally demanding behaviour. Their tumultuous relationships, mood swings and suicidal gestures can provoke anger and frustration in the therapist. The limited number of subject matter experts also experience high level of burnout.
Advocacy groups have also identified lack of funding for research on BPD, and exclusion of BPD from research studies. In the US $300 million a year is raised for Schizophrenia research vs. $5 million raised for BPD
The result is limited skilled professionals trained in Dialectical Behavioral Therapy (DBT). The most effective known treatment for BPD. To those impacted and their loved ones:
Within the community at large negative and blaming attitudes toward those with substance use and mental health challenges (concurrent disorders) are often internalized, leading to lower self-confidence and reluctance to seek and receive appropriate help.
Made to feel that they will never be accepted in society; shame, as well as prejudice and discrimination when seeking support, health care, housing, employment or other services often leads to social isolation, poverty, depression, and loss of hope for recovery.
We encourage you to always consult with a healthcare professional as to what the best treatment is for you.
Officially recognized in 1980 by the psychiatric community, BPD is more than two decades behind in research, treatment options, and family psycho-education compared to other major psychiatric disorders.
BPD has historically been met with widespread misunderstanding and blatant stigma... However, evidenced-based treatments have emerged bringing hope to those diagnosed with the disorder and their loved ones.
Usually treatment for BPD involves:
Symptoms associated with borderline personality disorder can be stressful and challenging for you and those around you. You may be aware that your emotions, thoughts and behaviors are self-destructive or damaging, yet you feel unable to manage them.
In addition to getting professional treatment, you can help manage and cope with your condition if you:
You may start by seeing your primary care doctor. After an initial appointment, your doctor may refer you to a mental health provider, such as a psychologist or psychiatrist. Here's some information to help you prepare for your appointment.
What you can do
Before your appointment, make a list of:
Take a family member or friend along, if possible. Someone who has known you for a long time may be able to share important information with the doctor or mental health provider, with your permission.
Basic questions to ask your doctor or a mental health provider include:
Don't hesitate to ask questions during your appointment.
A doctor or mental health provider is likely to ask you a number of questions. Be ready to answer them to save time for topics you want to focus on. Possible questions include:
We can’t control having strong emotions but can change how we respond to them.
Don’t let the behavior of others destroy your inner peace.
BE READY TO CHANGE YOUR GOALS, BUT NEVER YOUR VALUES.
Silence is sometimes the best answer.
Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.
1,2Mayo Clinic. Borderline Personality Disorder. 2020. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/home/ovc-20370232
The above information was compiled from: NEABPD: https://www.borderlinepersonalitydisorder.org (National Education Alliance for Borderline Personality Disorder)