Emotionally Unstable Personality Disorder
The International Classification of Diseases, 10th edition (ICD-10), has a more descriptive name for Borderline Personality Disorder. Whereas those who use the Diagnostic and Statistical Manual of Mental Disorders’ “BPD” nomenclature leave their diagnosees wondering what exactly it is they are on the border of, Emotionally Unstable Personality Disorder captures what most believe to be the cardinal symptom of BPD. Emotion Dysregulation is conceptualized as the cause and the product of other BPD symptoms: unstable interpersonal relationships, sensitivity to criticism, disturbed identity, and impulsive behaviours. As well as reinforcing BPD symptoms, emotion dysregulation also reinforces itself, in a cyclical pattern modelled by Carpenter & Trull in 20131.
Components of Emotion Dysregulation
In this model, biological sensitivity to emotions (elevated cortisol, dopamine and serotonin imbalances, overactive amygdala) in those with BPD intensifies individuals’ reactions to an emotional stimulus, resulting in intense and labile negative emotions. Labile is defined as unstable and rapidly shifting (I picture it as waves). The emotions are usually an amalgamation of fear, sadness, anger, and even love – but most individuals with BPD would have trouble isolating a particular emotion, as they mesh into an amorphous unit. Intense, unstable emotions combine with insufficient or maladaptive emotion regulation strategies to produce “emotion dysregulation consequences”: exacerbated emotions and interpersonal stress. In this way, emotions are perpetually aroused and sensitive to further stimuli.
Emotional Cascade Model
Selby, Anestis and Joiner proposed a similar model of emotion dysregulation in 2008: the Emotional Cascade Model2. This model was not specific to BPD, and described how individuals’ repetitive negative thought (rumination) about their negative mood and emotions leads to maladaptive behaviour like eating binges or non-suicidal self-injury. This behaviour exacerbates negative emotions and the cycle repeats itself. Applied to BPD3, the Emotional Cascades Model proved to act as a mechanism between BPD symptoms and behaviour dysregulation such as non-suicidal self-injury.
To summarize, emotion dysregulation has been theorized as the cardinal symptom of BPD, and is a pathway to maladaptive behaviour. It is composed of four elements: sensitivity, intense and labile emotions, inadequate emotion regulation strategies, and maladaptive emotion regulation strategies. These elements combine to produce negative consequences of emotion dysregulation such as loneliness, shame, and guilt which further exacerbate emotion sensitivity and perpetuate the cycle.
What can I do to help regulate my emotions?
In this video, Marsha Linehan (creator of Dialectical Behaviour Therapy; DBT) describes emotion regulation strategies.
- Carpenter, R. W., & Trull, T. J. (2013). Components of Emotion Dysregulation in Borderline Personality Disorder: A Review. Current Psychiatry Reports, 15(1), 335. http://doi.org/10.1007/s11920-012-0335-2
- Selby, E. A., Anestis, M. D., & Joiner, T. E. (2008). Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behaviour Research And Therapy, 46(5), 593-611. doi:10.1016/j.brat.2008.02.002
- Selby, E. A., Anestis, M. D., Bender, T. W., & Joiner, T. J. (2009). An exploration of the emotional cascade model in borderline personality disorder. Journal Of Abnormal Psychology, 118(2), 375-387. doi:10.1037/a0015711