Emotion Regulation and Borderline Personality Disorder (BPD)

disappointed guy with problems with emotional regulation due to BPD
Why is emotional regulation so important in borderline personality disorder (BPD)?. Claudia Burlotti/Getty Images

Many people with borderline personality disorder (BPD) experience intense emotions. In the Diagnostic and Statistical Manual of Mental Illnesses, 5th edition (DSM-5), the reference manual healthcare providers use to make a diagnosis, many of the symptoms of BPD relate to emotion regulation issues. 

What Is Emotion Regulation? 

Emotion regulation is a fairly complex combination of ways in which a person relates to and acts on his or her emotional experiences.

This includes:

  • Your ability to understand and accept his or her emotional experiences
  • Your ability to engage in healthy strategies to manage uncomfortable emotions when necessary
  • Your ability to engage in appropriate behaviors when distressed

People with good emotion regulation skills are able to control the urges to engage in impulsive behaviors, such as self-harm, reckless behavior or physical aggression, during times of emotional stress. 

An Example of Emotion Regulation vs. Dysregulation in BPD

For example, if someone who does not have BPD goes through a breakup, she likely feels sad and may be a bit depressed, but is still able to control her emotions and carry on with her routine. She'll still attend class or go to work. However, someone with BPD lacks the ability to regulate emotions appropriately. If he goes through the same situation, he may become depressed to the point of not functioning, such as engaging in destructive or violent behaviors or impulsive activities like promiscuity.

 

Borderline Personality Disorder and Emotions

In the criteria for diagnosing BPD, the majority include issues with emotions. Some of these include:

  • Quickly changing mood swings and irritability: People with borderline personality disorder have issues managing moods and expressing emotions, leading to intense anxiety and irritability. Mood swings can be intense as well as rapid. The anxiety and irritability may interfere with normal activities such as working on a job or even caring for yourself. Others may have trouble being around you during these episodes for a number of reasons, thus harming your relationships. 
  • Feelings of emptiness: Those with BPD often experience chronic feelings of emptiness. They will engage in all sorts of activities to try and fill the void, without any effect. Regardless of how many friends and loved ones they have, they often feel alone and sad. BPD can, in essence, begin a vicious cycle. Problems regulating emotions can lead to loss of friends. Loneliness, in turn, can worsen the ability to regulate emotions, and the feeling of isolation can interfere with your motivation to learn to regulate your emotions.
  • Difficulty controlling anger: Along with intense mood swings comes intense anger, seemingly out of nowhere. Slight inconveniences or slights can trigger rages in those with BPD, potentially leading to destructive or violent behaviors. 
  • Paranoia and a fear of abandonment: Individuals with BPD often are afraid of being alone or rejected, causing intense paranoia. That can cause them to act obsessive and constantly seek reassurance. Unfortunately, many of the behaviors which result from a need for reassurance can lead people to push someone with BPD further away. (Learn more about paranoid ideation in BPD.)

With difficulty regulating emotions, if you have BPD, you may experience difficulty coming down from anger or relaxing feelings of rejection.

You may lack the ability to regulate your emotions appropriately, causing disruptive behaviors. This can have a negative impact on your relationships, including with your significant other, friends and family. 

Managing Emotions With Borderline Personality Disorder

While BPD can make emotion regulation difficult, it is not impossible to learn this skill and recover from BPD.

If you struggle with BPD and emotions, you may want to consider seeing a therapist specializing in borderline personality disorder who will have a better understanding of the origins which lead to your emotional struggles.Together, you can work on strategies to help regulate your emotions.

Types of psychotherapy which have been found particularly helpful for people with BPD include cognitive behavioral therapy and dialectical behavior therapy.

There is a lot to be gained from therapy. You will learn appropriate reactions and skills to manage your mood swings. Over time, your emotion regulation will improve, helping you in your interpersonal relationships and daily life.

In addition to therapy, there are several self-help strategies for BPD which can further improve your ability to manage your emotions.

Bottom Line on Emotion Regulation and Borderline Personality Disorder

As noted above, emotion regulation plays a large role in many of the symptoms of BPD, but this does not mean that you will need to live with these symptoms forever. Newer studies are finding that, for those who are motivated, therapy can make a large difference which can, in turn, affect nearly every area of your life in a positive way. With continued therapy with a medical professional, recovery from BPD is possible. 

Sources:

Cristea, I., Gentili, C., Cotet, C., Palomba, D., Barbui, C., and P. Cuijpers. Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2017 Mar 1. (Epub ahead of print).

"Borderline Personality Disorder." Diagnostic and Statistical Manual of Mental Illnesses, 5th edition. American Psychiatric Association, 2013. 

Terzi, L., Martino, F., Beraldi, D., Bortolotti, B., Sasdelli, A., and M. Menchetti. Aggressive Behavior and Self-Harm in Borderline Personality Disorder: The Role of Impulsivity and Emotion Dysregulation in a Sample of Outpatients. Psychiatry Research. 2017. 249:321-326.

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