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Emotional Regulation Disorder (ERD)


Introduction

Emotional Regulation Disorder is a serious condition which is believed to affect between 1-3% of the general population yet despite being so prevalent is not commonly understood.

People who live in a relationship with a person who suffers from borderline personality disorder often know that something is terribly wrong with the behavior of their family member or loved-one but often do not know what to do about it or that there is even a name for it.


Alternate Names

There are a number of different names used around the world for the same disorder:

  • Borderline Personality Disorder (BPD)
  • Emotional Regulation Disorder (ERD)
  • Emotional Dysregulation Disorder
  • Emotional Intensity Disorder (EID)
  • Emotionally Unstable Personality Disorder (EUPD)
  • Emotion-Impulse Regulation Disorder (EIRD)
  • Impulsive Personality Disorder (IPD)

The most commonly used name today is Borderline Personality Disorder - or BPD - as defined in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR).

The term "Borderline" is a historic term coined to describe people who were diagnosed to be on the borderline between a neurotic and psychotic disorder. It is commonly felt that the "Borderline" label is misleading and stigmatizes the disorder. The fifth version of the Diagnostic & Statistical Manual (DSM-V) is scheduled for release in 2010. It is likely that the disorder will be renamed Emotional Regulation Disorder (ERD) or Emotional Dysregulation Disorder (EDD) in the DSM-V.


Characteristics & Traits

The following list is a collection of some of the more commonly observed behaviors and traits of those who suffer from BPD /ERD. Click on the links on each one for more information about a particular trait or behavior and some ideas for coping with each.

Note that these traits are given as a guideline only and are not intended for diagnosis. People who suffer from BPD are all unique and so each person will display a different subset of traits. Also, note that everyone displays "borderline" behaviors from time to time. Therefore, if a person exhibits one or some of these traits, that does not necessarily qualify them for a diagnosis of BPD. See the DSM Criteria on this page for diagnostic criteria.

Alienation - The act of cutting off or interfering with an individual's relationships with others.

"Always" and "Never" Statements - "Always" and "Never" Statements are declarations containing the words "always" or "never". They are commonly used but rarely true.

Anger - People who suffer from personality disorders often feel a sense of unresolved anger and a heightened or exaggerated perception that they have been wronged, invalidated, neglected or abused.

Baiting - A provocative act used to solicit an angry, aggressive or emotional response from another individual.

Blaming - The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Bullying - Any systematic action of hurting a person from a position of relative physical, social, economic or emotional strength.

Catastrophizing - The habit of automatically assuming a "worst case scenario" and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

Chaos Manufacture - Unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.

Cheating - Sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.

Circular Conversations - Arguments which go on almost endlessly, repeating the same patterns with no resolution.

Cognitive Dissonance - A psychological term for the discomfort that most people feel when they encounter information which contradicts their existing set of beliefs or values. People who suffer from personality disorders often experience cognitive dissonance when they are confronted with evidence that their actions have hurt others or have contradicted their stated morals.

"Control-Me" Syndrome - This describes a tendency which some people have to foster relationships with people who have a controlling narcissistic, antisocial or "acting-out" nature.

Denial - Believing or imagining that some painful or traumatic circumstance, event or memory does not exist or did not happen.

Dependency - An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.

Depression - When you feel sadder than you think you should, for longer than you think you should - but still can't seem to break out of it - that's depression. People who suffer from personality disorders are often also diagnosed with depression resulting from mistreatment at the hands of others, low self-worth and the results of their own poor choices.

Dissociation- Dissociation is a psychological term used to describe a mental departure from reality.

Domestic Theft - Consuming or taking control of a resource or asset belonging to (or shared with) a family member, partner or spouse without first obtaining their approval.

Emotional Blackmail - A system of threats and punishments used in an attempt to control someone’s behaviors.

Engulfment - An unhealthy and overwhelming level of attention and dependency on another person, which comes from imagining or believing one exists only within the context of that relationship.

Sense of Entitlement - An unrealistic, unmerited or inappropriate expectation of favorable living conditions and favorable treatment at the hands of others.

False Accusations - Patterns of unwarranted or exaggerated criticism directed towards someone else.

Favoritism - Favoritism is the practice of systematically giving positive, preferential treatment to one child, subordinate or associate among a family or group of peers.

Fear of Abandonment - An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.

Frivolous Litigation - The use of unmerited legal proceedings to hurt, harass or gain an economic advantage over an individual or organization.

Gaslighting - The practice of brainwashing or convincing a mentally healthy individual that they are going insane or that their understanding of reality is mistaken or false. The term “Gaslighting” is based on the 1944 MGM movie “Gaslight”.

Harassment - Any sustained or chronic pattern of unwelcome behavior by one individual towards another.

High and Low-Functioning - A High-Functioning Personality-Disordered Individual is one who is able to conceal their dysfunctional behavior in certain public settings and maintain a positive public or professional profile while exposing their negative traits to family members behind closed doors. A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.

Hoovers & Hoovering - A Hoover is a metaphor taken from the popular brand of vacuum cleaners, to describe how an abuse victim trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship, gets “sucked back in” when the perpetrator temporarily exhibits improved or desirable behavior.

Hysteria - An inappropriate over-reaction to bad news or disappointments, which diverts attention away from the real problem and towards the person who is having the reaction.

Identity Disturbance - A psychological term used to describe a distorted or inconsistent self-view

Impulsiveness - The tendency to act or speak based on current feelings rather than logical reasoning.

Infantilization - Treating a child as if they are much younger than their actual age.

Invalidation - The creation or promotion of an environment which encourages an individual to believe that their thoughts, beliefs, values or physical presence are inferior, flawed, problematic or worthless.

Lack of Object Constancy - An inability to remember that people or objects are consistent, trustworthy and reliable, especially when they are out of your immediate field of vision.

Learned Helplessness- Learned helplessness is when a person begins to believe that they have no control over a situation, even when they do.

Magical Thinking - Looking for supernatural connections between external events and one’s own thoughts, words and actions.

Moments of Clarity - Spontaneous periods when a person with a Personality Disorder becomes more objective and tries to make amends.

Mood Swings - Unpredictable, rapid, dramatic emotional cycles which cannot be readily explained by changes in external circumstances.

Neglect - A passive form of abuse in which the physical or emotional needs of a dependent are disregarded or ignored by the person responsible for them.

Normalizing - Normalizing is a tactic used to desensitize an individual to abusive, coercive or inappropriate behaviors. In essence, normalizing is the manipulation of another human being to get them to agree to, or accept something that is in conflict with the law, social norms or their own basic code of behavior.

No-Win Scenarios - When you are manipulated into choosing between two bad options

Panic Attacks - Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Parentification - A form of role reversal, in which a child is inappropriately given the role of meeting the emotional or physical needs of the parent or of the family’s other children.

Passive-Aggressive Behavior - Expressing negative feelings in an unassertive, passive way.

Pathological Lying - Persistent deception by an individual to serve their own interests and needs with little or no regard to the needs and concerns of others. A pathological liar is a person who habitually lies to serve their own needs.

Projection - The act of attributing one's own feelings or traits to another person and imagining or believing that the other person has those same feelings or traits.

Proxy Recruitment - A way of controlling or abusing another person by manipulating other people into unwittingly backing you up, speaking for you or "doing your dirty work" for you.

Push-Pull - A chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.

Raging, Violence and Impulsive Aggression - Explosive verbal, physical or emotional elevations of a dispute that are disproportionate to the situation at hand.

Sabotage - The spontaneous disruption of calm or status quo in order to serve a personal interest, provoke a conflict or draw attention.

Scapegoating - Singling out an individual or group for unmerited negative treatment or blame.

Selective Competence - The practice of demonstrating different levels of intelligence or ability depending on the situation or environment.

Selective Memory and Selective Amnesia - The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Self-Harm - Self Harm, also known as self-mutilation, self-injury or self-abuse is any form of deliberate, premeditated injury inflicted on oneself, common among adolescents and among people who suffer from Borderline Personality Disorder. The most common forms are cutting and poisoning/overdosing.

Self-Loathing - An extreme hatred of one's own self, actions or one's ethnic or demographic background.

Self-Victimization - Self-Victimization or "playing the victim" is the act of casting oneself as a victim in order to control others by soliciting a sympathetic response from them or diverting their attention away from abusive behavior.

Shaming - The difference between blaming and shaming is that in blaming someone tells you that you did something bad, in shaming someone tells you that you are something bad.

Situational Ethics - A philosophy which promotes the idea that, when dealing with a crisis, the end justifies the means and that a rigid interpretation of rules and laws can be set aside if a greater good or lesser evil is served by doing so.

Splitting - The practice of regarding people and situations as either completely "good" or completely "bad".

Thought Policing - A process of interrogation or attempt to control another individual's thoughts or feelings.

Threats - Inappropriate, intentional warnings of destructive actions or consequences.

Triangulation - Gaining an advantage over perceived rivals by manipulating them into conflicts with each other.

Triggering -Small, insignificant or minor actions, statements or events that produce a dramatic or inappropriate response.

Tunnel Vision - A tendency to focus on a single concern, while neglecting or ignoring other important priorities.


BPD Statistics

An estimated 2% of the US population is estimated to meet the clinical criteria for BPD. However, prevalence results vary widely as shown below. A number of studies have been performed to determine the prevalence of personality disorders and BPD. Prevalence results indicate that BPD affects anywhere between 0.5 and 5.9% of adults

People who have a first-degree relative with BPD are five times more likely to develop BPD themselves. Those who suffer child abuse are also more likely to develop BPD.

Some people who suffer from BPD are prone to suicidal behaviors and self-injury, especially as adolescents. About 8%-10% of diagnosed BPD patients commit suicide.

See Our Statistics section for more statistics on Personality Disorders.

Click here for some statistics on the possible origins of BPD.



Borderline Personality Disorder (BPD) - The DSM Criteria

Borderline Personality Disorder (BPD) is listed in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM) as an Axis II, Cluster B (dramatic, emotional, or erratic) Disorder:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, promiscuous sex, eating disorders, substance abuse, reckless driving, binge eating). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Common Myths About Personality Disorders

Myth: People with a Mental Illness all have a low IQ - this myth perpetuates the prejudice and associated stigma that people with a mental illness are "stupid". This stigma can discourage a person from admitting that they have a problem, getting the help they need or taking medication.

Fact: Personality Disorders affect the Entire Intelligence Spectrum -Here at Out of the FOG, we speak about low-functioning and high-functioning people in an attempt to differentiate between those who demonstrate high IQ and low IQ. We have seen examples of people with severe cases of personality disorders who are extremely intelligent, hold down jobs with high levels of responsibility or authority in government and in business and social groups.

 

Myth: Only Females have HPD and BPD - Only Males have NPD and APD.

Fact: BPD and HPD are more commonly diagnosed in women, and NPD and APD are more commonly diagnosed in men - but there are millions of people from both genders in all of the disorder categories.

 

Myth: All People with Personality Disorders were abused as children

Fact: About 75% of people with Personality Disorders were physically, emotionally or sexually abused as children. That leaves a huge number - about 1 in 4 - that were not.

 

Myth: People everywhere are basically the same.

Fact: Each person's thinking is as unique as the DNA inside them. - You can't interpret the thoughts and behaviors of a personality disordered individual based on your own logic or based upon what you would have to be thinking in order to act that way.

 

Myth: Personality Disorders aren't Real Mental Illnesses

Fact: Personality Disorders have been scientifically linked to observable neurological differences and we disregard them at our own peril.

 

Myth: People with personality disorders are basically just selfish.

Fact: Personality Disorders have been shown in some studies to be rooted in neurological differences in the way different regions of the brain communicate with each other.

 

Myth: People with personality disorders can get better if they just try harder.

Fact: Although management of symptoms is possible through a combination of medications, therapy and personal work, they can't make the disorder disappear altogether. Personality disorders are mental illnesses based on neurological differences for which there is no known cure.

Note that we are not suggesting here that people with personality disorders shouldn't be held accountable for their own behaviors - they absolutely should. But it would also be a mistake to regard people who suffer from personality disorders simply as mentally healthy people who are being selfish

 

Myth: People With Personality Disorders Never Get Better

Fact: A number of studies have shown that while there are no outright cures for personality disorders, many symptoms can be effectively managed through combinations of medications, therapy and hard work.

 

Myth: People With Personality Disorders get better as they get older.

Fact: Some Do and some Don't. See our section on Personality Disorder Recovery

 

Myth: You can bring about recovery in a person with a personality disorder through your own actions.

Fact: Personality Disorders are Real Mental Illnesses - and they don't depend on what we do, or don't do, or say, or don't say. You can't cure a personality disorder with love, anger, submission or ultimatums any more than you can cure a food allergy with a feather duster.

 

Myth: All People with Borderline Personality Disorder are Suicidal or commit acts of self injury

Fact: Self Injury is only one of 9 possible criteria. 5 of the 9 are required for a diagnosis of BPD. - See BPD DSM Criteria


BPD / ERD Treatment

There is no known cure for BPD / ERD. As a result, families of people who suffer from BPD / ERD are often left to fend for themselves and rely on their own resources.

However, some treatments do exist which have proven effective in managing symptoms. The most common approach is the combination of SSRI medication and DBT Therapy.

DBT - Dialectical Behavioral Therapy

Definition:

Dialectical Behavioral Therapy - Dialectical Behavioral Therapy (DBT) is a psychosocial treatment developed for patients with borderline personality disorder which combines intensive individual and group therapy.

Description:

Dialectical Behavioral Therapy (DBT) was developed for treating Borderline Personality Disorder by Marsha M. Linehan. Some therapists avoid treating patients whom they suspect may suffer from BPD, because of the demands some BPD patients put on the therapist. These demands include multiple phone calls after hours, suicidal ideation and suicidal threats, lack of respect for the therapist's boundaries or the boundaries of other patients and staff, aggressive outbursts and stalking.

DBT incorporates an intense program of weekly individual therapy sessions and weekly group therapy sessions.

Individual therapy focuses on addressing a prioritized set of issues starting with self-injury, then behaviors which disrupt therapy, then behaviors which disrupt healthy living. Patients are trained in a regime of four skills known as mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.

SSRI's - Selective Serotonin Reuptake Inhibitors

Definition:

SSRI - Selective Serotonin Reuptake Inhibitors, are the most commonly prescribed antidepressants for people who suffer from personality disorders. Popular SSRI's include Celexa, Lexapro, Prozac, Paxil, & Zoloft.

Description:

SSRI's relieve symptoms of depression by blocking the re-absorption (re-uptake) of a neurotransmitter in the brain called serotonin. More serotonin in the brain has been shown to improve mood.

SSRI's are generally considered milder than other types of antidepressants. Therefore, SSRI's are typically the first line of approach for practitioners.

Side-effects include: nausea, sexual dysfunction, headache, diarrhea, nervousness, rash, agitation, restlessness, sweating, weight gain, drowsiness and sleeplessness.


ERD Possible Causes

The causes for ERD are not precisely known. However, recent research has turned up some clues. Further study is necessary to definitively establish a cause. However, theories do exist.

There is some evidence relating the prevalence of ERD to the kind of environment a child grew up in. A significant percentage of people who suffer from ERD were also abused as children. However, this kind of correlation does not always prove that the environment they grew up in contributed to their own disorder - read our section on the Post Hoc Ergo Propter Hoc Fallacy for a possible explanation why.)

There is a higher incidence of personality disorders in those who have parents who suffer from a personality disorder. The reason's for this could possibly be genetic. It is possible that certain people are born with a genetic tendency to develop a personality disorder.

There is also a higher incidence of ERD in females. Read our section on the Amygdala for some information on gender differences in neural activity which may some day lead to a greater understanding of why certain disorders may afflict one gender more than another.


The Amygdala and it's Link to BPD / ERD

Definition:

Amygdala - The Amygdala is a small region of the brain which plays a key role in emotional regulation, emotional memory and responses to emotional stimuli.

Description:

Recent technological advances have given neurologists two new ways to create 3-D images of the brain. These techniques are known as Positron Emission Tomography (PET Scanning) and functional Magnetic Resonance Imaging (fMRI). By scanning a person's brain while prompting them to think in a certain way, scientists are unlocking clues as to which regions of the brain are responsible for different kinds of thought.

Much of this work has focused on the amygdala - a small region deep in the brain shown below. There is one amygdala the right side of the brain and one on the left as shown below.

Image of teh Amygdala, Courtesy: http://thebrain.mcgill.ca/

The Amygdala, courtesy The Brain From Top To Bottom @ http://thebrain.mcgill.ca/

The Amygdala's Role in Emotional Reactions

It is believed that the amygdala has an important rule in producing lightning-fast emotional responses to events, whenever a person recognizes an event with a strong emotional element (good or bad) such as events that results in fear, anger or rage or events that result in delight, joy or excitement.

The amygdala is believed to be part of our fast, instinctive and reactive brains. Not much conscious thought is involved if an object is hurled towards us and we instinctively duck. This ability to react instinctively to danger is thought to have historically played a critical function in survival of most species. Similarly, witness the reaction of a crowd whenever a sports team scores a goal. There is a universal instant response of throwing hands in the air, widening the eyes, leaping into the air etc, without much thought given. When you see these instinctive reactions occur, the amygdala is at work.

The Amygdala and Memory

The amygdala has also been shown to have an important function in enhancing memory functions by releasing stress hormones, such as adrenaline. It has been shown experimentally that rats, who have had their amygdala disabled lose their fear of cats. It has also been shown that increasing stress hormones improves memory of an event. This helps explain why people can remember stressful moments in great detail - such as times of disasters or crises, when adrenaline is released and yet can easily forget long periods when nothing significant seems to have happened.

Gender Differences in the Way the Amygdala is Connected

Another interesting finding resulted from a study comparing amygdala activity in males and females. When shown images containing strong emotionally arousing content, it was found that the amygdala on the right side of the brain was the most active in men, while the amygdala on the left side of the brain was most active in women.

Other experiments with people who are relaxing have shown that in men, the right amygdala is more closely connected to the rest of the brain than the left, while women show a stronger connectivity between the left amygdala and the rest of the brain. Additionally, in men the right amygdala seems to be strongly connected to regions of the brain normally associated with interactions with the external environment while in women, the left amygdala seems to be strongly connected to regions of the brain normally associated with more internal thought. This suggests that in an emotional context, men are biased toward thoughts about the external environment and women toward thoughts about the internal environment.

Source: Human Brain Imaging Studies of Emotional Memory: Uncovering Influences of Sex and Hemisphere by Larry Cahill.

The Link between the Amygdala and Emotional Regulation Disorder / Borderline Personality Disorder

In a famous experiment at Yale University, 15 people diagnosed with BPD and 15 people with no BPD diagnosis were shown photographs of faces with neutral, happy, sad, and fearful facial expressions while mapping the activity in the brain using fMRI. It was found that there is a lot more activity in the left amygdala of people who had been diagnosed with Emotional Regulation Disorder /Borderline Personality Disorder when exposed to an emotional stimulus than there is for most other people.

Source: Donegan et al, Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation.


BPD/ERD Support Groups & Links:

Out of the FOG Support Forum - Visit the support forum here at Out of the FOG.

Psychforums BPD forum - Psychforums Site.

BPD Recovery - http://www.bpdrecovery.com/ BPDRecovery is a site that focuses on recovering from Borderline Personality Disorder. The Site is run by a recovered Borderline. It is a non-discriminatory website which means that all individuals are welcome - whether you've been formally diagnosed or simply recognize yourself or someone you know in the diagnostic criteria, you are welcome here!

Anything to Stop The Pain - information site, blog and support board for Non-Borderlines, with a particular emphasis on supporting people who have children with BPD and people in a committed relationship with a person who suffers from BPD.

Emergence - http://www.emergenceplus.org.uk - UK site with personality disorder related information and services.

http://bpdcentral.com/support/email.shtml The Welcome to Oz Online Community for Family Members with a Borderline Loved One.

http://borderlinepersonality.ca/board BPD Support Site run by BPD Author A. J. Mahari.

http://www.BPDCentral.com - An information and support site about BPD run by Randi Kreger, co-author of "Stop Walking on Eggshells".

http://www.BPDFamily.com - Support Site for the family and relationship partners of individuals with BPD.


For More Information & Support...

If you suspect you may have a family member or loved-one who suffers from a personality disorder, we encourage you to learn all you can and surround yourself with support as you learn how to cope.

Submit feedback on this page here.

 
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