Personality disordersEmotional regulation in borderline personality disorderGiorgia TrinconeEditorial staffPsychotherapist with Cognitive Behavioral orientationUnobravo

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For emotional regulation we mean the process through which the person tries to manage their emotions, acting on them in various ways and intervening on different aspects, including the situations and stimuli that precede them.

Emotional regulation, in itself, has nothing pathological. All people, using different strategies, make continuous “adjustments” of their emotions and responses to these emotions, most of the time in a completely effective way. Let’s think, for example, of the hot bath we give ourselves at the end of a tiring day to relax or when we look away from scenes that are particularly frightening to us while watching a TV series.

When does emotional regulation become a problem?

We talk about problematic emotional regulation when we react quickly and often impulsively to emerging emotions, without checking whether these ways of acting are effective:

• in the long term
• to get closer to what is important to you.

What makes this process problematic, sometimes pathological, is its systematicity and generalization, i.e. when the same strategies are used repeatedly over time and across different situations, in inflexible ways and not very sensitive to changes in the context.

Examples of this are other personality disorders such as borderline personality disorder and histrionic personality disorder: emotions are experienced intensely and expressed impulsively, with blatant displays aimed at seeking attention in the first case and also the appreciation of others in the second.

Borderline personality disorder and emotional regulation

If we observe the characteristic behaviors of borderline personality disorderwe can see that, although they may appear different in form, they are the result of rigid and mostly dysfunctional attempts to suppress, get rid of or modify aspects of one’s emotional response.

For example, one of the characteristic and most painful emotional experiences for a person with borderline disorder is theabandonmentwhether real or perceived. When experienced, whatever the circumstance, it often leads the person to react impulsively in ways:

• not very effective in actually avoiding the probability of being abandoned in the future
• that distance the person from what they really want and consider important, such as connecting to others and establishing satisfying relationships.

The fear of abandonment can lead to suspicious behavior, which however must be distinguished from that of paranoid personality disorder.

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What the DSM-5 and epidemiological data say

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) identifies borderline personality disorder as a condition characterized by instability in interpersonal relationships, self-image and mood, with marked impulsiveness.

According to the DSM-5, the prevalence of borderline personality disorder in the general population is around 1.6%, according to some clinical studies, the prevalence can be up to 5.9%. This disorder is more frequently diagnosed in women, with a ratio of approximately 3:1 compared to men (American Psychiatric Association, 2013).

Emotional dysregulation can be one of the central features of the disorder, profoundly influencing the quality of life and social relationships of those who suffer from it.

Theoretical models of emotional regulation

Several theoretical models help understand emotional regulation in borderline personality disorder.

• Model by James Gross: Proposes that emotion regulation is a process involving awareness, evaluation, and modification of emotions. People with BPD can often struggle to identify and manage their emotions, resorting to ineffective strategies such as avoidance or suppression.
• Model by Marsha Linehan: Psychologist Marsha Linehan, creator of Dialectical Behavior Therapy (DBT), describes emotional dysregulation as the result of biological vulnerability combined with invalidating environments. This leads to difficulty tolerating intense emotions and impulsive responses.

These models highlight the importance of developing new skills to recognize, accept and modulate emotions, rather than trying to eliminate them.

Two types of emotional regulation

Emotional regulation can be:

• single or specific
• multiple or generalized.

Single or specific emotional regulation

We speak of single or specific emotional regulation when the regulation strategies are aimed at one specific emotion which the person finds difficult to manage and which is a source of great suffering for them, for example in cases of social anxiety or depression.

Multiple or generalized emotion regulation

It happens in all those cases where it is a whole variety of emotions (and not just a specific one) to lead to frequent, rigid, inflexible and mostly ineffective regulatory behaviors in the long term, which are implemented in different contexts and for a long time.

In the case of borderline disorder, what we witness is a emotional dysregulation multiple. The emotions that are the object of attempts to:

• adjustment
• suppression
• check

are different, as are the contexts in which these attempts are implemented.

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Super feeler

THE super feeler they are people who experience every emotion and every feeling in a way:

• sudden
• exceptionally intense
• with very rapid mood swings, so much so that they feel overwhelmed and at the mercy of their emotions, as if their “emotional machine” turned on and went from zero to 100 in an instant, constantly.

When emotion reaches its peak, these people can perceive any thought that comes to their mind as the absolute truth. This entails the risk of leaving control over one’s actions to the emotional and cognitive experience of the moment, with all the short and long-term consequences that may derive from it.

Emotions are not the problem

Most of the most recent and scientifically validated therapeutic approaches place the skill development that allow you to relate to your emotional experiences in a more detailed way aware and useful.

This allows you to choose how to act even in the presence of intense and difficult moods, so as to improve your personal, social and work functioning and, overall, your quality of life.

Neurobiology of emotional dysregulation

Neuroscientific research has highlighted that emotional dysregulation in borderline personality disorder may be linked to specific alterations in brain functioning.

• Amygdala: This structure is involved in the processing of emotions, particularly those related to fear and anger. In individuals with BPD, the amygdala tends to be overactive, leading to intense and difficult to control emotional reactions.
• Prefrontal cortex: This area of ​​the brain is critical for emotion regulation and impulse control. Neuroimaging studies have shown that the prefrontal cortex may be less active or less efficient in people with BPD, making it more difficult to manage strong emotions.
• Neurotransmitters: Alterations in serotonin and dopamine levels have been associated with greater impulsivity and emotional instability, typical characteristics of the disorder (Silbersweig et al., 2007).

These findings help to understand why emotional regulation can be so complex and challenging for those living with this disorder.

Assessment and diagnosis tools

To evaluate emotional dysregulation and borderline personality disorder, specialists can use several clinical tools.

• Structured clinical interview: Allows you to collect detailed information on the person’s personal history, emotions and behaviors.
• Questionnaires and self-assessment scales: Tools such as the Borderline Symptom List (BSL) or the Difficulties in Emotion Regulation Scale (DERS) can be useful for measuring symptom severity and difficulties in emotional regulation.
• Behavioral observation: The analysis of behaviors implemented in response to emotions can provide valuable information for diagnosis and treatment planning.

These tools, in the hands of qualified professionals, are fundamental for an accurate evaluation and for identifying the most suitable therapeutic path.

Evidence-based therapeutic approaches

In recent years, several evidence-based treatment approaches have been developed to help people with borderline personality disorder manage emotional dysregulation.

• Dialectical Behavioral Therapy (DBT): Designed by Marsha Linehan, this therapy focuses on teaching specific skills for emotional regulation, tolerance of distress, relationship management, and self-awareness. Numerous studies have demonstrated its effectiveness in reducing impulsivity and self-harm behaviors (Linehan et al., 2006).
• Acceptance and Commitment Therapy (ACT): This approach can help people develop greater acceptance of their emotions and engage in behaviors consistent with their values, even in the presence of difficult moods.
• Cognitive Behavioral Therapy (CBT): CBT can be helpful in identifying and changing dysfunctional thoughts that fuel emotional dysregulation.

These treatments, when conducted by experienced professionals, can help improve your quality of life and emotional well-being.

Practical strategies for emotional regulation

In addition to therapeutic support, there are some practical strategies that can help manage intense emotions in everyday life.

• Breathing and relaxation techniques: Practicing deep breathing or progressive muscle relaxation can help reduce the intensity of emotions and regain control in moments of crisis.
• Mindfulness: Cultivating awareness of the present moment, without judgment, can allow you to observe emotions without being overwhelmed by them. This practice is central to DBT and many modern therapies.
• Write an emotional diary: Writing down your emotions and the situations that trigger them can help you recognize your patterns and identify more effective strategies to deal with them.
• Ask for support: Talking to a trusted person or professional can offer comfort and new perspectives in times of difficulty.

Experimenting with these strategies, with time and practice, can promote greater emotional stability and a sense of mastery over one’s reactions.

Finding your emotional balance: Evidence Network’s support

Dealing with emotional dysregulation may seem like an insurmountable challenge, but you are not alone: ​​with the right support, it is possible to learn to recognize, manage and welcome your emotions, even when they seem too intense or overwhelming. A personalized psychological path can help you develop new strategies and can help improve the quality of your life, step by step. If you feel that your emotions are testing you or you simply want to take care of your emotional well-being, start the questionnaire to find your psychologist online and find out how Evidence Network can accompany you towards greater balance and serenity.