What does it mean?
Emotionally unstable personality (personality disorder) – a pathological developmental variant of the personality structure, with a significantly altered (reduced) ability to control one’s emotions, regardless of the consequences, which leads to impulsivity in both behavior and emotions, affects the ability to critically evaluate oneself, and also affects relationships with to others. People with an emotionally unstable personality disorder often experience drastic mood swings, it can be said that the mood is unpredictable, quite capricious; unclear self-image, polar variability of feelings towards others – from deep affection, love, closeness to deep dislike, anger, hatred. Such relationship “swings” bring disappointment and pain to oneself, and also lead to the inability to build long-term, stable relationships. There is a tendency to uncontrolled behavior during irritation, conflicts with others, especially when someone tries to limit or stop. [1, 2, 5, 10, 11, 12]
Emotionally unstable personality is characterized by 4 main areas of expression [9, 14]:
- 1. Emotional instability
- 2. Tendency to perceive and interpret stereotypes of others in a changed way
- 3. Impulsive behavior
- 4. Intense but unstable relationships
According to the ICD-10 (International Classification of Diseases), 2 types of emotionally unstable personality are distinguished: impulsive , characterized by emotional instability and lack of impulse control, as well as the borderline type , which also has self-image disorders, ambiguity of goals and inner desires, chronic feeling of emptiness, intense and unstable interpersonal relationships, tendency to self-harming behavior, including suicide attempts. [7.] Despite the above, there are various possibilities to help people with such disorders. In the course of treatment, the symptoms can be significantly reduced, which, in turn, will help improve the quality of life and relationships with others.
How to determine/evaluate the presence of personality disorders?
The diagnosis of personality disorders is determined by a psychiatrist or a psychotherapist, in addition to psychological research (conducted by a clinical psychologist). If you suspect that you or a loved one may be experiencing such disorders, you can start with a self-test for an emotionally unstable personality disorder (the self-test is a 100% safe diagnostic method). [1, 3, 10]
Personality disorders are usually diagnosed in late adolescence or early adulthood. To be diagnosed with a personality disorder before the age of 18, there must be significant symptoms that are stable, persistent, and last for at least a year. [1., 8., 9.]
More significant signs that may indicate an emotionally unstable personality disorder [1., 2., 10., 11., 12.]:
- 1. Rapid initiation of relationships and equally rapid termination;
- 2. Unstable relationships with family members, friends;
- 3. Changed/deformed and unstable self-image;
- 4. Impulsive and dangerous behavior, such as reckless driving, drinking alcohol – “rafting”, drug use, casual and/or unprotected sex, overeating;
- 5. Self-harmful behavior, such as scratching oneself, as well as suicidal thoughts, making specific plans, thinking;
- 6. Sharp, often unmotivated, mood swings that can happen every few hours or days;
- 7. Chronic feeling of inner emptiness;
- 8. Aggression and inability to control it;
- 9. Feeling of unreality, dissociation.
One such test is freely available on the Internet, in English [3.]
https://psychcentral.com/quizzes/borderline-test#is-it-accurate (this website also offers other self-tests for evaluating possible mental disorders).
The test has 12 questions with 5 answer options: completely disagree – 0 , disagree – 1 , neutral/divided feelings – 2 , agree – 3 , completely agree – 4 :
- 1. I almost always feel “empty”.
- 2. I have noticed that I do one or more of the following things – I drive dangerously (dangerous behavior on the road), I engage in casual sexual relations, I drink alcohol excessively, I use narcotic substances, I gamble, I engage in risky financial transactions/spending money recklessly, overeat
- 3. When I am very upset, abandoned, then I feel suspicious, I feel paranoid concerns, I feel ostracized, I develop dissociative disorders.
- 4. I often idealize others, especially when meeting for the first time, I feel comfortable sharing personal information, but later I feel that these people are not interested enough, which does not satisfy me.
- 5. Sometimes I am angry, strongly sarcastic, “poisonous”, but I cannot control myself.
- 6. I have self-harming, self-harming, suicidal behavior or intentions/threats.
- 7. I often experience a sudden change in my life path – completely changing my goals, values, career.
- 8. I often feel the fear of being abandoned, left behind, so I make desperate efforts to prevent this from happening.
- 9. My mood can change within a few hours or days, it can manifest itself with very pronounced anxiety, depression, irritability.
- 10. My opinion of others, especially people important to me, can change very drastically, without any warning.
- 11. I would say that all my romantic relationships were very bright, but unstable.
- 12. I have enough problems in my life that affect my ability to go to school, work, be with family and friends, and have romantic relationships.
The maximum number of points in the test is 48.
Results:
- 0-14 – there are no signs of an emotionally unstable personality;
- 15-19 – possible signs;
- 20-32 – there are signs of emotional instability;
- ≥33 – high probability of emotionally unstable personality disorder.
Risk factors.
There are various risk factors for the development of an emotionally unstable personality, but no one is 100% decisive. Often, patients with an emotionally unstable personality disorder experienced emotional and/or physical trauma in childhood – lack of communication in the family, a feeling of exclusion from the family or fear of it, a broken family, sexual/emotional abuse and violence. It has been observed that personality disorders develop more often in persons whose family members, especially brothers or sisters, also had personality disorders. There are studies on various changes in the structure of the brain, the relationship with personality disorders, however, there is no convincing evidence of their relationship with emotionally unstable personality disorders. [1, 2, 8, 11, 12]
More frequent complications: [12, 13, 14]:
- 1. Depression;
- 2. alarm;
- 3. eating disorders;
- 4. bipolar affective disorder;
- 5. dependencies.
The silent (high-functioning) variant of emotionally unstable personality disorder. These are people who will be able not to show their emotions and fit into everyday life. This type of disorder is difficult to recognize because it is successfully hidden. However, there are signs that will make it easier to recognize these disorders, mainly for the person himself [13.].
- 1. Mood swings that are not shown to others.
- 2. Suppressing or denying anger.
- 3. Avoiding people who have ever disappointed you.
- 4. Feeling of guilt and shame.
- 5. Excessive sensitivity, or “taking everything personally”.
- 6. Low self-esteem.
- 7. Feeling like a burden to others.
- 8. Feeling of inner emptiness.
- 9. Detachment from the world, reality, the feeling of being somewhere else (derealization).
- 10. Desire to please.
- 11. Anxiety and social isolation.
- 12. Fear of being rejected, being alone.
- 13. Inability to build relationships.
- 14. Self-harm, suicidal thoughts/actions.
What can be observed in Latvia?
In Latvia, in the period from 2014 to 2016, according to SPKC data, the group of patients with personality disorders diagnosed for the first time in adulthood is approximately 1% each year. The number of existing patients with personality disorders during this time period is 1.5-1.6% per year. The number of patients diagnosed with emotionally unstable personality disorders is approximately 600 (2014-602, 2015-611, 2016-637), but new patients in 2014 discovered 35, 2015 – 21, 2016 – 39. Compared to the total number of patients with specific personality disorders, which is 2014. – 1227, 2015 – 1233, 2016 – 1210, it can be concluded that emotionally unstable personality disorders make up a significant part of them, as well as, young patients with specific personality disorders in 2014. is 55, 2015 – 39, 2016 – 58. [4., 6.]
Specific personality disorders (F60 group according to ISK-10) [7]: “profound disorders of an individual’s personality and behavioral stereotypes, but are not a direct consequence of brain disease, damage or other psychiatric disorders. Usually involves several aspects of the personality, almost always associated with significant personal experiences and the breakdown of social ties. Most often, the disorder manifests itself in childhood or adolescence and continues into adulthood.”
And what happens elsewhere?
5.9% (approximately 14 million) of Americans (according to other sources 1.4%) suffer from an emotionally unstable personality disorder. About 20% of patients in psychiatric hospitals have this diagnosis (primarily and as a secondary diagnosis), and about 10% in outpatients. 75% of all patients are women. [11, 12]
Help/treatment.
People who have attempted self-harm or suicide, or are actively threatening to do so, need immediate medical attention. It is necessary to contact the Emergency Medical Service by calling 113, the EMS staff will further evaluate the situation and act accordingly. [1, 10, 12]
Help options [1, 2, 8, 12].
- 1. In psychotherapy: Dialectical behavioral therapy (DBT) – helps control mood
- swings in personality disorders; Cognitive behavioral therapy (CBT) –
- helps to discover, identify and change basic beliefs and behavior, helps to reduce
- anxiety, mood swings, frequency of self-harm; Schema therapy.
- 2. Medicinal therapy – there is no specific therapy, but it can stabilize the mood,
- reduce the symptoms of depression.
- 3. Therapy for family members and their education.
What should relatives do?
- 1. When learning about personality disorders, look for various information about it, because in society there is still stigma (prejudice) against mental disorders.
- 2. Try to recognize the signs of an emotionally unstable personality.
- 3. Encourage your loved one to seek help.
- 4. Determine boundaries and try to maintain them, which will not be easy.
- 5. Let the loved one take responsibility for himself.
- 6. Do not ignore threats of suicide, self-harming behavior.
- 7. Remember about yourself and your needs.
- 8. Talk to your loved ones about your feelings.
- 9. Do not condemn, do not moralize, do not give advice if they are not asked for.
References:
- https://www.nimh.nih.gov/health/topics/borderline-personality-disorder Borderline Personality Disorder April 2022
- https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder Borderline Personality Disorder, December 2017
- https://psychcentral.com/quizzes/borderline-test Borderline Personality Disorder test May 28, 2021
- https://nenoversies.lv/upload/tz_pvl_2016_final1.pdf
- https://www.spkc.gov.lv/sites/spkc/files/content/emocionalinestabilapersoniba_148x210.pdf
- https://www.spkc.gov.lv/lv/media/2722/download
- https://ssk10.spkc.gov.lv
- https://medlineplus.gov/ency/article/000935.htm Borderline Personality Disorder September 7, 2020
- https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview/ Overview – Borderline Personality Disorder July 17, 2019
- https://www.healthdirect.gov.au/borderline-personality-disorder-bpd Overview – Borderline Personality Disorder December 2020
- https://www.borderlinepersonalitydisorder.org/what-is-bpd/bpd-overview/
- https://www.healthline.com/health/borderline-personality-disorder#symptoms-and- diagnosis Borderline Personality Disorder March 24, 2022
- https://www.healthline.com/health/quiet-bpd#complications All About Quiet BPD (Borderline Personality Disorder) May 28, 2020
- https://www.mentalhealth.gov/what-to-look-for/personality-disorders/borderline-personality-disorder Borderline Personality Disorder March 1, 2022