Emotionally unstable personality disorder: balance, understanding and acceptance
This week’s Freudian Script concentrates on a mental health problem that is not often in the public eye. As opposed to correcting stereotypes about this condition, I will instead look at what emotionally unstable personality is, common stigma problems, portrayals in fiction, and how writers can consider the condition in their work.
WARNING: This post contains discussion of self-harm, suicide and abuse.
DISCLAIMER: Freudian Script discusses mental health problems for writers of fiction, to encourage accurate and sensitive portrayals. If you or someone you know is experiencing mental health problems, please seek help from a doctor.
What is emotionally unstable personality disorder (EUPD)?
Perhaps a better starting question is: what is a personality disorder?.
A personality disorder is when an adult has a set of personality traits that cause problems for them in their lives. These have likely developed from difficult early life experiences and were at one time useful to help survive those situations. However, as the person grows older, these are no longer helpful to them and instead create problems in work, relationships and coping with stress.
Current feeling among mental health professionals is that personality disorder is not a very helpful term. Nonetheless, I will use it here for clarity and to fit in with the classification systems we work by. I have previously mentioned a different personality disorder when discussing The Psychopath – that being antisocial or dissocial personality disorder.
Emotionally unstable personality disorder relates to a set of personality traits that are rooted in problems with emotional regulation. The person may feel their emotions are out of control or they have very rapid mood swings. For this reason, EUPD is sometimes mistaken for bipolar affective disorder, though the two can also co-exist.
There are two main types of EUPD:
> Impulsive type – The emotional instability predominates here with a lack of impulse control, so thoughts can be acted upon suddenly with later regret.
> Borderline type – Called “borderline” due its historic position between the “psychotic” and “neurotic” disorders, this type sees more disturbances in self-image with frequent self-loathing. This can be accompanied by chronic feelings of emptiness, intense but brief interpersonal relationships, and self-destructive behaviour, from self-harm to suicide attempts.
Why do people get EUPD?
There is a movement in psychiatry to re-brand EUPD as a “complex trauma disorder”. This is because this group has a very high incidence of childhood abuse, trauma and neglect.
If a young child doesn’t feel safe and nurtured, their ability to form secure attachments to others doesn’t develop as it should. Instead, they learn to protect themselves by withdrawing – but also continue to look for an attachment that is fulfilling, because relationships are an important part of human sustenance.
This constant push-pull on those close to them puts a strain on the relationship and they frequently break down. This reinforces the person’s beliefs about themselves as unlovable and they experience an increase in negative emotions, which they find difficult to regulate. This can then lead to increased self-harm, either directly from cutting or related behaviour or through other “punishment”, such as self-starvation.
Self-harm and EUPD
There is a lot of stigma, both outside and inside the medical community, of self-harm and personality disorder. Common ideas that I have heard expressed are that people with EUPD are “attention-seeking” or that their self-harm should not be taken seriously.
Let’s deal with these two thoughts:
“Attention-seeking” implies a conscious desire to act merely to gain attention. It is likened to a toddler throwing a tantrum. Instead, it can be viewed in the context of the difficult in emotional regulation. With secure support and appropriate role models, children learn to self-soothe their emotional distress. Most upsets may provoke an emotional reaction but it can be dealt with by the person with only minimal support from outside.
However, without that ability, any emotional upset can become a calamity. One of the most frequent is the break-up of a relationship. If you have a large amount of negative emotion, how do you deal with it? Self-harm can be used by people to relieve tension, to form part of that coping mechanism. It also attracts attention of people who can care for the person – however, if that is operating in the situation, it is on the unconscious level.
Secondly, self-harm should always be taken seriously. It is the strongest predictor of future suicide attempts, even without the immediate risks. Talking therapy to enable that person to understand the reasons behind their self-harm and explore alternate coping mechanisms, without adding to the guilt and shame that often accompanies being “found out”, can be a helpful stage in moving on.
Management for EUPD
Like many mental health problems, there is no “quick fix” for EUPD. Some people develop alternative coping strategies spontaneously, usually supported by developing appropriate relationships and proving their worth to themselves, and appear to “grow out of” their personality disorder.
However, the more severe end of the spectrum requires more support. Specific talking therapies form the main basis for assistance from mental health services, though some medications may be useful in blunting anxiety or helping mood stability.
I have previously talked about psychodynamic psychotherapy, which looks at how childhood experiences influences adult behaviour and interaction. This can help understanding of present difficulties and aid in coming to terms with previous distressing experiences as a child.
One type of therapy that was specifically developed for EUPD is dialectical behaviour therapy (DBT). It is particularly for people who use self-destructive behaviour as a coping mechanism and attempts to address both harmful behaviour and the underlying emotional difficulties. It takes place over a year, with both individual and group sessions, and has two distinct phases. The first phase is about safety and reducing the self-harm behaviours, to gain a measure of control and encourage the person to take on responsibility to aid the development of self-soothing. The second phase then works on the underlying emotional problems.
Examples of EUPD in fiction
The works that commonly look at EUPD are memoirs, like Girl, Interrupted (though the film is less accurate).
When researching this article, I found a theory that Anakin Skywalker could have EUPD, which is a very interesting take on that character. He has the early childhood trauma and absence of appropriate role modelling to precipitate a problem, with a very intense relationship with Padme and a definite lack of emotional control. However, he reinforces the stigmatising stereotype that people with EUPD are harmful to others where this is vanishingly rare in reality.
The most compelling example I’ve found is that of Elsa from Frozen. She has the early childhood trauma of hurting her sister Ana, coupled with an emotional and physical distance from her family due to her powers. The lack of control of her magic provides a parallel to poor emotional control – with the “conceal, don’t feel” attitude one which some children and teens grow up with from parental example, with the result that strong emotions come out sideways – in anger or explosions of ice. She has great difficulty with self-soothing, imposes isolation to prevent developing a potentially painful relationship and exposing her emotions, and reacts chaotically to any change in circumstances. For Elsa, her relationship with Ana can be seen as a positive force for change, to prove her self-worth and ability to form meaningful connections.
I think this is a very difficult topic to address as a writer. The risk of straying into bipolar affective disorder is quite high, and a word of caution in YA – some aspects of this presentation are normal teenage expression, part of personality development. It’s a failure to move beyond that phase that can lead to a personality problem.
If you do want to venture down this path, I recommend reaching out to someone with EUPD who can guide you through, or reading memoirs and personal accounts to get a good sense of what it is and what it isn’t. Good luck!