Emotional Dysregulation in Borderline Personality Disorder

“Why do you always overreact to everything I say?”

“You’re so sensitive.”

“It seems like you’re just incredibly negative.”

“I pretty much have to walk on eggshells whenever I’m around you for fear you’ll freak out about the most inconsequential things.”

Everly had been through more than her fair share of toxic relationships, and while she’d lived for a long time with the belief that she was simply unlucky enough to keep attracting people who weren’t good for her, who refused to meet her needs, who were going to — time after time — leave her feeling alone and abandoned, she’d started to become aware that there was a thread of similarity running through each of these relationships, as well as in her friendships and family engagements, and it didn’t have to do with the other person. It centered instead around the things people told her about herself. For too long, she’d been too afraid or angry or defensive to listen, but now, in her 30s and feeling less happy with her life circumstances though a little bit more at ease with herself in general, Everly had begun to take therapy seriously for perhaps the first time. It’s cliché to suggest that she was trying to “find herself” but in essence, that’s what she was doing.

Everly quit therapy with her first counselor after he mentioned that she might have borderline personality disorder (BPD) and that while it could be recovered from, it would be very hard work for both of them. She already knew her diagnosis, but how dare this man tell her what a difficult case she was without the benefit of having spent time with her! A few more miserable weeks went by, and she began to consider that her dismissal may have been too quick; perhaps he was just being honest and she really was just being too sensitive. She knew she needed to get back into therapy, but she couldn’t bring herself to go back to the same counselor; she felt ashamed and embarrassed and still a little angry. The second therapist was a woman who had a lot of experience working with people with BPD, but she didn’t appear interested in discussing it right away. She simply wanted to know Everly, and that felt good.

They worked on mindfulness-based stress reduction, based in part on a kind of meditative practice you employ no matter the task at hand (washing dishes or folding laundry, for example) to help keep you centered and grounded. This therapist taught Everly that it was more important to begin to identify with the part of herself that was witness to her moods and thoughts, rather than the moods and thoughts themselves. Through this practice, she gained some clarity and her temperament began to change; it grew more even.

There was also dialectical behavioral therapy (DBT) and something called schema therapy, and they both worked well for Everly in ways therapies hadn’t worked for her in her early 20s. This may have been simply because she was older and less emotionally volatile in general, or it may have been because she was more willing to own her diagnosis and to heal. Both likely played a factor.

The Science of Mood Dysregulation in BPD

The journal Biological Psychiatry has published new research that may shed light into the emotional dysregulation common to people with BPD. (Emotional dysregulation refers to an inability to modulate emotional responses, as well as to emotional reactions that appear to fall outside of the typical range.) The study analyzed the data for 154 people with BPD and 150 control subjects. Of those with BPD, Dr. Anthony Ruocco and fellow researchers at The University of Toronto saw “ … perhaps the sharpest picture we have so far of the patterns of brain activity which may underlie the intense and unstable emotional experiences associated with [BPD].”

The data were taken from brain imagining metrics used to examine brain activity. Those subjects with BPD showed “ … heightened activity in brain circuits involved in the experience of negative emotions and reduced activation of brain circuits that normally suppress negative emotion once it is generated.” Areas in the limbic system of the brain, including the hypothalamus, as well as parts of the prefrontal cortex, are responsible for managing emotional regulation — for gearing the body up to fight or flee in the face of danger, as well as for discerning when danger is truly present. In the case of people with BPD, these centers experience heightened activity, which makes them especially sensitive and somewhat compromised. This may be why BPD sufferers experience the emotional dysregulation that they do.

Learning to Regulate Mood

Perhaps one of the greatest things about being human is our ability to step outside of nature, our inherent design, and make subjective changes to our bodies and minds as we see fit. Learning emotional regulation is an important part of growing up; children begin to learn this essential skill from about the age of 3 or 4. When our ability to regulate doesn’t come naturally, however, we can still learn to do it. Our brains do not determine who we will be; we do. Which is an interesting paradox: if we are not our brains, who are we? (Hint: this is part of the journey of mindfulness mediation.)

There are lots of tools at our disposal for healing the consequences of poor emotional regulation as well as for improving our ability to modulate our emotional reactions. Everly is using some of these tools today, but there are others. As with her, it simply takes the willingness to admit that we need to try, and the will to take our life — and brains — into our own hands.