The Diagnostic and Statistical Manual of the American Psychiatric Association(Fourth Edition) is the “Bible” of mental illness. The DSM is being revised, and in a few years DSM 5 will come out. I think – along with a lot of others in the mental health field – that there is a diagnostic category we could use that might actually be useful but is being ignored because it is seen as indicative of a highly stigmatized disorder.
One of the revisions that didn’t make it into DSM 5 was the recommendation to create a disorder called “Emotional Dysregulation Disorder.” Instead, people who suffer from the inability to control their own emotional reactions and moods are lumped in the category of “Borderline Personality Disorder,” now to be called “Borderline Type.” Borderline Personality Disorder – BPD – is stigmatized even by mental health professionals. Until a type of therapy called “Dialectical Behavior Therapy” came into existence twenty years ago or so, it was considered ‘untreatable’ and ‘incurable,’ and many if not most therapists still see it this way.
There are ten symptoms, according to the DSM 5 proposal, of “Borderline Type.” A few of them are pretty extreme: self-harm (suicidality, cutting,etc.); aggression (being abusive to others); and schizotypy, which means really dissociating from reality. But the other seven are:
- Emotional lability – mood swings, having emotions that are easily triggered, are intense, and out of proportion to the trigger
- Separation insecurity – fears of rejection, fear of separation from significant others
- Anxiousness, including worry about the past and fear of the future or uncertainty
- Low self-esteem
- Depressivity – frequent feelings of being ‘down’
- Hostility, i.e., irritability, responding with anger to minor slights and insults
- Disinhibition- the tendency to be impulsive.
I don’t know about you, but those traits describe some people in my family and, when I was younger, me. And as a therapist it probably describes a quarter of the people I see.
And the core feature of this constellation of symptoms, which many want to call “Emotional Dysregulation Disorder” is the lack of self-control over one’s intense emotional reactions, over moods, and over impulses.
I see this deficit at the root of many addictions – if you can’t soothe yourself, calm yourself, keep from being sad and down all the time, you try to mask it with a substance or other powerful escape. And I see it at the root of many relationship problems: people who are emotionally dysregulated often think their reactions are grounded in reality and blame their partners for their moods. There is a Twelve-Step saying, “Feelings aren’t facts.” People who are emotionally dysregulated often don’t get that – it’s more like “If I feel it, it must be true.”
The thing is, if we recognized this in ourselves, our friends and family members, or our clients more often – there are things you can do about it, ranging from meditation to cognitive techniques to medication. But as long as these symptoms are seen as indicative of “Borderline Personality Disorder” not even therapists will want to see this in their clients. And that’s a shame, because there really are methods to turn that emotional inner storm into relative calm breezes, and to turn life from being an emotional roller coaster to an even, level road.