What is emotional regulation?
Emotional regulation is a complex process that involves initiating, inhibiting, and modulating one’s mental state and behavior in response to an external or internal stimulus. The process plays out as follows: an internal or external event (thinking about a something sad or encountering someone who is angry) provokes a subjective experience (emotion or feeling), then a cognitive response (thought), then an emotion-related physiological response (for example increase in heart rate or hormonal secretion), followed by a related behavior (avoidance, physical action or expression). Emotional regulation involves maintaining thoughts, behaviors and expressions within a socially acceptable range.
What is emotional dysregulation?
Emotional dysregulation refers to the inability of a person to control or regulate their emotional responses to provocative stimuli. It can also be termed “emotional hyperreactivity.” In life, each individual is repeatedly exposed to events and interactions such as conflict in a relationship, a personal criticism or a perceived abandonment. A person with emotional dysregulation reacts in an emotionally exaggerated manner to these environmental and interpersonal challenges by overreacting: bursts of anger, crying, accusing, passive-aggressive behaviors, or creation of chaos or conflict may ensue. This set of features is often described as part of a high conflict personality. Affective or emotional instability, bursts of anger, intense efforts to avoid real or perceived abandonment, and unstable interpersonal relationships point to underlying psychological issues intertwined with emotional dysregulation.
What causes emotional dysregulation?
Emotional dysregulation is a feature in a large percentage of psychological or psychiatric disorders in the DSM-IV. However, certain psychological illnesses involve emotional dsyregulation as a prominent characteristic, especially specific types of personality issues. For example, what is commonly referred to as “Borderline personality disorder” (BPD) may also termed Emotional Dysregulation Disorder (EDD), Emotional Regulation Disorder, Emotional Instability Disorder, Emotion-Impulse Regulation Disorder or Emotionally Unstable Personality Disorder. Emotional dysregulation is also a central feature of Narcissistic personality and Histrionic personality. Psychological trauma including Post-Traumatic Stress Disorder (PTSD) may cause significant emotional dysregulation. In PTSD, hyper-arousal often occurs related to unconscious or minor stimuli, exhibited as exaggerated startle responses, vivid intrusive thoughts, and flashbacks and nightmares related to past traumatic events. Persons with PTSD display emotional dysregulation characterized by excessive fear, anxiety, anger or sadness, reactions to a previous severe and often life-threatening traumatic event that are reinitiated.
Mood disorders, such as Bipolar Disorder and depression feature emotional dysregulation. These disorders have alterations of overall mood such as a prolonged decrease in mood level (depression) or elevation (mania or hypomania). However, they may also feature emotional hyperreactivity, or emotional overreactions to specific events and interpersonal interactions. Panic Disorder or Obsessive-Compulsive Disorder (OCD) often feature significant emotional dysregulation. These anxiety disorders can feature emotional hyperreactivity derived from anxiety or stress reactions. Persons with alcoholism or chemical dependency may also struggle with emotional dysregulation.
Traumatic brain injury, including frontal lobe disorders, are characterized by emotional dysregulation, as well as attention deficit issues, impulsivity, poor insight, lack of inhibition, impaired judgment, and depressive symptoms. These frontal-subcortical disorders can result not only from combat trauma, but also from infection, cancer, stroke, previous drug or alcohol use or neurodegenerative diseases. Explosive anger, often directed at family members, is a common occurrence, particularly in individuals in whom impulsivity, disinhibition, and emotional dysregulation are present.
What is the Prognosis for emotional dysregulation?
Emotional dysregulation, as discussed, is often a part of a psychological condition. The prognosis for persons who are emotionally dysregulated is highly variable, depending on the severity of their underlying issues. Medication when indicated, coupled with effective psychotherapy, sleep and stress management and psycho-education can significantly improve the quality of life of someone with emotional dysregulation. Dialectical Behavioral Therapy (DBT), has produced excellent results in helping persons with emotional dysregulation. DBT teaches the client how to learn to take control of their life, their emotions, and themselves through self-knowledge and cognitive restructuring.
PCH Treatment Center and emotional dysregulation
When a person with emotional dysregulation is having serious problems that are negatively impacting their daily life and personal and family relationships, an intensive treatment program is an appropriate option. Uncontrolled anger or rage, irritability, sadness or other manifestations of emotional instability signify a need for more immersive treatment. Once per week psychotherapy or medication is often ineffective at managing serious consequences of emotional dysregulation.
When a client arrives at PCH Treatment Center, they are assigned a doctoral level therapist who performs a complete initial assessment. If a previous diagnosis has been made, this will be carefully evaluated. Improper diagnoses and stigmatizing labels are discarded at PCH Treatment Center. A thorough evaluation is obtained and discussed among the clinical team. Relational psychotherapy is the cornerstone to treatment along with Mentalization, Dialectical Behavioral Therapy and Somatic Experiencing. Anger management, process groups, sleep management, psycho-education, and neurofeedback further enhance each client’s treatment experience. Holistic therapies including yoga, mindfulness meditation and a robust arts program are also important for recovery and healing. A family therapy weekend and individual family sessions are available which integrate family members or significant others into the client’s treatment environment. Each client also receives an evaluation by one of our staff psychiatrists. Each Client’s medication regimen is evaluated and adjusted accordingly. Our philosophy at PCH Treatment Center is to focus on holistic healing with the minimal amount of medication necessary.