Emotional Dysregulation

Emotional dysregulation refers to the inability of a person to control or regulate their emotional responses to provocative stimuli. It should be noted that all of us can become dysregulated when triggered. However, with some persons, particularly those with a history of psychological trauma, there are multiple triggers; additionally, the periods of dysregulation may be prolonged, causing major disruptions in relationships and daily functioning. Emotional dysregulation can also lead to or be associated with depression and anxiety.

When a person becomes emotionally dysregulated, they may react in an emotionally exaggerated manner to environmental and interpersonal challenges by displaying bursts of anger, crying, accusing, passive-aggressive behaviors, or by creating conflict. It is not unusual for a person to have poor reality testing when dysregulated—this relates to sensory pathways being shut down during the period of high emotional reactivity. 

Emotional dysregulation is usually relational, meaning it is triggered by a close personal contact such as a family member, child, loved one, ex-loved one or someone who has power or control over that person. As a result, emotional dysregulation is often related to issues of attachment. Particular early attachment styles to a primary caregiver may be a factor in the ability or inability to deal with or regulate emotions. A primary caregiver who was abusive or neglectful can also adversely affect the ability to emotionally regulate.

Another fundamental factor depends on each individual’s style of temperament. Temperament can be defined as the array of inborn traits that determine a person’s unique behavioral style and how they experience and react to the world. Individual temperament styles can be associated with emotional dysregulation.

Emotional dysregulation is a symptom of several different emotional and cognitive states. It is often a symptom of several mislabeled and misconceptualized psychological or psychiatric disorders, as listed in the DSM-5. However, certain psychological issues involve the dysregulation of emotions as a prominent characteristic, especially some types of personality issues. For example, what is commonly referred to as “borderline personality disorder” (BPD) may also be 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 and histrionic personality types. At PCH, we do not label people with “personality disorders.” However, emotional dysregulation is a common process we observe and work with in our client population.

Psychological trauma, including post-traumatic stress disorder (PTSD), may cause significant emotional dysregulation. Persons with complex trauma or PTSD display emotional dysregulation characterized by excessive fear, anxiety, anger, or sadness. These feelings are reactions to a previous severe and often life-threatening traumatic event that is reinitiated. 

Emotional dysregulation is also seen after a traumatic brain injury, including frontal lobe disorders. In the brain injured, there is dysregulation of emotions, 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 head injury, combat trauma, 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.

Emotional dysregulation is a part of the human experience. As mentioned earlier, we all can experience emotional dysfunction, exhibit dysregulated behavior, or even struggle with uncontrollable emotions when triggered. However, the prognosis for persons who are frequently emotionally dysregulated depends on the severity of their underlying issues. A strong and effective psychotherapy relationship is of paramount importance; psychoanalytic therapy in particular can be valuable in bringing out underlying issues related to dysregulation.

Other trauma-based treatments, such as process emotions groups, trauma groups, and psychoeducation, are beneficial. Therapies focused on learning regulation and mentalization skills, and other experiential activities such as yoga and aerobic exercise can also help those who become easily triggered and dysregulated.

Dialectical behavioral therapy (DBT) specifically addresses many of these issues and helps people learn to better regulate themselves. Through a combination of these therapies and activities, a person with emotional dysregulation can learn how to more effectively manage their emotions and lead a more productive life.

When a person experiencing frequent emotional dysregulation develops problems that are negatively impacting their daily life and personal and family relationships, PCH Treatment Center can help. Uncontrolled anger or rage, irritability, sadness, or extreme emotional lability signify a need for more immersive treatment. Associated depression and anxiety also signify that more intensive help is needed. Once per week, psychotherapy or medication is often ineffective at managing significant or overwhelming emotional dysregulation. 

PCH has worked with hundreds of clients with acute emotional dysregulation related to psychological trauma and other psychological conditions. We have found that those of our clients who put the work into our program are able to learn to regulate themselves and trust in relationships. PCH believes in offering many different modalities to help a person achieve emotional stability. When a client arrives at PCH, they are assigned a program director and a doctoral-level therapist who perform a complete initial assessment. 

Our team reviews previous diagnoses to confirm or reject their validity and develop a treatment plan centered around our non-pathologizing approach. Improper diagnoses and stigmatizing labels are re-evaluated and corrected at PCH Treatment Center. A client’s history, current psychological and emotional status, social and relational situations, medications, and other pertinent information are reviewed and discussed by our clinical team to produce an optimal treatment plan. 

PCH focuses on the psychological trauma that underlies emotional dysregulation and offers trauma-based therapies. Relational psychoanalytic psychotherapy is the cornerstone of our treatment for emotional dysregulation, in concert with somatic therapies (somatic experiencing, sensorimotor therapy, and EMDR), mentalization-based therapies, and dialectical behavioral therapy. Anger management, trauma-based process groups, sleep management, psychoeducation, neurofeedback, yoga, art, exercise, and mindfulness meditation further enhance each client’s ability to better regulate and provide tools to fall back on in the future. 

Each client also receives an evaluation by one of our staff psychiatrists. Our philosophy at PCH Treatment Center focuses on holistic healing with the minimal amount of medication necessary. Each client’s medication regimen is evaluated and adjusted accordingly. Often clients with emotional dysregulation are misdiagnosed with Bipolar Disorder II. Many are put on mood stabilizers or antidepressants, which are not appropriate or effective for emotional dysregulation. These medications will be adjusted or tapered after evaluation by our psychiatrist. We also avoid addictive substances that interfere with therapeutic goals.

The PCH family therapy program offers a family weekend and individual family sessions that integrate family members or significant others into the client’s treatment environment (when appropriate). It is often a delicate balance working with family members and our clients to achieve optimal healing. Our staff of family therapists is highly-trained, and they specialize in working within difficult family systems.