In adolescence, teenagers who present to the mental health team with a diagnosis of ASD, or Asperger, are frequently seen presenting traits in personality, depending on any evidence of conduct in their environment. I’m seeing a lot of young people, who have been diagnosed with ASD or ADHD, are frequently given the label Emotionally Unstable Personality Disorder-which isn’t fair considering EUPD is a name given to those with underlying trauma’s! So EUPD should really be re-named complex PTSD!
I personally don’t like the terminology PD because it’s a negative perception and one that is stigmatised against, especially the public in general. It’s hard enough trying to reduce the stigma around mental illness and when people have been admitted or diagnosed with a mental deficiency, this only perpetuates their problem, further adding to their distress which is conducive to their recovery.
What makes personality traits – A functioning difficulty!
Personality traits – words such as talkative, cheerful, cold, disorganized, compulsive, intellectual, shrewd, short-sighted, flirtatious, or ruthless may describe various traits about people you know. These persistent behaviour patterns are called personality traits, which are stable over time, consistent in a variety of situations, and differ from one individual to the next. Personality can be defined as the psychological qualities that bring continuity to an individual’s behaviour in different situations and at different times.
Personality is expansive and unique to all individuals. There is no one size that fits all, we come with biology, genetic patterns, social traditions etc, the list can go on, and all these elements of personality all contribute to the growing character of the person.
Being emotionally unstable is the new terminology for borderline personality disorder. It can also be a sign of childhood trauma, depression or anxiety disorder. The signs of an emotionally unstable person can vary. They may show signs of depression and anxiety, while also displaying several behaviours that can affect both themselves and the people around them.
There are two sides to the borderline Personality – emotionally stable and unstable personality disorder. Emotionally stable generally tends to refer to the Individual who is stable and calm.
People who score high in emotional stability (low in neuroticism) react less emotionally and are less easily upset. They tend to be emotionally stable, calm, and do not constantly experience negative feelings. The fact that these individuals are free from experiencing negative feelings does not mean that they experience a lot of positive feelings. The latter is a trait of the extraversion trait.
On the other hand, those with the feature of emotionally unstable personality disorder which is a pervasive pattern of unstable and intense interpersonal relationships, self-perception and moods. Impulses are poorly controlled. At times they may appear psychotic because of the intensity of their distortions.
Individuals with the disorder can present with:
Threats of suicide
Bouts of anger
Transient psychotic symptoms
Differential diagnosis associated with EUPD
Mental disorders secondary to medical conditions (head injuries, or those with seizure disorders).
Other personality disorders.
General learning disability.
Brief psychotic disorder.
Post-traumatic stress disorder.
Associated diseases secondary to EUPD
Post-traumatic stress disorder.
Behaviours expressed in Emotional outbursts
1. Impulsive actions – more likely to drive their car extremely fast, or drive under the influence of drugs or alcohol. Prone to risk taking and geared towards danger. Impulsive spending or gambling. They have very little self-control and may not entirely understand delayed gratification.
2. Anger issues – Unable to control their emotions in a healthy manner, as well as susceptible to outbursts of sadness or happiness, their anger is much more damaging. They may shout and scream or express their anger through violent actions. This doesn’t always mean that they’ll physically harm the person that they’re angry with, but they may slam doors and push objects.
3. Unstable relationships – some can be needy and clingy, due to abandonment, they may volley between feeling very affectionate towards a person, and then feeling badly about them as well. They may start arguments and break up with their significant others, only to want to get back together after a few hours or days.
4. Extreme reactions – If they perceive that they’re being wronged in some way, they can react right away instead of finding out more about the situation. Their perception of the world may be off, and they will react to that rather than the reality of the situation.
In relationships you may feel that you must tread lightly, figuratively having to walk on eggshells because your partner or someone you know behaves or acts all too frequently with a constellation of traits that feel negative and altogether toxic, this isn’t something personal, it’s a protection mechanism that they have put up, to avoid getting hurt, underneath this hurt, is a childhood trauma.
How to help loved ones who have unstable traits.
Have a plan in place for unpredictable explosive or trauma related behaviours.
Develop a crisis plan which Identifies potential triggers that could lead to a crisis. Look out for things that tend to trigger an outburst, such as a certain smell that reminds of the past event or trauma, or even an item or what someone says, identify these triggers as they do help inform how to manage and how others around you can assist and manage when you are having a trauma triggered episode.
The plan should specify self-management strategies that are likely to be effective. Is there a song that soothes, or do you need to smash crockery or punch a bag? Is there a certain picture that can help re-ground you? Removing yourself from the scene? going for a drive or walk to reduce outbursts? Make sure loved ones are aware of the plan too, this way, you can get support while you attempt recovery, tackling the trauma’s.
Establish how to access services (including support numbers for out-of-hours teams and crisis teams) This is essential if the self-harm behaviours are dangerous or if you tend to black out during a outburst and have no recollection afterward!
There is evidence that prevention and early intervention programmes are useful in reducing the risk of developing emotionally unstable personality disorder. Indicated prevention involves identifying individuals who exhibit early signs of early conduct problems and/or have an increased risk for this disorder but currently do not have a diagnosable disorder. I currently work in a pilot project, aimed at reducing those at high risk of hospital admission, we apply, psycho-social and dialectical behavioural therapy, DBT to reduce admission risk, including social exposure, social integration and behaviour management, is a great resource and one that you should consider for recovery, its far more effective than CBT, however, one size doesn’t fit all. I certainly believe getting to the root cause of the trauma when individuals are young, (before adulthood) is imperative and has the greater success rate for recovery. Developmentally, children are developing until they reach 21, so these years are vital and instrumental for rehabilitation to enhance wellbeing and life quality for young people with early trauma.
Early intervention services, includes and involves a system of co-ordinated services that promotes a child’s age-appropriate growth and development and supports families during the critical early years, these are likely to be CAMHS, school SENCO, GP, Psychiatrist and other mental health groups appropriate to diagnosis.
And remember, they can’t help it, the best you can so is support them, sympathise, empathise and show compassion while they recover and learn healthy emotional regulation.