Although the term “dysregulation” might not be immediately understood, most of us have seen dysregulation at one point or another. Dysregulation is visible in the grocery store when children throw themselves onto the ground and are literally unable to calm themselves down. Dysregulation can be seen when a beloved partner begins sobbing at a small “no,” seemingly without cause. Emotional dysregulation may even be seen when a parent stands stoically at a loved one’s funeral, seemingly incapable of showing any real sense of emotional loss or distress.
The term “dysregulation” is most commonly referring to emotional dysregulation (also called affectation). Emotional dysregulation is far from a simple or easy-to-understand condition; it can affect people from numerous different types of disorders, including both mood disorders including depression and personality disorders, such as Borderline Personality Disorder. Emotional dysregulation is the clinical term used to describe an emotional state that is difficult to control, including unhealthy patterns of emotional coping, a predilection toward outbursts of emotions, and an inability to or a struggle with expressing emotions effectively (if at all).
Emotional dysregulation is not considered a disorder in and of itself but is instead identified as a symptom of other disorders, including personality disorders, mood disorders, and behavior disorders. Emotional dysregulation, it could be argued, is one of the core symptoms of declining mental health overall, as it demonstrates an unhealthy relationship to emotional interactions, stress, relationships, and everyday life, including everyday setbacks. Although emotional dysregulation can exist on its own and can exist in individuals who do not have disorders of any kind, long-term emotional dysregulation is typically a clear symptom that something is already at play, or an emotional or mental disturbance is on its way.
Emotional dysregulation is extremely common in Bipolar Disorder and is often considered a key component in a diagnosis of Bipolar Disorder. Emotional dysregulation can be seen in the manic and depressive episodes symptomatic of Bipolar Disorder and may manifest as intense bouts of depression and anxiety, outbursts of anger, and feelings of panic, paranoia, and confusion. Because emotional dysregulation can negatively impact the way people view themselves, people with Bipolar Disorder experiencing emotional dysregulation might feel shame and embarrassment about their symptoms and how they manifest, leading to increased feelings of shame and isolation—which can, in turn, feed further into emotional dysregulation. In Bipolar Disorder, emotional dysregulation is typically one of the facets commonly tackled and worked through in therapy.
Bipolar Disorder and Borderline Personality Disorder are often linked, in part due to the link between them and emotional dysregulation. Whereas Borderline Personality Disorder manifests emotional dysregulation in the form of continual mood swings, low self-esteem, and ever-changing ideas and behaviors, Bipolar Disorder is more static in its expression, with longer periods between episodes of depression and mania. While BPD might demonstrate a tendency toward switching moods and behaviors in a matter of hours, Bipolar Disorder more commonly displays emotional dysregulation through extended periods of mania (usually a few hours to a few days, though weeks of mania, have been reported) and extended periods of depression (typically lasting at least one week, but commonly lasting two or more).
Borderline Personality Disorder (BPD) is a personality disorder primarily characterized by unstable emotional states, including disruptive anger, undue anxiety, and overwhelming depression. These constantly shifting moods often create unpredictable patterns of behavior and self-image, and individuals with Borderline Personality Disorder often report experiencing difficulty in relationships and daily functioning. Emotional dysregulation plays a pivotal role in the symptoms of Borderline Personality Disorder and is often one of the key symptoms used to diagnose the condition.
Although Borderline Personality Disorder is not the only disorder that demonstrates a predilection toward emotional dysregulation; indeed, one of the largest predictors of both emotional dysregulation and Borderline Personality Disorder is emotional abuse (of all forms) in childhood, which makes it almost necessary that the two would coincide. In Borderline Personality Disorder, emotional dysregulation manifests primarily in unpredictability: people with the disorder might experience explosive periods of anger, joy, fear, and frustration, all of which are expressed and engaged with little attention or ability to regulate emotional expression. Borderline Personality Disorder once had a reputation as being a disorder that was particularly difficult to treat, but a greater understanding of the components of Borderline Personality Disorder (including emotional dysregulation) has led to an increase in the efficacy of BPD treatment.
Emotional dysregulation is problematic in adults and children alike for a number of reasons, one of the most pressing being the inability to cope in a healthy way to stressors, setbacks, and demands. Emotional regulation plays a role in everyday life and must be used to function in virtually all tasks asked of schoolchildren, students, and employees, and the inability to regulate emotions properly can result in difficulty staying in school, difficulty achieving optimal grades, and difficulty securing and keeping jobs. These are all pivotal parts of growth and cultivating robust, healthy adult lives, making emotional dysregulation a very real threat to the mental health and well-being of the population.
Treating emotional dysregulation is typically not a matter of treating the single symptom, but is a matter of treating the greater psychological distress surrounding emotional dysregulation. As the previous paragraphs discuss, there are distinct disorders often associated with emotional dysregulation, but childhood neglect, abuse, and trauma can all play a role in emotional dysregulation, without the necessity of a dedicated disorder. Treating emotional dysregulation may be the first step, particularly for children, as this is often the first visible symptom of declining mental health in children, but is rarely the primary goal of treatment.
Although some of the disorders associated with emotional dysregulation require significant therapeutic intervention and may even require medication, others do not require intensive psychological interventions, as may be the case with disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder (ADD), and Oppositional Defiant Disorder (ODD). In these cases, emotional dysregulation is likely to present, but interventions are often school-based or delivered through other mediums, such as occupational therapy. In individuals with these disorders, emotional dysregulation often shows up in the form of impulse control and can manifest as difficulty concentrating, difficulty following directions, and difficulty staying seated for extended periods of time.
Treating emotional dysregulation is important for people of all ages, but can be particularly significant in children; helping children develop healthy coping and emotional regulation skills can decrease the risk factors for developing other mood and personality disorders later in life. If, for instance, a child is presenting with symptoms of elevated anxiety and subsequent emotional dysregulation in the first grade, treating those symptoms and imparting healthy coping skills could mitigate (or greatly reduce) the likelihood of developing other anxiety disorders as the pressures and difficulties of teenage and adult life approach. Although emotional dysregulation can be treated in adulthood, it is best treated early in its development, which is typically in childhood.
Eating disorders can also have emotional dysregulation as a symptom, as disordered eating is often a coping mechanism for other issues, including chronic low self-esteem, trauma, and Obsessive-Compulsive Disorder. Although eating disorders are not commonly discussed alongside emotional dysregulation, they are commonly associated in a clinical setting, as emotional dysregulation may be at the heart of the compulsions present in eating disorders. Treating emotional dysregulation is often one of the steps included in recovery for people with eating disorders, as learning how to manage triggers and compulsions is pivotal for learning how to eat food to support and sustain health, rather than using weight, food, and restriction as a means of coping.
Emotional Dysregulation: Outcomes
The outcomes associated with emotional dysregulation will depend on the condition associated with the symptom; Borderline Personality Disorder, for instance, might be more difficult to treat than General Anxiety Disorder and may require more sustained therapy sessions, or more additional interventions and services. Emotional dysregulation is a common symptom of numerous mood and personality disorders, and as such, it is commonly treated in therapy designed to alleviate the symptoms of diagnoses. When seeking treatment for emotional dysregulation, though, it is important to select a therapist with whom you can build trust; one of the most striking traits associated with emotional dysregulation is difficulty trusting, so engaging in a therapeutic relationship with a therapist, and having to terminate that relationship due to broken trust or incompatibility can actually set the process back.
Emotional dysregulation is best treated with the help of a qualified mental health professional, such as the individuals working through BetterHelp. Although it can be helpful to work on devoting greater attention to self-care and healthy coping mechanisms, many of the patterns involved in emotional dysregulation are deeply ingrained and are not readily uprooted. Therapists and other mental health professionals are equipped with the training and tools to teach their clients how to identify root causes of trauma and poor coping mechanisms and work to heal those issues at the root, rather than treating the symptom: emotional dysregulation.