Emotionally Unstable Personality Disorder

"Can't get out of the roller coaster of extreme feelings and tensions"


What is an emotionally unstable personality disorder, formerly borderline syndrome?

The term emotionally unstable personality disorder, formerly borderline syndrome, refers to long-term problems in the control of feelings and inner tension: this is mainly due to effects

  • in interpersonal relationships, these can be conflicting and unstable; or/and
  • self-damage, self-injury, pronounced tension and anxiety feelings,
  • sensations of inner emptiness and self-devaluation.

 Since these symptoms are often long-term and occur for the first time in particular at the age of 20, one speaks today of a personality disorder.


How do you recognize that you may be suffering from an emotionally unstable personality disorder?

The ability to spontaneously and consciously control feelings and internal tensions is particularly important in socially demanding situations: in interpersonal proximity, in conflict, in disappointment and rejection, and in the expression and realization of wishes and expectations. Such social situations and frustrations overwhelm some people so much that they react with uncontrollable anger, upset, accusations, impulse breakthroughs, aggression, but also callousness, self-devaluation or retreat. People with emotionally unstable personality disorder are particularly at risk for such reactions. It can also come to such a pronounced inner tension that they damage themselves in order to experience relief. Even damage can be directed to the outside through risky behaviour in the form of unbridled money spending or excessive food eating, excessive use of alcohol or drugs or uninhibited sexual behavior. Self-harming behaviour ("scarifying"), suicidal thoughts and suicides often occur in people with emotionally unstable personality disorder. The emotional life is often constantly swaying and characterized by inner emptiness. In more than half of the cases, sufferers report that they lack the certainty of "who you really are" due to an unwanted and persisting rollercoaster of feelings. Relations with other people are characterised by instability and change, while at the same time fear of separation and the effort to avoid abandonment at all cost is to be seen.


What possibilities does a doctor have to diagnose an emotionally unstable personality disorder?

In the beginning a detailed anamnesis must be taken. It includes the reconstruction of the life story in relation to interpersonal relationships and feelings, their developments and dangers, as well as the existence of family predispositions. The diagnosis is made using modern classification systems such as ICD-10 and DSM-IV.


What are the risk factors and accompanying diseases?

Young age, female sex, disturbed pain sensation as well as familial stress with psychiatric disorders are among the main risk factors. The disease occurs mainly between 18-30 years of age. The diagnosis is more often made for women (75%) than for men. In studies, patients have often reported traumatic experiences in their life history. The most common psychological disorders are prolonged depression (70%), depressed episodes (50%), substance abuse (30%) and an overlap with chronic and complex histories of post-traumatic stress disorder (30%). Other symptom overlaps are bipolar disorder, attention deficit disorder, and bulimia. The most common physical diseases in diagnosis are dietary disorders, infections and self-injury consequences.

What is the long-term prognosis?

Long-term studies in the USA have shown that the symptoms of emotionally unstable personality disorder in the course of 10 years regress, irrespective of the therapy carried out and the likelihood of the disorder recurring subsides. However, the degree of psychosocial impairment and the problems of psychosocial integration remain significantly increased. This is also true on average compared to the early beginning depression.


How are emotionally unstable personality disorders treated?

Imaging techniques have proven that patients with emotionally unstable personality disorder react quickly to emotional stress. The fundamentals of the therapy are therefore based on the profound knowledge of neuro-psychological fundamentals of the emotional and stress regulation, as well as derived dialectical-a behavioral techniques (DBT) and behaviour-regulating interventions. The treatment generally takes place at different levels of care (stationary, partially stationary, intensive outpatient and outpatient) with defined goals and time periods. Occupational rehabilitation is achieved in outpatient care levels. In our clinic, crisis intervention treatments with a duration of up to a maximum of 14 days are carried out under stationary treatment conditions. Priority is the problem of acute suicidal or often also para suicidal, i.e. not with the actual goal of self-killing of actions. Psychotherapy interventions from dialectical-behavioralen therapy (DBT) and cognitive-behavioral techniques are used. We think that long-term stationary stays are not conducive.
Medications are used after differential indication, if necessary. The following groups of substances are used: antidepressants with depressive symptoms, Stimmungsstabilisierer and lithium in bipolar symptoms, modern antipsychotics in the case of frequent reality fractures, and Opioidrezeptorantagonisten in Strong dissociation inclination. Benzodiazepines are generally not prescribed. A requirement medication is only prescribed in consultation with the competent senior physician in defined situations.


What can you do as a patient against this disease?

When diagnosed, it is particularly important to opt for a therapeutic alliance with clear agreements. In the further course, the observance and maintenance of a regular day-night rhythm, health-related behaviour and regular practice of skills for the regulation of emotions and behaviour are of the greatest importance.


How can relatives help a person with emotionally unstable personality disorder?

Interventions are useful in the long run if the communication methods in the family or the relationships between them have to be changed in the sense of the therapeutic goals. The family members can learn to become allies of the patient. You can actively support him in his changes. Meanwhile, there are also self-help groups for relatives. Too often, the disorder is still played down as a development-related disorder, or too much hopes are placed in purely drug-based approaches.


What consequences can an untreated emotionally unstable personality disorder have?

Significantly lowered life and health-related quality with educational breaks, repeated job losses, failed relationships and marriages. Increased risk of accompanying mental and physical illnesses as well as disabilities and anearly death. The risk of suicide (9%) is greatest in the young adult years.