What is emotional instability

Emotionally unstable personality disorder

Abstract

Emotionally unstable personality disorder is a personality disorder that is primarily characterized by a lack of impulse control. This leads to rash action without considering the consequences, as well as an increased willingness to conflict. A distinction is made between two manifestations of this personality disorder: First, an impulsive type, in which the willingness to conflict and an impulse control disorder are in the foreground. And secondly, the borderline type, in which, according to ICD-10, numerous other symptoms must also be present. Because of the clinical importance and complexity of the second disorder, this chapter deals primarily with the emotionally unstable personality disorder of the borderline type.

The term "borderline" is characterized by the multitude of symptoms that include both psychotic (e.g. delusion) and neurotic (e.g. affect disorders, fears) aspects. Patients' lives are accompanied by a disorder of self-image, a chronic feeling of emptiness and volatile relationships. Inpatient treatment is usually the result of self-destructive behavior with self-inflicted injuries ("cracks") and suicidal acts. The multimodal therapy concept is based on psychotherapy concepts that are supported by antidepressants and antipsychotics. The dialectical-behavioral therapy according to Linehan is used particularly frequently.

definition

Epidemiology

  • Age
    • Usually starts in adolescence
    • First treatment at the age of 20–30 years
    • Peak at about 27 years
  • Gender: ♀> ♂

Unless otherwise stated, the epidemiological data refer to Germany.

etiology

In the case of the emotionally unstable personality of the borderline type, a multifactorial event can be assumed

  • External factors: Traumatic events in childhood (sexual abuse, physical violence) are found in almost ⅔ of the patients
  • Genetic factors
  • Neurobiological Aspects

classification

ICD-10: Diagnostic Criteria for an Emotionally Unstable Personality Disorder

  1. The general diagnostic criteria of a personality disorder must be present
  2. In order to diagnose an emotionally unstable personality disorder (impulsive as well as borderline type) three of the five criteria mentioned must apply
    • Clear tendency to act unexpectedly and without considering the consequences
    • Clear tendency to quarrels and conflicts with others, especially when impulsive actions are prevented or reprimanded
    • Propensity for outbursts of anger or violence, with an inability to control explosive behavior
    • Difficulty maintaining actions that are not immediately rewarded
    • Inconsistent and capricious mood
  3. For the diagnosis of a borderline type, two of the five criteria mentioned must also apply
    • Disturbances and uncertainty regarding your own identity, self-image, goals and "inner preferences"
    • Tendency to engage in intense but unstable relationships, often resulting in emotional crises
    • Excessive efforts to avoid abandonment
    • Repeated threats or acts of self-harm
    • Persistent feeling of emptiness

In both the impulsive type and the borderline type, there is a willingness to conflict and impulse control disorder, but additional abnormalities must be proven in order to diagnose a borderline disorder!

Symptoms / clinic

Borderline type

The clinical picture of borderline disorder is highly complex. The term "borderline" is due to the fact that the disorder was classified between the formerly neurotic (e.g. conversion, anxiety, obsessive-compulsive disorder) and psychotic disorders (e.g. schizophrenia).

Polysymptomatic

  • Impulse control disorder: Patients experience uncomfortable states of tension that they can only resolve through short-term, impulsive actions. This can be seen in high-risk behavior, binge eating, excessive alcohol, dropping out of professional training, private relationships and therapy
  • Selfharming behaviour
    • Typical injury patterns
      • "Scratches"
      • Cigarette expressions
    • root cause
      • The action is usually carried out to "feel" and relieve yourself
      • Self-harm leads to euphoric kicks similar to addiction
      • Uncommon: Impulsive self-hatred leading to self-harm
  • Suicidality (see also: Suicidality in the context of underlying psychiatric diseases)
  • Derealization
  • Act
  • Increased affects
  • Affective instability
  • Polytoxicomania
  • Uncertainties regarding self-image and identity

Comorbidities

therapy

Psychotherapeutic procedures

Dialectical behavioral therapy

Based on cognitive behavioral therapy, Marsha Linehan's dialectical-behavioral therapy was specially developed for the treatment of emotionally unstable personality disorders of the borderline type. The therapy can take place in individual and group therapies, whereby it is of great importance that the therapist develops a strategy for understanding and appreciating the patient's problem in order to be able to guarantee adequate psychotherapy.

Schema therapy according to Young

In their lives, people learn certain basic schemes that serve to satisfy their basic psychological needs, but which at the same time also control their behavior. Unfavorable childhood experiences lead to schemata that are deliberately difficult to access and which are then primarily responsible for personality disorders. The schema therapy according to Young tries to make these misdeveloped (maladaptive) schemata therapeutically ineffective.

  • Characteristics of schema therapy
    • Combination of various therapeutic concepts (including cognitive behavioral therapy, psychodynamic therapy, gestalt therapy)
    • The therapist should be particularly empathetic towards the patient
    • Reparenting

Medical therapy

The administration of benzodiazepines should be avoided due to the potential for dependence!

Coding according to ICD-10-GM version 2021

Source: Based on the ICD-10-GM version 2021, DIMDI.

swell

  1. Bandelow et al .: Short textbook psychiatry. 2nd edition Steinkopff 2008, ISBN: 978-3-798-51835-3.