I recently had a client who created a huge amount of turmoil for me. I couldn’t put my finger on what was going on with him. He was erratic and tearful during our therapy sessions and left me feeling drained and exhausted. I knew the energy being projected onto me was unusual and far more intense than the average client but still I was unable to pinpoint what was going on for this particular client.
I would end each session scratching my head and feeling frustrated at the lack of progress and clarity. Of course, Cognitive Behavioural Therapy doesn’t work for everyone but my instincts told me there was something else going on here.
This client would regularly project his frustration on to me, telling me that his other exercise therapist who helped him to relax through exercise was far more useful and effective than I was. It was clear that this client would release a ‘sting’ every now and then. All of this behaviour was ahuge clue as to the underlying issue but it has taken eight sessions for me to finally figure out what was going on.
This client has Emotionally Unstable Personality Disorder:
Symptoms of EUPD:
Emotionally Unstable personality disorder (formerly known as Borderline Personality Disorder) is a mental disorder that results in four groups of symptoms:
- Impaired Emotional Control: excessive, poorly regulated emotional responses, especially anger, that change rapidly;
- Harmful Impulsivity: impulsive behaviors that are harmful to you or to others, such as spending sprees, excessive use of alcohol or drugs, self-injurious acts (e.g., cutting), physically aggressive acts and sexual indiscretions;
- Impaired Perceptions and Reasoning: suspiciousness, frequent negative perceptions of other’s intention, an unstable self-image, a poor sense of your identity, and difficulty in reasoning under stress; and
- Disrupted Relationships: tumultuous relationships with a person close to you that vary from extreme fear of abandonment to episodes of excessive anger and the desire to get away from that person.
This client was one of the very few clients who sent me unpleasant emails saying that I was not being effective enough and putting pressure on me to ‘fix’ him whilst doing very little of the work suggested during therapy sessions.
This is typical of someone with EUPD – they ‘project’ their inner chaos onto others and leave exhaustion and confusion in their wake.
How to manage Emotionally Unstable Personality Disorder
Cognitive Behavioural Therapy together with medication can be hugely beneficial to someone who has EUPD. The most commonly used and effective mood stabilizers for emotionally unstable personality disorder are topiramate (Topamax) and lamotrigine (Lamictal). These medications are also referred to as antiepileptic drugs because they are commonly used for people suffering from partial complex seizure disorder.
Dialectical behaviour therapy (DBT)
Dialectical behaviour therapy (DBT) is a type of therapy specifically designed to treat people with BPD.
DBT is based on the idea that 2 important factors contribute towards BPD:
- you are particularly emotionally vulnerable – for example, low levels of stress make you feel extremely anxious
- you grew up in an environment where your emotions were dismissed by those around you – for example, a parent may have told you that you had no right to feel sad or you were just “being silly” if you complained of feelings of anxiety or stress
These 2 factors may cause you to fall into a vicious cycle – you experience intense and upsetting emotions, yet feel guilty and worthless for having these emotions. Because of your upbringing, you think having these emotions makes you a bad person. These thoughts then lead to further upsetting emotions.
EUPD can be safely managed but it needs professional intervention. Seek help now to move towards a calmer more contented life.