Everyone feels terrible about themselves occasionally, but there’s a stark difference between transient feelings of low confidence and a persistent crisis of self-image.
Emotionally Unstable Personality Disorder (EUPD) [1] is a debilitating mental illness that seeks to attack our relationships and self-worth.
Also known as Borderline Personality Disorder (BPD), this condition is one of a small group known as “Cluster B” personality disorders, which involve more dramatic symptoms.
Hollywood portrayals and media misrepresentation have created an atmosphere of confusion around EUPD, with many people unsure how it is defined.
Essentially, personality disorders are illnesses that affect how someone views themselves and others.
Their view of themselves, mood swings, and fear of abandonment often mean they can’t function normally or maintain relationships.
According to The International Classification of Diseases (ICD) [2] 10th edition by the World Health Organisation, EUPD patients have problems with emotional regulation.
This means that a little good news can make them over joyous and a little bad news can make them feel rejected, alienated or hopelessly sad.
The DSM-5 adds to this, stating that BPD is “a pervasive pattern of instability of interpersonal relationships, self-image and marked impulsivity, beginning in early adulthood and present in a variety of contexts.”
It is difficult to pin down the exact causes behind EUPD, but experts have suggested a combination of genetic, psychological and environmental factors.
Those who have family living with EUPD may be more genetically vulnerable to the condition, despite limited evidence.
Other studies suggest people who live with personality disorders have more active parts of their brains. [3]
These overactive regions are responsible for self-control and emotional regulation.
However, the most definitive cause is also the most harrowing.
An overwhelming number of EUPD sufferers experience physical, sexual, or emotional abuse as children. [4]
This might have also included maternal detachment, abandonment or neglect.
Everyone suffering from EUPD will have a different experience of this complex condition.
For some, self-identity crises are common, and for others, they struggle to manage their ever-changing emotions.
Thankfully, symptoms have been condensed into a handle manual, often used by clinicians to treat personality disorders.
When identifying the symptoms of EUPD, the gold-standard text to refer to is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), [5]
This helpful manual outlines nine key criteria in an easy-to-understand format.
Both clinicians and patients can read through and judge the relevance of each symptom and how it relates to their situation.
Typically, someone with EUPD will relate to five of the following symptoms: [6]
Although EUPD is a long-term, often lifelong illness, this doesn’t mean it can’t be treated.
Like all mental health disorders, this illness cannot be cured in the traditional sense, but it can be successfully managed.
With the right help, those with personality disorders [7] go on to live fulfilled, comfortable lives.
Receiving a diagnosis is the best way to access treatment for EUPD here in the UK, and it starts by contacting your GP.
After an initial assessment performed by your doctor, you may be referred to secondary mental health services in the NHS.
Here, a psychiatrist will ask you to participate in an interview, asking questions regarding your physical health, life situation and symptoms.
A crucial element of diagnosis is ruling out similar conditions, and screening for co-occurring disorders.
This means figuring out whether you may have another illness such as anxiety, bipolar disorder, depression or Substance Use Disorder (SUD).
Following the assessment, your doctor or psychiatrist will make a formal diagnosis by compiling all the information they’ve given.
This allows them to recommend treatment options, [8] whether these are via the NHS or through a private mental health clinic.
Here in the UK, many people struggling with EUPD opt for NHS treatment, as it’s far more affordable than private care.
However, waiting times for talking treatments via the NHS [9] can be long, and specialist services might not be available at your nearest hospital.
Because of this, many people consider going private to access care immediately.
Despite the expense of these services, many therapists these days offer sliding scale payments to be more accessible.
Whether you opt for NHS or private care, the treatments you’ll encounter for EUPD will include a combination of the following methods.
Talking therapies are thought to be the most effective way of treating EUPD, especially when they occur one-on-one with a therapist.
In a non-judgemental clinical environment, patients can work through their difficult emotions, tackle childhood trauma, and foster ways of coping with their illness.
When searching Google for EUPD treatments, Dialectical Behaviour Therapy (DBT) is the first option that appears.
Widely considered the most effective treatment for personality disorders, DBT takes an integrated approach to healing, focusing on emotional recovery and learning how to thrive again.
DBT takes inspiration from its older counterpart Cognitive Behavioural Therapy, but instead of focusing purely on thought processes, it aims to treat emotional problems.
The overarching aim of most DBT programmes is to help the patient accept themselves and their EUPD while working through past trauma and suspending judgment.
By helping people accept painful emotions and learn to let them pass, DBT allows them to form new coping skills such as mindfulness and breathing techniques.
As part of their interpersonal skills training, patients are taught how to recognise and label negative feelings, helping them to cultivate healthier relationships with others and themselves.
MBT is accessed during residential treatment, as it is a specialised therapy not usually offered by the NHS.
As the name suggests, Mentalisation therapy [10] helps EUPD sufferers interrogate their mental processes.
Essentially, they’ll spend sessions “thinking about thinking,” identifying and challenging the various beliefs they hold.
By challenging the way they think, patients can gain a greater understanding of why they carry out self-destructive behaviours, often on impulse.
Over time, patients can learn how to step back and view a situation before making a decision.
For example, someone with EUPD has the frequent urge to self-harm and will act on this impulse without question.
This is because they don’t have the ability to step back and question their actions.
MBT will teach them how to protect themselves by knowing how to tell that they are upset and controlling their impulses.
Similarly to CBT and MBT, schema-focused therapy for borderline personality disorder [11] focuses on identifying and changing unhealthy thinking patterns.
To do this, ST takes inspiration from cognitive behavioural therapies and applies its overarching theory.
This theory states that when a child undergoes trauma or abuse, they are prone to developing unhealthy ways of viewing the world, which is known as maladaptive early schemas.
These ingrained beliefs and worldviews are often related to their sense of self.
With this in mind, schema-focused therapy for EUPD aims to identify the patient’s unique schemas, link these to past or current events, and then work on processing the emotions.
This involves re-thinking unhealthy coping mechanisms, such as abusing drugs or alcohol, and treating EUPD from its root causes.
When someone starts treatment for EUPD, they may be prescribed medication [12] to manage their symptoms.
While medications aren’t the be-all-and-end-all for treating this illness, they can be very useful when used alongside psychotherapy.
The most commonly prescribed medications include:
If someone is endangering themselves or others, they may be in a crisis phase of their Emotionally Unstable Personality Disorder.
In such a situation, sufferers may be admitted to a psychiatric hospital [13] where they’ll stay overnight and receive treatment.
This is to ensure their well-being and give them a safe space to convalesce.
Depending on someone’s severity, they may be partially hospitalised, which involves day-care before returning home, or they may be required to stay for weeks at a time.
During their stay, they’ll have the constant support of clinicians and psychiatrists, who will build a treatment programme to suit their needs.
For the initial phase of crisis, they may also need sedative medications to remain calm.
Holistic therapies, also referred to as alternative therapies, are becoming increasingly popular treatments for EUPD and other mental health disorders.
Because these therapies are non-traditional and don’t involve medication, they are often viewed as additional treatments.
In essence, HT helps individuals with EUPD achieve a healthier lifestyle, with activities introduced to promote mental and physical well-being.
This often includes artistic pursuits and creative outlets, which have been shown to help with emotional stabilisation and dopamine release.
Other popular holistic therapies include yoga, mindfulness, Pilates, cooking classes and martial arts.
Another key treatment for EUPD is Group Support Therapy which helps people form meaningful connections as part of their recovery.
These communities are designed to help people work together, listen to each other’s experiences, and ultimately support one another through the process of EUPD treatment.
They can share coping mechanisms that have helped them manage their emotions and stay grounded in the present moment.
Support groups can be accessed both in-person and online, with many found in communities across the UK.
Peer online support groups such as Emotions Matter BPD [14] offer programmes, education and resources for those impacted by BPD, whether it’s individuals with the illness, family members supporting them or professionals.
If you or someone you love is experiencing the symptoms of EUPD, don’t hesitate to access the help you need.
We know that the situation can feel overwhelming and that there are a lot of intense feelings involved when navigating personality disorder treatment.
To speak with a professional and assess your treatment options, call Rehab 4 Addiction today or complete our online inquiry form.
[1] https://pubmed.ncbi.nlm.nih.gov/31488741/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577172/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1863557/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5248407/
[6]https://www.google.co.th/books/edition/Borderline_Personality_Disorder_Demystif/oRYYuAEACAAJ?hl=en
[7] https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview/
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058872/
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199382/
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816926/
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248917/
[12] https://pubmed.ncbi.nlm.nih.gov/34151763/
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543278/
[14] https://emotionsmatterbpd.org/peer-support-groups-information
Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
