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Emotional Dysregulation / Borderline Personality Disorder

answered 04:09 PM EST, Thu April 26, 2012
anonymous anonymous
My 48 year old brother has borderline personality disorder and he also has diabetes and hepatitis C. He lives independently on a disability check in a room he rents near my home and since our parents passed I have been the person that kind of looks out for him.

His health has worsened lately and so he has become eligible for home visits from a nurse and some sort of healthcare assistant. This has been really great because it took a lot of the burden off of me.

The problem is he very hard to deal with and because can be very verbally abusive it has gotten difficult for the agency to find nurses who are willing to continue to visit him after a few visits.

He can be very pleasant and charming at times, but as soon as something doesn’t go his way his entire personality changes and he can be very scary. He is a big guy and people often feel threatened although he does not ever become violent.

I have tried talking about this with him and he really wants the home visits to continue but he just doesn’t seem able to control himself. I can’t bear the thought of losing this help. It has really changed my whole life for the better in a very big way. I can’t go back to the way it was before. Is there anything that could be done to control him better? I am close to washing my hands of him but without anyone he will just die and I can’t live with that either.

Dr. James Strawbridge Says...

Your brother has many challenges all of which are chronic or they never go away. However, there is hope.

Mood Changes

The overall theme for this illness is rapid and unpredictable change, in thoughts, moods, behaviors, relationships, and beliefs about himself. When frustrating situations happen, he may become over-whelmed with anger and either lash our at others or keep the anger bottled up inside themselves. Battling emotional dysregulation can be very tiring and confusing. People with this problem are in severe physical, emotional, and psychological pain almost all the time. They often lack a sense of who they are. Very often, these rapid changes are caused by re-occurring fears of being criticized or deserted by other people. Small disagreements or change of plans can cause problems as emotional dysregulation. In response to these types of situations, a person with emotional dysregulation can suddenly become sad, nervous, angry, or short-tempered. Unfortunately, personality styles like this often create problems in relationships, jobs, and other situations. This personality style is officially referred to a “personality disorders,” and in many others as a “boderline personality disorder.”

The treatment of this problem most often involves a long-term commitment. On average, most people with emotional dysregulation go to at least six mental health professionals seeking the right person to help them. Many seek individual psychotherapy, group therapy, or family therapy, but in severe cases, hospitalization or inpatient care may be necessary.

Dialectic Behavioral Therapy

Many types of treatments have been shown to be effective for some cases. However, the treatment that has received the most validation for its effectiveness is dialectic behavioral therapy, which was developed specifically to treat emotional dysregulation. This treatment has been shown to relieve symptoms of emotion dysregulation, decrease the tendency to commit suicide, and decrease the tendency to misuse drugs. This last factor is especially important, because in one study, the absence of an alcohol or drug problem was the best predictor of symptom reduction.

Dialectical behavioral therapy balances the need for change with acceptance and understanding of current behavior. Furthermore, the treatment aims to broaden the ability to be mindful of the present, while also decreasing self-harming behaviors. Also it will teach new skills to regulate emotions, behaviors, and thoughts.

Medications

Many people with emotional dysregulation are also prescribed multiple medications. For example, small studies of some antidepressants have demonstrated some benefits. Fluvoxamine (Luvox) can decrease quick mood changes, While fluoxetime (Prozac) can decrease impulsive anger and impulsive hostility. Studies of antipsychotic medication, such as clozapine (Clozaril), risperidon (Resperdal), and olanzapine (Zyprexa), have also shown some benefits, including reduced hallucinations, reduced self-harming behaviors, reduced hostility and depression, and an overall feeling of improvement, especially when used in conjunction with dialectical behavioral therapy.

Similar small studies of the mood stabilizers vaproic acid (Depakote), the anti-convulsant to topiramate (Topamax), the anticonvulsive lamotrigine (Lamictal), and omega-3 fatty acids have also shown some evidence of reducing hostile behavior in people with emotion dysregulation.

Ask your family physician for a psychiatric referral. A psychiatrist can provide needed help regarding prescriptions.

 

References:

Abarini, M.C.., F.R. Frankenbury, J. Hennen,and K.R. Silk. (2004) Mental health service utilization by boderline personality disorder patients and Axis II comparison subjects followed prospectively for six years. Journal of Clinical Psychiatry 65: 28-36. Retrieved from Internet 04.24.2012. Retrieved from the Internet 04.25.2012

Rinne, F. W. van den Brink, L. Wouters, and R. van Dyck .(2002). SSRI treatment of borderline personality disorder: A randomized, placebo-controlled clinical trial for female patients with borderline disorder: American journal of psychiatry 159: 2048-2054. Retrieved from Internet 04. 25. 2012.Salzman, C., A. N. Wolfson, A.

Scatzberg, J. Looper. R. Henke, M. Albanese, et al. (1995). Effect of Fluxatine on anger in symptomatic volunteers with borderline personality disorder Journal of Clinical Psychopharmacology. Retrieved from the Internet 04: 25-29.

Coccaro, E. F., and R. J. Kavoussi. (1993). Fluoxetine and impulsive aggressive behavior in personality-disorder subjects. Archives of General Psychiatry 54: 1081-1088. Retrieved from the Internet 04.25.2012

Chengappa, K. N., R., T. Ebeling, J. S., J.Levin,and H. Parepally. (1999). Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder, Journal of Clinical Psychiatry 60: 477-484. Retrieved from the Internet 04.26.2012

Rocca, P., L. Marchiaro, E. Cocuzza, and F. Bogetto. (2002). Treatment of borderline personality disorder with risperidon. Journal of Clinical Psychiatry 63: 241—244. Retrieved from the Internet 04. 25.2012

Schulz, S, C,m J, K, Camlin, S, A, Berry, and J. A. Jesberger. (1999). Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia. Biological of Clinical 46: 1429-14 Psychiatry 69: 242-244. Retrieved from the Internet 04. 27.2012

Schulz, S. C., K. L. Camlin, J. Barrachina, D. Puigemont, E. Alvarez, et al. (23005). Double-blind, placebo-controlled study of dialectical behavioral therapy plus olanzapine for borderline personality disorder. American Journal of Psychiatry 162: 1221-1224. Retrieved from Internet 04. 27.2012

Frankenburg, F. R. and M. C. Zanarini. (2002). Divaproex sodium treatment of woman with boderline personality disorder and bipolar II disorder. A double-blind placebo-controlled pilot study. Journal pf Clinical Psychiatry 63: 442-446. Retrieved from Internet 04.27.2012

Nickel. M. K., Nickel, P. Kaplan, C. Lahmann, M. Muhlbacker, K. Tritt, et al, (2005). Treatment of aggressive with topiramate in male boderline patients: A double-blind, placebo-controlled study. Biological Psychiatry 57: 495-499. Retrieved from Internet 04.27.2012

Tritt, K., C. Lahmann, P. K. Leiberch, W. K. Rother, T. H. Loew , et al. (2005) Lomotigine treatment of agression in female boderline-patients: A randomized, double-blind, placebo-controlled study, Journal of Psychopharmacology 19: 287-291.Retrieved from Internet 04.27.2012

Zanrini, M. C., and F. R. Frankenburg. (2003). Omega-3 fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. American Journal of Psychiatry 160: 167-169. Retrieved from Internet 04. 26.2012

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Page last updated Apr 30, 2012

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