Personality disorders appear when a person’s way of being, thinking and feeling deviates from the normal, altering his daily functioning, causing discomfort and preventing him from adapting to the daily situations of the person. life (social, professional, personal, …).
Today we will experience a very specific disorder, emotional instability of the personality disorder, Characterized by a marked impulsiveness alongside an unstable and temperamental mood.
The disorder in ICD-10 and DSM-5
Emotional instability of the personality disorder it is a disorder included in ICD-10, but not in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). The ICD-10 classification of personality disorders, compared to that of DSM-5, is more complex and structured.
The ICD-10 (International Classification of Diseases) groups personality disorders into different categories:
- Specific personality disorders (where emotional instability disorder is found).
- Mixed disorders and other personality disorders.
- Persistent personality changes.
Define Emotional Instability Personality Disorder as the existence of a marked predisposition to act impulsively whatever the consequences, next to an unstable and capricious mood.
In this model of behavior, the planning capacity is minimal and intense outbursts of anger are common, Which lead to violent attitudes or explosive demonstrations; these are easily provoked by receiving criticism or frustrating the subject in his impulsive acts.
There are two variations of this personality disorder, which share the general aspects of impulsivity and lack of self-control. They are as follows.
Impulsive type emotional instability personality disorder
is characterized by emotional instability and lack of impulse control. In addition, outbursts of violence or threatening behavior occur frequently, especially in the face of criticism from third parties.
It includes Explosive Aggressive Personality Disorder and Explosive Aggressive Personality Disorder for its diagnosis, and excludes Dissocial Personality Disorder for its diagnosis.
Borderline Emotional Unstable Personality Disorder
There are characteristics of emotional instability, and more distortions in body image, own goals, and intimate image (Which are presented in a confusing or modified way).
There is also a feeling of emptiness and the ease of being involved in intense and unstable interpersonal relationships, which can generate repeated emotional crises and be accompanied by a succession of threats of suicide or self-acts. -aggression. Self-harm can also occur without obvious precipitating factors. A tendency to self-harm thus appears.
He includes borderline personality disorder and borderline personality disorder for his diagnosis.
In DSM-5, ICD-10 borderline personality emotional instability disorder corresponds to borderline personality disorder (BPD).
Impulsivity treatment and impulse control
Let’s see how these two personality disorders can be treated in the clinical setting.
Focusing on the first subtype, Impulsive Type Emotional Instability Personality Disorder, we can differentiate two areas to be addressed: impulsivity and impulse control.
For impulsiveness they were bred self-study and problem-solving training techniques (Although the former are more focused on children and adolescents, they can also be used on adults).
Self-learning is a technique by which the subject gives himself a set of commands or instructions for the autonomous regulation of his own conduct.
The goal is to provide it to the child or adolescent a quick and efficient way to succeed in a task or behavior, Preventing him from acting impulsively.
The problem-solving technique, on the other hand, aims to solve problems through well-defined steps and with the division of the problem into small parts.
For the control of impulses, at the psychological and behavioral level, they can be used exposure techniques with response prevention (For example for pathological gambling associated with this personality disorder), alongside cognitive therapy.
Pharmacologically, neuroleptics, antidepressants, lithium and antiepileptics, among others, can be used to control impulses.
Treatment of borderline personality disorder
The most effective therapy for borderline personality disorder so far is Dialectical Behavior Therapy, developed by psychiatrist Marsha Linehan in the late 1990s.
The therapy poses TLP as an emotional dysregulation disorder. It follows an integrative approach and is based on behavioral and cognitive principles alongside the elements of mindfulness.
It is suitable for cases of BPD where suicide attempts have occurred; it also treats the symptoms of depression, anxiety, anger, impulsivity and impulse control inherent in the disorder. It consists of 3 fundamental strategies: change, acceptance and dialectical understanding. The 4 treatment modalities are: individual therapy, telephone contact, consultation with the therapist and group skills training.
- WHO (1992), ICD-10. Tenth revision of the international classification of diseases. Mental and behavioral disorders. Clinical description and diagnostic guidelines. Madrid: Ed. Meditor.
- Gempeler, J. (2008). Dialectical behavior therapy. Tower. Columbus. Psychiatry., 37 (1).
- Roncero, C., Rodríguez-Urrutia, A., Grau-López, L. and Casas, M. (2009). Impulse control and antiepileptic therapy disorders. Acts. Esp. Psychiatry., 37 (4), 205-2012.