Emotionally Unstable Personality Disorder (EUPD) – A carer’s perspective

Bearing witness to self-harm and suicidal risk, psychosis, anger, extreme sadness, vulnerabilities to abuse, exploitation, and sectioning is beyond devastating.

For those that don’t know, EUPD is a mental disorder which affects approximately 1% of the population, with more women than men presenting to services (Nice Guidance, 2015). It is typically diagnosed in adulthood (although traits can be identified in adolescence) (Nice Guidance, 2015). Many individuals are likely to have comorbid anxiety, depression, PTSD and/or disorders associated with alcohol and substance misuse (Leichsenring et al., 2011).

EUPD is distinguished by a long-standing instability in the context of sustaining relationships, emotional dysregulation, identity fragmentation, and impulsivity (Leichsenring et al., 2011).

Relationship difficulties

Those with EUPD are likely to display interpersonal difficulties including fear of abandonment and rejection and attachment problems (Snyder & Whisman, 2003). Although people with EUPD desire relationships, they experience difficulties in maintaining them due to high expectations of how others should behave towards them and their intense emotional responses to this (Snyder & Whisman, 2003).

Emotional dysregulation

Difficulties in regulating emotions is a common feature of EUPD. Individuals commonly display strong (and often inappropriate) reactions to stimuli (e.g. aggression) and may react by engaging in risky and/or self-destructive behaviour followed by feelings of guilt, shame, and worry about losing supportive networks (Snyder & Whisman, 2003). In general, people with EUPD are labile in mood, hypervigilant to emotional cues and have poor coping mechanisms (Carpenter & Trull, 2013).

Identity fragmentation

Many people with EUPD struggle to develop a consistent identity and often switch from one self-concept to another depending on their mood (Fucsh, 2007).

Impulsivity

Impulsivity is a prominent characteristic of EUPD often resulting in self-injury, recklessness, alcohol and/or substance abuse, excessive behaviours (e.g. overspending), suicide related behaviours (E.g. threats, attempts and completed suicide) (Snyder & Whisman, 2003). A high percentage (8-10%) of people with EUPD die by suicide (Leichsenring et al., 2011).

Research suggests common psychosocial and biological factors which contribute to the development of the illness, including childhood trauma (including abuse and neglect), numerous adverse experiences, abnormalities in the serotonergic system and increased amygdala activity in response to negative/inducing emotional stimuli (Leichsenring et al., 2011).

Personal experience

Being a carer for someone who experiences these difficulties can be incredibly taxing. Bearing witness to self-harm and suicidal risk, psychosis, anger, extreme sadness, conflicts between wants and needs, vulnerabilities to abuse and exploitation and sectioning is beyond devastating. It is undoubtedly detrimental to your own mental health and well-being. When you want to be there to support someone who also wants you but also pushes you away is conflicting and a difficult concept to work with. I often felt like a ping pong ball – bouncing between trying to be sensitive and supportive, to fearing being open and honest, to losing my nerve, to biting my lip, to walking away, to reminding myself that they can’t always control their emotions. However many guides there are to supporting someone with a EUPD, you’ll never really know until you’re faced with it and when that someone is a relative it is 5x harder.

Tips for caring for someone with EUPD

I’d say that the most important things when caring for someone with BPD is to:
Research EUPD to gain a better insight of what you’re dealing with
Prioritise your own self-care
Establish healthy boundaries with them
Not tolerate abusive behaviour
Recognise that the person’s behaviour is a form of communication (e.g. emotional distress) and if a behaviour is aimed towards you, remember that it’s not always intentional
Understand that their interpersonal difficulties stem from attachment problems and a fear of abandonment
Identify and try to minimise certain triggers
Collaborate with them to develop positive coping strategies
Try to stay calm
Avoid defensiveness
Try to make them feel acknowledged and understood

References

Carpenter, R.W., & Trull, T.J. (2013). Components of Emotion Dysregulation in Borderline Personality Disorder: A Review. Current Psychiatry Reports, 15(335). https://doi.org/10.1007/s11920-012-0335-2

Fucsh, T. (2007). Fragmented selves: Temporality and identity in borderline personality disorder. Psychopathology, 40(6), 379-387. https://doi.org/10.1159/000106468

Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 377(9759), 74-84. doi:http://dx.doi.org/10.1016/S0140-6736(10)61422-5

Nice Guidance. (2015, June, n.d.). Borderline personality disorder: Recognition and management. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/qs88/chapter/Introduction

Price, D. (2018, March 23). Laziness does not exist. Medium. https://humanparts.medium.com/laziness-does-not-exist-3af27e312d01

Skodol, A. (2020, January, n.d.). Borderline Personality Disorder (BPD). MSD Manual. https://www.msdmanuals.com/en-kr/home/mental-health-disorders/personality-disorders/borderline-personality-disorder-bpd#

Snyder, D.K., & Whisman, M.A. (Eds.). (2003). Treating difficult couples: Helping clients with coexisting mental and relationship disorders. The Guildford Press.