Emotionally Unstable Personality Disorder (EUPD): Diagnosis, Treatment, and Management
 |
| Credit via https://goodhealthpsych.com/ |
(TOC)
In-Sight into Emotionally Unstable Personality Disorder
Emotionally Unstable Personality Disorder is a perplexing condition that has
affected about 1.6% of the entire population with more cases reported in the
clinical setting [1]. EUPD presents as a long-standing person’s relationships,
self, and emotional functioning with effortful control of impulses.H3: Key
Features of EUPD
The Emotionally Unstable Personality Disorder termed Borderline Personality Disorder (BPD) has the following characteristics:
1. Unstable bonds – Patients with EUPD frequently develop many short-lived
intense and close bonds with other people. They are prone to developing an
intense fear of abandonment and find it difficult to hold on to stable
relationships.
2. Disturbance in self-concept: An individual suffering from EUPD suffers from an unrealistic
perception of self and goes through extreme highs and lows of self-worth
3. Affective dysregulation: Nonspecific intense and highly variable affect is
characteristic, including episodes of irritability, fury, and dysphoria, and
poor control of gamuts of effective expression.
4. Impulsiveness: There are excessive impulsive reckless activities such as
driving, taking drugs or eating excessively
5. Self-injurious behavior and risk of suicide: People with EUPD tend to cut
themselves or have thoughts of harming or killing themselves
6. Depersonalization: There may be periods of depersonalization – feeling cut
off from oneself or one’s surroundings.
7. Persistent Inner Emptiness: There are also chronic feelings of emptiness
and/or contentment devoid of activity.
8. Problems with Anger Control: There is often considerable rage and an
inability to control rage.
How Is EUPD Diagnosed?
The diagnosis of Emotionally Unstable Personality Disorder To this end, EUPD’s
diagnosis is based on the profile presented in the International Classification
of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) [2]. Thus, in order to be diagnosed with EUPD, a person needs
to fulfill a given number of criteria and, more importantly, display the
symptoms over a duration of time and across situations.
ICD- 11 Criteria
ICC is an abbreviation of the International Classification of Diseases, the 11th version which provides a standard for all diagnostic health information. Moreover, it is the system of classifying procedures and operations related to diseases, injuries, health problems, and other illnesses and conditions.
Some of the features of the ICD-11 include:
1. Revised and Expanded a Diagnostic Assessment: In addition, the ICD-11
carries a variety of ultimate health condition diagnostic criteria, which consider
the science and practice of medicine today.
2. Digital Integration: It supports an end-to-end digital process including
API, tools and online and off-line books.
3. Cultural and Language Independence: The framework for classification is
cohesively structured so that it is not culture or language-specific and can
therefore be utilized by everyone in the world.
4. Semantic Interoperability: Includes comparable statistics along with
semantic interoperability to enhance the sharing and analysis of data.
5. Broader Scope: ICD-11 contains positions on all health conditions including
mental, behavioral, or neurodevelopmental issues.
DSM-5 Defining Principles
Psychiatry has a wide-ranging scope, and equally so is the DSM-5 which assists
in rational and intelligent synthesis of psychiatric diagnoses. There are these
such major features:
1. DSM-5 provides the outlines and the diagnostic criteria for several
psychiatric illnesses, from the most prevalent mood disorders and anxiety
disorders to the rarer psychotic disorders and others.
2. Revised cardinal symptoms: Since there are a plethora of the latest studies
undertaken in respective fields, alterations have been made in the symptoms of
most disorders.
3. Dimension assessments: DSM-5 has dimensional assessments for specific types
of disorders which is useful in schizophrenia in particular in clarifying the severity
of symptoms.
4. Cultural Factors: The work manuals contain provisions on how to bear
cultural issues during diagnosing and treating patients.
5. Prescriptive Disorders
Etiology and Risk Factors
Etiology and Risk Factors
The etiology and risk factors associated with Emotionally
Unstable Personality Disorder (EUPD), also commonly referred to as Borderline
Personality Disorder (BPD), are notoriously intricate and multi-layered. Here
are some of them:
1. Genetic Factors: Family studies at a temporal dimension
have consistently demonstrated that borderline personality disorder has a
greater prevalence in some families than in others indicating the familial
aggregation of the disorder1. However, there are no definitive studies linking
any particular gene to the disorder1.
2. Assessment of Brain structure and Function: Research has
shown that patients with borderline personality disorder have the same
structures but enhanced functioning of the areas of the brain involved with emotion
and impulse regulation1.
3. Neurotransmitter Imbalance: Other chemical messengers,
more commonly referred to as neurochemicals like serotonin, have been proven to
have a relationship with BPD1. These are substances that modulate emotions and
behaviors1.
4. Environmental Factors: The occurrence of distressing
events in a person’s life, such as physical aggression or emotional
deprivation, or loss in childhood, tends to be very high among individuals with
diagnosis of BPD2. In addition, prolonged trauma and unstable home environments
are also contributing 2.
5. Personality Traits: Some attributes of character, for
example, provocative and emotionally oriented behavior, may contribute to the
manifestation of Borderline Personality Disorder.
6. Social and Cultural Factors: Some social or cultural
factors such as role or expectations, and compliance, may contribute to the
development and progression of BPD.
Having this knowledge will aid in the development of
effective treatment and care strategies for individuals suffering from
EUPD/BPD.
Genetic Factors
Emotional Unstable Personality Disorder (EUPD), or Borderline Personality
Disorder (BPD), has a genetic component as well. Some provisions are as
follows:
Family Studies: Family and twin studies have shown that
borderline disorder has a genetic component. Most studies demonstrate that
personality disorders run in a family, hence they are inherited
2. Genetic Predisposition: Although BPD has no known
individual gene associated with it, it is suspected that the syndrome arises
due to a set of genetic factors.
3. Neurobiological
Factors: Some researchers have suggested a link between BPD1 and morphological
changes in structures of the brain responsible for emotions, impulse control,
and aggression. These changes may be due to genetic factors.
4. Epigenetics:
Trauma and other environmental exposures can cause epigenetic changes that
modify the degree of phenotype expression. For instance, trauma can induce gene
methylation that can be relevant to the pathogenesis of BPD3.
Understanding the
aspects that contribute to the genetic risk of BPD will be beneficial in the early
identification of those individuals and planning strategies for management.
Neurobiological aspects
Imaging techniques have evidenced the presence of structural and functional
alterations of the brain in people with EUPD, particularly those regions
associated with emotion regulation, control over impulses, and social
understanding [5].
H3: Social Factors
EUPD has been mostly associated with negative childhood experiences such as
trauma, abuse, neglect, and poverty of social validation. Such exposures would
most likely interact with genetic factors predisposing to the disorder [6].
Making a diagnosis
Making an EUPD diagnosis is not an easy task since it shares much with other
psychological illnesses. Thus, the healthcare providers should also explore the
following diagnostic possibilities:
1. Bipolar Affective Disorder
2. Depressive Disorders
3. Stress-Related Disorders (PTSD)
4. Disorders of Attention and Activity (ADHD)
5. Other personality disorders (e.g. NPD, HPD)
Therapeutic interventions of EUPD
The treatment process of Emotionally Unstable Personality Disorder is a multidimensional one and most commonly includes psychotherapy as well as pharmacotherapy. An individual treatment plan should be developed addressing the particular disorder and one's symptoms.
Psychotherapeutic Approaches
There have been numerous psychotherapies developed to manage EUPD which have
proven to be effective, such include:
1. Dialectical Behavior Therapy (DBT): This treatment programme for borderline
personality disorder, BPD incorporates cognitive approaches alongside
meditative practices to assist patients in managing their emotions as well as
fostering their relationships with others
2. Mentalization-Based Treatment (MBT): This mode of therapy aims at improving
a person’s capacity to comprehend their own mental processes and those of others,
enhancing relationships, and controlling emotions
3. Schema-Focused Therapy (SFT): The aim of SFT is to target and change EUPD
symptom-relevant schemas and behaviors that are problematic
4. Transference Focused Psychotherapy (TFP): As a psychodynamic form of
therapy, this intervention works toward enhancing the subject's ability to
possess coherent and integrated images of himself and of other people [10].H3:
Pharmacological Interventions
There have been numerous psychotherapies developed to manage EUPD which have
proven to be effective, such include:
1. Dialectical Behavior Therapy (DBT): This treatment program for borderline
personality disorder, BPD incorporates cognitive approaches alongside
meditative practices to assist patients in managing their emotions as well as
fostering their relationships with others
2. Mentalization-Based Treatment (MBT): This mode of therapy aims at improving
a person’s capacity to comprehend their own mental processes and those of others,
enhancing relationships and controlling emotions
3. Schema-Focused Therapy (SFT): The aim of SFT is to target and change EUPD
symptom-relevant schemas and behaviors that are problematic
4. Transference Focused Psychotherapy (TFP): As a psychodynamic form of
therapy, this intervention works toward enhancing the subject's ability to
possess coherent and integrated images of himself and of other people.
Pharmacological Interventions
Edinburgh University Personality Disorder is a severe type of personality disorder. However, there may be different medications depending on particular symptoms aimed at:
1. Depression: Antidepressant medications such as Selective serotonin reuptake
inhibitors (SSRIs) are perhaps sometimes effective against mood symptoms and
impulsivity.
2. Mood stabilizers: Drugs like lamotrigine or valproic acid may stabilize the
patient’s mood and also help in curbing impulsivity.
3. Antipsychotic medications: Since there have been improvements in the
management of cognitive dysregulation as well as severe emotional
dysregulation, low short-term doses of atypical antipsychotic medication have
been introduced into use.
4. Anxiolytic medication: Use of benzodiazepines may be of short-term benefit
in acute anxiety, but should be reserved only for the most severe, persistent
cases due to the potential for dependence and abuse.
Management Strategies for Healthcare Professionals
Dealing with patients with EUPD effectively requires doing more than one component in a related manner. Healthcare practitioners need to adopt the following strategies:
1. Create and adhere to the therapeutic boundaries.
2. Create a crisis management plan in case of threats of self-harm or suicidal
ideation.
3. Promote participation in psychosocial and support interventions.
4. Educate patients and families on EUPD and its treatment.
5. Interprofessional practice is instituted in order to provide holistic care.
6. Manage co-occurring disorders such as substance abuse or eating disorders.
7. Evaluate and monitor the course of treatment periodically therefore changing
strategies if need be.
The Prognosis and the Long-term Effects
Over the years EUPD has been regarded as a chronic disorder that is resistant
to treatment. New studies, however, show that such pessimism is not realistic.
Within the framework of adequate therapy, the majority of EUPD patients have a
noticeable reduction of the symptoms with time [11].
Long-term outcomes can also be improved by the following:
1. Early treatment and diagnosis.
2. Active participation in evidence-based psychotherapeutic techniques.
3. Constructing networks of social support.
4. Enhancing occupational and educational activities.
5. Decreasing intentional self-injury and desire to commit suicide.
Shrinking Research Gaps and Improvement in EUPD Management
The comprehension of Emotionally Unstable Personality Disorder is improving and new areas in treatment and research are emerging:1. Neuroscience interventions: the feasibility of using neurofeedback and/or transcranial magnetic stimulation to manage EUPD symptoms.
2. Targeted treatment: Creating treatment regimens based on genetics and neurobiological strategies.
3. Telehealth treatment: Using phone apps and virtual reality in management and skill development for EUPD patients.
4. Intervention approaches Approaches aimed at prevention and early detection and management of a developing illness with symptoms of EUPD.
5. Trauma-informed care: Understanding and incorporating the impact of trauma
into the development and treatment of EUPD.
Over the years EUPD has been regarded as a chronic disorder that is resistant
to treatment. New studies, however, show that such pessimism is not realistic.
Within the framework of adequate therapy, the majority of EUPD patients have a
noticeable reduction of the symptoms with time.
Long-term outcomes can also be improved by the following:
1. Early treatment and diagnosis.
2. Active participation in evidence-based psychotherapeutic techniques.
3. Constructing networks of social support.
4. Enhancing occupational and educational activities.
5. Decreasing intentional self-injury and desire to commit suicide.
Shrinking Research Gaps and Improvement in EUPD Management
The comprehension of Emotionally Unstable Personality Disorder is improving and
new areas in treatment and research are emerging:
1. Neuroscience interventions: the feasibility of using neurofeedback and/or
transcranial magnetic stimulation to manage EUPD symptoms.
2. Targeted treatment: Creating treatment regimens based on genetics and
neurobiological strategies.
3. Telehealth treatment: Using phone apps and virtual reality in management and
skill development for EUPD patients.
4. Intervention approaches Approaches aimed at prevention and early detection
and management of a developing illness with symptoms of EUPD.
5. Trauma-informed care: Understanding and incorporating the impact of trauma
into the development and treatment of EUPD.
Conclusion
The effects of Emotionally Unstable Personality Disorder can be debilitating to
the patients and the caregivers as well. This urges the need to define and
understand the interrelation between EUPD, its diagnosis and available
treatment methods so that clinicians can help patients more efficiently. As the
current state of affairs in research progresses, the expectations for the
improvement of conditions of individuals with EUPD are also on the rise.