Guide
Guide | Reference

19  Emotion Regulation, Self-Concept, and Interpersonal Pain

19.1 Summary

  • Intense or unstable emotions, shifting self-concept, and painful relational patterns that drive distress and functional impairment.

19.2 Patient-Language Phrases

  • “My emotions feel too big to handle.”
  • “I don’t know who I am.”
  • “I’m terrified people will leave.”
  • “I feel empty or numb.”

19.3 Core Features

  • Rapid emotional shifts or intense affect.
  • Unstable self-image or chronic emptiness.
  • Fear of abandonment and relational volatility.

19.4 Boundary Markers

  • What it is: persistent patterns of regulation difficulty and relational pain.
  • What it is not: situational reactions that resolve with context changes.

19.5 Quick Structure

  • Variants / Spectrum
    • Emotion lability or explosive reactions.
    • Chronic shame or identity instability.
    • Interpersonal conflict or push-pull patterns.
    • Emotional numbing or dissociative shutdown.
  • Severity (0-4)
    • 0: No significant regulation or interpersonal difficulties.
    • 1: Mild, situational, manageable.
    • 2: Moderate, recurring, impacts function.
    • 3: Severe, persistent, with relational instability.
    • 4: Extreme, disabling or unsafe.
  • Time-course
    • Chronic with episodic spikes.
    • Trigger-linked to attachment or rejection cues.
  • Functional impact
    • Work/school: conflict, instability, absenteeism.
    • Relationships: ruptures, withdrawal, or intense dependency.
    • Self-care: impulsive or self-damaging behaviors.
  • Developmental expression
    • Adolescence: identity shifts, relational volatility.
    • Adulthood: chronic interpersonal instability.
    • Late life: isolation or entrenched patterns.
  • Cultural/context notes
    • Relationship norms and identity frameworks vary by culture.
    • Ongoing adversity amplifies relational pain.