Reference
Guide | Reference

29  Emotion Regulation, Self-Concept, and Interpersonal Pain

29.1 Summary

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

29.2 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.”

29.3 Core Features

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

29.4 Boundary Markers

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

29.5 Variants / Spectrum

  • Emotion lability or explosive reactions.
  • Chronic shame or identity instability.
  • Interpersonal conflict or push-pull patterns.
  • Emotional numbing or dissociative shutdown.

29.6 Severity Anchors (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.

29.7 Time-Course Patterns

  • Chronic with episodic spikes.
  • Trigger-linked to attachment or rejection cues.

29.8 Functional Impact

  • Work/school: conflict, instability, absenteeism.
  • Relationships: ruptures, withdrawal, or intense dependency.
  • Self-care: impulsive or self-damaging behaviors.

29.9 Common Mimics / Differential

  • Trauma-related dysregulation.
  • Mood episodes with irritability.
  • Substance-driven impulsivity.

29.10 Medical / Substance Rule-Outs

  • Substance intoxication or withdrawal.
  • Neurologic contributors to impulse control.

29.11 Developmental Expression

  • Adolescence: identity shifts, relational volatility.
  • Adulthood: chronic interpersonal instability.
  • Late life: isolation or entrenched patterns.

29.12 Cultural / Context Notes

  • Relationship norms and identity frameworks vary by culture.
  • Ongoing adversity amplifies relational pain.

29.13 Measurement Prompts

  • Brief emotion regulation screening.
  • Relationship instability tracking.

29.15 Documentation Snippet (1-2 lines)

  • “Reports intense emotional swings and fear of abandonment; Personality Functioning 3; chronic course.”