Emotions are described as short-lived feelings that come from a known cause, whilst moods are feelings that are longer lasting and have no clear starting point. However how emotions and moods may be defined, BPD is characterized by emotional states that can change quickly. The emotions, or “mood swings” as it is often described, change often, even within an hour. Any mood state can be experienced except feeling stable, just “normal”. People suffering from BPD often feel they cannot control their emotions. These rapidly changing emotions make it difficult to be in a stable relationship. The lack of control over their emotions as well as awareness how it affects the people close to them, feeds into their already poor self-esteem. In this article we will look at which mood states can be experiences, and then we will touch on the treatment options to stabilize these moods.
Together with instability in their interpersonal relationships and self-image, instability in affect (moods) are the top three characteristics of BPD. My previous article ‘Borderline Personality Disorder for beginners’ describes all the symptoms of BPD.
Which mood states and emotions can a person suffering from BPD experience?
People who have BPD suffer a lot. They usually have many problems to deal with daily, as well as issues from the past. They usually have interpersonal relationship problems, and feel they do not have many, if any, people close to them who will support them. These problems can contribute to feeling depressed. However, the low mood (called dysphoria) that characterizes major depressive disorder is present most of the day, nearly or every day, for at least two weeks.
Sufferers of chronic/persistent depressive disorder as well as those with BPD can experience chronic dysphoria, overeating and low self-esteem, but people with BPD do not have sustained symptoms of related to sleep and energy. This means that people with BPD can feel very sad and down most of the time, but they do not tick all the boxes to be diagnosed with Major Depression.
- Hypomania and mania
To meet the criteria for Bipolar Mood Disorder at least one manic or hypomanic episode is necessary. These episodes are characterised by periods of elevated, euphoric, or irritable mood- basically being on a “high” without a clear reason to be e.g. using drugs. People with BPD often have short lived episodes of being hyperactive and silly.
- Chronic emptiness
This is an interesting mood state, and very typical of BPD. The moods that come with BPD are extreme, and in between depression and euphoria there is a state of “feeling nothing” or feeling dead inside. This is an extremely uncomfortable state which is difficult to tolerate, and the person can go over into an action that will make them feel more “alive” e.g. cutting.
- Irritability and anger
This presents as frequently losing your temper, constantly being angry and can even lad to physical fights.
All the variants of anxiety are usually present- panic attacks, constant worrying and stressing or even symptoms of full-blown Post Traumatic Stress Disorder.
- In a nutshell- people suffering from BPD basically never feel normal
When asked when last they felt normal (e.g. not depressed, too happy, empty or angry) most sufferers of BPD will reply never, or they often cannot remember when they last felt ok.
These rapidly changing moods are highly uncomfortable, and most people who have unstable moods as described above with often think about suicide. There might be multiple suicide attempts. BPD is characterized by extremes in every sphere of life, and ironically the feel most ‘at home’ when their moods or relationships are unstable. Being ‘in the middle of the road’, content as things are, is a difficult state to be in. This also applies to the idea of being alive. Many sufferers of BPD are ambivalent about whether they want to be dead or alive.
We will look at the treatment of BPD in a next article, but regarding managing the moods it includes:
- Psychotherapy is most effective to help the patient to regulate and tolerate their moods. This can be in a group or individual setting. Dialectical Behavioural Therapy (DBT) is an effective psychotherapeutic modality where skills are learned such as Emotional Regulation and Distress Tolerance.
- Antidepressants are mostly not effective for these mood states. More often we will prescribe a mood stabilizer or antipsychotic.