How does Emotionally Unstable Personality Disorder (EUPD) impact court users involved in legal proceedings? And how can an intermediary assist? Communicourt intermediary, Rhianna McGreevy, takes a closer look at this diagnosis and strategies to improve access to justice.
Emotionally Unstable Personality Disorder [EUPD] (also known as Borderline Personality Disorder [BPD]), is a complex and misunderstood condition. Individuals who carry this diagnosis may experience longstanding pervasive difficulties in relating to others and themselves. The difficulties that individuals with EUPD experience will usually be apparent in multiple situations across their personal and professional lives.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies 10 personality disorders, which are subdivided into three ‘clusters’. These clusters group the disorders in terms of their defining characteristics. EUPD is one of four personality disorders in Cluster B, all of which are defined by their “dramatic, emotional or erratic” nature.
What causes EUPD?
It is hard to determine what causes EUPD, but studies have suggested that it is likely a combination of genetic and environmental factors. The heritability of EUPD is estimated to be around 46%. However, while genetic pre-disposition may increase your likelihood of diagnosis, there are many other factors that contribute to someone’s overall risk of developing EUPD. The individual, their environment and their personal circumstances are all extremely influential.
It is common for people with EUPD to have experienced a significant trauma. Common environmental factors that have been experienced by people with EUPD include being the victim of sexual, physical, or emotional abuse, or the experience of adverse childhood experiences (ACEs) which can include growing up in a neglectful environment, growing up in fear, or living in the shadow of a relative with poor mental health or substance abuse issues.
Stigma and labels
EUPD is heavily stigmatised as a condition, and individuals with the diagnosis are often deeply and profoundly misunderstood. Using the word ‘disordered’ to describe an individual’s personality can denote a sense that there is something wrong with the very essence of who they are. The individual with EUPD may find that others do not view their behaviour in the context of their diagnosis, but rather see the individual as being wilfully and deliberately unreasonable or selfish.
This simplifies a very complex subjective experience and disregards the deeply rooted causes of EUPD. Our brains are constantly trying to adapt and survive, and personality disorders are often developed in response to difficult circumstances. Emotionally unstable personality disorder, and the thoughts, feelings and behaviours that accompany it, are more helpfully viewed as the brain trying to adapt in order to survive the abandonment, abuse, or neglect it has experienced in the past, and to protect the self from experiencing similar traumas in the future.
Symptoms of EUPD
Individuals with EUPD often live with an intense fear of abandonment. They may carry a deep-rooted belief that they are inherently ‘bad’, and that others are ‘good’. They may also be hypersensitive to the possibility of rejection. If they feel as though there is a threat of being abandoned, whether this threat is real or imagined, this can cause them to spiral into self-destructive patterns.
The emotions that accompany rejection or abandonment can be incredibly painful for individuals with EUPD to process, and the resultant behaviours may explode outwards in the form of lashing out at others or sabotaging interpersonal relationships. Individuals may also internalise rejection as confirmation of their essential ‘badness’, or ‘worthlessness’, and this may manifest as feelings of deep self-loathing, disassociation from the self, or even self-harm and suicide. Between 3% and 10% of people diagnosed with EUPD take their own lives, a figure that is 50 times higher than the suicide rate in the general population.
Another common feature of EUPD is unstable and tumultuous personal relationships. There may be intense and abrupt changes in how they perceive and relate to those closest to them. A person with EUPD may have unrealistic perceptions of others, lurching between seeing someone as an idealised version of themselves who can do no wrong, to an enemy who is vindictive and cruel. The emotional inner life of individuals with EUPD is very complex and intense, which means that they can find it difficult to understand other people’s perspectives. This can be unpredictable and difficult to deal with and consequentially makes it very difficult for people with EUPD to sustain long-term, healthy interpersonal relationships. Their personal lives may be characterised by patterns of instability and volatility.
Relationship to self
In the same way that individuals with EUPD may struggle to relate to others, they can equally have difficulty relating to their own sense of self. They may behave impulsively, suddenly shifting their identity, career, outlook or plans. They may be self-destructive or reckless and engage risky behaviour, such as substance abuse, gambling or self-harm.
Individuals with EUPD are highly sensitive, and can experience intense emotional shifts, which may be triggered by relatively small stimuli. Analogously, if a person had experienced a serious injury to their leg, it would only take the slightest of impacts for the wound to be re-opened, and for the intense pain to return. Similarly with EUPD, what may seem a minor incident to others, can result in an all-consuming and apparently disproportionate emotional response. In particular, individuals with EUPD may have difficulty managing conflict in relationships and regulating their anger. They may have outbursts which escalate out of control. They may find it difficult to calm down and self-soothe, and their anger may eventually collapse inwards into feelings of shame and guilt, which intensifies their negative self-view.
EUPD is often characterised by chronic feelings of emptiness. This may manifest as a feeling of numbness and an unsettling sense of disconnection, both with others and with the self. In these periods of emptiness, people with EUPD may appear restless and seek external distraction. In times of extreme emotional distress, this sense of disconnection may deepen into a state of de-personalisation or de-realization. This is a temporary state of extreme dissociation, where the individual detaches from reality completely. The individual may feel as though they are not a real person or that they don’t exist at all.
In addition to the specific challenges of EUPD, the diagnosis has a high rate of comorbidity, which means that individuals with EUPD often live simultaneously with other mental health issues. The most common comorbid diagnoses with EUPD are depression, anxiety and substance abuse. This adds a separate and distinct layer of challenge for the individual, which could further impact their ability to manage the challenges of their diagnosis.
EUPD in court proceedings
Living with emotionally unstable personality disorder can be intense and challenging at the best of times. These difficulties are only heightened in the court environment, which can be relentless, stressful, and highly emotional. Without adequate support, there may be a significant negative impact upon individuals with EUPD who have to attend court. The experience may have destructive consequences for their emotional wellbeing, and their ability to fairly participate in the court process may be impacted as a result.
Intermediaries can offer a level of assistance and support to individuals with EUPD which may improve their experience of court and increase their ability to participate. Intermediaries are not advocates, support workers or mental health professionals, and we are employed solely to assist the understanding and participation of the individual. However, there are circumstances in which intermediary assistance can positively affect emotional management. For example, if an individual is becoming distressed in court proceedings because they are struggling to understand what is happening, the support of an intermediary to understand what is being discussed may prevent them from becoming emotionally dysregulated.
Clear, consistent communication
When working with service users with EUPD, it is crucial that good communication is modelled by professionals. The most effective communicators will present information in an accessible way, with patience, dedication, and transparency as central principles. Anything less than this may leave the service user feeling left in the dark and confused. For individuals with complex emotional needs, clear and consistent communication is especially important. For example, language may be routinely used in court with which the service user is unfamiliar, or time constraints may mean that there is not an adequate chance within each hearing to process information. The service user may not be informed about the purpose of a specific hearing, or they may not have any concept of what to expect from the court day. For individuals with complex emotional needs, situations like these may leave them feeling left behind, unimportant or disregarded. This could be triggering for the individual and may cause them to spiral into an adverse emotional response.
The intermediary role, as a dedicated communication specialist who is ultimately impartial, can help to mitigate some of the risk of a negative experience for a service user with EUPD. In court, the intermediary will endeavour to make sure that the service user is fully informed about what is being discussed at all stages of proceedings, by using simplified explanations and visual aids. The intermediary can also create a court timetable, to manage expectations about what is happening within the court day. The intermediary can ensure that the service user has a clear sense of the purpose of each hearing, and that they feel included in the conversations which concern them. An intermediary’s presence can help to bridge the gap between the complex legal discussions that take place at court, and the unique emotional needs of a service user with EUPD.
Intermediaries are adept at building rapport, and this is central to a constructive working relationship with any service user, but particularly one who has a diagnosis of EUPD. Working closely with someone with this diagnosis can be an unpredictable experience, and the difficulties that individuals with EUPD have with emotional regulation will only be exacerbated in an emotional court environment. When rapport is established, this is a foundation of trust from which effective strategies can be implemented, and support offered in moments of dysregulation. For example, the intermediary can assist the service user by implementing grounding exercises, such as deep breathing. They could also offer the use of anxiety aids, such as fiddle objects, to assist the service user to remain calm. The intermediary can offer a level of emotional support to the service user if things reach a crisis point.
It is important, however, for clear emotional boundaries to be in place at all times. The balance needs to be appropriate, and the impartial role of the intermediary uncompromised. The intermediary must not be inflexible, if they are too rigid and stringent with their emotional energy, they may appear defensive or cold. Conversely, if the intermediary does not establish healthy personal limits, they may find themselves taking on the emotions of others, which may interfere with their ability to provide appropriate support.
If an intermediary is able to build a strong rapport and working relationship with a service user who has EUPD, they may be able to anticipate the triggers which cause negative reactions and prevent them from occurring before things spiral out of control. The service user may function better at a particular time of day, or in a particular setting. The intermediary can make recommendations to the court based on this, for example, suggesting that hearings take place in the afternoon, or suggesting the service user attends from a familiar environment, such as their solicitor’s office. The service user may find it harder to regulate their emotions if they are fatigued, uncomfortable or hungry. Although this may sound relatively simple, these factors can have significant consequences and are easily avoided. The intermediary can monitor the service user’s wellbeing and alert the court to take breaks as needed. The service user may be triggered by coming into contact with specific individuals, and special measures, such as screens, can be used to prevent individuals from encountering other parties in proceedings.
Often individuals with EUPD will find it difficult to remain calm when they feel they are being ‘attacked’. Whilst court is undeniably a tense environment, and giving evidence is doubtless a stressful experience, the intermediary can make recommendations to help make this process less fraught. For example, when giving evidence, it may assist the service user if they are asked questions in a neutral tone, as they may respond poorly to an adversarial approach. The service user may be more likely to give their best evidence if questions are pooled, and asked by one advocate, as this limits the number of people the service user will have to interact with and may remove an element of anxiety about the process. The service user may be assisted by frequent breaks whilst giving evidence, to manage the increased pressure on their communication skills, and the likelihood that they may become dysregulated if they have to confront difficult and distressing topics during questioning.
EUPD is a complex condition which is extremely challenging for those it impacts. The emotional turmoil that individuals with this diagnosis may experience can be a significant barrier to their understanding and participation in court. There is no simple remedy for the challenges that this diagnosis poses, but the assistance of an intermediary can offer dedicated support and strategies to assist individuals with EUPD throughout proceedings.
Learn more about mental health and communication difficulties on The Access Brief, a growing library of downloadable resources for legal professionals, developed by intermediaires. The collection includes guides to Attention Deficit Hyperactivity Disorder, Post-Traumatic Stress Disorder, creating visual aids to support clients with communication needs, writing easy read documents and more!
To learn more about ‘Hidden Disabilities’ like EUPD, tune into series 2 of our Accessing Justice Podcast. In this series, we talk to experts about conditions which affect communication, but may be overlooked at court, from stammering and trauma, to ADHD.