Emotional dysregulation

I was recently reading an article on emotional dysregulation. Sounds impressive eh?

The person who is capable of emotional regulation can initiate, maintain and modulate the occurrence, intensity and duration of internal feeling states. Impressive eh? In other words they are capable of self soothing.



In Transactional Analysis terms one could describe emotional dysregulation in the following ways



The child begins life in a symbiosis with mother. It has to do this or it will die as it has no Adult or Parent ego states to keep it alive. The child will use mother’s Parent and Adult ego states to get food and water and all the psychological needs it has for love and human contact.

As the child grows in its early days it learns that at times it will experience distress of various kinds. It has hunger, thirst, wind, a need to be changed and so forth. It learns or is programmed to let mother’s Adult and Parent ego states know of its needs by crying. When mother hears the cry she swings into action and sets about solving the child’s distress and thus the child is emotionally regulated as the distress eases.

When this happens the child learns four things
It learns that it is important, it has worth and people will help it out
It learns that it can get its needs met
It introjects a soothing Parent ego state into its own Parent ego state
It learns the experience the feeling satisfied and calmed down



Sometimes this does not happen. For instance mother may be suffering post natal depression. She begins to find herself isolated in the house, lying in bed for long periods of time during the day. When the new-born cries she finds it very hard to get out of bed to deal with the child, at times she does not even recognise the child is crying. As a result the child has to cry for long periods before it is dealt with and sometimes the help never comes and the child just gives up crying.

When this happens the child learns
That it is of little worth
It develops the injunction, “Don’t get your needs met”
It does not introject an internal soothing parent figure
It has no experience of the feeling of being soothed

Combine this with certain inborn natural temperament qualities and the young person can be set up with a life of emotional dysregulation. Consider this list of temperament qualities.



If the child is born with a negative quality of mood and an intense level of reaction combine this with a lack of internal self soothing ability, a “Don’t get your needs met” injunction, that it is of little worth and has no experience of what it feels like to be soothed then it is likely to suffer emotional dysregulation.

Should this happen then the person will develop other ways of coping with the dysregulation. Three common ways are:

Self harming. This is common with the borderline personality. As I mention in my book on working with the suicidal there are eight main reasons for self harming

1. Self harming as part of gang tattooing behaviour.
2. Self harming to make self feel real which can be found in those who dissociate.
3. Self harming to make self feel something.
4. Self harming used as a means of tension relief and to release pressure build up.
5. Self harming as a physical expression of emotional pain. Self harming is seen as providing concrete evidence of the pain.
6. Self harming as a means to self nurture. It allows the person to care for self as can be found in Munchausen Syndrome.
7. Self harming as a means to punish self and an expression of self hatred.
8. Self harming as a means to manipulate others or as a cry for help.



People who self harm as a way to cope with emotional dysregulation would most often be doing it for the reason cited as number 4.

Drug use. Some cope with emotional dysregulation by self medicating with drugs weather they be licit or illicit



Comfort eating. One way to soothe self is to eat good tasting food. When this happens the person is said to engage in what is called comfort eating. They deal with ongoing painful emotions by self soothing using eating.

Therapy with such people is not all that complex. The therapist simply soothes the client when necessary. Of course this is easier said than done but the overall direction of treatment is quite clear. This soothing can range from lending a sympathetic ear and a soothing voice, to holding work, to the client learning methods of self soothing such as using a pacifier and so forth.

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The anorexic relationship - Part 2.

The internet really does provide some interesting insights into the human psyche at times. An example of this is the Pro-ana (Pro-anorexia) websites. I had look at these a few years ago and then a couple of days ago. There are now hundreds which I found in a few minutes so there are probably many thousands of them out there.

For example:

Pro Ana Tips and Tricks

Pro ana sites here’s a list of great sites

A most interesting social phenomena to arise via the internet.

Here is some information from them

There is no such thing as an eating disorder. People have anorexic and bulimic life styles because they pursue perfection. Just like elite athletes, musicians and others pursue it. Perfection is beauty

Pro-ana 10 commandments
1. If you aren't thin you aren't attractive.
2. Being thin is more important than being healthy.
3. You must buy clothes, style your hair, take laxatives, starve yourself, do anything to make yourself look thinner.
4. Thou shall not eat without feeling guilty.
5. Thou shall not eat fattening food without punishing oneself afterwards.
6. Thou shall count calories and restrict intake accordingly.
7. What the scale says is the most important thing.
8. Losing weight is good/gaining weight is bad.
9. You can never be too thin.
10. Being thin and not eating are signs of true will power and success.



Secrecy tips
Don't bring up the subject of food around other people. Have your excuses for not eating ready in case they should bring the subject up. Some excuses I use : "My stomach's a little upset", "I'm too (tired, excited, nervous, busy, etc) to eat", "I don't feel like (whatever food it is), I'll get something later", "I did eat, didn't you see?", and "I stopped by (Burger King, Subway, etc) earlier".

Don't deny everything if confronted. People will believe a little truth with a big lie much easier than a huge lie. Act as if it's no big deal instead of reacting emotionally and people will tend to believe you.

Watch where you dispose of uneaten food or other "evidence", make sure that it isn't going to be seen or found by anyone. Wrap food up and throw it away outside the house. If you live alone, always take the trash out before anyone else comes over.

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In the previous post on the anorexic relationship I mentioned how food refusal was a very primal and basic act of rebellion. I think it is safe to say that these comments placed for public viewing on the internet are a rebellious and defiant act at least in part. These people know how some others will react to them and that will be with the Critical Parent ego state.

Guess what?
Now we have Anti Pro-ana websites or comments on the internet

Anorexia on the internet

Pro-ana website dangerous to young women

Pro-ana websites

This last one makes the interesting statement
“Many sites treat eating disorders as lifestyle choices, rather than the illnesses they truly are”. (end quote)

Two things I would like to say. First this demonstrates the anorexic relationship dynamic of the RC and CP transactions. The pro-ana sites are being ‘naughty’ and doing things which they know authority wont like and that authority will respond by ‘scolding’ them.

RC: “I am going to hurt myself in front of you and you try and stop me”.
CP: “You shouldn’t do that and I will try and stop you, (in this instances by trying to ban Pro-ana websites)”.



This transactional dynamic will perpetuate the anorexic behaviour such that the psychology behind the anorexic behaviour is reinforced. In this case the dynamic is being played out over the internet instead of between counsellor and anorexic in the therapy room or hospital and anorexic on the inpatient ward. This model presents anorexia as a relational experience.

It also shows how the anorexic can force the authority to become involved. The anti pro-ana sites are correct. The information provided by the pro-ana sites will adversely affect some young girls who read them. So what does the authority do?

If they do nothing, thus avoiding playing into the anorexic relationship and thus don’t reinforce the anorexic behaviour young girls will continue to be adversely effected. If they act to have the information stopped then they play into the anorexic relationship. Then it is highly likely the authority will be perceived as CP by the anorexic even if they are not being CP.

In addition.
Why aren’t there pro-depressive or pro-insomniac websites which provide secrecy tips or promote insomnia and depression? Why are there no websites promoting an insomniac or depressive life style?

Maybe because these conditions do not have a rebellious aspect like anorexia and anorexia involves a style of relating whereas depression and insomnia do not. Depression and insomnia don’t need an insomnia relationship or depressive relationship for the condition to continue like anorexia does.




There is however also a healthy aspect to pro-ana websites. A person with anorexia has been told over and over either covertly or overtly that she is sick, dumb, naughty, bad, selfish, neurotic and so on endlessly.

At least some of the Pro-ana websites are saying:
“I’m anorexic and I’m OK”, with comments that follow the statement before:

“Many sites treat eating disorders as lifestyle choices, rather than the illnesses they truly are”.

This may be the Free Child aspect of the anorexic saying, “I want to survive and grow towards health”. They reject what the helping professionals say to them about being sick, neurotic and so forth. They say I am a good person even if I choose the anorexic life style. From a therapeutic point of view this is a most positive move. It is going to reduce the psychopathology due to the acceptance of self as OK no matter how they live.

This exposes an inherent contradiction in all psychotherapy and counselling. On the one hand the therapist says to the client that they are ok and good and acceptable. However, the therapist also says there is actually something wrong with you or you wouldn’t need to come to therapy in the first place. By the very act of me being a therapist I am saying to the client that there is something in you that needs to be changed and the Child ego state of the client is very likely to take this as it having something wrong with it or is bad about it.

The pro-ana websites are rejecting this contradiction and thus it is a healthy move by them.

As you can see the pro-ana movement is a most interesting phenomena which is quite complex and has both good and bad aspects to it.

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The anorexic relationship (editted)

OLJ asks:
does the adapted child take over as a protection for the free child?


My response:
One could say that the AC protects the FC. If a child is confronted with adverse parenting its first thought is to survive. It will make a decision on what it needs to do so as to survive physically and psychologically.

For instance, a child does not eat its dinner to which mother gets very angry and hits it. The child is then forced into a position where it has to make a decision on how to survive. That decision can be anything and they will vary widely between children. The decision results in the Adapted Child behaviour. The Free Child part of the youngster senses danger and thus it makes some adaption to the environment as a response to that danger.

For instance the child may decide that mother’s anger is very frightening so it will conform, behave and eat up all its food. It does this as a short term solution to the danger. This is the AC

Another child may decide that mummy is bad for getting angry, it is being unfairly treated and throws its plate full of food on the floor. The AC response in this case is an angry rebellious response that fights back which the child sees as its solution to the problem. This is the AC.



As we know the AC is divided into the Conforming Child (CC) and Rebellious Child (RC) ego states. Both these adapt to authority. The CC by doing what it is told and the RC by doing the opposite to what it is told. Neither is what the child wants fro itself (the FC).

Hence we end up with an eating disorder like anorexia. This person adapts to the authority by swinging between CC and RC responses to authority. At one level these people are often quite nice people who seem to conform (CC). On the other hand anorexia is one of the most basic rebellious responses a child can do to a parent. Food refusal.

Mother puts the spoon full of food into the mouth of the young child to which it closes its lips tightly. One of the most primal forms of rebellion a person can do. Mother pushes the spoon harder onto the lips to which the child squeals in defiance and ‘accidentally’ knocks the plate of food off the table onto the floor.

The anorexic is highly rebellious individual. However often when you meet them they will not appear so. This may explain why the majority of anorexics are female (95%). In our child rearing patterns open angry rebellion is usually less acceptable for girls than it is for boys. The girl has to express her rebellion in a more disguised way. She says, “I just don’t feel hungry and I can’t eat”. Angry rebellion expressed in a polite way. Whereas the rebellious boy is more likely to hit our angrily in a direct and open way.



The other feature of all this is the Free Child is no where to be seen. It has been lost long ago in the past. The anorexic and authority get deeply engrossed and locked into CP to AC transactions The FC is forgotten about.

The anorexic is not lying when she says she does not feel hungry. In this instance hunger is a function of the FC. She has been so out of touch with her FC for so long she can no longer even recognise it. Thus she does not feel the hunger sensations when they come. Thus we end up with the dynamics of the anorexic relationship.



The anorexic comes from a background where she perceives the parents to be overly controlling and authoritarian and thus perceives transactions coming from their CP to her Child ego state (1). She responds to this with two transactions at one time.
2 - she will appear to be CC and compliant
3 - underneath she is highly rebellious and uses a most primal form of rebellion against authority, food refusal.

At the same time she has become so divorced from her FC over a long period of time she no longer can even recognise when she feels hungry.

So what does the counsellor do
1. Establish a relationship with the anorexic that includes other transactions besides CP to Child. This may be hard to do as the anorexic will perceive you to be CP even when you are not. Secondly she is so rebellious that she may kill herself from starvation. This can force the authority to intervene in an authoritative way even when they don’t want to.

This is one reason why I have a general rule of thumb when working with client’s who have eating disorders. I will not spend more than 50% of the consultation discussing food, weight and eating. We will spend at least 50% of the consultation discussing other matters unrelated to these areas. Some clients find this hard to do at first because food, eating and weight is all they ever talk (and think) about.

This allows the client and me to get away from the CP to C transactions and introduce other kinds of transactions into the therapeutic relationship. Also I don’t want to have a relationship with the client that is food obsessed. I want a more normal relationship with the client were we can talk about good things sometimes that feel nice for the client and me.

2. Assist the anorexic to reconnect with her FC
If one can get some FC to FC transactions going in the therapeutic relationship then that is a very good start indeed. If this happens then the anorexic relationship is already starting to morph into something else.

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