Something I keep running into in my work: patients who have significant, consistent trouble regulating their emotions, but no other features of BPD, no anger disorder, no ADHD. Every diagnostic code I reach for is a partial fit at best. BPD has emotional dysregulation as a central feature but requires a whole additional cluster of traits. ADHD lists it as a common presentation but not a criterion. IED is specifically about anger. Curious whether the research community has ever seriously considered a stand-alone category, and what the resistance actually is.
Is the resistance more about clinical utility than theory though? Like, would a new category actually change how anyone gets treated, or does that not matter for the research question.
That's the thing: "clinical utility" is doing a lot of work there. Useful for whom, under what treatment model, with what evidence base. The answer changes depending on which of those you operationalize first. Which is exactly why this is worth researching rather than assuming.
The interesting question to me isn't whether emotional dysregulation could stand alone. It's whether the decision to embed it inside other categories reflects a genuine theoretical position or just diagnostic convenience. If it's the latter, that's never been properly examined. The field has more or less assumed that comorbidity patterns justify the current structure, which is not the same thing as demonstrating that the current structure is correct.
I have patients who would describe themselves basically this way and I've never known what to call it.
This runs into a deeper problem in the field: whether psychiatric categories should be organized around etiology, presentation, or treatment response. Each approach gives you a different taxonomy and none of them agree. That argument has been going on since DSM-III and hasn't resolved. A stand-alone dysregulation category looks very different depending on which organizing principle you use.