STEPPS for over-controlled and under-controlled emotional dysregulation in older adults with personality disorders: A case study

Objectives: This paper aims to present a clinical illustration of under-controlled and over-controlled emotional dysregulation behaviors in older adults with personality disorders (PD). Furthermore, another aim is to explore how Systems Training for Emotional Predictability and Problem Solving for Older Adults (STEPPS-OA) can be useful for both types of emotional dysregulation.

Methods: A 65-year-old woman with emotional under-control and a 67-year-old woman with emotional over-control participated in STEPPS-OA. STEPPS-OA is a treatment program consisting of 21 weekly group sessions, individual sessions and support group meetings.

Results: The participant with under-control struggled with impulsivity and destructive behaviors. She learned to use techniques to recognize the buildup of tension and manage emotions. The participant with over-control struggled with difficulties in differentiating and expressing emotions. She learned to use techniques to recognize suppressed feelings and began practicing assertive behaviors.

Conclusions: Emotional dysregulation can occur from either over-controlled or under-controlled behaviors in older adults with PD. STEPPS-OA seems to be a promising treatment option for both types of behavior because the interventions seem to fit both cases.

Clinical implications: STEPPS-OA is a promising treatment option for older adults with PD and emotional over-controlled and under-controlled behaviors.