Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: emotional dysregulation or shame?

Emotional dysregulation

Emotional dysregulation is a transdiagnostic formulation mechanism that can amplify impulsivity, interpersonal rupture, avoidance, and risk.

AffectBehaviourInterpersonal+1

Shame

Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.

AffectTraumaAttachment+1

Definition

ADifficulty modulating the intensity, duration, expression, or behavioural consequences of emotional states.

BA painful self-conscious affect in which the self is experienced as exposed, defective, unacceptable, or at risk of rejection.

Core process

AHigh emotional sensitivity, intense arousal, limited regulation strategies, and rapid action urges interact under stress.

BGlobal negative self-evaluation and anticipated social devaluation drive hiding, appeasing, attacking, or withdrawal.

Look for

ARapid affect shifts · Impulsive coping

BDowncast gaze · Concealment

Patient language

A“It goes from zero to one hundred”

B“There is something wrong with me”

Maintaining cycle

ATrigger -> intense emotion -> urgent behaviour -> consequences -> shame or threat -> further dysregulation

BExposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies

Treatment leverage

AIncrease pause, labelling, and tolerable regulation options before action urges dominate.

BReduce concealment and self-attack while building tolerable interpersonal safety.

Check before using

AMood shifts are better explained by episodic mania, delirium, intoxication, or seizure activity.

BThe primary affect is guilt about a specific harm with intact self-worth.

Formulation language

Emotional dysregulation appears to intensify threat cues into urgent action, creating consequences that then feed further distress.

Open full guide

Formulation language

Shame appears to organise the patient around hiding and self-protection, reducing exposure but maintaining isolation and self-criticism.

Open full guide

Browse the map Use both hypotheses

Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: emotional dysregulation or shame?

Emotional dysregulation

Emotional dysregulation is a transdiagnostic formulation mechanism that can amplify impulsivity, interpersonal rupture, avoidance, and risk.

AffectBehaviourInterpersonal+1

Shame

Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.

AffectTraumaAttachment+1

Definition

ADifficulty modulating the intensity, duration, expression, or behavioural consequences of emotional states.

BA painful self-conscious affect in which the self is experienced as exposed, defective, unacceptable, or at risk of rejection.

Core process

AHigh emotional sensitivity, intense arousal, limited regulation strategies, and rapid action urges interact under stress.

BGlobal negative self-evaluation and anticipated social devaluation drive hiding, appeasing, attacking, or withdrawal.

Look for

ARapid affect shifts · Impulsive coping

BDowncast gaze · Concealment

Patient language

A“It goes from zero to one hundred”

B“There is something wrong with me”

Maintaining cycle

ATrigger -> intense emotion -> urgent behaviour -> consequences -> shame or threat -> further dysregulation

BExposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies

Treatment leverage

AIncrease pause, labelling, and tolerable regulation options before action urges dominate.

BReduce concealment and self-attack while building tolerable interpersonal safety.

Check before using

AMood shifts are better explained by episodic mania, delirium, intoxication, or seizure activity.

BThe primary affect is guilt about a specific harm with intact self-worth.

Formulation language

Emotional dysregulation appears to intensify threat cues into urgent action, creating consequences that then feed further distress.

Open full guide

Formulation language

Shame appears to organise the patient around hiding and self-protection, reducing exposure but maintaining isolation and self-criticism.

Open full guide

Browse the map Use both hypotheses