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: splitting or emotional dysregulation?

Splitting

Splitting can simplify unbearable ambivalence but may destabilise relationships, teams, and self-experience.

DefenceInterpersonalAffect+1

Emotional dysregulation

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

AffectBehaviourInterpersonal+1

Definition

AAn all-or-none way of organising self, others, or situations into wholly good or wholly bad categories when mixed representations feel intolerable.

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

Core process

AConflicting positive and negative representations are not integrated, so affective state strongly shapes the current view.

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

Look for

ASudden idealisation or devaluation · Team splitting

BRapid affect shifts · Impulsive coping

Patient language

A“They are the only one who understands me”

B“It goes from zero to one hundred”

Maintaining cycle

AAttachment threat -> intense affect -> polarised appraisal -> rupture -> threat increases

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

Treatment leverage

AHelp the patient tolerate mixed representations without escalating shame or abandonment fear.

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

Check before using

AThe person can hold mixed views but is making a stable, evidence-based judgement.

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

Formulation language

Under attachment threat, splitting may make it hard to hold mixed feelings about self and others, intensifying rupture and repair cycles.

Open full guide

Formulation language

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

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: splitting or emotional dysregulation?

Splitting

Splitting can simplify unbearable ambivalence but may destabilise relationships, teams, and self-experience.

DefenceInterpersonalAffect+1

Emotional dysregulation

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

AffectBehaviourInterpersonal+1

Definition

AAn all-or-none way of organising self, others, or situations into wholly good or wholly bad categories when mixed representations feel intolerable.

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

Core process

AConflicting positive and negative representations are not integrated, so affective state strongly shapes the current view.

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

Look for

ASudden idealisation or devaluation · Team splitting

BRapid affect shifts · Impulsive coping

Patient language

A“They are the only one who understands me”

B“It goes from zero to one hundred”

Maintaining cycle

AAttachment threat -> intense affect -> polarised appraisal -> rupture -> threat increases

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

Treatment leverage

AHelp the patient tolerate mixed representations without escalating shame or abandonment fear.

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

Check before using

AThe person can hold mixed views but is making a stable, evidence-based judgement.

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

Formulation language

Under attachment threat, splitting may make it hard to hold mixed feelings about self and others, intensifying rupture and repair cycles.

Open full guide

Formulation language

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

Open full guide

Browse the map Use both hypotheses