How to Tell the Difference Between Being Emotionally Dysregulated and Being in a Crisis

One of the hardest things for people to figure out in therapy is this question:“Am I just really dysregulated right now, or am I actually in a crisis?” I get it, I've been there myself.

If you’ve ever gone back and forth between “I’m fine, I can handle this” to “Oh shit, something is seriously wrong,” you’re not alone. Many people we work with @ WMC struggle to tell the difference, especially if intense emotions have been a constant part of their lives for a long time.

So here’s the thing... Emotional distress and crisis can feel very similar to the untrained eye. Both can come with big emotions, racing thoughts, physical discomfort, and urges to escape the feeling ASAP. But they’re not the same, and knowing the difference actually matters, because the support you need in each situation is going to differ.

Heres how I like to think of it...emotional dysregulation is when your emotions are intense, overwhelming, and uncomfortable, but you still have some access to coping. You might feel anxious, angry, sad, panicky, or flooded, but there’s at least a small part of you that can pause, reflect, and maybe even try a skill, even if you don’t want to. Dysregulation feels terrible, but it’s something your nervous system can move through with support, skills, and time.

A crisis is a different beast. A crisis is when your ability to cope is significantly compromised. It’s the point where distress has crossed a threshold and become unsafe to manage alone. In crisis, our thoughts might become more rigid or extreme. We feel trapped, desperate, or unable to imagine the feeling passing. Urges to self-harm, use substances, disappear, or act impulsively can feel louder and more urgent. Our body might feel completely hijacked by survival mode. In DBT, we call this "surpassing your TLA". Your TLA is your tolerable level of arousal...in other words, how heightened emotionally can you be, while still tolerating it? and when we go past that window of tolerance, we are now entering into crisis territory.

One way I explain it to clients is this. Dysregulation is being knocked off balance. Crisis is being knocked off balance and losing your footing entirely.

The tricky part is that we often try to use regular coping skills when they’re already in crisis, and then feel like they’re failing when those skills don’t work. But honestly, that’s not a skill issue, that’s a timing issue. When we are in crisis, the goal shifts from emotional insight or growth to safety and stabilization.

This is why it’s so important to help ourselves or our clients identify early warning signs that signal the move from distress into crisis. These signs are personal and can show up in different ways for different folks! For some people, it’s specific thoughts like “I can’t do this anymore” or “I need this to stop right now.” For others, it’s physical sensations like feeling numb, disconnected, or completely flooded. Behaviors can be clues for us too, like isolating, canceling everything, engaging in risky behavior, or feeling unable to reach out for help.

One of the most useful things you can do is name these signs ahead of time, when you’re not in the middle of them. When you're in your wise mind! Things like knowing which hospitals are closest to you, what your insurance covers, who you could call to sit with you, what environments feel safest, and which medications or PRNs may help calm your nervous system can make a huge difference. When someone is already overwhelmed, decision-making becomes much harder, so planning ahead reduces the cognitive load when we are already at our max.

For people who feel like they’re living in a near-constant state of survival mode, it’s also important to say this part out loud. Sometimes skills alone aren’t enough, especially if the nervous system rarely gets a break. This is where I'd say working with a psychiatrist and exploring medication options can be very helpful! Low-dose SSRIs, mood stabilizers, or anxiety-targeted medications can help lower baseline emotional intensity, making skills more accessible. Medication isn’t a failure or a shortcut. For many people, it’s one piece of a larger support system. In DBT, we call this Pills and Skills! a little corny, I know...

If you’re wondering where you fall right now, ask yourself this gentle question: Do I still have even a small amount of access to coping, or does everything feel out of reach? If there’s some access, we’re likely looking at dysregulation. If there’s none, that’s a sign that we may need more support than skills alone can provide in that moment. And lets remember- neither means you’re weak or broken. They’re simply different nervous system states asking for different responses!

Learning to tell the difference takes time and practice, and a bit of compassion for yourself. And like most things in DBT, it’s not about getting it perfect right away. It’s about noticing earlier, responding sooner, and giving yourself permission to ask for help when you need it!