The core features of individuals with elevations on this scale are instability and unpredictability of mood and behavior. One moment they might feel dejected and disillusioned; sometime later, feelings of euphoria are followed by a phase of intense anger, irritability, and self-destructiveness—possibly even involving self-mutilation. Their self-destructiveness reflects a severely punishing conscience. In addition, much of their unstable behavior seems to be directed by internal factors rather than a reaction to environmental events. They have marked mood swings, intermittent periods of depression, generalized anxiety, and intense emotional attacks on others, followed by apathy and dejection. Although these behaviors often create significant interpersonal difficulties, these clients are also extremely concerned with maintaining the care and emotional support of others. Although they often elicit rejection, they strongly react to fears of abandonment. They might intermittently idealize people, but their ambivalence eventually gives way to devaluing and criticizing the same people they have previously idealized. Thus, their relationships are characterized by ambivalence, instability, and intensity. Underlying many of these behaviors is an extremely poorly developed sense of identity, which is at the core of their dissolution of controls. Their poorly defined sense of self might eventually give way to feelings of emptiness and to disorganized thoughts. Under stress, they might have transient psychotic episodes. However, these episodes are rarely sufficient to be considered a formal thought disorder, and these clients typically return fairly quickly to their previous levels of functioning. They typically describe themselves as depressed, impatient, tense, irritable, disturbed, and anxious.