Emotional Dysregulation in ADHD


Emotional dysregulation, defined as “emotional response that is poorly regulated and does not fall within the traditionally accepted range of emotional reaction” (Webmd 2021), is a common symptom among a wide range of mental disorders including Attention Deficit/Hyperactive Disorder (ADHD). Emotional dysregulation for many with ADHD may not just feel like a constant struggle with oneself but can additionally feel like a constant battle with those around them. Its misunderstood nature frequently ends up causing conflict in the lives of those with it, and often results in the further exacerbation of other existing ADHD symptoms.

Emotional dysregulation is a relatively common symptom of ADHD with prevalence among adults ranging from 30-70% in adults and 25-25% in children (Rüfenacht et al. 2019). It is associated with impaired activity of the amygdala and cingulate gyrus of the limbic system in the brain,both of which are involved in emotion and pain regulation. In one study, activity of cingulate activity was found to be lower in study participants with ADHD in comparison to those without ADHD (Webmd 2011). Other studies have found amygdala hyperactivity in participants with ADHD (Shaw et al. 2014). Additionally, weaker connections between the cerebral cortex – which is notably involved in the perception of external stimuli and decision making – and the amygdala are associated with those with ADHD (Nigg 2021). This can cause emotional reactions that are disproportionate to the stimuli/cause.

In emotional dysregulation, emotional reactivity can manifest in a variety of ways. This may include intense levels of anger (or rage), high anxiety levels, dissociating, and even suicidal thoughts (Webmd n.d.). Those with ADHD and emotional dysregulation may have a much lower frustration tolerance and higher reactivity to situational stressors. At the opposite end of the spectrum, reactivity can include over-excitement, joy, or passion. At either end, people observing these reactions may seem frightening or distressing and can lead to the degradation of relationships. Outsiders looking in may understand neither the emotional reaction nor the degree of it and this type of misunderstanding could influence the perception of the person with ADHD emotional dysregulation. They can consequently (and incorrectly) see them as volatile, inflexible to change and overly sensitive as personality traits rather than a result of an ADHD symptom.

Emotional dysregulation in ADHD is not just misunderstood among the public and the people in the lives of those affected by it, it is also misunderstood by medical and mental health professionals. Emotional dysregulation is a common symptom among multiple unrelated disorders, including Bipolar Disorder, Borderline Personality Disorder, Post Traumatic Stress Disorder, and Autism Spectrum Disorders. Its commonality among mood disorders and personality disorders makes it easy for ADHD to be mistaken as a mood or personality disorder (Marangoni 2018). That is not to say that mood and personality disorders cannot occur in individuals with ADHD, in fact bipolar disorder and personality disorders have a comorbidity rate upwards of 47.1% and 50% respectively (Katzman 2017). However, the overlap of symptom criteria makes distinguishing ADHD from other disorders difficult. This is an unfortunate source of misdiagnosis that can lead to additional complications and difficulties.

Despite the disruptions that emotional dysregulation may cause, it is treatable. Before treatment can be recommended and/or administered it is important to recognize and address emotional dysregulation as a symptom. Many stimulant medications have been found to be effective in treating emotional dysregulation in ADHD, as have cognitive and behavioral psychotherapies (Shaw et al. 2014). It is additionally crucial that thorough and holistic examination of individuals occur by mental health and medical professionals.

 

Resources

Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302.

Marangoni, C. (2018). ADHD, Bipolar Disorder, or Borderline Personality Disorder. Psychiatric Times, 35(10)

Nigg, J. (2021). “How ADHD Amplifies Emotions”. ADDitude.

Rüfenacht, E., Euler, S., Prada, P. et al. (2019). Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD). Borderline Personality Disorder Emotional Dysregulation, 6.

Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. The American journal of psychiatry, 171(3), 276–293.

Study: Many With ADHD Can’t Control Emotions. Web M.D. (2011). https://www.webmd.com/add-adhd/news/20110506/study-many-with-adhd-cant-control-emotions

What is Emotional Dysregulation? Web M.D. (2021). https://www.webmd.com/mental-health/what-is-emotional-dysregulation

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