Emotion dysregulation involves difficulties in modulating emotional responses appropriately. Signs include intense, rapidly shifting emotions, irritability, and anger outbursts.
InADHD, emotion dysregulation is associated withimpulsivityand deficits inexecutive functioning, leading to challenges in managing emotions effectively.
While not a core diagnostic criterion, research suggests that emotion dysregulation is a prevalent feature of ADHD that contributes to impairment in multiple domains, warranting further investigation into its nature, underlying mechanisms, andtreatment implications.
Key Points
Rationale
Although not part of the core diagnostic criteria, recent evidence suggests that emotion dysregulation is a prevalent feature of ADHD that contributes to impairment (Shaw et al., 2014).
Most research to date has focused on emotion dysregulation in children with ADHD (Bunford et al., 2015; Christiansen et al., 2019).
However, difficulties with emotion regulation persist into adulthood (Hirsch et al., 2018). This systematic review aimed to synthesize the current evidence on the nature, neurobiology, and clinical implications of emotion dysregulation in adults with ADHD.
Method
The authors conducted asystematic reviewfollowing PRISMA guidelines. They searched PsycInfo, Medline, Eric, PsycArticle, Psicodoc, and Scopus databases for empirical studies published in English that included adults diagnosed with ADHD and measured emotion regulation.
22 studies met inclusion criteria and were reviewed.
Sample
The reviewed studies included adults aged 18+ diagnosed with ADHD according to DSM-IV or DSM-5 criteria. Sample sizes ranged widely. Most participants were recruited from clinical settings.
There was heterogeneity in terms of gender distribution, ADHD subtypes, medication status, and psychiatric comorbidities.
Measures
A variety of measures were used to assess ADHD symptoms and emotion regulation across studies.
ADHD measures included clinical interviews such as the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) and the Diagnostic Interview for ADHD in adults (DIVA 2.0), as well as self-report rating scales like the Adult ADHD Self-Report Scale (ASRS-v1.1) and the Conners’ Adult ADHD Rating Scales (CAARS).
Emotion regulation was measured using self-report questionnaires assessing various facets of emotional functioning, including the Difficulties in Emotion Regulation Scale (DERS) for emotional control, the Cognitive Emotion Regulation Questionnaire (CERQ) for cognitive emotion regulation strategies, and the Emotion Reactivity Scale (ERS) for emotional reactivity and lability.
Results
Adults with ADHD consistently showed greater emotion dysregulation compared to healthy controls, with effect sizes in the medium to large range (d=0.31-2.27).
Emotion dysregulation was associated with ADHD symptom severity, executive dysfunction, and functional impairment. Adults with ADHD tended to use more maladaptive emotion regulation strategies like emotional suppression.
A few neuroimaging studies found abnormal activation patterns in prefrontal-limbic circuits involved in emotion regulation in ADHD adults compared to controls.
Insight
This systematic review provides evidence that many adults with ADHD struggle with regulating their emotions effectively, above and beyond the impact of core ADHD symptoms.
The findings suggest that emotion dysregulation is an important source of difficulty that should be assessed and targeted in treatment.
The neuroimaging results, while preliminary, point to differences in the neural circuitry underlying emotional processing and regulation in ADHD that warrant further investigation.
More research is needed to understand the developmental trajectory of emotion dysregulation in ADHD and how it interacts with core symptoms and comorbidities over time.
Examining emotion regulation could lead to more comprehensive models of ADHD and interventions that better address the full range of difficulties patients experience.
Strengths
This review had several methodological strengths, including:
Limitations
Despite strengths, this review also came with several limitations, including:
Implications
The results highlight the importance of assessing and treating emotion dysregulation in adults with ADHD.
Pharmacological and psychosocial interventionstargeting emotion regulation in ADHDappear promising but require further evaluation in controlled trials.
Accounting for emotion dysregulation could improve diagnostic accuracy and treatment outcomes.
At a theoretical level, the findings suggest that influential models of ADHD focusing solely on cognitive deficits like executive dysfunction are likely insufficient to explain the full range of symptoms and impairments.
The field should move towards more integrative models incorporating emotional and motivational processes.
References
Primary reference
Soler-Gutiérrez, A. M., Pérez-González, J. C., & Mayas, J. (2023). Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review.Plos one,18(1), e0280131.https://doi.org/10.1371/journal.pone.0280131
Other references
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).https://doi.org/10.1176/appi.books.9780890425596
Bunford, N., Evans, S. W., & Wymbs, F. (2015). ADHD and emotion dysregulation among children and adolescents.Clinical Child and Family Psychology Review, 18(3), 185-217.https://doi.org/10.1007/s10567-015-0187-5
Christiansen, H., Hirsch, O., Albrecht, B., & Chavanon, M. L. (2019). Attention-deficit/hyperactivity disorder (ADHD) and emotion regulation over the life span. Current Psychiatry Reports, 21(3), 1-11.https://doi.org/10.1007/s11920-019-1003-6
Hirsch, O., Chavanon, M., Riechmann, E., & Christiansen, H. (2018). Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD).Journal of affective disorders,232, 41-47.https://doi.org/10.1016/j.jad.2018.02.007
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder.American Journal of Psychiatry, 171(3), 276-293.https://doi.org/10.1176/appi.ajp.2013.13070966
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
