We focus on emotion dysregulation itself, rather than on diagnoses that may include emotion dysregulation and be comorbid with ADHD. We thus include individuals with emotion dysregulation who do not meet criteria for any DSM diagnoses beyond ADHD.
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However, emotion dysregulation is a dimensional entity, not a categorical diagnosis, and here we consider the full spectrum of emotion dysregulation within ADHD, not just extremes. In its extreme form, emotion dysregulation is likely to emerge as a major etiological factor behind the frequent, severe temper outbursts and irritability of the new DSM-5 diagnosis, Disruptive Mood Dysregulation Disorder. For example, of the three symptoms clusters in Oppositional Defiant Disorder-angry/irritable mood, defiant behavior and vindictiveness- only the first plausibly reflects dysregulated emotions ( 8). For example, a study which contrasted 105 irritable, emotionally dysregulated children with ADHD against 395 non-irritable ADHD children found increased rates not only of Oppositional Defiant Disorder but also Depression and Dysthymia ( 7).Įmotion dysregulation is also not synonymous with any single DSM-5 disorder. Here, we focus on the clinical expression of emotional dysregulation as irritability, which is often linked with reactive aggression and temper outbursts ( 3- 5).Įmotion dysregulation is a dimensional trait that is not unique to ADHD rather, it undercuts the traditional divide between internalizing and externalizing diagnoses and indeed may partly explain their high correlation ( 6). We define it as encompassing emotional expressions and experiences that are excessive in relation to social norms and context-inappropriate rapid, poorly controlled shifts in emotion (‘lability’) and the anomalous allocation of attention and to emotional stimuli. Emotion dysregulation arises when these adaptive processes are impaired, leading to behavior that defeats the individual's interests. These processes trigger behavioral and physiological responses that can be modulated in line with goals. It encompasses the processes that allow the individual flexibly to select, attend to, and appraise emotionally arousing stimuli. In line with previous theorists, we define emotion regulation as an individual's ability to modify an emotional state so as to promote adaptive, goal-oriented behaviors ( 2).
Here, we consider the overlap of emotion dysregulation with ADHD, focusing on prevalence, pathophysiology and treatment. Renewed interest in this overlap makes a review timely.
Only by DSM-III did emotional symptoms became an ‘associated feature’ rather than a diagnostic criterion of ADHD. Indeed, in the early conceptualization of ADHD as reflecting ‘minimal brain damage’, emotion dysregulation was placed above inattention among the cardinal symptoms ( 1).
It has long been recognized that emotion dysregulation is common in individuals with neurodevelopmental disorders, including Attention-Deficit/Hyperactivity Disorder (ADHD). The differing predictions from each model can guide future research into this much-neglected population. Three models to explain the overlap between emotion dysregulation and ADHD are considered: emotion dysregulation and ADHD are correlated but distinct dimensions emotion dysregulation is a core, diagnostic feature of ADHD and the combination constitutes a nosological entity, distinct from both ADHD and emotion dysreguation alone. Third, while current treatments for ADHD often also ameliorate emotion dysregulation, a focus on this combination of symptoms reframes clinical questions and could stimulate novel therapeutic approaches. Second, emotion dysregulation in ADHD may arise from deficits in orienting towards, recognizing and/or allocating attention to emotional stimuli these deficits that implicate dysfunction within a striato-amygdalo-medial prefrontal cortical network. First, emotion dysregulation is prevalent in ADHD throughout the lifespan and is a major contributor to impairment. The authors examine the current literature using both quantitative and qualitative methods.
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It has long been recognized that many individuals with ADHD also have difficulties with emotion regulation but lack of consensus on how to conceptualize this clinically challenging domain renders a review timely.