Emotional dysregulation

Emotional dysregulation (ED) is a term used in the mental health community that refers to emotional responses that are poorly modulated and do not lie within the accepted range of emotive response.[1]

Emotional dysregulation can be associated with an experience of early psychological trauma, brain injury, or chronic maltreatment (such as child abuse, child neglect, or institutional neglect/abuse), and associated disorders such as reactive attachment disorder.[2] Emotional dysregulation may be present in people with psychiatric disorders such as attention deficit hyperactivity disorder,[3] autism spectrum disorders, bipolar disorder, borderline personality disorder, complex post-traumatic stress disorder, and fetal alcohol spectrum disorders.[4][5][6] In such cases as borderline personality disorder and complex post-traumatic stress disorder,[7] hypersensitivity to emotional stimuli causes a slower return to a normal emotional state. This is manifested biologically by deficits in the frontal cortices of the brain.[8]

Possible manifestations of emotional dysregulation include angry outbursts or behavior outbursts such as destroying or throwing objects, aggression towards self or others, and threats to kill oneself. Emotional dysregulation can lead to behavioral problems and can interfere with a person's social interactions and relationships at home, in school, or at place of employment.

Etymology

The word "dysregulation" is a neologism created by combining the prefix "dys-" to "regulation". According to Webster's Dictionary, dys- has various roots and is of Greek origin. With Latin and Greek roots, it is akin to Old English tō-, te- "apart" and in Sanskrit dus- "bad, difficult."

Child psychopathology

There are links between child emotional dysregulation and later psychopathology.[9] For instance, ADHD symptoms are associated with problems with emotional regulation, motivation, and arousal.[10] One study found a connection between emotional dysregulation at 5 and 10 months, and parent-reported problems with anger and distress at 18 months.[11] Low levels of emotional regulation behaviors at 5 months were also related to non-compliant behaviors at 30 months.[12] While links have been found between emotional dysregulation and child psychopathology, the mechanisms behind how early emotional dysregulation and later psychopathology are related are not yet clear.

Symptoms

Smoking, self-harm, eating disorders, and addiction have all been associated with emotional dysregulation.[13] Somatoform disorders may be caused by a decreased ability to regulate and experience emotions or an inability to express emotions in a positive way.[14] Individuals who have difficulty regulating emotions are at risk for eating disorders and substance abuse as they use food or substances as a way to regulate their emotions.[15][16] Emotional dysregulation is also found in people who are at increased risk to develop a mental disorder, in particular an affective disorder such as depression or bipolar disorder.[17][18]

Early childhood

Research has shown that failures in emotional regulation may be related to the display of acting out, externalizing disorders, or behavior problems. When presented with challenging tasks, children who were found to have defects in emotional regulation (high-risk) spent less time attending to tasks and more time throwing tantrums or fretting than children without emotional regulation problems (low-risk). These high-risk children had difficulty with self-regulation and had difficulty complying with requests from caregivers and were more defiant.[19] Emotional dysregulation has also been associated with childhood social withdrawal.[20] Common signs of emotional dysregulation in early childhood include isolation, throwing things, screaming, lack of eye contact, refusing to speak, rocking, running away, crying, dissociating, high levels of anxiety, or inability to be flexible.

Internalizing behaviors

Emotional dysregulation in children can be associated with internalizing behaviors including[13]

  • exhibiting emotions too intense for a situation
  • difficulty calming down when upset
  • difficulty decreasing negative emotions
  • being less able to calm themselves
  • difficulty understanding emotional experiences
  • becoming avoidant or aggressive when dealing with negative emotions
  • experiencing more negative emotions

Externalizing behaviors

Emotional dysregulation in children can be associated with externalizing behaviors including[13]

  • exhibiting more extreme emotions
  • difficulty identifying emotional cues
  • difficulty recognizing their own emotions
  • focusing on the negative
  • difficulty controlling their attention
  • being impulsive
  • difficulty decreasing their negative emotions
  • difficulty calming down when upset

Protective factors

Early experiences with caregivers can lead to differences in emotional regulation. The responsiveness of a caregiver to an infant's signals can help an infant regulate their emotional systems. Caregiver interaction styles that overwhelm a child or that are unpredictable may undermine emotional regulation development. Effective strategies involve working with a child to support developing self-control such as modeling a desired behavior rather than demanding it.[21]

The richness of environment that a child is exposed to helps development of emotional regulation. An environment must provide appropriate levels of freedom and constraint. The environment must allow opportunities for a child to practice self-regulation. An environment with opportunities to practice social skills without over-stimulation or excessive frustration helps a child develop self-regulation skills.[21]

Emotional dysregulation and substance use

Several variables have been explored to explain the connection between emotion dysregulation and substance use in young adults, such as child maltreatment, cortisol levels, family environment, and symptoms of depression and anxiety. Vilhena-Churchill and Goldstein (2014)[22] explored the association between childhood maltreatment and emotional dysregulation. More severe childhood maltreatment was found to be associated with an increase in difficulty regulating emotion, which in turn was associated with greater likelihood of coping by using marijuana. Kliewer et al. (2016)[23] performed a study on the relationship between negative family emotional climate, emotional dysregulation, blunted anticipatory cortisol, and substance use in adolescents. Increased negative family emotional climate was found to be associated with high levels of emotional dysregulation, which was then associated with increased substance use. Girls were seen to have blunted anticipatory cortisol levels, which was also associated with an increase in substance use. Childhood events and family climate with emotion dysregulation are both factors seen linked to substance use. Prosek, Giordano, Woehler, Price, and McCullough (2018)[24] explored the relationship between mental health and emotion regulation in collegiate illicit substance users. Illicit drug users reported higher levels of depression and anxiety symptoms. Emotional dysregulation was more prominent in illicit drug users in the sense that they had less clarity and were less aware of their emotions when the emotions were occurring.

Treatment

See Management of borderline personality disorder and Attention deficit hyperactivity disorder management.

The main treatment when diagnosed as being part of BPD is psychotherapy. The most popular form is dialectical behaviour therapy (a variety of cognitive behavioural therapy that includes meditation)[25][26].

When diagnosed as being part of ADHD, norepinephrine and dopamine reuptake inhibitors such as methylphenidate (Ritalin)[27] and atomoxetine[28] are often used.

See also

References
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  3. Retz, Wolfgang; Stieglitz, Rolf-Dieter; Corbisiero, Salvatore; Retz-Junginger, Petra; Rösler, Michael (9 January 2014). "Emotional dysregulation in adult ADHD: what is the empirical evidence?". Expert Review of Neurotherapeutics. 12 (10): 1241–1251. doi:10.1586/ern.12.109. PMID 23082740.
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