The 19th Symptom of ADHD: Emotional Dysregulation
There are 18 official symptoms of ADHD. In my experience, there's another symptom that almost everyone I've met with ADHD struggles with: emotional dysregulation. ADHD can really mess with your emotions. It can be like a rollercoaster ride, with extreme highs and lows. Sometimes it's a rush, but other times it's a total nightmare, and those negative emotions can be especially intense and disruptive to daily life.
Emotional regulation refers to the ability to manage and regulate one's emotional responses to various situations. Here are some of the emotional regulation difficulties associated with ADHD:
Impulsivity: Individuals with ADHD may struggle with impulsivity, which can lead to impulsive emotional responses. They may have a harder time controlling their immediate emotional reactions, which can lead to outbursts or overreactions.
Poor frustration tolerance/irritability: Individuals with ADHD may have a harder time tolerating frustration or delays in gratification, which can lead to emotional dysregulation. They may become easily overwhelmed and upset when things do not go as planned or when faced with challenges.
Emotional lability: Emotional lability refers to rapid shifts in emotional states, such as going from feeling happy to feeling sad or angry. Individuals with ADHD may experience emotional lability, which can be challenging to manage.
Rejection sensitivity: Individuals with ADHD may be more sensitive to rejection or perceived rejection, which can trigger strong emotional reactions. They may be more prone to feeling hurt or angry when they feel excluded or criticized.
Difficulty with emotional self-awareness: Individuals with ADHD may have a harder time recognizing and understanding their own emotions, which can make it challenging to regulate them effectively. They may struggle to identify their emotions or may misinterpret them, leading to inappropriate responses.
Overall, these emotional regulation difficulties associated with ADHD can impact an individual's relationships, school or work performance, and overall quality of life. Many of my ADHD therapy clients seek therapy primarily for difficulties with emotion regulation that are affecting their private lives - particularly when it comes to caring for children and interacting with their spouse/partner.
I have seen emotion dysregulation significantly improved with the use of stimulant drugs, both in my clients and in my son. These drugs can increase all and any aspects of self-control, including experience and expressing of emotions. Other psychotropic medications like antidepressants can also be helpful for emotional regulation.
Sometimes the emotional dysregulation that comes with ADHD can be mistaken as part of bipolar disorder, or borderline personality disorder. These two disorders explicitly note emotional dysregulation as core symptoms, while of course ADHD doesn't. It is certainly possible to have ADHD and bipolar and/or borderline personality disorder, and they are more common comorbid disorders in people with ADHD. But, ADHD is more common in the population than either bipolar or borderline personality disorder, and I would hope that mental health clinicians would consider ADHD when they are confronted with emotion dysregulation in a client. Mood stabilising medications often used for bipolar disorder are not currently recommended for use with ADHD, but I would hope they are a possible future area of research into whether they could be efficacious for emotional dysregulation in people with ADHD also.
Here is a fantastic one-hour podcast by ADHD expert clinician and researcher Dr Russell Barkley on the overlooked symptom of emotional dysregulation in ADHD.
And here's an equally brilliant podcast by ADHD-specialist psychiatrist Dr William Dodson on emotional dysregulation and rejection sensitivity dysphoria.