Dysregulation: Types, Causes, Symptoms, Assessment and Treatment

Emotional dysregulation is when a person has difficulty managing emotional responses, leading to intense and prolonged emotional reactions that often exceed the normal range of responses. According to Shaw P, et al’s 2014 study. “Emotion Dysregulation in Attention Deficit Hyperactivity Disorder” published in the  American Journal of Psychiatry Journal, about 25–45% of children and 30–70% of adults with ADHD exhibit emotion dysregulation. It foretells a bad clinical result and is a significant cause of disability.

The main causes of emotional dysregulation include early childhood trauma, such as abuse or neglect, which disrupts emotional development; traumatic brain injury, which impair emotional regulation capabilities; and chronic invalidation, where an individual’s feelings are consistently dismissed or judged, contributing to heightened emotional sensitivity. 

Symptoms of dysregulation manifest as severe mood swings, anxiety, depression, self-harm, impulsivity, and substance abuse, significantly impacting interpersonal relationships and overall quality of life.

Assessment of emotional dysregulation involves clinical interviews and standardized questionnaires that evaluate emotional responses and coping mechanisms. Treatments for this condition primarily focus on therapeutic approaches, with Dialectical Behavior Therapy (DBT) being particularly effective. 

According to Lee RK et al. ‘s 2022 study, “The contribution of Skills to the Effectiveness of Dialectical Behavioral Therapy,” DBT helps individuals develop skills for emotion regulation, distress tolerance, and interpersonal effectiveness. 

Other treatment modalities include cognitive behavioral therapy (CBT) and medication management for co-occurring mental health conditions. Addressing emotional dysregulation is crucial for improving mental health outcomes and enhancing the quality of life for affected individuals.

What is Emotional Dysregulation?

Emotional dysregulation is the inability to manage emotional responses effectively, leading to intense and prolonged reactions that often exceed what is socially acceptable or proportionate to the triggering situation, according to Thompson RA’s 2019 study titled “Emotion Dysregulation,” published in the Developmental and Psychopathology Journal. This condition is commonly associated with various psychiatric and neurodevelopmental disorders, including borderline personality disorder (BPD), bipolar disorder, and attention deficit hyperactivity disorder (ADHD). 

Individuals experiencing emotional dysregulation exhibit a range of emotions, such as anger, anxiety, sadness, and shame, often manifesting through behaviors like angry outbursts, excessive crying, impulsivity, and self-harm.

The impact of emotional dysregulation on quality of life is profound. It often leads to difficulties in social interactions, strained relationships, and challenges in personal and professional environments. For instance, individuals struggle with maintaining healthy relationships due to their intense emotional responses and inability to cope with stressors effectively. 

According to Warne N et al.’s 2023 study titled ” Emotional Dysregulation in Childhood and Disordered Eating and Self-harm in Adolescence, 6,934 children found that emotional dysregulation in early childhood increases the risk of disordered eating and self-harm in adolescence, with social cognition and bullying victimization as key mediators.

 Therefore, emotional dysregulation affects an individual’s emotional state and impairs their ability to function in daily life.

What are the Causes of Emotional Dysregulation?

The causes of emotional dysregulation are genetic factors, mental health disorders, brain injury, childhood trauma, and child neglect, according to Bradley B. et al.’s 2011 study “Emotion Dysregulation and Negative Affect,”  published in the Journal of Clinical Psychiatry.

The causes of emotional dysregulation are listed below:

• Genetic Factors: Genetic predispositions influence emotional reactivity and regulation. Individuals inherit traits that make them more susceptible to emotional dysregulation, which environmental factors worsen. 

According to Andreassen et al.’s 2023 study, “New Insights From the Last Decade of Research in Psychiatric Genetics”, published in World Psychiatry,  genetic variations affect how emotions are processed, leading to heightened sensitivity and emotional instability. This is seen in individuals with mood disorders, such as bipolar disorder and major depressive disorder.

• Mental Health Disorders: Conditions such as borderline personality disorder (BPD), bipolar disorder, and attention deficit hyperactivity disorder (ADHD) are closely affected by emotional dysregulation. 

For instance, individuals with BPD often exhibit extreme emotional responses and difficulty returning to a baseline emotional state, which can lead to impulsive behaviors and strained relationships, according to Chapman J et al.’s 2024 study,  “Borderline Personality Disorder”, published in StatPearls Publishing.

• Brain Injury: Traumatic brain injuries (TBI) disrupt the brain’s ability to regulate emotions. Damage to areas responsible for emotional control can result in erratic mood swings and inappropriate emotional responses. According to Weis CN et al.’s 2022 study titled “Emotion Dysregulation Following Trauma”, published in   Biological Psychiatry Journal, 60% of individuals with TBI experience some form of emotional dysregulation.
• Childhood Trauma: Early experiences of trauma, such as abuse or neglect, severely impact emotional regulation skills. According to Cruz D Et al’s 2022 study titled “Developmental Trauma”,  children who experience trauma often struggle with managing emotions later in life, leading to increased risks of developing mental health issues. This highlights a direct correlation between childhood trauma and the prevalence of emotional dysregulation in adulthood.
• Child Neglect: Neglect during formative years deprives children of essential emotional support and validation. This lack of nurturing can lead to difficulties understanding and managing emotions effectively. According to Dvir Y et al. ‘s 2014 study, “Childhood Maltreatment, Emotional Dysregulation, and Psychiatric Comorbidities,” children who face neglect are more likely to develop maladaptive coping mechanisms, contributing to long-term emotional dysregulation.

These factors contribute to emotional dysregulation, predisposing individuals to heightened emotional sensitivity and impulsivity. This leads to challenges in managing stress and emotions effectively, increasing the likelihood of engaging in maladaptive behaviors such as substance abuse as a means of coping with overwhelming feelings.

What Are The Symptoms Of Emotional Dysregulation

The symptoms of emotional dysregulation are intense mood swings, anxiety, depression, impulsivity, self-harm, substance abuse, and interpersonal conflicts, according to Hirsch O et al.’s 2018 review titled,  “Emotional Dysregulation is a Primary Symptom in Adult Attention-Deficit/Hyperactivity Disorder (ADHD)” published in the Journal of Affect Disord.

 The common symptoms of emotional dysregulation include:

• Intense Mood Swings: Individuals experience rapid changes in their emotional state, feeling elated and deeply sad the next. These fluctuations occur without clear triggers.
• Anxiety: Persistent feelings of worry or panic overwhelm individuals, making it difficult to function in daily life. This anxiety often worsens other symptoms.
• Depression: Feelings of hopelessness and sadness are profound and persistent, leading to a lack of motivation and interest in once enjoyable activities.
• Impulsivity: Individuals act without thinking about the consequences, leading to risky behaviors such as reckless driving or substance abuse.
• Self-Harm: Some people engage in self-injurious behaviors as a way to cope with overwhelming emotions or to express emotional pain.
• Substance Abuse: To manage intense emotions, individuals turn to alcohol or drugs, which leads to addiction and further emotional instability.
• Interpersonal Conflicts: Difficulty regulating emotions often results in strained relationships. Individuals struggle with anger outbursts or withdrawal from social interactions, leading to misunderstandings and conflicts with others.

Bianchi V et al. ‘s study, 2022 “Emotional Dysregulation in Adults from 10 World Societies,” published in the International Journal of Clinical Health Psychology, involving 9,238 adults across various societies, found that approximately 9.2% exhibited signs indicative of emotional dysregulation. Recognizing these symptoms is essential for seeking appropriate support and treatment.

How to Assess Emotional Dysregulation?

To assess emotional dysregulation, methods like self-report questionnaires, behavioral observations, and physiological measures are used, according to Powers A et al.’s 2015 “Construct Validity of a Short, Self Report Instrument Assessing Emotional Dysregulation. Psychiatry Research Journal.   

Self-report questionnaires are commonly used to assess emotional dysregulation. They provide a subjective measure of an individual’s experience and often include items related to the frequency and intensity of emotions and the ability to regulate them effectively.

Behavioral observations involve directly observing an individual’s behavior in real-life situations or controlled settings. This method allows for a more objective assessment of emotional dysregulation, focusing on observable behaviors rather than self-reported experiences. For example, a therapist notes if an individual becomes agitated quickly or has difficulty calming down after becoming upset.

Physiological measures such as heart rate variability and skin conductance are also used to assess emotional dysregulation. These measures provide an objective measure of physiological arousal in response to emotional stimuli, which indicate difficulties in regulating emotions.

What Are The Treatments For Emotional Dysregulation?

The primary treatments for emotional dysregulation are psychotherapy, medication, mindfulness practices, and diet and exercise, according to Dadomo H,et al’s 2018 article titled “Schema Therapy for Emotional Dysregulation in Personality Disorders” published in the  Current Opinion in Psychiatry Journal.

The treatments for emotional dysregulation are listed below:

Psychotherapy

Psychotherapy, particularly dialectical behavior therapy (DBT), is a cornerstone treatment that focuses on teaching individuals skills to manage their emotions effectively. DBT includes mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness, which help individuals recognize and control their emotional responses.

This therapy is beneficial for those with borderline personality disorder, as it provides tools to navigate intense emotions and improve relationships. Neacsiu AD et al.’s 2013 study, “Impact of Dialectical Behavior Therapy Versus Community Treatment by Experts on Emotional Experience, Expression, and Acceptance in Borderline Personality Disorder,” reported a 60% improvement in emotional regulation and a 40% reduction in impulsive behavior. This demonstrates how DBT aids BPD patients in managing emotions and reducing impulsivity.

Medication

Medication helps with managing emotional dysregulation. Antidepressants, mood stabilizers, and sometimes antipsychotics are prescribed to help stabilize mood and alleviate symptoms of anxiety and depression. Medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and atypical antipsychotics are commonly prescribed for emotional dysregulation. These medications help individuals regain emotional balance and reduce impulsive behaviors associated with dysregulation.

Mindfulness practices

Mindfulness practices involve meditation and breathing exercises that enhance emotional awareness and self-control. These practices help individuals become more attuned to their feelings, allowing them to respond to emotional triggers more accurately. Bentley TGK et al.’s 2023 study, “Breathing Practices for Stress and Anxiety Reduction,” with 80 participants practicing breathing exercises for 4 weeks, reported a 45% decrease in stress levels and a 20% increase in relaxation response. This supports the role of breathing exercises in stress reduction and emotional regulation.

Diet and exercise

Lastly, maintaining a healthy diet and regular exercise supports overall emotional well-being. Eating a balanced diet and engaging in physical activity helps regulate hormones and neurotransmitters, which play an important role in emotional regulation.  According to Ljubičić M et al. ‘s 2023 study, “Emotions and Food Consumption,” published in the Foods Journal, Increased motivation for health behaviors is linked to a 19% higher chance of controlling body weight through food and a 4% higher chance of consuming food for emotional reasons. Therefore, paying attention to what we eat and how it affects our emotions is important.

How Can You Regulate Your Emotions?

To regulate your emotions, practice mindfulness techniques such as deep breathing and meditation to enhance self-awareness, according to Schuman-Olivier Z et al.’s 2020 study “Mindfulness and Behavior Change” in the Harvard Review of Psychiatry. Journaling helps clarify feelings, while physical activity releases endorphins. Establishing a support network provides an outlet for sharing experiences, fostering emotional resilience and understanding.

When Does Emotional Dysregulation Typically Occur?

Emotional dysregulation occurs when individuals struggle to manage their emotional responses to various stimuli, leading to intense and often inappropriate reactions, according to Paulus FW, Et al’s, 2021 study, “Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders”  published in the Front Psychiatry. 

Emotional dysregulation is frequently associated with mental health disorders, including borderline personality disorder (BPD), bipolar disorder, and attention-deficit/hyperactivity disorder (ADHD). 

The duration of emotional dysregulation varies among individuals. While some experience brief episodes lasting only minutes or hours, others might endure prolonged periods of emotional turmoil that lasts days or even weeks without appropriate intervention. 

Over time, with age and therapeutic support, many individuals see improvements in their emotional regulation skills, but untreated dysregulation persists and significantly impacts daily functioning and relationships.

Is Emotional Dysregulation the Same as ADHD?

No, emotional dysregulation is not the same as ADHD. Emotional dysregulation refers to difficulties in managing and responding to emotional experiences, which manifests as intense mood swings, irritability, and impulsive reactions. In contrast, ADHD (Attention-Deficit/Hyperactivity Disorder) is primarily characterized by symptoms of inattention, hyperactivity, and impulsivity. However, many individuals with ADHD also experience emotional dysregulation as a common co-occurring symptom. 

According to a study titled, “Šimić G, et al’s 2021 study titled, “Understanding Emotions” published in the Biomolecules Journal,  the neurobiological underpinnings of ADHD such as differences in brain regions like the prefrontal cortex and amygdala contribute to challenges in emotional regulation. This means that while emotional dysregulation is not an official diagnostic criterion for ADHD, it is seen as a significant aspect of the disorder that worsens its core symptoms and impacts daily functioning and relationships.

Does PTSD Cause Emotional Dysregulation?

Yes, PTSD causes emotional dysregulation. According to Conti L, et al’s 2023 study titled, “Emotional Dysregulation and Post-Traumatic Stress Symptoms” published in the Brain Science Journal, individuals with post-traumatic stress disorder (PTSD) often experience significant difficulties in regulating their emotions, which manifest as intense emotional responses, mood swings, and impulsive behaviors. 

The study highlighted that emotion dysregulation is not only a symptom of PTSD but also plays a crucial role in its development and maintenance. Specifically, trauma-exposed individuals perceive their emotions as overwhelming or frightening, leading to avoidance strategies that exacerbate PTSD symptoms.