Emotional dysregulation is a symptom of ADHD that many people seem to experience despite it not being in the official diagnostic criteria. It involves intense emotions that individuals may find difficult to manage.
Research is ongoing on the connection between emotional dysregulation and attention deficit hyperactivity disorder (ADHD). However, various studies show many people with ADHD experience emotional dysregulation as well as other symptoms.
This article explains emotional dysregulation and its connection to ADHD. It also includes personal stories from Dr. Gilly Kahn, a licensed psychologist who also has personal experience living with ADHD.
Emotional dysregulation refers to difficulty in regulating and controlling emotions. Emotional dysregulation may manifest in various ways, including:
- being unaware of the feelings of others
- experiencing intense emotions, such as high anxiety or angry outbursts
- having difficulty turning one’s focus away from their emotions
- experiencing quick changes in mood and unpredictable emotions
- having a low tolerance for situations that may be frustrating
- becoming overly excited
- focusing mainly on the negative
Read more about emotional dysregulation.
Dr. Gilly Kahn’s story: My experience with ADHD and emotional dysregulation
Like many other women, I was only diagnosed with ADHD recently. This is because females (assigned at birth) tend to go underdiagnosed compared to males. Emotional dysregulation is also not included as a criterion for ADHD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders,5th Edition, Text Revision (DSM-5-TR).
The truth is that there are overlapping brain areas between the ones governing emotional dysregulation and the more recognized ADHD symptoms (e.g., impulsivity and other executive functioning challenges). If someone struggles with holding back on interrupting someone else or with staying still, it will probably also be hard for them to manage their emotions.
I’m explaining all of this because I think that’s a big part of what threw me off when I considered whether I might have ADHD. I’ve always been an “emotional girl,” and a lot of times, the knee-jerk reactions I have as a result of intense emotions leave me feeling ashamed. A lot of this is tied to rejection-sensitive dysphoria (RSD), which describes extreme sensitivity to perceived or actual rejection.
Emotional dysregulation has affected me in my personal relationships, but also at work. It can be excruciatingly difficult for me to “keep it together” sometimes. For example, there have been a few incidents where I started (literally) sobbing in my professor’s office (in grad school), in a supervisor’s office, or with a work colleague. One hundred percent of those examples involved me feeling rejected.
Read about ADHD in females.
At one time, emotional dysregulation was considered a core part of ADHD. However, during the time researchers were adding the condition to the DSM, they chose to focus on other aspects, such as inattention and hyperactivity.
While emotional dysregulation is not listed in the DSM-5-TR as part of ADHD criteria, researchers typically agree that there is a strong connection between it and ADHD.
In recent years, researchers have once again begun taking a closer look at this connection. A
The three models are:
- Core, defining feature: Emotional dysregulation is a core feature of ADHD. It is as central to the condition as impulsivity, inattention, and hyperactivity.
- Distinct entity: Emotional dysregulation and ADHD are separate but co-occurring conditions. Emotional dysregulation stems from a different part of the brain, meaning that people with ADHD are more likely to develop it than those without ADHD.
- New condition: ADHD and emotional dysregulation together make up an entirely new condition that is distinctive from ADHD.
Research on this connection is ongoing. Some researchers believe that advances in science and neuroimaging may one day identify the exact causes and connections.
Emotional dysregulation can affect various aspects of daily life.
Work
There are many ways that emotional dysregulation can affect a person at work. For instance, the stress that is involved with meeting deadlines may be difficult for them to handle.
Minor issues or frustrations may lead them to experience overwhelming fear or anxiety. Also, they may find it difficult to build healthy relationships with their peers and colleagues.
Personal relationships
Difficulty in regulating emotions can cause conflict in relationships with romantic partners, friends, and family. An individual may find that they spend more time ruminating than finding solutions to issues.
Minor disagreements may act as a trigger and lead to full-blown arguments. This can cause misunderstandings and hurt feelings.
Dr. Gilly Kahn’s story: How emotional dysregulation affects me
I wouldn’t say emotional dysregulation affects my daily life as long as I am cognizant of my sensory limits and actually slow down when I need to.
For me and for a lot of other ADHDers, stress can be debilitating. So a key part of learning how to manage your emotional responses involves learning how to detect when you are starting to feel tapped-out and what to do in those moments. If the moment calls for busting out your noise-canceling headphones or going to sit in a quiet, dark room — you should do it. I see relaxation as an investment. If you don’t do it, you won’t be productive, and, more importantly, you’ll be miserable.
ADHD, more generally, does affect my daily functioning — mainly my ability to sit calmly and concentrate on things that do not interest me. Stimulant medication helps me get my work done without feeling like I’m dying inside. It also helps my mood because I also have a history of depression. Some days are still really hard, even with medication.
Mental health
Emotional dysregulation can make it difficult for individuals to cope with frustration, anger, and sadness. This may lead to or worsen other mental health conditions.
Research from 2022 shows that there may be a strong connection between emotional dysregulation and depression.
Behaviors
Research has found that individuals with emotional dysregulation may be more likely to participate in behaviors that may be dangerous or pose a risk to themselves or others.
Research from 2023 found that individuals with emotional dysregulation may be more likely to experience substance misuse. Research from 2020 found that people with emotional dysregulation may be more likely to participate in dangerous driving practices.
ADHD can make it more difficult for individuals to manage their emotions. This may be because the function and structure of the brain in someone with ADHD are different from those without it.
There are generally two main reasons ADHD is connected to emotional dysregulation.
Amygdala
The amygdala is a small, almond-shaped structure inside the brain. It helps to regulate emotions,
- fear
- anxiety
- anger
- aggression
Research from 2016 notes that there may be a difference in the activation and size of the amygdala in people with ADHD. This can cause difficulty in controlling impulses and may also lead to experiencing stronger emotions.
Frontal cortex
The frontal cortex plays an important role in expressing, regulating, and interpreting emotions. It
The frontal cortex helps a person decide what they should and should not say or do.
Research from 2022 found that there may be a decrease in the activation of the frontal cortex in those with ADHD. This means it is less likely to inhibit major reactions in the way it typically would. This may make it difficult for individuals to respond to emotions in the way they would generally be expected to.
Learn more about the parts and functions of the brain.
Dr. Gilly Kahn’s story: How I manage my emotional dysregulation
What has helped me the most with managing these challenges are medication (guanfacine, which is an alpha agonist that is often recommended for ADHDers struggling with RSD) and just accepting myself for who I am. I am a deeply caring individual. Without that, I would not have the connections I create with my clients in therapy.
Some supervisors have even described me as “composed” and “professional” — possibly so much so that they felt they couldn’t “read” me. That’s the thing with ADHD that I think a lot of people misunderstand. It isn’t predictable like people want it to be. The condition itself is a mess.
There are also sensory issues that need to be considered. Because rather than being a condition characterized by “inattention,” ADHD is better understood as attention dysregulation. So of course, if we are having a painful feeling, it may feel physically painful and intense. And, of course, if anyone feels extreme physical and emotional pain, they will find it hard to control their behavioral responses. A big part of this process is inevitable.
Patience and minimizing sensory input are helpful strategies for managing emotional dysregulation in ADHD. When I feel emotionally dysregulated, I often need to be left alone until I can get my emotions back to baseline. Trying to get someone with ADHD to “calm down” in the heat of the moment is like throwing a bunch of baseballs at their face and telling them to “catch.”
Treatment for ADHD typically includes medications, such as stimulants or nonstimulants. It may
Other tips to help manage emotions include:
- Acknowledge emotions: A person could remind themselves that emotions, even big ones, are a natural part of life. They could acknowledge the emotions they are experiencing and remind themselves that they do not have to act on them. It may help to do something that calms them down, such as walking away, reading a book, or taking a hot shower.
- Stop and breathe: In a situation where a person feels their emotions are building up, it can help to take a moment and focus on their breathing before they react.
- Reframe self-talk: Thinking that situations were worse than they actually were can fuel anger, sadness, and frustration. Reframing how one thinks about a situation can help take power away from the thoughts and allow the individual to view it more clearly.
- Reflection and triggers: When a person experiences a situation where their emotions take control, they could take time to reflect on it to see if they can identify certain triggers they may have. Understanding one’s triggers can help them avoid or minimize them in the future. It may not always be possible to avoid triggers, but a person can prepare themselves emotionally beforehand if they can identify it.
ADHD resources
Visit our dedicated hub for more research-backed information and in-depth resources on ADHD.
Emotional dysregulation causes difficulty in controlling and managing emotions. Research shows that there is a strong connection between emotional dysregulation and ADHD.
This may be due to differences in the structure and function of certain areas of the brain, such as the amygdala and frontal cortex, in those with ADHD.
Individuals can help manage ADHD with medications and therapy. However, there are also self-care tips to help manage emotional dysregulation, including pausing before reacting, learning triggers, and acknowledging their emotions.