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Emotional dysregulation

Difficulty controlling and moderating one's emotional reactions

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It is often linked to physical factors such as brain injury, psychological factors such as adverse childhood experiences, and ongoing maltreatment including child abuse, neglect, or institutional abuse.

Emotional dysregulation may be present in people with psychiatric and neurodevelopmental disorders such as attention deficit hyperactivity disorder, autism spectrum disorder, bipolar disorder, borderline personality disorder, complex post-traumatic stress disorder, and fetal alcohol spectrum disorders. The dysregulation of emotions is also present in individuals with mood disorders and anxiety disorders. In such cases as borderline personality disorder and complex post-traumatic stress disorder, hypersensitivity to emotional stimuli causes a slower return to a normal emotional state and may reflect deficits in prefrontal regulatory regions. Damage to the frontal cortices of the brain can cause deficits in behavior that can severely impact an individual's ability to manage their daily life. As such, the period after a traumatic brain injury, such as a frontal lobe disorder, can be marked by emotional dysregulation. This is also true of neurodegenerative diseases.

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

Signs and symptoms

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

Childhood

Dysregulation is more prevalent in children, and is generally seen to decrease as children develop. During early childhood, emotional dysregulation or reactivity is considered to be situational rather than indicative of emotional disorders. It is important to consider parental mood disorders as genetic and environmental determinants. Children of parents with symptoms of depression are less likely to learn strategies for regulating their emotions and are at risk of inheriting a mood disorder. When parents have difficulty regulating their emotions, they often cannot teach their children to regulate properly. The role of parents in a child's development is acknowledged by attachment theory, which argues that the characteristics of the caregiver-child relationship impact future relationships. Current research indicates that parent-child relationships characterized by less affection and greater hostility may result in children developing emotional regulation problems. If the child's emotional needs are ignored or rejected, they may experience greater difficulty dealing with emotions in the future. Moreover, conflict between parents is linked to increased emotional reactivity or dysregulation in children. Other factors involved include the quality of relationship with peers, the child's temperament, and social or cognitive understanding. Additionally, loss or grief can contribute to emotional dysregulation.

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). High-risk children had difficulty with self-regulation, had difficulty complying with requests from caregivers and were more defiant. Emotional dysregulation has also been associated with childhood social withdrawal.

Internalizing behaviors

Emotional dysregulation in children can be associated with internalizing behaviors including:

  • 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; and
  • experiencing more negative emotions.

Externalizing behaviors

Emotional dysregulation in children can be associated with externalizing behaviors including:

  • 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; and
  • difficulty calming down when upset.

Adolescence

In adolescents, emotional dysregulation is a risk factor for many mental health disorders including depressive disorders, anxiety disorders, post-traumatic stress disorder, bipolar disorder, borderline personality disorder, substance use disorder, alcohol use disorder, eating disorders, oppositional defiant disorder, and disruptive mood dysregulation disorder. Dysregulation is also associated with self-injury, suicidal ideation, suicide attempts, and risky sexual behavior. Emotional dysregulation is not a diagnosis, but an indicator of an emotional or behavioral problem that may need intervention.

Attachment theory and the idea of an insecure attachment are implicated in emotional dysregulation. Greater attachment security correlates with less emotional dysregulation in daughters. Moreover, it has been observed that more female teens struggle with emotional dysregulation than males. Professional treatment, such as therapy or admittance into a psychiatric facility, is recommended.

Adulthood

Emotional dysregulation tends to present as emotional responses that may seem excessive compared to the situation. Individuals with emotional dysregulation may have difficulty calming down, avoiding difficult feelings, or focusing on the negative. On average, women tend to score higher on scales of emotional reactivity than men. A study at University College Dublin found that dysregulation correlates to negative feelings about one's ability to cope with emotions and rumination in adults. They also found dysregulation to be common in a sample of individuals not affected by mental disorders.

Part of emotional dysregulation, which is a core characteristic in borderline personality disorder, is affective instability, which manifests as rapid and frequent shifts in mood of high affect intensity and rapid onset of emotions, often triggered by environmental stimuli. The return to a stable emotional state is notably delayed, exacerbating the challenge of achieving emotional equilibrium. This instability is further intensified by an acute sensitivity to psychosocial cues, leading to significant challenges in managing emotions effectively.

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