Emotional Dysregulation in ADHD: An Introduction
The more that we learn about ADHD, the more we uncover common experiences of ADHDers that are not captured within the current ADHD diagnostic criteria. (Not that I am surprised by that… anyway!) One such experience is emotional dysregulation. I choose to use the term dysregulation here because while I want to avoid pathologizing language I also want to acknowledge that ADHDers often feel overwhelmed with their emotions in a way that has a negative impact on their quality of life. This is not meant to insinuate that ADHDers should strive for some sort of neurotypical standard of emotional regulation and subsequently disregard their emotions. I believe quite the opposite. I also understand, personally and professionally, that ADHDers who experience emotional dysregulation often desire techniques to help themselves in a variety of ways ranging from self-soothing to feeling better in interpersonal experiences.
So, what exactly is emotional dysregulation? When I use this term, I am referring essentially to a sequence of events that occurs: something triggers an emotion, the emotional experience is intense, the person experiencing the intense emotion feels negatively affected by the experience, and the affected person struggles with knowing how to soothe themselves and move forward. This definition is intentionally vague as it can show up in different ways for different folx and can also vary by emotion(s).
Here is an example: Molly, an ADHDer, experiences a verbal disagreement with a coworker in a common area at her place of work. She feels anger, hurt, and embarrassment. Her experience with these emotions causes a cascade of internal experiences: her heart rate and breathing rate increase, she begins sweating, she feels cramping in her belly, tears begin forming in her eyes, and the nature of her thoughts become decidedly critical of herself and others. Note that this all occurs at once and within seconds, and Molly likely cannot name all of these components in the moment. Instead, she simply notices a quick, intense, and negative experience in her mind and body. The quickness and intensity of this experience leaves Molly a bit stunned and at a loss for how to move forward in her day, much less in the current interaction with her coworker. She disengages from the conversation with her coworker and retreats to her office, where she closes the door and cries. It takes some time for her heart rate and breathing rate to decrease, and her thoughts remain very critical of herself. She finds it difficult to concentrate on her work for the rest of the day, and fights the urge to resume the disagreement with her coworker - whether to explain herself further or to express her emotions to the coworker. This experience continues into the evening, disrupting her ability to be fully present with her partner at home. Beginning the following work day is also anxiety-provoking as Molly still doesn’t know how to move forward with her coworker and continues to criticize herself for the disagreement. Doesn’t sound pleasant, does it? What Molly is experiencing can be characterized as emotional dysregulation. Not only did she have physical and mental experiences that were unpleasant, she was left with interpersonal difficulties as well - feeling that she couldn’t resolve the disagreement with her coworker and feeling less present with her partner after work.
So, what is the cause of emotional dysregulation in ADHDers? That’s a bit complicated. There are a variety of theories. Some theories indicate differences in brain structure in ADHDers that cause the increased intensity of emotional experience. Couple this with difficulties with other executive functions (yes, emotional regulation is an executive function!) such as task completion and attention, and there you have a possible explanation of why ADHDers not only feel intensely but have difficulties resolving and/or moving forward from experiences. What a boatload of fun!
Why is it important for ADHDers to engage in emotional regulation strategies? Again, the goal here is not to push ADHDers to fit into a neurotypical mold. The goal is also not to ignore or suppress emotions. The goal is to identify helpful, affirming tools to aid ADHDers in understanding and moving through their emotions. Okay, great! But again, why is this important? Great question! Unfortunately, without strategies to understand and move through emotions, it can be easy for ADHDers to turn to self-destructive means to “manage” their emotions in order to self-soothe and “fit in” or maintain relationships. This may look like substance abuse, ongoing dismissal of one’s own emotions (which can lead to burnout), impulsive behavior (overspending, risky driving, etc.), or other behaviors that ultimately do not help in the long run. So, again, the goal is not for ADHDers to put their emotions away to please others, but instead to find ways to meet their emotional needs and continue to function in a way that makes sense in their lives.
There is a LOT to be said about what is helpful for ADHDers in engaging in emotional regulation. I cannot capture all of the nuance here, but below are some initial steps for ADHDers dealing with emotional dysregulation:
Mindfulness and Self-Awareness: I know, I know. Everyone says to engage in mindfulness. But for ADHDers, it may be more difficult to gauge emotional states in real time. So, engaging in mindfulness practices such as deep breathing, meditation, or body scanning can help increase awareness of emotional states as they arise.
Emotion Identification: Similar to the first point, it may be difficult for ADHDers to label their emotions. Using tools like an emotions chart may help to identify emotions. Collecting other data, such as how you feel physically during a certain emotion, can also help increase understanding and awareness of your current emotional state. Further, it may help to express the emotions you identify through writing or verbal communication.
Coping Strategies: Create a toolbox of coping strategies. These are unique to each person. I really emphasize having several tools in your toolbox, as a one-size-fits all approach to emotional regulation isn’t great, especially for ADHDers. We need variety! These tools can include breathing techniques, sensory grounding exercises, or physical activity to release built-up tension. Positive distractions may also be helpful, like engaging in hobbies or activities when you feel overwhelmed.
Physical Health Check-Ins: This may seem like a random addition to this list. And yes, I know, everyone always says to get enough sleep, exercise, and so on. But it really is important! Actually, it is especially important for ADHDers, because we often experience difficulty in appraising our physical needs. Sleep deprivation, dehydration, hunger, and other unmet physical needs can certainly contribute to the frequency and intensity of emotional dysregulation.
Again, these are just some beginning steps for working on emotional regulation. I hope this is helpful for you!