Emotional dysregulation

Emotional dysregulation is characterized by an inability to flexibly respond to and manage emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.^[1][2][3][4]

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.^[5]

Emotional dysregulation may be present in people with psychiatric and neurodevelopmental disorders such as attention deficit hyperactivity disorder,^[6]autism spectrum disorder, bipolar disorder, borderline personality disorder, complex post-traumatic stress disorder, and fetal alcohol spectrum disorders.^[7][8][9] The dysregulation of emotions is also present in individuals with mood disorders and anxiety disorders.^[10] In such cases as borderline personality disorder and complex post-traumatic stress disorder,^[11] 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.^[12] 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.^[13]

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.^[14]

The word dysregulation is a neologism created by combining the prefix dys- to regulation. According to Webster's Dictionary, dys- has various roots and is of Greek origin. With Latin and Greek roots, it is akin to Old Englishtō-, te- 'apart' and Sanskritdus- 'bad, difficult'. It is frequently confused with the spelling disregulation, with the prefix dis meaning 'the opposite of' or 'absence of'; while disregulation refers to the removal or absence of regulation, dysregulation refers to ways of regulating that are inappropriate or ineffective.

There are links between child emotional dysregulation and later psychopathology.^[15] For instance, ADHD symptoms are associated with problems with emotional regulation, motivation, and arousal.^[16] One study found a connection between emotional dysregulation at 5 and 10 months, and parent-reported problems with anger and distress at 18 months.^[17][18] Low levels of emotional regulation behaviors at 5 months were also related to non-compliant behaviors at 30 months.^[19] While links have been found between emotional dysregulation and child psychopathology, the mechanisms behind how early emotional dysregulation and later psychopathology are related are not yet clear.

Smoking, self-harm, eating disorders, and addiction have all been associated with emotional dysregulation.^[20]Somatoform disorders may be caused by a decreased ability to regulate and experience emotions or an inability to express emotions in a positive way.^[21] 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.^[22][23] 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.^[24][25]

Early experiences with caregivers can lead to differences in emotional regulation. The responsiveness of a caregiver to an infant's signals can help an infant regulate their emotional systems. Caregiver interaction styles that overwhelm a child or that are unpredictable may undermine emotional regulation development. Effective strategies involve working with a child to support developing self-control, such as modeling a desired behavior rather than demanding it.^[63]

The richness of an environment that a child is exposed to helps the development of emotional regulation. An environment must provide appropriate levels of freedom and constraint. The environment must allow opportunities for a child to practice self-regulation. An environment with opportunities to practice social skills without overstimulation or excessive frustration helps a child develop self-regulation skills.^[63]

Several variables have been explored to explain the connection between emotional dysregulation and substance use in young adults, such as child maltreatment, cortisol levels, family environment, and symptoms of depression and anxiety. Vilhena-Churchill and Goldstein (2014)^[64] explored the association between childhood maltreatment and emotional dysregulation. More severe childhood maltreatment was found to be associated with an increase in difficulty regulating emotion, which in turn was associated with a greater likelihood of coping by using marijuana. Kliewer et al. (2016)^[65] performed a study on the relationship between negative family emotional climate, emotional dysregulation, blunted anticipatory cortisol, and substance use in adolescents. Increased negative family emotional climate was found to be associated with high levels of emotional dysregulation, which was then associated with increased substance use. Girls were seen to have blunted anticipatory cortisol levels, which was also associated with an increase in substance use. Childhood events and family climate with emotional dysregulation are both factors seemingly linked to substance use. Prosek, Giordano, Woehler, Price, and McCullough (2018)^[66] explored the relationship between mental health and emotional regulation in collegiate illicit substance users. Illicit drug users reported higher levels of depression and anxiety symptoms. Emotional dysregulation was more prominent in illicit drug users in the sense that they had less clarity and were less aware of their emotions when the emotions were occurring.

Many people experience dysregulation and can struggle at times with uncontrollable emotions. Thus, potential underlying issues are important to consider in determining severity.^[13] As the ability to appropriately express and regulate emotions is related to better relationships and mental health, parental support can help regulate the emotions of children struggling with emotional dysregulation. Training to help parents address this issue focuses on predictability and consistency. These tenets are thought to provide comfort by creating a sense of familiarity and thus safety.^[67]

While cognitive behavioral therapy (CBT) is the most widely prescribed treatment for such psychiatric disorders, a commonly prescribed psychotherapeutic treatment for emotional dysregulation is dialectical behavioral therapy (DBT), a psychotherapy which promotes the use of mindfulness, a concept called dialectics, and emphasis on the importance of validation and maintaining healthy behavioral habits.^[68][69]

When diagnosed as being part of ADHD, norepinephrine and dopamine reuptake inhibitors such as methylphenidate (Ritalin)^[70] and atomoxetine^[71] are often used. A few studies have also showed promise in terms of non-pharmacological treatments for people with ADHD and emotional problems,^[72][73] although the research is limited and requires additional inquiry.

Eye Movement Desensitization and Reprocessing (EMDR) can help recovery from emotional dysregulation in cases where the dysregulation is a symptom of prior trauma.^[47] Outside of therapy, there are helpful strategies to help individuals recognize how they are feeling and put space between an event and their response. These include mindfulness, affirmations, and gratitude journaling.^[28]Hypnosis may also help to improve emotional regulation.^[37] Movement such as yoga and aerobic exercise can also be therapeutic by aiding with regulation and the ability to understand how one's mind influences behavior.^[13]