ADHD & Emotional Dysregulation - bigger than attention?

I recently found myself in an absolute spiral of ruminative self-blaming and weirdly over-reactive thinking about an interaction online. This isn’t the first - or last - time I’ve felt like that but this time, I spotted it and gave it a label. No, not RSD: I used ‘emotional dysregulation’.

It made me wonder - do I really ‘get’ RSD - and why does another model - DESR - make more sense for me?

Most importantly - why is ADHD so often connected to really challenging emotional responses at every age?

The Rise of RSD

RSD has gained attention on ADHD-related social media platforms. You can easily find courses, webinars, blogs—you name it— all talking about Rejection Sensitivity Dysphoria - RSD. While the DSM-5 only mentions it in association with depression, most people attribute the term to Dr. William Dodson. He began using guanfacine to support patients experiencing these responses and began discussing these experiences as RSD more publicly. Coinciding with the rise of ADHD-focused social media platforms, this concept captured widespread attention as so many people recognised their own inner emotional turmoil in this term.

The Challenge of Diagnosis

The challenge lies in its absence as a recognized diagnosis. It is based on experiences, rather than something quantifiable or measurable so far. People may experience intense emotions like anger or sadness when criticized or rejected. They can be self-critical and may avoid new experiences or interactions due to fear of rejection - but these are not unique to ADHD and one of the criticisms has been this lack of specificity. Although there are many articles and studies exploring ‘rejection sensitivity’, very few use it with the addition of ‘dysphoria’.

Frustratingly, lots of adults with late diagnosed ADHD have found that their lifelong ‘depression’ is in fact emotional dysregulation. It looks like other mood disorders when assessed using scales and in discussion, leading to inappropriate treatment plans. This could well be why many late diagnosed ADHD adults discover their depression disappears when the root cause - the ADHD - is treated instead of the mood disorder.

Whatever the cause, it’s a very popular concept: there are around 165,000 monthly searches for RSD in the United States alone, indicating its growing relevance in ADHD discussions. People are looking for an answer and so far, RSD appears to be it.

 Why does Emotional Impulsivity (EI) affect our Executive Functions?

Our ability to regulate our emotions is deeply connected to our executive functions. These skills help us manage tasks and control our behavior. When our self-regulation becomes challenging, it can disrupt these functions, impacting everything from planning to impulse control. The key is that this impulsive response isn’t ‘inhibited’ - or managed - in the same way as typically developing brains would: we find it much harder to suppress or interrupt our emotional response even if we manage to contain it internally. While our brains are busy processing this big emotional response, the areas responsible for other executive functions as well are busy. It’s using a lot of our processing power to down-regulate these feelings and might try to distract us from them with a reward that isn’t in line with our long term personal vision.

DESR: A Closer Look

Dr. Russell Barkley refers to this as DESR - Deficient Emotional Self Regulation - which describes the unpredictable and often damaging range of emotional experiences in individuals with ADHD. His research suggests that DESR can have a cascading effect on other executive functions, such as working memory and planning. It’s why we often find it so much harder to remember what we were doing or focus and take action on a task if we’ve been ‘triggered’ (as the young folk say).

Clinical Implications

Recognizing dysregulation as an aspect of ADHD rather than just a secondary symptom has significant implications for diagnosis and treatment. It suggests that therapies should address not just attention and hyperactivity but also focus on improving self-regulation.

Leading neuropsychologists recommend a multi-faceted approach to treatment, incorporating cognitive-behavioral therapy, medication, and lifestyle changes.

Critics and Counterpoints

Some critics argue that emotional dysregulation isn’t exclusive to ADHD and is also be present in other conditions. It's essential to consider these perspectives for a balanced understanding and before we use our emotional responses or DESR as part of a self diagnosis.

If it is part of other psychiatric conditions or neurodevelopmental differences, it might mean that treatment needs to be different.

Practical Suggestions for Managing Emotions

Of course, we need to know what to DO about this emotional experience of life - it can be crippling when we feel that our emotions are in the driving seat.

1. Mindfulness: Practicing mindfulness can enhance our ability to regulate emotions effectively. (My "RadiantMind" course offers guided mindfulness exercises tailored for those with ADHD.)

2. Recognition & self-compassion/acceptance: Identifying signs of emotional dysregulation can lead to better outcomes.

3. Seeking Professional Help: Consulting with a neuropsychologist or other professionals specialising in regulation can offer insights and support.

(Alternatively, consider joining the "Vibrant Visionaries" group coaching for community support and expert guidance.

RSD, DESR - and you.

While many of us resonate with the concept of "Rejection Sensitivity Dysphoria," it's crucial to base our understanding on evidence-based information.

Emotional self-regulation, as explained by experts like Dr. Russell Barkley, provides a broad, neuro-scientifically supported framework for understanding these ‘big emotions’ that are so common, frequent and genuinely painful.

Personally, I find that the term "DESR" shifts the focus from feeling that I am being labeled as overly sensitive, towards recognising it as another of brain-based differences that are tied to ADHD in general.

Do you agree? Have you felt that RSD is actually empowering for you? I would love to know - and also what strategies you have found most useful for surfing these emotional waves.

 Want to learn more?

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Warmly,

Katherine

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Further reading:

Barkley, R. (2010). Differential diagnosis of adults with ADHD: the role of executive function and self-regulation.

Barkley, R. A. & Fischer, M. (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 503‐513.

Barkley, R. A. & Murphy, K. R. (2011). Deficient emotional self‐regulation in adults with ADHD: The relative contributions of emotional impulsiveness and ADHD symptoms to adaptive impairments in major life activities. Journal of ADHD and Related Disorders, 1(4), 5‐28.

Braaten, E. B., & Rosen, L. A. (2000). Self‐regulation of affect in attention deficit‐hyperactivity disorder (ADHD) and non‐ADHD bys: differences in empathic responding. Journal of Consulting and Clinical Psychology, 68, 315‐321.

Lyvers, M., Makin, C., Toms, E., Thorberg, F. A., Samios, C. (2014). Trait Mindfulness in Relation to Emotional Self-Regulation and Executive Function.

Sullivan, E., Holton, K., Nousen, E., Barling, A., Sullivan, C. A., Propper, C., Nigg, J. (2015). Early identification of ADHD risk via infant temperament and emotion regulation: a pilot study.

Surman, C., Biederman, J., Spencer, T., Miller, C. A., Petty, C., Faraone, S. (2015). Neuropsychological Deficits Are Not Predictive of Deficient Emotional Self-Regulation in Adults With ADHD.

Ben-Dor Cohen, M., Eldar, E., Maeir, A., Nahum, M. (2021). Emotional dysregulation and health related quality of life in young adults with ADHD: a cross sectional study. Health and Quality of Life Outcomes.

Elmaghrabi, S., Nahmias, M., Adamo, N., di Martino, A., Somandepalli, K., Patel, V., McLaughlin, A., De Sanctis, V. A., Castellanos, F. (2018). Is Increased Response Time Variability Related to Deficient Emotional Self-Regulation in Children With ADHD? Journal of Attention Disorders.

Korucu, I., Ayturk, E., Finders, J. K., Schnur, G., Bailey, C. S., Tominey, S., Schmitt, S. (2022). Self-Regulation in Preschool: Examining Its Factor Structure and Associations With Pre-academic Skills and Social-Emotional Competence. Frontiers in Psychology.

Caes, L., Dick, B., Duncan, C. L., Allan, J. (2020). The Cyclical Relation Between Chronic Pain, Executive Functioning, Emotional Regulation, and Self-Management. Journal of Pediatric Psychology

Sylva, K., Sammons, P., Melhuish, E., Siraj, I., & Taggart, B. (2020). Developing 21st-century skills in early childhood: The contribution of process quality to self-regulation and pro-social behaviour. Journal of Early Childhood Education and Care.

Roczniewska, M., & Bakker, A. (2021). Burnout and self-regulation failure: A diary study of self-undermining and job crafting among nurses. Journal of Advanced Nursing.

Heydarnejad, T., Hosseini Fatemi, A., & Ghonsooly, B. (2021). The interplay among self-regulation, emotions and teaching styles in higher education: A path analysis approach. Journal of Applied Research in Higher Education.

Hautakangas, M., Kumpulainen, K., & Uusitalo, L. (2021). Children developing self-regulation skills in a Kids’ Skills intervention programme in Finnish Early Childhood Education and Care. Early Child Development and Care.