An Exploratory Study of Emotional Dysregulation Dimensions in Youth With Attention Deficit Hyperactivity Disorder and/or Bipolar Spectrum Disorders

Abstract

Emotional dysregulation (ED) is currently the most frequently used term to describe children with an impaired regulation of emotional states. Recent research studies speculate whether ED may be a neurodevelopmental disorder itself, a shared risk factor, or a common key feature of several psychiatric disorders, including, among others, attention deficit hyperactivity disorder (ADHD), and bipolar spectrum disorders (BSD). The association between ADHD and ED is one of the main reasons of misconceptions in the definition of boundaries between ADHD and BSD, leading to the frequent misdiagnosis of ADHD as BSD. Since ED is a multidimensional concept, a novel instrument—the Reactivity, Intensity, Polarity and Stability (RIPoSt) scale—was recently developed to assess the different dimensions of ED, which could help in detecting specific ED profiles in clinical youths. Our study included 154 patients, aged 13.8 ± 2.3 years, diagnosed with either ADHD, BSD, or comorbid condition, and a school-based sample of 40 healthy control (HC) adolescents, aged 12.5 ± 1.2 years. The RIPoSt scale and the Child Behavior Checklist were administered to both groups. Our results indicate that affective instability and negative emotionality subscales, as well as negative emotional dysregulation, are higher in BSD, both pure and comorbid with ADHD, while emotional impulsivity is higher in the comorbid condition and similar in the ADHD and BSD alone group; all clinical groups scored higher than HC. Conversely, positive emotionality is similar among clinical groups and within them and HC. Our findings also support the validity of the RIPoSt questionnaire, since the instrument proved to have good-to-excellent internal consistency, and strongly significant positive correlations were found with the CBCL-Dysregulation Profile, which is a commonly used, indirect measure of ED. Hence, the five subscales of the RIPoSt can be reliably used as an effective tool to study the emotional dysregulation in different clinical conditions, to help disentangle the complex relationship between ADHD and juvenile BSD and to provide clinicians with crucial evidence for better diagnostic characterization and therapeutic indications.

Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis

“…One study (Rowland et al, 2013a ) compared BD with schizophrenia using the CERQ. Three studies (Kim, Kim, & Kim, 2022 ; Masi et al, 2021 ; Sesso et al, 2021 ) compared BD with ADHD using the ERQ (Kim et al, 2022 ), the Reactivity, Intensity, Polarity and Stability questionnaire (RIPoSt-40) (Masi et al, 2021 ), or the RIPoSt youth version (Sesso et al, 2021 ). Two studies (Becerra et al, 2013 ; Kim, Yu, Lee, & Kim, 2012 ) compared BD with anxiety disorders adopting the DERS (Becerra et al, 2013 ) or the RRS (Kim et al, 2012 ).…”

Emotional Dysregulation and Sleep Problems: A Transdiagnostic Approach in Youth

“…Patients were also asked to complete the following questionnaires to assess ED: The Youth Self Report for ages 11 to 18 (YSR—11/18) [ 24 ], a widely used self-assessment measure consisting of 113 items related to emotional and behavioral problems based on self-report; The RIPoSt-Y questionnaire [ 25 , 26 ], a 31-item self-assessment measure designed to qualitatively and quantitatively explore three main dimensions of ED in adolescence, namely affective instability, emotional reactivity, and interpersonal sensitivity. …”

“…The RIPoSt-Y questionnaire [ 25 , 26 ], a 31-item self-assessment measure designed to qualitatively and quantitatively explore three main dimensions of ED in adolescence, namely affective instability, emotional reactivity, and interpersonal sensitivity.…”

Comorbidities in Youth with Bipolar Disorder: Clinical Features and Pharmacological Management

“…Furthermore, early-onset impaired regulation of emotional states, including low threshold, rapid increase, excessive intensity, inappropriate expression, and slow normalization of emotionality, resulting in mood lability and instability, severe irritability, low tolerance to frustration, temper outburst, and hyper-arousal, is currently defined as Emotional Dysregulation [ 9 - 11 ], and is related to the cyclothymic temperament [ 12 ]. This condition can be interpreted as a neurodevelopmental disorder of emotion regulation, and a transdiagnostic prodrome of different mental disorders, including not only mood disorders, but also ADHD [ 13 , 14 ], Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) [ 15 , 16 ], anxiety disorders [ 17 , 18 ], OCD [ 5 , 19 ], ASD [ 20 , 21 ] and eating disorders (ED) [ 22 ], resulting in individuals with more complex and unstable clinical expression, and increased sensitivity and vulnerability to environmental and interpersonal stimuli [ 23 ].…”