Comparison of Emotional Dysregulation Features in Cyclothymia and Adult ADHD

Abstract

Background and Objectives: Emotional dysregulation is central to the problem of the overlap between attention-deficit/hyperactivity disorder (ADHD) and cyclothymia. The aim of the study was to evaluate comorbidity rates between ADHD and cyclothymic disorder and to explore demographic and clinical differences among the groups, focusing on affective temperament and emotional dysregulation. Materials and Methods: One hundred sixty-five outpatients attending the Second Psychiatry Unit at the Santa Chiara University Hospital (Pisa) were consecutively recruited: 80 were diagnosed with ADHD, 60 with cyclothymic disorder, and 25 with both conditions. Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) and the 40-item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RI-PoSt-40) were administered. Results: Cyclothymic patients were more frequently female and older with respect to the ADHD groups. Both comorbid and non-comorbid ADHD patients showed significantly lower educational attainment and more frequently had substance use disorders. Panic disorder was common in non-comorbid cyclothymic patients, who showed significantly higher rates of familial panic disorder, major depressive disorder and suicide attempts in comparison with patients only diagnosed with ADHD. Cyclothymic patients without ADHD were also characterized by fewer hyperthymic temperamental traits, higher depressive and anxious dispositions, and a greater negative emotionality. No significant differences among groups were observed for cyclothymic temperament and overall negative emotional dysregulation, but comorbid patients with both conditions scored the highest in these subscales. This group also showed significantly higher affective instability with respect to ADHD patients without cyclothymia and was less frequently diagnosed with bipolar disorder type II than patients from both the other groups. Conclusions: ADHD and cyclothymia often co-occur and show similar levels of emotional dysregulation. However, cyclothymic patients may be more prone to negative emotionality in clinical settings. Subjects with “sunny” cyclothymic features might escape the attention of clinicians unless ADHD is present.

Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review

“…When the criteria were not clear, the inclusion or exclusion of the article was decided among all three authors. S1 Table shows the bibliometric properties of the included articles [13,[51][52][53][54][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74], which are marked with � in the references section.…”

“…Nevertheless, Ru ¨fenacht et al [63] found that the ADHD group had higher emotion dysregulation scores compared to other clinical and community samples [t = 4.79; p < 0.001] but less than BPD and ADHD + BPD [p < 0.001]. As for the comparison in ED between ADHD and cyclothymia, Brancati et al [68] only found significant differences in negative emotionality and in negative/ positive emotionality ratio measured with the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40), in which adults with cyclothymia scored higher than ADHD.…”

History of Childhood/Adolescence Referral to Speciality Care or Treatment in Adult Patients with Attention-Deficit/Hyperactivity Disorder: Mutual Relations with Clinical Presentation, Psychiatric Comorbidity and Emotional Dysregulation

“…Indeed, almost half of this subsample was diagnosed with cyclothymic disorder. Other recent studies from our group highlighted a large overlap and phenomenological similarity between patients diagnosed with adult ADHD and cyclothymic disorder [ 48 , 58 ]. Moreover, mild affective disorders, such as cyclothymia, labile personality, and minor, chronic and intermittent depressive disorders, have been diagnosed in up to 65–80% of untreated patients included in early investigations on ADHD in adults [ 59 , 60 ].…”

Affective Temperaments Misdiagnosed as Adult Attention Deficit Disorder

“…High scores on anxiety traits also were highly associated with receiving the adult ADHD label. A recent study from Italy found that about one-quarter (23.8%) of DSM-IV –defined patients with adult ADHD could be diagnosed with DSM-IV –defined cyclothymia, and a similar number of DSM-IV –defined patients with cyclothymia could be diagnosed with DSM-IV –defined adult ADHD (29.4%) (Brancati et al, 2021). All told, these studies support an overlap between bipolar illness and cyclothymia with DSM -defined adult ADHD that is in the 20% to 50% range.…”