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

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder, with an onset in childhood, that accompanies the person throughout their life, with prevalence between 3 and 5% in adults. Recent studies point towards a fourth core symptom of the disorder related to the emotional information processing that would explain the repercussions that ADHD has on the social, academic, and professional life of the people affected. This review aims to describe emotion dysregulation features as well as the brain activity associated in adults with ADHD. A search of the scientific literature was launched in specialized databases: PsycInfo, Medline, Eric, PsycArticle, Psicodoc and Scopus, following PRISMA guidelines. Twenty-two articles met the inclusion criteria: (a) an ADHD clinical diagnosis, (b) participants over 18 years old, (c) emotion regulation measurement, (d) empirical studies, and (c) in English. Due to the heterogeneity of the studies included, they were classified into three sections: measures and features of emotion regulation (ER) in people with ADHD, neurological and psychophysiological activity related to ER, and treatments. The studies found that meet the selection criteria are scarce and very heterogeneous both in aims and in sample features. Adults with ADHD show a more frequent use of non-adaptive emotion regulation strategies compared to people without ADHD symptoms. Moreover, emotion dysregulation was associated with symptom severity, executive functioning, psychiatric comorbidities, and even with criminal conviction. Different patterns of brain activity were observed when people with and without ADHD were compared. These results may suggest that psychopharmacological treatments as well as behavioral therapies could be useful tools for improving emotional difficulties in adult ADHD.

Emotion regulation across psychiatric disorders

“…This observation aligns with previous literature indicating a link between ADHD and emotional dysregulation. 31 The heightened emotional dysregulation in anxiety-related disorders aligns with the well-established connection between anxiety and emotional reactivity. 32,33 Similarly, individuals with compulsive sexual behavior disorder demonstrate distinctive patterns of emotional dysregulation.…”

Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles

“…Attention-deficit hyperactivity disorder (ADHD) is a valid and recognized neurodevelopmental disorder affecting around 2.8% of the adult population ( 106 ) and is characterized by hyperactive-impulsive and/or inattentive symptoms with onset in childhood, before 12 years old ( 7 ). ED is considered as a central symptom of adult ADHD ( 25 , 107 ), and several authors have emphasized its central role in externalizing behaviors and functional impairment in social and professional spheres ( 8 , 25 , 107 ). When looking at ED triggers in adult ADHD, we believe – as suggested by some authors ( 25 ) - that impatience and boredom are the most relevant one, especially in patients with hyperactivity, even though this aspect has not specifically been studied to our knowledge.…”

Inflammation and emotional regulation: a narrative review of evidence and mechanisms in emotional dysregulation disorders

“…Interestingly, recent genome-wide association studies (GWAS) demonstrated that ED should not be considered a mere comorbidity of ADHD, being associated per se with genetic liability for the disorder (293). In view of these and similar findings, it has been proposed that ED is a core aspect of ADHD (284,294,295) and that ADHD should be included among the EDD (5). Some authors also suggest that ED should be seen as the fourth dimension of ADHD and integrated into its diagnostic criteria (285,296,297).…”