Emotional dysregulation is a common sign of ADHD defined as the reduced ability to control emotions and related behaviors arising from those emotions.
People with ADHD tend to have more frequent and intense emotional reactions compared to others. They may feel emotions very strongly or have difficulty calming down once emotionally aroused.
While not every person with ADHD experiences this, it is estimated that 30% to 70% of adults with ADHD and 25% to 45% of children with the disorder have significant emotion dysregulation.
Dr Russell Barkley, a Clinical Psychologist who focuses on ADHD, has stated the following:
‘The emotion that an individual experiences would come up very quickly, much more strongly than in others, because they are not suppressing and inhibiting and moderating it… it’s especially problematic with the negative emotions of impatience, frustration, hostility, anger…’
Behaviors linked to regulation struggles range from worry and fatigue to drops in productivity and self-esteem.
An example of such affect can be seen when a person with ADHD experiences a form of heightened emotional sensitivity and reacts intensely (e.g., very angry or frustrated) to a situation that others may have perceived as a minor inconvenience.
For example, imagine your friend cancels on you last minute. Someone who is able to regulate their emotions may feel disappointed but sends their friend a text back that says ‘Ok, no worries. Let’s plan something for another time.’ Then they are able to move on with their day.
However, someone with ADHD and difficulties regulating emotions may feel intense disappointment, anger, and even rejection. They may impulsively send a lengthy accusatory text expressing their annoyance at their friend.
Why Do People with ADHD Struggle with Emotion Regulation?
Individuals with ADHD often face challenges in regulating their emotions due to several factors related to the disorder’s core characteristics:
- Impulsivity: The impulsive nature of ADHD can lead to quick, intense emotional reactions before the person has a chance to process and modulate their response.
- Executive function deficits: ADHD affects executive functions, including impulse control and emotional self-regulation.
- Inhibitory control difficulties: Research suggests that problems with inhibitory control in ADHD can make it harder to suppress strong emotional responses.
- Attention issues: Difficulty shifting attention away from emotional stimuli can prolong and intensify emotional experiences.
Additionally, individuals with ADHD may develop maladaptive cognitions or negative thought patterns over time, which can further complicate emotional regulation.
These may stem from experiences of perceived failure or negative feedback related to ADHD symptoms.
It’s important to note that while emotion dysregulation is common in ADHD, it’s not universal. The degree of difficulty can vary widely among individuals, and many people with ADHD can develop effective strategies for managing their emotions with proper support and treatment.
Signs of Emotional Dysregulation in ADHD
Emotion dysregulation in ADHD can manifest in various ways, including:
- Heightened emotional sensitivity, where individuals react more intensely to both positive and negative stimuli
- Difficulty self-soothing or calming down after experiencing intense emotions
- Problems refocusing attention away from strong emotions
- In some cases, emotional detachment as a coping mechanism for overwhelming feelings”
Discussion of these and other signs are below:
Emotional sensitivity
Individuals with ADHD may react more intensely to both positive and negative stimuli. For example, a minor problem can lead to disproportionally heightened levels of frustration, or similarly, a small achievement can trigger excessive excitement.
“I equated it to feeling like living without skin – it’s everything just pricks a little harder or hurts a little more and I do feel that this is something that I relate to.”
Ardelle
This can lead to mood swings and impulsivity in emotional reactions, making it challenging to maintain emotional stability.
For example, you get positive feedback at work and subsequently shout in happiness in the office instead of having a more controlled reaction to the good news.
Enhanced sensitivity to adverse situations such as rejections and arguments is also common, with tendencies to have a negativity bias and interpret ambiguous situations for the worse instead of viewing them from a neutral lens.
Increased sensitivity to perceived rejection or criticism can also happen, potentially leading to emotional distress in social situations.
Difficulty self-regulating primary emotional response
Difficulty in self-regulating primary emotional responses can be directly linked with impulsivity reactions, with outbursts and on-the-spot-made decisions being the frequent default reaction.
For example, a student with ADHD becomes increasingly frustrated due to a difficult piece of homework. As a result, they shout in anger, slam the textbook, and give up on completing their work.
Their difficulty in managing this anger leads to an outburst that is more intense and disruptive than the situation warrants, making it challenging to complete the tasks at hand.
This can also happen for positive emotional responses as well, e.g., receiving a gift and yelling loudly out of heightened excitement.
“I’m very emotionally volatile. Something will happen and it’ll be like, this is literally the best day ever or something else will happen and I’ll just be so sad that I cannot stop crying for five hours. And it’s very little things that set me off.”
From Ginapp et al. (2023).
Difficulties self-soothing
People with ADHD may find it hard to calm down after experiencing intense emotions. This emotional overwhelm can then make it hard to focus and relax.
If it is a difficult emotion, such as stress or frustration, it may linger a lot longer than for neurotypical people.
For example, you had an argument with your partner, but even after the issue has been resolved, you are struggling to calm down; you keep replaying everything in your head, and your heart is still beating quickly.
Such persistence in emotional distress can have severe consequences in day-to-day functioning with a direct impact on both emotional and psychological states.
“When I become so stressed that I can’t do anything, then I lie down and stop caring and I feel like I’m a failure.”
From Öster et al. (2020).
These self-soothing challenges can have a particularly negative impact on people who have both ADHD and have experienced a traumatic event.
Difficulty organizing and executing appropriate secondary emotions
Difficulty organizing and executing appropriate secondary emotions is linked to moving from the initial emotional response to a secondary, more socially appropriate emotion.
This fluctuation can be tricky for people with ADHD as they may struggle to curb their initial impulsive reaction, calm down after it, reassess the situation, and respond in a more thought-out manner.
For example, your partner expresses dislike for something you have done, and you immediately get a big influx of frustration and anger, finding it difficult to have a level-headed discussion and resolve the issue.
You can think of it as emotionally dominant reactivity and logically dominant reactivity fighting for the wheel. More often than not, due to executive function difficulties, emotional reactivity takes precedence.
“I worry that my emotions are too intense for other people … I perceive myself as being exhausting to others. But maybe I’m just exhausted with myself because it’s exhausting being in my brain.”
‘Alex’
Consequently, such difficulties can directly affect social interactions with others, as people with ADHD may struggle to convey their feelings effectively.
People may thus find this difficulty in organizing emotions challenging to deal with, leading to less intent to socialize with others.
Problems refocusing attention away from strong emotions
Maintaining attention and concentration for prolonged periods of time is a commonly shared experience for people with ADHD.
If you couple this with a strong emotional reaction, then the ability to refocus attention on what needs doing and overall responsibilities can be even more impaired.
For example, someone got chastised at work for missing a deadline for a piece of work. This then wields intense emotions of frustration and sadness, with the person being rendered emotionally frozen and incapable of returning to a relaxed baseline and proceeding with their work.
“(describing an experience with being rejected) It’s literal pain for me. I literally feel it in my chest and it hurts. I’ll sit and think about it for an extremely long time and nit-pick it and replay it over and over again.”
From Ginapp et al. (2023).
Emotional detachment
Emotional detachment can manifest as a coping mechanism for all the aforementioned struggles.
Some individuals with ADHD may, thus, choose to withdraw from emotional situations completely in an effort to minimize exposure to potentially triggering situations and to regain a sense of control.
For example, if someone close to you is going through a breakup and all the friends get together to offer support, you might appear disinterested or emotionally distant even when you genuinely care, or you might remain silent even if you want to comment or contribute.
“I don’t deal with anger outbursts. I don’t really feel like I’m emotionally reactive in a flamboyant or extreme way. I feel it’s a lot of internal stuff for me.”
Ardelle
Such reduced expressiveness and emotional detachment can lead to difficulties in connecting with others on an emotional level and processing emotions in a healthy way, which is a vital component in building long-lasting and meaningful connections with others.
It can thus be easy for relationships, both romantic and platonic, to get damaged because of it.
Consequently, one’s social life can be reduced, romantic partners may be difficult to reach and maintain, and family relationships can begin to strain if frequent friction points arise.
What Can Happen if Someone With ADHD Becomes Overwhelmed?
When someone with ADHD becomes overwhelmed, it can have a significant impact on their well-being and daily functioning.
ADHD already presents challenges in areas like attention, organization, and impulse control, so being overwhelmed can exacerbate such difficulties.
Overwhelm-Shutdown Cycle
The overwhelm-shutdown cycle is a behavioral response and emotional pattern that can happen in individuals with ADHD. The stages can look like the following:
- Initial Overwhelm: A task or situation feels overwhelming, e.g., a complex project, a high-pressure deadline, or a socially demanding event. The individual may then experience heightened stress, anxiety, or frustration in response to perceived demands.
- Escalating Stress: As the overwhelming situation continues, stress and emotional intensity can increase with challenges in emotional management, staying focused, procrastinating, and maintaining a sense of control. This heightened emotional state can lead to emotional dysregulation, including mood swings and impulsivity.
- Depleting Coping Resources: With this stress and emotional intensity, individuals with ADHD can deplete coping resources with the ability to self-regulate and manage emotions diminishing. This can result in exhaustion, burnout, and helplessness.
- Shutdown Response: In direct response to the overwhelming and emotionally charged situation, the individual then enters a “shutdown” phase, such as withdrawal from the task or situation. The person may disengage, become uncommunicative, or avoid the task altogether. This withdrawal is a coping mechanism to protect themselves from further emotional turmoil.
This cycle can become repetitive, so when faced with similar situations, this sequence of stages can be automatically triggered, affecting daily functioning, work/school, and relationships.
“I just feel paralyzed like I shut down completely, all the emotions are just gone and I cant do anything anymore.”
From Ginapp et al. (2023).
Let us look at some of these areas in more detail.
Difficulties Concentrating
Being overwhelmed can lead to heightened emotional responses, so individuals may experience intense feelings of frustration, anxiety, irritability, etc., making it challenging to manage emotions effectively.
These can manifest as outbursts, mood swings, and emotional shutdowns.
Additionally, overwhelm can impair focus due to challenges in task concentration and decreased productivity, leading to increased frustration.
Similarly, procrastination may also manifest as a coping mechanism, as facing an overwhelming task or situation may lead to avoidance and delaying important responsibilities.
Physical and Mental Overwhelm
Physically, someone may experience an increase in symptoms like headaches, muscle tension, and sleep disturbances, while emotionally, this can negatively impact self-esteem, and personal perception often leading to mental exhaustion and burnout.
This can create a vicious cycle where overwhelm feeds into these physical and emotional symptoms, exacerbating them further.
Relationship Struggles
Overwhelm in ADHD may also pressurize relationships, whether romantic or between friends or family.
Loved ones may struggle to understand this reactive behavior, which can then lead to conflicts and misunderstandings.
“I feel like I’m very ambivalent. I blow hot and cold when it comes to people and friends and connections. One minute, like I really like you; in the next minute, I’m like, I don’t know what I think of that person.”
Ardelle
Additionally, performance at work or school may be affected in terms of missed deadlines, incomplete assignments, and difficulty managing responsibilities.
Consequently, some people may choose to withdraw and socially isolate themselves. This can be both to avoid such relationship strains and work expectations and also to get away from emotionally intense external stimuli.
“In my experience with rejection, I feel like a lot of the time it can make me self-isolate. If I feel like someone has excluded me over something trivial, I’ll just push myself away farther.”
From Ginapp et al. (2023).
Unfortunately, this can exacerbate loneliness and increase fears around socializing.
Therefore, it is imperative that individuals with ADHD develop strategies to manage overwhelm.
Recognizing the signs and taking proactive steps to address them can help them navigate daily life more successfully and maintain a healthy and balanced well-being.
The ADHD Brain’s Role In Emotional Dysregulation
There are notable differences in brain structure and function between individuals with ADHD and those without ADHD, particularly in areas related to executive function that directly affect our ability to regulate emotions.
Some of the key differences can be seen in:
Prefrontal Cortex
The prefrontal cortex (PFC) is a critical brain region responsible for executive functions such as decision-making, impulse control, emotional regulation, and attention.
Research has shown that individuals with ADHD often exhibit structural and functional differences in the PFC compared to non-ADHD individuals. These differences may include reduced volume or activity in this region.
Research has also uncovered notable delays in PFC maturation, reduced volume, and smaller size when comparing ADHD children and non-ADHD children, demonstrating that such structural differences can be observed and begin from a young age.
Frontostriatal Pathways
The communication pathways between the prefrontal cortex and the striatum, which is part of the brain’s reward and motivation system, are vital for executive function.
These pathways facilitate the integration of several processes needed for healthy emotional regulation.
Disruptions in frontostriatal pathways can lead to difficulties regulating attention, emotions, and motivation, hindering the brain’s ability to control emotional responses and impulses.
In ADHD, these pathways may not function optimally, contributing to emotional dysfunction.
Dopamine Levels
ADHD is also associated with differences in the dopamine system in the brain.
Dopamine is a neurotransmitter involved in reward, motivation, and the regulation of emotions and attention.
Research suggests that individuals with ADHD may have lower dopamine levels or differences in dopamine receptor sensitivity.
This lower baseline can influence the ability to react to tasks that may not provide immediate emotional rewards appropriately.
Additionally, it can impact the brain’s response to rewarding stimuli and its ability to regulate motivation and impulsive behaviors, directly impacting emotional reactivity.
Brain Connectivity
Functional MRI studies have revealed altered connectivity patterns in the brains of individuals with ADHD.
These differences in connectivity can then impact the coordination of brain regions responsible for executive functions and in turn, emotional regulation.
Abnormal amygdala connectivity has also been noted from early on, as seen in ADHD research with a children’s cohort.
The amygdala is responsible for how we react to stimuli and certain behavioral reactions like the fight-or-flight response. Impaired connectivity in this area can thus directly impact emotion regulation abilities.
Further Reading
References
Arnsten, A. F. (2009). Toward a new understanding of attention-deficit hyperactivity disorder pathophysiology: an important role for prefrontal cortex dysfunction. CNS drugs, 23, 33-41.
Barkley, R (Host). (2021-present). ADHD Experts Podcast. 369 – Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything [Audio podcast].
Biederman, J., Spencer, T. J., Petty, C., Hyder, L. L., O’Connor, K. B., Surman, C. B., & Faraone, S. V. (2012). Longitudinal course of deficient emotional self-regulation CBCL profile in youth with ADHD: prospective controlled study. Neuropsychiatric disease and treatment, 267-276.
Blum, K., Chen, A. L. C., Braverman, E. R., Comings, D. E., Chen, T. J., Arcuri, V., … & Oscar-Berman, M. (2008). Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatric disease and treatment, 4(5), 893-918.
Bodalski, E. A., Flory, K., Canu, W. H., Willcutt, E. G., & Hartung, C. M. (2023). ADHD symptoms and procrastination in college students: The roles of emotion dysregulation and self-esteem. Journal of Psychopathology and Behavioral Assessment, 45(1), 48-57.
Friedman, L. A., & Rapoport, J. L. (2015). Brain development in ADHD. Current opinion in neurobiology, 30, 106-111.
Ginapp, C. M., Greenberg, N. R., Macdonald-Gagnon, G., Angarita, G. A., Bold, K. W., & Potenza, M. N. (2023). The experiences of adults with ADHD in interpersonal relationships and online communities: A qualitative study. SSM-Qualitative Research in Health, 3, 100223.
Ginapp, C. M., Greenberg, N. R., MacDonald-Gagnon, G., Angarita, G. A., Bold, K. W., & Potenza, M. N. (2023). “Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults. Plos one, 18(10), e0292721
Gruber, R. (2014). ADHD, anxiety and sleep: a window to understanding the interplay between sleep, emotional regulation and attention in children?. Behavioral Sleep Medicine, 12(1), 84-87.
Hirsch, O., Chavanon, M., Riechmann, E., & Christiansen, H. (2018). Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD). Journal of affective disorders, 232, 41-47.
Hulvershorn, L. A., Mennes, M., Castellanos, F. X., Di Martino, A., Milham, M. P., Hummer, T. A., & Roy, A. K. (2014). Abnormal amygdala functional connectivity associated with emotional lability in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(3), 351-361.
Marques, S., Correia-de-Sá, T., Guardiano, M., Sampaio-Maia, B., & Ferreira-Gomes, J. (2024). Emotion dysregulation and depressive symptoms mediate the association between inhibitory control difficulties and aggressive behaviour in children with ADHD. Frontiers in psychiatry, 15, 1329401.
Öster, C., Ramklint, M., Meyer, J., & Isaksson, J. (2020). How do adolescents with ADHD perceive and experience stress? An interview study. Nordic Journal of Psychiatry, 74(2), 123-130.
Pan, M. R., Zhang, S. Y., Chen, C. L., Qiu, S. W., Liu, L., Li, H. M., … & Qian, Q. J. (2023). Bidirectional associations between maladaptive cognitions and emotional symptoms, and their mediating role on the quality of life in adults with ADHD: a mediation model. Frontiers in Psychiatry, 14, 1200522.
Retz, W., Stieglitz, R. D., Corbisiero, S., Retz-Junginger, P., & Rösler, M. (2012). Emotional dysregulation in adult ADHD: what is the empirical evidence?. Expert review of neurotherapeutics, 12(10), 1241-1251.
Ross, P., & Randolph, J. (2016). Differences between students with and without ADHD on task vigilance under conditions of distraction. Journal of educational research and practice, 4(1), 1-10.
Sato, J. R., Hoexter, M. Q., Castellanos, X. F., & Rohde, L. A. (2012). Abnormal brain connectivity patterns in adults with ADHD: a coherence study.
Scherer, K. R. (2005). What are emotions? And how can they be measured?. Social science information, 44(4), 695-729.
Sedgwick-Müller, J. A., Müller-Sedgwick, U., Adamou, M., Catani, M., Champ, R., Gudjónsson, G., … & Asherson, P. (2022). University students with attention deficit hyperactivity disorder (ADHD): a consensus statement from the UK Adult ADHD Network (UKAAN). BMC psychiatry, 22(1), 292.
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276-293.
Szymanski, K., Sapanski, L., & Conway, F. (2011). Trauma and ADHD–association or diagnostic confusion? A clinical perspective. Journal of Infant, Child, and Adolescent Psychotherapy, 10(1), 51-59.
