Emotional Dysregulation in ADHD

When I first read the diagnostic criteria, something felt missing. There was attention, there was restlessness, there was impulsivity. There was no emotion.

Yet the side that has troubled my life most has always been the emotional side. I could cope with being untidy. I could not cope with being unable to recover for three days after a single sentence.

I am not the only one to notice this gap. The review by Shaw and colleagues (2014) discusses exactly this and proposes treating emotional dysregulation not as an environmental side effect of ADHD but as a central component. The international consensus statement also lists emotion regulation problems as frequent in ADHD (Faraone et al., 2021).

What is happening

Emotion regulation is the distance between feeling an emotion and acting on that emotion. In ADHD this distance shortens.

Three separate things happen at once.

It rises fast. The emotion comes without a moment of thinking in between. Anger, joy, disappointment; all at the same speed. When I receive a piece of news I cannot decide what I will feel; I have already felt it.

It comes high. Its intensity is bigger than those around expect. I have heard "what is there to make such a big deal of" many times, and each time I heard it I thought I was doing something wrong.

It comes down late. This is called emotional inertia: once in the emotion, getting out is hard. It does not die down by itself, something has to step in.

The mechanism underneath is thought to be the same as the brake: the system that stops an automatic reaction comes into play late with emotions too (Barkley, 1997). When I learned this, something fell into place. What I experience when I interrupt and what I experience when I react out of proportion to a sentence turn out to be the same mechanism.

Where it shows up

• Frustration tolerance. Small obstacles produce a disproportionate reaction. The printer does not work, the day is over. The most irritating side of this for me is that in that moment I really believe the day is over.
• Rejection sensitivity. An unanswered message, a sentence whose tone has changed. The intensity can be lived like a physical shock; I covered it in the article on rejection sensitivity.
• Sudden decisions. Decisions made when emotion is high: quitting a job, cutting someone off, changing everything. The emotion passes, the decision stays.
• Outbursts of anger. Waves that come fast and go fast, leaving shame behind. I covered them in a separate article.
• Accumulated shame. The regret that follows the reaction settles over time into one's perception of one's character. The article on shame and self-compassion is about this.

The intensity of an emotion is not a character flaw. The issue is that intensity coinciding with the moment of decision.

What helps

Naming. Putting what you feel into words reduces its intensity. Saying "I'm disappointed and ashamed" instead of "I'm angry" turns the emotion into an object that can be managed. When I first heard this it seemed too simple to me. After trying it I understood: while looking for the word, a second has already passed, and that second is the second I was missing.

The decision-delay rule. Not making any lasting decision while emotion is high. The form that works for me is this: I write, I do not send. A resignation letter is written, not sent. It is read again in the morning.

Starting from the body. Dealing with thoughts while the emotion is at its peak does not work. Walking, cold water, slowing the breath; all of them bring a physiological descent, and without the descent the thought does not settle. In the years when I tried it the other way round, all I did was argue with myself, and I never won that argument.

Mapping the triggers. Knowing which situations are expensive helps: hunger, lack of sleep, crowds, feedback, waiting. It becomes possible to plan those days differently.

Planning what comes after. Deciding in advance what to do after the wave has passed is more important than the wave itself. My rule is this: if I broke something I apologize, but I do not pass judgment on myself. The sentence "I did it again, so that's the kind of person I am" makes the next wave bigger.

Getting help from therapy. Emotion regulation skills can be taught. Dialectical behavior therapy is a structured program developed in this area and is also used in ADHD. The decision about medication and treatment is the doctor's.

Why it is so tiring

Emotional dysregulation has an invisible cost: the work of prediction through the day.

Because I do not know what will hurt me, I enter every setting a little on guard. Before a meeting I ask myself "what could happen today." While waiting for feedback, I prepare my answer before it arrives. This preparation is visible to no one and it is real work.

The second cost is recovery. After a wave passes I do not return to my former state at once. There is an interval of an hour, sometimes half a day, in which I am no use. There is no equivalent of that interval in my calendar; so each time I fall behind the plan, and because I fell behind I am also upset.

The third is hiding. The energy spent on not showing the reaction is more than the reaction itself. At the end of a long day, the reason I am exhausted is usually not the work I did; it is the reactions I did not show during the day.

Writing these down, I see this: the sentence "I can't control my emotions" is the wrong description. All day long I control them far too well. Where it falls short is the moment control runs out, and that moment generally falls at the end of the day.

Confusion with bipolar disorder

Mood fluctuation brings bipolar disorder to mind, and this distinction matters, because the treatments differ.

The most practical distinguishing measure is duration. In ADHD emotion changes within hours and is usually tied to a trigger. In bipolar disorder the episodes last days or weeks, and other things such as the need for sleep and energy level change together with them. A doctor makes this distinction; I wrote a detailed article comparing the two under the heading ADHD or bipolar.

For those around you

While writing this section I am thinking of myself too, because when I am inside a wave I never know what to say to the person in front of me.

I found a sentence that works: "I'm high right now, let's talk a bit later." This sentence does not end the argument, it postpones it. Almost all the arguments I could postpone turn out much smaller the next day.

What does not work is the other person saying "calm down." That sentence never produced calm in me; it only produced the feeling of being left alone.

The only question after the wave has passed. "What was this emotion rightly telling me?" Under most waves there is something real: overload, unfairness, tiredness. The intensity can be exaggerated but the message is not empty. Separating out the message makes it possible, next time, to intervene before the wave.

When to look for help

If emotional waves affect your work, your relationships or your safety, this stops being something to deal with alone. If you have thoughts of harming yourself do not wait: in Turkey there is the 112 emergency line and the ALO 183 social support line.

For my part I learned this: for years I told no one about this side, because I was afraid that when I did, I would be called "unstable." What happened when I told was something else. Something that has a name can be worked on; something that has no name is only carried.