Emotional Dysregulation

What is emotional dysregulation?

Emotional dysregulation is a mental health symptom that involves trouble controlling your emotions and how you act on those feelings. To those around you, your emotions and reactions will seem out of proportion compared to what you’re reacting to. It’s similar and closely linked to executive dysfunction.

When you manage or regulate your emotions, you can steer and direct how you feel and react. Most people learn how to do this as children and develop it as they get older. It’s also a key part of being adaptable or resilient to challenges, learning and more.

You can think about emotional regulation like volume control for your feelings. When you use the volume control for a device, you can keep it from being too loud. With emotional dysregulation, your brain can’t regulate emotion signals. In effect, your volume control doesn’t work like it should, making your emotions “louder” and harder to manage.

An example of learned emotional regulation is how children eventually outgrow temper tantrums. During childhood, tantrums are normal and an expected part of your child’s development. As children get older, they generally learn how to manage their emotions. That’s why tantrums become less frequent and eventually stop.

What does emotional dysregulation look like?

The effects of emotional dysregulation are most visible in what you say and how you act. Some examples of emotional dysregulation include:

• Having trouble steering your moods, causing you to feel stuck or unable to make yourself feel better, especially with negative moods and emotions like depression, anxiety, etc.
• Becoming easily frustrated by small inconveniences or annoyances.
• Mood swings.
• Impulsive behavior.
• Mania or hypomania.
• Trouble with emotions interfering with how you pursue goals and achieve desired outcomes.
• Being prone to losing your temper.
• Persistent irritability or anger between outbursts.

When does emotional regulation become a problem?

When emotional dysregulation is severe, it can cause symptoms that disrupt your life, social relationships, career and more.

Some of the more severe effects can include:

• Verbal outbursts (shouting, yelling, screaming or crying).
• Aggressive or even violent behavior (towards objects, animals or people).
• Trouble maintaining friendships, relationships or other forms of social connection.

What are the most common causes of emotional dysregulation?

Emotional dysregulation is a symptom of differences or issues with how certain parts of your brain communicate or work together. It can be a symptom of mental health conditions. But it’s also very common in people who are neurodivergent. Many people with emotional dysregulation have more than one condition that causes or contributes to it.

Emotional dysregulation is most likely to happen in three main groups of people:

• People with mental health conditions. These conditions usually involve disruptions in mood, personality and self-control ability.
• People who are neurodivergent. These are people whose brains developed or work differently than expected. People whose brains developed and worked as expected are “neurotypical.”
• People with damage to certain areas of their brain.

Mental health conditions that can cause emotional dysregulation

Emotional dysregulation is a symptom of many mental health conditions. Some examples include:

• Disruptive, impulse control and conduct disorders, especially conduct disorder, disruptive mood dysregulation disorder and oppositional defiant disorder.
• Trauma-related disorders, especially post-traumatic stress disorder.
• Personality disorders (especially borderline personality disorder).
• Bipolar disorder.
• Obsessive-compulsive disorder.
• Depressive disorders.
• Anxiety disorders.

Neurodivergent conditions and traits that can involve emotional dysregulation

Emotional dysregulation is possible when you have differences in how your brain developed or how it works now. Some examples of this include:

• Attention-deficit/hyperactivity disorder (ADHD).
• Autism spectrum disorder.

There’s another form of emotional dysregulation common in people with ADHD. Rejection sensitive dysphoria isn’t a medical condition, but it’s something most people with ADHD experience. It involves feelings of intense pain or other negative emotions when you feel rejected or that you’ve failed at something.

Damage- and disruption-related conditions

Emotional dysregulation is possible when there’s damage to certain areas of your brain or disruptions in brain activity. Any condition that damages your brain or disrupts how it works can have this effect. Some of the most common conditions include:

• Alcohol, substance and nonmedical drug intoxication (emotional dysregulation is a temporary effect of many types of intoxication).
• Substance use disorders.
• Stroke.
• Delirium.
• Infections (such as those that cause encephalitis or meningitis).
• Seizures and epilepsy.
• Degenerative brain diseases, especially Alzheimer’s disease, frontotemporal dementia, etc.
• Head injuries, especially those that cause concussions or traumatic brain injuries.
• Brain cancers and tumors.

How is emotional dysregulation treated?

Many people who have emotional dysregulation can learn to manage its effects. But treatments can make learning to manage them easier.

Treatments work best for neurodivergent-related health conditions. When emotional dysregulation happens because of brain damage or disrupted brain activity, it’s not treatable directly.

The main forms of treatment are:

• Psychotherapy. Also known as mental health therapy, this treatment involves working with a mental health professional. They can help you understand how and why you experience emotional dysregulation. A key part of psychotherapy is learning coping skills and strategies that can help you prevent the more severe effects of emotional dysregulation.
• Medications. These can help make it easier for you to manage emotions. How they do this depends on the medication itself, the condition it’s treating and more.
• Supportive and symptomatic care. These involve treating the underlying conditions or factors causing or contributing to emotional dysregulation. For example, concussions aren’t directly treatable. However, treating the symptoms of concussion can ease and speed up recovery. As a person recovers, their emotional dysregulation will improve and even go away (unless they had it before the concussion).

Emotional dysregulation isn’t a condition you can self-treat. The conditions and circumstances that cause it need a healthcare provider to diagnose them and guide treatment.

Emotional dysregulation can also happen with damage to or disruptions in brain activity. Some of the conditions that cause emotional dysregulation to happen are dangerous, and a few are medical emergencies that need immediate care.

What are the possible complications or risks of not treating it?

You can generally adapt to or learn to live with mild emotional dysregulation, and getting treatment can help.

Emotional dysregulation can have major negative effects on your life when it’s moderate to severe. Emotional dysregulation can disrupt many areas of life, including:

• Friendships and relationships.
• Education.
• Career.

In the most severe cases, people with emotional dysregulation may become aggressive or violent because of difficulties controlling their emotions. Some may engage in self-harm or suicidal behaviors. Others may behave recklessly or in a way that puts them at risk for serious injuries or death.

Emotional dysregulation that involves aggressive or violent behavior can also lead to possible legal repercussions. That includes encounters with law enforcement, arrest or criminal charges.

Can emotional dysregulation be prevented?

Emotional dysregulation happens unpredictably. Most conditions that cause it are unpreventable. It may be possible to reduce the risk of developing emotional dysregulation from certain conditions that cause brain damage or disrupt brain activity.

Some things you can do to reduce your risk of those conditions include:

• Wear activity-specific safety equipment (such as helmets or seat belts).
• Manage health conditions like Type 2 diabetes, high blood pressure (hypertension) or epilepsy.
• Reach and maintain a weight that’s healthy for you.
• Don’t ignore infections that can spread to your brain, especially ear and eye infections.
• Take medications as prescribed and avoid nonmedical drug use.
• If you drink alcohol, do so in moderation (up to two drinks per day for men and people assigned male at birth and up to one drink per day for women and people assigned female at birth).

When should emotional dysregulation be treated by a doctor or healthcare provider?

When emotional dysregulation affects your life in any way, talking to a healthcare provider is a good idea. It’s especially important to talk to a provider if emotional dysregulation begins to disrupt key parts of your life, including your social relationships, work, etc.

It’s also essential to get medical attention when emotional regulation develops suddenly. That’s because it can be a key indicator of dangerous or even life-threatening conditions.

If a loved one gradually develops emotional dysregulation, it’s important to encourage them to talk to a healthcare provider. Many age-related conditions like Alzheimer’s disease or dementia can cause emotional dysregulation that appears gradually. A healthcare provider can diagnose these conditions and offer guidance or treatment recommendations (if possible) to help.

When to get help for emotional dysregulation in your child

Many people encounter signs of emotional dysregulation in their children. When this is the case, it’s important to remember that emotional regulation isn’t something children develop automatically. It takes time for them to learn and get better at it.

Like all skills, some children learn emotion regulation faster or do it better early on. Others may need more help. When it’s the latter, be patient with your child. Just like it took practice and effort to learn to tie your shoes or ride a bike when you were young, it can be challenging to learn how to regulate emotions. Supporting your child can make it much easier and make a major difference in how emotional dysregulation affects them throughout their lifetime.

Talk to your child’s healthcare provider if you’re concerned that their emotional regulation isn’t developing as it should. They can assess if there’s a cause for concern. They can also offer resources or advice regardless of whether your child has a condition related to their emotional regulation difficulties.

When to get emergency help

IMPORTANT: Emotional dysregulation can often involve self-harming or suicidal thoughts and behaviors. You should go to the ER or call 911 (or your local emergency services number) if you have thoughts about harming yourself, including thoughts of suicide, or about harming others. If you have thoughts like this, you can call any of the following:

• Suicide and Crisis Lifeline (United States). To call this line, dial 988.
• Local crisis lines. Mental health organizations and centers in your area may offer resources and help through crisis lines.
• 911 (or your local emergency services number). You should call 911 (or the local emergency services number) if you feel like you’re in immediate danger of harming yourself. Operators and dispatchers for 911 lines can often help people in immediate danger because of a severe mental crisis and send first responders to assist.

Is emotional dysregulation the same as ADHD?

No, ADHD and emotional dysregulation are very different. ADHD is a diagnosable medical condition. Emotional dysregulation is a symptom of many conditions.

However, ADHD and emotional dysregulation have a long history. In years past, receiving an ADHD diagnosis required that you also have emotional dysregulation. While that’s no longer required for an ADHD diagnosis, experts still know it’s a common feature of ADHD. Providers often take emotional dysregulation into account when offering treatment guidance.

A note from Cleveland Clinic

Emotional dysregulation can make it feel like you can’t control your emotions. The feelings you experience can feel overwhelming or cause problems in your life. But it’s important to know that emotional dysregulation is a recognized issue with many conditions. It’s also one that’s very treatable. Better still, it’s possible to learn coping strategies and skills that can help you better manage your emotions. That way, you can feel like you have more control over your feelings, rather than feeling it’s the other way around.