DESR, or deficient emotional self-regulation, is a core facet of ADHD that may carry significant consequences. However, it is not included the disorder’s diagnostic criteria. As new research confirms the prominent role emotional dysregulation plays in ADHD’s appearance and individual patient outcomes, that may be changing. Here, learn about DESR, its central role in ADHD, along with implications for diagnosis and treatment.
Deficient emotional self-regulation (DESR) is a relatively new term used to describe the problem of impulsive emotion coupled with emotional self-regulation difficulties long associated with attention deficit hyperactivity disorder (ADHD or ADD). DESR may be new to the ADHD lexicon, however, it can be argued that it is a core and commonly overlooked component of the disorder — and one that can help predict a patient’s impairments, and even improve diagnostic and treatment practices.
How Does Deficient Emotional Self-Regulation Relate to ADHD?
Emotional dysregulation is noticeably missing from diagnostic criteria for ADHD. However, most patients and experts recognize that it is central to the disorder. DESR, a manifestation of emotional dysregulation, specifically refers to deficiencies with these four components of emotional self-regulation:
- Ability to inhibit inappropriate behavior triggered by strong emotions. I argue that this emotional impulsiveness (EI) is an aspect of poor inhibition associated with ADHD that is illustrated by low frustration tolerance, impatience, being quick to anger, aggression, greater emotional excitability, and other negative reactions, all of which are related to the impulsivity dimension of the disorder
- Ability to self-soothe and down-regulate a strong emotion to reduce its severity
- Ability to refocus attention from emotionally provocative events
- Ability to organize or substitute more moderate, healthier emotional responses in the service of goals and long-term welfare
To understand the role of EI and DESR in ADHD is to acknowledge the prominent role of emotional control difficulties in the disorder’s appearance and outlook, including understanding the following:
DESR & ADHD: Why It’s Important
Why major comorbid disorders often develop as a result of these challenges
The major life impairments not adequately explained by traditional symptoms of ADHD
A wealth of compelling evidence — from ADHD’s clinical conceptualization over time to neuroanatomical and psychological research — clearly shows that EI and DESR are key components of ADHD and should be incorporated into the disorder’s diagnostic criteria and treatment practices.
Emotional dysregulation has been shown to uniquely predict the following
- social rejection in children with ADHD
- interpersonal hostility and marital dissatisfaction in adults with ADHD
- greater parenting stress and family conflict in parents of children with ADHD; greater stress in parents with ADHD
- road rage, DUIs, and crash risks during driving
- job dismissals and workplace interpersonal problems
- dating/cohabiting relationship conflict
- impulse buying; poor finances
DESR Diagnostic Implications
Elevating EI and DESR’s place in ADHD would greatly assist with differential diagnosis of the disorder from mood disorders and other conditions involving emotional dysregulation. In other words, it would reduce the odds of misdiagnosis for patients who are simply experiencing what is central to ADHD itself. (Individuals with ADHD are commonly misdiagnosed with mood disorders.)
Mood disorders, however, are common in individuals with ADHD, so comorbidity must be considered. Duration could be a guiding diagnostic principle used to distinguish a legitimate mood disorder from the emotional dysregulation associated with ADHD. Emotions, unlike moods, are of short duration, setting-specific, provoked, and easily traced to the source. EI-DESR is a “top-down” deficit in regulating rational emotional responses to events; its impact is typically shorter in duration than that of a mood disorder.
Mood disorders are generally “bottom-up” excessive expressions of emotions likely attributed to underlying amygdala-limbic system activities. Moods are of long duration — lasting hours, days, or weeks. Moods are cross-situational and irrational in the case of mood disorders (it is often not clearly understood, for example, what triggers a patient with bipolar disorder to become manic, or the opposite).
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Original article posted by ADDitude Mag.