ADHD Emotional Dysregulation: When Emotions Become Too Much

ADHD emotional dysregulation is the reduced ability to control emotions and related behaviors arising from those emotions (Retz, Stieglitz, Corbisiero, Retz-Junginger & Rösler, 2012).

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.

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…’ (Barkley, 2021)

Behaviors linked to regulation struggles range from worry and fatigue to drops in productivity and self-esteem (Sedgwick-Müller et al., 2022).

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, your friend cancels on you last minute. This generates intense feelings of disappointment and even rejection, so you impulsively send a lengthy accusatory text expressing your frustration. 

Now, while for neurotypicals, these unexpected cancelations may seem insignificant in the grand scheme of things, to someone with ADHD, it can be seen as a highly emotional issue. Therefore, this challenge to self-regulate primary emotional responses can lead to impulsive reactions. 

What Does it Mean to Regulate Emotions?

Emotions are an altered physical state often resulting from a reaction to a stimulus. They are completely natural and form part of the human experiences. Due to these emotions, we can then experience feelings and thoughts and express behavioral responses (Scherer, 2005).  

Regulating emotions is the ability to understand and recognize your reactions to situations and exhibit a controlled response in alignment with your personal values and societal expectations of what is deemed an “acceptable” reply. 

An example of regulating emotions is when someone criticizes you at work. Instead of impulsively reacting to the situation, you take a step back, assess the situation, acknowledge your feelings, and respond in a composed manner. 

While emotional dysregulation is often comorbid with ADHD, people can still be diagnosed with ADHD without having any significantly poor emotional regulation struggles.

ADHD is a complex and heterogeneous condition, meaning it can manifest differently in different individuals. Therefore, some individuals with ADHD may experience emotional dysregulation more prominently, while others may not.

Signs of Emotional Dysregulation in ADHD

Emotional dysregulation in ADHD can manifest as several behavioral and feeling-based responses.

It is important to note that ADHD emotional dysregulation can appear differently in people, so this is not a definitive list of signs.

Similarly, if you feel like you identify with some of these behaviors, it does not directly mean that you have ADHD. Consult a professional who specializes in neurodiverse conditions, and they can help answer your questions and perform an official assessment.

Here are some of the most common signs to look out for:

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 (Biederman et al., 2012).

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 (Szymanski, Sapanski & Conway,  2011).

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 negative emotions (frustration or 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 (Ross & Randolph, 2016).

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:

1. 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.
2. 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.
3. 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.
4. 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 (Gruber, 2014), while emotionally, this can negatively impact self-esteem (Bodalski, Flory, Canu, Willcutt & Hartung, 2023), 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 (Arnsten, 2009). 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 (Friedman & Rapoport, 2015), 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 (Arnsten & Rubia, 2012).

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 (Blum et al., 2008).

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 (Sato, Hoexter, Castellanos & Rohde, 2012).

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 (Hulvershorn et al., 2014).

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

Managing Emotional Dysregulation In ADHD

References

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