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Emotional dysregulation

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Emotional dysregulation (ED) is a term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response.

Possible manifestations of emotional dysregulation include angry outbursts or behavior outbursts such as destroying or throwing objects, aggression towards self or others, and threats to kill oneself. These variations usually occur in seconds to minutes or hours. Emotional dysregulation can lead to behavioral problems and can interfere with a person's social interactions and relationships at home, in school, or at place of employment.

Emotional dysregulation can be associated with an experience of early psychological trauma, brain injury, or chronic maltreatment (such as child abuse, child neglect, or institutional neglect/abuse), and associated disorders such as reactive attachment disorder.[1] Emotional dysregulation may be present in people with psychiatric disorders such as attention deficit hyperactivity disorder, bipolar disorder, borderline personality disorder, narcissistic personality disorder, and complex post-traumatic stress disorder.[2][3] ED is also found among those with autism spectrum disorders.[2] In such cases as borderline personality disorder and complex post-traumatic stress disorder[4], hypersensitivity to emotional stimuli causes a slower return to a normal emotional state. This is manifested biologically by deficits in the frontal cortices of the brain.[5]

Etymology

The word "dysregulation" is a neologism created by combining the prefix "dys-" to "regulation". According to Webster's Dictionary, dys- has various roots and is of Greek origin. With Latin and Greek roots, it is akin to Old English tō-, te- "apart" and in Sanskrit dus-" bad, difficult."

Child psychopathology

There are links between child emotional dysregulation and later psychopathology.[6] For instance, ADHD symptoms are associated with problems with emotional regulation, motivation, and arousal.[7] One study found a connection between emotional dysregulation at 5 and 10 months, and parent-reported problems with anger and distress at 18 months.[8][citation needed] Low levels of emotional regulation behaviors at 5 months were also related to non-compliant behaviors at 30 months.[9] While links have been found between emotional dysregulation and child psychopathology, the mechanisms behind how early emotional dysregulation and later psychopathology are related are not yet clear.

Symptoms

Smoking, self-harm, eating disorders, and addiction have all been associated with emotional dysregulation.[10] Somatoform disorders may be caused by a decreased ability to regulate and experience emotions or an inability to express emotions in a positive way.[11] Individuals who have difficulty regulating emotions are at risk for eating disorders and substance abuse as they use food or substances as a way to regulate their emotions.[12][13] Emotional dysregulation is also found in people who are at increased risk to develop a mental disorder, in particular an affective disorder such as depression or bipolar disorder.[14][15]

Early childhood

Research has shown that failures in emotional regulation may be related to the display of acting out, externalizing disorders, or behavior problems. When presented with challenging tasks, children who were found to have defects in emotional regulation (high-risk) spent less time attending to tasks and more time throwing tantrums or fretting than children without emotional regulation problems (low-risk). These high-risk children had difficulty with self-regulation and had difficulty complying with requests from caregivers and were more defiant.[16] Emotional dysregulation has also been associated with childhood social withdrawal.[17] Common signs of emotional dysregulation in early childhood include isolation, throwing things, screaming, lack of eye contact, refusing to speak, rocking, running away, crying, dissociating, high levels of anxiety, or inability to be flexible.

Internalizing behaviors

Emotional dysregulation in children can be associated with internalizing behaviors including[10]

  • exhibiting emotions too intense for a situation
  • difficulty calming down when upset
  • difficulty decreasing negative emotions
  • being less able to calm themselves
  • difficulty understanding emotional experiences
  • becoming avoidant or aggressive when dealing with negative emotions
  • experiencing more negative emotions

Externalizing behaviors

Emotional dysregulation in children can be associated with externalizing behaviors including[10]

  • exhibiting more extreme emotions
  • difficulty identifying emotional cues
  • difficulty recognizing their own emotions
  • focusing on the negative
  • difficulty controlling their attention
  • being impulsive
  • difficulty decreasing their negative emotions
  • difficulty calming down when upset

Protective factors

Early experiences with caregivers can lead to differences in emotional regulation. The responsiveness of a caregiver to an infant's signals can help an infant regulate their emotional systems. Caregiver interaction styles that overwhelm a child or that are unpredictable may undermine emotional regulation development. Effective strategies involve working with a child to support developing self-control such as modeling a desired behavior rather than demanding it.[18]

The richness of environment that a child is exposed to helps development of emotional regulation. An environment must provide appropriate levels of freedom and constraint. The environment must allow opportunities for a child to practice self-regulation. An environment with opportunities to practice social skills without over-stimulation or excessive frustration helps a child develop self-regulation skills.[18]

See also

References

  1. ^ Schechter Daniel (2009). "Disturbances of attachment and parental psychopathology in early childhood. Infant and Early Childhood Mental Health Issue". Child and Adolescent Psychiatry Clinics of North America. 18 (3): 665–687. doi:10.1016/j.chc.2009.03.001. PMC 2690512. PMID 19486844.
  2. ^ a b Pynoos R., Steinberg A., Piacentini J. (1999). "Bipolar disorder–Bipolar Disorder, and Autism Spectrum Disorders. A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders". Biological Psychiatry. 46: 1542–1554. doi:10.1016/s0006-3223(99)00262-0.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Schore, A., (2003). Affect dysregulation and disorders of the self. New York: Norton.
  4. ^ "A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD". Clinical Psychology Review. 58: 1–15. 2017-12-01. doi:10.1016/j.cpr.2017.09.001. ISSN 0272-7358.
  5. ^ Treatment of Aggression, Anger and Emotional Dysregulation in Borderline Personality Disorder - ClinicalTrials.gov. (2007, April 25). Retrieved March 29, 2012, from http://clinicaltrials.gov/ct2/show/NCT00467038 [unreliable medical source?]
  6. ^ Elien De Caluwé; Mieke Decuyper; Barbara De Clercq (July 2013). "The child behavior checklist dysregulation profile predicts adolescent DSM-5 pathological personality traits 4 years later". European Child & Adolescent Psychiatry. 22 (7): 401–411. doi:10.1007/s00787-013-0379-9.
  7. ^ Barkley R. A. (1997). "Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD". Psychological Bulletin. 121: 65–94. doi:10.1037/0033-2909.121.1.65. PMID 9000892.
  8. ^ Stifter C. A., Jain A. (1996). "Psychophysiological correlates of infant temperament: Stability of behavior and autonomic patterning from 5 to 18 months". Developmental Psychobiology. 29: 379–391. doi:10.1002/(sici)1098-2302(199605)29:4<379::aid-dev5>3.0.co;2-n.
  9. ^ Stifter C. A., Spinrad T. L., Braungart-Rieker J. M. (1999). "Toward a developmental model of child noncompliance: The role of emotion regulation in infancy". Child Development. 70: 21–32. doi:10.1111/1467-8624.00003.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ a b c Macklem, G.L. (2008). Practitioner's Guide to Emotion regulation in School – Aged Children. NY: Springer.
  11. ^ Waller E, Scheidt CE (2006). "Somatoform disorders as disorders of affect regulation: a development perspective". International Review of Psychiatry. 18: 13–24. doi:10.1080/09540260500466774.
  12. ^ Sim L., Zeman J. (2006). "The contribution of emotion regulation to body dissatisfaction and disordered eating in early adolescent girls". Journal of Youth and Adolescence. 35 (2): 207–216. doi:10.1007/s10964-005-9003-8.
  13. ^ Tice D.M., Bratslavsky E., Baumeister R.F. (2001). "Emotional distress regulation takes precedence over impulse control: If you feel bad, do it!". Journal of Personality and Social Psychology. 80: 53–67. doi:10.1037/0022-3514.80.1.53. PMID 11195891.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Kanske, P.; Schönfelder, S.; Forneck, J.; Wessa, M. (2015-01-20). "Impaired regulation of emotion: neural correlates of reappraisal and distraction in bipolar disorder and unaffected relatives". Translational Psychiatry. 5: e497. doi:10.1038/tp.2014.137. ISSN 2158-3188. PMC 4312831. PMID 25603413.
  15. ^ Heissler, Janine; Kanske, Philipp; Schönfelder, Sandra; Wessa, Michèle (2014-01-01). "Inefficiency of emotion regulation as vulnerability marker for bipolar disorder: evidence from healthy individuals with hypomanic personality". Journal of Affective Disorders. 152–154: 83–90. doi:10.1016/j.jad.2013.05.001. ISSN 1573-2517. PMID 23948633.
  16. ^ Calkins, S. D., & Dedmon, S. A. (2000). Physiological and behavioral regulation in two-year-old children with aggressive/destructive behavior problems. Journal of Abnormal Child Psychology.
  17. ^ Garcia-Coll C., Kagan J., Reznick J. (1984). "Behavioral inhibition in young children". Child Development. 55: 505–529.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ^ a b Bronson M. B. (2000). Self-regulation in early childhood. New York: Guilford Press.
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