Emotional Regulation & ADHD
March 4, 2024
Written by: Taylor Molstad, M.Ed., Registered Provisional Psychologist
March is the month that holds Neurodiversity Celebration Week, which this year is the 18-24th. You might have heard this term, or others like neurotypical or neurodivergent—so what do these mean? These terms underscore the diverse and rich ways folks can experience and interact with the world. There's no singular "right" approach to thinking, behaving, or learning. Most people come across these terms in conversations around autism, Attention-Deficit/Hyperactivity Disorder (ADHD), and learning differences such as dyslexia, but they extend far beyond these boundaries. The neurodivergent community is expansive and encompasses a spectrum of experiences. So, what does this blog focus on today? On ADHD! Specifically, the emotional impact of being an ADHDer.
I want to make 2 notes before jumping in:
Navigating emotions with ADHD can be a unique journey, and there are numerous interventions that can empower you to feel more in control. It's crucial to emphasize that ADHD is not something that needs fixing – there's nothing wrong with you, and you aren't a problem to be dealt with. However, some individuals find that acquiring certain skills helps them navigate challenges associated with ADHD. What works for one person may not work for you, and that's perfectly okay. It's common to feel frustrated when the “standard” solutions don't seem to click. Remember, you have the freedom to explore different approaches, tweak strategies, and discover what resonates with your unique brain.
The words we choose to describe neurodivergent experiences matter, and everyone ha their preferences. In this blog, I interchangeably use "ADHDer" and "folks with ADHD." If either term doesn't resonate with you, feel free to substitute it with phrasing that suits your preference.
Emotional Regulation & ADHD
An aspect of ADHD I often hear a lot of folks struggling with is difficulties around emotional regulation issues. They feel that they are “too sensitive” which sometimes results in emotional outbursts. Surprisingly, despite the real and distinct role that emotional dysregulation plays in adult ADHD, the official manuals used by mental health professionals, such as ICD-10 and DSM-5-TR, currently don't recognize it as a core aspect of the condition.
In contrast to these manuals, recent research has consistently shown that emotional dysregulation is a significant and tangible part of the ADHD experience in adults. One study revealed that difficulties with emotional regulation can lead to internalizing symptoms like anxiety and sadness, impact relationships, and pose challenges in daily life for individuals with ADHD. Furthermore, the tendency for emotional avoidance observed in those with ADHD (often as a response to feeling that their emotions are uncontrollable) is believed to also be a key factor in understanding the struggles they face, ranging from anxious and depressive symptoms to difficulties in maintaining both romantic and platonic relationships.
… Now What?
I have ADHD and I struggle with all of these things… So what now? It's completely normal and okay to feel a mix of emotions about it. Acknowledging these challenges can be both validating and, at times, frustrating. It's like having a heightened self-awareness, where you recognize what's happening but feel powerless to fully control it. The internal dialogue becomes a familiar refrain I hear from ADHDer’s: "I know this is happening, but I just can't seem to stop it."
ADHD often comes with a hefty load of personal responsibility and, unfortunately, a side of shame. Questions like "Why can't I just be normal?" or "What is wrong with me?" might echo in your mind. The weight of these thoughts is something I frequently hear about in my sessions with ADHD clients, and it's a sentiment that resonates in my personal life too, when navigating relationships with friends and family who share the ADHD journey.
The good news is that there are ways to embrace and soften the emotional landscape for those with ADHD who carry the gift (yes, gift) of sensitivity.
Psychopharmacology
ADHD medications, including both stimulants and non-stimulants, often take the spotlight as the primary approach to managing ADHD symptoms. It's important to acknowledge that the impact of medication can vary widely from person to person. While some individuals find that medication significantly enhances their daily life, others grapple with side effects that can outweigh the benefits. Understandably, the effectiveness of ADHD medication in adults hovers around or below 50%, which could explain the diverse responses to medication.
When we focus on emotional dysregulation, research suggests that ADHD medications have a small to moderate impact in adults. The hypothesis here is that these medications primarily target neurochemicals in the brain, which contribute to alleviating the core symptoms of ADHD. However, emotional regulation involves many different areas of the brain, potentially explaining why medications might be less effective in this domain.
Non-Medication Options
If you're discovering that medication isn't the right fit for you or isn't quite addressing emotional regulation issues, have no fear– there are alternatives to explore! Individuals with ADHD commonly express lower confidence in managing their emotions and often find themselves employing less effective strategies like suppression. It's crucial to remember that emotions aren't inherently good or bad, but they can pose challenges in our lives. So, I want to give you a few strategies to try out that you may find helpful in those moments of big feelings.
Ride The Wave With Urge Surfing: Guilt and shame often arise when we speak or act impulsively, which is a common challenge for many with ADHD due to impulsivity. To mitigate this, consider "urge surfing,"– a practice of allowing the emotional wave to pass or decrease in intensity before responding. When the urge to react impulsively arises, take a moment to let the emotion's intensity decrease. This can be achieved by giving yourself an “out”, even if it is just a brief pause in a social interaction. Whether it's a simple statement like "I need a glass of water" or a more detailed expression like "I'm feeling X (anger, hurt, sadness), and I need some time to process," creating a space before reacting can make a big impact in making sure that we are acting in a way that aligns with our values.
Mindfulness: I understand the initial hesitation, especially that wide-eyed look I often see from ADHD clients when I suggest mindfulness. But stay with me for a minute. Mindfulness isn't about emptying your mind; it's about returning to the present moment. Imagine you stop for a moment and focus on how your feet feel on the floor. You might think something like this: "I feel the way my toes feel cold in my shoes, I am notici–did I lock my house when I left this morning? I can't remember if I turned off my hair straightener." It's perfectly normal for your thoughts to dip back into your usual fast-paced flow. The key is to gently guide your focus back, trying again without judgement. And how does this connect to our emotions? Well, research suggests that individuals with ADHD who practise mindfulness often feel more in control of their feelings.
Take Care of Yourself: I hear so often about ADHDers who end up skipping meals or putting off important appointments. Life is already busy, and being neurodivergent adds another layer of complexity. Sometimes, the most effective way to tackle emotional dysregulation is by ensuring we're steering clear of triggers that can heighten our sensitivity to emotional reactions. Prioritize essentials like getting enough sleep, having regular meals, and incorporating movement into your day instead of being sedentary. Self-care truly is your first line of defence. It's not always a smooth journey, but consider taking it one step at a time. Don't pressure yourself to miraculously embrace a perfect routine overnight. Concentrate on one aspect until you feel at ease before introducing anything else.
Final Thoughts
Navigating life as an ADHDer can be exhausting, complicated, but also joyful. It's important to approach yourself with gentleness, recognizing there's absolutely nothing wrong with YOU. Every step you take toward exploring mindfulness, managing emotions, and embracing self-care is a step toward alleviating some of the weight that comes with being a soft and sensitive person. Remember that there is nothing wrong with being sensitive or experiencing emotions more intensely than others. The goal isn't to change you; instead, these tools are here to help you view your sensitivity as a strength, something to embrace rather than silence or feel embarrassed about. If you ever feel the need for additional support, consider reaching out to a therapist who can provide a safe and non-judgmental space for you to explore these aspects of yourself.
Refereces
Corbisiero, S., Stieglitz, R. D., Retz, W., & Rösler, M. (2013). Is emotional dysregulation part of the psychopathology of ADHD in adults?. ADHD Attention Deficit and Hyperactivity Disorders, 5, 83-92. https://doi.org/10.1007/s12402-012-0097-z
Soler-Gutiérrez, A. M., Pérez-González, J. C., & Mayas, J. (2023). Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review. Plos one, 18(1), e0280131. https://doi.org/10.1371/journal.pone.0280131
Lenzi, F., Cortese, S., Harris, J., & Masi, G. (2018). Pharmacotherapy of emotional dysregulation in adults with ADHD: a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 84, 359-367. https://doi.org/10.1016/j.neubiorev.2017.08.010
Bodalski, E. A., Knouse, L. E., & Kovalev, D. (2019). Adult ADHD, emotion dysregulation, and functional outcomes: Examining the role of emotion regulation strategies. Journal of Psychopathology and Behavioral Assessment, 41, 81-92. https://doi.org/10.1007/s10862-018-9695-1
Reimherr, F. W., Roesler, M., Marchant, B. K., Gift, T. E., Retz, W., Philipp-Wiegmann, F., & Reimherr, M. L. (2020). Types of adult attention-deficit/hyperactivity disorder: a replication analysis. The Journal of Clinical Psychiatry, 81(2), 21798. https://doi.org/10.1007/s12402-015-0176-z
Knouse, L. E., Cooper-Vince, C., Sprich, S., & Safren, S. A. (2008). Recent developments in the psychosocial treatment of adult ADHD. Expert Review of Neurotherapeutics, 8(10), 1537-1548. https://doi.org/10.1586/14737175.8.10.1537
