According to the DSM-5, the universally used handbook for diagnosing mental disorders, ADHD is classified by the existence of two types of symptoms: symptoms related to inattention and symptoms related to hyperactivity and impulsivity. For example, a typical clinician assessing for signs of ADHD might ask a patient how often they feel restless and fidgety when seated, or how frequently they get distracted by things in their external environment. If you asked someone with ADHD about their symptoms, however, they would most likely admit to also having difficulty managing emotions such as anger.
Until recently, evidence for emotional instability as a symptom of ADHD has been largely anecdotal. However, current research has demonstrated that emotional dysregulation – that is, the inability to regulate or modulate an emotional response – is not only a symptom but also a core feature of ADHD. In fact, a 2020 study published in BMC Psychiatry found that 70% of adults with ADHD experience emotional dysregulation or experience rapid and exaggerated changes in mood. While these emotional outbursts will vary from person to person, they often manifest as fits of frustration, irritability, or rage.
Despite the prevalence of emotional dysregulation in people with ADHD, proneness to anger is not usually acknowledged, especially in everyday discussions about the disorder. Such a lack of public awareness has serious implications for those that experience anger issues as a result of ADHD. Bursts of seemingly inexplicable rage can cause rifts in interpersonal relationships, negatively impact work life, and increase susceptibility to other mental health problems such as anxiety and depression. As such, it is vital that people with ADHD educate those in their lives about the reality of emotional dysregulation and also learn strategies to help manage bouts of frustration and anger.
Emotional Regulation vs. Emotional Dysregulation
Emotional regulation is defined as the process that allows us to modify an emotional response in order to promote a goal-oriented behavior. For example, imagine you have just been reprimanded at work for a mistake made by another co-worker. In the moments following, you’re likely to be flooded with feelings of anger and indignation. You might want to react defensively or lash out. Before you have a chance to do so, however, the emotional regulation processes in your brain help you remember other, more appropriate responses to this mishap. Rather than acting rashly, you decide to speak to the co-worker who made the mistake. You ask them to resolve the issue. By choosing to modify your initial emotional reaction, you were able to maintain composure and professionalism in the workplace.
Conversely, emotional dysregulation arises when these modification processes are impaired. This can lead to a reaction that hinders or defeats one’s goals. In the situation above, someone with emotional dysregulation will have immense difficulty inhibiting the anger they feel in the moment. Instead of speaking to their co-worker or supervisor first, they went straight to their head boss and angrily tried to defend themselves. Unfortunately, this impulsive response only worsened the issue.
What Does Emotional Instability Look Like In ADHD?
For people with ADHD, challenges with emotional stability can be broken down into a few distinct problem areas. The first is affective intensity, which refers to how strongly an emotion is experienced in the moment. Individuals with ADHD tend to have very high affective intensity and therefore, feel emotions much more intensely than a neurotypical person would. A second problem area is emotional regulation. As demonstrated in the scenario above, people with ADHD often struggle to modulate their intense emotional response to a situation. Emotional lability, a third problem area, refers to frequent and rapid changes in mood. Lastly, people with ADHD have specific issues with anger and irritability. They are more prone to experiencing these emotions than neurotypical people are.
Although these problem areas are distinct from one another, their effects tend to interact and compound. For instance, individuals with ADHD are not only more susceptible to anger, but they also experience anger frequently and intensely in everyday life. On top of this, they have trouble down-regulating intense emotions when they occur, which often leads to uncontrollable and extreme emotional outbursts. While these outbursts may be short-lived, the repercussions can be permanently detrimental.
Why Does ADHD Cause Emotional Dysregulation?
ADHD is often discussed in relation to its symptoms (e.g. inattention, impulsivity, and hyperactivity), but it can be viewed more generally as a disorder that limits one’s capacity for executive functioning. Executive functions are mental processes that allow us to selectively prioritize important things in our environment, and inhibit or filter out things that might be distracting or harmful. Located in the prefrontal cortex (colloquially known as the rational brain), these mental processes allow us to orient our behaviors toward a specific goal.
At the same time, another brain system is actively working to try to influence our behaviors. Buried deep within the brain, the limbic system controls behaviors related to survival. These include feeding, reproduction, and fight-or-flight reactions. It is the part of the brain that elicits our most instinctual and emotional responses, which explains why it is also simply called the emotional brain. One particularly crucial structure for evoking emotional responses is the amygdala. It’s specifically responsible for stimulating feelings of anger, aggression, fear, and anxiety.
For a neurotypical adult, the rational and emotional brains are in constant communication.
They work in concert to come up with the most appropriate response to different situations. For instance, take the work conflict scenario described above. Being wrongly reprimanded caused the amygdala to fire off, which evoked an instinctual anger response. At the same time, however, the prefrontal cortex quickly appraised the situation and recognized that an emotional outburst at work would not be productive or beneficial. It then sent a signal back down to the amygdala that it should stop the emotional response.
So what happens in an ADHD brain in this situation? Remember that ADHD causes significant deficits in the prefrontal cortex. Because the rational brain is inherently weaker in individuals with ADHD, it is less proficient at modifying or inhibiting an intense emotional response. As such, the rational brain has considerably less sway over a situation than the emotional brain – the behaviors dictated by the emotional brain often win out over more logical solutions. It’s no wonder then why someone with ADHD would march straight into their boss’ office to complain about an issue, rather than taking the more rational route.
How To Manage Your Anger: Interventions and Solutions
Having ADHD can make one feel like they’re at the whim of their emotions. Ignoring anger-related impulses can seem like an impossible task, even when the issue at hand is relatively minor. If you are struggling to manage your angry outbursts, try these solutions:
Identify your triggers
ADHD can increase one’s general susceptibility to anger, but the situations that elicit an anger response will vary from person to person. It’s important to get familiar with your anger triggers so you can anticipate them in the future and then work to change your response. For instance, maybe you are someone who becomes enraged when dirty dishes are left in the sink.
A full sink might cause you to impulsively lash out at your spouse or children, which greatly hinders your relationship with them. Rather than continuing to engage in this cycle of anger, try making a mental note that dirty dishes often trigger an outburst. The next time you see that the dishes haven’t been washed, take a moment to acknowledge that this is a trigger. Pause for a few seconds and put words to your emotions. Doing so can reduce the intensity of your anger and give you more control over how you respond.
Use the STAR method (Stop, Think, Act, Recover)
Once you identify an anger trigger, it’s important to have a strategy in mind that helps put the rational brain (instead of the emotional brain) in the driver’s seat. To begin harnessing control over your executive functioning, you need to first remember to stop and take a pause before reacting. In that pause, take a few deep breaths and think about the situation from various perspectives.
Ask yourself: Does this situation warrant an angry outburst? What will be the repercussions of my outburst? How will my outburst be received? After you have considered the situation from all sides, then you can act in a way that you deem is appropriate. Use the recover stage to reflect on the events that transpired. Determine how this might affect your response next time.
Move your body
Regular exercise is one of the most researched ways to reduce emotional stress and improve your general quality of life. Getting out and moving your body is fuel for your brain. It has been proven to reduce executive functioning deficits in ADHD, which gives individuals more control over their emotional reactions. You can try taking daily walks, head to the gym, or sign up for yoga classes. The important thing is that you find time to prioritize your body and do so consistently each week.
Try joining a DBT Skills Training Group
Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based therapy program. It is designed to help individuals who often become overwhelmed with emotion and are highly reactive to events in their environment. DBT consists of four modules: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Each module provides concrete skills for gaining more control over your internal and external world. DBT skills training groups also offer a sense of community with others that understand what it’s like to struggle with emotional dysregulation.
Living with emotional dysregulation can make life feel erratic and out of control. For people with ADHD, the rational brain and the emotional brain are often engaged in a tug of war, and the rational brain has a hard time winning. This can lead to frequent and intense emotional outbursts directed at the people around them. With the right strategies, however, individuals with ADHD can establish control over their emotional reactions and put the rational brain back in the driver’s seat.
Begin Therapy for Mindfulness and ADHD in New York, NY
Learning to cope with anger and other strong emotions can be easier said than done. This is why our team is happy to offer support in addressing ADHD symptoms from our New York-based practice. You can start your therapy journey with The ATTN Center by following these steps:
- Reach out to us through our convenient online therapy contact page!
- Learn more about our team and the services offered here!
- Begin the journey to understanding your diagnosis and living your best life!
Other ADHD Services Offered by The ATTN Center in NYC
We understand that different aspects of your life may be affected by ADHD. Our team is happy to offer a variety of services to support you in coping with ADHD symptoms. This includes therapy for ADHD-related anxiety and depression, group therapy, ADHD-focused therapy, testing, and neurofeedback options. At ATTN Center of NYC, we do everything in our power to treat ADHD without the use of medication, but we understand in some severe cases additional measures may be needed. As a result, we also maintain close relationships with many of NYC’s best psychiatrists as well. Feel free to learn more by visiting our blog or FAQ page today.