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Aslan IH, Dorey L, Grant JE, Chamberlain SR. Emotion regulation across psychiatric disorders. CNS Spectr 2024; 29:215-220. [PMID: 38695189 PMCID: PMC7615973 DOI: 10.1017/s1092852924000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
OBJECTIVE Difficulties with emotion regulation have been associated with multiple psychiatric conditions. In this study, we aimed to investigate emotional regulation difficulties in young adults who gamble at least occasionally (ie, an enriched sample), and diagnosed with a range of psychiatric disorders using the validated Difficulties in Emotion Regulation Scale (DERS). METHODS A total of 543 non-treatment-seeking individuals who had engaged in gambling activities on at least 5 occasions within the previous year, aged 18-29 were recruited from general community settings. Diagnostic assessments included the Mini International Neuropsychiatric Inventory, Minnesota Impulsive Disorders Interview, attention-deficit/hyperactivity disorder World Health Organization Screening Tool Part A, and the Structured Clinical Interview for Gambling Disorder. Emotional dysregulation was evaluated using DERS. The profile of emotional dysregulation across disorders was characterized using Z-scores (those with the index disorder vs. those without the index disorder). RESULTS Individuals with probable ADHD displayed the highest level of difficulties in emotional regulation, followed by intermittent explosive disorder, social phobia, and generalized anxiety disorder. In contrast, participants diagnosed with obsessive-compulsive disorder showed relatively lower levels of difficulties with emotional regulation. CONCLUSIONS This study highlights the importance of recognizing emotional dysregulation as a trans-diagnostic phenomenon across psychiatric disorders. The results also reveal differing levels of emotional dysregulation across diagnoses, with potential implications for tailored treatment approaches. Despite limitations such as small sample sizes for certain disorders and limited age range, this study contributes to a broader understanding of emotional regulation's role in psychiatric conditions.
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Affiliation(s)
- Ibrahim H. Aslan
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Lucy Dorey
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jon E. Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Samuel R. Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
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Blay M, Bouteloup M, Duarte M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Association between pathological narcissism and emotion regulation: The role of self-mentalizing? Personal Ment Health 2024. [PMID: 38710596 DOI: 10.1002/pmh.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 05/08/2024]
Abstract
Pathological narcissism (PN) is a common psychopathological issue leading to maladaptive strategies to cope with self-esteem threats, including self-enhancement and exploitation (grandiose strategies) or internalized shame, depression, and social withdrawal (vulnerable strategies). Mentalizing is a key process for regulating self and other representations and their associated emotions. Patients with PN further struggle with emotion dysregulation (ED), which during development is intertwined with the growing capacity to mentalize. We seek to contribute to emerging empirical data documenting the associations between PN and ED and between PN and mentalizing, and to provide information on the nature of their mutual relationships. In the present study, we assessed PN, ED, and three mentalizing dimensions (mentalizing self, other, and motivation to mentalize) in 183 patients consulting in our outpatient unit specialized in ED. We found that narcissistic vulnerability was negatively associated with self-mentalizing and positively associated with overall ED, both even after adjustment for borderline and attention deficit hyperactivity disorder (ADHD) symptoms. However, the association with ED was not maintained after further adjustment for self-mentalizing or overall-mentalizing, which suggests that mentalizing may play a mediating role in this relationship. On the other hand, narcissistic grandiosity was positively associated with other-mentalizing and ED and negatively associated with self-mentalizing in bivariate analyses, but these last two associations were not maintained after adjustment for comorbid borderline and/or ADHD symptomatology. This study provides new information on the link between PN and ED and on key mentalizing dimensions meaningfully relating to PN, notably through a potential role of self-mentalizing processes between PN and ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Groupe Santé Basque Développement, Lyon, France
- Université Paris-Saclay, UVSQ, INSERM, Centre de recherche en Epidémiologie et Santé des Populations Team "DevPsy", Villejuif, France
| | - Margaux Bouteloup
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Miguel Duarte
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eleonore Pham
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Marlène Jan
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay, France
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Nolan LJ, Higgs S. The role of irrational beliefs in the relationship between attention deficit hyperactivity disorder (ADHD) symptoms and disordered eating in two general student samples. Appetite 2024; 195:107229. [PMID: 38246426 DOI: 10.1016/j.appet.2024.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
Attention deficit hyperactivity disorder (ADHD) symptoms are associated with disordered eating and negative mood. The purpose of this study was to examine whether irrational beliefs mediate this relationship along with previously reported mediators such as depression and impulsivity. Irrational beliefs trigger negative automatic thoughts which are believed, in cognitive behavior therapies, to be a source of psychopathology. Challenges brought about by symptoms of ADHD may lead to habitual emotion-eliciting thought patterns which, in turn, could lead to negative mood and disordered eating. Undergraduate students (N = 127) completed online questionnaires assessing ADHD symptoms and disordered eating and several potential mediators including irrational beliefs, depression, impulsivity, interoceptive accuracy, and reward responsiveness. The results, which were replicated in a second study (N = 254), indicated that irrational beliefs and depression mediated the relationship between ADHD symptoms and disordered eating. In the second study, impulsivity due to negative urgency was also a mediator. These findings support the theory that the symptoms of ADHD lead to enhancement of irrational beliefs, depression, and negative urgency which are linked to disordered eating.
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Affiliation(s)
- Laurence J Nolan
- Department of Psychology, Wagner College, Staten Island, NY, 10301, USA.
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK
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李 思, 王 美, 杨 燕, 王 卓, 刘 沛, 罗 婷, 陶 煜, 黄 颐. [Effect of Emotion Regulation on Anxiety/Depression Symptoms in Children With Attention-Deficit/Hyperactivity Disorder: The Mediating Role of Social Problems and the Moderating Role of Family Functioning]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:346-352. [PMID: 38645874 PMCID: PMC11026903 DOI: 10.12182/20240360601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Indexed: 04/23/2024]
Abstract
Objective To investigate the mediating effect of social problems in the effect pathway of emotional dysregulation influencing anxiety/depression emotions in children with attention-deficit/hyperactivity disorder (ADHD) and to explore the potential moderating effect of family functionality. Methods A total of 235 children diagnosed with ADHD were enrolled in the study. The paticipants' age ranged from 6 to 12. Emotion Regulation Checklist, Achenbach's Child Behavior Checklist (CBCL) Social Problems Subscale, CBCL Anxious/Depressed Subscale, and Family Assessment Device were used to evaluate the emotional regulation, social problems, anxiety/depression emotions, and family functionality of the participants. A moderated mediation model was employed to analyze whether social problems and family functionality mediate and moderate the relationship between emotional regulation and anxiety/depression emotions. Results Social problems partially mediated the impact of emotional dysregulation on anxiety/depression emotions in ADHD children, with the direct effect being 0.26 (95% confidence interval [CI]: [0.17, 0.36], P<0.001), the indirect effect being 0.13 (95% CI: [0.07, 0.19], P<0.001), and the mediating effect accounting for 33% of the total effect. Family functionality exhibited a positive moderating effect on the relationship between social problems and anxiety/depression emotions. Conclusion This study contributes to the understanding of complex factors influencing anxiety/depression in children with ADHD, providing reference for the further development of targeted interventions for children with ADHD and the improvement of prognosis.
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Affiliation(s)
- 思迅 李
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 美雯 王
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 燕平 杨
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 卓 王
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 沛 刘
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 婷婷 罗
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 煜杰 陶
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 颐 黄
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
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Blay M, Duarte M, Dessouli MA, Durpoix A, Rüfenacht E, Weibel S, Speranza M, Perroud N. Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles. Front Psychiatry 2024; 15:1260138. [PMID: 38384590 PMCID: PMC10879599 DOI: 10.3389/fpsyt.2024.1260138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Développement Group, Lyon, France
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
| | - Miguel Duarte
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie-Alix Dessouli
- Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Amaury Durpoix
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
| | - Eva Rüfenacht
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
- U1114, INSERM, Strasbourg, France
| | - Mario Speranza
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay-Rocquencourt, France
| | - Nader Perroud
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
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Nordby ES, Guribye F, Schønning V, Andersen SL, Kuntsi J, Lundervold AJ. A Blended Intervention Targeting Emotion Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder: Development and Feasibility Study. JMIR Form Res 2024; 8:e53931. [PMID: 38231536 PMCID: PMC10831671 DOI: 10.2196/53931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Many adults with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotion regulation. Such difficulties are known to substantially impact quality of life and overall functioning. Yet, there is a lack of treatment interventions specifically designed to address these challenges. OBJECTIVE This study aimed to describe the development and assess the feasibility, along with the initial clinical outcomes, of a novel blended intervention for adults with ADHD. The blended intervention combines both face-to-face and digital components and is specifically designed to address emotion dysregulation in ADHD. METHODS This intervention was an 8-week blended intervention combining weekly face-to-face group sessions with a supplementary digital companion app. The intervention is based on elements from dialectic behavioral therapy skills training and positive psychology. To evaluate its feasibility, we performed a 10-week feasibility study with an uncontrolled pre-post study design, including 16 adults with ADHD and co-occurring emotion dysregulation. The feasibility measures encompassed adherence, satisfaction, and perceived credibility of the intervention. Clinical outcomes were evaluated by self-reported symptoms of emotion dysregulation, inattention, hyperactivity-impulsivity, executive function, depression, anxiety, and a measure of quality of life. Paired sample 2-tailed t tests were used to analyze clinical outcomes with a Bonferroni-corrected significance level. RESULTS Both treatment credibility and treatment satisfaction were rated favorably by the majority of the participants. In particular, the participants emphasized meeting others with ADHD as beneficial. In terms of adherence, 3 participants withdrew before initiating the intervention, while another 4 participants did not complete the intervention. On average, the participants who enrolled in the intervention attended 6.2 of the 8 group sessions and completed 6.7 of the 8 skills training modules in the companion app. In terms of clinical outcomes, there was a reduction in symptoms of emotion dysregulation from before to after the intervention (d=2.0). Significant improvements were also observed in measures of inattention (d=1.1) and hyperactivity-impulsivity (d=0.9). However, no significant improvements were found in the domains of depression, anxiety, quality of life, and executive functioning. CONCLUSIONS The results are encouraging, both in terms of feasibility and the preliminary clinical results on emotion dysregulation. The blended format, combining digital and face-to-face elements, may also seem to offer some advantages: the group-based format was valued as it facilitated peer interaction, while a rather high completion of modules in the companion app highlights its potential to enhance skills training between the group sessions. Future randomized controlled trials are called for to further evaluate the clinical effectiveness of the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT05644028; https://clinicaltrials.gov/study/NCT05644028.
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Affiliation(s)
- Emilie S Nordby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Frode Guribye
- Department of Information Science and Media Studies, Faculty of Social Sciences, University of Bergen, Bergen, Norway
| | - Viktor Schønning
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Mitsea E, Drigas A, Skianis C. Digitally Assisted Mindfulness in Training Self-Regulation Skills for Sustainable Mental Health: A Systematic Review. Behav Sci (Basel) 2023; 13:1008. [PMID: 38131865 PMCID: PMC10740653 DOI: 10.3390/bs13121008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
The onset of the COVID-19 pandemic has led to an increased demand for mental health interventions, with a special focus on digitally assisted ones. Self-regulation describes a set of meta-skills that enable one to take control over his/her mental health and it is recognized as a vital indicator of well-being. Mindfulness training is a promising training strategy for promoting self-regulation, behavioral change, and mental well-being. A growing body of research outlines that smart technologies are ready to revolutionize the way mental health training programs take place. Artificial intelligence (AI); extended reality (XR) including virtual reality (VR), augmented reality (AR), and mixed reality (MR); as well as the advancements in brain computer interfaces (BCIs) are ready to transform these mental health training programs. Mindfulness-based interventions assisted by smart technologies for mental, emotional, and behavioral regulation seem to be a crucial yet under-investigated issue. The current systematic review paper aims to explore whether and how smart technologies can assist mindfulness training for the development of self-regulation skills among people at risk of mental health issues as well as populations with various clinical characteristics. The PRISMA 2020 methodology was utilized to respond to the objectives and research questions using a total of sixty-six experimental studies that met the inclusion criteria. The results showed that digitally assisted mindfulness interventions supported by smart technologies, including AI-based applications, chatbots, virtual coaches, immersive technologies, and brain-sensing headbands, can effectively assist trainees in developing a wide range of cognitive, emotional, and behavioral self-regulation skills, leading to a greater satisfaction of their psychological needs, and thus mental wellness. These results may provide positive feedback for developing smarter and more inclusive training environments, with a special focus on people with special training needs or disabilities.
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Affiliation(s)
- Eleni Mitsea
- Net Media Lab & Mind & Brain R&D, Institute of Informatics & Telecommunications, National Centre of Scientific Research ‘Demokritos’ Athens, Agia Paraskevi, 15341 Athens, Greece;
- Department of Information and Communication Systems Engineering, University of Aegean, 82300 Mytilene, Greece;
| | - Athanasios Drigas
- Net Media Lab & Mind & Brain R&D, Institute of Informatics & Telecommunications, National Centre of Scientific Research ‘Demokritos’ Athens, Agia Paraskevi, 15341 Athens, Greece;
| | - Charalabos Skianis
- Department of Information and Communication Systems Engineering, University of Aegean, 82300 Mytilene, Greece;
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Petruso F, Giff A, Milano B, De Rossi M, Saccaro L. Inflammation and emotion regulation: a narrative review of evidence and mechanisms in emotion dysregulation disorders. Neuronal Signal 2023; 7:NS20220077. [PMID: 38026703 PMCID: PMC10653990 DOI: 10.1042/ns20220077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Emotion dysregulation (ED) describes a difficulty with the modulation of which emotions are felt, as well as when and how these emotions are experienced or expressed. It is a focal overarching symptom in many severe and prevalent neuropsychiatric diseases, including bipolar disorders (BD), attention deficit/hyperactivity disorder (ADHD), and borderline personality disorder (BPD). In all these disorders, ED can manifest through symptoms of depression, anxiety, or affective lability. Considering the many symptomatic similarities between BD, ADHD, and BPD, a transdiagnostic approach is a promising lens of investigation. Mounting evidence supports the role of peripheral inflammatory markers and stress in the multifactorial aetiology and physiopathology of BD, ADHD, and BPD. Of note, neural circuits that regulate emotions appear particularly vulnerable to inflammatory insults and peripheral inflammation, which can impact the neuroimmune milieu of the central nervous system. Thus far, few studies have examined the link between ED and inflammation in BD, ADHD, and BPD. To our knowledge, no specific work has provided a critical comparison of the results from these disorders. To fill this gap in the literature, we review the known associations and mechanisms linking ED and inflammation in general, and clinically, in BD, ADHD, and BD. Our narrative review begins with an examination of the routes linking ED and inflammation, followed by a discussion of disorder-specific results accounting for methodological limitations and relevant confounding factors. Finally, we critically discuss both correspondences and discrepancies in the results and comment on potential vulnerability markers and promising therapeutic interventions.
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Affiliation(s)
| | - Alexis E. Giff
- Department of Neuroscience, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Switzerland
| | - Beatrice A. Milano
- Sant’Anna School of Advanced Studies, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Luigi Francesco Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospital, Switzerland
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Ben-Dor Cohen M, Nahum M, Traub Bar-Ilan R, Eldar E, Maeir A. Coping with emotional dysregulation among young adults with ADHD: A mixed-method study of self-awareness and strategies in daily life. Neuropsychol Rehabil 2023:1-25. [PMID: 37971947 DOI: 10.1080/09602011.2023.2279181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Emotional dysregulation (ED) impacts functional outcomes among individuals with attention-deficit hyperactivity disorder (ADHD). Self-awareness and strategies may enhance coping with ED yet are rarely studied in ADHD. OBJECTIVES To explore ED-related self-awareness and strategies in daily life of adults with ADHD, and to examine the interrelations between them and their association with symptoms. METHODS Sixty young adults with ADHD participated in a mixed-method study. At baseline, self-awareness and strategies were assessed using the Self-Regulation Skills Interview (SRSI); ADHD symptoms were self-rated using the ASRS symptom checklist. Then, symptoms were rated over 5-days using ecological momentary assessment (EMA). RESULTS Significant challenges in self-awareness and strategies were demonstrated quantitatively and qualitatively. Awareness of ED was associated with variability of ADHD symptoms on EMA yet not with symptom severity. Qualitative content analysis revealed a range of self-awareness levels, which were related to noticing ED-related cues and understanding contextual factors predictive of ED. Self-awareness and strategies were significantly associated. Strategies varied regarding effort, individual preference and temporality. CONCLUSIONS Variability of ADHD symptoms was negatively associated with self-awareness of ED. Strategy selection in daily-life among adults with ADHD may be affected by self-awareness and by a possible trade-off between short-term effort and long-term effectiveness.
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Affiliation(s)
- Maayan Ben-Dor Cohen
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruthie Traub Bar-Ilan
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Eldar
- Psychology Department, Faculty of Social Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cognitive Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adina Maeir
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Bemmouna D, Weiner L. Linehan's biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization. Front Psychiatry 2023; 14:1238116. [PMID: 37840783 PMCID: PMC10570453 DOI: 10.3389/fpsyt.2023.1238116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.
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Affiliation(s)
- Doha Bemmouna
- Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
| | - Luisa Weiner
- Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
- Département de Psychiatrie Adulte, Hôpitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
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