ADHD & Emotional Regulation

Welcome to Thriving with ADHD, a podcast where we'll share everyday practical tips to thrive in life as an adult with ADHD. This podcast is brought to you by Animo Sanu Psychiatry, a behavioral health practice with a specialist ADHD clinic based in North Carolina. And this is your host, Nada Pupovac. Welcome to Thriving with ADHD, dear ADHD community. We are back with a new fantastic and very important episode with Animo Sanos physician assistant Stephanie Solomon.

Stephanie and I are going to talk about ADHD and emotional regulation. As always, before we jump into conversation... Let's learn a bit more about Stephanie. Stephanie brings a unique combination of education and clinical experience to her role as a physician assistant. She is involved in all aspects of patient care, including taking...

detailed histories and physical exams, developing and implementing treatment plans and prescribing medications. Stephanie's commitment to providing comprehensive and compassionate care is evident. in everything that she does. Stephanie, welcome back to Thriving with ADHD. Today, it's very important topic, I think very crucial for ADHD community and that's

emotional regulation, and ADHD. So I'm happy to have you back. And I'm sure you will be a perfect person to talk about this topic with us. Yeah, I'm happy to be here. Thank you.

Yeah, yeah. I'm delighted to have you back. So can you explain the connection between ADHD and emotional regulation and why people with ADHD often struggle? with managing their emotions? Sure. So emotional dysregulation is basically an inability to modulate one's emotional experience and expression.

which can result in excessive emotional response or lead to extreme or overblown reactions that don't really fit the situation. So although it's not formally... a part of the diagnostic criteria for ADHD, it's increasingly seen as a core ADHD symptom that is clinically associated with greater functional impairment and comorbidities. Emotional dysregulation amongst children diagnosed with ADHD is estimated to be about between 24 to 50 percent in adults diagnosed with ADHD.

The prevalence of emotional dysregulation is estimated to be around 70%. People with ADHD often experience emotional dysregulation due to how ADHD affects brain systems involved in emotional control and regulation. So the part of your brain that plays a significant role in processing emotions. particularly those related to fear, threat, and stress is called your amygdala and tends to be.

your amygdala tends to be more reactive in ADHD, leading to stronger and often disproportionate emotional responses to situations that might not be as intense for others. And then there's also the prefrontal cortex, which is the part of your brain that is responsible for regulating the amygdala's responses and helping to calm emotions and impulses. So in a typical brain...

The prefrontal cortex helps regulate the amygdala's emotional responses by providing thoughtful, recent input before acting on emotions. In ADHD... The prefrontal cortex is often underactive or less effective at controlling the amygdala. It tends to have reduced activity and weaker connectivity. So once emotions are triggered.

They can become more overwhelming, leading to impulsive reactions and difficulty calming down. It can be difficult to respond to your feelings in a way that helps you achieve your goals. Additionally, untreated ADHD symptoms can significantly impact emotional regulation, making it harder for individuals to manage their emotions effectively. ADHD-related impulsivity for example, makes it harder to pause and think before responding to emotional triggers.

People may have difficulties with organization, procrastination, and completing tasks with ADHD, so that can lead to chronic stress. And this stress lowers tolerance for emotional triggers and increases irritability. That sounds like a vicious circle. And it sounds like people with ADHD have it coming from all sides.

Yeah, hopefully we will talk about some solutions and things that can help. But let's talk a bit more about some common signs of emotional dysregulation in people with ADHD. Sure. So many people with ADHD have heightened emotional sensitivity, making them more reactive to emotional stimuli. And so this can result in overreacting to... criticism or stress or feeling easily frustrated or overwhelmed. They may have emotional impulsivity, so they may react impulsively to stress, frustration.

or other emotional triggers without the typical delay that allows others to manage their emotional responses. They may feel emotions so intensely that result in impulsive behaviors they regret later, like yelling, storming off, or making rash decisions. They may have difficulty managing anger, so quick impulsive outbursts of anger.

even in response to minor triggers can occur. For someone with ADHD, impulsive anger can arise because their brain isn't as adept at holding back immediate emotional reactions. And this can cause intense reactions to small frustrations or perceived slights that others might be able to ignore or manage more calmly. People with ADHD also tend to react quickly.

to emotional stimuli often without pausing to think through their response and to reflect on the best way to handle a situation such as using calming techniques or problem-solving strategies before reacting emotionally. They may have rapid shifts in their mood. So people with ADHD might experience going from calm to furious in seconds, or they may experience highs and lows more frequently and intensely.

and don't have much control over the transitions between them. They may have delayed emotional recovery, which is essentially difficulty returning to a baseline state after an emotional response. So after experiencing frustration or excitement, it can take longer for someone with ADHD to calm down or reset. They may stay upset, frustrated, or agitated longer than someone without ADHD.

they may have low frustration tolerance. So people with ADHD often have a low tolerance for situations where they feel triggered and frustrated. situations that require patience, persistence, or delayed gratification, and this can trigger anger. So for example, waiting in line or dealing with unexpected changes or trying to complete a difficult task may provoke strong feelings of anger or irritability. So just overall, like I mentioned, feeling completely overwhelmed by their emotions.

People with ADHD frequently experience emotions so deeply that they become overwhelmed or flooded. Things may feel very all or nothing or like zero to 100. So it's often hard to see past the emotion and get perspective. like is this thing really as bad as I feel like it is? What is a more rational response to the situation? So it's hard for them often to kind of ask themselves those questions so that they can react in a different way.

okay and i think everything you said leads us to the next question so how all of these overwhelming emotions impact daily lives of people living with ADHD that meaning relationships work and overall well-being yeah so because of these challenges Individuals with ADHD may resort to poor or effective coping strategies such as avoidance. So they may ignore or avoid stressful situations instead of addressing them directly. They may result...

or resort to aggression. So lashing out in anger or frustration due to an inability to control emotional impulses. Procrastination. So delayed tasks or responsibilities that trigger emotional discomfort. may cause someone to procrastinate, but this only adds to stress later on. They may overuse distractions. So activities like video games, internet browsing, or eating to escape from emotional discomfort can occur.

And they may shut down and withdraw from social situations or become emotionally numb to avoid dealing with with intense feelings. So as far as relationships, people with. emotional dysregulation may have trouble maintaining friendships and romantic relationships due to impulsivity and difficulty managing emotions. Minor pet peeves can lead to explosive reactions that can make your friends and loved ones feel like

they have to walk on eggshells around you. Emotional difficulties can directly affect social interactions with others as people with ADHD may struggle to convey their feelings effectively. you may end up ruminating on issues or on an issue versus trying to find a healthy solution. And then as far as in the workplace, they may have difficulty maintaining employment.

due to their impulsivity, difficulty managing stress and anxiety, conflicts with colleagues and difficulty with time management and productivity. So workplace stressors like deadlines can trigger anxious feelings and make it more difficult to meet demands. If you're the hypersensitive or temperamental coworker, it can make your work life stressful and harm your ability to advance in your career. can also affect academic settings. So emotional dysregulation can make

concentrating, learning, and being productive harder due to intense stress. So students with emotional dysregulation may have difficulty in academic settings due to high demands for productivity. also struggle with managing the stress and pressure of testing and exams. And then it can also affect other areas of your life, like self-esteem can cause, you know, a lot of low self-esteem, parenting stress.

People who are parents who have ADHD might be more stressed or have more stress just parenting in general because of the emotional dysregulation. also result in things like impulse buying and therefore maybe poor credit. Research also shows that people with trouble regulating emotions are more likely to participate in risky behaviors such as substance abuse.

and dangerous driving. So this can result in more like road rage and crash risks. And then also self harm. So emotional dysregulation can, you know, tends to result more in self-harm than maybe those who don't have those issues regulating their emotions. Okay, so Stephanie, you told us a lot of...

maybe hard truths to swallow. So I would like now to change the tide a bit and talk about solutions and strategies. What strategies, what therapies have proven to be effective in helping individuals with ADHD to improve emotional dysregulation and generally to gain emotional... regulation skills sure so

Well, first off, you want to name your emotions. So taking a break to acknowledge the feeling can be a first step towards regaining control. Research has shown that naming your emotions, also known as effective labeling, can reduce the intensity. of negative emotions and possibly increase the intensity of positive ones.

So recognizing one's emotions is a crucial first step in effective emotional regulation. When emotions are left unrecognized, they can build up leading to emotional escalation, a situation. where small irritations turn into overwhelming feelings. When individuals are aware of their emotional state, they can make deliberate choices about how to respond rather than reacting impulsively.

So emotional recognition involves identifying and labeling the emotions you're feeling, which increases self-awareness. When you can name the emotion, so for example, I feel frustrated or I feel anxious, it helps you understand what's happening internally.

And this clarity allows you to acknowledge the emotion before it escalates and spirals out of control and better understand why you're feeling that way and what triggered it. It then allows you to separate your emotional response from the situation itself. which gives you more control. It also allows you to use appropriate coping mechanisms like deep breathing, reframing thoughts or taking time to cool off, which prevents negative emotions from intensifying.

And over time, regularly recognizing and addressing emotions helps build emotional resilience. There's also mindfulness. So mindfulness practices such as meditation and deep breathing exercises. can help increase awareness of one's emotions and tap into your ability to self calm. Many studies have found that these practices facilitate clinically significant improvements in stress, anxiety, and overall well-being.

Cognitive behavioral therapy can be helpful in learning how to cope with and regulate emotions by identifying and changing negative thought patterns and can also help individuals with ADHD to recognize and label emotions accurately. It also helps to challenge emotions which are not context appropriate and to cope with intense negative emotional reactions. Diet and exercise can be helpful.

So exercise, you know, some studies have suggested that physical exercise has a positive impact on emotion regulation ability, especially aerobic exercise intervention has a more significant effect. Regular physical activity can improve mood and reduce feelings of anxiety and depression by increasing neurotransmitters, lowering cortisol levels, and releasing endorphins, which create feelings of calmness and help reduce anxiety.

As far as diet, protein-rich foods and complex carbs like whole grains and fruits and veggies can promote neurotransmitter production and deficiency in micronutrients like magnesium, zinc. iron, and B vitamins can lead to worse ADHD symptoms and emotional dysregulation. Things like artificial colors and preservatives have been shown to trigger hyperactivity and emotional instability in some children with ADHD.

Processed foods often contain high amounts of sugar and unhealthy fats, which can negatively affect mood and energy, contributing to mood swings and irritability. There also appears to be some benefit from omega-3 fatty acid. supplementation and ADHD. So given that low levels of omega-3 fatty acids are associated with anomalies during emotional processing and ADHD, emotional dysregulation in ADHD may benefit from supplementation of that. There's also...

the factor of sleep. So sleep plays a crucial role in regulating emotions. Individuals with ADHD are more likely to have sleep problems. Ensuring adequate sleep can help improve your emotional regulation. Good sleep helps by decreasing the intensity of emotional responses to stress or frustration, making it easier to stay calm under pressure and improving the ability to pause and reflect before reacting emotionally. It also can help.

reduce impulsivity in emotional situations. So I mentioned people with ADHD often struggle with sleep issues such as insomnia, restless sleep, or difficulty waking up, which can worsen emotional dysregulation. And then practicing self-care, so engaging in activities that promote physical, emotional, and mental well-being, such as yoga or getting a massage can help reduce stress and improve emotional regulation.

Go ahead. One more thing I was going to mention using visualization and imagery. So these mental strategies involve creating vivid mental images or scenarios that can help reduce stress, manage intense emotions and foster calmness. and control. So by mentally transporting oneself to a peaceful place or scenario, the brain shifts focus away from the emotional trigger and reduces physiological arousal.

So visualizing a peaceful scene like a beach or a mountain can help you to relax and calm your emotions when feeling overwhelmed. And they can engage all the senses to make the scene as vivid as possible. So for example, hearing the ocean or feeling the breeze. Excellent. I think you gave us loads of options and suggestions how emotional dysregulation could be improved. And I suppose not one... solution will work for all people but

I think the beauty of what you said is that there are so many ideas and options that people maybe can try with one. Maybe meditation is not for everyone. Maybe some people do better with exercise. I would say I encourage people to try some of these and see if it works for them. If not, try something else. But again, you provide loads of...

possibilities and ideas how emotional dysregulation could be improved. So thank you for that. That's that's excellent. And of course, we don't live in isolation and we live in the communities, in families. We interact with our peers, educators, colleagues. So how it is. that people that live around individuals with ADHD can help and support management of their emotions. And also, can they play a role in the therapeutic process as well? Yeah, definitely.

Family members can help by encouraging their loved one to share their feelings. Active listening without judgment creates a safe space for expression. So using reflective listening, for example, it sounds like you're feeling frustrated because... can help the person to kind of acknowledge their emotions and work together to do that.

Setting clear expectations and boundaries can help. So clearly defining family rules and routines can reduce anxiety and emotional outbursts. Celebrate each other's strengths. Focus on their accomplishments. and strengths rather than dwelling on challenges. Positive reinforcement builds self-esteem. Educators can help by creating a supportive classroom environment.

So establishing predictable routines and providing visual schedules. Use common corners where students can take breaks when feeling overwhelmed. They might provide emotional cues. using visual or verbal cues to help the student recognize and name their emotions. So they may say things like, it looks like you're upset, would you like a moment to breathe? They can also teach social and emotional skills.

They can incorporate social emotional learning into the curriculum, focusing on empathy, emotional identification and self-regulation. They may be patient and flexible. allowing for accommodations like extended deadlines or reduced workloads during emotional difficulties and avoid punitive responses to emotional outbursts. So instead... they can discuss their behavior calmly after the moment has passed. As far as peers, peers can help each other by promoting inclusion.

by encouraging group activities that highlight the strengths of individuals with ADHD, fostering a sense of belonging. Teach peers, you know, we should teach peers to recognize that ADHD-related behaviors are not intentional and to approach them with empathy rather than judgment. Invite others to join in activities that are calming and enjoyable, such as art.

or nature walks, which may help regulate emotions. And they can stand up for others. So if other people are misunderstanding or mistreating someone, peers can advocate. by explaining ADHD's challenges and asking for kindness. So by creating a supportive environment and offering practical tools, family members, educators, and peers can help individuals with ADHD better navigate their emotions and develop.

long-lasting self-regulation skills. I love this. I love this kindness over judgment and support. Hopefully, we all can do our bit to help. create society that's less judgmental and doesn't stigmatize individuals with ADHD. So I really love this. Let's wrap up and

If there is one thing from everything you talked about in this episode that you would like our listeners to remember, what that would be? Just know that emotional regulation is something that's... it's common with individuals with ADHD. So if you're someone that struggles with that, you're not alone. Just surround yourself with people who will

Be supportive of your challenges. Emotions are a normal part of being human and are a natural reaction to situations we experience. So it's okay to express our emotions in a healthy way, such as... through talking about them or writing them down. No one can completely eliminate difficult emotions, whether or not they have ADHD, and it's okay to feel them.

Excellent. Thank you so much, Stephanie. You gave us loads of ideas. You explained beautifully the connection between emotional regulation and ADHD. And I hope that we all learned from... everything you said here. So it was really beautiful. Thank you so much. Thank you. Thanks, Nana. Hope to see you next time. Sounds good. Bye-bye. Thank you for listening to Thriving with ADHD.

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