Emotional Dysregulation: Symptoms, Causes and Treatment

Emotional dysregulation is a term that describes difficulties in managing, experiencing, or expressing emotions in ways that are adaptive or socially appropriate. While everyone experiences emotional ups and downs, emotional dysregulation is characterized by persistent, intense, or poorly controlled emotional responses that can interfere with daily life. It is a transdiagnostic phenomenon, meaning it appears across a range of mental health conditions, from mood and anxiety disorders to ADHD, eating disorders, and borderline personality disorder (BPD). In this article, we’ll explore the key symptoms, underlying causes, and evidence-based treatments for emotional dysregulation.

Symptoms of Emotional Dysregulation

Emotional dysregulation is more than just feeling sad, angry, or overwhelmed. It involves a complex interplay of emotional intensity, awareness, control, and expression, often leading to distress and impairment in relationships, work, and personal wellbeing. Recognizing its symptoms is the first step toward understanding and addressing this pervasive problem.

Intensity	Awareness	Control	Reference
Heightened	Poor awareness	Impulse problems	1, 5, 8
Rapid shifts	Lack of clarity	Maladaptive coping	4, 9
Overreactivity	Non-acceptance	Emotional lability	1, 4, 9
Negative focus	Emotional rigidity	Suppression	8, 9

Table 1: Key Symptoms

Key Dimensions of Emotional Dysregulation

Emotional dysregulation manifests through several interrelated dimensions. These include:

• Heightened Emotional Intensity: People often experience emotions more strongly or for longer periods than others. This can include both negative and positive emotions, but negative affect (such as sadness, anger, or anxiety) is most commonly problematic 1, 8.
• Poor Emotional Awareness and Clarity: Individuals may struggle to accurately identify or understand what they are feeling, leading to confusion and difficulty in responding to emotions effectively 1, 5, 8.
• Difficulty Controlling Emotional Responses: A hallmark symptom is the inability to inhibit or modulate emotional reactions. This may show up as impulsive actions, rapid mood swings, or outbursts that are disproportionate to the situation 4, 5, 9.
• Maladaptive Coping Strategies: Instead of adaptive strategies like problem-solving or acceptance, people may resort to suppression, avoidance, rumination, or other less effective ways of managing emotions 9.

Emotional Lability and Reactivity

Another key feature is emotional lability—rapid and unpredictable shifts in mood and affect. Individuals may feel calm one moment and intensely upset the next, often with little external provocation 4, 9. This instability may also include:

• Negative Emotional Focus: A tendency to dwell on negative emotions or events, amplifying distress and making it harder to recover 1, 9.
• Emotional Rigidity: Difficulty shifting from one emotional state to another or responding flexibly to changing situations 8.

Transdiagnostic Presentation

Emotional dysregulation is not limited to one condition. It is seen in:

• ADHD: Emotional impulsivity and deficient self-regulation are common, with symptoms like irritability, frustration, and sudden mood changes 2, 3, 4.
• Borderline Personality Disorder: Severe difficulties in emotion regulation, frequent use of maladaptive strategies, and pronounced emotional instability 9, 12.
• Eating Disorders: Poor awareness and acceptance of emotions, leading to impulsive behaviors like binge eating 5.
• Mood and Anxiety Disorders: Heightened negative affect and poor regulation of distressing emotions 1, 7.

Causes of Emotional Dysregulation

Understanding what causes emotional dysregulation is crucial for prevention and intervention. Its origins are multifaceted, involving biological, psychological, and environmental factors that interact throughout a person's development.

Biological	Psychological	Environmental	Reference
Genetic	Poor coping	Trauma, maltreatment	6, 14
Neurocognitive	Maladaptive schemas	Invalidating environment	12, 14
Emotional traits	Negative beliefs	Early deprivation	1, 6, 14
Brain function	Cognitive rigidity	Stress, adversity	3, 14

Table 2: Key Causes

Biological and Genetic Factors

Research suggests that genetic predispositions and neurobiological mechanisms contribute significantly to emotion regulation ability. Some people may be born with a temperament that makes them more emotionally sensitive or reactive. Neurocognitive deficits—such as problems with attention, impulse control, or executive function—are also linked to emotional dysregulation, particularly in ADHD 2, 3, 4, 14.

Early Life Experiences and Trauma

Childhood maltreatment, such as abuse, neglect, or chronic invalidation, is strongly associated with later emotional dysregulation 6, 14. Early trauma can disrupt the development of neural systems responsible for emotion regulation, leading to lasting difficulties in managing emotions. Repeated exposure to adversity may sensitize the nervous system, making emotional responses more intense and harder to control 6.

Psychological Factors: Cognitive and Emotional Schemas

Cognitive factors also play a major role. Maladaptive schemas—deeply held beliefs about oneself and the world, often shaped by early experiences—can distort emotional responses and promote maladaptive coping strategies 14. Negative self-concept, rigid thinking patterns, and difficulties in cognitive reappraisal (the ability to reinterpret negative events) are commonly observed in emotionally dysregulated individuals 8, 14.

Environmental and Social Influences

Environmental factors, especially chronic stress or invalidating family and social environments, can exacerbate emotional dysregulation. When emotions are not recognized, validated, or supported in childhood, individuals may fail to develop adaptive skills for managing distress 12, 14. This is particularly evident in BPD, where a transactional model describes how biological vulnerability and invalidating environments interact to produce chronic emotion regulation difficulties 12.

Transdiagnostic and Shared Origins

Emotion dysregulation is a transdiagnostic feature with shared underlying mechanisms across disorders. For example, early trauma and neurocognitive deficits may predispose individuals to a range of conditions, from mood disorders to ADHD and BPD, all characterized by emotion regulation challenges 1, 6, 12, 14.

Treatment of Emotional Dysregulation

While emotional dysregulation can be deeply distressing, a range of evidence-based treatments offer hope for recovery and improved quality of life. Treatment approaches are increasingly tailored to the specific needs and underlying mechanisms of each individual.

Therapy	Skills Focus	Medication	Reference
DBT	Mindfulness, distress tolerance	Antipsychotics, stimulants	10, 12, 13
Schema Therapy	Reappraisal, emotion processing	-	14
CBT	Problem-solving	-	14
Art Therapy	Expression, self-understanding	-	11

Table 3: Key Treatments

Psychotherapy: Dialectical Behavior Therapy (DBT)

DBT is one of the most well-established treatments for emotion dysregulation, especially in BPD but also in other conditions marked by emotion regulation difficulties 10, 12. DBT integrates:

• Mindfulness: Enhancing awareness of emotions without judgment.
• Distress Tolerance: Building skills to cope with intense emotions without resorting to harmful behaviors.
• Emotion Regulation: Learning to identify, label, and modulate emotions.
• Interpersonal Effectiveness: Improving relationships and assertive communication.

DBT skills training has been shown to significantly reduce emotion dysregulation, even in individuals without BPD but with high emotional difficulties 10.

Schema Therapy

Schema Therapy (ST) blends cognitive, behavioral, and emotion-focused techniques to address deeply ingrained maladaptive schemas and emotional patterns 14. ST is especially useful for chronic or treatment-resistant emotional dysregulation, as it targets both the cognitive and emotional roots of the problem.

Cognitive Behavioral Therapy (CBT) and Skills Training

CBT-based interventions focus on changing maladaptive thinking patterns and teaching adaptive coping strategies. However, standard CBT may not always be sufficient for severe emotional dysregulation; integrating emotion-focused or experiential techniques can enhance outcomes 14.

Creative and Experiential Approaches

Art-based therapies, especially those informed by DBT principles, offer unique avenues for emotional expression, processing, and self-understanding. Recent pilot studies have found that peer-led art therapy groups can significantly improve emotion regulation and wellbeing in people with BPD and related difficulties 11.

Pharmacological Interventions

Medications are sometimes used as adjuncts, particularly when emotion dysregulation is part of a neurodevelopmental disorder like ADHD or autism spectrum disorder (ASD). For example:

• Stimulants and Antipsychotics: Shown to improve emotional dysregulation and irritability in ADHD and ASD, respectively (notably risperidone and aripiprazole) 13.
• Medication Cautions: Pharmacological treatment should always be considered within a comprehensive, individualized plan and monitored for side effects 13.

Transdiagnostic and Preventative Approaches

Given the transdiagnostic nature of emotional dysregulation, interventions that build general emotion regulation skills—such as mindfulness, distress tolerance, and acceptance—are increasingly emphasized in both prevention and treatment 5, 10. Teaching these skills early, and in diverse clinical populations, can address the shared emotional vulnerabilities underlying many psychiatric conditions.

Conclusion

Emotional dysregulation is a complex, multifaceted challenge that cuts across many mental health conditions. Understanding its symptoms, roots, and treatment options is essential for anyone affected by emotional difficulties, as well as for clinicians and caregivers.

Key Takeaways:

• Emotional dysregulation involves intense, poorly controlled, or poorly understood emotional responses that impair daily life.
• Symptoms include heightened intensity, poor awareness, emotional lability, and maladaptive coping strategies 1, 4, 5, 8, 9.
• Causes are multifactorial, involving genetic, neurocognitive, psychological, and environmental factors, with early trauma and invalidating environments playing key roles 6, 12, 14.
• Evidence-based treatments include DBT, Schema Therapy, CBT, art-based therapies, and (in select cases) medications, with a strong emphasis on building adaptive emotion regulation skills 10, 11, 12, 13, 14.
• Addressing emotional dysregulation can significantly improve wellbeing and functioning, and interventions should be individualized and comprehensive.

By increasing awareness and access to effective interventions, we can help those struggling with emotional dysregulation lead more balanced, fulfilling lives.