Deficient emotional self-regulation (DESR) is not an official symptom of ADHD. It does not appear in the DSM-5, yet its four core facets, as defined by Russell Barkley, PhD, are familiar to most people with ADHD:
- The emotional impulsiveness associated with DESR is illustrated by low frustration tolerance, impatience, being quick to anger, aggression, and strong emotional excitability.
- DESR brings an inability to self-soothe and down-regulate a strong emotion to reduce its severity.
- DESR makes it difficult to refocus attention from emotionally provocative events.
- DESR brings an inability to organize or substitute more moderate, healthier emotional responses in the service of goals and long-term welfare.
The neurological connection between ADHD and emotion is clear. We know that the brain’s emotional circuitry — the amygdala and larger limbic system to which it is connected, plus the prefrontal cortex — is also implicated in ADHD. Research confirms that emotional regulation is a primary dimension of the executive functioning impaired by ADHD, yet these defining features are excluded from ADHD’s diagnostic criteria. As a result, individuals with ADHD risk not only missed diagnoses but misdiagnoses, Barkley says.
The emotional symptoms of ADHD are commonly mistaken for signs of a mood disorder, especially when they appear in adult women, who may be misdiagnosed with depression or even bipolar disorder and receive inappropriate, ineffective treatment as a result.
"When we see emotion regulation problems in people with ADHD, particularly very impulsive expression of emotion and difficulties grappling with and moderating emotion once it’s provoked, that is ADHD," Barkley says. "There is no reason to go looking for a comorbid disorder to explain that; that is the executive deficit emotion regulation problem."
In the video above, Barkley explains how to differentiate signs of ADHD’s emotional lability from those of a mood disorder, a topic he covers in greater depth in the ADDitude article, "DESR: Why Deficient Emotional Self-Regulation is Central to ADHD (and Largely Overlooked)."
For more information about DESR and its role in ADHD, watch the full replay of Barkley’s free ADDitude webinar, "Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything."
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