The Emotional Aspect of Living With ADHD

“ADHD can make it harder to manage minor corrective feedback at work, and it kind of escalates into more of an emotional event than it might for someone who didn't have that core belief [of incompetence] and didn't have ADHD affecting their emotional regulation,” says adult ADHD specialist Justin Barterian, PhD, a psychologist at the Ohio State University Wexner Medical Center in Columbus, Ohio.

Emotional dysregulation also is not limited to emotions like anger or sadness, says Tuckman, a professional expert at the advocacy organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). Your positive emotions also can overwhelm your ability to keep them in check. For example, says Tuckman, you may be so smitten with your new romantic partner that you declare your love or jump right into bed with them.

“This can lead to various negative outcomes, from scaring off a potential partner to regretting being sexual too quickly or not using protection,” says Tuckman.

Why Does Emotional Dysregulation Occur in ADHD?

You experience emotions like happiness, anger, sadness, and fear in response to what’s happening around you or to you. Some psychologists break this process into four steps:

1. Something occurs that could trigger an emotional response
2. You turn your attention to what’s happening
3. You consider what’s going on and weigh its significance
4. You have an emotional reaction

Emotional regulation, when it works correctly, enables you to:

• Determine your emotional reaction to such situations
• Control how you express the emotions that the situation has triggered

That process breaks down in many people with ADHD. That’s because the disorder impacts a part of the brain called the prefrontal cortex, which helps to regulate emotions. This brain region also oversees other aspects of what’s called executive function. Such functions, which are impaired by ADHD, include:

• Paying attention
• Getting and staying on task
• Managing impulses
• Organizing and planning

“ADHD is a disorder of executive functioning and attentional control, and it takes a lot of attentional control to manage your emotions,” says Barterian. “When you have ADHD, you essentially have less of that control.”

However, emotional dysregulation is not a symptom required for a diagnosis of ADHD, and experts disagree on why it develops in those with the disorder. Some believe it may be a holdover from oppositional defiant disorder, which many children with ADHD also have. Other experts say it may be connected to bipolar disorder. Still others hold that it is, in fact, a characteristic feature of adult ADHD.

Comorbidities Complicate ADHD

Comorbidities are medical conditions that you have in addition to another health problem. They occur frequently in ADHD. Recent research shows that nearly 3 out of 4 people with ADHD have another mental health issue. The most common: depression and anxiety. Both develop in up to about half of people with ADHD. Why?

“Quite simply, ADHD gives one more to be anxious and depressed about, at least when it's insufficiently managed,” says Tuckman.

Adults with ADHD struggle in major aspects of their lives, such managing their work and family responsibilities. As tasks go undone and you struggle to stay engaged and organized, anxiety builds.

“Feeling constantly behind, knowing you're dropping balls, having people frustrated with you, and yet still struggling to stay on top of all your obligations — these are all good reasons to feel bad,” says Tuckman.

That, in turn, can contribute to depression, Tuckman adds: “Since folks with ADHD know very well what they should do but struggle with doing it at times, it's easy to be pessimistic that things will work out better next time.”

If you have ADHD and also struggle with emotional dysregulation, you may be more at risk of both depression and anxiety, says Tuckman.

“We all have setbacks from time to time, but someone who tends to be less emotionally regulated is more likely to have their feelings run away with them and then have a harder time reining them back in,” he explains.

Recognizing the Signs of Depression and Anxiety

“Everyone experiences transient stress and feelings of sadness from time to time,” says Barterian, “but when these symptoms persist over time and start to interfere with functioning in daily life, it is important to reach out to health care professionals for further evaluation.”

Here’s what to watch for.

Depression

Depression causes you to continually feel low. That not only affects your thoughts but also your sleep, appetite, and your interest in things. Your doctor may diagnose you with depression if you have ongoing symptoms of depression for two weeks or longer, including:

• Feeling sad, anxious, empty, or hopeless
• Feeling irritable, restless, or frustrated
• Feeling worthless, guilty, or helpless
• Feeling fatigued or that you lack energy
• Losing interest or no longer enjoying hobbies or other activities you used to like
• Feeling less able to concentrate or remember things
• Having sleep difficulties
• Losing your appetite
• Thinking of death and/or considering suicide or attempting suicide

Anxiety

Also called generalized anxiety disorder, this condition causes persistent, excessive, and intense worries — about health, money, work, etc. — that impact your life in significant ways. Its symptoms include:

• Excessive worry about things you do every day
• Difficulty managing your worries
• Often feeling irritable
• Trouble relaxing or often feeling restless
• Difficulty concentrating
• Sleep problems, such as struggling to fall asleep and/or stay asleep
• Physical issues, like headaches, stomachaches, and muscle aches

As you can see, some symptoms of depression and anxiety overlap. They also overlap with some of the symptoms of ADHD. If you experience symptoms like these, talk with your doctor.

Tuckman suggests asking yourself the following questions about what you’re feeling:

• Is it affecting your ability to take care of yourself — or even your desire to?
• Is it holding you back from socializing, or are you notably less present when you are around people?
• Do you too often find yourself stuck in negative thought loops?
• Are you really down on yourself, on life, or for the future?

“A solid ‘yes’ to any of these questions probably merits some attention and even more so if you can say yes to more than one,” says Tuckman. “The good news is that addressing one's ADHD can also improve anxiety and depression.”

What Impact Does Emotional Dysregulation Have on Adults With ADHD?

When your emotions get the better of you, you may say or do things that you later regret. Given how frequently adults with ADHD have trouble keeping their emotions in check, such regrets can pile on — and so can the consequences, at work, in relationships, and other walks of life.

Barterian describes an issue that can arise at work and elsewhere. We all make mistakes, but the fear of being judged harshly — even for minor slip ups — can be particularly strong if you are an adult with ADHD. That fear may keep you from admitting and correcting a mistake in order to avoid criticism.

“As time goes on, that mistake tends to become a bigger mistake, and it can lead to more problems,” says Barterian.

Adults with ADHD, he continues, also tend to feel heightened anxiety over everyday work duties.

“And since we don't like feeling anxiety, the most natural reaction to that is to avoid what’s triggering it,” Barterian says.

The result: Work doesn’t get done or done on time. That increases your chances of being disciplined or fired. In fact, says Tuckman, employees with ADHD are more likely to be fired or quit impulsively, in part because of emotional dysregulation. “This can have significant impacts on not only short-term income, but also on future career opportunities and lifetime earnings,” says Tuckman.

Your emotional difficulties can do more than complicate your ability to finish tasks; they also may contribute to a reputation as a troublesome employee. One example: Your employer announces a new policy that nobody likes. Unable to mask how upset you are, you blurt out your displeasure while your co-workers remain silent.

“Everyone else may be thinking the same thing, but the person who speaks up is more likely to be disciplined or not be promoted later,” says Tuckman, who adds that similar outbursts can sour personal relationships. This is particularly true if the emotions that most often get the better of you tend toward those like anger, frustration, and annoyance.

“This can burn out friendships and negatively impact romantic relationships and parenting,” says Tuckman. “A small number of negative interactions, especially if they are pretty intense, can erase a lot of positive experiences.”

Such experiences also have internal consequences. In addition to regret over the incidents themselves, you may have or develop intense feelings of shame over your inability to manage your emotions. And the negative feedback you get from others following an incident adds yet another layer. For example, your friends may accuse you of being mean, selfish, or worse, says Tuckman.

“If you hear this often enough, you start to believe it yourself,” he says.

How Can Adults With ADHD Regulate Their Emotions?

A lifetime of emotional dysregulation can’t be resolved overnight, but a variety of approaches and practices can give you the tools to better manage your emotions.

Medication

Stimulant medications are the mainstay treatment for ADHD, and they appear to help adults with ADHD better manage their emotions. Many such prescription drugs are available, including:

• Combined dextroamphetamine and amphetamine (Adderall)
• Dexmethylphenidate (Focalin)
• Lisdexamfetamine (Vyvanse)
• Methylphenidate (Concerta, Ritalin)

“We know that stimulant medications are the most effective treatment for ADHD,” says Barterian. “When folks with ADHD take a stimulant medication, we often find they are better able to practice strategies to regulate their emotions.”

Tuckman points out that medication improves attention and reduces procrastination. That helps adults with ADHD get things done on time, thereby easing stress.

“Less stress makes it easier to pause before reacting emotionally to whatever happens next,” says Tuckman. “In addition, medication also helps with impulse control and gives an extra moment to think before acting.”

What Can You Do to Improve Your Emotional Regulation?

Professional treatment will provide you with the most effective tools for managing emotional dysregulation. However, the following practices can complement your treatment plan.

Breathing exercises: Breathing deeply and slowly can help you calm your emotions when they get the better of you. Honos-Webb says you also can do such exercises before situations that often trigger you. For example, if you often get anxious at work, take breaks and do an exercise like box breathing: Breathe in while you count to four, hold your breath for a count of four, breathe out for a count of four. Then, after counting to four again, repeat this process. Do this three to four times.

Meditation and mindfulness: This can be combined with breathing exercises to curb your impulses and emotions by situating yourself in the present moment. You’ll benefit from as little as five to 10 minutes per day.

Learning your triggers: Honos-Webb recommends identifying the types of situations that regularly get you worked up. If you know you will soon find yourself in such a situation, you can prepare in advance — by deep breathing or meditating, for example — so that you respond with more equanimity.

Positive reframing: When you feel triggered, reframe your response. If you get cut off in traffic, for example, tell yourself it’s nothing personal; the driver may be rushing to the hospital. “That kind of self-talk helps you reframe the situation and give you a different perspective,” says Honos-Webb.

Replay: If you do have an episode in which your emotions get the better of you, wait until you have calmed down and then replay it in your mind, says Honos-Webb. Ask yourself whether you saw things clearly in the moment and what you can do differently next time.

Regular exercise: A walk or a trip to the gym, says Honos-Webb, can do wonders for your mood if you’re feeling down in the dumps. Bonus: It also can help chill hyperactivity.

One last thing to keep in mind: ADHD is a complex disorder, and you’re a complex person. It may take some time to figure out what works best for managing your emotional dysregulation. If what you try first does not help, make adjustments or move on to something else, ideally while working with a therapist’s guidance.

“It's about matching each person's individual needs,” says Tuckman.