What Is Deficient Emotional Self-Regulation (DESR)?

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Deficient emotional self-regulation (DESR) has been proposed by some experts to be a contributor or feature of attention-deficit/hyperactivity disorder (ADHD). However, it is not part of the current diagnostic criteria for ADHD, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Yet, of the 6.1 million children who live with ADHD in the United States, it's suggested that almost half also have DESR.

Regardless, it remains unclear whether deficient emotional self-regulation is a symptom of ADHD or a separate but related condition. There isn't even agreement yet about how to define and study DESR in order to learn more.

What Is Deficient Emotional Self-Regulation?

Deficient emotional self-regulation refers to a person's inability to regulate their responses to certain emotions and often includes:

  1. Trouble regulating physiological arousal caused by strong emotions, such as an increase in blood pressure or breathing faster
  2. Engaging in inappropriate behavior when faced with a positive or negative emotion
  3. Difficulty changing focus when faced with strong emotions
  4. Disorganized or uncoordinated behavior once emotions are activated

People with ADHD who are also living with DESR generally exhibit emotional reactions that are out of proportion to the situation. In other words, if you have DESR, you may react to a situation in the same way as someone who is under extreme stress or strain.

This term was defined in 2015 by Dr. Russell Barkley as part of a debate about whether DESR should be considered part of an ADHD diagnosis or an associated trait. It is just one of many emotional symptoms associated with ADHD, such as emotional impulsivity, instability, and reactivity.

While DESR is not included in the diagnostic criteria for ADHD, it can have serious negative effects on a person's daily functioning. DESR can also worsen other ADHD symptoms.

DESR and Executive Function

To better understand DESR, it's important to understand the concept of executive function, as this underlies the capacity for self-regulation. If you think about your mind as a group of individuals, executive function is your brain's ability to corral that group to coordinate together and get things done.

In other words, instead of being scattered and aimless, jumping from one thing to the next, executive function allows you to focus on what's most important. It also enables you to shift tasks easily when required and keep the bigger picture in mind.

Some of the abilities that are generally grouped under executive functions are:

  • Ability to process information and stay alert
  • Ability to start a task and get organized
  • Ability to switch tasks without getting stuck
  • Ability to use working memory and access your memories
  • Ability to monitor yourself and regulate your actions

It has been argued that the ability to regulate emotions does not belong on this list. Rather, emotion regulation is a thread running through all of these processes. And when it fails, the whole system fails. This explains why having DESR can cause so many impairments in different areas of one's life.

In general, executive function makes it much easier to respond to the demands of daily life, but in individuals with ADHD, executive function is often poor.

Symptoms of Deficient Emotional Self-Regulation

Let's take a step back for a moment and outline the precise experiences that you might be having if you live with DESR. The symptoms of deficient emotional self-regulation typically include:

  • Emotional impulsivity
  • Low frustration tolerance
  • Mood lability (sudden or exaggerated mood changes)
  • Temper outbursts, or disproportionate anger and frustration

When you feel overwhelmed by your emotions, it becomes harder to focus on other cognitions such as staying with a task or making an appropriate choice for the situation that you are in.

What looks like a lack of willpower is actually a flood of emotion that is so overwhelming that it's virtually impossible to stay the course and be productive. This often leads to procrastination, the inability to focus on long-term rewards, and trouble managing excitement and intense interest in new things.

DESR Outcomes

In addition to the immediate symptoms of deficient emotional self-regulation, there are also longer-term impacts and indirect effects that can occur.

For example, one study involving 329 adults (206 with ADHD and 123 without ADHD) found that people with ADHD who also live with deficient emotional self-regulation tend to experience more impairment in daily life. So, if you have DESR, you may also have a:

  • Greater risk of never being married or being divorced
  • Higher risk of car accidents or arrests
  • Lower quality of life
  • Poorer social adjustment

With DESR, you may also experience feelings of fear, shame, anger, and hopelessness at your inability to manage your emotions, affecting many different areas of your life.

Causes of DESR

What causes deficient emotional self-regulation? A study of 23 people with ADHD, 27 with ADHD combined with DESR, and 33 with neither ADHD or DESR, suggested that there was a familial link between ADHD and DESR. This indicates that there may be a genetic component.

Another study connected self-regulation issues with language deficits. This research suggested that the better a child is at communicating their needs, the better they are at having them met, reducing the likelihood of an overly emotional response. Language abilities also assist with the development of problem-solving skills.

Deficient emotional self-regulation is also associated with sleep disturbances. A 2021 study found that children and teens with ADHD who had higher deficient emotional self-regulation also experienced more sleep problems.

DESR Treatments

Because DESR is associated with ADHD versus being formally recognized as a standalone condition, treating ADHD is usually also the treatment for DESR. The two main ADHD treatment options are medication and therapy.

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Stimulant medication normally prescribed for ADHD may also help manage deficient emotional self-regulation. Prescription medicines can be helpful when used correctly and monitored to ensure that side effects are minimized and that dosage is optimal.

However, not everyone does well with medication in terms of effectiveness, side effects, and interactions with other medications that you might already be taking. It's important to discuss all these issues with your doctor if you are considering taking medication to manage DESR.


Therapy such as cognitive behavioral therapy (CBT) or mindfulness-based techniques can also be helpful for developing better emotional self-regulation. These types of therapies train the brain to respond to triggers in different ways. They also teach new coping skills to help manage emotions when they become overwhelming.

For some people, therapy combined with medication is the most effective approach. This allows you to experience optimal effects of both forms of treatments.

Mindfulness may be a useful technique for dealing with this condition. A 2019 study found that children who were treated with mindfulness-based group therapy had lower levels of DESR after treatment.

Coping With DESR and ADHD

If you have ADHD and also believe that you are living with DESR, know that you are not alone. Approximately 60% of people diagnosed with ADHD are also thought to have deficient emotional self-regulation.

There are coping methods that you can employ on your own to help manage daily life. Ideas include practicing daily meditation to increase mindfulness, getting regular exercise to help modulate emotions, and watching the foods that you eat that may contribute to emotional highs and lows.

Beyond this basic layer of coping, it is important to speak to your doctor or a mental health professional if you find it difficult to control your emotions or emotional responses on a daily basis.

A Word From Verywell

Given that DESR is not a recognized criteria for the diagnosis of ADHD, additional research is needed before we have definitive answers as to the best treatment options for those with both ADHD and DESR. Additionally, not everyone with ADHD is also living with DESR.

Therefore, the best thing to do is communicate with your health professional and make them aware of the symptoms you are experiencing. It is only through this awareness that better treatment options can be made available.

Also, consider reaching out to a support group to connect with people who can understand and relate to the issues you are facing. If no support group exists in your area, you may even start your own.

Finally, if the person with DESR is a family member or someone you know, offer them patience as they work through these issues. Your support during times of difficulty can be incredibly helpful.

9 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Arlin Cuncic, MA
Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology.