What Is Deficient Emotional Self-Regulation (DESR)?

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Deficient emotional self-regulation (DESR) is not among the defining criteria for a diagnosis of attention deficit disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, of the 6.1 million children who live with ADHD in the United States, it's suggested that about half may also have DESR. Regardless, it remains unclear whether deficient emotional self-regulation is a symptom of ADHD or a related condition.

Definition of Deficient Emotional Self-Regulation

Deficient emotional self-regulation refers to the inability to regulate physiological arousal caused by overwhelming emotions. This term was defined in 2015 by Russell Barkley as part of a debate about whether DESR should be an integral part of a diagnosis of ADHD or an associated trait.

Deficient emotional self-regulation has also been known as other related terms such as the following concepts:

  • emotional lability
  • emotional impulsivity
  • emotional dysregulation
  • frustration discomfort
  • irritability
  • emotional reactivity
  • emotional instability
  • poor distress tolerance

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

While DESR is not recognized in the DSM-5 as a criterion for ADHD, emotional impulsivity is defined as actions that are the following:

  • poorly conceived
  • prematurely expressed
  • unnecessarily risky
  • inappropriate to the situation

What Is Executive Functioning?

In order to better understand DESR, it's important to understand the concept of executive functioning. While DESR is not included in the diagnostic criteria for ADHD, it can have serious negative effects on the daily functioning of those who struggle. In fact, DESR can worsen other ADHD symptoms.

Executive function (EF) is what underlies the capacity for self-regulation. If you think about your mind as a group of individuals, then executive function is your brain's ability to corral that group of individuals to coordinate together and get things done.

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

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.

What's more, previously, the capacity to regulate emotions was thought to be one type of executive function. In other words, the ability to rein in negative emotions or to not let your emotions overwhelm you was thought to be a part of executive function.

To help you understand, here are some of the other abilities that are generally grouped under executive functions:

  • ability to process information and stay alert
  • ability to not get stuck and switch tasks
  • ability to start a task and get organized
  • ability to use working memory and access your memories
  • ability to regulate actions and monitor yourself

However, 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 the above 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.

When you feel overwhelmed by your emotions, that makes it 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 it makes it virtually impossible to stay the course and be productive. And instead, it leads to procrastination, the inability to focus on long-term rewards, and even a struggle to manage excitement and intense interest in new things.

If you or someone you know is struggling with DESR, it's not your imagination that it is the hardest part of living with ADHD; given the effects in all areas of your life, this is completely understandable.

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 are as follows:

  • low frustration tolerance
  • emotional impulsivity
  • mood lability
  • quick bursts of disproportionate anger and frustration
  • impatience
  • excitability in the face of everyday events
  • snapping at small disappointments

Outcomes

In addition to the immediate symptoms of DESR, there are also longer-term impacts and indirect effects on the lives of those who struggle.

A study conducted with 206 adults with ADHD and 123 without ADHD in 2011 and published in the American Journal of Psychiatry indicated that people living with ADHD who also live with deficient emotional self-regulation experience more impairment in daily life. Below are some issues you may face if you have DESR:

  • greater risk of never being married or being divorced
  • higher risk of car accidents or arrests
  • overall lower quality of life
  • poorer social adjustment

In general, you may also experience feelings of fear, shame, anger, and hopelessness at your ability to manage your emotions, and as a result, many different areas of your life.

Causes

What causes deficient emotional self-regulation? In a study of 23 people with ADHD, 27 with ADHD combined with DESR, and 33 without neither, along with their siblings, it was shown that there was a familial link between ADHD and DESR.This suggests that there is a genetic component to DESR among those with ADHD. In other words, DESR is not just a learned behavior; it may run in families due to a genetic component.

Solutions for Deficient Emotional Self-Regulation

What can you do to get help if you are living with DESR? The two main treatment options are medication or therapy.

Medication

Stimulant medication normally prescribed for ADHD may also help you to manage deficient emotional self-regulation. However, not everyone does well with medication in terms of how well it works, side effects, and overlap 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. Medication can be helpful when used correctly and monitored to ensure that side effects are minimized and that dosage is optimal.

Therapy

Therapy such as cognitive-behavioral therapy (CBT) or mindfulness-based techniques can be helpful to allow you to develop better emotional self-regulation.

Through these types of therapies, you would be training your brain to respond in different ways to triggers and learning new coping skills to manage emotions when they become overwhelming. Therapy can also be combined with medication so that you experience optimal effects of both treatments.

Coping With DESR and ADHD

If you have ADHD and also believe you are living with DESR, know that you are not alone and that there are coping methods that you can employ on your own to manage daily life. Ideas include practicing daily meditation to engage in a practice of mindfulness, getting regular exercise to help modulate your emotions, and watching the foods that you eat that may contribute to highs and lows.

Beyond this basic layer of coping, it is important to speak to your doctor or a mental health professional if you are truly struggling on a daily basis.

A Word From Verywell

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

In the meantime, the best thing you can do is to communicate with your health professional so that he or she is aware of the symptoms and struggles you are facing. It is only through this awareness that better treatment options can be made available.

Finally, if the person with DESR is someone whom you know or a family member, try to remember to show patience as they work through these issues. Your support during times of difficulty will be more helpful than anything else, despite how hard it may be in the moment to offer.

If you find yourself struggling to cope emotionally yourself, remember to take breaks as needed and perhaps reach out to a support group for families who will understand and relate to the issues you are facing.

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Article Sources
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  1. Centers for Disease Control and Prevention. National Prevalence of ADHD and Treatment.

  2. Association for Child and Adolescent Mental Health. Emotional Impulsivity and Deficient Emotional Self Regulation Might Be Core Symptoms of ADHD.

  3. Surman CB, Biederman J, Spencer T, Miller CA, Mcdermott KM, Faraone SV. Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study. Atten Defic Hyperact Disord. 2013;5(3):273-81. doi:10.1007/s12402-012-0100-8

  4. Surman CB, Biederman J, Spencer T, et al. Deficient emotional self-regulation and adult attention deficit hyperactivity disorder: a family risk analysis. Am J Psychiatry. 2011;168(6):617-23. doi:10.1176/appi.ajp.2010.10081172. 

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