Emotional Dysregulation in Children and Adolescents

Emotional Dysregulation (ED) is defined as the inability to regulate and organize emotions to produce an appropriate emotional response and subsequent return to baseline. With regard to the intensity of reactions it partially overlaps with the concept of irritability, which is however regarded to be a more dispositional trait. ED represents a major health risk and is associated with diverse forms of childhood psychiatric disorders and symptoms like attention deficit hyperactivity disorder, oppositional defiant- and conduct disorders (ODD and CD), personality disorders, self-injurious behavior and suicidality. In clinical settings, dysregulation problems are especially prominent, occurring in 26.0–30.5% of children admitted to child and adolescent psychiatric clinics or mental health facilities. A recent study could demonstrate that especially disturbed emotion regulation contributes to self-injurious behavior in a large group of adolescents presenting to a child and adolescent psychiatric emergency service (Kandsperger et al.). The occurrence of typical phenomena associated with ED, like severe tantrums, low frustration tolerance, aggression, negative mood and suicidality is even higher than the full syndrome of ED, with estimates of about 45% in child psychiatric patients between 6 and 18 years. An additional impact of Lockdown-related stressors on children and adolescents can also be discussed. Thirty percentage of adults with emotional instability report having injured themselves at primary school age.

Several authors also mention emotionally dysregulated behavior as one of the leading symptoms of BPD and ADHD/DMDD. On the opposite note, emotion regulation capacity prevents the onset of multiple psychiatric and physical disorders and promotes successful social and professional development as described above. In connection with Emotion Dysregulation, large and rigorous studies also emphasize that this behavior results in high costs for health and other services services.

In addition to biological vulnerability, epidemiological research suggests that the onset of most psychiatric disorders across the life course in nearly half of cases is attributable to adverse childhood experiences and stress related disorders. Negative impact of adverse childhood experiences on general health seems to attributable partly to maladaptive strategies for emotion regulation, such as smoking, alcohol, overeating. Sleep problems related to the traumatic impact of adverse childhood experiences can be directly related and be an important target for treatment. Furthermore, early life trauma impairs neurobiological structures and functions related to emotion regulation, such as the orbitofrontal gyrus and frontolimbic connections. A challenge for clinical practice is the assumption that patients with ED remain notoriously difficult to treat.

Better equipment with psychotherapeutic tools for Emotion Regulation and characterization of the ecological contingencies, and an understanding of the developmental pathways through which early experience shapes later behavior, can help clinicians to tailor intervention efforts more precisely, to prevent future dysfunction.

Therefore, studies focusing on pathogenetic aspects of ED by addressing neurobiological underpinnings and childhood adversity are collected in this issue. Furthermore, interventions and therapies that give an overview on established therapeutic tools such as DBT and the younger “derivatives” and describe novel interventions developed from the recent ED-Framework, are included in this topic. Together with review articles on state of the art advancements in ED, research in this issue explores the adverse childhood experiences framework or describing empirical research on neurobiological associations.

With original articles and reviews on diagnosis and classification of ED our aim was to achieve with this issue a large transdiagnostic long-term benefit for research as well as clinical aspects since understanding and improving human emotion regulation capacity prevents the onset of multiple psychiatric and physical disorders and promotes successful social and professional development as will be shown in this issue.

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Summary

Emotional Dysregulation in Children and Adolescents

Emotional dysregulation (ED) is characterized by the inability to regulate and organize emotions, resulting in inappropriate emotional responses and a delayed return to a baseline emotional state. The intensity of these reactions partially overlaps with the concept of irritability, though irritability is considered a more dispositional trait. ED poses a significant health risk and is associated with various childhood psychiatric disorders and symptoms, including attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, personality disorders, self-injurious behavior, and suicidal ideation.

ED is a prevalent concern in clinical settings, affecting 26.0–30.5% of children admitted to child and adolescent psychiatric clinics or mental health facilities. Recent research has demonstrated that disturbed emotion regulation contributes significantly to self-injurious behavior among adolescents presenting to emergency services. The occurrence of common ED-related phenomena, such as severe tantrums, low frustration tolerance, aggression, negative mood, and suicidal ideation, is even higher than the full spectrum of ED, affecting approximately 45% of child psychiatric patients between the ages of 6 and 18. The impact of lockdown-related stressors on children and adolescents can also be considered, with 30% of adults experiencing emotional instability reporting self-harm during their primary school years.

Several authors identify emotionally dysregulated behavior as a key symptom of borderline personality disorder and attention-deficit/hyperactivity disorder with disruptive mood dysregulation disorder (ADHD/DMDD). Conversely, the ability to regulate emotions effectively prevents the development of numerous psychiatric and physical disorders and fosters successful social and professional development. Extensive research emphasizes the significant financial burden associated with ED on healthcare and other services.

Beyond biological vulnerabilities, epidemiological research suggests that adverse childhood experiences and stress-related disorders contribute to the onset of nearly half of psychiatric disorders across the lifespan. The adverse impact of childhood trauma on overall health is partially attributed to maladaptive emotion regulation strategies, including smoking, alcohol use, and overeating. Sleep problems arising from the traumatic effects of adverse childhood experiences can be directly related and serve as an important target for treatment. Moreover, early life trauma can impair neurobiological structures and functions involved in emotion regulation, such as the orbitofrontal gyrus and frontolimbic connections.

Clinicians face the challenge of treating patients with ED, who are often resistant to treatment. Enhancing psychotherapeutic tools for emotion regulation, characterizing ecological contingencies, and understanding the developmental pathways by which early experiences shape later behavior can guide clinicians in tailoring interventions more effectively to prevent future dysfunction.

This issue focuses on the pathogenetic aspects of ED, exploring neurobiological underpinnings and childhood adversity. It includes interventions and therapies that provide an overview of established tools, such as dialectical behavior therapy (DBT) and its newer "derivatives," as well as novel interventions developed from the recent ED framework. Research in this issue explores the adverse childhood experiences framework and describes empirical research on neurobiological associations. Additionally, original articles and reviews on the diagnosis and classification of ED aim to contribute to a broader transdiagnostic long-term benefit for both research and clinical practice.

By improving our understanding and enhancing human emotion regulation capacity, we can effectively prevent the onset of multiple psychiatric and physical disorders and promote successful social and professional development, as demonstrated throughout this issue.

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Summary

Emotional Dysregulation in Children and Adolescents

Emotional dysregulation (ED) refers to the inability to manage and organize emotions effectively, leading to inappropriate emotional responses and difficulty returning to a stable emotional state. While ED shares some similarities with irritability, it's considered a distinct concept representing a significant health risk.

ED is linked to a variety of childhood mental health disorders, including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), personality disorders, self-harm, and suicidal thoughts. It's particularly prevalent in clinical settings, affecting a significant percentage of children admitted to psychiatric facilities.

Research highlights the impact of ED on self-injurious behavior, particularly among adolescents seeking emergency psychiatric care. Beyond the full syndrome, common symptoms like severe tantrums, low frustration tolerance, aggression, negative moods, and suicidality are even more widespread in child psychiatric patients. The influence of lockdown-related stressors on children and adolescents is also a relevant factor.

The ability to regulate emotions is crucial for preventing various mental and physical health problems and promoting successful social and professional development. Studies emphasize the substantial financial burden associated with ED on healthcare and other services.

Research indicates that adverse childhood experiences and stress-related disorders contribute significantly to the development of mental health disorders, including those related to ED. These negative experiences often lead to maladaptive emotion regulation strategies, such as substance abuse and unhealthy coping mechanisms. Early life trauma can disrupt brain structures and functions involved in emotion regulation, further exacerbating the challenges associated with ED.

Clinicians face the challenge of treating patients with ED, who often present difficulties in therapy. However, advancements in psychotherapeutic tools and a deeper understanding of the developmental impact of early experiences can empower clinicians to tailor interventions more effectively, preventing future dysfunction.

This issue presents a collection of studies focusing on the biological and environmental factors contributing to ED. It explores interventions and therapies, including well-established approaches like Dialectical Behavior Therapy (DBT) and newer treatments informed by recent ED frameworks. Furthermore, it delves into the role of adverse childhood experiences and examines the neurobiological underpinnings of ED.

This compilation of original research and reviews aims to foster a comprehensive understanding of ED, benefiting both research and clinical practice. By promoting a deeper understanding and improving human emotion regulation capabilities, the issue seeks to contribute to the prevention of mental and physical health issues and facilitate social and professional success.

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Emotional Dysregulation in Children and Adolescents

Emotional Dysregulation (ED) is when someone can't control their emotions and act appropriately. It's like being really easily upset and having trouble calming down. This can be a big problem for kids and teens, and it's linked to things like ADHD, oppositional defiant disorder, and even self-harm.

About 30% of kids who go to mental health clinics have ED. A recent study showed that ED is a major factor in why teens might hurt themselves. ED can also lead to things like bad temper tantrums, not being able to handle frustration, and feeling angry or sad a lot.

Experts also say ED is a big part of borderline personality disorder (BPD) and ADHD. On the other hand, learning to control your emotions can help you avoid mental and physical problems, and do well in school and at work.

Sadly, ED is often caused by tough childhood experiences, like abuse or neglect. These experiences can make it harder for kids to learn how to manage their emotions. This can lead to unhealthy habits like smoking, drinking, or overeating. Trauma can also make it hard to sleep, which is another problem related to ED.

It's hard to treat ED, but researchers are working on new therapies and ways to understand the brain. By figuring out how ED develops, we can create better treatments and help kids and teens before things get worse.

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Emotional Dysregulation in Kids

Emotional Dysregulation (ED) is when someone has trouble controlling their feelings. They might get really upset or angry easily, and it takes a long time for them to calm down. It's like when you're playing a game and you lose, and you get so mad you want to throw the game! ED can be a problem for kids and teens, and it can lead to other issues like having trouble paying attention, getting into fights, and feeling sad all the time.

Some kids with ED might even hurt themselves or think about hurting themselves. ED is a common problem in kids who need help with mental health issues. They might have a hard time going to school or making friends because of how they feel.

A lot of things can cause ED, like bad things that happened in the past or having a family history of mental health problems. It's important to help kids with ED learn how to manage their feelings so they can have a happier and healthier life.

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