Breaking down emotional dysregulation and how you can manage it | Dr Gilly Kahn (PhD, clinical psychologist, author)

Dr. Gilly Kahn on breaking down emotional dysregulation, and the approach on how to manage it.

Ever notice how a tiny spark of emotion can set off mental fireworks when you have ADHD? One minute you’re making dinner, the next you’re replaying a random comment from three days ago and feeling it in your bones. Those quick flips between “totally fine” and “why am I like this” can feel isolating, yet they’re a real part of the ADHD experience. This week, we’re digging into that roller coaster.

Dr. Gilly Kahn is a clinical psychologist, ADHD advocate, and writer based in Atlanta. In her practice, she works with children, teens, and adults, blending Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, and other evidence-based tools to help neurodivergent clients find steadier ground. When she’s not seeing clients or mommying, she’s translating research for everyday readers in outlets like Psychology Today and ADDitude, and her clinical perspective has shown up everywhere from Forbes to TIME. Her first book, Allow Me to Interrupt: A Psychologist Reveals the Emotional Truth Behind Women’s ADHD, is now available for pre-order and promises to bring that same clear voice to a wider stage.

If emotions have ever blindsided you mid-Zoom or left you wiped out before noon, settle in. Gilly’s clear framework and three starter strategies might change how you treat your brain the next time a feeling hits hard.

As humans with vulnerabilities, assumptions, and heavy emotions—we often jump the gun on identifying ways to “fix” problems. We do this too quickly—before taking a minute to ask ourselves whether we even understand a “problem” in the first place.

No, I’m not talking about problems like, “My friends left me out of the group chat” (not yet, at least). First, we’re talking about defining concepts. And in this case, our concept is emotion regulation. The problem with throwing around the phrase “emotion regulation” without defining it and literally breaking it down is that, in trying to help people regulate their emotions, we may be missing important components of what we are trying to address.

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Emotional dysregulation and ADHD

ADHD expert, Dr. Russell Barkley, has been arguing for at least 10 years that emotional dysregulation should be included as a core feature of ADHD. As early as 1902, physicians (like George Still, who wrote about “defects in moral control”) linked ADHD-like symptoms with struggles reflective of emotional dysregulation.

Altogether, Dr. Barkley explains, the history of ADHD, neuroanatomy of ADHD, abundant research supporting the link between ADHD and emotional dysregulation, common comorbidities (like oppositional defiant disorder), and frequent social difficulties experienced by ADHDers, all lend to the rationale that emotional dysregulation is a core feature of ADHD (despite it continuously being left out of DSM criteria).

Similarly, in my upcoming book, Allow Me to Interrupt: A Psychologist Reveals the Emotional Truth Behind Women’s ADHD, I include personal stories of women with ADHD who describe their history of significant challenges with regulating their emotions and the consequences of feeling deeply misunderstood. In the book, I also dive into my personal experiences with rejection sensitivity dysphoria (with similar scientific explanations in this ADDitude Magazine blog post I wrote), and my clients’ related experiences of extreme sensitivity to perceived or actual criticism by others.

But what do we mean by “emotional dysregulation?” To explain emotional dysregulation, let’s take a step back and first define emotion regulation.

Emotion regulation refers to one’s ability to:

1. Inhibit unhelpful behavioral responses to a trigger

2. Self-soothe and down-regulate physiological (bodily) arousal

3. Redirect their attention to behave effectively

4. Plan/organize their responses to avoid big problems down the line

Here’s an example. Say an adult with ADHD is particularly sensitive to perceived rejection. We’ll roll with the example I mentioned above and imagine this fine fella (let’s call him “Jim”) finds out that his best friends intentionally left him out of a separate group chat they formed on WhatsApp. For Jim to have intact and well-functioning emotion regulation skills, at the moment that he found out about the group chat, he would’ve had to:

1. Refrain from confronting his friends in an aggressive, accusatory way OR refrain from gossiping about them

2. Bring down the intensity of his uncomfortable emotions so the event doesn’t affect him as much (physiologically)

3. Be able to distract himself so that he can handle the situation more effectively (e.g., immediately decide to go out for a walk or do something else to get his mind off the issue to assist in downregulation and in planning an effective response)

4. Recognize that there can be consequences if he does immediately respond in an “overblown” way

If you struggle at doing these things and you have ADHD, well, welcome to the club. In a sense, obviously these abilities are hard for us. If we struggle with planning, organization, behavioral inhibition, and regulating our attention and motivation, of course regulating our emotions and emotional responses will be challenging.

Put simply, the flip-side of emotion regulation—emotional dysregulation—refers to significant difficulty in terms of:

1. having frequent experiences of intense emotions

2. moving on once an intense emotion is taking place, and

3. implementing adaptive or helpful behaviors in response to the emotion because of issues with planning and impulsivity.

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Cool beans. So, what can we do about this? (Good question.)

Now that we’ve appropriately defined both emotion regulation and emotional dysregulation, we can start to address each piece of the puzzle. Let’s describe each tip within the context of Jim’s dilemma:

1. Step away from the trigger and redirect your attention. In Jim’s case, that would mean stepping away from his phone and going for a walk or leaving to run a few errands. Both examples would involve Jim physically distancing himself from the object (or person or context) that set him off and shifting his attention to a different task. Why is this helpful? When people are angry or hurt (especially those with ADHD), they can develop a one-track mind. Leaving the trigger gives us the opportunity to pause that one-track mind and start on a different track. That way, when we return to the trigger, we are at least somewhat clearheaded and can tackle the problem with intentionality.

2. After separating yourself from the trigger, practice relaxation or distress tolerance strategies. Dialectical Behavior Therapy (DBT) distress tolerance skills (e.g., TIP skills) and relaxation skills (e.g., diaphragmatic breathing, progressive muscle relaxation, guided imagery) can help with the physiological downregulation piece once you are away from the trigger. Jim might go outside and practice deep breathing, draw, or practice mindfulness skills before returning to the hypothetical drawing board to address the problem.

3. Once you feel more calm and collected, start to intentionally problem-solve. Here are some steps you can take to problem-solve effectively: (a) write out the problem in one sentence (e.g., Jim would write, “My friends left me out of the group chat”); (b) write down potential solutions to the problem, even if you are unlikely to follow some of those solutions (because—you never know, you may end up changing your mind); (c) cross out or “veto” the solutions you will absolutely not do; (d) grab a blank sheet of paper and divide it into three columns (one that is titled “solution,” one that is titled “pros,” and one titled “cons”); (e) then write the remaining solutions down one column of the page; (f) and go through each solution identifying pros and cons. Once all of this is done, review your solutions and corresponding pros and cons and then develop a Plan A and a Plan B (your backup plan in case the first plan falls through or fails). Jim’s Plan A might be “Reach out to one trusted friend in the group and ask what happened.”

I hope you can walk away from this post with a better understanding of emotion regulation, emotional dysregulation, and ways to manage emotional dysregulation as an ADHDer.

Of course, these are not the ONLY ways to handle these difficulties, but I’ve found (as a woman with ADHD and as a clinical psychologist specializing in neurodiversity) that they are often a great start.

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