What Is Deficient Emotional Self-Regulation (DESR)?

Deficient emotional self-regulation (DESR) has been proposed by some experts to be a 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 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 is still no agreement on how to define and study the condition.

What Is Deficient Emotional Self-Regulation?

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

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

People with ADHD who also have DESR generally exhibit emotional reactions disproportional 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 one of many emotional symptoms associated with ADHD, such as emotional impulsivity, instability, and reactivity.

DESR and Executive Function

To better understand DESR, it's important to understand the concept of executive function, as it 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 the group to coordinate getting things done.

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

Some abilities generally grouped under executive functions include:

• 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 impair so many areas of one's life.

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 longer-term impacts and indirect effects that can occur.

For example, one study involving 329 adults (206 with ADHD and 123 without ADHD) found people with ADHD who also live with deficient emotional self-regulation tend to experience more impairment in daily life. This can include effects on relationships, social life and rule-following.

Causes of DESR

What causes deficient emotional self-regulation? A study of 23 people with ADHD, 27 with ADHD and DESR, and 33 with neither ADHD nor DESR, suggested there was a familial link between ADHD and DESR. This indicates there may be a genetic component.

Another study connected self-regulation issues with language deficits. This research suggested 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 children and teens with ADHD who had more 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 also usually the treatment for DESR. The two main ADHD treatment options are medication and therapy.

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Medication

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

However, not everyone does well with medication as it ranges in can range in effectiveness, cause side effects, and interact with medications you may already be taking. It's important to discuss these things with your doctor if you are considering taking medication to manage DESR.

Therapy

Therapy such as cognitive behavioral therapy (CBT) or mindfulness-based techniques can also help develop 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 the optimal effects of both forms of treatment.

Coping With DESR and ADHD

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

There are coping methods 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 keep track of how the foods you eat 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 daily.

Recap

Given that DESR is not a recognized criterion 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.

You may 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.