Emotional Dysregulation, Mental Health Disorders, and the Role of Treatment
If you’re the parent of a teenager, you probably have direct, experiential knowledge of the ups and downs of their emotional life. And since you were once a teenager and lived through adolescence yourself, you can think back to what your emotional life was like when you were a teen.
Was it smooth?
Was it rocky?
Did you understand all the emotions you had?
Did you let your emotions get the better of you more than once or twice?
The chances are it was a combination of all of the above. You had good days. You had meh days. If you’re like most of us, you had all kinds of days. Days that were all over the emotional spectrum. Some days seemed like the worst day of your life. Some days seemed like the best day of your life. And some days were everything all rolled into one. The good, bad, meh, or plain normal days without highs or lows.
Now that you’re an adult, you look back and understand that the emotional rollercoaster you experienced during adolescence is par for the course – and you can empathize with and hopefully forgive your teen for their moods, their attitudes, and their impulsive and unpredictable behavior.
Because those words summarize how adolescence often looks and feels from the outside. Mood and attitude. Impulsive and unpredictable.
Teenagers are like that for good reason. Their brains – our brains – develop from two directions at once: bottom up and top down. The bottom part refers to the oldest parts of our brains, which generate emotions and involuntary, unconscious reactions. The top part refers to the newest parts of our brains, which generate rational thought, regulate impulses, weigh risk and reward, and modulate emotions.
Teenagers and the Developing Brain
What happens during adolescence is that, developmentally speaking, the bottom part outpaces the top part. The old part is more powerful than the new part.
We call the old part old because on the individual level, it’s one of the first parts of the brain to develop: it being the limbic system, which is associated with emotion and reward. It’s the origin of things experiences like pleasure and pain and emotions like love and fear. On an evolutionary level, we call that part of the brain old because biology tells us that in organisms with complex brains, that part was one of the first to appear.
We call the new part new because on the individual level, it’s one of the last parts of the brain to develop: it being the prefrontal cortex, which is associated with complex logical thought, the ability to assess and predict outcomes based on given information, and inhibit behavior that may be counterproductive. On an evolutionary level, we call that part of the brain new because biology told that in an organism with complex brains, the prefrontal cortex was one of the last structures to appear – and no other animal on earth has a prefrontal cortex like the one humans have.
Therefore, when the old part of the brain is more powerful than the new part of the brain, the resulting behavior may appear chaotic, uncontrolled, irrational, and illogical – like a toddler. And when the old brain and the new brain start competing for dominance, behavior can appear logical in one moment, and illogical the next.
In other words, almost exactly like a teen.
That type of behavior is not what we mean by emotional dysregulation.
Instances of moodiness, impulsivity, and irrational behavior contrasted with moments of mature, rational behavior is developmentally appropriate, typical teen behavior.
What is Emotional Regulation?
To define emotional dysregulation, it helps to start with a definition of emotional regulation. To that end, we’ll offer definitions from two peer-reviewed journal articles. The first is from “Emotional Dysregulation in Adolescents: Implications for the Development of Severe Psychiatric Disorders, Substance Abuse, and Suicidal Ideation and Behaviors,” while the second is from “Positive and Negative Emotion Regulation in Adolescence: Links to Anxiety and Depression.”
Unless otherwise specified, all the information in this article comes from those two articles. If you’re interested in taking a deep dive into this subject, please read those articles – but fair warning: they’re filled with technical jargon and science talk. If that interests you, though, we encourage you to have a look.
But let’s get to our first definition, from the first article:
“Emotional regulation can be described as how a person sustains, strengthens, or impedes his emotions according to his purposes or goals. Emotional regulation is fundamental for human life, and well-being and emotions are usually in a balance between them. Negative physiological emotions are counterbalanced by positive ones, and this equilibrium is the mainstay of human physiological affective states.”
Now let’s look at the second definition, from the second article:
“Emotion regulation is defined broadly as the capacity to manage one’s own emotional responses. This includes strategies to increase, maintain, or decrease the intensity, duration, and trajectory of positive and negative emotions. Learning to regulate emotions is a key socio-emotional skill that allows flexibility in emotionally-evocative situations.”
Here’s a gross oversimplification of those definitions: emotional regulation is how we stay balanced and ensure our emotions don’t dictate our behavior.
What is Emotional Dysregulation?
Now we can move on to a definition of emotional dysregulation. We’re lucky, because immediately after defining emotional regulation, both articles continue by defining what dysregulation means.
Here’s the first:
“…however, this delicate and refined mechanism may sometimes become dysfunctional when negative emotions are not correctly counterbalanced. This imbalance may cause maladaptive behaviors, especially during adolescence, a period where emotional states should be finely regulated.”
Now the second:
“…disruptions to emotion regulation capacities…are central to theories of how anxiety and depressive disorders manifest and are maintained. These theories suggest that reduced capacities to downregulate heightened negative affect are common to both anxiety and depression, whereas reduced ability to regulate positive affect may be more specific to depressive disorders.”
Here’s a gross oversimplification of those definitions: emotional dysregulation is the absence of the ability to stay emotionally and psychologically balanced, and can often result in behavior that’s considered maladaptive or counterproductive.
Emotional Dysregulation and Adolescent Mental Health
Do Teens with Emotional Dysregulation Need a Mental Health Treatment Center?
Let’s back up a moment, to our discussion of emotions and typical teen behavior. We need to contrast the unpredictable nature of teen emotion with what we mean by clinical emotional dysregulation. In typical teen behavior, the emotions win some of the time, and the prefrontal cortex wins some of the time. Emotional dysregulation – when diagnosed clinically – means that for various complex reasons, the brain develops regulatory functions that lead to pathology, a.k.a. mental illness.
Evidence shows that emotional dysregulation in adolescents is associated with and is a known risk factor for the following mental health disorders:
- Depressive disorders
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder (BD)
- Borderline personality disorder (BPD)
- Substance use disorder (SUD)
- Alcohol use disorder (AUD)
- Eating disorders
- Oppositional defiant disorder (ODD)
- Disruptive mood dysregulation disorder (DMDD)
In addition, emotional dysregulation is associated with and a risk factor for the following maladaptive behaviors:
- Non-suicidal self-injury (NSSI)
- Suicidal ideation (SI)
- Suicide attempts (SA)
- Risky sexual behavior
All of those disorders and behaviors above are serious. If your child or teen is diagnosed with emotional dysregulation issues by a mental health professional, then there’s a very good chance that that professional will also recommend professional treatment and support at a behavioral health treatment center or a psychiatric facility that specializes in treating adolescents.
It’s important to understand that effective treatments for emotional dysregulation – and the associated mental health disorders – exist and are available to your teen. We’ll talk about those evidence-based treatments in a moment.
First, we’ll discuss the cause of emotional dysregulation in teens.
What Causes Emotional Dysregulation?
The exact cause of emotional dysregulation is the subject of ongoing research and debate. However, decades of research indicate that children who experience significant early trauma are more likely to develop maladaptive emotional patterns – a.k.a. emotional dysregulation – than children who do not experience early childhood trauma.
Childhood experiences that can lead to emotional dysregulation include:
- Emotional and/or physical neglect
- Emotional and/or physical abuse
- Sexual abuse, up to and including rape
- Caregiver maltreatment
- Parental mental illness
- Parental alcohol/substance use disorder
- Loss and grief, i.e. death in the family
- Exposure to domestic violence
- Exposure to neighborhood violence
Here’s how researchers describe the connection between early adversity and emotional dysregulation:
“In humans, childhood maltreatment, especially repeated trauma, disrupts the acquisition of appropriate emotional regulation and interpersonal skills. This disruption of skill acquisition may occur as a result of psychological experiences but is also a sign of the neurobiological effects of maltreatment.”
There are two important things to note: first, not all people who experience trauma early in life develop emotional dysregulation, and second, parental/caregiver neglect are not the only sources of childhood trauma. Trauma may originate in the environment – neighborhood violence – or trauma may originate outside the home, as in some cases of physical, emotional, and sexual abuse.
We’re saying that because if your teen has emotional regulation issues, you may read this and instantly think “I am the cause.” That’s not necessarily true. Trauma has various origins, many of which have nothing to do with parental behavior. However, if your teen has emotional dysregulation, it’s important to assess yourself for any history of mental illness, alcohol/substance use disorder, or emotional dysregulation.
We’ll now move on to discuss effective, evidence-based treatments for teens with emotional dysregulation.
Treatment for Emotional Dysregulation: Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT)
For adolescents who develop a mental health disorder such as depression, anxiety, or PTSD, or bipolar disorder as a result of emotional dysregulation, medication can help manage the symptoms of those disorders. Antidepressants help some types of depression, anxiolytics help some anxiety disorders, and various other medications help people manage the phases of bipolar disorder.
However, with the advent of the integrated treatment model for behavioral health, we know that medication is rarely the only piece of the puzzle. Evidence shows that a combination of therapy, medication, lifestyle changes, and community support offers the best chances of sustainable healing and recovery.
For teens with emotional dysregulation or mental health disorders related to emotional dysregulation, evidence indicates two types of effective therapy:
1. Cognitive behavioral therapy (CBT)
During CBT therapy, a therapist and a teen:
- Identify unwanted symptoms or behavior
- Discuss and identify the connection between thoughts and emotion
- Discuss and identify the connection between emotion and behavior
- Work to substitute unwanted thoughts and behaviors – i.e. maladaptive coping mechanisms – with different, productive, and life-affirming thoughts and behaviors
2. Dialectical behavior therapy (DBT)
During DBT therapy, a therapist and teen focus on the following five core DBT skills:
- Mindfulness involves increasing awareness of the present moment
- Emotion Regulation focuses on handling unpredictable feelings
- Interpersonal Effectiveness prioritizes improving relationships
- Distress tolerance helps teens manage difficult emotions safely.
- Walking the middle path includes:
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- Accepting the world without trying to change it.
- Understanding there’s more than one way to view a problem
- Validating different perceptions of a given set of circumstances
- Validating personal perceptions of a given set of circumstance
- Believing that change comes through action
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The reason DBT seems tailor-made for teens with emotional dysregulation is because that’s not far from the truth. Dr. Marsha Linehan invented DBT to help people manage disruptive emotions or behaviors when no other approaches worked. She did not develop DBT specifically for teens, but she did develop the fifth core skill mentioned above – Walking the Middle Path – for teens with extreme behavioral/emotional regulation issues.
Help For Teens With Emotional Dysregulation
We want you to take one important thing away from this article: treatment for teens with emotional dysregulation issues and mental health disorders related to emotional dysregulation issues works. Treatment takes time, commitment, and effort from you and your teen – but everything you put in is worth it. Effective, timely treatment can change everything. It can be the difference between a life dominated by the symptoms of a mental health disorder and a life that your teen decides they want to live, based on their wants, needs, and vision of the future.
