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Questions About Adult Adhd Patients: Dimensional Diagnosis Emotion Dysregulation Competences And Empathy

How to ADHD in a neurotypical world | Jessica McCabe | TEDxBratislava

Irastorza LJ*

Arganda Mental Health Center, Hospital Universitario del Sureste, Madrid, Spain

*Corresponding Author:

Hospital Universitario del Sureste, Madrid, SpainTel: +34 918701125E-mail:

Received date: October 17, 2016 Accepted date: November 07, 2016 November 14, 2016

Citation: Irastorza LJ. Questions about Adult ADHD Patients: Dimensional Diagnosis, Emotion Dysregulation, Competences and Empathy. Acta Psychopathol. 2016, 2:43. doi: 10.4172/2469-6676.100069

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Objective: To analyze certain diagnostic personality components of Attention Deficit and Hyperactivity Disorder patients and explore their consequences in competences, as well as to explain possible relationships to empathy. Given that emotion regulation is altered in ADHD, we seek to distinguish these disturbances from certain personality disorders.

Method: We have conducted a short review of dimensional personality components and emotion dysregulation. The results of our study with several personality dimensions in adult outpatients comprise the background. Furthermore, we examine certain competences and comment in empathy in these patients.


Emotion dysregulation Competences Empathy Attention Deficit and Hyperactivity Disorder




Personality dimensions in ADHD


Emotional disturbances

Empathy and ADHD

Empathy is the ability and tendency to share and understand others internal states .


Fastening On A Feeling

When an adolescent with ADHD becomes enraged when a parent refuses him use of the car, for example, his overly emotional response may be due to “flooding” a momentary emotion that can gobble up all of the space in his head just like a computer bug can gobble up all of the space on a hard drive. This focus on one emotion crowds out other important information that might help him modulate his anger and regulate his behavior.

What Is Rejection Sensitive Dysphoria

Rejection sensitive dysphoria is not a formal diagnosis, but rather one of the most common and disruptive manifestations of emotional dysregulation a common but under-researched and oft-misunderstood symptom of ADHD, particularly in adults. Rejection sensitive dysphoria is a brain-based symptom that is likely an innate feature of ADHD. Though the experience of rejection sensitive dysphoria can be painful and even traumatic, RSD is not thought to be caused by trauma.

Dysphoria is the Greek word meaning unbearable its use emphasizes the severe physical and emotional pain suffered by people with RSD when they encounter real or perceived rejection, criticism, or teasing. The emotional intensity of RSD is described by my patients as a wound. The response is well beyond all proportion to the nature of the event that triggered it.

One-third of my adult patients report that RSD was the most impairing aspect of their personal experience of ADHD, in part because they never found any effective ways to manage or cope with the pain.

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Connection Between Adhd And Empathy

So now we have a firm grasp of empathy and its opposite narcissism, but where does that leave us with ADHD and empathy? Good question.

Children with ADHD possess many notable characteristics. They tend to act impulsively, get bored easily, and become quickly distracted. One of the side effects of the combination of many of these symptoms can result in a lack of empathy.

ADHD related behaviors in some respects mirror traits associated with narcissistic individuals. In fact, some researchers believe that some cases of ADHD could rather be instances of childhood narcissism.

Such instances, though, most likely are not very common. We, here at FastBraiin, would recommend seeing a qualified professional to correctly identify ADHD.

The core issue remains the same, though: some ADHD behaviors can look similar to narcissism or a lack of empathy or awareness.

For instance, the impulsivity seen in ADHD can appear as an indifference to others. Similarly, bursts of hyperactivity or tantrums related to ADHD could appear as an infatuation with oneself and lack of perception of others.

Short attention spans can appear that ADHD individuals just dont identify or care about others.

All these things do not have to be the case, but unfortunately the connection between ADHD and empathy often is negative. As a result, this can lead to larger problems in relationships for individuals with ADHD.

How Is Rejection Sensitive Dysphoria Different From A Mood Disorder

5 Emotions That Trigger Anxiety Among ADHD Patients

RSD is characterized by intense but short-lived emotional pain triggered by a distinct event of real or perceived rejection, criticism, or teasing. Mood disorders, on the other hand, are characterized by the following:

Mood Disorder
Offset of mood episode is gradual over a period of weeks to months Episodes end quickly in a matter of hours
Duration of episode must be > 2 weeks Episodes rarely last more than a couple of hours.

In other words, the moods of ADHD and RSD are normal in every way except their intensity.

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The Negative Effect Of Adhd On Emotional Intelligence

Lukenotes,Fall 2019

The Challenge of ADHD in AdulthoodAttention-Deficit/Hyperactivity Disorder is a neurobiological disorder that usually presents in early childhood characterized by various combinations of problems with attention deployment, heightened physical activity level and lack of emotional or behavior self-control. Recent estimates suggest a prevalence of about 8.4 percent in children.

The manifestations of ADHD, occurring in 4.4 percent of adults, can vary over time. For example, the rambunctious, high energy, overactive child may become an outwardly calm and quiet, but internally restless adult. The disorder can be easily misdiagnosed in adults. Several of its symptoms occur in non-ADHD individuals, although at relatively lower levels of intensity and duration. Also, certain psychiatric and medical disorders have symptoms similar to ADHD, including major depression, anxiety, bipolar disorder, autism spectrum disorder, learning disorder, sleep apnea, hypothyroidism and hypoglycemia.

Emotional intelligence is comprised of various abilities present at birth, and acquired skills learned through experience and practice. Acquired EI skills appear to have nearly unlimited potential for growth throughout an individuals lifetime. Thus, being born with low emotional intelligence is not a life sentence. Ones EI can be transformed in ways that markedly enhance success in interacting with ones self or with other human beings.

Mood Swings Are Affect Disorders

Affects have different dimensions.

1.1.1. Affect quality = which emotion


1.1.2. Affect regulation = appropriateness and intensity of an emotion Affect adequacy = appropriateness of emotion quality = appropriate emotion
  • Is the type of emotion appropriate to the situation?
  • Is the same emotion always felt in the same situations?
  • Is the same emotion always felt in different situations?
  • Distrust among paranoids Affect intensity = intensity of emotion
  • Is the intensity of the emotion appropriate to the situation?
  • Is the emotion appropriately perceived?
  • E.g. fear of heights
  • Is the expression of the emotion appropriate?
  • E.g., exaggerated display of qualitatively adequate emotions in histrionic PS
  • E.g., reduced expression of qualitatively adequate emotions in schizoid PS
  • Affect deflectability or stability.
    • How much an emotion can be triggered or changed by external stimuli
    • How quickly the emotion arises / disappears
    • E.g. fast change of emotions in ADHD, even more in Borderline
    • Healthy flooding / draining of emotions from several minutes to several hours

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    What Does Rejection Sensitive Dysphoria Feel Like

    The excruciating pain of RSD is often beyond description. Patients describe the intensity of RSD as awful, terrible, catastrophic, or devastating, but they cannot verbalize the quality of the emotional experience.

    No one likes to be rejected, criticized, or to be seen as a failure. It is unpleasant, so people avoid those situations if they can. RSD is distinguished by its extreme, unbearable intensity, which sets it apart from normal emotional responses familiar to people who are neurotypical.

    This intense pain is often experienced as a physical wound the patient feels as if they were stabbed or punched in the chest. Commonly, people will hunch over, grimace, and clutch their chests when they describe their RSD experience.

    How Therapy Can Help

    ADHD in Adulthood: The Signs You Need to Know

    If you live with ADHD, therapy can go a long way toward helping you understand how specific symptoms show up in your life.

    ADHD that goes undiagnosed and untreated can have a major impact on your life and relationships, but a trained therapist can offer specialized guidance with:

    • identifying specific symptoms and their impact
    • learning ways to manage those symptoms more effectively
    • practicing communication skills to bring up share your needs with the people in your life
    • exploring ideas to connect with others in meaningful ways
    • unpacking any concerns that you have about a lack of empathy

    Sandra Calzadilla, LMHC, explains, Think of it this way: Can you go to the gym and work out on your own? Sure, but if you feel you need more assistance in what exercises you need to do, how often, and for how long, an expert can keep you on track to meeting your goals.

    For instance, if you frequently run late, a therapist might help you explore potential triggers, like getting distracted by things around the house, and identify a few changes you could make to stick to your schedule.

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    Adhd And Physical Sensitivities

    Many people with ADHD are also hypersensitive to their physical surroundings. Sounds as subtle as the humming of the air conditioning or lights from a flickering candle or the scratching from a tag on a shirt can become major distractions. When a person is unable to filter and inhibit their responses to incoming stimulilike sights and soundseverything becomes a distraction.

    Instead of having problems with inattention, this person may pay attention to everything whether it is relevant or not. This can be very disorienting. Difficulties integrating sensory input may also contribute to physical sensitivities.

    A simple pat on the shoulder from a caring teacher may feel irritating to some students with ADHD. As a result, the reaction creates problems for this child and confusion for the teacher. For adults with ADHD, these sensitivities around touch and sensory stimulation can also create quite a few problems in intimate relationships.

    How To Teach My Child About Empathy Towards Others

    As it turns out, many coaching professionals and therapists believe that one can learn empathy. Experts agree that parents can raise their children to be more compassionate and empathetic. Much of teaching empathy lies with demonstrating what it looks like.

    To teach your child compassion and empathy, show them empathy. Show them appreciation and attention and care. All children can pick up on compassion showed to them by their parents.

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    What Distinguishes Affective Disturbances Of Adhd From Comorbid Affective Disorder

    First, consider that the emotional disturbances in ADHD are just that emotions, and not moods. Emotions are short duration, provoked, and often situation specific to the setting of the provocation. They are also largely rational which is to say understandable to others given that typical people would have had the same subjective reaction to the provocation. But the difference is that the typical person would have acted to suppress the voluntary aspects of the emotion over which they have some volitional control rather than express it publicly. They would then have engaged in the self-regulatory steps to down-regulate or otherwise alter the emotion to make it more compatible with the situation, others, and the persons longer-term goals and welfare. Recovery from such a provoked change in emotional state can be relatively quick compared to moods, though perhaps not as easily as is seen in typical people given that those with ADHD have more difficulties down-regulating strong emotions using executive self-control.

    What Adult Adhd Really Feels Like

    Do You Have ADD or ADHD? Check these 15 Signs and Symptoms!

    As therapist and author of Survival Tips for Women with ADHD, Terry Matlen, who also has ADHD, explains, feels like you’re being attacked in all areas of your daily life like sounds, and lights, and sensory things can be overwhelming.2 Others describe feeling disconnected and dissimilar3 or like theres a constant buzzing4 in their head. People with ADHD also have difficulty regulating their emotions, which may include anger, irritability, shifts in mood, and sensitivity. Some even describe feeling emotionally numb.5

    According to Thomas Brown, PhD, challenges with intense emotions boil down to brain chemistry.6 People with ADHD may experience working memory impairments, which allow a momentary emotion to become too strong, thus flooding the brain with one intense feeling.

    ADHD can also manifest in a variety of physical sensations. Along with being hypersensitive to external stimuli like sights and sounds, people with ADHD are twice as likely to have migraines than those without ADHD.7 Other common physical comorbidities among the ADHD population are immunological dysregulation, including asthma, and altered gut health.8 Adults with ADHD are also likely to have an anxiety disorder,9 which may bring a host of other physical ailments like stomach pain, nausea, insomnia, fatigue, rapid breathing, increased heart rate, sweating, and muscle pain.10

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    Emotional Dysregulation And Adhd

    People with ADHD feel things strongly. Not that neurotypical people dont, but in the case of ADHD, its ADHD-specific, relating to brain activity. We tend to focus on one emotion and stay there. We linger in stories, even if theyre untrue. We ruminate. Our imaginations run wild. We have trouble shifting focus.

    Back And Name Your Emotions

    While people with ADHD dont usually struggle with recognizing emotions, taking a break to acknowledge the feeling can be a first step toward regaining control. Before reacting or making any decision, do the following:

    • Leave the situation. Go for a walk outside go to the bathroom get a glass of water, and stand in the backyard. If someone else is involved, say you need a few minutes to catch your breath and process.
    • Identify all the bodily signs of your emotions. Is your heart racing? Is it hard to breathe? Are you sweating?
    • Name the feeling. Anger? Shame? Sadness? Try to describe it as clearly and specifically as you can.

    Because emotions can feel so overwhelming, and people with ADHD usually find challenges with calming down or talking themselves into a better mood, this exercise is a good compromise that can help dial down the intensity without relying on regulation skills you might not have.

    It can help you detach a bit by putting you into the mode of analyzing the feeling rather than just being flooded by it.

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    What Triggers Rejection Sensitive Dysphoria

    Sometimes called hysteroid dysphoria in Europe, rejection sensitive dysphoria is characterized by intense mood shifts triggered by a distinct episode, typically one of the following:

    • criticism, no matter how constructive
    • persistent self-criticism or negative self-talk prompted by a real or perceived failure

    The new mood sweeps in immediately and it matches the individuals perception of the trigger. If these triggered emotions are internalized, the person can instantaneously appear as if they have a full Major Mood Disorder syndrome complete with suicidal thinking. If the feelings are externalized, they are commonly expressed as a rage at the person or situation that wounded them so severely. The moods return to normal very quickly so that a person with ADHD can have multiple episodes of mood dysregulation in a single day.

    Many people with RSD say its always been a part of their lives, however some report growing significantly more sensitive in adolescence.

    Addictive Like Eating Associated With Attention

    Autism Spectrum Disorder, Cluster B Personality Pathology, & Empathy

    Both childhood and adult ADHD symptoms were positively correlated with BE and FA .

    The prevalence of probable adult ADHD was significantly higher for individuals with significant BE or FA than individuals without these addictive like eating behaviors . Bariatric surgery candidates with significant BE or FA had a higher risk of probable adult ADHD = 3.759, 95% confidence interval : 1.5509.116 FA: OR = 4.131, 95% CI: 17269.883). The presence of probable adult ADHD was 24.4% among patients who showed both significant BE and FA.

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    When To Seek Help

    If youre experiencing significant problems with social relationships or in your relationship with yourself its advisable to seek the help of a health professional to treat ADHD and ERD symptoms.

    A health professional can help you find a support group or a therapist who can teach you strategies for managing your emotions in a way that works for you.

    Looking for mental health support? You can check out Psych Centrals Find Help resource for some options.

    Adhd Brain Fully Engaged

    As a seeker of everything that means something, this is my favorite phase. Its the most intense emotional state and I fall into it less frequently than the others. Whether Im insanely happy, or desperately sad, Im feeling something, and that means everything to me. Ill roll around in the emotions, soaking them up and breathing them in. I know its a passing fancy, but I fully appreciate the act of feeling and being alive. Passion is my best friend here. You just dont know if shes going to show up ready to ravage someone with a wild lovemaking session or throw a table lamp in his direction.

    Brain: Go ahead and do a Flashdance chair routine.

    I ignore my brain when Im in this phase because neither one of us knows whats going on. At this point, I think my brain has given me free rein to the heart, kind of like hoping the spaghetti sticks to the wall and we all come back in one piece when its over.

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    Assessment Instruments Used In The Study

    Several instruments were used to assess emotion regulation and reactivity, cognitive strategies to avoid worries, and empathy.

    The Emotion Reactivity Scale is a self-report questionnaire enquiring about emotional experience on regular basis. It consists of 21 items measuring emotion reactivity, based on three aspects: emotion sensitivity, intensity, and persistence. Each item is rated on a 5-point Likert scale from 0 to 4 , with scores ranging from 0 to 40 for emotion sensitivity, 0 to 28 for emotion intensity and 0 to 16 for persistence, and total scores ranging from 0 to 84 . The validated French version was used . Studies found that total scale and subscales had good internal consistency, and factor analyses revealed that both a single-factor and a three-factor model fit the data well . The scale can therefore be used with total scores and subscores.

    The Basic Empathy Scale in Adults is a 20-item self-report scale, focusing on two components of empathy, the cognitive and affective components . Each item is rated on a 5-point Likert scale , with a score ranging from 20 to 100 . Nine items evaluate cognitive empathy and 11 affective empathy. The validated French version was used . The scale, initially validated in adolescents, was subsequently validated in an adult sample showing that the two-factor model was appropriate.

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