Emotional Regulation and Dysregulation

 

Emotional dysregulation is a core problem in borderline personality disorder (BPD) that has many characteristics with ADHD. In fact it has been suggested that there is an emotional variant of ADHD displaying similar features as BPD. We have hypothesized that the underlying problem is similar in BPD and ADHD, but associated to different networks: while BPD relates to suboptimal control of the interoceptive and emotional processes ADHD relates to suboptimal control of exteroceptive (and non-emotional) processes. Moreover, we have suggested that these states represent extremes in a normally distributed of capacity to regulate non-emotional and emotional processes, respectively. Thus, these psychiatric states should be related to each other and the dysregulations should be present to a lesser sub-clinical degree in normal population. In line with these ideas we have been able to show that there is a relation between the non-emotional attentional problems and emotional regulation problems in a large material of patients with ADHD or BPD and normal controls (Ryden et al 2013 - in review). Moreover, we have been able to show that both rated problems with emotional regulation and biological capacity for emotional regulation is directly associated with the brain volume in lateral orbitofrontal cortex (a region that is involved in complex emotional regulation) in 143 healthy subjects (Petrovic et al 2013 – in review). Since ADHD has been highly attributed a dysfunctional dopamine system in which the salience for external input is dampened we hypothesize that a similar dysfunction is present in BPD - but more related with networks processing emotional signals. Both the endogenous dopamine system and reward expectations seem to be dysfunctional in BPD and ADHD.