ADHD Emotional dysregulation

Hey brains, I was wonder what was everyone’s experience with emotional dysregulation, and I actually have a few questions about people’s subjective experience with it.

Now I have an extensive diagnosis of ADHD, and neurology testing, seen different neurologists, school recommendations etc. As far as I’ve been told clinically and from peers, my ADHD is quite severe, although I like to think I sometime manage it well, some people honestly can’t tell but that’s only the silver lining after putting blood, sweat, and tears into manage symptoms in every way possible. This may be important later.

Now I’ve obviously had pretty bad emotional dysregulation since a child, anger issues and well every emotion actually. But i’ve gotten better at coping, my frontal lobes developed a bit more so I manage better and stimulant medication depresses the limbic system, so that helps in its own way.

Now my questions are about people’s emotional dysregulation are pertaining to the paradoxical controversy of “hyper-focus”, which is like a really intensified state of focus on something, without medication or any pharmacological intervention needed, it tends to be something that the person is personally interested in or enjoys, possibly something novel or exciting as well. This state of hyper-focus tends to be intense, any concept of time just stops existing, you could be working on a project that really interests you for 9 hours straight without feeling tired, or hungry.

Now imo, “hyper-focus” is sometimes misrepresented, or at least oversimplified even sometimes in research, I think it’s sometimes looked at very narrowly, as only 1 impairment of ADHD causing it. I think it’s a series of impairments or at least abnormalities/differences that work together as a system to cause this effect.

An example being is that the way adults with ADHD learn, in regards to a reinforcement schedule, is a lot closer than that of children, than when compared to neurotypical adults. Like the less instantaneous a reinforcement schedule is, that harder and harder it is for a person with ADHD to learn something, or respond to it. This in it’s self is due to different factors of ADHD, such as time management, protective thinking.

But I think Emotional Dysregulation is a lesser known part of ADHD, and honestly I think it’s one of the most important parts of ADHD.

But when it comes to “hyper-focus” I think Emotional Dysregulation is a primary factor in this phenomenon. I think honestly a lot of the time, hyper-focus can really represent forms of hypo-mania, and mania but with the cognitive and executive function differences as well. Now a lot of people have many miss information about what mania really is, they tend to think it’s a psychotic symptom only, and that there’s only one type of it. But I think since many comes in different forms and severity, and all factors of ADHD range in severity, this could be a large factor in explaining why some people with ADHD, report never experiencing hyper-focusing.

Anyways, i’m going to relate sleep deprivation, emotional regulation, and hyper focus together and ask.

For those of you who experience, emotional dysregulation, especially on something like video games or T.V, have you ever had episodes of this, that last like 16-20 hours straight, where you don’t notice time go by, you don’t sleep, unmedicated this happens, you’re doing something that requires mental effort, for hours on end, and yet seem to not be fatigued by it at all, until you crash. I’ve done this in elementary, before a diagnosis, before medication, honestly it’s not always healthy but it definitely saved my grades a few times. But what extent do you brains do this to?

Also just curious if any of you have been misdiagnosed as bipolar and it was later changed, I think it’s very common, and their very similar, but bipolar has a variable of randomness and emotional dysregulation does not.

I work very hard to control all the symptoms of my ADHD, secondary disorders caused by it’s symptoms, etc. etc. And as Dr. Russel A Barkley said “it’s the diabetes of the brain, its a chronic disorder you have to treat daily, to avoid it’s secondary consequences.”

It’s just my mom said, that I should be over this stuff by now, and I “should be in the driver seat by now”, and the thing is, I work really hard to try a be there, but just because I’m there today, doesn’t mean im going to be there tomorrow. It’s very hard that you constantly are doing bad things, and are totally unaware of it, until it’s too late, then somehow are supposed to main constant 24/7, 365 days a year control over it, and it’s not 1 thing, it’s tons, time management, over indulgence. etc. etc.

Well I gtg but Toodles! and thanks for reading

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I had the Bipolar diagnosis first. I won’t say that it was misdiagnosed, because I still think it rings true, but I do look back and wonder whether things I had attributed in the past to the Bipolar diagnosis were actually related to ADHD. I still think that for me they are distinct, and so I still receive treatment for both. It’s been effective tackling it that way.

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As i’ve always thought, misdiagnosed, mismedicated, or w.e it be, as long as it’s effective, something’s positive, although optimal efficiency is should always be strive for.

Although whenever someone is diagnosed with bipolar I always question it with a bit of skepticism, not that I don’t trust them.

The reason being, is that statistically, some studies have showed, in larger populations, that the misdiagnosis rate of bipolar and other emotional dysregulation disorders, is in some cases as much as 80% which is absurdly high. So a lot of people who are diagnosed with bipolar end up getting rediagnosied with a different disorder instead years later, such as Borderline personality disorder (BPD).

Bipolar disorder and Borderline personality disorder, which is also refereed to as emotional dysregulation disorder, are very similar, almost identical in the actual nature of the disorder, there’s genetic causes for both, common patterns in commodities, even the range of said disorders can be the same, just like how people with Bipolar type 2 may have hypo-manic episodes but the severity never reaches full blown mania, people with BPD can have the same severity, as well as how people with Bipolar type 1 can reach mania, people with BPD can reach mania as well based on severity.

The core differentiating difference between the disorders, is the variable that Bipolar disorder has a factor of randomness to it, a neurological emotional response that cannot be attribute to any stimuli either internal or external.

This difference in reality is a lot harder to discern that it would seem, because let’s take a case of someone with BPD with a high severity. In this hypothetical scenario let’s say a friend of theirs starts talking to the affected person about a football game that occurred last night, and at first everything is normal. Then 15 minutes into the conversation, affected person is noticeably angered, and to the point in which they can’t mask or hide it, it shows in the connotation of their voice, word choice, and body language, they’re actually so angered that they really don’t even know why they are angry, what caused it, but they’re just pissed off. Especially to the friend, this would seem random, sporadic and of the bipolar sort of emotional dysregulation. The friend didn’t say anything that would have caused the affected person to become angry, nothing in their environment had happened, so to the friend this would very much seem like an strong emotional reaction that was caused by nothing at all, and totally random, it may seem this way even to the affected person, as they got so pissed off, that they became unaware of what made them react this way.

But let’s say in reality in this scenario, the affected person had a thought, let’s say the thought was about something mean the their estranged father had said to them a week ago, and this thought or recollection of events, may only take a few seconds, and is quickly forgotten when the overwhelming magnitude of the anger starts to take over. Then even to the affected person, the emotional over reaction, seems random and without cause, over reaction is something that is explained by both Bipolar and BPD, but the cause is the important differentiating factor. And since the person immediately forgot the cause, especially because it was a cause from an internal stimuli, a thought or recollection, and not that of an external stimuli, it seems random even to them.

Now this is important in the treatment of the disorder, because while many Bipolar treatment will work efficiently for BPD, and even vise versa, behavioral interventions such as exercise, meditation, and a big one being mindfulness and reflection, have larger impacts on BPD because it’s response are always caused by a stimulus, and not random. These things would still help Bipolar, not to the extent that they would BPD, because Bipolar has the variable of randomness.

Also keep in mind, that many of the diagnosis of these disorders, are really not carried out by the people who specialize in this field, most people don’t go to an M.D psychiatrist who specializes in mood disorders, if they have a concern of being bipolar, because said professionals, are often rare, and expensive. Tons of people are diagnosed by General practitioners, regular M.D’s or regular D.O’s with no specialization, Nurse practitioners, and the list continues, this is almost a necessary evil if you will, because in reality these people are not fully qualified to carry out this diagnosis, there’s a reason that this specialized training exists, but due to the fact that it’s expensive and rare, and really outright difficult, to find people who are fully qualified, it’s almost necessary that this process is carried out by under qualified people. So with this in mind, and the very similar nature of the disorder, it’s no surprise that it’s a very common misdiagnosis, you wouldn’t trust a regular surgeon even though they have specialized training, to go receive neurosurgery, you would go to a specialized neurosurgeon. But too commonly the majority of people go to regular doctors and such for specialized psychiatric conditions, and not a specialized psychiatrist or neurologist.

Skepticism is a great thing, always question the world around you, it’s how we learn and grow. You very well could be bipolar and ADHD, i’m not saying you aren’t just saying you should always, question things especially given the statistics on the subject.

Just food for thought.

I appreciate your reply, and thank you for reading and responding. Hope all is well for you and those you care for.

Toodles !

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I would add that there are many qualified professionals trained in diagnosis that are not MDs. Clinical social workers, psychologists, nurse practitioners, and physician assistants can all fill that role. While not all MDs or DOs get substantial education in psychiatry, there are definitely some who are adequate. It’s always important to discuss with your provider what your questions are regarding their comfort level and skill or training in that area.

It’s important for people to know that they don’t have to seek out a psychiatrist to get fully diagnosed and treated as most people, as you said, will not have access to that.

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I thought I noted that not all MD’s and DOs are qualified, but while yes a social worker, psychologist, nurse practitioners and physician assistant can fill the role, it does not mean that they should.

Not all, but A large portion of them, lack years of specialized training, also many such a physician assistants etc. Are going to go off of the DSM, which has it’s flaws when it comes to psychiatric conditions, many attributes of disorders that are well represented in current viable research are not at all reflected in the DSM.

A perfect example being emotional dysregulation in ADHD, is not represented in the DSM 4 or 5, but about any psychiatrist, especially a psychiatrist who specializes further more into ADHD specifically, is going to be more than well aware of emotional dysregulation in ADHD.

I did mention that people can be treated by others than psychiatrists and neurologists, but it should be noted that this is not going to be as efficient and comes with risks.

Nurse practitioners, and physician assistants have no specialization training or education, in regard to something such as ADHD, they have education and training that some what incorporates ADHD sure, but they lack years of specialized education that psychiatrist and neurologists have, some of which is solely on ADHD if they further specialize.

Social workers are more qualfiable, although many lack the further specialization in their education for clinical positions, not to mention, the education difference is note worthy regardless of if the social worker does hold a clinical position. The difference in education in things such as pharmacology, and understanding the neural anatomy of these conditions, is a integral part of treatment.

A psychologist varies a very large spectrum. It really depends on the education and specialization of the psychologist as some can have little education, and legally are not actually able to diagnosis someone, and other can have a lot more education and specialization in mental health fields, but they still lack large portions of education compared to a medical doctor, such as a psychiatrist, that play a very important role in understanding the disorder, treating it, and still diagnosing it, especially when it comes to disorders that are so similar to each other, such as bipolar and BPD.

The thing being, while all of these professions are legally able to diagnosis, sometimes treat, mental health conditions, it does not mean that they should, the fact they can, does not mean they are well qualified to do so, but as it currently stands, it is a necessary evil if you will. This is difficult and outright impossible for many people, the amount of people with extensive education and specialization training are far few, this makes it a difficult process and expensive.

But the research statistics of misdiagnosis, under-diagnosised, over-diagnosised, especially when specifically in contrast to the numbers of misdiagnosied mental health conditions from psychiatrists or neurologists, compared to the numbers with nurse practitioners, reflect the inadequacy of having such professions fulfill this role. This is nothing against people in these professions, actually I have nothing but the most respect for people in professions, but they large differences in merit/credentials between the professions poses negative implications and research has reflected that. Psychology, psychiatry, neurology, etc. Stand to be one of the most complex and difficult fields of education and in the health field altogether, the human brain is very complex and even further so regarding abnormalities within the brain. So there tends to be a negative implication when people without specialized education for specifically that field, fulfill the role, i’m not saying that currently they shouldn’t do it, but it’s not realistic to believe or suggest, (not saying you are), that someone who is a nurse practitioner, or let’s say a primary health care provider, lacking this specialization, adequately fulfills this role to the same degree as those professions who have the further training and education, and are specialized to do so. And i’m also more so saying this as a large generalization, yes, maybe there’s a few primary physicians that stay up to date on the research of a condition such as ADHD, and somehow self taught them selves to a degree equivalent to years of education, but that’s not going to be true for the overwhelming majority.

Once again to just illustrate my point, so i’m not misrepresenting it, a surgeon has extensive specialized medical education and training, but that does not mean in anyway shape or form, a surgeon can adequately perform neurosurgery to the degree a neurosurgeon can. Maybe a few can, maybe a large amount of them can do a decent job on it, but there’s a reason that you go to a neurosurgeon for brain surgery, there’s a reason we have neurosurgeons to begin with and not just surgeon do it, there’s accolades and in reality there’s the efficiency of performance, maybe a surgeon could efficiently do it, but that does mean it is optimal, or as efficient as a neurosurgeon.

If you had a surgeon, go to perform brain surgery, to remove a tumor on you, and he goes, “well I can kinda perform neurosurgery I did it like once or twice before.” That would probably bother you to say the least, but if he was the only surgeon that you had access to, or could afford etc. then you might just go with it, because it’s better than nothing, and a surgeon is probably a lot better than a physician assistant at neurosurgery, but a neurosurgeon is far greater than both of them at it.

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