Eva Moehler
Romuald Brunner
Carla Sharp- 1Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
- 2Department of Child and Adolescent Psychiatry, University of Regensburg, Regensburg, Germany
- 3Department of Psychology, University of Houston, Houston, TX, United States
Editorial on the Research Topic
Emotional Dysregulation in Children and Adolescents
Emotional Dysregulation (ED) is defined as the inability to regulate and organize emotions to produce an appropriate emotional response and subsequent return to baseline. With regard to the intensity of reactions it partially overlaps with the concept of irritability (1), which is however regarded to be a more dispositional trait. ED represents a major health risk (2) and is associated with diverse forms of childhood psychiatric disorders and symptoms like attention deficit hyperactivity disorder, oppositional defiant- and conduct disorders (ODD and CD), personality disorders, self-injurious behavior and suicidality. In clinical settings, dysregulation problems are especially prominent (3), occurring in 26.0–30.5% of children admitted to child and adolescent psychiatric clinics or mental health facilities. A recent study could demonstrate that especially disturbed emotion regulation contributes to self-injurious behavior in a large group of adolescents presenting to a child and adolescent psychiatric emergency service (Kandsperger et al.). The occurrence of typical phenomena associated with ED, like severe tantrums, low frustration tolerance, aggression, negative mood and suicidality is even higher than the full syndrome of ED, with estimates of about 45% in child psychiatric patients between 6 and 18 years (4). An additional impact of Lockdown-related stressors on children and adolescents can also be discussed [e.g., (5)]. Thirty percentage of adults with emotional instability report having injured themselves at primary school age (6).
Several authors also mention emotionally dysregulated behavior as one of the leading symptoms of BPD and ADHD/DMDD (7). On the opposite note, emotion regulation capacity prevents the onset of multiple psychiatric and physical disorders and promotes successful social and professional development as described above (8). In connection with Emotion Dysregulation, large and rigorous studies (6) also emphasize that this behavior results in high costs for health and other services services.
In addition to biological vulnerability, epidemiological research suggests that the onset of most psychiatric disorders across the life course in nearly half of cases is attributable to adverse childhood experiences and stress related disorders (9, 10). Negative impact of adverse childhood experiences on general health seems to attributable partly to maladaptive strategies for emotion regulation, such as smoking, alcohol, overeating (11). Sleep problems related to the traumatic impact of adverse childhood experiences can be directly related (10, 12) and be an important target for treatment. Furthermore, early life trauma impairs neurobiological structures and functions related to emotion regulation, such as the orbitofrontal gyrus and frontolimbic connections (13). A challenge for clinical practice is the assumption that patients with ED remain notoriously difficult to treat (14).
Better equipment with psychotherapeutic tools for Emotion Regulation and characterization of the ecological contingencies, and an understanding of the developmental pathways through which early experience shapes later behavior, can help clinicians to tailor intervention efforts more precisely, to prevent future dysfunction (15).
Therefore, studies focusing on pathogenetic aspects of ED by addressing neurobiological underpinnings and childhood adversity are collected in this issue. Furthermore, interventions and therapies that give an overview on established therapeutic tools such as DBT and the younger “derivatives” and describe novel interventions developed from the recent ED-Framework, are included in this topic. Together with review articles on state of the art advancements in ED, research in this issue explores the adverse childhood experiences framework or describing empirical research on neurobiological associations.
With original articles and reviews on diagnosis and classification of ED our aim was to achieve with this issue a large transdiagnostic long-term benefit for research as well as clinical aspects since understanding and improving human emotion regulation capacity prevents the onset of multiple psychiatric and physical disorders and promotes successful social and professional development as will be shown in this issue.
Author Contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's Note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Stringaris A. Irritability in children and adolescents: a challenge for DSM-5. Eur Child Adolesc Psychiatry. (2011) 20:61–6. doi: 10.1007/s00787-010-0150-4
2. Plener Paul L, Michael K, Pllak S, Fegert JM, Brown RC. Nichtsuizidales selbstverletzendes Verhalten im Jugendalter. Dtsch Arztebl Int. (2018) 115:23–30. doi: 10.3238/arztebl.2018.0023
3. Copeland WE, Shanahan L, Egger H, Angold A, Costello EJ. Adult diagnostic and functional outcomes of DSM-5 disruptive mood dysregulation disorder. Am J Psychiatr. (2014) 171:668–74. doi: 10.1176/appi.ajp.2014.13091213
4. Nigg J. Annual research review: on the relations among self-regulation, self-control, executive functioning, effortful control, impulsivity, risktaking and inhibition for delvelopmental psychopathology. J Child Psychology and Psychiatry Allied Disciplin. (2017) 58:361–83. doi: 10.1111/jcpp.12675
5. Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C. Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. Eur Child Adolesc Psychiatry. (2021) 25:1–11. doi: 10.1007/s00787-021-01726-5
6. Plener PL, Kapusta ND, Kölch MG, Kaess M, Brunner R. Nichtsuizidale Selbstverletzung als eigenständige Diagnose. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie. (2012) 40:113–20. doi: 10.1024/1422-4917/a000158
7. Sharp C. Adolescent personality pathology and the alternative model for personality disorders: self development as nexus. Psychopathology. (2020) 53:198–204. doi: 10.1159/000507588
8. Moffitt TE, Arseneault L, Belsky D, Dickson N. A gradient of childhood self-control predicts health, wealth, and public safety. Proc Natl Acad Sci U S A. (2011) 108:2693–8. doi: 10.1073/pnas.1010076108
9. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-Suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. (2011) 168:1266–77. doi: 10.1176/appi.ajp.2011.10111704
10. Palmer C, Oosterhoff B, Bower J, Kaplow J, Alfano D. Associations among adolescent sleep problems, emotion regulation, and affective disorders: Findings from a nationally representative sample. J Psychiatric Res. (2018) 96:1–8. doi: 10.1016/j.jpsychires.2017.09.015
11. Möhler E, Resch F. Early Life Stress [Early Life Stress]. Prax Kinderpsychol Kinderpsychiatr. (2019) 68:575–91. doi: 10.13109/prkk.2019.68.7.575
12. Liang L, Shi X, Wang Z, Wang S, Li Z, Wang A. Sleep problems and emotional dysregulation mediate the relationship between childhood emotional abuse and suicidal behaviors: a three-wave longitudinal study. J Affect Disord. (2021) 295:981–8. doi: 10.1016/j.jad.2021.09.003
13. De Bellis MD. Developmental traumatology: the psychobiological development of maltreated children and its implications for research, treatment, and policy. Develop Psychopathol. (2001) 13:539–64. doi: 10.1017/S0954579401003078
14. Gunderson JG, Daversa MT, Grilo CM, McGlashan TH, Zanarini MC, Shea MT, et al. Predictors of 2-year outcome for patients with borderline personality disorder. Am J Psychiatr. (2006) 163:822–6. doi: 10.1176/ajp.2006.163.5.822
Keywords: emotion, self-regulation, disruptive mood dysregulation, emotion regulation, Emotion Dysregulation
Citation: Moehler E, Brunner R and Sharp C (2022) Editorial: Emotional Dysregulation in Children and Adolescents. Front. Psychiatry 13:883753. doi: 10.3389/fpsyt.2022.883753
Received: 25 February 2022; Accepted: 11 March 2022;
Published: 07 April 2022.
Edited and reviewed by: Jean Marc Guile, University of Picardie Jules Verne, France
Copyright © 2022 Moehler, Brunner and Sharp. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Eva Moehler, e.moehler@sb.shg-kliniken.de