Emotional Dysregulation and Adult ADD

Anyone and everyone has intense emotions. Some express and some suppress those emotions more than others.

Emotional dysregulation is common in adults and children with ADD. This can manifest as anger, outbursts, oppositional and defiant behavior, impulsive speech or actions, or disruptive behavior toward others which can be intentional or involuntary. Some behavior is simply hyperactivity—they literally cannot sit still—a very disruptive behavior in a classroom, family dinner, or a business forum.

When it becomes disabling to the person expressing the behavior or to those receiving the behavior it is, in my opinion, a medical condition that needs intervention. The definition of disabling is when normal behavior or activity is impaired because of the behavior. Sometimes the impairment is minor, sometimes severe, but it nonetheless, disabling to “normal” life.

When trying to decide if, how, and what intervention is needed, it becomes imperative to define any and every underlying condition or conditions that are treatable and reversible. This requires an extensive knowledge to psychopathology including the depressive disorders, the anxiety disorders, bipolar disorders, schizoaffective disorders, substance abuse disorders, and pharmacology to understand if a medication or drug is contributing to the behavior.

Additional ongoing medical problems may exacerbate these symptoms, especially if they induce pain, such as migraine headache, back or joint pain, or fibromyalgia. After just resolving my personal case of sciatica, I can attest it disrupts the “norm”. My 9-year-old granddaughter noted loudly that “Pops looks disheartened”! I couldn’t have picked a more accurate choice of words—definitely not my happier-than-I-should-be self. Then there are internal disruptions to normal brain function such as menopause, PMS (pre-menstrual syndrome), or thyroid disorders that further prevent the brain from attending normal stresses leading to very disruptive behavior.

It is not often easy to diagnose, much less treat, all of these conditions. Some patients have many of these conditions at the same time, each interacting with the other. When trying to assess whether such behavior is part of a larger mental illness such as bipolar or part of a social conditioning process, as seen in abusive households where abuse and lack of constructive parenting produce mental pathology, a mental “team” approach can be helpful. Certainly, a physician with training in the above, a mental health counselor, perhaps a social worker, a dietician for the obese or malnourished sugarholics, laboratory scientists for testing, or even imaging specialists to visualize the brain or other vital organs.

All physicians are taught the “problem-oriented diagnosis” approach. We literally list each problem as a separate diagnosis, look at that problem on its own accord, then try to solve each problem independently, all the while visualizing the entire problem list. I always look for “two-firs”—solving two problems with one treatment. Examples would be using an anti-hypertensive medicine known as clonidine to assist with insomnia, while also improving PTSD and anxiety by blocking the hormone adrenalin from the overactive adrenal gland, which makes the “fight or flight” hormone. If the female patient has hot flashes and insomnia from menopause, I’ll use estrogen replacement under the tongue, where it goes straight to the brain, to resolve the hot flashes, improve sleep, and calm the agitation. These two treatments fit my other criteria when seeking a treatment solution: easy, simple, fast, cheap, and safe. In several weeks the patient is calmer, well slept and rested, has better memory, and is less anxious and excitable.

If only all cases were that simple.

Stanford A. Owen, MD is Certified by the American Board of Internal Medicine, the Neuroscience Education Institute as Master Psychopharmacologist, and the American Board of Physician Nutrition Specialists. He is owner and director of ADD Clinics of Mississippi, located in Gulfport, MS and Slidell, La.

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