Emotional Dysregulation in Adult ADHD and Response to Atomoxetine
Abstract
Background Before 1980, attention-deficit/hyperactivity disorder (ADHD) was called minimal brain dysfunction and included emotional symptoms now listed as "associated features" in DSM-IV. Data from two multicenter, placebo-controlled studies with 536 patients were reexamined to assess: 1) the pervasiveness of these symptoms in samples of adults with ADHD; 2) the response of these symptoms to atomoxetine; and 3) their association with depressive/anxiety symptoms.Methods The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) was used to assess temper, affective lability, and emotional overreactivity, thus identifying patients exhibiting "emotional dysregulation." Other DSM-IV Axis I diagnoses were exclusionary. Outcome measures were the Conners' Adult ADHD Rating Scale (CAARS) and the WRAADDS.Results Thirty-two percent of the sample met post hoc criteria for emotional dysregulation and had higher baseline scores on ADHD measures, a lower response to placebo, and greater response to atomoxetine (p = .048). Symptoms of emotional dysregulation had a treatment effect (p < .001) at least as large as the CAARS (p = .002) and the total WRAADDS (p = .001). Emotional dysregulation was present in the absence of anxiety or depressive diagnosis.Conclusions Symptoms of emotional dysregulation were present in many patients with ADHD and showed a treatment response similar to other ADHD symptoms.
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Among non-stimulant treatments, improvement of emotion regulation on atomoxetine paralleled improvement in core symptoms of ADHD among adults.
“Among the non-stimulant treatments, improvement of emotion regulation on atomoxetine paralleled improvement in core symptoms of ADHD among adults (71).”
From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [71]
Recent clinic-based studies report impairing emotion dysregulation in between 34-70% of adults with ADHD, although population based studies are needed.
“This has been supported to some extent by recent clinic-based studies reporting impairing emotion dysregulation in between 34-70% of adults with ADHD, although population based studies are needed (69-73)–Table 1.”
From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [71]
Atomoxetine may be indicated in patients with comorbid substance use disorders, emotional dysregulation or social anxiety.
“Atomoxetine may be indicated in patients with comorbid substance use disorders, emotional dysregulation or social anxiety [295-297].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [296]
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- Authors
- Reimherr, F. W., Marchant, B. K., Strong, R. E., Hedges, D. W., Adler, L., Spencer, T. J., West, S. A., & Soni, P.
- Affiliations
- University of Utah (US)
- Brigham Young University (US)
- New York University (US)
- Harvard University (US)
- CNS Healthcare (US)
- Corresponding author
- Reimherr, Frederick W.
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2005-07
- Volume
- 58
- Issue
- 2
- Pages
- 125-131
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2020006801
- Cited by
- 258
- References
- 30
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 10 · 2023: 11 · 2022: 12 · 2021: 10 · 2020: 6 · 2019: 11 · 2018: 12 · 2017: 17 · 2016: 14 · 2015: 17 · 2014: 22 · 2013: 16 · 2012: 15
- FWCI
- 4.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- adult ADHD, emotional dysregulation, atomoxetine, temper, emotional lability, treatment response, depressive symptoms, anxiety symptoms, Conners' Adult ADHD Rating Scale
- MeSH terms
- Atomoxetine Hydrochloride, Adult, Affective Symptoms, Analysis of Variance, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Depressive Disorder, Double-Blind Method, Female, Humans, Male, Middle Aged, Norepinephrine, Propylamines, Adrenergic Uptake Inhibitors, Mood Disorders
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