Emotional dysregulation - Neurophysiological correlates

• 1. Regulation of emotion and mood
• 2. Emotional dysregulation in ADHD: sympathetic and parasympathetic nervous system
• 3. Working memory and emotional dysregulation
• 4. Correlation of emotional dysregulation with hyperactivity and inattention
• 5. Correlation of emotional dysregulation with fractional brain white matter anisotropy
• 6. Empathy

1. Regulation of emotion and mood¶

Emotion and mood is controlled by limbic-cortical-striatal-pallidal-thalamic circuitry, consisting of connections between¹²

• PFC
  • Orbitalmedial
    • Decision making
    • Emotional behavior
    • Reward-oriented behavior
    • Inhibition of impulsive behavior
      • Decreased dopaminergic excitation of the omPFC decreases its ability to inhibit impulsive behavior³
  • Orbital
    • Nutritional information
    • Expectation of rewards
    • Linking stimuli to a reward, especially to the reward value of the stimulus
  • Medial
    • Decision making, emotional and reward behavior
    • Projected to control centers of internal organs in hypothalamus and periaqueductal gray
    • Modulation of the activity of the internal organs in response to affective stimuli
      • Breathing rate
      • Heart rate
      • Blood pressure
      • Digestion
    • Increased activity of the mPFC correlates with increased skin conductance, which in turn correlates with increased activity of the sympathetic nervous system, which correlates with increased emotional arousal
  • Dorsolateral
    • Selection of where to focus attention
• Striatum
  • Dorsal
    • Caudate nucleus
      • Whose size correlates negatively with anhedonia
  • Ventromedial
    • Nucleus accumbens
    • Olfactory bulb
    • Globus Pallidum
      • Whose size correlates negatively with anhedonia
    • Ventral pallidum
      • Whose size correlates negatively with anhedonia
• Hippocampus⁴
  • Ventral
    • Subiculum
  • Put fear in context
  • Increase or decrease fear response based on past experiences and memories
  • A link is assumed between stress-related impaired hippocampus and emotional dysregulation, especially anxiety⁴
• Thalamus
  ⇒ Thalamus
  • Mediodorsal
  • Midline
• Amygdala
  ⇒ The amygdala - the stress conductor
  • Crucial for
    • Emotional learning
    • Fear conditioning
  • Mediates emotional reactions to stress

This network uses reciprocal connections with

• Cortical regions that control higher cognitive functions
• Regions that control autonomic functions, including.
  • Periaqueductal gray
  • Hypothalamus

to match higher cognitive functions with information from the body organs and external environmental conditions to influence mood and emotional states.⁵

Connections between oPFC / mPFC and the dlPFC mediate neurophysiological correlations in mood disorders between⁶⁷⁸

• Mood dysregulation
• Working memory problems
• Impairment of cognitive flexibility

Injuries to the right orbitofrontal PFC caused disinhibited emotional responses and inappropriate social behaviors, including a blunted response to punishment, as well as (possibly only early in life) social and moral evaluation problems.⁹

Impairment in processing negative emotional stimuli was associated with increased activity in the left anterior insula to the inferior frontal gyrus.¹⁰

One study found evidence that emotional dysregulation was the symptom linking ADHD and gambling addiction.¹¹

2. Emotional dysregulation in ADHD: sympathetic and parasympathetic nervous system¶

Several studies found abnormalities in both sympathetic and parasympathetic nervous system responses in ADHD sufferers that correlated with their emotional dysregulation.

According to these findings, healthy children showed systematic variations in parasympathetic activity (RSA) depending on emotion valence (stronger activation for negative emotions, lower activation for positive emotions) and task demand (stronger activation for suppression than for induction). In contrast, children with ADHD showed a stable pattern of increased parasympathetic activity (RSA) in all task conditions compared with baseline.¹²

A more comprehensive replication study confirmed this and found that in ADHD, emotionally negative and positive stimulation tasks correlated with significantly increased parasympathetic and sympathetic reactivity.¹³

Vagally mediated high-frequency heart rate variability correlates with deficits in emotional self-regulation across the lifespan in ADHD .¹⁴

3. Working memory and emotional dysregulation¶

Deficits in working memory can contribute to emotional dysregulation.¹⁵ Working memory is associated with emotion regulation.
A study of children with ADHD aged 6 to 16 years examined the interplay between identified working memory/emotion regulation patterns, demographic characteristics, and the role of comorbid diagnoses. Two distinct, invariant, unrestricted classes of working memory/emotion regulation were found:¹⁶

• Class 1 (62%):
  • Working relationship impaired
    • significantly lower values in the digit span test
  • Emotion regulation consistently functional
• Class 2 (emotionally dysregulated):
  • average working memory scores
  • increased emotion regulation problems.

Working memory indicators and emotion regulation scores measured by parents (not teachers) correlated poorly.
There was no correlation between class membership and comorbid diagnoses, age, gender, or verbal IQ.

4. Correlation of emotional dysregulation with hyperactivity and inattention¶

One study found a relationship between hyperactivity/impulsivity and emotional dysregulation, but not between inattention and emotional dysregulation.¹⁵

In contrast, another study found that emotional dysregulation seemed to correlate more with inattention than with hyperactivity/impulsivity.¹⁷ Higher inattention correlated here with

• Decreased emotional clarity, which increased difficulties in interpersonal relationships
• Lower access to emotion regulation strategies, which increased symptom burden
• Impairments in school and work.

5. Correlation of emotional dysregulation with fractional brain white matter anisotropy¶

The fractional anisotropy of 19 lanes of white matter associated with

• Affective-processing
• Sensory-processing
• Integrating
• Cognitive

Control circuitry were positively correlated with emotional dysregulation severity in unaffected individuals, whereas they were negatively correlated with emotional dysregulation in ADHD individuals.
ADHD symptom severity and diagnosis correlated negatively with fractional anisotropy of these white matter tract bundles, whereas intelligence correlated positively.¹⁸

6. Empathy¶

Empathy is divided into emotional (affective) empathy and cognitive empathy. Emotional empathy develops earlier than cognitive empathy. Emotional empathy uses limbic and paralimbic brain regions. Cognitive empathy requires fine-tuned maturation of prefrontal and temporal networks. Injuries to the ofPFC, vmPFC, or right parietal brain regions impair both types of empathy.¹⁹
Emptional empathy is thought to be influenced by the oxytocinergic system, whereas²⁰ cognitive empathy is thought to be influenced by the dopaminergic system.²¹
Emotional and cognitive empathy, while operating independently, appear to influence each other. Emotional empathy is considered an automatic bottom-up process, whereas cognitive empathy is described as a top-down modulator.¹⁹