Emotion dysregulation in adults with ADHD: associations with age, sex, menopausal status, substance use, and exposure to violence

Background

Although ADHD is diagnostically defined by inattention, hyperactivity, and impulsivity, many adults also experience significant emotion dysregulation (ED), characterized by heightened reactivity and difficulties returning to emotional baseline. Increasingly, ED is considered a clinically relevant dimension of ADHD due to its impact on daily functioning, interpersonal functioning, and risk-related behaviors. Previous research suggests that ED may be linked to adverse life experiences, including trauma and substance misuse, although findings remain inconsistent. The aim of this study was to examine associations between ED, demographic variables, substance misuse, and exposure to violence in adults with ADHD.

Methods

A cross-sectional, anonymous paper-based survey was conducted among adults with ADHD attending routine clinical visits between May and December 2025. The final sample included 377 participants (222 women, 137 men, 18 identifying as non-binary or preferring not to disclose; age range: 18–73 years, M = 50.13). Emotion dysregulation was assessed using the DERS-8 and expressed as percentile scores. Additional measures included self-reported substance misuse, exposure to physical, psychological, and sexual violence, and perceived parental substance misuse.

Due to non-normal distributions, nonparametric tests (Mann–Whitney U, Spearman correlations) and logistic regression analyses were applied.

Results

Women reported slightly higher levels of emotion dysregulation than men, although the effect size was small. ED was positively associated with age in both sexes, with a stronger relationship observed in men. Women reporting menopausal status demonstrated higher ED levels compared to those not in menopause, though this effect was small and should be interpreted cautiously given the relatively small subgroup size.

In regression analyses, emotional dysregulation did not reach statistical significance as a predictor of substance misuse, although a positive trend was observed. In contrast, male sex emerged as the primary predictor of substance misuse (OR = 3.23, p = .001), while emotion dysregulation did not reach statistical significance.

For violence exposure, higher levels of ED significantly increased the probability of reporting such experiences (OR = 1.02, p = .001), independent of sex. Additionally, male sex was associated with a lower likelihood of reporting violence exposure (OR = 0.62, p = .042). Exposure to violence and perceived parental substance misuse were common across the sample.

Conclusions

Emotion dysregulation appears to be a clinically meaningful dimension of adult ADHD, particularly in relation to exposure to violence. While its direct association with substance misuse was not statistically significant, observed trends suggest a potential relationship that warrants further investigation. Substance misuse risk appears to be primarily associated with sex rather than emotion dysregulation.

These findings support the inclusion of emotion regulation assessment in routine ADHD care, particularly in individuals with a history of trauma or violence exposure, and highlight the need for interventions targeting emotional processes alongside core ADHD symptoms. Limitations include the cross-sectional design and reliance on self-report; future studies should incorporate longitudinal designs and multimethod assessment approaches.

Keywords:ADHD; emotion dysregulation; DERS-8; violence exposure; substance misuse; adult psychiatry; sex differences; aging

References

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