Mental Illness: Emotional Dysregulation

This post is meant to provide a brief overview on symptoms of mental illness and then insight into living with the symptom. It should not be used as a diagnostic tool, but if you relate to what you read, it may be time to have a conversation with a mental health professional. 

Emotional dysregulation is the inability to regulate emotional reactions. There are four main aspects to this issue according to Psychology Today.

• A lack of awareness, understanding, and acceptance of emotions
• A lack of adaptive strategies for regulating emotions (the intensity and/or duration)
• An unwillingness to experience emotional distress whilst pursuing desired goals
• An inability to engage in goal-directed  behaviors when experiencing distress

These are mental and behavioral strategies that ultimately make negative emotions worse.

What does emotional dysregulation look like?

• Experiencing intense emotions
• Crying in response to a variety of feelings, even happiness
• Struggling to take your focus away from your emotions
• Having mood swings and unpredictable emotions
• Having a low tolerance for frustrating situations
• Being unaware of the feelings of other people
• Becoming overly excited

Emotional dysregulation can be aspects of multiple mental illnesses such as depression, anxiety, panic disorders, and borderline personality disorder. They may involve dysregulated behaviors such as self harm, substance abuse, etc. which are unhealth coping mechanisms.

It can also be a side effect of neurodivergence such as ADHD or autism which may result in a meltdown for some if the triggers are strong enough.

Emotional dysregulation can negatively impact multiple areas of your life resulting in workplace difficulties, issues studying or in school, relationship conflicts, worsening mental health struggles, and increasing a tendency for risky behaviors (i.e. substance abuse, dangerous driving, etc.)

What can you do to have healthy emotional regulation?

Practice good mental and physical health as outlined in our sections on self care.

• Exercise
• Deep Breathing
• Yoga
• Acceptance
• Awareness
• Learn your tirggers
• Try the F.O.U.L. Method
• Try the R.A.I.N. Method
• Reframe self talk
• Therapy & Medication may help depending on the reason for dysregulation
• CBT and DBT therapies are often used for emotional regulation

Helpful Links:

Article: Emotional Dysregulation in Children and Adolescents with Psychiatric Disorders (NIH)

Understanding ADHD (by ADDA)

What is Emotional Dysregulation? (Psychology Today)

"Emotional dysregulation is most often something I hear talked about in regards to ADHD these days. I live with three adults with ADHD so its a common conversation in our house. It is interesting to talk about how I have the same symptom as part of my PTSD/PMDD while my bestie has it because of ADHD. The way it works in our heads is different but the end result is the same.

Sometimes the world is just really overwhelming and the ability to regulate or function "normally" is shot. I am pretty good at recognizing when I have reached my limit and shutting myself away until I can regulate again.

I think most often for me it feels like standing still and quiet when the emotions inside me are begging me to just scream and throw things. Its like my emotions are too big for my body and they need to get out somehow, but some rational part of me knows we can't behave that way. It can come from a place of rage or pain or frustration. It takes an enormous amount of self control to just hold my tongue and walk away. I know this is healthy management but it feels like absolute garbage in the moment.

I tried to describe it before so I am going to share my prose "Scream" which I think captures the feeling quite well.

SCREAM

Somedays I just want to scream. I don't want to censor or silence myself. It's beyond longing to simply release the feral beast trapped within. She is not a quiet, passive person. She rages, slamming against the walls of her prison while snarling and clawing any happiness nearby. She need not be provoked for simply being awake is enough to draw forth a mighty anger bore from the darkest reaches of my own soul. Today, I want to scream. I don't want to reason with those I love or hope for their acceptance. Somehow today I want to scream to the overcast skies that there are still unhealed wounds, that I can not bear the saline words ground into them. The silent denial of truths that rock my world, the blissful ignorance of the black abyss monster always poised to drag me under the churning waves. The endless nights laying awake because I can feel the shadows settle as my demons hover over me waiting to lead a legion of nightmares into my slumbering mind. It's the conflict of the primal being as she struggles with her rational form. It's the cramped box of expectation as the air runs out.

- D.M.

Mental Illness: Nightmares & Insomnia

This post is meant to provide a brief overview on symptoms of mental illness and then insight into living with the symptom. It should not be used as a diagnostic tool, but if you relate to what you read, it may be time to have a conversation with a mental health professional. 

Nightmares and Insomnia are part of the human experience. Almost everyone will experience these at some point in their life but people with mental illness may experience chronic nightmares or insomnia, meaning it is a long standing continuous symptom. 

Sleep is an important part of your overall health and disruptions to it can generate their own sets of issues as well as making other mental illness symptoms worse.

Insomnia can be a symptom (secondary insomnia) or a sleep disorder on its own (primary insomnia) that makes it hard to fall asleep or stay asleep. Most adults need seven to nine hours of sleep a night and will experience short term insomnia at some point in their life- typically due to stress or illness. Natural changes during aging may also results in insomnia. Chronic insomnia is insomnia that lasts for three months or more typically due to another illness or disorder.

What Causes Insomnia?

Insomnia can have many causes. 

• Genetics
• Stress
• Irregular person schedule due to work, school, or travel
• Poor Sleep habits
• Heart burn
• Mental Illness
• Nightmares
• Medication
• Sleep Disorders
• Sleep Apnea
• Caffeine
• Nicotine
• Alcohol
• Aging
• Changes in activity level

How many people have insomnia?

According to the Cleveland clinic - roughly 1 in 3 adults

When do I get help for insomnia?

• Sleepiness during waking hours that is hard to resist
• Microsleeping during the day, especially if during work or while driving

How is Insomnia treated?

• Developing good sleep habits
• Setting a sleep schedule
• Having wind down time
• Being comfortable
• Limiting device usage
• Being mindful of eating/drinking before bed
• Exercise
• Medication
• Sedative Drugs
• Hypnotic Drugs
• Antidepressants
• Melatonin
• Some herbal supplements
• Mental Healthcare

Nightmares are not just "bad dreams", they are dreams that can lead to emotionally disturbing feelings such as fear, anxiety, or terror. They can generate physical symptoms like a racing heart, sweating, or rapid breathing. Chronic nightmares can be a symptom of different types of mental illness or a disorder of their own. Nightmares can be the cause of insomnia.

Nightmares are not the same as night terrors. Night terrors mainly affect children who may physically act out with screaming, shouting, thrashing about early in their sleep cycle. Typically the child will not recall they had a night terror.

Nightmares affect adults and children but lead to strong feelings which will be recalled later. They tend to happen later in the night during REM sleep.

How often do people "normally" have nightmares? (Source: www.psychologytoday.com/us/conditions/nightmares )

• Women tend to have nightmares more often than men
• 6% of adults report nightmares at least once a month
• Between 1% and 2% of adults have nightmares more often than once a month
• Less than 1% report frequent nightmares that disrupt daily function

How are Nightmares treated?

• Creating a healthy sleep routine with good sleep hygiene 
• Creating a safe, healthy sleep routine that includes practices such as relaxing, reducing screen time, and sleep journaling may help
• Treating any underlying issues (i.e. substance abuse, physical health concerns, etc.)
• Certain health conditions are comorbid with nightmares such as cancer, Parkinson's disease, and coronary heart disease
• Substance abuse may also result in nightmares
• Therapy
• Therapy to address trauma, stressors, or anxiety that is reoccurring in nightmares may reduce the frequency of nightmares
• Medication (used for persons with PTSD, anxiety or depression) 
• Some medications can cause nightmares so adjusting those may reduce the nightmares
• Medication can be prescribed to treat nightmares

Note: There is a documented link between nightmares and suicide risk. You can read more here: https://www.apa.org/monitor/2024/10/science-of-nightmares

"Nightmares are one of my longest standing PTSD symptoms. The first truly awful one I can remember happened the night of my fifteenth birthday. I can still remember it vividly twenty years later.

I have chronic nightmares. The vast majority of my dreams that I can recall are nightmares and I have had multiple a night for as long as I can remember. The severity ranges from almost comical (still scary while dreaming) to horrific gore that makes me wake up and vomit. I have been too scared to fall asleep at times because I knew I hit a trigger and the nightmares were coming for me.

They are consistently so violent that my long time therapist told me I should never take prescription sleep aids because she was concerned I would be a danger to myself or others if it caused me to sleep walk while having nightmares. She did suggest I try melatonin or Unisom to help me fall asleep to see if I couldn't manage more sleep around the nightmares.

Over the years I have tried several different ways of managing my nightmares, some more successful than others. I spent most of my late teens and early twenties working myself into exhaustion then sleeping with headphones on. I spent my mid twenties working a lot and then using exercise or sleep to push myself into a deep sleep that went past dreaming. 

Sleeping in sunlight seems to consistently result in dream free sleep so I often nap in my car on my lunch break or sleep in a hammock in the sun when the weather is nice.

Part of my medication journey as an adult in my thirties is trying out prazosin for the nightmares. It helps in that while I still have nightmares they don't seem to "stick" very well. I can wake up from them and fall back asleep without it triggering anxiety or insomnia. It is easily the best and most sleep I have gotten since the nightmares started when I was a teen. I still have them and I still have insomnia but that is once or twice a week instead of every night. I am starting to have and remember regular dreams now which is novel to me still. Its still not the normal amount of sleep that most people get and I still have a lot of nightmares but it is still an improvement.

To be completely honest, the sleep deprivation between insomnia and nightmares amplifying some of my other symptoms was one of the primary reasons I decided I should not go through with a pregnancy or care for a newborn. I just couldn't see a world where I could be trusted if my already fractured sleep was even more scarce. I realize that may seem like an extreme choice to some people and many of my loved ones still don't understand, but luckily my therapist and OBGYN both took my concerns seriously and helped me get the sterilization procedure I wanted. The older I get, the happier I am with my choice. I will dedicate a whole other post to that decision but if you know you aren't able to function then seek medical professionals that take you seriously."

- D.M.