Diagnostic and statistical manual of mental disorders
The Diagnostic and Statistical Manual of Mental Diseases is a publication by the American Psychiatric Association that uses a common vocabulary and set of criteria to classify mental disorders.
Inattentive and hyperactive symptoms are the two most common categories of ADHD symptoms. However, new research published in The Journal of Clinical Psychiatry suggests that this distinction may not accurately reflect how the disorder manifests in adults, and that it may overlook the crucial element of emotional dysregulation, which affects many people with ADHD but is not recognized by official psychiatric criteria.
Nearly 1,500 persons with ADHD had their symptoms measured using several rating scales. The researchers discovered that the traditional inattentive vs. hyperactive paradigm failed to accurately reflect how the patients' symptoms manifested. However, they discovered evidence for two groups in which the majority of the subjects could be classified: inattentive presentation, which includes symptoms primarily related to focus and disorganization, and emotional dysregulation presentation, which includes anger, mood swings, and overreactivity. Both groups showed signs of hyperactivity. Despite the fact that the latter group had more severe symptoms, some data suggests that they react better to treatment.
According to research author Frederick Reimherr, a psychiatrist at the University of Utah, the criterion for diagnosing ADHD "needs to change to adulthood." Adults with ADHD who exhibit severe emotional symptoms may be mistaken as having bipolar disorder, resulting in ineffective therapy, he adds. The emotional symptoms of ADHD, on the other hand, respond well to first-line therapies like stimulants and therapy.
Other experts, however, believe that "emotional dysregulation," as defined by the study, is still linked to hyperactivity. "Emotional dysregulation is not some new, distinct symptom element," says Virginia Commonwealth University psychiatrist Russell Barkley; rather, it's one way that ADHD's signature disinhibition might appear. While he warns against depending too heavily on a single "subtyping" approach, he is "pleased to learn that emotional dysregulation is a significant factor in adult ADHD."