In this blog, I start a series of blogs which will elucidate on why I believe addictive behaviours to be the consequence of an emotional dysfunction partly perpetuated by genetics and partly by the environmental influence of insecure attachment to primary care givers and also childhood maltreatment.
All these factors appear to alter or impair brain regions implicated in emotional processing and regulation. This emotional dysfunction appears to contribute to initial use, abuse and addiction cycle all addictive behaviours.
Here I will briefly explain what I mean by emotional dysregulation and by emotional processing deficit, while highlighting how it appears to be a pathomechanism in addictive disorders.
Research suggests (1) suggest individuals with poorly regulated emotions often turn to alcohol to escape from or down-regulate their emotions, creating a risk for diagnosable problems in relation to alcohol difﬁculties as this impairment in emotion regulation is associated with alcohol-related disorders and substance-related disorders (2).
Experiential avoidance of thoughts, emotions, sensations,memories, and urges can lead to a variety of negative outcomes such as problems with substance use, because it paradoxically increases negative thoughts (3). Thus risk factors include suppression (including both expressive suppression and thought suppression), avoidance (including both experiential avoidance and behavioral avoidance), and rumination.
Emotional distress, which is chronically higher in people with emotion dysregulation, appears to potentiate (heighten) reward systems in the brain (1), and this potentiation may be even greater in individuals high in reward sensitivity, increasing the chances they will turn to alcohol. Intake of alcohol will be reinforced both by the satisfaction of high appetitive drives and by the reduction of negative emotions these individuals otherwise cannot regulate. Thus, the combination of emotional dysregulation and high reward sensitivity should be a potent risk factor for the development and/or maintenance of substance abuse and eating disorder.
Emotion dysregulation may occur if emotions are experienced as intense and overwhelming, when individuals have not learned how or when to apply effective strategies, when strategies are not applied flexibly, when the strategies fail, or when strategies are overused, emotion regulation patterns may interfere with the ability to successfully achieve goals. Emotion dysregulation still involves attempts at regulation, but the process leads to maladjustment rather than adjustment. For example, emotion dysregulation may result in poor interpersonal relationships, difficulty concentrating, feeling overwhelmed by emotions, or inability to inhibit destructive behaviors.
Components of emotional dysregulation include a tendency for emotions to spiral out of control, change rapidly, get expressed in intense and unmodified forms, and/or overwhelm both coping capacity and reasoning. (1)
Self regulatory deficits like these may emerge from an interaction of intrinsic biological factors as well as from chaotic or stressful early life experiences, particularly child abuse and problematic attachments with caregivers.
Emotional Dysregulation may be present in overly restricted emotional expression and avoidance or excessive emotionality and excitement seeking. This research (1) highlighted that the idea that emotional dysregulation is a distinct construct, related to but not reducible to negative effect (anxiety, mood, negative emotions) and may be seen as the result of the developmental capacity to adaptively regulate emotions being disturbed by early disruptive experiences. In other words, abuse in early childhood can help determine how we cope with our emotions.
Selby (2) addresses the issues of why does emotion dysregulation appear to result in behavioral dysregulation? In essence, the way we regulate our emotions may actually cause us to lose control of them. These are often considered “impulsive” behaviors, without premeditation. While not a behavioral emotion regulation strategy per se, urgency may be part of what causes certain individuals to engage in behavioral dysregulation. Individuals who exhibit high levels of urgency, feeling the need to act when faced with emotional distress, may be more likely to engage in maladaptive behaviors such as substance abuse as a result of emotion dysregulation.
As we see this urgency (3), often referred to as negative urgency (urgent action prompted by distress/negative emotions), as being the consequence of emotion processing deficits whereby emotion does not adaptively guide decision making via the reflective deliberation of the prefrontal cortex but in failing to recruit this region, instead recruits sub-cortical, limbic regions in a attempt to alleviate the unpleasant experience of undifferentiated (unprocessed - ie unidentified emotions).
This undifferentiated emotion state can manifest as a distress and this distress signal in the brain creates an urge to act, respond, make decisions which is simply based on relieving/alleviating this distress and is nothing to do with any other longer term considerations. It illustrates the thin line between distress based impulsivity and compulsivity.
Thus addicts of various hues appear to act (react) via distress based impulsivity to choose short term, lesser gains rather than longer term greater gains. This decision making profile is seen across all addictive behaviours and is also seen in children of alcoholics and those who generally have alexithymia (inability to recognise and describe emotions; to be without words for emotions). It is akin to the intolerance of uncertainty of obsessive compulsive disorder and anxiety disorder.
Thus we suggest this intolerance of uncertainty based on emotion processing deficit, this distress based decision making profile, is a vulnerability to later addictive behaviours.
Thus emotion processing deficits can interact with emotional dysregulation, equally emotion processing deficits can lead to emotional dysregulation, they have a reciprocal relationship.
I will discuss emotion processing deficits in more detail in my next blog.
1. Bradley, B., DeFife, J. A., Guarnaccia, C., Phifer, J., Fani, N., Ressler, K. J., & Westen, D. (2011). Emotion dysregulation and negative affect: Association with psychiatric symptoms. Journal of Clinical Psychiatry, 72(5), 685-691.
2. Selby, E. A., Anestis, M. D., & Joiner, T. E. (2008). Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behaviour Research and Therapy, 46(5), 593-611.
3. Whiteside, S. P., & Lynam, D. R. (2001). The ﬁve-factor model and impulsivity: Using a structural model of personality to understand
impulsivity. Personality and Individual Differences, 30, 669–689.