The association between emotion regulation and aggression in adults with attention deficit hyperactivity disorder

Aim: The association between attention deficit hyperactivity disorder (ADHD) and aggression is well-known. Emotional dysregulation is one of the most studied mechanisms underlying this relationship. Emotional dysregulation (ED) is a multifaceted construct with different aspects, including high emotional reactivity, low distress tolerance, ineffective use of adaptive emotion regulation strategies and negative urgency. ED is a key determinant of aggression, and this relation has been mostly studied with children. Different findings have been reported in studies with adults with ADHD. This study aims to evaluate the association between aggression and various aspects of ED in adults, and whether ADHD diagnostic status moderates this association. Materials and Methods: A total of 85 participants, 43 with ADHD and 42 healthy controls, were included in the study. Diagnostic Interview for ADHD in Adults, Hamilton Depression Scale, Hamilton Anxiety Scale, Paced Auditory Serial Addition Test-Computerized (PASAT-C) and simultaneous measurement of skin conductance levels, Emotional Stop-Signal Task, Adult ADHD Self-Report Scale, Difficulties in Emotion Regulation Scale (DERS), Adult Temperament Questionnaire-Short Form, Buss-Perry Aggression Questionnaire (BPAQ) and Lifetime History of Aggression (LHA) were used in the assessment. The association between ED and aggression, and the moderating effect of ADHD diagnostic status on this relationship were evaluated using structural equation modeling and moderated multiple regression. Results: DERS, BPAQ and LHA scores were significantly higher in ADHD group. ADHD group had poor performance and reported higher subjective distress levels during PASAT-C, but skin conductance levels were found to be similar. Turkish version of LHA showed good internal consistency, concurrent and discriminant validity. A significant portion (58.5%) of the total variation in aggressive behavior was explained by ED in SEM. The findings indicated that ADHD diagnostic status did not moderate the association between ED and aggression. Conclusions: Emotional dysregulation has a significant effect on aggression independent of ADHD diagnostic status. Improving emotional regulation skills to reduce aggression and the risk of aggressive behavior may be an effective strategy. Keywords: Aggression, aggressive behavior, attention deficit hyperactivity disorder, emotional dysregulation, emotion regulation