When mental health professionals describe/diagnose emotional dysregulation, how do they distinguish between people who are incapable of regulating their emotions, as opposed to people who have not been taught to/do not try to/or see no benefit from controlling their emotions?
I’m not trying to suggest that mental health conditions are not real. Just wondering how professionals make the distinction - especially since they are often relying largely on subjective allegations.
For that matter, how do parents make the distinction as to whether a child cannot behave - as opposed to will not, or would not respond to more effective parenting techniques?
Likely not a perfect analogy, but many people question whether it is appropriate to refer to poorly behaved dogs, as opposed to the products of poor training.
Something like this came up with our younger daughter, whose emotions run pretty hot, very close to the surface.
She’d get worked up and angry, and start to lash out both verbally and physically. We calmly reminded her not to let her feelings control her. She said it was difficult. We asked if she ever got mad at her teacher; she said yes. We asked if she hit her teacher and yelled in the classroom. She said no. We observed this meant she could control herself there, but she wasn’t controlling herself here.
She looked like a lightning bolt hit her. And ever since, she’s been much more effective at self-regulation. She’s still a bit of a firecracker, but she doesn’t flip out any more.
This is a bit like ‘the gay question’. Is it is a lifestyle choice to be reviled, ridiculed, shunned, and beaten?’ Or is it something that most homosexual people would have avoided if only they could?
Is it just manipulation and selfishness that makes children scream uncontrollably, hide in a corner, break things they love, alienate their friends and relations, get sent to a shrink?
I know, let’s try escalating punishments! We’ve never done that before.
Sounds like good parenting on your part. Not all kids have good parents. I can imagine that at some point years of ineffectual parenting can program one’s brain such that the distinction I’m perceiving is meaningless.
I’m not sure how much “treatment plans” would differ either. And, the way our health care system works, treaters have an incentive to diagnose pathologies, as opposed to recommending/providing “life coaching” or somesuch.
Not sure I’m suggesting exactly that. And I think you are taking my OP to an extreme that will interfere with meaningful discussion.
Do you believe that ANY people are just jerks/selfish/inconsiderate/lazy? Or is such behavior ALWAYS the result of some pathology that ought to be excused/accommodated - as opposed to someone who just has never learned better, or had sufficient incentive to act differently?
And, as Cervaise well describes, there MIGHT be ways to parent effectively that do not involve increased punishment.
One of the things that my Nurse Practitioner wife sees every single day in her practice is families from lower socioeconomic strata with kids who have behavioral issues.
Less education + less money has a marked tendency to amount to worse diet and exercise habits. Kids raised on nothing but processed food and simple carbohydrates may manifest that in any number of ways, including behavioral issues.
When my wife can convince these parents to dramatically reduce their children’s consumption of simple carbs, processed food, fruit juice, soda pop, and ‘junk,’ there is often a marked improvement.
Without any significant change in any other realm of ‘parenting.’
These things can very easily be multifactorial.
I wonder whether this lines up with @DSeid 's experience in pediatrics.
I don’t generally see huge improvements from nutritional changes alone.
As the question of the op - yeah it is pretty much as @Cervaise presents. We consider issues as more likely inherent when they are from early age onset, persistent, and impairing function in more than one environment.
Of course inherent tendencies can sometimes be managed with behavioral interactions.
IMHO, the best analogy is that people are like various liquids. Some have a high boiling point, some have a low one. Water takes a relatively long time to boil, but some liquids will boil even by just the temperature of your hand warming them up. Same with people’s anger and emotions.
I think it depends on whether they go against their own self-interest. If a guy gets angry and starts punching people weaker than him, he may have emotional problems, or he may just be an asshole and a bully. If a guy gets angry and starts punching MMA fighters, he probably has emotional problems. As always, context is king.
I appreciate that people have different “boiling points”, but I don’t believe liquids can choose to modify their behaviors in the way people can. Of course I’m not saying ALL people can simply choose to alter ALL of their behaviors/choices. But many (most?) folk can at least try to - say - count to 10 before saying/doing something you know someone else will react badly to. Or at least apologize later.
How do you best describe someone who thinks they just don’t need to make that effort? I suspect there is a continuum ranging from “selfish inconsiderate jerks” (the technical term! ;)) to folk with unavoidable disorder.
Self interest impresses me as difficult to assess. If someone isolates themself from social interaction, or from workplace challenges, is it against their best interest becuase it deprives them of social interaction or workplace promotions? Or is it IN their best interest in that they prefer their solitude and a low demand job?
With the guy who punches people weaker than him - or a kid who routinely hits other kids - how do you distinguish between the person w/ emotional problems and the asshole. That is at the heart of my question.
What does she say about the parenting practices of those families? I imagine some pathology is genetically inherited. But I suggest that in at least some instances, lousy parents create lousy kids who become lousy adults.
Is there a reason you use the words “issues” and “tendencies” as opposed to diagnosed pathologies? We all have issues and tendencies, but most of us do not use those as excuses from common obligations and responsbilities. How different is the treatment for someone who has “mood dysregulation disorder” from someone who just would benefit from some “behavior modification.” I’d imagine assigning a diagnosis has something to do with the ability to be compensated by insurance…
To add to one point, some folks have grown up in environments where restraint and being calm instead of showing anger was actually considered a sign of weakness, not strength. They grew up in an environment where if you didn’t retaliate promptly, it would invite further bullying or predation. For such people, not only are they conditioned into reacting instantly based off of feelings, it’s actually even what makes most sense from a survival/evolution perspective. Being calm wouldn’t be of benefit to them, so they never learned a reason why they should count to ten before showing anger.
Either that, or they grew up constantly being ignored any time they showed displeasure with only a “1 to 5” level of anger, and only heeded when they showed 6 or greater levels of wrath (on the 1-to-10 scale.) So they learned to react with great anger anytime they needed to be heeded. Without getting too deep into racial weeds (which could take the thread in another direction,) there are some racial-minority individuals, for instance, who are stereotyped as “angry all the time,” but it’s because nobody took their complaints seriously when they were calm and quiet.
IMHO, my wife goes out of her way not to reason backward from the behavior of the child(ren) who are sitting in front of her for 15-20 minutes at a time to forming conclusions about what kind of parents the children have.
I think she would view this as too great, and invariably unfounded, a leap to make.
She may see that a kid is ‘running roughshod over’ Mom in the patient exam room, but that’s a snapshot of a story that’s likely to be highly complex and doesn’t really fall within her remit in that exam room.
Cesar Millan (The Dog Whisperer) “trains humans and rehabilitates dogs.” That’s not really my wife’s job description
She can ask pointed questions and gather rather solid information about diet, nutrition, screen time, sleep, bullying, friends, etc., etc., offering concrete and tactical suggestions, but I don’t think she feels at all comfortable characterizing the parents beyond the things she can reasonably ascertain in this setting.
They didn’t say anything like that. What they argued was that there may not always be a distinction between the two concepts.
The whole concept of emotional dysregulation is that people have difficulty controlling their emotions. It’s not a black and white thing. Think of emotional control as a tank that can be filled. These people have smaller tanks, and use it up more quickly.
Cervaise’s story sounds very normal. It’s not like the kid was choosing to act out at home. They just had limited ability, and reserved that for when they were out, while letting go at home where they feel safe.
This is normal for everyone. Everyone lets down their emotional guard when they are at home. I’m sure you’ve had a bad day where you’ve worked to keep your mouth shut, only to come home and let it out. The difference is that you have more in your tank, so you can do it better.
Cervaise’s intervention, which was nonjudgmental–a key factor in any treatment, helped the kid realize they could budge their self-restraint differently. And it helped them have the confidence that it was a solvable problem. But it doesn’t mean that they were willfully not trying at home.
The part I take issue with is bringing in the concept of people being “jerks/selfish/inconsiderate/lazy.” You seem to equate that with “never learned better,” or lacking “sufficient incentive.” But, for someone with a low emotional tank, these are very much valid reasons they might have trouble with emotional regulation.
At the end of the day, treatment has to assume that they can get better. But it also cannot assume they are bad people. If you do that, they they give up. If they are good people, then they are encouraged to keep trying.
There may be extreme cases where you need to tell the difference. But, most of the time, assuming it is not willful makes more sense.
One additional point I wanted to add was that too often, parents and society confuse “squelching feelings” with “resolving the problem.”
It’s kind of like a tyrant who suppresses all free speech and then thinks proudly, “I’ve solved all problems in my nation. Look, no complaints!” When in fact, his populace may be seething with discontent and always just right below boiling point.
So a lot of the anger-management “techniques” that parents and teachers teach kids is often highly counterproductive. They try to quell all the symptoms of anger without resolving what it is that’s causing the kid to be angry. And either this creates a highly unhealthy kid who needs therapy decades later, or the kid squelches it until he cannot any longer, and then has a WORSE outburst than if he had been allowed to vent in a healthy, calm way.
Ironically, these parents or teachers themselves are often ones who fly off the handle and have no problem shouting or lashing out at people they don’t like.
Unwilling or never learned how to deal with frustration in their young lives because mom dad grandpa is always bailing them out by making the frustration go away and the kid never learns to successfully handle life’s little frustrations. Then you have a grown kid or adult throwing epic tantrums because they never picked up the skill of dealing with frustrations. They feel entitled
Well, in our case we TRIED all the parenting techniques on Older Child. Didn’t really work. (They pretty much all worked great on our younger child!) And also our child’s personality is one where she really does want to please adults, and when she’s asked to do a thing she generally will try to. So the fact that emotional regulation wasn’t happening by itself, even when she had all the incentives in the world to do so, was in retrospect a big clue.
She is much better at regulation now, due to a) therapy on specific techniques for emotional regulation, b) therapy to chip away at anxiety plus a low dose of anti-anxiety medication (it turns out that a lot of the emotional dysregulation was based on anxiety), c) finding other kids that shared her interests (I don’t know how this works directly, but I have definitely noticed a distinct correlation – I think there was some sort of feedback loop where she was able to be with other kids and observe their typical regulated behavior more?) and d) getting older and more mature – her emotional maturity is, I think, a few years behind a typical kid, but she is getting there! I’m so proud of her.
So I know a middle schooler with poor impulse control, who continually makes crappy choices, doesn’t tell his family where he is, gets in fights at school, etc. He is wicked smart and a natural athlete, which works in his favor, but he is definitely the kind of boy who would be on a downward trajectory in a typical scenario; his family is below poverty level with all the stresses that entails. Also he spent most of his childhood in a Nigerian refugee camp, learned English as a ten year old, and has never attended any school for two consecutive years. Does he “know” how to regulate his emotions, or is he “deliberately” acting out?
My point is that people’s emotions and how they are expressed are very complex, and depend upon a host of factors including early environment, genetics, brain chemistry, societal pressures, gender expectations, and things nobody even knows about yet.
Any either/or dichotomy is simplistic and false.
I’m on the austism spectrum, and as a child was regularly either withdrawn and in hiding, or overloaded and melting down into helpless sobs. I was consistently accused of being manipulative or 'trying to ruin things for everyone" when quite literally nothing could be farther from my reality. So I have my biases.
Possible. But perhaps even more are the opposite: Facing such a constant deluge of annoyances, grievances, injustices, hardships, wrongs, or whatnot that eventually it becomes a “straw that broke the camel’s back” situation.
I’m by no means trying to equating those various terms, and I’m sorry my attempts to stimulate discussion while not writing a thesis gave that impression. Are ANY people “jerks” (or whatever word you’d prefer)? Or does EVERYONE who acts in a manner I - and I suggest many - consider jerk-like simply have a “low emotional tank.”
Also, once someone learns they have “a low emotional tank”, what efforts ought they make to avoid stressors and/or modify their behavior? Does their “low emotional tank” absolve them of responsibility.
Again, I don’t think I was suggesting a dichotomy. Pretty sure I referred, instead, to a continuum.
