Emotion Dysregulation and Mentalization in Adult Attention-Deficit/Hyperactivity Disorder

Purpose: This study examined the relationships among attention-deficit/hyperactivity disorder (ADHD) symptoms, emotion dysregulation, and reflective functioning (RF) in adults. Specifically, it explored whether reflective functioning uncertainty-defined as difficulties in understanding one's own and others' mental states-was associated with the relationship between ADHD symptom severity and emotion dysregulation. Methods: In this case-control observational study, 40 adults with ADHD and 40 healthy controls completed the Adult ADHD Self-Report Scale (ASRS), the Difficulties in Emotion Regulation Scale (DERS), and the Reflective Functioning Questionnaire (RFQ). Analyses included group comparisons, correlation analyses, linear regression models, and adjusted mediation analysis. Results: Compared with controls, adults with ADHD showed significantly greater emotion dysregulation and higher reflective functioning uncertainty. ADHD symptom severity was positively associated with both emotion dysregulation and reflective functioning uncertainty. Mediation analysis supported a significant indirect effect, whereas the direct effect was not statistically significant, a pattern consistent with a possible indirect pathway. Conclusions: These findings suggest that difficulties in reflective functioning may be associated with the relationship between ADHD symptoms and emotion dysregulation in adults with ADHD. Assessing emotion dysregulation and reflective functioning may improve the clinical characterization of adult ADHD. Further studies with larger samples, longitudinal designs, and multimethod assessment are needed to clarify the directionality and clinical implications of these relationships.