On the regulation and dysregulation of emotions in child psychopathology: commentary on Blader et al. (2025)

Abstract

Blader et al.'s (2025) recent annual review article makes an important contribution to the literature on emotion dysregulation in child and adolescent mental health. In addition to synthesizing the current evidence base, the authors put forth a cogent formalized view of emotion regulatory processes and how they go awry. Much has been written on emotion (dys)regulation and psychopathology (for overviews, see Lincoln et al., 2022; Paulus et al., 2021; Sheppes et al., 2015). It would therefore be reasonable to ask what novel contribution could be made by a new review article at this time. But for all that has been written, there is much work still to be done. Blader et al. (2025) admirably rise to meet this challenge. We hope this commentary amplifies and adds to their effort. Below, we reflect on a few aspects of their contribution and offer some further thoughts that may inform future work in this area.

Blader, Garrett, and Pliska's (2025) recent annual review article makes an important contribution to the literature on emotion dysregulation in child and adolescent mental health. In addition to synthesizing the current evidence base, the authors put forth a cogent formalized view of emotion regulatory processes and how they go awry. Much has been written on emotion (dys)regulation and psychopathology (for overviews, see Lincoln, Schulze, & Renneberg, 2022; Paulus, Ohmann, Möhler, Plener, & Popow, 2021; Sheppes, Suri, & Gross, 2015). It would therefore be reasonable to ask what novel contribution could be made by a new review article at this time. But for all that has been written, there is much work still to be done. Blader et al. (2025) admirably rise to meet this challenge. We hope this commentary amplifies and adds to their effort. Below, we reflect on a few aspects of their contribution and offer some further thoughts that may inform future work in this area.

A fundamental question facing anyone doing this kind of research is whether to focus on emotion regulation or emotion dysregulation. Although it could be argued (and, it seems, is often implicitly assumed) that these are two sides of the same phenomenological coin, this is not necessarily the case. For example, one recent methodological review (Freitag et al., 2023) asserted that emotion dysregulation should not be confused with emotion regulation deficits (the former being the presence of intense maladaptive responses, the latter being the absence of specific adaptive skills). Indeed, emotion regulation and emotion dysregulation have their own separate and expansive literatures, which overlap and intersect in ways that are not always clear or consistent. It has often been suggested that there should be a consilience of the research on emotion regulation and dysregulation. Many of us have tried to consume these literatures, only to become so mired in the details that we soon abandon the venture with plans to return another day. Where we have failed, Blader et al. (2025) succeed. Leveraging a rigorous systematic review methodology, they integrate this literature to bring forward a model for further testing.

Specifically, Blader et al. (2025) organized their review following a regulated systems framework, interpreting the available research findings in the context of emotion regulation as a looped system. To illustrate this point, they draw a useful parallel to a thermostat‐controlled heater as an example of an engineered closed‐looped system. The thermostat regulates the heat of the room by continually reading the actual temperature and evaluating it in relation to a desired setpoint. If the temperature drops below the setpoint, the thermostat activates the heater and warms the room until that difference dissipates, at which point the heater shuts off. Blader et al. (2025) argue that emotion regulation could work in a similar fashion. Much like the thermostat keeps the room's temperature controlled, so too does emotion regulation involve a continuous monitoring of the social environment, and responsively working to keep a person's affective state in balance. The concept of emotion dysregulation, then, implies that this regulatory process has gone awry. The thermostat has broken—or at least, something somewhere in the heating system is not working properly. When this happens to an actual heating system, the problem can be fixed because it is known how the system is supposed to work. But it is not so straightforward to “fix” a dysregulated emotional system. Blader et al. (2025) follow this line of reasoning to its logical conclusion: Understanding how emotion regulation systems work when they are functioning properly is central to understanding what is happening when they are not.

Thinking about emotion dysregulation from a regulated systems perspective seems useful for several reasons. First, it moves past surface‐level semantic confusion. “Dysregulation” has become a popular term in psychology and psychiatry. In addition to seeing the usage of the term increase exponentially in recent years, we also see it pairing with a variety of modifiers. One can speak of affective, behavioral, cognitive, autonomic, and sleep dysregulation, to name a few. Similarly, it is easy to refer to synonyms (e.g., emotional dysfunction), approximate antonyms (e.g., regulation), and narrower constructs (e.g., irritability) interchangeably with emotion regulation and dysregulation. Seldom do we stop and take stock of precisely what these terms mean or what we mean by them. Such words—even a single word, like “dysregulation”—can mean different things to different people. In the youth mental health field, some of us have even attempted to define a clinical profile as “dysregulation” to ensure that at least people studying youth around the world were examining the same phenotype (Althoff, 2010). Yet of course, advancing knowledge on any subject must begin with clarification and precision in the terms used to define the topic. Blader et al. (2025) have made it very clear what they mean by emotion regulation and dysregulation.

Second, a regulated systems approach lends itself to testable hypotheses, identification of research gaps, and model refinement over time. For example, by trying to fit the extent of evidence at different points along a looped emotion regulatory system, Blader et al. (2025) identified a relative paucity of research on automatic, negative‐feedback processes that are usually at the core of regulatory control mechanisms. This would be the emotional equivalent of an internal thermostat that automatically raises or lowers the affective temperature to return it to the desired setpoint. Further, they describe the input and output processes of emotion dysregulation and offer opportunities to consider how interventions may need to be adapted to play a role in this process. The process heuristic for this model offers many insights into how further study can proceed. All this is not to ignore the contributions of many others who have advanced the understanding of emotions and regulation from a “process” perspective (e.g., Cole, Ramsook, & Ram, 2019; Lincoln et al., 2022; Paulus et al., 2021; Sheppes et al., 2015). The regulatory perspective maps these processes out according to a clearly defined, engineered system that can function and malfunction.

Third, this approach does not ignore or exclude specific forms of psychopathology but rather helps shed light on their etiology, presentation, course, and treatment. Emotion dysregulation has been highlighted as prominent across numerous forms of psychopathology across development, including mood, anxiety, psychotic, and eating disorders, as well as posttraumatic stress disorder (PTSD), borderline personality disorder, and autism spectrum disorder, to name a few (Paulus et al., 2021; Sheppes et al., 2015). Beyond simply seeing the myriad ways emotion dysregulation can crop up in the clinical presentations of such disorders, we have recently seen a growing number of mental health interventions developed and evaluated from an emotion regulation perspective (Lincoln et al., 2022). However, much of this literature has focused on adult psychopathology, which highlights the need for further clinical research on emotion (dys)regulation in children and adolescents.

Finally, the regulated systems model helps bridge the gap between emotion dysregulation and irritability. In youth mental health, emotion dysregulation recently came to the fore in the debate around diagnosing pediatric bipolar disorder based on chronic irritability, a specific type of emotion dysregulation (Leibenluft et al., 2024). Research stemming from this controversy contributed to the creation of disruptive mood dysregulation disorder (DMDD), a diagnosis characterized by chronic irritability and severe temper outbursts in DSM‐5; and a subtype of oppositional defiant disorder (ODD) defined by chronic irritability and anger in ICD‐11. Somewhere in this nosological neighborhood lies what Blader et al. (2025) refer to as the “clinical phenotype [of emotion dysregulation] where intense anger leads to behavioral dyscontrol” (abstract). How, then, should researchers and clinicians think about emotion dysregulation and chronic irritability? Irritability has been defined and conceptualized as an elevated proneness to anger—a narrower concept, discernable from emotion dysregulation which is broader and more encompassing (Leibenluft et al., 2024). In turn, emotion dysregulation has numerous definitions (Freitag et al., 2023) and its relationship to irritability has not been well defined. Blader et al. (2025) help move the field past thinking about irritability and emotion dysregulation as overlapping or concentric circles. Rather, irritability could be a specific kind of positive feedback loop, within a closed‐loop system, in which an initial stimulus triggers an escalation of anger, rapid intensification of negative affect, with a cascade of cognitive, behavioral, and physiological effects (Blader et al., 2025).

While closed‐loop (automatic) processes appear relevant from an anger escalation perspective, Blader and colleagues found little evidence for closed‐loop mechanisms for intervention or down‐regulation of this angry arousal. Open‐loop (deliberate) regulatory strategies show promise for treatment. Indeed, intervention in a dynamic system likely requires the involvement of something exogenous to that system. Much of the research on emotion regulation treatment involves the development and deployment of emotion regulatory skills, for example, as in Dialectical Behavior Therapy or the Unified Protocol (Lincoln et al., 2022). We suspect that open‐loop strategies may be similarly helpful in interventions for chronic irritability in youth. It may be useful to think broadly about what disruptors could be introduced into the irritability/anger system. For example, there is now robust meta‐analytic evidence that arousal‐decreasing activities (e.g., deep breathing, meditation, yoga) can help to decrease anger and aggression (Kjærvik & Bushman, 2024).

In reflecting on our own research, emotion dysregulation provides an excellent example of the difference between conceptualization and operationalization or between a construct and a process. Many of us have operationalized emotion dysregulation as a psychological construct, including salient problems that children can have with emotional, behavioral, and social functioning—the sort of thing that can be measured with rating scales and modeled through factor analyses. For example, the Dysregulation Profile on the Child Behavior Checklist and related measures (e.g., Youth Self Report, Strengths and Difficulties Questionnaire) identifies a constellation of problems including ADHD symptoms, anxiety/depression, and aggression/oppositionality that forms a potent admixture that is remarkably predictive of future psychopathology (Althoff, 2010). Similarly, clinically referred youths can be characterized by latent profiles of dysregulation based on various indicators (e.g., irritability, anger, emotion coping, total psychopathology) rated by parent‐ and youth‐report at baseline (Evans, Wei, Harmon, & Weisz, 2021). This research has shown that children with latent profiles of high dysregulation and irritability respond to evidence‐based psychotherapies (specifically, cognitive‐behavioral therapy, and behavioral parent training) just as well as those with low dysregulation.

As useful as these “construct” approaches can be, they admittedly only scratch the surface of what is happening in youth with emotion dysregulation. Indeed, emotion dysregulation is not a static construct reflected by miscellaneous indicators. Rather, current research and theory points to a process model of emotion dysregulation (e.g., Cole et al., 2019; Sheppes et al., 2015). This is where Blader et al.'s (2025) contribution fits well. The review has put forth a view of ways in which processes can be disordered or adjusted, which resonates with and advances the current evidence base on emotion dysregulation. These “process” accounts present some tension with more static “construct” accounts of dysregulation—the notion that one could measure such a thing with a questionnaire or rating scale. But this tension is useful. Progress in these areas, both clinically and scientifically, will require some degree of reconciliation of emotion dysregulation as both a construct and a process.

Emotions are fuzzy things. There is a healthy debate to be had about how the term “dysregulation” should be used. We should have that debate, and meanwhile, we should not presume that we are speaking about the same thing. Despite our best attempts at studying, renaming, or clarifying emotion dysregulation, it is likely that without some conciliation of these various conceptualizations and operationalizations, we will continue to all speak about different parts of the elephant. Blader et al.'s (2025) contribution is a laudable step toward elucidating how the parts fit together as a whole. Echoing their contribution, we wish to promote a unified and optimistic take‐home message: Emotion regulation and dysregulation can be usefully conceptualized from a regulatory systems perspective, and process and construct models of emotion dysregulation are mutually informative. This way of thinking can help clarify future research directions. For example, studies of dysregulation phenotype constructs may be well suited for large samples, longitudinal designs, and prevention and intervention trials. At the same time, studies of specific stages in emotion regulatory processes may be well‐suited for experimental, computational, and intensive longitudinal approaches. We invite readers to consider emotion dysregulation as a process that can be operationalized as a construct, all within the context of a regulatory system. In this way, we hope the field can advance beyond the fuzziness of emotions and get closer to a shared language of emotion dysregulation in youth mental health.