European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55 S51
The role of emotional instability in adult ADHD,
borderline personality disorder, bipolar disorder,
autism and intellectual disability: A
transdiagnostic construct or disorder specific
syndrome?
S103
Emotional instability and adult
attention-deficit hyperactivity
disorder (ADHD)
P. Asherson
Institute of Psychiatry-Psychology and Neuroscience, King’s College
London, Social Genetic and Developmental Psychiatry, London,
United Kingdom
Background ADHD is defined in DSM-5 by developmentally
inappropriate and impairing levels of inattentive and hyperactive-
impulsive symptoms. However, emotional dysregulation is consid-
ered to be an associated feature of the disorder that supports the
diagnosis of ADHD. The common co-occurrence of emotional liabil-
ity (EL) in ADHD raises the question of whether EL should be viewed
as a component of ADHD or reflecting a comorbid condition.
Aims To address the question of whether EL should be viewed as
a third dimension of ADHD.
Method We investigated the association of EL with ADHD and
impairment scores, in a sample of adults with ADHD that had been
carefully selected for absence of comorbid conditions that could
give rise to EL using both rating scale and experience sampling
methods tomeasure emotional instability. We reviewed the effects
of stimulants and atomoxetine on EL and the covariation of EL with
ADHD inattention and hyperactivity-impulsivity. We further con-
sidered the phenotypic and genetic association of EL with ADHD
using population twin data.
Results From these studies, we found that EL is strongly asso-
ciated with ADHD even in non-comorbid cases and gives rise
to additional impairments after ADHD symptoms are controlled
for in the analysis. Stimulants and atomoxetine both improve EL
and these improvements are correlated with changes in ADHD
symptoms, indicating a shared treatment response. Genetic model
fitting suggests a common pathway model, consistent with a single
genetic liability for inattention, hyperactivity-impulsivity and EL.
Conclusions Taken together these findings suggest that EL can be
viewed as a third dimension of ADHD. Patients presenting with
chronic emotional instability should always be screened for ADHD.
Disclosure of interest The author has not supplied his declaration
of competing interest.
S104
Emotional instability and borderline
personality disorder
U. Ebner-Priemer ∗, P. Santangelo , M. Bohus
1 Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
2 Central Institute of Mental Health, Psychiatric and Psychosomatics
Psychotherapy, Mannheim, Germany
∗ Corresponding author.
Affective instability is widely regarded as being the core problem in
patients with borderline personality disorder (BPD) and the driving
force behind the severe clinical manifestations of BPD symptoms.
In ICD-10, BPD is even labelled as emotionally unstable person-
ality disorder. In the last years, the advent of electronic diaries, in
combinationwith sophisticated statistical analyses, enabled study-
ing affective instability in everyday life. Surprisingly, most recent
studies using state-of-the-art methodology to assess and model
affective instability in BPD failed to showany specificity, supporting
the idea of a transdiagnostic construct. In addition, dysfunctional
emotion regulation strategies revealed results contradictory to
current clinical beliefs. Using multiple data sets and multilevel
modelling, we will demonstrate that to understand affective insta-
bility it is important:
– to statically model basic subcomponents of affective dynamics
simultaneously;
– in combination with dysfunctional regulation strategies;
– cognitive processes in everyday life.
Altogether, current research suggests that the dynamics of affective
states and their intentional regulation are even more important to
psychological health and maladjustment, than the affective states
itself. Current initiatives to fundamentally improve psychopatho-
logical research are looking at basic physiological processes
spanning across disorders. However, these approaches do fall
short in understanding human behaviours as dynamical processes
that unfold in the broadest setting imaginable – everyday life.
Only the combination of basic physiological processes and meth-
ods assessing dynamical affective mechanisms in everyday life
will enhance our understanding how dysregulations and dysfunc-
tions of fundamental aspects of behaviour cut across traditional
disorders.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
S105
Emotional instability and bipolar
disorder
S. Frangou
Icahn School of Medicine at Mount Sinai, Psychiatry, New York, USA
Background Affective dysregulation is a core feature of bipolar
disorder (BD) and a significant predictor of clinical and functional
outcome. Affective dysregulation can arise from abnormalities
in multiple processes. This study addresses the knowledge gap
regarding the precise nature of the processes that may be dysreg-
ulated in BD and their relationship to the clinical expression of the
disorder.
Methods Patients with BD (n = 45) who were either in remission
or in a depressive or manic state and healthy individuals (n = 101)
were compared in terms of the intensity, duration and physiological
response (measured using inter-beat intervals and skin conduc-
tance) to affective and neutral pictures during passive viewing and
during experiential suppression.
Results Compared to healthy individuals, patients with BD
evidenced increased affective reactivity to neutral pictures and
reduced maintenance of subjective affective responses to all pic-
tures. This pattern was present irrespective of clinical state but
wasmore pronounced in symptomatic patients, regardless of polar-
ity. Patients, regardless of symptomatic status, were comparable to
healthy individuals in terms of physiological arousal and voluntary
control of affective responses.
Conclusion Our study demonstrates that increased affective reac-
tivity to neutral stimuli and decreased maintenance of affective
responses are key dimensions of affective dysregulation in BD.
Disclosure of interest The author has not supplied his declaration
of competing interest.
S106
Emotional instability and autism and
intellectual disability
J. McCarthy
King’s College London, Forensic & Neurodevelopmental Sciences,
London, United Kingdom