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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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.919

S104

Emotional instability and borderline

personality disorder

U. Ebner-Priemer

1 ,

, P. Santangelo

1

, M. Bohus

2

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.920

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.921

S106

Emotional instability and autism and

intellectual disability

J. McCarthy

King’s College London, Forensic & Neurodevelopmental Sciences,

London, United Kingdom