title: Difficulties in emotional regulation and substance use disorders: a controlled family study of bipolar adolescents.
abstract: BACKGROUND
  Self-regulatory mechanisms appear etiologically operant in the context of both substance use disorders (SUD) and bipolar disorder (BD), however, little is known about the role of deficits in emotional self-regulation (DESR) as it relates to SUD in context to mood dysregulation. To this end, we examined to what extent DESR was associated with SUD in a high-risk sample of adolescents with and without BD.
  
  
  METHODS
  203 families were assessed with a structured psychiatric interview. Using the Child Behavior Checklist (CBCL), a subject was considered to have DESR when he or she had an average elevation of 1 standard deviation (SD) above the norm on 3 clinical scale T scores (attention, aggression, and anxiety/depression; scores: 60 × 3 ≥ 180).
  
  
  RESULTS
  Among probands and siblings with CBCL data (N=303), subjects with DESR were more likely to have any SUD, alcohol use disorder, drug use disorder, and cigarette smoking compared to subjects with scores <180 (all p values <0.001), even when correcting for BD. We found no significant differences in the risk of any SUD and cigarette smoking between those with 1SD and 2SD above the mean (all p values >0.05). Subjects with cigarette smoking and SUD had more DESR compared to those without these disorders.
  
  
  CONCLUSIONS
  Adolescents with DESR are more likely to smoke cigarettes and have SUD. More work is needed to explore DESR in longitudinal samples.
authors: Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA. twilens@partners.org
authors: Timothy E
authors: TE
authors: Wilens
authors: MaryKate
authors: M
authors: Martelon
authors: Jesse P
authors: JP
authors: Anderson
authors: Rachel
authors: R
authors: Shelley-Abrahamson
authors: Joseph
authors: J
authors: Biederman
mesh_terms: D000293:Adolescent; D000374:Aggression; D000437:Alcoholism / Q000150:complications / Q000523:psychology; D001007:Anxiety / Q000523:psychology; D001288:Attention / Q000502:physiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000523:psychology; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D015897:Comorbidity; D019955:Conduct Disorder / Q000150:complications / Q000523:psychology; D003863:Depression / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012574:Schools; D012907:Smoking / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*
keywords: Adolescents; BD; Bipolar disorder; CBCL; Child Behavior Checklist; Cigarettes; DESR; Deficits in emotional self-regulation; Dysregulation; Juvenile bipolar disorder; Substance use disorders; Tobacco