Dysregulation Research Articles

Emotion dysregulation in autism: Severity and correlates in early childhood

AbstractEmotion dysregulation (ED) is common and severe in older autistic youth, but is rarely the focus of early autism screening or intervention. Moreover, research characterizing ED in the preschool years (when autism is typically diagnosed) is limited. This study aimed to characterize ED in autistic children by examining (1) prevalence and severity of ED as compared to children without an autism diagnosis; and (2) correlates of ED in autistic children. A sample of 1864 parents (Mean child age = 4.21 years, SD = 1.16 years; 37% female) of 2–5 year‐old children with (1) autism; (2) developmental concerns, but no autism; and (3) no developmental concerns or autism completed measures via an online questionnaire. ED was measured using the Emotion Dysregulation Inventory‐Young Child, a parent report measure characterizing ED across two dimensions: Reactivity (fast, intense emotional reactions) and dysphoria (low positive affect, sadness, unease). Autistic preschoolers, compared to peers without developmental concerns, had more severe ED (+1.12 SD for reactivity; +0.60 SD for dysphoria) and were nearly four and three times more likely to have clinically significant reactivity and dysphoria, respectively. Autistic traits, sleep problems, speaking ability, and parent depression were the strongest correlates of ED in the autism sample. While more work is needed to establish the prevalence, severity, and correlates of ED in young autistic children, this study represents an important first step. Results highlight a critical need for more high‐quality research in this area as well as the potential value of screening and intervention for ED in young autistic children.

Needing to shout to be heard? Caregiver under‐responsivity and disconnection between vocal signaling and autonomic arousal in infants from chaotic households

AbstractChildren raised in chaotic households show affect dysregulation during later childhood. To understand why, we took day‐long home recordings using microphones and autonomic monitors from 74 12‐month‐old infant–caregiver dyads (40% male, 60% white, data collected between 2018 and 2021). Caregivers in low‐Confusion Hubbub And Order Scale (chaos) households responded to negative affect infant vocalizations by changing their own arousal and vocalizing in response; but high‐chaos caregivers did not, whereas infants in low‐chaos households consistently produced clusters of negative vocalizations around peaks in their own arousal, high‐chaos infants did not. Their negative vocalizations were less tied to their own underlying arousal. Our data indicate that, in chaotic households, both communicating and responding are atypical: infants are not expressing their levels of arousal, and caregivers are under‐responsive to their infants' behavioral signals.

School-based eating disorder prevention programmes and their impact on adolescent mental health: systematic review.

Growing evidence indicates an association between disordered eating and a range of mental health problems, including anxiety, depression and emotional dysregulation. This study aimed to explore whether reducing risk factors for eating disorders, such as body dissatisfaction and low self-esteem, through school-based programmes can enhance adolescent mental health. We searched PubMed, PsycINFO, EMBASE and Web of Science from the date of inception to 15 October 2023. Data were synthesised by using a systematic narrative synthesis framework, and formal assessments were conducted to assess the quality of the included studies. After title/abstract screening and full-text assessment, 13 articles met the pre-specified inclusion criteria, comprising a total of 14 studies (n = 5853). Notably, three studies encompassed multiple programmes, leading to the identification of 17 eating disorder prevention programmes. Among these programmes, seven (41%) employed dissonance-based approaches. Topics covered in the programmes included psychoeducation, body acceptance, sociocultural issues, nutrition and physical activities, self-esteem and stress coping. Ten (59%) of the programmes were effective in improving adolescent mental health. Six of the 14 studies (43%) did not specify follow-up time, and quality assessments found the majority to be of either high (five studies, 36%) or fair (eight studies, 57%) quality. The findings from the ten effective programmes consistently support the use of body acceptance strategies in improving the mental health of adolescent students. Brief interventions delivered by trained, non-licensed facilitators appear good for the sustainable implementation of in-school psychological services to support well-being among adolescents.

Self-injury and suicidal behaviors in high-risk adolescents: Distal predictors, proximal correlates, and interactive effects of impulsivity and emotion dysregulation.

Suicide rates are rising among U.S. youth, yet our understanding of developmental mechanisms associated with increased suicide risk is limited. One high-risk pathway involves an interaction between heritable trait impulsivity and emotion dysregulation (ED). Together, these confer increased vulnerability to nonsuicidal self-injury (NSSI), suicide ideation (SI), and suicide attempts (SAs). Previous work, however, has been limited to homogeneous samples. We extend the Impulsivity × ED hypothesis to a more diverse sample of adolescents (N = 344, ages 12-15 at Baseline, 107 males and 237 females) who were treated for major depression and assessed four times over two years. In multilevel models, the impulsivity × ED interaction was associated with higher levels and worse trajectories of NSSI, SI, and SAs. As expected, stressful life events were also associated with poorer trajectories for all outcomes, and NSSI was associated with future and concurrent SI and SAs. These findings extend one developmental pathway of risk for self-harming and suicidal behaviors to more diverse adolescents, with potential implications for prevention.

Mild behavioural impairment in Parkinson’s disease: a systematic review

Abstract Behavioural symptoms are common manifestations of Parkinson’s disease (PD). Early behavioural symptoms characterise mild behavioural impairment (MBI). The prevalence and intensity of MBI in people with PD (PwP) have been studied across various cohorts. However, methodological differences have obscured our understanding of MBI in these individuals. This systematic review examines and synthesises findings from relevant studies, enhancing understanding of the symptoms and implications of MBI in PD. Nine studies from five separate research institutions were identified. The conceptualisation of MBI varied considerably, affecting the reported prevalence rates of MBI in individuals with early-stage PD. Among PwP, MBI was associated higher education and impaired cognition. Affective dysregulation and impulse control disorders were primary contributors to MBI; abnormal perception was least contributor. This systematic review underscores the specific characteristics and incidence of MBI in early-stage PD. Mood and impulse control disorders are primary concerns associated with MBI. Future longitudinal studies are required to clarify the progression of these symptoms and evaluate MBI’s potential as an indicator for PD-related dementia or increased dependency.

Overparenting and adolescent's trait anxiety: Unraveling the roles of basic psychological needs frustration and emotion dysregulation.

Parental involvement is widely recognized for its beneficial impact on child development. However, helicopter parenting, as an excessive and developmentally inappropriate involvement, can lead to significant mental health challenges. While the general effects of overparenting on well-being have been well-documented, its specific underlying mechanisms are still underexplored. The present study aimed to examine the serial mediating roles of basic psychological needs (BPN) frustration and emotion dysregulation in the link between helicopter parenting and trait anxiety among 391 adolescents chosen via convenience sampling. The results of structural equation modeling revealed that helicopter parenting significantly predicted higher levels of trait anxiety (β=0.367, p<.01). Furthermore, the indirect effect of helicopter parenting on trait anxiety was statistically significant through the serial mediation of BPN frustration and emotion dysregulation (β=0.134, p<.01). In fact, over-controlling parenting can lead to frustration of adolescents' BPN and, in turn, restricted access to effective emotion regulation strategies, which may ultimately increase trait anxiety among adolescents. These findings underscore the critical need for balanced parental involvement to foster healthy psychological development of adolescents.

Zuranolone: A Rapidly Acting Oral Neuroactive Steroid Antidepressant for the Treatment of Postpartum Depression.

Severe depression, anxiety, and mood dysregulation during pregnancy and postpartum are risk factors for the safety and health of mother and baby. Current best practice guidelines recommend screening for depressive and anxiety symptoms before and during pregnancy, in addition to the postpartum period. Rapid identification and treatment of depression has the potential to be life-saving and prevent deleterious consequences, including impaired mother-infant bonding, emotional dysregulation, and other developmental problems. The current article reviews the neurobiological mechanisms of postpartum depression and a novel rapidly acting oral pharmacotherapeutic neuroactive steroid, zuranolone. [Journal of Psychosocial Nursing and Mental Health Services, 62(11), 7-10.].

Emotion dysregulation, dissociation, and borderline personality disorder symptoms as correlates of maladaptive daydreaming in a general sample: the crucial role of experiential avoidance

Emotion dysregulation, dissociation, and borderline personality disorder symptoms as correlates of maladaptive daydreaming in a general sample: the crucial role of experiential avoidance

Using random forest to identify correlates of depression symptoms among adolescents.

Adolescent depression is a significant public health concern, and studying its multifaceted factors using traditional methods possess challenges. This study employs random forest (RF) algorithms to determine factors predicting adolescent depression scores. This study utilized self-reported survey data from 56,008 Canadian students (grades 7-12) attending 182 schools during the 2021/22 academic year. RF algorithms were applied to identify the correlates of (i) depression scores (CESD-R-10) and (ii) presence of clinically relevant depression (CESD-R-10 ≥ 10). RF achieved a 71% explained variance, accurately predicting depression scores within a 3.40 unit margin. The top 10 correlates identified by RF included other measures of mental health (anxiety symptoms, flourishing, emotional dysregulation), home life (excessive parental expectations, happy home life, ability to talk to family), school connectedness, sleep duration, and gender. In predicting clinically relevant depression, the algorithm showed 84% accuracy, 0.89 sensitivity, and 0.79 AUROC, aligning closely with the correlates identified for depression score. This study highlights RF's utility in identifying important correlates of adolescent depressive symptoms. RF's natural hierarchy offers an advantage over traditional methods. The findings underscore the importance and additional potential of sleep health promotion and school belonging initiatives in preventing adolescent depression.

Early-Onset Trajectories of Emotional Dysregulation in Autistic Children

Early-Onset Trajectories of Emotional Dysregulation in Autistic Children

A cluster analysis of attachment styles in patients with borderline personality disorder, bipolar disorder and ADHD

BackgroundInsecure adult attachment has been associated with psychiatric disorders characterized by emotional dysregulation, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the differences in attachment patterns between these diagnostic groups. The aim of this study was to identify clusters of adult attachment style in a cross-diagnostic group of patients with BDP and/or BD and/or ADHD and explore the characteristics of these clusters based on temperament profile, childhood trauma and psychiatric diagnoses.MethodsK-means cluster analysis was used to identify subgroups, based on the Attachment Style Questionnaire Short Form dimensions, in a clinical cohort of 150 young adults (113 women and 37 men, mean age ± SD = 23.3 ± 2.1) diagnosed with BPD, and/or BD, and/or ADHD.ResultsThree distinct clusters were identified: a secure, an insecure/avoidant-anxious and an insecure/avoidant cluster. These three clusters differed in temperament profile and related psychiatric diagnoses.ConclusionsThe three clusters of attachment in individuals with BPD, BD and/or ADHD could support differentiation between the disorders as well provide information usable for planning of treatment.

Reducing emotion dysregulation online in nonclinical population with compassion focused therapy and emotional competencies program: A randomized controlled trial.

The present randomized controlled study aimed to evaluate the effects of two interventions on emotional dysregulation as a primary outcome and on depression, anxiety, stress, well-being, self-compassion and emotional competencies as secondary outcomes. Finally, the mediating role of emotional dysregulation as a core process in the effect of interventions on anxiety-depressive and stress symptoms was evaluated. One hundred and seventy-nine individuals aged 18-68 years (M = 39, SD = 12.4; 83.9% females) with emotion regulation difficulties were randomly assigned to one of the three 12-weeks online programs: Compassion Focused Program (CFP), an Emotional Competencies Program (ECP) or a Waitlist control condition (WL). Participants completed pre-, post- and 3 months follow-up measures of each outcome. Mixed effect linear models compared groups on primary and secondary outcomes. Results showed that (1) perceived credibility and expectancy and satisfaction did not differ between the two interventions, (2) both interventions reduced emotion regulation difficulty, depression, anxiety and stress symptoms, and enhanced well-being, self-compassion, and emotional competencies; (3) ECP was more effective to enhance well-being than CFP; (4) CFP was more effective to enhance emotional competencies than ECP, and (5) emotion regulation difficulty mediated the effect of the interventions on depression, anxiety, and stress symptoms. Findings offer preliminary support for the usefulness of online CFP and ECP to reduce emotion dysregulation, symptoms of depression, anxiety, and stress and to increase well-being, self-compassion and emotional competencies. These results are discussed regarding clinical practice and the transdiagnostic role of emotional dysregulation.

A Preliminary Investigation of a Conceptual Model Describing the Associations Between Childhood Maltreatment and Alcohol Use Problems

Background/Objectives: Childhood maltreatment has been linked to numerous adverse outcomes in adulthood, including problem substance use. However, not all individuals exposed to childhood maltreatment develop substance use problems, indicating the role of other factors in influencing this outcome. Past work suggests that adverse early life experiences, including childhood maltreatment, lead to neurobiological changes in frontolimbic functions that, in turn, result in altered stress and reward responses, heightened impulsivity, affect dysregulation, and, ultimately, increased risk for maladaptive behaviors such as substance use. The aim of this preliminary investigation using cross-sectional data was to test associations between these factors in the relationship between childhood maltreatment and alcohol use problems in a sample of emerging adults. Methods: Emerging adults (18–30 years old) who identified as regular drinkers (i.e., drinking at least 2–4 times in the past month) were recruited from a crowd-sourcing platform (Prolific) as well as community samples. Participants completed online standardized questionnaires assessing reward sensitivity and responsiveness, impulsivity, emotion regulation, and alcohol consequences. Results: Path analyses demonstrated good fit for the data (SRMR = 0.057, RMSEA = 0.096, 90% CI [0.055, 0.142], CFI = 0.957). Childhood maltreatment was associated with reward responsiveness (β = −0.026, Z = −4.222, p &lt; 0.001) and emotion dysregulation (β = 0.669, Z = 9.633, p &lt; 0.001), which in turn was associated with urgency and, subsequently, alcohol consequences (β = 0.758, Z = 7.870, p &lt; 0.001). Conclusions: Although these findings are preliminary, the current study is one of the first to test a comprehensive model addressing the relationship between childhood maltreatment and alcohol use problems. The findings have the potential to inform treatment strategies that target motivation and goal-directed action for reducing and managing consequences associated with childhood maltreatment. Future research should test the model using longitudinal data to address the limitations of a cross-sectional study and assess temporal associations between constructs.

Early remission of deliberate self-harm predicts emotion regulation capacity in adulthood: 12.4 years follow-up of a randomized controlled trial of adolescents with repeated self-harm and borderline features

AbstractEmotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: “Treatment for Adolescents with Deliberate Self-harm”; http://ClinicalTrials.gov/;NCT00675129

A Pilot Controlled Trial of Relaxation Training Combined with a Video Game Reinforcing Emotional Regulation to Improve Anger Management in Children and Adolescents.

Untreated anger and aggression in youth confer heightened risk for subsequent psychosocial problems. However, engaging youth in treatment for anger can be difficult given barriers to accessing care and high rates of attrition. This study examined whether learning relaxation skills and practicing them using a videogame, whose operation was contingent upon keeping heart rate close to baseline levels, could help children learn to manage anger and aggression. Youth ages 7-17 with elevated levels of anger (N = 39) were randomized to receive the active video game condition or a control game that displayed heart rate but did not stop the game if heart rate became elevated. Youth underwent baseline screening, 6 treatment sessions, and follow-up assessments at 2-weeks and 3-months. Compared to the control condition, children in the active condition demonstrated significantly greater improvements in clinician-rated aggression severity (d = 1.48) and youth-rated emotion dysregulation (d = 3.46) at 2-weeks post-treatment. The active group maintained these improvements at 3-month follow-up, but no longer significantly differed from the control group. Intervention effects were nonsignificant for parent-reported emotion dysregulation and aggression. In addition, the intervention group youth, but not control group, experienced increased time with heart rate below baseline over the course of the 6 sessions. Findings suggest a promising brief intervention for reducing aggression and emotion dysregulation in children while they are waiting for longer-term outpatient therapy. Clinical Trial Registration Number: NCT03270813.

Supporting emotion regulation in children on the autism spectrum: co-developing a digital mental health application for school-based settings with community partners.

KeepCalm is a digital mental health application, co-designed with community partners, that incorporates wearable biosensing with support for teams to address challenging behaviors and emotion dysregulation in children on the autism spectrum. We followed a user-centered design framework. Before app development, we conducted design workshops, needs assessment interviews, a systematic review, and created an Expert Advisory Board. Once we had a working prototype, we recruited 73 participants to test and help improve the app across five testing cycles. Participants rated the app across testing cycles as highly acceptable, appropriate, feasible, and with good usability. Qualitative data indicated that KeepCalm helped teachers (a) be aware of students' previously unrealized triggers, especially for nonspeaking students; (b) prevent behavioral episodes; (c) communicate with parents about behaviors/strategies; and (d) equipped parents with knowledge of strategies to use at home. We learned that in order to make the app acceptable and appropriate we needed to make the app enjoyable/easy to use and to focus development on novel features that augment teachers' skills (e.g., behavioral pattern and stress detection). We also learned about the importance of maximizing feasibility, through in-person app training/support especially regarding the wearable devices, and the importance of having aides involved. Our findings have informed plans for wider-scale feasibility testing so that we may examine the determinants of implementation to inform adaptations and refinement, and gather preliminary efficacy data on KeepCalm's impact on reducing challenging behaviors and supporting emotion regulation in students on the autism spectrum.

Emotion dysregulation in misophonia: Findings from a nationally representative sample

A core feature of misophonia is the emotional distress that occurs in response to specific sounds (e.g., slurping, pen clicking). Despite the theorized connection between emotion dysregulation and misophonia, there is very little research on this topic. Examining emotion dysregulation and identifying the specific emotion regulation deficits that are associated with worse misophonia symptoms would advance our understanding of potential transdiagnostic factors central to misophonia symptoms; thereby informing the development of more targeted interventions. The current study sought to: 1) characterize emotion dysregulation among individuals with misophonia, 2) compare emotion dysregulation between individuals with clinical and subclinical misophonia, and 3) examine the unique role of emotion dysregulation across three domains of misophonia symptoms. This study included a large, nationally representative sample of U.S. adults (N = 4005; 51.5% female; 62.5% White, non-Hispanic). Participants completed self-report questionnaires to assess misophonia symptoms (i.e., misophonia sounds, emotional and behavioral reactions to misophonia sounds, and misophonia-related impairment), stress, and emotion dysregulation. The results revealed participants with misophonia reported significantly worse emotion regulation abilities compared to individuals with subclinical levels of misophonia. In addition, emotion dysregulation was significantly associated with sensitivity to misophonia sounds, reactions to misophonia sounds, and misophonia-related impairment, even after accounting for covariates. Results support emotion dysregulation as an important element in misophonia and suggest certain dimensions of emotion dysregulation should be considered in future research and in the evaluation of treatment strategies used to reduce misophonia symptoms.

The Daydream Spectrum: The Role of Emotional Dysregulation, Internalized Stigma and Self-Esteem in Maladaptive Daydreaming Among Adults With ADHD, ASD, and Double Diagnosis.

Maladaptive daydreaming (MD) is characterized by vivid, excessive fantasy activity that becomes prioritized over other activities and may result in avoidant coping strategies. Little is known about the relationship between MD and internalized stigma in the neurodivergent sample. The current study aimed to examine emotional dysregulation, escapism and self-perception (self-esteem and internalized stigma) as potential determinants of MD in three groups: adults on the autism spectrum, with ADHD, and both diagnoses ("AuDHD"), including their neurodivergent symptoms (autistic traits, empathizing, ADHD symptoms). A sample of 293 persons (139 with ADHD, 74 on the autism spectrum, and 80 with both diagnoses) completed self-report scales concerning ADHD symptoms, autism spectrum symptoms, empathizing, self-esteem, daydreaming as escapism, emotional dysregulation, maladaptive daydreaming, and internalized stigma. A correlation analysis was implemented. Additionally, a group comparison and quantile regression for the 25th, 50th, and 75th percentile of maladaptive daydreaming in the three groups were executed. The results showed that internalized stigma, emotional dysregulation, escapism, and self-esteem have significant associations with MD in the neurodiverse sample. The ADHD group achieved the lowest scores in emotional dysregulation, discrimination experience, and social withdrawal. The groups did not vary in MD rates, stereotype endorsement, stigma resistance, nonacceptance of emotional responses, and impulse control difficulties. The AuDHD group achieved higher results than the ASD group only in the ADHD symptoms. Quantile regression revealed differences in the predictors of maladaptive daydreaming in the three groups. ADHD symptoms and self-suppression escapism were significant predictors for the higher levels of MD in persons with singular autism or ADHD diagnosis. The results showed no differences in MD rates, although there were significant variations in predictive features among the three samples. The role of internalized stigma and self-esteem was highlighted in the results as significant associates of MD prevalence. These outcomes expand the current knowledge in the context of maladaptive daydreaming, internalized stigma, self-esteem and emotional dysregulation in a neurodiverse sample and allow for proposing clinical applications and further research directions.

Mediating effects of child schema mode in the relationship between negative parent-child relationships in childhood and non-suicidal self-injurious behavior in college students

This study was aimed to investigate the psychological mechanisms underlying non-suicidal self-injurious behavior. For this purpose, we hypothesized that dysfunctional child modes act as a psychological mechanism to influence the relationship between negative parent-child relationships in childhood and current cognitions (catastrophizing), emotions (emotional dysregulation and depression), and behaviors (non-suicidal self-injurious behaviors). A sample of 430 college students (male 97, female 333) with experience of non-suicidal self-injurious behavior was selected to test the multi-mediation effects of child schema mode (angry, impulsive), catastrophizing, emotional dysregulation, and depression on the relationship between negative parent-child relationships in childhood and non-suicidal self-injury. As a result of structural equation modeling analysis, it was found that negative parent-child relationships in childhood directly influenced child schema mode, catastrophizing, depression, and non-suicidal self-injurious behaviors. In addition, it was found that negative parent-child relationships in childhood were dually mediated by child schema mode and depression and child schema mode and emotional dysregulation. The present study highlights the mediating role of child schema modes as a psychological mechanism underlying the relationship between negative parent-child relationships in childhood and non-suicidal self-injurious behavior. Based on these findings, the usefulness and direction of schema therapy interventions in the field of non-suicidal self-injury counseling are discussed.

Sexual Victimization History and Emotion Regulation in Daily Life: A Role for Stress Sensitization.

Relative to other types of traumatic experiences, a lifetime history of sexual violence (SV) has been linked with more persistent and severe mental health outcomes, but the reasons for this discrepancy have not been clearly established. Stress sensitization, or the amplification of responses to daily stressors as a function of trauma history, offers one possible explanation. Using ecological momentary assessment, the current study tested stress sensitization effects in daily life for individuals with a history of SV, focusing on emotion regulation as an outcome. Smartphone surveys were delivered four times per day over a 2-week period to assess relationships between prior SV exposure, daily stressors, and emotion regulation in an undergraduate sample (N = 122). As expected, individuals with lifetime exposure to SV evidenced increased emotion dysregulation and maladaptive emotion regulation in response to daily stressors relative to nonexposed peers, even after accounting for cumulative trauma. However, the SV and non-SV groups did not differ significantly on state adaptive emotion regulation. Instead, experiencing daily stressors was associated with increased adaptive emotion regulation for individuals in both groups. Broadly, results suggest that SV is uniquely associated with increased sensitivity to daily stressors, manifested as emotion dysregulation and use of maladaptive emotion regulation strategies to regulate emotions. These findings are consistent with emerging research on the neurobiology of trauma and with an emphasis on emotion regulation skills in leading interventions for SV-exposed individuals. Stress sensitization warrants additional attention as a factor linking SV and mental health problems.