Mind-Wandering, Emotion Dysregulation, and Non-Suicidal Self-Injury in Adult Attention-Deficit/Hyperactivity Disorder: A Comparative Study with Remitted Major Depressive Disorder Sema ÇAĞAL ᵃ, Erol OZAN ᵇ, Mehmet Akif ERSOY ᶜ, Beyhan ÖZYURT ᵈ

ÇAĞAL, Sema; OZAN, Erol; ERSOY, Mehmet Akif; ÖZYURT, Beyhan · 2026 · Crossref

DOI: 10.21203/rs.3.rs-9507122/v1

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Summary

This study investigates whether the association between Attention-Deficit/Hyperactivity Disorder (ADHD) and Non-Suicidal Self-Injury (NSSI) is independent of a history of depression. While NSSI and emotional dysregulation are common in both ADHD and Major Depressive Disorder (MDD), it remains unclear if these behaviors in ADHD stem from ADHD-specific cognitive processes, such as excessive mind-wandering, or from comorbid depressive symptoms. To address this, the researchers compared adults with ADHD to a control group of individuals with MDD in full remission (rMDD), aiming to determine if mind-wandering and emotional dysregulation are distinct features of ADHD or general mechanisms shared with depression. The cross-sectional study included 93 participants: 48 adults diagnosed with ADHD and 45 with rMDD, confirmed via the Structured Clinical Interview for DSM-5. Participants were matched for age, sex, and education, and excluded if they had comorbid mental disorders. Data were collected using the Adult ADD/ADHD Scale, the Inventory of Statements about Self-Injury (ISAS), the Difficulties in Emotion Regulation Scale (DERS), and the Mind Excessively Wandering Scale (MEWS). Statistical analyses included intergroup comparisons using non-parametric tests, Spearman’s rank correlations, and multivariate logistic regression to identify predictors of an ADHD diagnosis. Results indicated no significant differences between the ADHD and rMDD groups in lifetime NSSI prevalence or total DERS scores, suggesting similar levels of emotional dysregulation and self-harm history. However, MEWS scores were significantly higher in the ADHD group. Within the ADHD cohort, ADHD symptom severity strongly correlated with both mind-wandering (r=0.81) and emotional dysregulation (r=0.67). Crucially, ISAS scores correlated moderately with DERS (r=0.55) but not with ADHD severity or mind-wandering. Logistic regression revealed that age and illness duration predicted ADHD diagnosis, but mind-wandering scores did not independently predict the diagnosis. The ADHD group also reported significantly higher rates of childhood academic difficulties, disciplinary actions, and adult traffic violations. The findings suggest that excessive mind-wandering is a persistent, trait-like cognitive feature of adult ADHD, distinct from the rumination associated with depression. While emotional dysregulation is a transdiagnostic process present in both groups, NSSI in ADHD appears more closely linked to emotion regulation difficulties than to mind-wandering itself. The study concludes that mind-wandering in ADHD represents a multidimensional cognitive-emotional process involving internal distractibility and executive dysfunction. These results imply that clinical interventions for ADHD should extend beyond core attentional symptoms to include strategies targeting emotion regulation and mind-wandering to mitigate risky behaviors like NSSI.

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• anxiety depression driving