Emotional Dysregulation and Temperament in Adolescents with Acute Psychiatric Conditions: Gender Differences and the Role of Psychiatric Diagnosis

Background: Emotional dysregulation (ED) is a transdiagnostic construct implicated in a broad range of psychiatric conditions. However, the influence of gender on ED remains understudied, particularly among adolescents with severe mood and behavioral disorders. Furthermore, few studies have controlled for confounding effects of specific psychiatric diagnoses. Methods: We assessed 182 adolescents (80.8% female; mean age 15.7 years) referred to our clinical institution. Participants completed the Cyclothymic–Hypersensitive Temperament Questionnaire (CHTQ), the Reactivity, Intensity, Polarity, and Stability Questionnaire (RIPoSt-Y), and the K-SADS-PL interview. Results: Females reported significantly higher levels of CHTQ mood lability (7.53 vs. 5.94, p = 0.012), RIPoSt-Y affective instability (62.33 vs. 53.31, p = 0.023), and interpersonal sensitivity (30.80 vs. 24.97, p < 0.001). They also exhibited higher rates of cyclothymic–hypersensitive temperament (46.6% vs. 14.7%, p = 0.001). Regression analysis revealed that gender and specific psychiatric diagnoses exerted significant independent effects on ED dimensions. Mood lability/hypersensitivity was significantly predicted by bipolar disorder (p = 0.001), depressive disorder (p = 0.002), and female sex (p = 0.025). Affective instability was independently predicted by bulimia nervosa (p = 0.019), depressive disorder (p = 0.004), and female sex (p = 0.033). Significant predictors for interpersonal sensitivity included female sex (p = 0.002), depressive disorder (p = 0.008), bulimia nervosa (p = 0.044), and the absence of conduct disorder (p = 0.048). Conclusions: Female adolescents with severe psychiatric presentations exhibited higher levels of ED, specifically regarding mood lability, affective instability, and interpersonal sensitivity. These associations persisted independently of current mood disorder diagnoses or comorbidities. While findings from this clinical cohort may not be fully generalizable to the general population, they highlight the need for gender-informed clinical interventions for adolescents characterized by severe ED.