• ADHD
• affective temperaments
• Cyclothymia
• Emotional Dysregulation
• RIPOST
• scale
• validation

BACKGROUND: Emotional Dysregulation (ED) is a condition characterized by intense and rapid mood changes of both polarities and by the tendency to over-react to external stimuli, especially within the interpersonal field. ED is subordinate to the broader construct of affective disturbance, defined as a disruption in the multi-system response (subjective experience, expressive behaviours, physiology) of emotions, moods, and stress responses that can lead to impulsive behaviours. There are many important correlations between affective temperaments and different aspects of ED and impulsivity. Cyclothymic and irritable temperament proved to be positively linked with the trait impulsiveness. Attentional impulsiveness revealed significant positive correlations with depressive, cyclothymic, irritable and anxious temperament and negative correlation with hyperthymic temperament. ED, emotional impulsiveness, mood instability and emotional lability have been used to refer to similar conceptualizations and represents the temperamental basis of cyclothymia. Different degrees of ED, associated with changes of energy and motivation, are described in cluster B personality disorders and in all neurodevelopmental disorders. The fact that all these conditions share with cyclothymia difficulties in modulating their behaviours during emotional states suggests a plausible common neurophysiological basis. The association between ADHD and affective lability as well as stress intolerance, mood instability, and emotional over-reactivity has been analysed in several studies. Furthermore, it has been proposed that ED traits should be considered a core feature of ADHD, along with hyperactivity and inattention, rather than associated symptoms.
AIM OF THE STUDY: The main purpose of this study was to evaluate and validate the psychometric properties of the Italian version of the “Reactivity Intensity Polarity and Stability scale” (RIPoSt) in clinical populations of Cyclothymic and ADHD patients and control subjects. Our working hypotheses was the existence of higher RIPoSt scores in patients with a diagnosis of cyclothymia or ADHD than controls, and a correlation between the elevated emotional dysregulation and the cyclothymic temperament.
METHODS: The study sample consisted of 374 subjects (33.08 years, SD ± 11.5) divided in 51 ADHD patients, 120 cyclothymic patients and 203 adult healthy controls. There were 250 females (66.8%) and 124 males (33.2%). Reliability and validity were assessed by standard psychometric tests (Convergent Validity, Known Groups validity, Factor analysis). We examined the internal consistency of the RIPoSt scale, as well as the validity of this questionnaire, by testing its associations with an existing and validated scale for temperament evaluation (Brief TEMPS-M).
RESULTS: The reliability was excellent for both RIPOST total score and every single subscale, exceeding the value of .70 (ranging from .723 to .963). Only the Emotional Polarity (P/N) subscale showed a lower but still acceptable level of reliability with a .723 for the whole sample (and with values of the subscales ranging from .694 to .715). Every single subscale and the RIPOST total score were positively and significantly correlated with one another (p<.001), with Pearson’s coefficients ranging from .646 to .797. In addition, the subscale scores were highly correlated with the RIPOST total score, with coefficients ranging from .846 to .914. Moreover, RIPoSt total score was positively and strongly correlated with the Depressive and Cyclothymic Brief TEMPS-M subscales (Pearson’s coefficients respectively .700 and .800). Post hoc comparisons using the Scheffe’s test revealed a significant difference between the 3 groups, with higher scores for Cyclothymic and ADHD patients. Principal Components Analysis with Varimax rotation resulted in a 4-factor solution: the first with highest explained variance (16.570%) represents Emotional Intensity; the second identifies Emotional Instability (14.639% of variance); the third Emotional Impulsivity (11.438% of variance); the fourth Positive Emotionality (9.887% of variance). Post hoc comparisons using the Scheffe's test revealed significant differences in factor scores between the 3 groups, with higher scores for Cyclothymic and ADHD patients in factor 1, 2 and 3. No significant differences among groups were observed in the factor 4.
CONCLUSIONS: Excellent internal consistency was found as well as a strong convergent validity with the Brief TEMPS-M scale, who explored the temperament of the subjects. As expected, the questionnaire performed differently among the three diagnostic groups explored. The results also provided strong support for convergent validity, with a significant correlation with the Brief TEMPS-M scale. Particularly, all the RIPoSt scores appeared to be from moderately to strongly correlated with the with Cyclothymic, Irritable, Depressive and Anxious temperaments. There was no correlation with Hyperthymic temperament. The RIPoSt scale showed good psychometric properties, as outlined above, and might be a promising instrument to use in different psychiatric samples, in order to identify specific phenotypes to be used in clinical, neurobiological and genetic studies.