• emotional dysregulation
• attention-deficit/hyperactivity disorder.
• affective instability
• irritability
• emotional over-reactivity
• screening
• mood disorders
• anxiety disorders
• neurodevelopmental disorders
• bipolar disorder

Background: Emotional dysregulation (ED) refers to the inability to effectively manage emotional experiences or expressions that hinder appropriate goal-oriented behavior. Moderate impairment on at least two domains among temper control, affective lability, and emotional over-reactivity has been proposed to identify ED in adults with attention-deficit/hyperactivity disorder (ADHD). No screening measure designed for use in diverse psychiatric samples currently exists.
Aims: This study aimed to develop a self-report screening tool for ED based on the 40-item version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40). Criteria for identifying ED were predefined based on the previously suggested approach in adults with ADHD.
Methods: 150 adult outpatients were enrolled between February and July 2023 at the Second Psychiatry Unit of Pisa University Hospital. Differences between patients with and without ED were tested. To develop our screening instrument, a decision tree algorithm was trained by hyperparameter tuning through 5-fold cross-validation in 120 subjects and tested on the remaining 30.
Results: 75 subjects met criteria for ED (50%). ED was associated with lower age and higher prevalence of psychiatric conditions, including minor mood disorders, ADHD, cannabis use disorders, and eating disorders. We identified a decision tree consisting of six items from RIPoSt-40 that effectively detected ED. The algorithm exhibited accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 80% or higher in both the training and testing sets.
Conclusion: The screening version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-SV) demonstrates promise as a valuable tool for ED screening in clinical settings.