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Saturday, August 1, 2026

Behavioral epigenetics

From Wikipedia, the free encyclopedia

Behavioral epigenetics is the field of study examining the role of epigenetics in shaping animal and human behavior. It seeks to explain how nurture shapes nature, where nature refers to biological heredity and nurture refers to virtually everything that occurs during the life-span (e.g., social-experience, diet and nutrition, and exposure to toxins). Behavioral epigenetics attempts to provide a framework for understanding how the expression of genes is influenced by experiences and the environment to produce individual differences in behaviourcognitionpersonality, and mental health.

Epigenetic gene regulation involves changes other than to the sequence of DNA and includes changes to histones (proteins around which DNA is wrapped) and DNA methylation. These epigenetic changes can influence the growth of neurons in the developing brain as well as modify the activity of neurons in the adult brain. Together, these epigenetic changes in neuron structure and function are thought to have an influence on behavior.

Background

In biology, and specifically genetics, epigenetics is the study of heritable changes in gene activity which are not caused by changes in the DNA sequence; the term can also be used to describe the study of stable, long-term alterations in the transcriptional potential of a cell that are not necessarily heritable. Genetic activity can be influenced by environmental factors, as well as parenting styles, diet and even social interactions.

Examples of mechanisms that produce such changes are DNA methylation and histone modification, both alter how genes are expressed without changing the underlying DNA sequence and both are also essential for learning and memory. Gene expression can be controlled through the action of repressor proteins that attach to silencer regions of the DNA.

Modifications of the epigenome do not alter DNA.

DNA methylation turns a gene "off" – it results in the inability of genetic information to be read from DNA; removing the methyl tag can turn the gene back "on".

Histone modification changes the way that DNA is packaged into chromosomes. These changes impact how genes are expressed.

Epigenetic changes occur not only in the developing fetus, but also in individuals throughout the human life-span.

Discovery

The first documented example of epigenetics affecting behavior was provided by Michael Meaney and Moshe Szyf. While working at McGill University in Montréal in 2004, they discovered that the type and amount of nurturing a mother rat provides in the early weeks of the rat's infancy determines how that rat responds to stress later in life. This stress sensitivity was linked to a down-regulation in the expression of the glucocorticoid receptor in the brain. In turn, this down-regulation was found to be a consequence of the extent of methylation in the promoter region of the glucocorticoid receptor gene. Immediately after birth, Meaney and Szyf found that methyl groups repress the glucocorticoid receptor gene in all rat pups, making the gene unable to unwind from the histone in order to be transcribed, causing a decreased stress response. Nurturing behaviours from the mother rat were found to stimulate activation of stress signalling pathways that remove methyl groups from DNA. This releases the tightly wound gene, exposing it for transcription. The glucocorticoid gene is activated, resulting in lowered stress response. Rat pups that receive a less nurturing upbringing are more sensitive to stress throughout their life-span.

This pioneering work in rodents has been difficult to replicate in humans because of a general lack of availability of human brain tissue for measurement of epigenetic changes.

Cognition

Learning and memory

A 2010 review discussed the role of DNA methylation in memory formation and storage, but the precise mechanisms involving neuronal function, memory, and methylation reversal remained unclear at the time.

Further research investigated the molecular basis for long-term memory. By 2015 it had become clear that long-term memory requires gene transcription activation and de novo protein synthesis. Long-term memory formation depends on both the activation of memory promoting genes and the inhibition of memory suppressor genes, and DNA methylation/DNA demethylation was found to be a major mechanism for achieving this dual regulation.

Rats with a new, strong long-term memory due to contextual fear conditioning have reduced expression of about 1,000 genes and increased expression of about 500 genes in the hippocampus of the brain 24 hours after training, thus exhibiting modified expression of 9.17% of the rat hippocampal genome. Reduced gene expressions were associated with methylations of those genes and hypomethylation was found for genes involved in synaptic transmission and neuronal differentiation.

Further research into long-term memory has shed light on the molecular mechanisms by which methylation is created or removed, as reviewed in 2022. These mechanisms include, for instance, signal-responsive TOP2B-induced double-strand breaks in immediate early genes. More than 100 DNA double-strand breaks occur, both in the hippocampus and in the medial prefrontal cortex (mPFC), in two peaks, at 10 minutes and at 30 minutes after contextual fear conditioning. This appears to be earlier than the DNA methylations and demethylations of neuron DNA in the hippocampus that were measured at one hour and 24 hours after contextual fear conditioning.

The double strand breaks occur at known memory-related immediate early genes (among other genes) in neurons after neuron activation. These double-strand breaks allow the genes to be transcribed and then translated into active proteins.

One immediate early gene newly transcribed after a double-strand break is EGR1. EGR1 is an important transcription factor in memory formation. It has an essential role in brain neuron epigenetic reprogramming. EGR1 recruits the TET1 protein that initiates a pathway of DNA demethylation. Removing DNA methylation marks allows the activation of downstream genes (see Regulation of gene expression#Regulation of transcription in learning and memory. EGR1 brings TET1 to promoter sites of genes that need to be demethylated and activated (transcribed) during memory formation. EGR-1, together with TET1, is employed in programming the distribution of DNA demethylation sites on brain DNA during memory formation and in long-term neuronal plasticity.

DNMT3A2 is another immediate early gene whose expression in neurons can be induced by sustained synaptic activity. DNMTs bind to DNA and methylate cytosines at particular locations in the genome. If this methylation is prevented by DNMT inhibitors, then memories do not form. If DNMT3A2 is over-expressed in the hippocampus of young adult mice it converts a weak learning experience into long-term memory and also enhances fear memory formation.

In another mechanism reviewed in 2022, the messenger RNAs of many genes that had been subjected to methylation-controlled increases or decreases are transported by neural granules (messenger RNPs) to the dendritic spines. At these locations the messenger RNAs can be translated into the proteins that control signaling at neuronal synapses.

Studies in rodents have found that the environment exerts an influence on epigenetic changes related to cognition, in terms of learning and memory; environmental enrichment correlated with increased histone acetylation, and verification by administering histone deacetylase inhibitors induced sprouting of dendrites, an increased number of synapses, and reinstated learning behaviour and access to long-term memories. Research has also linked learning and long-term memory formation to reversible epigenetic changes in the hippocampus and cortex in animals with normal-functioning, non-damaged brains. In human studies, post-mortem brains from patients with Alzheimer's dementia show high levels of histone de-acetylase.

Psychopathology and mental health

Anxiety and risk-taking

Monozygotic twins are identical twins. Twin studies help to reveal epigenetic differences related to various aspects of psychology.

Due to the stress that can be placed on individuals can increase levels of anxiety and the way the epigenetics are responding in relation to the individual. Epigenetics investigate how alterations upon environment and behavior can affect the way in which genes operate. Within research, it's know that majority of epigenetic modifications identified have been involved with anxiety-like phenotypes that involve genes that regulate the hypothalamic-pituitary adrenal axis which results to the way our bodies respond to stress that we endure as people. Epigenetics is altered by many influences, whether it be genetic and or environmental. Within the prenatal times it is evident that through changes of DNA methylation, that maternal and pre-maternal distress have been connected to modifications in the fetal HPA axis. This demonstrates that the link between our development, stress and anxiety a mother can feel during this time creates a linkage in the response of how the epigenetic may be altered in the response of the HPA axis. Linkage of the impacts of childhood trauma in connection with epigenetic and anxiety, in that there is a change in DNA methylation process, increasing the chances of neuroendocrine damage to likely occur. In relation, the neuroendocrine damage induces the state of depression, making it mentally unstable for a person to possibly perform their daily activities. The Brain-derived neurotropic factor (BDNF) is known to change its state because of epigenetic mechanisms and contributes to the alters within the development process necessary for the brain of us individuals. Alterations within the epigenetic process can be treated using different types clinical procedures, by targeting specific changes and the treating them with the proper sort of care.

Stress

The hypothalamic pituitary adrenal axis is involved in the human stress response.

Animal and human studies have found correlations between poor care during infancy and epigenetic changes that correlate with long-term impairments that result from neglect.

Studies in rats have shown correlations between maternal care in terms of the parental licking of offspring and epigenetic changes. A high level of licking results in a long-term reduction in stress response as measured behaviorally and biochemically in elements of the hypothalamic-pituitary-adrenal axis (HPA). Further, decreased DNA methylation of the glucocorticoid receptor gene were found in offspring that experienced a high level of licking; the glucorticoid receptor plays a key role in regulating the HPA. The opposite is found in offspring that experienced low levels of licking, and when pups are switched, the epigenetic changes are reversed. This research provides evidence for an underlying epigenetic mechanism. Further support comes from experiments with the same setup, using drugs that can increase or decrease methylation. Finally, epigenetic variations in parental care can be passed down from one generation to the next, from mother to female offspring. Female offspring who received increased parental care (i.e., high licking) became mothers who engaged in high licking and offspring who received less licking became mothers who engaged in less licking.

In humans, a small clinical research study showed the relationship between prenatal exposure to maternal mood and genetic expression resulting in increased reactivity to stress in offspring. Three groups of infants were examined: those born to mothers medicated for depression with serotonin reuptake inhibitors; those born to depressed mothers not being treated for depression; and those born to non-depressed mothers. Prenatal exposure to depressed/anxious mood was associated with increased DNA methylation at the glucocorticoid receptor gene and to increased HPA axis stress reactivity. The findings were independent of whether the mothers were being pharmaceutically treated for depression.

Drug addiction

Signaling cascade in the nucleus accumbens that results in psychostimulant addiction
This diagram depicts the signaling events in the brain's reward center that are induced by chronic high-dose exposure to psychostimulants that increase the concentration of synaptic dopamine, like amphetamine, methamphetamine, and phenethylamine. Following presynaptic dopamine and glutamate co-release by such psychostimulants, postsynaptic receptors for these neurotransmitters trigger internal signaling events through a cAMP-dependent pathway and a calcium-dependent pathway that ultimately result in increased CREB phosphorylation. Phosphorylated CREB increases levels of ΔFosB, which in turn represses the c-Fos gene with the help of corepressorsc-Fos repression acts as a molecular switch that enables the accumulation of ΔFosB in the neuron. A highly stable (phosphorylated) form of ΔFosB, one that persists in neurons for 1–2 months, slowly accumulates following repeated high-dose exposure to stimulants through this process. ΔFosB functions as "one of the master control proteins" that produces addiction-related structural changes in the brain, and upon sufficient accumulation, with the help of its downstream targets (e.g., nuclear factor kappa B), it induces an addictive state.
 

Environmental and epigenetic influences seem to work together to increase the risk of addiction. For example, environmental stress has been shown to increase the risk of substance abuse. In an attempt to cope with stress, alcohol and drugs can be used as an escape. Once substance abuse commences, however, epigenetic alterations may further exacerbate the biological and behavioural changes associated with addiction.

Even short-term substance abuse can produce long-lasting epigenetic changes in the brain of rodents, via DNA methylation and histone modification. Epigenetic modifications have been observed in studies on rodents involving ethanol, nicotine, cocaine, amphetamine, methamphetamine and opiates. Specifically, these epigenetic changes modify gene expression, which in turn increases the vulnerability of an individual to engage in repeated substance overdose in the future. In turn, increased substance abuse results in even greater epigenetic changes in various components of a rodent's reward system (e.g., in the nucleus accumbens). Hence, a cycle emerges whereby changes in areas of the reward system contribute to the long-lasting neural and behavioural changes associated with the increased likelihood of addiction, the maintenance of addiction and relapse. In humans, alcohol consumption has been shown to produce epigenetic changes that contribute to the increased craving of alcohol. As such, epigenetic modifications may play a part in the progression from the controlled intake to the loss of control of alcohol consumption. These alterations may be long-term, as is evidenced in smokers who still possess nicotine-related epigenetic changes ten years after cessation. Therefore, epigenetic modifications may account for some of the behavioural changes generally associated with addiction. These include: repetitive habits that increase the risk of disease, and personal and social problems; need for immediate gratification; high rates of relapse following treatment; and, the feeling of loss of control.

Evidence for relevant epigenetic changes came from human studies involving alcohol, nicotine, and opiate abuse. Evidence for epigenetic changes stemming from amphetamine and cocaine abuse derives from animal studies. In animals, drug-related epigenetic changes in fathers have also been shown to negatively affect offspring in terms of poorer spatial working memory, decreased attention and decreased cerebral volume.

Eating disorders and obesity

Epigenetic changes may help to facilitate the development and maintenance of eating disorders via influences in the early environment and throughout the life-span. Pre-natal epigenetic changes due to maternal stress, behaviour and diet may later predispose offspring to persistent, increased anxiety and anxiety disorders. These anxiety issues can precipitate the onset of eating disorders and obesity, and persist even after recovery from the eating disorders.

Epigenetic differences accumulating over the life-span may account for the incongruent differences in eating disorders observed in monozygotic twins. At puberty, sex hormones may exert epigenetic changes (via DNA methylation) on gene expression, thus accounting for higher rates of eating disorders in men as compared to women. Overall, epigenetics contribute to persistent, unregulated self-control behaviours related to the urge to binge.

Schizophrenia

Epigenetic changes including hypomethylation of glutamatergic genes (i.e., NMDA-receptor-subunit gene NR3B and the promoter of the AMPA-receptor-subunit gene GRIA2) in the post-mortem brains of people with schizophrenia are associated with increased levels of the neurotransmitter glutamate. Since glutamate is the most prevalent, fast, excitatory neurotransmitter, increased levels may result in the psychotic episodes related to schizophrenia. Epigenetic changes affecting a greater number of genes have been detected in men with schizophrenia as compared to women with the illness.

Population studies have established a strong association linking schizophrenia in children born to older fathers. Specifically, children born to fathers over the age of 35 years are up to three times more likely to develop schizophrenia. Epigenetic dysfunction in human male sperm cells, affecting numerous genes, have been shown to increase with age. This provides a possible explanation for increased rates of the disease in men. To this end, toxins (e.g., air pollutants) have been shown to increase epigenetic differentiation. Animals exposed to ambient air from steel mills and highways show drastic epigenetic changes that persist after removal from the exposure. Therefore, similar epigenetic changes in older human fathers are likely. Schizophrenia studies provide evidence that the nature versus nurture debate in the field of psychopathology should be re-evaluated to accommodate the concept that genes and the environment work in tandem. As such, many other environmental factors (e.g., nutritional deficiencies and cannabis use) have been proposed to increase the susceptibility of psychotic disorders like schizophrenia via epigenetics.

Bipolar disorder

Evidence for epigenetic modifications for bipolar disorder is unclear. One study found hypomethylation of a gene promoter of a prefrontal lobe enzyme (i.e., membrane-bound catechol-O-methyl transferase, or COMT) in post-mortem brain samples from individuals with bipolar disorder. COMT is an enzyme that metabolizes dopamine in the synapse. These findings suggest that the hypomethylation of the promoter results in over-expression of the enzyme. In turn, this results in increased degradation of dopamine levels in the brain. These findings provide evidence that epigenetic modification in the prefrontal lobe is a risk factor for bipolar disorder. However, a second study found no epigenetic differences in post-mortem brains from bipolar individuals.

Major depressive disorder

The causes of major depressive disorder (MDD) are poorly understood from a neuroscience perspective. The epigenetic changes leading to changes in glucocorticoid receptor expression and its effect on the HPA stress system discussed above, have also been applied to attempts to understand MDD.

Much of the work in animal models has focused on the indirect downregulation of brain derived neurotrophic factor (BDNF) by over-activation of the stress axis. Studies in various rodent models of depression, often involving induction of stress, have found direct epigenetic modulation of BDNF as well.

Psychopathy

Epigenetics may be relevant to aspects of psychopathic behaviour through methylation and histone modification. These processes are heritable but can also be influenced by environmental factors such as smoking and abuse. Epigenetics may be one of the mechanisms through which the environment can impact the expression of the genome. Studies have also linked methylation of genes associated with nicotine and alcohol dependence in women, ADHD, and drug abuse. It is probable that epigenetic regulation as well as methylation profiling will play an increasingly important role in the study of the play between the environment and genetics of psychopaths.

Social insects

Several studies have indicated DNA cytosine methylation linked to the social behavior of insects, such as honeybees and ants. In honeybees, when nurse bee switched from her in-hive tasks to out foraging, cytosine methylation marks are changing. When a forager bee was reversed to do nurse duties, the cytosine methylation marks were also reversed. Knocking down the DNMT3 in the larvae changed the worker to queen-like phenotype. Queen and worker are two distinguish castes with different morphology, behavior, and physiology. Studies in DNMT3 silencing also indicated DNA methylation may regulate gene alternative splicing and pre-mRNA maturation.

Limitations and future direction

Many researchers contribute information to the Human Epigenome Consortium. The aim of future research is to reprogram epigenetic changes to help with addiction, mental illness, age related changes, memory decline, and other issues. However, the sheer volume of consortium-based data makes analysis difficult. Most studies also focus on one gene. In actuality, many genes and interactions between them likely contribute to individual differences in personality, behaviour and health. As social scientists often work with many variables, determining the number of affected genes also poses methodological challenges. More collaboration between medical researchers, geneticists and social scientists has been advocated to increase knowledge in this field of study.

Limited access to human brain tissue poses a challenge to conducting human research. Not yet knowing if epigenetic changes in the blood and (non-brain) tissues parallel modifications in the brain, places even greater reliance on brain research. Although some epigenetic studies have translated findings from animals to humans, some researchers caution about the extrapolation of animal studies to humans. One view notes that when animal studies do not consider how the subcellular and cellular components, organs and the entire individual interact with the influences of the environment, results are too reductive to explain behaviour.

Some researchers note that epigenetic perspectives will likely be incorporated into pharmacological treatments. Others caution that more research is necessary as drugs are known to modify the activity of multiple genes and may, therefore, cause serious side effects. However, the ultimate goal is to find patterns of epigenetic changes that can be targeted to treat mental illness, and reverse the effects of childhood stressors, for example. If such treatable patterns eventually become well-established, the inability to access brains in living humans to identify them poses an obstacle to pharmacological treatment. Future research may also focus on epigenetic changes that mediate the impact of psychotherapy on personality and behaviour.

Most epigenetic research is correlational; it merely establishes associations. More experimental research is necessary to help establish causation. Lack of resources has also limited the number of intergenerational studies. Therefore, advancing longitudinal and multigenerational, experience-dependent studies will be critical to further understanding the role of epigenetics in psychology.

Emotional dysregulation

From Wikipedia, the free encyclopedia

Emotional dysregulation is characterized by an inability to flexibly respond to and manage emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.

It is often linked to physical factors such as brain injury, psychological factors such as adverse childhood experiences, and ongoing maltreatment including child abuse, neglect, or institutional abuse.

Emotional dysregulation may be present in people with psychiatric and neurodevelopmental disorders such as attention deficit hyperactivity disorderautism spectrum disorder, bipolar disorder, borderline personality disorder, complex post-traumatic stress disorder, and fetal alcohol spectrum disorders. The dysregulation of emotions is also present in individuals with mood disorders and anxiety disorders. In such cases as borderline personality disorder and complex post-traumatic stress disorder, hypersensitivity to emotional stimuli causes a slower return to a normal emotional state and may reflect deficits in prefrontal regulatory regions. Damage to the frontal cortices of the brain can cause deficits in behavior that can severely impact an individual's ability to manage their daily life. As such, the period after a traumatic brain injury, such as a frontal lobe disorder, can be marked by emotional dysregulation. This is also true of neurodegenerative diseases.

Possible manifestations of emotion dysregulation include extreme tearfulness, angry outbursts or behavioral outbursts such as destroying or throwing objects, aggression towards self or others, and threats to kill oneself. Emotion dysregulation can lead to behavioral problems and can interfere with a person's social interactions and relationships at home, in school, or at their place of employment.

Etymology

The word dysregulation is a neologism created by combining the prefix dys- to regulation. According to Webster's Dictionary, dys- has various roots and is of Greek origin. With Latin and Greek roots, it is akin to Old English tō-, te- 'apart' and Sanskrit dus- 'bad, difficult'. It is frequently confused with the spelling disregulation, with the prefix dis meaning 'the opposite of' or 'absence of'; while disregulation refers to the removal or absence of regulation, dysregulation refers to ways of regulating that are inappropriate or ineffective.

Child psychopathology

There are links between child emotional dysregulation and later psychopathology. For instance, ADHD symptoms are associated with problems with emotional regulation, motivation, and arousal. One study found a connection between emotional dysregulation at 5 and 10 months, and parent-reported problems with anger and distress at 18 months. Low levels of emotional regulation behaviors at 5 months were also related to non-compliant behaviors at 30 months. While links have been found between emotional dysregulation and child psychopathology, the mechanisms behind how early emotional dysregulation and later psychopathology are related are not yet clear.

Symptoms

Smoking, self-harm, eating disorders, and addiction have all been associated with emotional dysregulation. Somatoform disorders may be caused by a decreased ability to regulate and experience emotions or an inability to express emotions in a positive way. Individuals who have difficulty regulating emotions are at risk for eating disorders and substance abuse, as they may use food or substances as a way to regulate their emotions. Emotional dysregulation is also found in people who have an increased risk of developing a mental disorder, particularly an affective disorder such as depression or bipolar disorder.

Childhood

Dysregulation is more prevalent in children, and is generally seen to decrease as children develop. During early childhood, emotional dysregulation or reactivity is considered to be situational rather than indicative of emotional disorders. It is important to consider parental mood disorders as genetic and environmental determinants. Children of parents with symptoms of depression are less likely to learn strategies for regulating their emotions and are at risk of inheriting a mood disorder. When parents have difficulty regulating their emotions, they often cannot teach their children to regulate properly. The role of parents in a child's development is acknowledged by attachment theory, which argues that the characteristics of the caregiver-child relationship impact future relationships. Current research indicates that parent-child relationships characterized by less affection and greater hostility may result in children developing emotional regulation problems. If the child's emotional needs are ignored or rejected, they may experience greater difficulty dealing with emotions in the future. Moreover, conflict between parents is linked to increased emotional reactivity or dysregulation in children. Other factors involved include the quality of relationship with peers, the child's temperament, and social or cognitive understanding. Additionally, loss or grief can contribute to emotional dysregulation.

Research has shown that failures in emotional regulation may be related to the display of acting out, externalizing disorders, or behavior problems. When presented with challenging tasks, children who were found to have defects in emotional regulation (high-risk) spent less time attending to tasks and more time throwing tantrums or fretting than children without emotional regulation problems (low-risk). High-risk children had difficulty with self-regulation, had difficulty complying with requests from caregivers and were more defiant. Emotional dysregulation has also been associated with childhood social withdrawal.

Internalizing behaviors

Emotional dysregulation in children can be associated with internalizing behaviors including:

  • exhibiting emotions too intense for a situation;
  • difficulty calming down when upset;
  • difficulty decreasing negative emotions;
  • being less able to calm themselves;
  • difficulty understanding emotional experiences;
  • becoming avoidant or aggressive when dealing with negative emotions; and
  • experiencing more negative emotions.

Externalizing behaviors

Emotional dysregulation in children can be associated with externalizing behaviors including:

  • exhibiting more extreme emotions;
  • difficulty identifying emotional cues;
  • difficulty recognizing their own emotions;
  • focusing on the negative;
  • difficulty controlling their attention;
  • being impulsive;
  • difficulty decreasing their negative emotions; and
  • difficulty calming down when upset.

Adolescence

In adolescents, emotional dysregulation is a risk factor for many mental health disorders including depressive disorders, anxiety disorders, post-traumatic stress disorder, bipolar disorder, borderline personality disorder, substance use disorder, alcohol use disorder, eating disorders, oppositional defiant disorder, and disruptive mood dysregulation disorder. Dysregulation is also associated with self-injury, suicidal ideation, suicide attempts, and risky sexual behavior. Emotional dysregulation is not a diagnosis, but an indicator of an emotional or behavioral problem that may need intervention.

Attachment theory and the idea of an insecure attachment are implicated in emotional dysregulation. Greater attachment security correlates with less emotional dysregulation in daughters. Moreover, it has been observed that more female teens struggle with emotional dysregulation than males. Professional treatment, such as therapy or admittance into a psychiatric facility, is recommended.

Adulthood

Emotional dysregulation tends to present as emotional responses that may seem excessive compared to the situation. Individuals with emotional dysregulation may have difficulty calming down, avoiding difficult feelings, or focusing on the negative.[37] On average, women tend to score higher on scales of emotional reactivity than men.[40][41][42] A study at University College Dublin found that dysregulation correlates to negative feelings about one's ability to cope with emotions and rumination in adults. They also found dysregulation to be common in a sample of individuals not affected by mental disorders.

Part of emotional dysregulation, which is a core characteristic in borderline personality disorder, is affective instability, which manifests as rapid and frequent shifts in mood of high affect intensity and rapid onset of emotions, often triggered by environmental stimuli. The return to a stable emotional state is notably delayed, exacerbating the challenge of achieving emotional equilibrium. This instability is further intensified by an acute sensitivity to psychosocial cues, leading to significant challenges in managing emotions effectively.

Effect on relationships

Established relationships

Relationships are generally linked to better well-being, but dissatisfaction in relationships can lead to increased divorce, worsened health, and potential violence. Emotional dysregulation plays a role in relationship quality and overall satisfaction. It can be difficult for emotionally dysregulated individuals to maintain healthy relationships. People who struggle with emotional dysregulation often externalize, internalize, or dissociate when exposed to stressors. These behaviors are attempts to regulate emotions but often are ineffective in addressing stress in relationships. This commonly presents itself as intense anxiety around relationships, poor ability to set and sustain boundaries, frequent and damaging arguments, preoccupation with loneliness, worries about losing a relationship, and jealous or idealizing feelings towards others. These feelings may be accompanied by support-seeking behaviors such as clinging, smothering, or seeking to control.

The counterpart of emotional dysregulation, emotional regulation, strengthens relationships. The ability to regulate negative emotions in particular is linked to positive coping and thus higher relationship satisfaction. Emotional regulation and communication skills are linked to secure attachment, which has been related to higher partner support as well as openness in discussing negative experiences and resolving conflict. On the other hand, emotional dysregulation has a negative impact on relationships. Multiple studies note the effects of emotion dysregulation on relationship quality. One study found that relationship satisfaction is lower in couples that lack impulse control or regulatory strategies. Another study found that both husbands' and wives' emotional reactivity was negatively linked with marriage quality as well as perceptions of partner responsiveness. The literature concludes that dysregulation increases instances of perceived criticism, contributes to physical and psychological violence, and worsens depression, anxiety, and sexual difficulties. Dysregulation has also been observed to lower empathy and decrease relationship satisfaction, quality, and intimacy.

Sexual health

Research conflicts on whether higher levels of emotional reactivity are linked to increases or decreases in sexual desire. Moreover, this effect could differ between men and women based on observed differences in emotional reactivity between genders. Some research posits that higher emotional reactivity in women is linked to greater sexual attraction in their male partners. However, difficulties in regulating emotions have been linked to poorer sexual health, both in terms of ability and overall satisfaction.

Emotional dysregulation plays a role in nonconsensual and violent sexual encounters. Emotional regulation skills prevent verbal coercion by regulating feelings of sexual attraction in men. Consequently, a lack of emotional regulation skills can cause both internalizing and externalizing behaviors in a sexual context. This may mean violence, which can serve as a strategy for regulating emotion. In a non-violent context, insecurely attached individuals may seek to satisfy their need for connection or to resolve relational issues with sex. Communication can also be hindered, as emotional dysregulation has been linked to an inability to express oneself in sexual situations. This can lead to victimization as well as further sexual difficulties. Thus, the ability to both recognize emotions and express negative emotions are important for communication and social adjustment, including within sexual contexts.

Mediating effects

While personal characteristics and experiences can contribute to externalizing and internalizing behaviors as listed above, emotional regulation has an interpersonal aspect. Couples who effectively co-regulate have higher emotional satisfaction and stability. Openly discussing emotions in the relationship can help to validate feelings of insecurity and encourage closeness. For partners who struggle with emotional dysregulation, there are available treatments. Couples' therapy has shown itself to be an effective method of improving relationship satisfaction and quality by positively affecting the process of emotional regulation in relationships.

Protective factors

Early experiences with caregivers can lead to differences in emotional regulation. The responsiveness of a caregiver to an infant's signals can help an infant regulate their emotional systems. Caregiver interaction styles that overwhelm a child or that are unpredictable may undermine emotional regulation development. Effective strategies involve working with a child to support developing self-control, such as modeling a desired behavior rather than demanding it.

The richness of an environment that a child is exposed to helps the development of emotional regulation. An environment must provide appropriate levels of freedom and constraint. The environment must allow opportunities for a child to practice self-regulation. An environment with opportunities to practice social skills without overstimulation or excessive frustration helps a child develop self-regulation skills.

Substance use

Several variables have been explored to explain the connection between emotional dysregulation and substance use in young adults, such as child maltreatment, cortisol levels, family environment, and symptoms of depression and anxiety. Vilhena-Churchill and Goldstein (2014) explored the association between childhood maltreatment and emotional dysregulation. More severe childhood maltreatment was found to be associated with an increase in difficulty regulating emotion, which in turn was associated with a greater likelihood of coping by using marijuana. Kliewer et al. (2016) performed a study on the relationship between negative family emotional climate, emotional dysregulation, blunted anticipatory cortisol, and substance use in adolescents. Increased negative family emotional climate was found to be associated with high levels of emotional dysregulation, which was then associated with increased substance use. Girls were seen to have blunted anticipatory cortisol levels, which was also associated with an increase in substance use. Childhood events and family climate with emotional dysregulation are both factors seemingly linked to substance use. Prosek, Giordano, Woehler, Price, and McCullough (2018) explored the relationship between mental health and emotional regulation in collegiate illicit substance users. Illicit drug users reported higher levels of depression and anxiety symptoms. Emotional dysregulation was more prominent in illicit drug users in the sense that they had less clarity and were less aware of their emotions when the emotions were occurring.

Treatment

Many people experience dysregulation and can struggle at times with uncontrollable emotions. Thus, potential underlying issues are important to consider in determining severity. As the ability to appropriately express and regulate emotions is related to better relationships and mental health, parental support can help regulate the emotions of children struggling with emotional dysregulation. Training to help parents address this issue focuses on predictability and consistency. These tenets are thought to provide comfort by creating a sense of familiarity and thus safety.

While cognitive behavioral therapy (CBT) is the most widely prescribed treatment for such psychiatric disorders, a commonly prescribed psychotherapeutic treatment for emotional dysregulation is dialectical behavioral therapy (DBT), a psychotherapy which promotes the use of mindfulness, a concept called dialectics, and emphasis on the importance of validation and maintaining healthy behavioral habits.

When diagnosed as being part of ADHD, norepinephrine and dopamine reuptake inhibitors such as methylphenidate (Ritalin) and atomoxetine are often used. A few studies have also showed promise in terms of non-pharmacological treatments for people with ADHD and emotional problems, although the research is limited and requires additional inquiry.

Eye Movement Desensitization and Reprocessing (EMDR) can help recovery from emotional dysregulation in cases where the dysregulation is a symptom of prior trauma. Outside of therapy, there are helpful strategies to help individuals recognize how they are feeling and put space between an event and their response. These include mindfulness, affirmations, and gratitude journaling. Hypnosis may also help to improve emotional regulation. Movement such as yoga and aerobic exercise can also be therapeutic by aiding with regulation and the ability to understand how one's mind influences behavior.

Molecular diagnostics

From Wikipedia, the free encyclopedia
Specialist using "QIAsymphony", an automation platform for molecular diagnostic tests

Molecular diagnostics is a collection of techniques used to analyze biological markers in the genome and proteome, and how their cells express their genes as proteins, applying molecular biology to medical testing. In medicine the technique is used to diagnose and monitor disease, detect risk, and decide which therapies will work best for individual patients, and in agricultural biosecurity similarly to monitor crop- and livestock disease, estimate risk, and decide what quarantine measures must be taken.

By analysing the specifics of the patient and their disease, molecular diagnostics offers the prospect of personalised medicine. These tests are useful in a range of medical specialties, including infectious disease, oncology, human leucocyte antigen typing (which investigates and predicts immune function), coagulation, and pharmacogenomicsthe genetic prediction of which drugs will work best. They overlap with clinical chemistry (medical tests on bodily fluids).

History

Molecular diagnostics uses techniques such as mass spectrometry and gene chips to capture the expression patterns of genes and proteins

The field of molecular biology grew in the late twentieth century, as did its clinical application. In 1980, Yuet Wai Kan et al. suggested a prenatal genetic test for Thalassemia that did not rely upon DNA sequencingthen in its infancybut on restriction enzymes that cut DNA where they recognised specific short sequences, creating different lengths of DNA strand depending on which allele (genetic variation) the fetus possessed. In the 1980s, the phrase was used in the names of companies such as Molecular Diagnostics Incorporated and Bethseda Research Laboratories Molecular Diagnostics.

During the 1990s, the identification of newly discovered genes and new techniques for DNA sequencing led to the appearance of a distinct field of molecular and genomic laboratory medicine; in 1995, the Association for Molecular Pathology (AMP) was formed to give it structure. In 1999, the AMP co-founded The Journal of Medical DiagnosticsInforma Healthcare launched Expert Reviews in Medical Diagnostics in 2001. From 2002 onwards, the HapMap Project aggregated information on the one-letter genetic differences that recur in the human populationthe single nucleotide polymorphismsand their relationship with disease. In 2012, molecular diagnostic techniques for Thalassemia use genetic hybridization tests to identify the specific single nucleotide polymorphism causing an individual's disease.

As the commercial application of molecular diagnostics has become more important, so has the debate about patenting of the genetic discoveries at its heart. In 1998, the European Union's Directive 98/44/ECclarified that patents on DNA sequences were allowable. In 2010 in the US, AMP sued Myriad Genetics to challenge the latter's patents regarding two genes, BRCA1, BRCA2, which are associated with breast cancer. In 2013, the U.S. Supreme Court partially agreed, ruling that a naturally occurring gene sequence could not be patented.

Techniques

The Affymetrix 5.0, a microarray chip

Development from research tools

The industrialisation of molecular biology assay tools has made it practical to use them in clinics. Miniaturisation into a single handheld device can bring medical diagnostics into the clinic and into the office or home. The clinical laboratory requires high standards of reliability; diagnostics may require accreditation or fall under medical device regulations. As of 2011, some US clinical laboratories nevertheless used assays sold for "research use only".

Laboratory processes need to adhere to regulations, such as the Clinical Laboratory Improvement Amendments, Health Insurance Portability and Accountability Act, Good Laboratory Practice, and Food and Drug Administration specifications in the United States. Laboratory Information Management Systems help by tracking these processes. Regulation applies to both staff and supplies. As of 2012, twelve US states require molecular pathologists to be licensed; several boards such as the American Board of Medical Genetics and the American Board of Pathology certify technologists, supervisors, and laboratory directors.

Automation and sample barcoding maximise throughput and reduce the possibility of error or contamination during manual handling and results reporting. Single devices to do the assay from beginning to end are now available.

Assays

Molecular diagnostics uses in vitro biological assays such as PCR-ELISA or Fluorescence in situ hybridization. The assay detects a molecule, often in low concentrations, that is a marker of disease or risk in a sample taken from a patient. Preservation of the sample before analysis is critical. Manual handling should be minimised. The fragile RNA molecule poses certain challenges. As part of the cellular process of expressing genes as proteins, it offers a measure of gene expression but it is vulnerable to hydrolysis and breakdown by ever-present RNAse enzymes. Samples can be snap-frozen in liquid nitrogen or incubated in preservation agents.

Because molecular diagnostics methods can detect sensitive markers, these tests are less intrusive than a traditional biopsy. For example, because cell-free nucleic acids exist in human plasma, a simple blood sample can be enough to sample genetic information from tumours, transplants or an unborn fetus. Many, but not all, molecular diagnostics methods based on nucleic acids detection use polymerase chain reaction (PCR) to vastly increase the number of nucleic acid molecules, thereby amplifying the target sequence(s) in the patient sample. PCR is a method that a template DNA is amplified using synthetic primers, a DNA polymerase, and dNTPs. The mixture is cycled between at least 2 temperatures: a high temperature for denaturing double-stranded DNA into single-stranded molecules and a low temperature for the primer to hybridize to the template and for the polymerase to extend the primer. Each temperature cycle theoretically doubles the quantity of target sequence. Detection of sequence variations using PCR typically involves the design and use oligonucleotide reagents that amplify the variant of interest more efficiently than wildtype sequence. PCR is currently the most widely used method for detection of DNA sequences. The detection of the marker might use real time PCR, direct sequencing, microarray chipsprefabricated chips that test many markers at once, or MALDI-TOF The same principle applies to the proteome and the genome. High-throughput protein arrays can use complementary DNA or antibodies to bind and hence can detect many different proteins in parallel. Molecular diagnostic tests vary widely in sensitivity, turn around time, cost, coverage and regulatory approval. They also vary in the level of validation applied in the laboratories using them. Hence, robust local validation in accordance with the regulatory requirements and use of appropriate controls is required especially where the result may be used to inform a patient treatment decision.

Benefits

A microarray chip contains complementary DNA (cDNA) to many sequences of interest. The cDNA fluoresces when it hybridises with a matching DNA fragment in the sample.

Prenatal

Conventional prenatal tests for chromosomal abnormalities such as Down syndrome rely on analysing the number and appearance of the chromosomesthe karyotype. Molecular diagnostics tests such as microarray comparative genomic hybridisation test a sample of DNA instead, and because of cell-free DNA in plasma, could be less invasive, but as of 2013 it is still an adjunct to the conventional tests.

Treatment

Some of a patient's single nucleotide polymorphismsslight differences in their DNAcan help predict how quickly they will metabolise particular drugs; this is called pharmacogenomics. For example, the enzyme CYP2C19 metabolises several drugs, such as the anti-clotting agent Clopidogrel, into their active forms. Some patients possess polymorphisms in specific places on the 2C19 gene that make poor metabolisers of those drugs; physicians can test for these polymorphisms and find out whether the drugs will be fully effective for that patient. Advances in molecular biology have helped show that some syndromes that were previously classed as a single disease are actually multiple subtypes with entirely different causes and treatments. Molecular diagnostics can help diagnose the subtypefor example of infections and cancersor the genetic analysis of a disease with an inherited component, such as Silver-Russell syndrome.

Infectious disease

Molecular diagnostics are used to identify infectious diseases such as chlamydiainfluenza virus and tuberculosis; or specific strains such as H1N1 virus or SARS-CoV-2. Genetic identification can be swift; for example a loop-mediated isothermal amplification test diagnoses the malaria parasite and is rugged enough for developing countries. But despite these advances in genome analysis, in 2013 infections are still more often identified by other meanstheir proteome, bacteriophage, or chromatographic profile. Molecular diagnostics are also used to understand the specific strain of the pathogenfor example by detecting which drug resistance genes it possessesand hence which therapies to avoid. In addition, assays based on metagenomic next generation sequencing can be implemented to identify pathogenic organisms without bias.

Disease risk management

A patient's genome may include an inherited or random mutation which affects the probability of developing a disease in the future. For example, Lynch syndrome is a genetic disease that predisposes patients to colorectal and other cancers; early detection can lead to close monitoring that improves the patient's chances of a good outcome. Cardiovascular risk is indicated by biological markers and screening can measure the risk that a child will be born with a genetic disease such as Cystic fibrosis. Genetic testing is ethically complex: patients may not want the stress of knowing their risk. In countries without universal healthcare, a known risk may raise insurance premiums.

Cancer

Cancer is a change in the cellular processes that cause a tumour to grow out of control. Cancerous cells sometimes have mutations in oncogenes, such as KRAS and CTNNB1 (β-catenin). Analysing the molecular signature of cancerous cellsthe DNA and its levels of expression via messenger RNAenables physicians to characterise the cancer and to choose the best therapy for their patients. As of 2010, assays that incorporate an array of antibodies against specific protein marker molecules are an emerging technology; there are hopes for these multiplex assays that could measure many markers at once. Other potential future biomarkers include micro RNA molecules, which cancerous cells express more of than healthy ones.

Cancer is a disease with excessive molecular causes and constant evolution. There's also heterogeneity of disease even in an individual. Molecular studies of cancer have proved the significance of driver mutations in the growth and metastasis of tumors. Many technologies for detection of sequence variations have been developed for cancer research. These technologies generally can be grouped into three approaches: polymerase chain reaction (PCR), hybridization, and next-generation sequencing (NGS). Currently, a lot of PCR and hybridization assays have been approved by FDA as in vitro diagnostics. NGS assays, however, are still at an early stage in clinical diagnostics.

To do the molecular diagnostic test for cancer, one of the significant issue is the DNA sequence variation detection. Tumor biopsy samples used for diagnostics always contain as little as 5% of the target variant as compared to wildtype sequence. Also, for noninvasive applications from peripheral blood or urine, the DNA test must be specific enough to detect mutations at variant allele frequencies of less than 0.1%.

Currently, by optimizing the traditional PCR, there's a new invention, amplification-refractory mutation system (ARMS) is a method for detecting DNA sequence variants in cancer. The principle behind ARMS is that the enzymatic extension activity of DNA polymerases is highly sensitive to mismatches near the 3' end of primer. Many different companies have developed diagnostics tests based on ARMS PCR primers. For instance, Qiagen therascreen, Roche cobas and Biomerieux THxID have developed FDA approved PCR tests for detecting lung, colon cancer and metastatic melanoma mutations in the KRAS, EGFR and BRAF genes. Their IVD kits were basically validated on genomic DNA extracted from FFPE tissue.

There are also microarrays that utilize hybridization mechanism to diagnose cancer. More than a million of different probes can be synthesized on an array with Affymetrix's Genechip technology with a detection limit of one to ten copies of mRNA per well. Optimized microarrays are typically considered to produce repeatable relative quantitation of different targets. Currently, FDA have already approved a number of diagnostics assays utilizing microarrays: Agendia's MammaPrint assays can inform the breast cancer recurrence risk by profiling the expression of 70 genes related to breast cancer; Autogenomics INFNITI CYP2C19 assay can profile genetic polymorphisms, whose impacts on therapeutic response to antidepressants are great; and Affymetrix's CytoScan Dx can evaluate intellectual disabilities and congenital disorders by analyzing chromosomal mutation.

In the future, the diagnostic tools for cancer will likely to focus on the Next Generation Sequencing (NGS). By utilizing DNA and RNA sequencing to do cancer diagnostics, technology in the field of molecular diagnostics tools will develop better. Although NGS throughput and price have dramatically been reduced over the past 10 years by roughly 100-fold, we remain at least 6 orders of magnitude away from performing deep sequencing at a whole genome level. Currently, Ion Torrent developed some NGS panels based on translational AmpliSeq, for example, the Oncomine Comprehensive Assay. They are focusing on utilizing deep sequencing of cancer-related genes to detect rare sequence variants.

Molecular diagnostics tool can be used for cancer risk assessment. For example, the BRCA1/2 test by Myriad Genetics assesses women for lifetime risk of breast cancer. Also, some cancers are not always employed with clear symptoms. It is useful to analyze people when they do not show obvious symptoms and thus can detect cancer at early stages. For example, the ColoGuard test may be used to screen people over 55 years old for colorectal cancer. Cancer is a longtime-scale disease with various progression steps, molecular diagnostics tools can be used for prognosis of cancer progression. For example, the OncoType Dx test by Genomic Health can estimate risk of breast cancer. Their technology can inform patients to seek chemotherapy when necessary by examining the RNA expression levels in breast cancer biopsy tissue.

With rising government support in DNA molecular diagnostics, it is expected that an increasing number of clinical DNA detection assays for cancers will become available soon. Currently, research in cancer diagnostics are developing fast with goals for lower cost, less time consumption and simpler methods for doctors and patients.

Allergy

Molecular diagnostics is increasingly used in allergology, especially for food and respiratory allergy. Conventional diagnosis is based on clinical history, skin-prick testing and measurement of serum allergen-specific IgE to whole allergen extracts. Molecular-based allergy diagnostics, also called component-resolved diagnostics, measures IgE to individual allergen molecules rather than only to extracts. This can help distinguish genuine sensitization from cross-reactivity, refine assessment of clinical risk in some allergies, and support decisions about allergen immunotherapy. Multiplex platforms, such as Allergy Explorer (ALEX), can test IgE reactivity to many allergen extracts and molecular components in a single assay. Precision allergy molecular diagnosis (PAMD®) is a broader diagnostic approach using molecular IgE profiles to guide prognosis, risk assessment and personalized management, although results must be interpreted together with the patient’s clinical history.

 

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