Positive emotional dysregulation as a mediator between cannabis use and emotional disorder risk: sex-specific pathways

• Positive ED and its three subscales mediated the cannabis-emotional disorder link. • The mediational effects of positive ED were only significant among female users. • Higher magnitude of effects were observed for the accept subscale. • Female users display higher positive ED and emotional symptomatology than males and non-users. Cannabis use exacerbates emotional symptomatology. Emotional dysregulation (ED) is a transdiagnostic variable that may underlie the cannabis-emotional disorder link. Previous research has predominantly focused on ED when experiencing negative emotions while overlooking emotionally dysregulated behavior in the context of positive emotions (positive ED). This is the first study examining the mediating role of positive ED in the relationship between cannabis use and emotional disorder risk in youth, considering sex as a moderator. 6,365 [55.8% females; M age ( SD ) = 19.37(2.63)] participants were assessed between September 2023-April 2024. Participants self-reported past-month cannabis use, emotional disorder risk [Brief Symptom Inventory-18 (BSI-18)] and positive ED [Difficulties in Emotion Regulation Scale-Positive (DERS-P)]. Analyses included zero-order correlations, two-way ANOVAs, and simple moderation and moderated mediation models, with cannabis use as the independent variable, emotional disorder risk as the outcome, DERS-P as mediators, and sex as the moderator. Cannabis use was associated with an increased emotional disorder risk, and higher levels of positive ED mediated this association. Sex emerged as a significant moderator, such that the indirect effect of cannabis use on emotional disorder risk via positive ED was stronger in females for ED total score and subscores, particularly through lack of emotional acceptance. In males, lower interference of goal-directed behavior mediated this association. Transdiagnostic interventions targeting positive ED may be especially beneficial for young cannabis users, with sex-sensitive approaches potentially enhancing their effectiveness.