ADHD and ADD are controversial diagnoses. Some believe that they are not distinctive conditions in themselves and others believe strongly in the opposite – that they lie underneath many other personality disorders (BPD, NPD) and mental health issues (Anxiety, OCD, Depression).
The article below, written by US psychotherapist Rebecca Olmsted looks at how the misdiagnosis and misunderstanding of ADHD and ADD can lead to feelings of shame in a person who struggles with many issues typically associated with the conditions such as impulse control, the ability to focus or hyper-focus, procrastination, and other so-called “Executive Skills”. It can means that they strongly feel that there is something wrong with them, that they don’t fit in. I will look at ADD/ADHD in further posts and also other ‘neuro-atypical’ conditions such as Aspergers and Autism. In the meantime, I am sharing Rebecca’s article which I feel highlights some of the issues surrounding these diagnoses.
It is a common experience for people with ADHD and ADD to feel misunderstood like something unexplainable is wrong with them. And the feeling that goes with that – which is often barely recognised – is shame.
“I don’t fit in”
Attention Deficit Hyperactivity Disorder. What a mouthful! Over the last ten years, our understanding of ADHD has changed quite a bit, and if it were to be named today, it might not even be called a deficit or a disorder. Previously considered a childhood problem, it is now recognized that ADHD continues into adulthood. Like shame, ADHD has many faces, but they all seem to stem from one constant – an impairment of executive function.
Executive function is the ability to track and manage sensory and mental input, making moment by moment decisions. It relies on short term memory– you can think of executive function as the air traffic controller of the mind. When it is impaired, the person has trouble getting things done, that “normal” people seem to accomplish without great effort. Shame can arise from feeling “I should be able to do this”. The person feels something is wrong with them. They feel different from others and often frustrated with themselves. Not knowing how to address the problem can also lead to a feeling of powerlessness.
What is shame? At its core, shame is the sense that something is fundamentally wrong with me (contrasted with the belief that I have problems to work on but that I am fundamentally okay). Shame is an emotion that blends with other emotions, such as sadness and anger, and almost any behaviour. Shame is a real chameleon – and to complicate the picture, not all shame is bad. But the shame we are talking about here is painful and debilitating.
Factors that may further complicate the picture (keeping in mind that ADHD is both under and over diagnosed and that many people feel “everyone has ADHD”):
- The ADHD person may not be diagnosed. Without a diagnosis, it is difficult to address the practical and relational issues. Remember, in a shame state, the person thinks it’s their fundamental identity that’s flawed, not what they do.
- The ADHD person may be diagnosed, but may feel stigmatized, or may feel that it is an “excuse” diagnosis. This indicates that in the past they have not gotten proper treatment and support. This can happen when people are medicated as children but haven’t received therapy, coaching or social support to deal with the negative self-image that can result from ADHD.
- ADHD often co-occurs with other conditions, such as trauma, depression, anxiety, substance abuse, bipolar disorder, learning differences and sensory processing disorders.
All of the above can lead to feeling – and being – misunderstood.
While hyperactivity is part of the name of ADHD, there is also an inattentive type. Because they tend not to attract attention to themselves, people with the inattentive type often do not get help. In school, these students are often told that they do not perform up to their abilities. (Noticing that others are disappointed in you leads to shame). Both types hate being bored, and you could interpret both the daydreaming and the hyperactivity as avoidance of boredom. People with the inattentive type may be shamed by labels such as “bad at following instructions”, unmotivated, disrespectful, or even rebellious.
People with ADHD receive repeated negative messages about their ability or willingness to perform according to expectations, as Dr William Dodson explains. This usually starts in school and often continues into the workplace. Many people with ADHD have job dissatisfaction. This, despite the fact that many of them are hard-working and enthusiastic – some of the most inventive and intelligent people you meet. Difficulties at school or the workplace can be the source of a great deal of shame.
ADHD is an invisible disability with social implications. Most people with ADHD have been told many times that they should just try harder, without any recognition of how hard they are already trying. What appears to others as problematic behaviours, such as ” being disorganized”, frequently late, not listening, etc, may be perceived internally by the person with ADHD as just more reasons why they really are fundamentally flawed. The person with ADHD may be upset with themselves over their inability to “keep it together”. The process of explaining this difficulty to someone, a boss or even an acquaintance, who sees “disorganization” as an excuse for laziness or incompetence could easily be a shaming experience.
What to do about it? Find your tribe, get some therapy and or coaching
ADHD is not a lifelong sentence to disappointment! It is a very treatable condition and can be the source of great joy.
Personality traits that often go with ADHD are enthusiasm, creativity and resilience. People with ADHD are often very hard workers. A strength-based approach is like a breath of fresh air to a person who’s been shamed.
In therapy, we work on counter-shaming, going back to the root experiences that somehow got turned into a negative self-image. Building on strengths and coming up with strategies to deal with communication problems, organization. We are so fortunate today to have a plenitude of resources for dealing with ADHD. Here are a few:
Magazine ADDitude magazine
Podcast: ADHD Rewired with Eric Tivers, Distraction with Dr Ned Hallowell.
Website: Totally ADD
Youtube: How To ADHD
Books: The Disorganized Mind, by Nancy Ratey, You Mean I’m not Lazy, Stupid or Crazy?, by Kate Kelly and Peggy Ramundo