ADHD-
Giving Voice to Adult ADHD.
What it's really like to live with adult ADHD.

KEY POINTS-
True understanding of ADHD usually comes when it affects someone's life or someone around them.
For people unfamiliar with ADHD, the stories of people with ADHD and their experiences can shed light on it.
Several interview studies explored the experiences of adults with ADHD with diagnosis, treatment, and coping.

Is it difficult to figure whether adult ADHD is a negative or a positive? Do others' doubts about ADHD affect you? Read what other adults with ADHD have to say about it.
Apart from having something touch one’s life or the life of a loved one, enlightenment and changing human minds and beliefs often happens through hearing and empathizing with the accounts and stories of people facing those difficulties1—in this case, adult ADHD.

Several qualitative studies using interviews and accounts of the lived experience of adults with ADHD have been published in recent years, including a psychiatrist-in-training’s personal and professional experiences with his own ADHD.2-5 A singel post will not do justice to the nuances of these accounts, but here are some takeaway themes that resonated with me.

Issues with recognizing ADHD and help-seeking
Adults with ADHD often struggle for a long time before seeking help, often due to social stigma about ADHD. The process of getting a specialized evaluation for adult ADHD itself is often difficult and laborious, which is another impediment.

The fact that attention problems are highly context-specific—such as adults with ADHD being able to focus well on interesting topics—creates doubts in their minds and in the minds of others about the relevance of ADHD despite undeniable problems in their lives, not to mention that ADHD involves much more than attention problems.

Impulsivity problems are frequently cited in accounts of adults with ADHD and hyperactivity is often minimized because it is experienced as an internal sense of restlessness. Such examples of not fitting the stereotype of what ADHD looks like and stigma further delay recognition (especially for women with ADHD).

Many adults with ADHD eventually seek help at the encouragement of others in their lives.

The experience of “chaos,” difficulties structuring one’s time, and the corresponding emotional effects (anxiety, agitation, and mood lability) are commonly cited problems. Emotional dysregulation may lead adults with ADHD to first seek help for mood and anxiety issues based on the assumption (now understood to be mistaken) that emotions are not associated with ADHD.

There are common reports of ambivalence about an ADHD diagnosis. For some adults, the reaction is positive, including relief and clarity. For others, there are negative and sometimes resistant reactions to a diagnosis, such as regret for lost opportunities. Most late-identified adults with ADHD go through a re-examination process of their sense of self-identity. Ultimately, though, the eventual ADHD diagnosis is generally not regretted and, in fact, is seen as validation of their circumstances.

The psychiatrist-in-training expressed the realization that “high functioning does not exclude dysfunction.”

Coping experiences
A consensus was that ADHD makes “everything a little harder.”

Everyone in these qualitative studies cited the use of some form of time management and organizational strategies to manage adult ADHD.

Another common theme was setting up ADHD-friendly environments and systems to support coping and well-being.

Increased self-awareness and accurate understanding of ADHD helped reduce self-blame as well as to identify personal strengths and aptitudes. For some, this included a sense of courage and resilience that grew from navigating difficulties, setbacks, and even failures.6

On the other hand, many adults found their difficulties with adjusting to new situations and roles to be stressful—such as a new job, moving, or parenthood.

Treatments and support
Medications, psychosocial treatment, various accommodations, and support groups adapted to adult ADHD were reported as helpful options with positive effects on functioning.

The psychiatrist-in-training with ADHD avoided ADHD medications for a while due to their negative reputation in his field, though he later found them to be very helpful. He still noted that despite their obvious benefits for his ability to focus, he had side effects in which he felt they inhibited his “real me” personality, at times.

Psychological effects of adult ADHD
Many individuals reported a sense of low self-esteem or a “less than” self-view, at some point.

Individuals had diverse ways to view and describe their ADHD:

ADHD as a difference or trait versus disorder.
ADHD as a limiting label versus self-identifying with ADHD.
ADHD as an interface of both negative and positive aspects.
Ultimately, most individuals in the qualitative studies reported learning to approach various tasks and roles differently to account for the effects of ADHD and with a greater sense of optimism.

The effects of others’ opinions
There were accounts of citing ADHD symptoms and related difficulties to others (including helping professionals) and having them be trivialized, dismissed (“You’re in college. You can’t have ADHD"), or attributed to negative characteristics, such as “laziness.”

Such negative messaging was described as contributing to masking problems, avoidance of help-seeking, being overly apologetic to avoid criticism, and a sense in at least one case of viewing others as “putting up with me.”

The psychiatrist-in-training noted that, once diagnosed and treated, he could be more empathic with patients and their experiences of medication side effects, not just patients with ADHD. He also cited the stigma about ADHD in behavioral healthcare, including individuals (including other doctors) who choose to pay out of pocket for behavioral health services covered by their insurance to avoid their psychiatric diagnosis coming to light in some manner.

Summary
The number of individuals providing accounts in these published studies is not large. However, they are enough to start giving voice to adult ADHD. Their voices will hopefully echo through classic data-driven studies to help others hear and see adults with ADHD and help them obtain effective help and support.

ADHD-
What Role Does ADHD Play in Eating Disorder Treatment?
Eating disorder recovery takes attention, self-regulation, and intention.
Reviewed by Michelle Quirk

KEY POINTS-
Studies show that people with ADHD are more than three times as likely as the general population to develop an eating disorder.
Understanding ADHD symptoms that may be associated with the onset and maintenance of an eating disorder can be key to recovery.
A thorough assessment provides valuable information that can clarify a personal path to recovery by taking any comorbidities into account.

The statistics are startling. It turns out that people with attention-deficit/hyperactivity disorder (ADHD) are more than three times as likely as the general population to develop an eating disorder (ED). Some studies place this number even higher.

In addition, more than one-third of adult female patients being treated in a clinic for eating disorders who were given an adult ADHD self-test qualified for the diagnosis of ADHD.

When we treat ADHD, we can't ignore the impact it has on our relationship with food and our body, and when we treat eating disorders, we can't ignore the impact they have on our ability to focus, plan and regulate our emotions. —Dr. Roberto Olivardia, Ph.D.

So, ADHD and eating disorders often seem to come together, with significant shared genetic causality. This is true in children, across the lifespan, and in both men and women.

What Eating Disorders Correlate With ADHD
ADHD doesn’t predict the development of just any kind of eating disorder.

Eating disorders in the presence of ADHD can lead to significant reductions in quality of life, social isolation and devastating health consequences. —Dr. Kali Cyrus, MD

Specifically, the significant increase in risk is related to disorders involving loss of control with food, rather than specific obsessions about bodily appearance or weight management. In children with ADHD, this manifests as a 12-fold increase in the likelihood of developing the behaviors related to what is called “loss-of-control eating.” In adults, this manifests as an increased risk of developing one of three eating disorders: bulimia nervosa, anorexia nervosa (binge/purge subtype), or binge eating disorder.

Shared Mechanisms in ADHD and Eating Disorders
ADHD doesn't cause eating disorders, but it can contribute to disordered eating behaviors…. —Dr. Kimberly Dennis, MD

When it comes to disordered eating behaviors and ADHD, these three symptoms emerge most frequently: hyperactivity, inattention, and impulsivity. At a broader level, ADHD has been related to difficulties in executive function, emotion regulation, and conduct.

Let’s look at some of the most common shared mechanisms:

Reward system: The dopamine neurotransmitter is responsible for experiencing pleasure, controlling attention, and processing information, reward, learning, and motivation. Dopamine function is altered in both people with a loss-of-control ED and in people with ADHD. If your reward and learning system is not working fully, self-regulating may be more difficult and the reinforcement of attuned eating behaviors can be weakened, and, thus, unhelpful habits may stick around.

Inattention: Inattention to cues both inside and outside of the body can lead to disordered eating behaviors. For example, if you’re not paying proper attention to your body’s hunger and satiety signals, you may continue to eat even when you are full.

Impulsivity: Impulsivity can lead to sudden, unplanned behavioral choices typically made in response to strong or evocative cues. In the impulsive state, individuals typically value smaller-sooner rewards that will provide instant dopamine (such as consuming only ice cream for dinner after seeing an ad for it) than larger-later rewards that lead to better overall health (such as consuming a balanced meal along with ice cream).

Considerations for Eating Disorder Recovery
While ADHD symptomatology can be associated with the development of an eating disorder, it may also maintain unwanted eating behaviors. It is important to identify which ADHD symptoms might play a contributing role and figure out how to work with or mitigate these issues.

In particular, addressing attentional issues and impulse-control behaviors will have flow-on benefits to recovering from the eating disorder.

Attentional Issues
There are two helpful strategies for working with inattention:

Improve your inner attention: To help with inner appetite signals, it is good to learn practices that develop interoceptive awareness, such as mindfulness, yoga, meditative body scans, and so forth.

Add extra external cues: Use a gentle structure for meals and snacks. Then, add modern technology. Set alarms to alert you to mealtimes—with backup alarms in case you get distracted by an interesting project that interferes with eating when you are comfortably hungry. Not surprisingly, getting overly hungry can lead to feeling out-of-control hunger when you finally take a break or being tempted to skip eating in an attempt to diet.

Impulsivity
To manage the interference of impulsive behaviors, accept this part of yourself, set barriers, plan ahead, and draw your attention to the larger-later rewards you desire over those shorter-sooner immediate rewards. These can be done using the techniques mentioned above.

For example, you could use visual reminders or notes placed on your fridge that remind you that diets don’t work and why your long-term health goals matter to you. Losing a few pounds quickly will not sound as tempting if you keep in mind how often diets fail. Or you might keep a few easy-to-heat, frozen meals, fruit, yogurt, nuts, and cut veggies available for times when you might want to grab an unplanned snack.

Comorbidities
Having two or more mental health conditions at the same time, also known as comorbidity, can have a significant impact on the treatment of both—such as having an eating disorder and ADHD. Studies have shown that comorbidity may be associated with increased severity of symptoms, greater social impairment, lower quality of life, and higher risk of relapse. Thus, it is important to have a thorough assessment that offers a complete picture to pave a realistic path to recovery.

Though all health treatment should be tailored to address the individual needs of each person, that does not always happen. Treatments for ADHD and eating disorders should also be integrated, holistic, and focused on treating each individual as a whole. Be an advocate for yourself. If you are concerned you have ADHD, obsessive-compulsive disorder, anxiety, depression, trauma, or any other mental health problem that is not being addressed and worry that it may be getting in the way of recovering from an ED, speak up.

Medications
If you are taking medication to manage ADHD,​​ know that there is promising research that suggests this medication may be beneficial for some types of eating disorder behaviors, so don’t fear your medication. Stimulants can, however, be associated with changes in appetite and interfere with interoceptive awareness. Thus, pay attention to satiety and do not skip meal times so that your eating does not, inadvertently, become restrictive.

The Upsides of ADHD Can Be Helpful
There are many options for developing skills that boost executive function, enhance emotion regulation, and create actions that align with your values. Some strategies that may be helpful include mindfulness practices, emotion-awareness skills, structured eating plans, apps that encourage goal setting and establishing priorities, understanding effective communication habits, adding pauses before taking action, applying time-management tools, and learning cognitive behavior therapy strategies.

Beyond interventions for change, there are numerous upsides to having ADHD. In one recent study (2022), Schippers et al. concluded that knowing the positive benefits of ADHD may significantly enhance coping. Five themes emerged as life-enhancing to participants:
Creativity
Being dynamic
Flexibility
Socio-affective skills
Higher-order cognitive skills
How can you leverage the positive aspects of ADHD to recover from an ED and build a meaningful life?

ADHD-
If You Think You Have ADHD, Ask Yourself These 5 Questions.
Identify the source of your challenges to get the right solutions.
Reviewed by Ekua Hagan

KEY POINTS-
Generally, if one family member has ADHD, they’re not the only one.
Some people with ADHD find their symptoms, such as forgetfulness or messiness, affect their relationships with other people.
The ability to regulate emotions when they become intense is a skill that many people with ADHD struggle with.
Unless you’ve been stranded on an island for the past decade, you’ve probably heard and read a lot about the phenomenon of adults getting diagnosed with ADHD. Many people age 18 and over feel like they have significant problems focusing, getting things done, procrastinating, and generally being efficient in their jobs and their personal lives. Many of these individuals have been successful academically; they may have even been honors graduates and high achievers. Their experiences look typical on the surface, but they say their life is a mess. Not to mention, social media has thousands of blogs, testimonials, and other resources about adult ADHD. There’s even a YouTube channel called “How to ADHD.”

This post gives you questions you can ask yourself to help decide if you might have ADHD and benefit from a formal evaluation from a psychologist.

1. Do your symptoms disrupt your ability to function at work or at school?
People often think they might have ADHD if the problems they have functioning are quite disruptive. Their struggles prevent them from being efficient, which means things take much longer than they should to complete. Many people hate their jobs because they feel like their responsibilities highlight the weaknesses they have in being efficient and organized. Or they get incredibly bored with their work, so they can’t always put their best foot forward. They may question their career choices or majors in college because they don’t feel motivated to complete tasks on time.

2. Do you struggle in personal relationships?
Some people find their ADHD symptoms affect their relationships with other people. They may be forgetful, which annoys their friends or partner, they’re messy and disorganized, they talk too much or too loudly, or they constantly interrupt people. The quality of their relationships is therefore compromised by their challenges.

Note: If similar problems are disruptive to your professional or personal life, it’s definitely time to seek support from someone with expertise in assessing and treating ADHD.

3. Do you experience intense emotions?
The ability to regulate emotions when they become intense is a skill that many people with ADHD struggle with. They talk about losing control of their emotions, becoming reactive quickly, and being unable to calm down after getting really upset or excited. There are other mental health conditions for which this is also potentially an issue, but it’s much more common among people with ADHD than has been talked about in the research until recently.

4. Do other people in your family struggle with, or have they been diagnosed with, ADHD?
You may not know if other people in your family have been diagnosed, so it’s worth having a conversation with a parent or sibling to find out more. There is a genetic component to ADHD, so it can run in families. Generally, if one family member has it, they’re not the only one.

5. Are you struggling with other conditions or circumstances that might mimic the ADHD experience?
It is true that you could be one of those people who have compensated and functioned well, despite having ADHD that was overlooked when you were younger. It happens, and I do evaluations routinely with clients who meet the criteria, according to the DSM-5. But you may not know that there are other mental health conditions that affect focus, which can result in many of the other problems that we attribute to ADHD. Individuals with a history of trauma, for example, may exhibit some of the same cognitive symptoms, such as inattention, trouble making decisions, difficulty with organization, and trouble finishing things they start. These symptoms are also present in many people with depression and related mood disorders and anxiety. Additionally, individuals with chronic medical conditions, like thyroid disease and anemia, can also experience cognitive symptoms similar to those of ADHD.

Sometimes people struggle with focus and disorganization if they’re overcommitted. Our society encourages us to be busy, to be involved in a lot of things, and to fill our days, but it’s possible to be too busy, and when this happens, it’s hard to focus on what is right in front of us. We have high expectations for ourselves and struggling to meet them may create an experience that feels like ADHD.

Understanding the underlying source of your challenges is important because interventions, including medication, may change, depending on the reason for them. Getting to the bottom of why you struggle with these challenges needs to be investigated if they are becoming disruptive to the life you want to have. Talk to a mental health professional about your concerns, so that you can get the right answers.