Mistaken Diagnoses of ADHD?

Can we talk a bit about ADHD and feeling the feels?

I work with a number of clients who’ve received diagnoses of ADHD at some point in their lives. As you may know, there’s some evidence that suggests a link between ADHD and entrepreneurial inclination, so this isn’t too surprising.

What I find striking is that many of these clients display difficulty in regulating their emotions. Some recent research indicates that this is actually one of the central features of ADHD.

Most of these folks simply shut their emotions down, relying instead on their heavily developed intelligence.

They actually feel quite a bit, but because it can be difficult for them to manage the emotions that do arise, they rely on stopgap measures, which has the unfortunate consequence that their emotions come out sideways - snapping at loved ones, conversion into anxiety, or reliance on food or substances to cope.

Here’s what interests me…

Our attentional systems depend upon the regulation of affect (the biological basis of emotion) in order to function. When affect is well regulated, we’re able to switch flexibly between contextual and focused attention with greater ease. We can zoom out or in as the situation requires and meet the task at hand.

However, when our emotional foundation is shaky, we’re no longer in control of our attention, and one or the other mode dominates - we’re overwhelmed by the flood of information, or we’re narrowly restricted.

As Daniel Hill writes in Affect Regulation Theory, “Helping patients to remain regulated while focusing their attention on things that would normally dysregulate them is one of the arts of psychotherapy.”

Here’s how I would approach this with you if you were my client:

We’d take a close look at the contexts in which your system begins to fall apart, as well as what happens when it does. Inevitably we’re going to see a couple of things occur.

The first is that your body is going to display a characteristic pattern of muscular contraction. It’ll make a certain shape, one that is remarkably consistent when you experience moments of insecurity. If you’ve ever noticed that your shoulders get tense when you’re stressed, you have a clue as to part of your shape.

Last week, for example, a client was describing an insecurity around others that he thought were smarter than he was. As he talked through the experience, I saw a tiny shift in his posture that — to me — indicated his torso was no longer being supported from below.

So I asked him, “Do you have legs when you’re insecure?”

It took him a moment to understand what I was asking, but it became blindingly clear to him that no, he in fact did not experience himself as having legs when he was insecure. It’s like he only existed from the waist up.

Once we identify a gap, we can work with that. There are plenty of ways to develop awareness of various parts of the body that have gone “offline” and bring them back into the overall self-image. Doing so basically rebuilds your sense of self from the bottom up.

But the other thing we’re inevitably going to see is that there’s some interpersonal conflict that arises in the context leading up to your system starting to fall apart.

There’s going to be an argument, a comment somebody made, another idiotic email…and right *there* we’re going to see that you squash an emotional response. You feel something (spoiler alert: almost always anger), and just that fast you stifle its expression.

We’re going to be able to observe how you preserve the attachment to that other person at the expense of your own authenticity.

This isn’t just you, I should say.

This is what we have to do in order to survive early development. It’s just that you’re no longer a child, so you most likely have other options available to you at this point.

When we have a sense of both the physical and emotional compensations you make to stressful situations, we can begin to reassemble your affect regulation again, which in turn means that you have greater control over your attentional system.

Then you’re no longer being hijacked by an automatic stress response, instead you’re more flexibly engaged with the work in front of you, able to focus on the details as needed without losing sight of the big picture.

The things that we tend to cluster under the label of “ADHD” offer enormous advantages in the right contexts, and if you can hedge your bets against the downside risks, you’re much better positioned to capitalize on the gifts available to you.