Nearly a third of adolescents and adults with ADHD list emotional instability as one of the most impairing aspects of the condition, yet its diagnostic criteria don’t even mention emotions. Here, Dr. William Dodson explains the most common emotional impairments associated with ADHD.
There are 18 diagnostic criteria for attention deficit disorder (ADHD or ADD), and not a single one mentions emotions. Instead, they list outwardly visible symptoms that can be observed, counted, and easily cited in research statistics – like difficulty listening, distractibility, and forgetfulness. The out-of-control feelings that (very often) come with ADHD are ignored for three main reasons:
Not everyone with ADHD experiences extreme emotions.
People with ADHD hide their emotional problems because they are embarrassed or ashamed of the way they feel.
Emotions are impossible to measure, so researchers ignore them.
But any clinician knows it’s the emotional impact of ADHD that most commonly brings people into the office. That’s what is really causing problems. In my clinical experience, emotional instability is often described as the most impairing aspect of the condition. This emotionality is nearly universal, yet in manifests in many distinct ways.
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1. Flash Emotions
Many people with ADHD are blindsided by their own emotions, especially when they change at lightning speed — without any time to reflect, think, or feel. In these cases, they act on or express emotions without a chance to filter them.
The sudden emotion that gets people with ADHD in trouble the most is the flash temper. As one patient told me, “You go from zero to FU in an instant.” Medications can treat this symptom, and give people with ADHD the same two seconds that everybody else has to feel an emotion coming on and decide, “I really shouldn’t express that.”
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More often than not, people with ADHD will use a description like “anxious” to explain how they are feeling, but mean something entirely different. From the beginning, physicians have to learn how that unique individual is using the words, and what they really mean by them.
Most people with ADHD have a very low frustration tolerance. They can be overly emotional about the stressors they experience. They don’t have a barrier that allows them to set aside uncomfortable emotions, and they often become completely flooded by a feeling, making it unbearable.
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4. Unaware of Others’ Emotions
People with ADHD can be hypersensitive and overwhelmed by everything that's going in a room. Or, they can seem very cold, very insensitive, or blissfully unaware of the feelings of others. When they disengage — whether due to lack of focus or because they’re overwhelmed — they can seem callous or narcissistic.
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5. Sensitive to Rejection
People with ADHD are exquisitely sensitive to rejection and criticism. They can experience hopelessness and demoralization because they try to succeed by imitating the paths to success of people without ADHD, and then fail over and over again because the same paths don't work for them.
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6. Overreaction/Easily Overwhelmed
One of the biggest problems with ADHD is overreaction, where the emotional reaction doesn't match the nature or the seriousness of the trigger. People with ADHD can have a great deal of difficulty distinguishing between dangerous threats and minor problems. So many times they overreact and, as one of my patients says, “Need to be talked in off the ledge.” The hyperarousal of ADHD means that most people with ADHD never experience peace. Their minds are always going 100 mph until they are exhausted.
Individuals with ADHD spend a lifetime facing criticism about their abilities, compared to the neurotypical way, that can have a significant impact on self-image and self-worth.
People with ADHD have a hard time being aware of social appropriateness and interactions, so they end up being socially ostracized and, as the saying goes, they are the last picked but the first picked on. Consequently, most people with ADHD grow into adulthood with a profound feeling that they are less than everybody else in some way. They feel uncool and unwanted, and sometimes even profoundly defective. The term you'll hear very commonly is "damaged goods," and that the person with ADHD feels generally incompetent in the world.
The resulting shame and guilt often produce a situation in which positive feedback just slings right past them. They never even notice it. They're much more in tune to the negative feedback they get. Consequently, the shame almost always dominates all the other emotions. As Freud said, "Shame is the master emotion." It's the only emotion that doesn't seek expression and it can determine whether other emotions get expressed or even acknowledged and dealt with.