ADHD And Shame
How Empathy And Healthy Guilt May Help
Jeremy sits on the bench, waiting for his mother to arrive, his head bowed, his feet shuffling back and forth, unable to find a comfortable resting place. He’s accused of impulsively smacking a little girl in his preschool class after she pushed him. Now he’s in big trouble.
That’s how it starts for kids — especially boys — with ADHD. By the time they reach adulthood, they’ve been accused, reprimanded and punished for everything from forgetting their homework to blurting out inappropriate comments. It is estimated that by the time they reach the age of 12, kids with ADHD have received more than 20,000 more negative messages about themselves than children without ADHD.
Most of us know that kids and adults with ADHD tend to be forgetful, have difficulty sustaining attention and focusing, get easily bored, require enough — but not too much — stimulation, need frequent breaks, over-react with minimal provocation, and a host of other annoying behaviors neatly detailed in the Manual of Mental Disorders (DSM). The usual treatment: medication and/or therapy. That certainly helps.
The problem is that by the time someone is diagnosed with the “disorder,” there’s a good chance they’ve developed another symptom, one far more debilitating than not being able to find their keys or spacing out in the middle of a conversation. It’s called Shame, and the longer it takes to get a diagnosis, the longer they’ve been living with it. Shame is the hidden tormentor. In fact, the word shame comes from a word meaning “to hide.”
Shame is more debilitating than any other component of ADHD, and causes the most emotional havok.
Shame vs. Guilt
Shame is what people with ADHD try to hide, even from themselves. And unless you’re finely attuned to what shame looks like and feels like, you won’t recognize it. Yet shame is more debilitating than any other symptom of ADHD, and causes the most emotional havok. While guilt (the feeling you get when you know you did something wrong) can lead to repair by simply admitting and apologizing, shame leaves you feeling inherently flawed, bad and ultimately unworthy. It’s not as if you’ve done something “bad;” You are bad. According to Dr. Edward Hallowell, a pioneer in the field of treating ADHD, shame is “toxic,” even “traumatic.” It raises stress hormone levels and corrodes memory and executive functions. Shame, he says, is arguably the most painful of all the symptoms associated with attention deficit disorder.
Shame comes from years of feeling bad about behaviors you cannot control. Unable to manage emotions, you lash out. Unable to focus, you may fail in school. Unable to remember what someone just said, you incur the ire of parents and teachers. Over time, you lose friends, respect and and even trust (including trust in your own judgment). No wonder people with shame-based ADHD feel flawed and unworthy. There is no way to repair or redeem themselves.
Research indicates that shame not only erodes self esteem, but interferes with the ability to form healthy relationships, to succeed in careers, and even to speak up for fear of judgment and humiliation. You don’t need to have ADHD to experience shame, but shame is almost a given if you do have it. And shame, by itself, is associated with depression and suicidality.
In the Beginning…
In its early incarnation, ADHD was called Minimal Brain Dysfunction, a pathologizing term which stirred up connotations of people who were just not right in the head. When I was an undergraduate in psychology at UCLA in the 1970s, the name had changed to Hyperkenetic Syndrome, suggesting less pathology; Instead it focused more on the aspect of hyperactivity. Later, it was called Attention Deficit Disorder. According to the DSM, it took two forms: ADD and ADHD, the H having been removed in cases where there is no hyperactivity or impulsivity. Today, both types fall under one label: ADHD.
In truth, the name Attention Deficit Disorder is a misnomer because people with ADHD aren’t deficient in attention; rather, they are attending to too many things at once and are thus prone to distraction and difficulty focusing. The book Driven to Distraction by Drs. Edward Hallowell and John Ratey, published in 1994, dispelled many of the previous myths and focused on positive characteristics like creative and divergent thinking, ability to multi-task and abundance of energy. Many of our greatest inventors, artists and athletes have been — or could have been — diagnosed with ADHD. Some researchers speculate that in hunter-gatherer societies these were the hunters. Today, they are pegged as troublemakers, dreamers and misfits. In a sedentary, conformist culture, it’s hard for them to find their place.
Shame not only erodes self-esteem, but interferes with the ability to form healthy relationships, to succeed in careers, and even to speak up for fear of judgment and humiliation
It’s no surprise that more boys than girls get diagnosed. Their “acting out” behavior renders them more visible than the quiet daydreamers sitting in the back of the classroom. The latter may be girls with ADHD. It used to be that boys were diagnosed with ADHD, while girls were diagnosed with ADD. In her book Women With Attention Disorder; Embrace Your Differences and Transform Your Life, author Sari Solden notes that ADHD inattentive type (formerly ADD) is the most common form of the disorder in girls.
Ironically, for boys, the good news is that because they get diagnosed earlier, they receive treatment earlier, and this may mitigate some of the shame. Solden points out that people who remain undiagnosed the longest internalize their problems and suffer more from depression, anxiety and self-image struggles. Since girls get diagnosed later, they present with more shame, although boys who are not diagnosed until adulthood may suffer the greatest shame.
It’s often not until they grow up that girls (now women) admit to lifetime struggles with disorganization, poor self-regulation, concentration and follow through. When they show up in the therapist’s office, it is often because of difficulties in relationships or careers. Only then do they learn the source of their problems. This is because girls are more shame-prone than boys to begin with. Research shows that from the age of three, girls across the board exhibit more shame than boys, especially in response to failure. ADHD just makes it worse, so that girls carry a secret feeling that there is something wrong with them, but they don’t know what.
One woman complained that she could never deal with authority, which she attributed to her many firings from jobs; another woman said she was unable to organize herself enough to run her business, which ultimately failed, and yet another woman found herself constantly over-reacting to her boyfriend who told her she was “too high maintenance” and broke up with her. Women like this may not even know they have ADHD. They are bright, capable and believe they “should” be doing better; maybe they are lazy, they conjecture.
When men with ADHD enter therapy, relationship problems may be the primary motivator, but they already know they have the disorder and that it may be a contributing factor; they just don’t know how to fix it.
Emotions are so fraught for people with ADHD that they try to suppress, deny or avoid them altogether.
Shame and Blame
A common dynamic among sufferers of shame, in general, and people with ADHD, in particular, is their proneness to the Shame and Blame Cycle. This starts when the ADHD individual is confronted about some annoying behavior. They have two choices: Feel the shame and embarrassment and add it to the stockpile of other shaming incidents; or defend against the shame by blaming the other person; making it their fault, turning it around and creating a wall of confusion, even gaslighting their so-called attacker. This may seem preferable from a self esteem perspective, but the shame does not evaporate. It dives down even deeper, into the unconscious. And relationally, it probably causes more problems than accepting the blame and feeling the shame. Afterall, no one wants to be counter-blamed or gaslighted. It’s a sure way to end a relationship.
The driving force behind Shame and Blame is emotional dysregulation — the inability to contain and process feelings. Emotions are so fraught for people with ADHD that they try to suppress, deny or avoid them altogether. They don’t want to feel them, talk about them, or be around other people who exhibit them because they don’t know what to do with them.
The healthy response is to apologize or make amends. People with ADHD go immediately to shame, bypassing healthy guilt.
If you suffer from shame-based ADHD or think you might have it:
1. Get an evaluation by either a licensed therapist or psychiatrist who specializes in it.
2 Learn to identify feelings and develop strategies for dealing with them.
3. Separate your behavior from who you are, and apologize when appropriate.
4. Take a breath before reacting
5. Learn the difference between shame and guilt
Medication and therapy can help in this regard. You can also learn tools for getting organized, reducing impulsivity and communicating more effectively. Loved ones can also help. They can do so by not adding to the shame and by appreciating the unique individual you are, rather than just seeing your “disorder.” Here are some ways loved ones can create closeness and diminish shame:
- Don’t make excuses for ADHD behaviors. People with the disorder know what their challenges are. Trying to ignore them or make excuses doesn’t help. Understanding and supporting them in their struggle will be ultimately more helpful.
- Most importantly, avoid shaming comments. We all make mistakes. When we do, we feel guilty; that’s the appropriate feeling to have. The healthy response is to apologize or make amends. People with ADHD go immediately to shame, bypassing healthy guilt. You can help the ADHD person shift from shame to guilt by avoiding comments like “You always…” “You never…” “You did it again…” which leads to their feeling they can never do anything right. This generates more shame.
- Use humor. Being able to laugh at one’s “growing edge” is a healthy antidote to shame. When you joke about a behavior, you encourage your loved one to do so as well. By saying something like, “I think you’re having an ADD moment,” in a kind, non blaming tone, you create an atmosphere of lightness around what the person is doing. And you give them permission to do so too.
- Recognize your own contribution to problems between you, even if you think your ADHD partner is mostly to blame. If you are right, your partner is wrong. This sets up a “no win” situation that can ignite the shame and blame cycle. Maybe your tone or level of anxiety activated a reaction, although not intentionally. You can point that out. You may, for example, recognize that your own intensity or strong feeling has activated them, without blaming yourself or them.
- Try a little empathy (and tenderness). Try to put yourself in their place. Imagine what you would want or need from others, and try to be that person.
The degree of impairment from ADHD varies. Symptoms range from mild to severe. Some people have discovered effective ways of managing, minimizing and dealing with their symptoms by adulthood. For some, ADHD is the least of their struggles. Loved ones are essential to their treatment plan; their understanding, compassion and sense of what unique gifts the ADHD person brings makes a huge difference. After all, they are not their ADHD; ADHD is just something they have, something they wrestle with. And don’t we all wrestle with something?