The Emotional Lives of Girls with ADHD

Unrecognized Struggles

Research show that girls with ADHD show fewer externalizing symptoms and more often get an ADD-diagnosis. However, these girls exist and are struggling without being recognized. They experience social and academic challenges, keeping it together in school, exploding at home. The masking and compensating drain their energy, and the meltdowns and tantrums hurt their self-esteem. When these girls grow up and enter puberty, a period of intense biological, social and existential changes and challenges everyone can suddenly see them! Young women with ADHD will be increasingly impaired by emotional dysregulation and show up in healthcare for depression, anxiety, eating disorders, self-harm, and injuries, or in the social services for trauma or victimization. But we miss them again since we get the causality backwards!  We “blame” their struggles on trauma, bullying, peer rejection or depression instead of considering if it may be their very ADHD that puts their risk for depression, trauma, or rejection sensitivity dysphoria. 

Clearly, the emotional lives of girls and women with ADHD is a big deal and emotional dysregulation is more the rule than the exception in ADHD. We use our emotions to communicate our needs to others and struggling to recognize and regulate emotions is a huge handicap in life. It is important to disentangle emotional dysregulation in ADHD from distinct comorbidity such as depression, anxiety, bipolar disorder, or borderline personality disorder since they are more common in ADHD and may need specific treatment outside of the ADHD-treatment. The downstream consequences of ADHD such as increased risk for peer rejection, shame and stigma also increase the risk to develop depression, social anxiety, or rejection sensitivity dysphoria. Obviously, there are different and quite complex mechanisms underlying the overlap between ADHD, mood disorders and emotions.

Scientific Perspective

A way of looking at the science behind the overlap of ADHD and emotional dysregulation that resonates well with the testimonies I hear in my clinical practice is developed by my friend Predrag Petrovic describing emotional dysregulation in ADHD and borderline personality disorder (BPD) as two similar but not entirely overlapping top-down brain regulation mechanisms. ADHD is viewed as difficulties in regulating” cool” or executive attention while BPD represents difficulties in controlling the ”hot” emotional circuits. In this way of looking at it, ADHD and BPD becomes ”sister-conditions” of similar but not identical processes and Petrovic argue that we may talk about an ”emotional subtype” of ADHD located in between ADHD and BPD.

Treatment

Treatments for emotional dysregulation often build on the fact that the problem is not the emotions per se but how we react to it.  Many girls and young women with ADHD describe that the mess created around them from interpreting people and situations as more negative than they are and impulsively acting out on these feelings can trigger endless spirals of apologies and shame. A key to better emotional intelligence is therefore to recognize when your brain is more easily triggered (perhaps during PMS?) and work actively to reappraise your perceptions and emotions and refrain from acting until you feel emotionally anchored. 

If someone shows you a picture of a woman crying and asks you to guess how she’s feeling, you’d probably say that she looks sad. But if you then hear that she just met with her son, who has been traveling in Asia for a year you might perceive her reaction differently, right? 

This re-interpretation influences our emotional brain processes, something we make use of when we develop our emotional intelligence.