Adult ADHD: Validating Imposter Syndrome and Social Stigma

More than most other mental health issues people discuss during our therapy sessions, I notice those with ADHD carry with them a recurrent sense of imposter syndrome.  I regularly hear clients say things like:

“Why can’t I just do the thing that other people can do?”

“I physically should be able to do this task.”

“Logically, I know this needs to be done. I want to do it. It would reduce my stress. But something is stopping me.”

“It’s not for lack of care, I really don’t remember hearing that part of the conversation.”

“Maybe I really am just lazy. But it doesn’t feel the same as being lazy…”

We’ve done the diagnostics. We’ve ruled out other possibilities, or found co-occurring disorders. We’ve identified the areas of executive dysfunction, social impacts, possible RSD, and academic or occupational impairments. Often, we’ve collaborated with psychiatrists who are familiar with ADHD and have reached the same diagnosis.

Yet that internal voice of doubt and self-criticism remains.

This sense of uncertainty exists for several understandable reasons.

Diagnosis

Often clients will describe the diagnostic process for adult ADHD as validating. Usually, it’s something a person has wondered about themselves for years. The confirmation of “yes, your experience fits that of many others” and the knowledge that there are strategies to reduce symptoms, can elicit an enormous sense of relief.

Depending on how friends and family react to the diagnosis, that relief can easily change into self-doubt.

Non-Physical Representations

By its very nature, as for most mental health disorders, ADHD is an invisible issue. We don’t wear the disorder on our sleeve for all to see.

Numerous clients have talked to me about being called “lazy.” Some have been accused of “selective listening.” Social events or errands are unintentionally forgotten about, missed, or double-booked. The “stuck-ness” of ADHD paralysis looks an awful lot like being a couch potato to the untrained eye.

In reality, that couch-bound person is experiencing an internal battle of mental effort. Pressure-filled “shoulds”, decision fatigue from the inability to prioritize/start/complete tasks, and fighting the allure of maladaptive coping mechanisms all feed into the “stuckness.” Couple hyperfocus on something less pressured with time-blindness, and the result can look the same. Distraction can soothe distress temporarily, but extending procrastination leads into an increase of anxiety, and then the cycle repeats.

So, the adult with ADHD doesn’t carry outward physical traits of the disorder.

ADHD manifests physically in their environments. At home, AHD can look like the pile of dishes and half-finished laundry. Financially, like forgotten bills or empty savings. Socially, friendships are lost due to the unintentionally long passage of time between contact. In terms of career, it exists as missing deadlines, work piling up, and sometimes over-complicating otherwise simple processes.

The Fear of Special Treatment

This is not to say that those with any mental health diagnosis should automatically garner pity or receive special exceptions. It is still an individual’s responsibility to seek out ways to manage their own health, physical and mental. It is still within our control to attempt solutions daily, and seek appropriate accommodations where necessary.

This is another area where the imposter syndrome of ADHD rears its head.

Academic accommodations exist for the purpose of bringing a person up to a level playing field with others, not to cheat the system. Yet, many times a college student with ADHD will avoid seeking out helpful tools – like accommodations – out of a sense of not wanting to abuse the system. Though it doesn’t always happen it can often lead to low grades, a breakdown from burnout, or even dropping out altogether.

Apprehension to disclose ADHD translates into the workplace as well.

Even when disclosed, some working environments are inherently not ADHD-friendly. In either case, a person with ADHD at work may experience scrambling to find acceptable excuses and constantly over-explaining themselves. Sometimes the mental health struggle looks like the inability to hold down a job long-term.

Despite the legitimate diagnosis, many clients still feel a sense of shame around needing assistance to compete at the same level as peers. This experience of shame also seems to deter adults from considering exploring an ADHD diagnosis in the first place.

“Over-Diagnosis” and Stereotypes

Another factor that deters adults seeking ADHD treatment stems from a great deal of outdated information.

In terms of stereotypes, “ADHD” brings to mind an elementary age boy who can’t sit still in class, has too much energy, and may act out much to the frustration of parents and teachers. This only encapsulates the predominantly hyperactive type of ADHD.

Just as valid are the other two presentations of ADHD: Predominantly Inattentive Type and Combined Type. Lack of public awareness about the other subtypes of ADHD could explain why women often slip through screenings during childhood. They often exhibit “daydreamy-ness” rather than being rambunctious.

In addition, many mainstream sources are not up to date.

ADHD continues to be portrayed as a childhood phase most people grow out of. Decades of research point to a minority of people outgrowing the disorder. For most people, if you retain symptoms of ADHD into your 20s, it will be symptoms to manage life-long.

Pharmaceutical Stigma

Attention Deficit/Hyperactivity Disorder is a diagnosis that carries with it a history of stigma and stereotypes. Research shows that ADHD is one of the most treatable mental health disorders, especially with a two-handed approach of medication management (psychiatry) and counseling (psychotherapy) (Mason, 2023).

Clients who opt in for using medication to manage ADHD symptoms often describe the effect as a window into an awareness they hadn’t thought themselves capable of. Some describe it as a calming of buzzing background noise and others liken their improvement in mental clarity to a metaphor: “it’s like going from the effort of swimming through molasses to swimming in clear water.”

One of the biggest stigmas belies the most effective treatment option: stimulant medication.

Too often the public narrative surrounding stimulant prescriptions describes the college student seeking illicitly obtained stimulants to perform better academically.

The fallout from this type of drug abuse is that those who need stimulant medications to simply function at a typical level find numerous obstacles in their paths.

Medical and health systems are still catching up to the latest research on ADHD prevalence and treatment options. Unfortunately, doctors are not immune from the impacts of social stigma. As a result, many health care providers are still subject to the biases of yester-year and hesitant to diagnose or prescribe for ADHD. In addition to old information, many providers are subject to ever-restrictive laws and regulations about prescribing controlled substances. Numerous clients have struggled to find a primary doctor able to prescribe stimulant medications or a pharmacy with sufficient supply.

Looking Forwards

Fortunately, new advancements in medication and counseling are seeping their way into public awareness over time.

Vyvanse, for example, is a non-abusive ADHD medication and designed so it cannot be abused the same way other stimulants can. Vyvanse has been around for a few decades now. Recently in Fall 2023, the generic versions of Vyvanse became available, making this a more accessible and affordable option. This more affordable option could help to quell some of the stigma surrounding ADHD medications and substance abuse.

Counseling too is becoming more versed at instilling practical strategies for those with ADHD.

Rather than employing the traditionally non-directive style of talk-therapy, clients seeking reduction of ADHD symptoms benefit from a more directive style. Remote therapy offers the opportunity to do the work in one’s immediate home environment and vastly improves outcomes.

Over time, working with ADHD clients has led to many improvements in my own counseling style. Goals become more concrete and strategies become tailored to the individual’s way of functioning. Ultimately, healing happens when the individual has the agency to design a lifestyle that supports their character traits and minimizes their impairments.

We live in a world that largely rewards conformity and discourages divergence. Successfully managing ADHD symptoms comes down to designing a lifestyle to your own specifications and finding space within this world that allows you to play to your own strengths, grow through making mistakes, and follow your unique rhythm.

Hanna Knudson, MS CMHC, PCLC

Citations

Mason, O., MD. (2023, October 11). How a Physician Treats ADHD with Combination Therapy. ADDitude. https://www.additudemag.com/adhd-medication-combination-therapy-treatment/