adhd-esteem-1In my previous article on Attention Deficit Disorder or (ADD), I described many of the classic symptoms and discussed the fact that so many adults still suffer with it and were never diagnosed or treated as children. In fact, “up to 60% of children retain their symptoms into adulthood” (Regina Bussing, M.D. and John M. Grohol, Psy.D., “Attention Deficit Disorder: An Introduction to ADD/ADHD”  Jan. 6, 2012: web page: http://psychcentral.com/disorders/adhd/). As they grew up with the ADD/ADHD, they developed other symptoms and problems along the way, which resulted in misdiagnoses and complications as the other symptoms manifested.

It is very common to experience depression, anxiety, and learning disabilities, to be diagnosed with “Oppositional Defiant Disorder” at school-age, and later, be diagnosed with either “Bipolar Disorder” or “Borderline Personality Disorder”. It is especially important to note that a very high percentage also develop addictions. The medications for such disorders may have helped a little, but not enough. The person then feels even more discouraged. ADD may be an underlying cause of much of your pain and suffering!

Here is an excellent example I pulled off the (www.medscape.org/viewarticle/558594) internet  of a woman who spent a lifetime being misdiagnosed and consequently not getting better. She had tried many different medications to treat the various symptoms of depression and anxiety and had been in and out of therapy to deal with the behavior problems and mood swings, all of which negatively affected her job and her marriage. Needless to say she had spent a lifetime suffering with symptoms that mimicked other mental health diagnoses and was finally correctly diagnosed with ADD and given the correct medication.

A woman agreed to her husband’s request for psychiatric consultation to discuss her accident and resulting job loss. Upon questioning, the psychiatrist established that her depressed mood preceded both her accident and job loss. She reported that her earliest contact with the mental health system was as a child. In fourth grade, the patient was seen by a psychologist to address her “persistent separation anxiety”. Throughout middle school she did poorly academically and underwent educational testing. She scored very high on the IQ examination and her teachers and counselors were perplexed by the discrepancy between her daily performance and overall aptitude. As she aged, her problems continued. In college, a psychologist informed her that she had “Borderline Personality Disorder”. Subsequent psychiatric diagnoses included “Major Depressive Disorder”, “Bipolar II disorder”, and “Dysthymia”.

Misdiagnosed and co-occurring

Unfortunately, this may sound all too familiar. Because so many of the symptoms of ADD/ADHD (“attention deficit disorder with hyperactivity”: note: throughout the article, I will only refer to this disorder as “attention deficit” or “ADD” because not everyone has the hyperactivity component) mimic other mental health disorders, it is often misdiagnosed and therefore mismanaged. Needless to say, this can become extremely frustrating over the years and leaves the person feeling different, wondering why they don’t fit in, and can’t act the way everyone else does. It also makes them feel guilty for not being able to better manage their behavior, or excel in school or their job. Basically, they feel damaged, like they will never be “normal” and it often leaves them hopeless.

Similarly, symptoms of attention deficit and other problems such as depression and anxiety, and Borderline Personality Disorder, can and do overlap and occur together in many cases, thus creating a layering of issues over the years which require careful examining.

Depression may actually develop and be caused by years of struggling with ADD. However, uncovering a lifelong pattern of underachievement, procrastination, and inability to complete tasks, is essential in discovering ADD as an existing condition before depressive symptoms ever presented themselves. Sleep disturbance is another diagnostic symptom of depression, which also commonly occurs with attention deficit, because they have rapidly changing thoughts and ideas, which interfere with them falling asleep or staying asleep. Again, discovering that this problem was present long before the depression developed, is very helpful diagnostically.

Bi-polar Disorder is a combination of depressive and manic episodes and is often misdiagnosed in someone who actually has ADD, and especially ADHD, instead. This is because the “mania” can mimic ADD. The similar symptoms include: impaired attention, distractibility, restlessness, mood swings, rapid speech, and “flightiness” or “scatteredness”. The diagnostic difference is the duration of the apparent mania which can last for weeks or months, while with ADD, they only last for a few hours or a few days.

As always, establishing that the symptoms of ADD were present since childhood is very important in preventing such a misdiagnosis. It is extremely common to meet adults who have been unsuccessfully treated for Bi-Polar and once they are properly treated for the ADD, they improve greatly.

Anxiety and OCD (obsessive compulsive disorder)  “Generalized Anxiety” has many overlapping features with  ADD. Feeling anxious, restless, worrying a lot, and panicking, are all pretty typical symptoms of both disorders. However, people who only have generalized anxiety do not display the other tell-tale signs of ADD such as impulsivity, disorganization, and attention deficit.

Sometimes a person with ADD will develop certain habits that may seem like OCD, although it is indirect response to their ADD. For example, they may need to remind themselves in a very vigilant methodical way to do something like turn off the coffee pot or put their keys in a certain place every time in order not to lose them. Obsessive thinking and worrying have developed in direct response to a lifetime of disorganization and unpredictable impulses in order to survive and compensate for the attention deficit traits.

In conclusion, ADD might be a the crux of many other problems that have developed over the years and although the treatment; medication and therapy you received up until now may have been beneficial, it was never enough or it felt like something else was still wrong or off. Do not underestimate the psychological impact on your self-esteem and self-worth, nor the tremendous impact on your personal and social relationships.

Written by: Giselle Belanger, RN, LCSW  (psychotherapist) Available for appointments in person, by phone, or by skype webcam. Contact info: [email protected] Mex cell:  (322) 138-9552 or US cell: (312) 914-5203.