The Missing Link in Thriving with Adult ADHD: Overcoming Shame
by Scott Shapiro, MD - Specializing in Adult ADHD in New York City
How long have you been struggling in your life and feeling stuck?
• Do you often know exactly the “what” and “how” of what you need to do, but can’t execute?
• Have you had to work three or four times harder than everyone else just to keep up?
• Have you had to work three or four times harder than everyone else just to keep up?
• Have you tried harder and harder, except can’t seem to achieve the level of professional competence you desire?
• Have you often wondered why you initially did well in school, maybe even excelled, but started having increased difficulties as the work became more challenging and your life became more complicated?
• Are you confused and wondering why you’re always procrastinating or not achieving your goals even though, deep down, you know how important your goals are?
• How hard has it been to live like this for so long?
Source: iStock PeopleImages
Source: iStock PeopleImages
Many self-help articles and books on ADHD address the symptoms, challenges, and treatments, both medical and psychological. However, to cope most effectively with ADHD, it is essential to address the lifelong patterns and beliefs of shame that often accompany lifelong ADHD. Otherwise, your success living with ADHD may be limited—even with the help of an accurate diagnosis, medication and treatment. This is because the experience of chronic shame often becomes a firmly held belief of being less than, a failure or defective.
Beliefs create part of one’s identity and according to many theories of the mind and personality, beliefs are firmly held and resistant to change. Thus, paradoxically, an individual with a strong belief of shame may inadvertently perpetuate this belief by many mechanisms such as minimizing praise, ruminating about past and current failures, or spending time with critical people, either in professional or personal relationships.
Take Lucy* for example. She works as a research analyst at a consulting firm and has struggled with concentration, focus, and organization her entire life. Yet she has never been evaluated for ADHD.
At her last job review, she was placed on probation (the reason she called me for an appointment). Growing up, she was bullied and teased by her classmates for being a “space cadet.” Her parents often punished her for not doing her homework and getting low grades. They sometimes offered to help, but their frustration turned into irritability and Lucy felt like a failure. She thought she was a disappointment to them. Lucy’s teachers also often said she was so smart but “not living up to her potential.”
She knew the material and enjoyed learning; however, she felt demoralized by not being able to effectively do her work. She couldn’t figure out what was “broken” or wrong with her. She describes a life-long, painful journey of feeling defective, also known as shame.
She knew the material and enjoyed learning; however, she felt demoralized by not being able to effectively do her work. She couldn’t figure out what was “broken” or wrong with her. She describes a life-long, painful journey of feeling defective, also known as shame.
She was finally diagnosed with ADHD in college and placed on medication, which significantly improved her core symptoms of poor motivation, low focus, disorganization, and impulsivity. However, she pursued a major in accounting which required significant attention to detail was very challenging to her. After graduation, she accepted a job as an internal financial auditor with a very critical boss. These events may seem like coincidences, but is quite a common pattern that I see in my patients with ADHD.
At work, whenever she is confronted with a challenge or task, she becomes anxious, flooded with memories of past failures and disappointments. Her anxiety and criticisms from her boss often causes her to avoid her work and procrastinate, thus reinforcing her anxiety and shame.
Shame is the chronic sense or feeling that there is something bad or broken about you, that you are defective or “less than” others. The origins of shame and defectiveness can vary: it might be due to any number of experiences or events. But frequently it stems from a child feeling different or defective, as a result of negatively impactful experiences and messages from family members or the outside world. Any experience that sends a message to the child that he or she is different and therefore “less than” can result in shame or a sense of defectiveness.
Such differences might be in socio-economic status, behavior compared to other children, ethnicity, medical problems, allergies, sexual orientation, learning differences…and even ADHD. Additionally, traumatic experiences—sexual or physical abuse and bullying—can create shame and defectiveness.
And shame is not only a feeling. It is also a belief that one is broken, damaged, or defective. Having this belief, this experience of shame, can create strong feelings of anxiety and fear. Beliefs are very powerful. Beliefs influence how we see ourselves, how we see our potential in the world.
Beliefs usually develop in childhood and are then perpetuated and reinforced throughout our lives. Researchers believe that our beliefs are influenced by and develop out of our natural, biological temperament and our environment.
One powerful way to address shame using CBT is to become more aware of the negative chatter in our own heads and to evaluate if there are some distortions. Many therapists call this negative chatter, the inner critic, that voice inside our head that creates doubts and worries, saying things like “you’ll never be able to complete this”, “this isn’t good enough”, “you aren’t smart enough”. However, the inner critic may be stronger in people with ADHD due to childhood struggles.
CBT is a powerful, evidenced based treatment that focused on the interaction between thoughts, behaviors and feelings. One key element of CBT is that the stories and thoughts we tell ourselves affects how we feel and what we believe.
Does this voice sound familiar? This toxic voice tends to make you more critical of yourself and others. It can take the “wind our of your sails”, sap your energy, love and creativity, and exacerbate your already challenged symptoms of focus, concentration and motivation. It can be particularly strong if you grew up around critical adults and peers.
Here are four steps to fight the inner critic.
First, become more aware of the voice and when it pops up. Mindfulness can help and so can realizing your own red flags such as feeling bored anxious, or paralyzed. When you notice it, label it. “Oh, there is the inner critic.”
Second, write out what the inner critic is saying. Some examples include:
“I will never get this project done.”
“I am going to get fired.”
“There is something wrong with me.”
“I can’t focus.”
“I can’t do my work.”
“I will never learn this.”
“I am going to get fired.”
“There is something wrong with me.”
“I can’t focus.”
“I can’t do my work.”
“I will never learn this.”
Third, notice what type of inner critic is it. Is it blaming, negative, critical etc.
Fourth, use counter statements that are prepared ahead of time. Be open to them even though may sound like “positive thinking” or wishful thinking like on Saturday Live memorialized in the 1990s. Research has demonstrated the power and impact. Some examples include:
“Done is better than perfect”
“I am a work in progress”
“I can take my time”
“I don’t have to please everyone”
“I am a work in progress”
“I can take my time”
“I don’t have to please everyone”
Give this technique a try. I often recommend that people record the counter statements on a card or on their smartphones. I have worked with thousands of patients and have found this to be an effective strategy for many of my patients in overcoming shame from ADHD.
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*Disclaimer: Details of cases have been altered to protect the confidentiality of any and all individuals.
