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The Pain of Undiagnosed ADHD in Adult Relationships

Melissa Orlov Jan 25 presenter
 

Editor’s note: Melissa Orlov, LLC, is a marriage consultant who specializes in working with couples impacted by ADHD. She is the author of the award-winning book, The ADHD Effect on Marriage: Understand and Rebuild Your Marriage in Six Steps, and provides seminars for couples and therapists. Her continuing education presentation for GoodTherapy.org, The ADHD Effect on Couples, is scheduled for 9 a.m. PST on January 25. This event is available free with 1.5 CE credits for all GoodTherapy.org members. For details, please click here.

In your couples practice, you may well encounter couples in which one partner is chronically angry while the other keeps making mistakes that are hard to understand, such as regularly forgetting to do something they’ve committed to, constantly irritating their partner by being late, or never cleaning up after themselves. The angry partner tries many things to motivate his or her partner—nagging, scolding, pleading, crying—but nothing seems to work. The forgetful partner is genuinely contrite, yet continues doing the same “stupid” things.

It is possible that this couple’s relationship is being impacted by undiagnosed attention-deficit hyperactivity (ADHD).

Learning how to work with couples affected by ADHD is a relatively new and very much needed skill in couples therapy. It is only recently that we have been thinking much about ADHD in adults, and according to expert ADHD researcher Dr. Russell Barkley, as many as 90% of adults with ADHD remain undiagnosed (1). Clients often don’t know they have ADHD or that it contributes to their marital issues. Many times, neither do their therapists. Unfortunately, unrecognized ADHD can wreak havoc in a relationship—in some research studies, almost doubling rates of marital dysfunction and divorce (2).

One of the side effects of the repetitive missteps of an ADHD partner is that anger builds in the relationship. Chronic distractibility, disorganization, and difficulty remembering things are hallmark traits of adult ADHD that can severely impact one’s life. They also don’t play particularly well in a relationship or at home. A chronically distracted partner is often not particularly good at attending to his or her partner in a way that communicates love. The feelings of love are there, but the partner is simply off doing other things. It is no surprise that non-ADHD partners often report that they feel intensely lonely in their relationship (3).

As distraction, disorganization, and other ADHD symptoms continue unabated, partners of those with ADHD can lose patience and become so angry that it colors every aspect of the relationship. Minor gaffes become major blow-ups because they are symbolic of bigger issues in the relationship. For example, an ADHD partner who leaves the milk out on the counter may be reprimanded by his or her partner for “never paying attention” or being “lazy,” even though in other situations leaving milk out might be considered a “nonevent.”

With enough rebukes, an ADHD partner (who often suffers from self-esteem issues in any event) begins to avoid engaging with the non-ADHD partner. Anger that he or she is being constantly criticized builds, too. Arguments escalate more and more quickly, and the couple find themselves in a strong, negative behavioral spiral. They don’t understand their partner’s seemingly arbitrary behavior, but do understand they don’t like it.

My observation is that by the time ADHD-impacted couples make it to counseling, they are often in very significant trouble. They’ve tried everything they can think of to “fix” things, but because they don’t know about the ADHD, have not found a workable solution to their conflicts. They are suffering from great emotional pain, and are often feeling hopeless about the relationship. Many are trying to decide whether to get divorced, but are confused. They feel they ought to be able to do better and don’t understand why they can’t.

The good news for therapists is that working with these couples can literally turn their lives around. First, couples are typically greatly relieved to realize that there is a reason for their problems. Also, identifying ADHD provides a significant chance for behavioral improvement in the ADHD partner. With effort, about 70% of those with ADHD can find treatment that provides almost complete, or at least very significant, improvement in their symptoms (1).

Naming the problem not only provides renewed hope, it creates an opening for redirecting interactions between partners. Certain types of communication tactics, organizing habits, and ways to “attend” to each other simply work better than others for couples impacted by ADHD. These are often not the same tactics that couples not impacted by ADHD use (3), so therapists need new training to optimize their effectiveness.

Sometimes that training includes learning a new style of interacting with clients. I find that these couples respond well to an “activist” approach to counseling that puts the therapist in multiple roles at different points in the therapy—that of expert educator, listener, ADHD coach, sex advisor, and investigator, to name some of the most common. These couples tend not to learn through self-reflection. Rather, they need active guidance to learn a new skill set that will enable them to live together successfully and bridge their often very considerable differences.

Yes, these couples often have really significant problems. Not all of them stay together. But with the right assistance, many of them are able to turn their relationships back into something they treasure. For therapists, it can be incredibly fulfilling work.

References:

  1. Barkley, R.A. (2010). Taking charge of adult ADHD. New York, NY: The Guilford Press.
  2. Barkley, R. A., Murphy, K. R., Fischer, M. (2008). ADHD in adults: What the science says.New York, NY: The Guilford Press.
  3. Orlov, M.C. (2010). The ADHD effect on marriage: Understand and rebuild your relationship in six steps. Plantation, FL: Specialty Press.

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Comments
  • martha.C January 7th, 2013 at 12:36 PM #1

    While I’m no therapist myself, I find it surprising that such a large percentage of adults with ADHD are never diagnosed. And when that happens it is true that their marriage suffers as well. And not knowing that ADHD is present will make it seem like the person has a problem with the relationship/marriage itself.

    So mere knowledge of the issue and a diagnosis can change just so much.Instead of fighting with each other the couple would then seek help of a therapist! That a diagnosis can make such a difference is a great thing! And the diagnosis will happen only when there is knowledge. So let us start to spread this knowledge. I urge each one of you who has witness a marriage having troubles and exhibiting these things to see if one partner does actually have ADHD (or any other mental health problem) due to which the issues occur. It may well be the difference between treatment and divorce!

  • Joanne January 7th, 2013 at 3:23 PM #2

    In response to Martha c I am not surprised at all that so many adults were never diagnosed because this is such a new thing to me. Before you just had kids who were rambunctious and there was no real name that one felt like had to be put to it.

  • Shane January 7th, 2013 at 11:18 PM #3

    A unknown enemy arching havoc in your marriage?Not good.Cause unless you know the enemy or even the presence Of it you’re not gonna look for ways to fight against it.Further it shifts the blame on the undiagnosed partner and that is never a good thing. Not only is the marriage suffering in such a case but the undiagnosed individual is taking more and more damage each day.

  • Seal January 8th, 2013 at 3:51 AM #4

    I want to have my husnamd tested after reading this, because while he does not exhibit all the signs, he is certainly disorganized and kind of spacey all the time, and It drives me up the wall because I am so focused and anal about keeping things neat and orderly. I can’t tell you how many fights and disagreements we have had over this very thing, and he always says that this is just the way he works best, but to me it is just slows him down and this is a poor excuse. How should I even bring this up to him that I think that there could be some sort of underlying problem, and then how do I find someone who specializes in adult care and testing in this area?

  • Melissa Orlov January 8th, 2013 at 6:27 AM #5

    A good, non-threatening way to bring the topic of adult ADHD up is to pick up a copy of “Delivered from Distraction” by Ned Hallowell. It provides an upbeat but very informative introduction to ADHD. Many ADHD adults who read it will recognize themselves and then consider getting a diagnosis. Likewise, many couples “see” their stories in my own book, “The ADHD Effect on Marriage,” the first part of which describes the patterns that marriages impacted by ADHD have in them. So this, too, can help someone consider getting a diagnosis. Ultimately, it is the person who might have the ADHD who needs to be agreeable to seeking a diagnosis, though you can gently suggest that ADHD is a possibility worth exploring because if ADHD is present it is generally manageable.

    There are quite a few online resources for finding therapists who understand ADHD – I suggest you start with this site, since it’s all about finding the right therapist!

  • Amber January 8th, 2013 at 8:08 AM #6

    I have a friend who I met in high school that I really enjoyed spending time with. So much, in fact, that I really liked him and wanted to date him. He seemed to show interest as well and he said he’d call. Two hours later, sometimes he’d remember to call. He would schedule a time to pick me up and he’d always be late. It seemed like I was never nor would ever be a priority to him. One day, I asked him what he would say if somebody asked him about us. Would he say we were boyfriend/girlfriend or just friends? After that conversation, things fizzled out and we both moved on. Fast forward about 20 years and I found out he and his wife were divorcing. I was always amazed that she could hold his attention. Anyway, the reason they were divorcing was b/c his adult ADHD ruined their relationship. I sure wish he could acknowledge that he needs help so he doesn’t go down the same path again. He really is a great person and I’d love to see him settle down and find happiness.

  • K Langa January 8th, 2013 at 8:10 AM #7

    Yet another convenient excuse for irresponsible behavior in adults. When is the field of psychology going to acknowledge that some people are just selfish and irresponsible??!!

  • Alena January 8th, 2013 at 5:27 PM #8

    I can’t believe what I’m reading. When is this over “diagnosis” going to stop? Pop a pill for this, pop a pill for that. It’s nothing but a money-making business.

  • SANDRA January 8th, 2013 at 9:41 PM #9

    And how exactly do these people enter adulthood,get married and have issues without ever getting diagnosed?I think that is where the fault lies – in not knowing you have an issue. Also, the family should play a role in this.If they see continually different or weird behavior then they should suggest the individual to see a professional.that way the disorder can be diagnosed,a marriage could be saved and the future partner saved from a lot of problems!

  • Melissa Orlov January 9th, 2013 at 7:45 AM #10

    Let me see if I can reply adequately to the last three comments:
    First, it’s hard to see how diagnosing only 10% of the cases is “overdiagnosis.”

    Second, there is a VERY large body of research about ADHD addressing the question of whether or not it is “real.” In spite of media hype to the contrary, the research shows that it is, without a doubt, real. Not only that, but it is one of the more destructive mental health issues when it comes to how many realms of one’s life are negatively impacted. This makes getting adults properly diagnosed are real mental health priority. For anyone who wishes to understand the science better (rather than just parrot back the impression of the media, for example) take a look at “ADHD in Adults: What the Science Says” by Barkley, Murphy and Fischer. It’s long, detailed and very informative. On page 435 (yes, there’s that much to review) you’ll find this definitive quote: “Statements to the effect that ADHD is not a valid disorder, is a myth created by mercenary pharmceutical companies…for sheer commercial gain, or is indistinct from other disorders…are not only wrong, they are egregiously so…To continue to make such statements in the face of such overwhelming evidence to the contrary is to show either a stunning scientific illiteracy or reflect planned religious or political propaganda intended to deceive the uninformed or unsuspecting general public.” This is a pretty definitive statement as far as science goes and I (and the authors of the statement) welcome all to study the science behind ADHD.

    As for the question of whether someone has ADHD or is simply selfish…there are some people out there who are selfish to be sure. This is why you seek an evaluation for ADHD. If you have ADHD, the symptoms can sometimes be interpreted as simply being selfish (for example, being very distracted and following your own thoughts and actions or having trouble following through on tasks you’ve agreed to” – both of which can come across as being “selfish.”) If you have ADHD, then the symptoms can be addressed so that the behavior which had previously been incorrectly assumed to be motivated by self-interest (i.e. selfish rather than distracted) can now be impacted by treatment.

    Even for those who are frustrated and angry about what they think is selfish behavior (perhaps including the poster of the comment) then benefit from the change. But it only comes from proper diagnosis so that the real issue can be addressed.

    These last three comments are exactly why it is so important for therapists to understand how ADHD impacts adults.

  • Alena January 20th, 2013 at 8:14 PM #11

    But I wasn’t referring to the 10% of people who have already been “diagnosed”, but rather to the remaining 90% who have not yet been but who most likely will be “diagnosed”.

  • Brooke April 23rd, 2013 at 8:32 PM #12

    In response to all posts, I am a secondary school teacher and work with students with adhd. In one of my classes, there is a student with adhd who is very intelligent, yet is so distracted that I would spend 90% of classtime redirecting the student to task. Knowing he has difficulty with his impulses means that teachers don’t label him as lazy, naughty or incapable but have access to strategies to assist this child who deserves our support. On a different note, regarding adult adhd, it had never crossed my mind that adults may be undiagnosed. It never crossed my mind that it wasn’t a work based concern that I dealt with in response to children and their needs, children who are thankfully being diagnosed early so that their future opportunities are less impacted through adult support and self enabling strategies. So quite separately, I had been coming home from work to a family and marriage for 12 years where over time my marriage was experiencing bizarre (to me) challenges. Challenges which had me seeking professional help for depression, which I was told I didn’t have, which confused me even more because I felt so lonely and isolated and frustrated. One day I watched a show on Adult adhd. The show basically detailed the signs and symptoms. I was gobsmacked. Id been taking myself off to doctors because Id felt I was losing my mind, when in fact, my husband absolutely had adhd, and responding to his behaviours in my marriage was exhausting me. Imagine this, he is a smart, hardworking, kind and wonderful husband and father. Yet, the issues I was having with him were things like simply talking. Id follow him around the yard to keep dialogue going, Id explain I had a big problem and he couldn’t resist washing the dirty bucket in his eye view, I explained I was experiencing extreme grief at my fathers recent death and he said we would talk about it in the car when we drove to a wedding 2 hours away in 2 weeks time. He works like a Trojan, exhausting himself daily. He cant read a book, as its too demanding, so over time I found myself doing the research for his business or website development or whatever for him because he just couldn’t sit and do it. Our intimacy suffers, he can go for 6 months without any physical intimacy, I’ve even got to the point where I’ve hoped he was having an affair or gay or something that might explain his lack of focus on me, and I’ve come to accept that just isn’t it. He is hyper organised, he needs to know what’s for dinner at 5.30am when he leaves for work, he needs lists for everything and seems to think cleaning that bucket is more important to do now as dinner is at 6pm, than my or our kids needs. When a person is so wonderful in so many ways and you experience this stuff, its hard to understand. I don’t nag, I gave that up ages ago, I was actually to the point of saying to him that this is the saddest potential breakup of my life, because I cant go my whole life with this as my lot.
    That was before I had researched, and read the science of adhd more closely. Talk about liberating!
    Wow, never divorcing this guy now. Understanding him has meant the world of difference to our communication, strategies and actions. He feels understood, he understands his past better, his schooling better, his “Easily distracted” comment on every report card his whole life. Don’t judge, listen, learn and understand the impact from other peoples perspectives.

  • Melissa Orlov April 24th, 2013 at 2:42 PM #13

    Thank you so much for sharing your story! People often ask me why, even though I was working with people in the area of ADHD, I didn’t realize my husband has ADHD sooner. We just don’t even think about ADHD in adults…until we do. And when we do, it is completely liberating, as you say.

  • Brooke April 25th, 2013 at 9:33 PM #14

    I hope sharing my story reveals something of the nature of ADHD in adults.

    My husband is completely competent and charming, a nice guy, well loved, liked and respected and to most, would show no signs of ADHD.

    I only learned about ADHD in children as a result of working as a teacher, there was no reason for me to reflect on my husbands behaviour in terms of ADHD self diagnosis, even as I became aware of the strategies to assist children. As a high school teacher I teach 5 year levels, over 100 different students a week. Each class cohort has around 25 students. In each class the cohort has a range of learning needs and can be impacted by a number of issues from literacy, English as a second language, Aspergers, autism, gifted and talented and ADHD, not to mention physical disability or illness such as diabetes or epilepsy. I teach in a mainstream school by the way. Teachers have a duty of care and a responsibility to support all learners and
    this may provide non teachers with a perspective on the realities of educating content whilst spinning the plates of individual learner needs. Adolescents are also experiencing ‘adolescence’ social and hormonal changes etc. In my previous post I mentioned the one student, to highlight the reality that this student required 90% of my attention in his class over this term even though students in the class with other needs are present. Had I not understood ADHD he would most likely have spent more time with the “behaviour management” team (in detention)than learning. So, how did I not recognise this in my husband?

    Well firstly, as I’ve since discovered ADHD symptoms are unique to individuals and what I was looking at as adolescent or childhood behaviour was actually ADHD, in my student and husband, of course in my marriage I viewed my husband through deficit in many ways because he happened to be an adult in my personal context. How insulting when he was trying so hard to overcompensate for his personal sense of lack.

    My husband had – since childhood, managed to find ways to use his ‘strengths’ productively. People see him as a resource for completing their jobs quickly and efficiently and he has always taken on other peoples tasks and felt proud that he was asked and had become so appreciated. I was always being told how lucky I was to have such a productive husband, lovely lawn, clean house, home at night, caring father, and of course he is all of those things. How ever what no one could see was that he was like a train on a never ending track, that they were indeed ‘using’ his efforts which for him was busy work and urgent, urgent, urgent, even if his kids were sick or his life suffered. He had significant issues coping at work and at home, where I was his only witness and support. Over time, as the responsibilities of our adult lives increased and he appeared to remain in what I saw as a perpetual state of adolescence, things became increasingly difficult. I called him ‘Dory’ (from Finding Nemo) as a joke because he would walk off mid sentence with some job or idea and forget we were talking, the kids saw him as fun dad because he would come home after 12 hours work, go bushwalking and bike riding, cook a weeks food and crash into bed with them,unless he was off on his own doing some impulsive buying on the internet or staying up all night to fix the handle on the bin. The actual busyness of work, kids, uni study, pregnancy, bill paying, washing and the thousand other mundane chores I was left with along with translating the news or other information he couldn’t focus on had exhausted me and I was seeing marriage counsellors, psychologists and others (alone)to try to fix myself for not being happy when I had such a great guy!

    Also, life ‘happens’. E.g. My dad died, my sister had a stroke, his dad got cancer and so on.
    The emotional work of keeping all this going was my job alone. Intimacy may be the last thing you would think of as soul destroying, but it became zero. I started to feel embarrassed to ask about it, like I was some sex starved weirdo, new to me as Id spent most of my previous life, fending off unwelcome sexual attention . Id become so accustomed to it being not there that I ignored it, although I was acutely aware of it. Bringing it up was difficult as he would say it was the kids and his work but I was exhausted and still had time for a hug. The psychological trauma this has caused me is vast.

    This blogs title is “The pain of undiagnosed ADHD”.
    The pain is that for the non ADHD spouse, the loss is immense if you view your marriage through the lens of what could or should be happening in your idea of normal. The pain I have suffered is at times a genuine loss of self, the self blame for the issues, the years of sadness and isolation and confusion. Knowing my husband has ADHD allows me so much relief from these emotions and affords a way forward. Our lives are 100% transformed to the positive as a result. I truly hope that the doubters (who must not know or be married to a person with ADHD)come to understand the reality of adult ADHD. And if “diagnosis” is indeed a Placebo for adult laziness as suggested by other writers, I don’t care! Its working for me after 12 years of misery.
    Adults are simply grown up children. Why wouldn’t adults have ADHD? I thank YOU Melissa for dedicating your career focus on this issue.

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