DEAR DR. NERDLOVE: I first want to express my appreciation for the work you do in helping people become their best versions of themselves. I saw one of your YouTube videos explaining your journey with diagnosis and treatment of ADHD, so I’m hoping you can give me some insight into what my husband is going through.
Ok, some backstory. I’m a 34 year old woman married to Buck (not his real name), a 35 year old man. We’ve been married for 10 years, together for 14. We’ve spent pretty much all of our adult lives together. We have a three and a half year old and a five month old baby together. Buck is an awesome guy. His hobbies are playing guitar, brewing beer, and weight lifting. He cooks meals often, does the shopping, has a good job that allows me to be a stay at home mom, plays with our son, buys me thoughtful gifts, and more. He makes me laugh and is a good lover too. He is also into some of the same nerdy things I am, so we have fun watching sci-fi stuff and playing board games (well, before we had babe #2 anyway!). He’s also down for outdoor adventures like camping, hiking, etc. like I said, he’s just a great guy.
My/our problem is that ever since he started working full-time at a professional job and becoming a father, he’s been struggling big time with emotional regulation, reactivity that seems to stem from anxiety, and what I have recently discovered is probably rejection-sensitive dysphoria. I tried for literally years to figure out what is going on with him because his behaviors towards me and our son have been challenging to deal with to say the least, and unintentionally abusive at times. I know he is a good guy with a good heart, and that there was something causing him to not be in control of his emotions. After exploring lots of possibilities I asked him one day if he had ever been evaluated for ADHD, and he said that he had been diagnosed with it as a kid and medicated for it for a while. I was pretty shocked that he never told me this! He apparently didn’t think it was a real thing. I joined a support group for wives with partners with ADHD, and have been learning an incredible amount about adult ADHD. The knowledge I have gained from that group and my own research has been hugely helpful in understanding Buck and his struggles, and has given me more appreciation for everything he has accomplished and all that he does for our family. I’ve also learned strategies that I can use to avoid RSD reactions, and about the importance of setting boundaries for myself.
It’s been seven months since I found out about Buck’s diagnosis as a child, and while I’ve learned so, so much about ADHD…he hasn’t. He isn’t convinced that it’s a problem for him even though I’ve explained over and over again that his behaviors and over-the-top reactions to things are not only inappropriate, but sometimes feel abusive. Growing up his family was pretty dysfunctional when it came to discipline, communication, and expressing emotions, so I understand that he may not feel like he’s doing anything wrong by having angry outbursts or being majorly disrespectful towards me since that’s what he saw as normal growing up. I told him the other day that if he didn’t start treatment of some kind — he’s not interested in medication, but has (kind of?) agreed to therapy, supplements, and a mindfulness practice specifically for ADHD — I was going to leave him. I’m looking at it as a boundary that I need to have to protect myself and our kids, but I obviously really want him to follow through on this.
So at long last my questions: Is it fair for me to demand he treat his ADHD? If so, is it also fair for me to put a time limit on seeking treatment? Like, if he doesn’t start seeing a therapist and practicing mindfulness in the next month then I’m out type of time limit. I’m having trouble with his complete avoidance of this, but want to support him in this journey since he’s totally worth it in my opinion. Any insights you have on this would be so appreciated!
Too Tired To Come Up With Clever Sign-Off
DEAR TOO TIRED TO COME UP WITH CLEVER SIGN-OFF: I’m sorry you are going through this TTCUWCSO with your husband. You’re right to want to push him to go into treatment, just as you’re right to feel like his behavior has reached levels that you simply cannot and are not willing to put up with.
That’s one of the reasons why it’s important that, if he HAS been diagnosed with ADHD before, it’s important that he starts getting treatment. One question that desperately needs answering is, is his behavior a symptom of the disorder, or is it separate.
This can actually be hard to tease apart. One of the things that doesn’t get brought up much when talking about ADHD — especially if it’s gone undiagnosed for a while — is the effect it can have on relationships. This is something that actually goes both ways. If you’re the person with ADHD, it can feel like you’re struggling constantly and your partner’s just always on your back. This, of course, leads to a dynamic where you are more likely to say or do whatever you think it takes to get them to back off and leave you alone for a while. Meanwhile, if you’re in a relationship with someone with ADHD, it can feel like you’re being neglected or constantly made a lower priority. You can’t rely on them to actually follow through with what they said they’d do. Words seem to go in one ear and out the other and, worse, they seem to pay attention to just about anything except you.
And that’s before we get into the issues of emotional dysregulation, morbid fear of rejection in almost any form and just the general sense of feeling frustrated and overwhelmed with… just about everything, really. And part of what’s the most frustrating — and what makes folks with ADHD the most irritable and upset — is that our brains will simply not do something. It’s not that you don’t know you need to write that report or file that paperwork, it’s that you literally can’t. You can’t get started on it, and your brain will often end up hyperfocusing on something else… which again, you can’t break away from. It’s not a matter of will, it’s about neurochemical deficiencies and it’s the most frustratingly maddening thing ever.
Plus there’s the ever present out-of-sight, out-of-mind issue, where even things that are important, that you are determined to remember and take care of, simply fade into the background and disappear.
So yeah from the jump: your husband really does need to work on getting treatment. I can speak from experience about just how much of a difference treatment can make when you have ADHD.
Which is why his reticence is understandably frustrating.
You would think that with all the drawbacks and all the problems that ADHD can cause, you’d think that getting treated would be a no-brainer. It’s understandable that you’d be frustrated with your husband; it seems like it should be a simple decision to go back for treatment. Why wouldn’t you, especially when it seems like it’s all upside, no downside?
To answer that question, you have to look at it from his perspective. To start with, even as mental health care has been increasingly destigmatized, there’s still that sense of shame of having a mental illness. For men, especially adult men, having ADHD can feel especially shameful because it feels like we should just be able to muscle through it. Even when you know better, it still feels like weakness or failure on your part. You just aren’t disciplined enough, not tough enough, don’t have enough grit. For someone who grew up in a household that really bought into toxic ideas of masculinity, it can be hard to shake the feeling that you’re taking a shortcut for something that you should be able to overcome on your own.
Another possibility is that Buck had a bad experience with his medication. ADHD meds, like a lot of psychiatric medication, are often more art than science, and different treatments can affect people differently. A lot of the earlier medications for ADHD had some gnarly side-effects; a loss of appetite and insomnia are common, but a lot of folks had issues like blinding migraines or nausea. If the medication didn’t feel like it helped and the side-effects were particularly unpleasant, it’s understandable that he wouldn’t want to give it another go-round, even with new and more effective meds.
But it’s also entirely possible that part of why Buck is digging his heels in is because he feels like you’re attacking him.
Don’t get me wrong: you are VERY well within your rights to draw boundaries and tell him that you need him to get treatment. His behavior’s gone past the point that it’s damaging both his relationship with you and your own emotional health.
But at the same time, the way the two of you go about those conversations can end up being counterproductive. For example, it can be really difficult, for both parties, to separate the symptoms from the person. You — and presumably he — know intellectually how much of this is (or may be) due to his having ADHD, but emotionally it can be hard to distinguish between them. Even when you know somebody’s inattention or absent-mindedness is the result of their condition, it’s still hard to not take it as a judgement on their feelings for you. Similarly, even when you know you have a condition that makes it harder for you to accomplish or remember things, it’s easy to feel like you’re being treated like a child or an inferior. In both cases, it’s very, very easy to let things get personal when those conversations get heated, even when you don’t intend to. That has the net effect of turning it less into a discussion about how to make things better and more of a fight about who has the right to be angry. Or worse, it becomes an opportunity to air all the grievances that’ve been piling up.
The way you’re phrasing things to him, especially talking about how what he does can feel abusive, may well sound like you’re attacking him as a person. From his perspective, with not just his RSD but also his feelings of frustration and being unable to get a break, this may feel like just one more way that you don’t understand him or appreciate how hard he works and so on. That feeling of “I try so goddamn hard, why can’t anyone acknowledge that instead of telling me how I’m f--king up” can cause people to push back in part because they feel like the other person just doesn’t GET them. As such, they may reject solutions out of hand because they don’t believe the other person is correct; if their partner doesn’t understand, why should they try the solution their partner suggested.
And if he’s feeling like you’re acting more like a parent or supervisor than a spouse… well, that’s going to feel especially s--tty, possibly even emasculating.
To add to that: one of the effects of ADHD, as I’m sure you’ve learned, is emotional dysregulation. Even setting RSD aside, folks with ADHD have a hard time controlling their emotions. In some ways, it’s almost like having two settings: slightly below normal and over-the-top, and the level of pressure it takes to flip the switch is variable at best. When you’re feeling especially attacked, pressured or otherwise treated unfairly, things tend to go off… messily and all over the place. And unfortunately, one of the side-effects of this is that it’s very easy to hear what they THINK you’re saying instead of what you’re ACTUALLY saying.
That’s why I think one of the things that may help is to look into couple’s therapy, especially with a counselor who’s familiar with ADHD in adults. Having someone facilitate the conversation may make it easier for you two to actually understand each other, instead of throwing up walls instinctively. It can also help to change the way you describe his behavior when you talk with him. Separating the symptoms from the man, especially when dealing with conflicts, can go a long way towards defusing things. It can also help to talk about just what triggers these outbursts; not with a mind towards preventing them, but simply to understand how he’s feeling and why he’s feeling that way. Not only will it help you understand his triggers, but for him, feeling like someone is actually listening to him and making an effort to understand is going to be huge.
At the same time, having a third party involved, especially someone who understands ADHD symptoms, can help him realize just how much the untreated symptoms are affecting his relationship with you and the kids. That outsider’s perspective could help him realize why his behavior has been so harmful and why it’s pushed you to the point of needing to make an ultimatum.
I would also talk with him about his experiences with treatment in the past. It may well be that the treatment he received didn’t help. He may never have gotten the right dosage, or the medication just didn’t work for him. And if that was the case, then it’s understandable why he might think that ADHD is just not a thing. Talking about his past experiences may help him change his stance and help him be willing to try different therapies, even if those didn’t work for him last time.
However, I would also caution you that all of this takes time. While medications like Vyvanse don’t have a ramp-up period the way SSRIs and MAOIs do, therapy and treatment is still a marathon, not a sprint. For a lot of folks, it’s not just about treating the symptoms of the disorder, it’s dealing with the emotions and coping mechanisms that get wrapped up in there with them. Just because the symptoms go away or ease up, that doesn’t mean that you’re suddenly operating at peak efficiency and all of your previous issues are gone. And if he’s taking the route of therapy and mindfulness meditation but not medication… well, that’s definitely going to take time. I can tell you from experience: mindfulness meditation is something you have to practice, and it takes time to not just make it a successful habit but to get results.
In the meantime, there’s an excellent article from HelpGuide that talks about managing relationships with ADHD. Reading through it with Buck may help open up avenues of conversation and help foster some productive changes. It can help the two of you have a better grasp of what the other is feeling and experiencing and — with luck — foster a little more peace and understanding so that Buck will be willing to get the help he needs.
I’m sorry that the two of you are going through this, but hopefully this is something that can be fixed. It will just take time, patience, love and clear, effective communication for both of you, as well as treatment for him.
Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, email@example.com