Women Uncovering ADHD Later in Life: The Confusion, and the Relationship Fall Out

I’ve noticed so many female clients coming to me for talk therapy with a presenting problem of relationship issues or anxiety, only to uncover the underlying disorder of ADHD driving their symptoms, overstimulating their senses, and overwhelming their lives and relationships.

I will describe two cases.

Holly* came to me saying she wanted help because she was “10 months postpartum and I’m still having trouble controlling my emotions and triggers. I’ve been on antidepressant/anxiety medication since I was 2 months postpartum. Medication helps some but I want to focus on assessing my triggers and how to better manage them. Because of this, I’ve been having issues with my husband and our relationship.”

The presenting concerns she reported were dealing with triggers and emotions post-partum, and concerns in her relationship.  Holly went on to say:

“I am finding myself blowing up over the tiniest things like the dog getting stuck under my feet and dropping something on the floor. Or my son making loud sounds. Like I am getting overstimulated very quickly and I can’t focus on calming myself down.”

The deeper we went into her history it was evident ADHD symptoms were present in many areas of her life. Nobody caught it in her childhood. She was a girl who followed the rules and didn’t act out.

After a few months of therapy, Holly had taken my recommendation to be assessed for ADHD medication options.  She began taking medication and a few months later she had applied to a PhD program and was ready to move on from therapy.  She was medicated, and no longer found her life to be unmanageable.  She had worked through issues in childhood and her family and learned new tools and skills.  She and her husband bought a new house and Holly had a new outlook on life.

Sarah* came to me with presenting problems with her relationship, anxiety, and depression.

Sarah talked a lot about the relationship with her husband.  She described emotional extremes in her thinking and her reactions.  They had complex issues, and couldn’t seem to communicate.  Disagreements would go from 0 to 60 so fast, and they couldn’t seem to get past some of the emotional immaturity and ignorance they both were vulnerable to.

I considered borderline personality as a working diagnosis, although that didn’t seem to quite fit.  She had no history of self-harm or suicidal ideation.  Other relationships throughout her lifetime were mostly positive.  

It’s very common for ADHD to be misdiagnosed as other conditions.  The more she talked the more ADHD symptoms emerged.  

She described intense frustration with distractibility, and difficulty concentrating.  She couldn’t keep organized.  No matter how desperately she wanted and tried to be she couldn’t find structure.  She became enraged daily by certain stimuli.  Certain noises, textures, and touches that wouldn’t bother most people could send Sarah over the edge.

One day she told me that the sounds of her husband eating cereal from a glass bowl gave her a crazy impulse to scream and slap that bowl and spoon out of his hand and send it flying.  Instead, she covered her ears.  This happens daily she reports, and she feels so bad and guilty because she knows it’s not his fault.  But she can’t help but make comments about him chewing with his mouth closed, and to please be more quiet with his Captain Crunch.  It’s not that it is just annoying and frustrating.  People who experience this level of sensitivity are experiencing emotional pain.

Misophonia: a condition that describes this rage and pain. 

Misophonia, also called selective sound sensitivity syndrome, is a condition in which certain sounds trigger an outburst marked by irritation, anger, or aggression. People with misophonia react in an extreme and often emotional way to certain trigger sounds.

She knew she overreacted to her husband and children.  She became angry quickly and couldn’t seem to help her reactions before it was too late.  We began to explore her triggers so that she could start taking action by simply noticing when these moments occur.

Her relationships with her husband and children were suffering.

She would report that she could be looking right at the television screen, appearing as if she were immersed in the show.  But she would have no idea what was going on.

She got distracted instead by what her daughter was thinking or feeling, what her husband said earlier that bothered her.  Or what she had to do the next day.

Sarah was also grieving.  She was grieving due to decisions she made during moments of impulsivity through the years.  Impulsivity is a symptom of ADHD.  She made choices that impacted her marriage, and trust with her husband.  Choices that led to too much spending and debt.  Choices that impacted her health.

She was grieving missing out on the early years of her children’s lives.  She worked full-time.  She was giving 100 percent to her clients, but would then get home and be done for the day.  She still had to raise a family and somehow be a good wife and mother, but she always felt like she was failing.  Looking back now she tells me she is grieving because when she thinks of the first five years of her children’s lives she can’t remember a lot of it.  She can’t remember holding her babies, rocking them, being with them.  She was there.  Her memory is just so fuzzy.  I explained to Sarah what Wendy Richardson said in her book “When Too Much isn’t Enough.  Ending the Destructive Cycle of ADHD and Addictive Behavior.”

This is what the author says:  

“Many people with ADHD describe periods when their attention becomes so engaged that they can’t disengage.  The results of having your total attention focused in one place can be awesome.  It’s amazing what some people with ADHD create during periods of absolute attention.  However, this type of attention can take its toll on relationship problems, exhaustion, fatigue, and sometimes failing health.  When your attention is captured, you are elsewhere, which means you are not where you are.  Your children or spouse will be talking to you, but what they say doesn’t register in your thoughts or feelings.  People who tend to become highly engaged in what they’re doing can miss out on life.  Over the years they can become isolated and lonely.”

This is likely what Sarah was experiencing.  She had to show up for work.  And when she was there she gave it her all.  Sarah’s brain could only handle so much.  And she was detaching at home.

Sarah startles easily when hearing a loud noise.  She hated when her husband would use harsh words and tone.  She couldn’t tolerate negativity.  She reported feeling traumatized by yelling.  Her father yelled, and she remembers living with fear her entire childhood of getting in trouble or being yelled at.  Arguments with her husband would leave her feeling traumatized, and then the black-and-white thinking would appear.  She often perceived herself as the victim and her husband as the problem.  She experienced love/hate ups and downs so much that it impacted the health of her marriage.

She struggled with boundaries in all her relationships.  She knew it wasn’t healthy to keep the peace in efforts to avoid conflict, but that’s where she ended up naturally.  She would need help to change.

She described being completely overwhelmed and consumed by clutter in her home.  No matter how hard she tried to organize, she couldn’t.  Not without help.  In my office, I often observed her seeking things from her purse.  She would be looking for something she couldn’t find.  A pen.  Her keys.  Her phone.

She would describe deep pain and frustration over a question in her mind she couldn’t answer for years.  Why did she struggle with addiction?  She grew up thinking her childhood was “normal.”  Don’t most people with addiction have trauma of some kind?  There were themes of normalcy in her childhood, although the more stories she told, the more a narrative was emerging of some mild to moderate trauma.  Some were environmental, while others were related to her brain biology.  She had never heard of “neurodiversity,” “executive functioning,” or “frontal lobe” until her thirties. 

She and her husband both had always experimented with alcohol and drugs but never became dependent on them.  Or never found themselves in a situation where they couldn’t stop.  

Until opiates came into the picture. Soon they both were out of control, and they couldn’t seem to stop a train of continued drug use.  Not even in the face of numerous negative consequences.  

In the process of therapy, Sarah began to explore a narrative that finally made sense.

She experimented with drugs and became stuck on opiates because she was using them to self-medicate.  She would have a false sense of belief that she needed opiates to be productive and function.  If she had only known she had ADHD, she could’ve gotten help.

Sarah reported she was never diagnosed with ADHD, but when looking back, she could recall many things that were now starting to make sense.

She was slow to process.  She remembered hearing jokes and feeling embarrassed because she felt like the only one who didn’t get it.  After thinking about the joke, she would finally understand it.  Maybe.

She struggled with her memory.  She could produce information for a test she studied for.  Then the information would be gone.  

She couldn’t watch scary movies with any violence.  Her friends loved to watch horror movies at sleepovers, but she remembers feeling so nervous about it and hating the movie, trying her best to discreetly cover her eyes and ears.  She thought she was the weird one.  Now sheunderstands that scary movies are sensory overload.  She still can’t watch much violence, and for sure no horror.  It’s too emotionally painful, and over-stimulating.

She couldn’t absorb information like some of her friends who could listen to the teacher lecture and do ok on a test.  For Sarah to do well in school she had to work very hard to get average grades.  And it had nothing to do with intelligence.

Girls often get overlooked when they have ADHD.   Especially the inattentive type.  If a girl isn’t bouncing on the walls like another boy in the class who has ADHD, it can easily be overlooked and unnoticed.  She’s more likely to be found daydreaming.

After uncovering these things in therapy Sarah is now doing much better.

She reports it’s a relief to understand why she is the way she is.  Now she can focus on how to manage it.

Sarah has a doctor who understands and gets her.  It took going through a few practitioners to find one that could treat her effectively.  She worried nobody would believe her.  Bringing it up made her nervous because she never knew if she could articulate it well enough or not.

 She now feels a great deal of gratitude and can see the gifts and strengths in her disorder and outside her disorder as a whole person.  She tells me she now knows her superpower.  And her boundaries get stronger every day.

She now has conversations with her husband about ADHD and how it impacts her.

Her husband still becomes agitated at times with Sarah but does seem to understand better.  She reports their relationship is better than it has been in years.  But there’s still a lot of work to be done.

And they began couples therapy.

*Names and some details changed to protect client privacy