Monday, May 3, 2010

Pt. 2: When a "Good News" Diagnosis Means Bad News for the Relationship




Years ago, when my husband first agreed to be evaluated for ADHD, he did it on one condition: that I be evaluated for it, too.  Whether he simply disliked being singled out or truly thought me ADHD'ish remains lost in the mists of time and perhaps distorted perception. 
      My guess: He simply wasn't connecting the dots between his actions and my reactions, which from his perspective seemed to come irrationally flying out of nowhere. From my perspective, of course, my reactions were entirely justified. But could I be sure? No.  Beside, something had to be up with me if I continued to "ride the rollercoaster" of miscommunications, conflict, agreements gone kerflooie, and so on.  So, I happily agreed to join him in a professional workup.           
      Two lengthy evaluations later, my husband was diagnosed with ADHD and I was not. Instead, the psychiatrist pronounced me "complex" and said, "We usually recommend that our patients with ADHD have partners who are organized and can take care of practical matters."  It took me a minute to comprehend: Wait, you're prescribing ME for my husband? (What might they prescribe if my husband didn't already happen to be married to an organized  person. Divorce? A professional organizer love-match-making service? I didn't think to ask.)
       For the next few years, we endured some head-spinning confusion as we struggled to understand and smooth out the dynamics between the two of us, between our respective neurons, and various permutations thereof. During that tumultuous time, an outside observer might have been tempted to diagnose us with a smorgasbord of conditions. And, at some points, we certainly would have agreed. 
Fast forward several years. My husband still has ADHD, though most of the time it's now just a difference and not a big deal. I still don't have ADHD, as my husband will confirm. I'm not perfect (who is?), but I'm much less confused, anxious, depressed, and reactionary than I used to be while the ADHD Roller Coaster ran full tilt and neither of us knew why. We've both made big changes.
     Our story will resonate for many couples affected by unrecognized ADHD. That is, once the ADHD was diagnosed and addressed in a cooperative way, the rest of their challenges were more easily targeted and resolved. It was truly a "good news" diagnosis. For other couples, though, reaching the ADHD diagnosis creates more questions about the relationship's dysfunction than it answers.  Which brings us to Part II of why the good-news diagnosis of ADHD sometimes means bad news for the relationship.


Recap Pt. I: Good News/Bad News


To recap Part I on this topic from last month (click here to read the entire post):

       Newly diagnosed adults with ADHD begin treatment, often including medication, and soon the "fog" of distractibility, impulsivity, and inattention begins dissipating.  With newfound clarity, many of these adults start re-examining their choices – job and career, friendships, health habits, and sometimes even their mates.
      Frequently for the first time in their lives, adults feel solidly optimistic about their ability to evoke permanent changes; after all, they finally have the right answers and right tools. As they excitedly embrace new competencies and confidence, though, inevitably the "balance of power" in their relationship starts shifting.
            
        Jack provided our case study in Part I. Newly on board with ADHD treatment, he expressed bitter resentment over what he felt was his wife's abject lack of appreciation for his stellar progress. He concluded she had unacknowledged problems of her own,  including a drinking habit that had grown increasingly problematic over the years. Last I heard from him, they were headed to divorce.   
        Last month, I offered a few reasons why Jack might not be seeing his wife's side of things and might even be misperceiving his level of progress. The post-ADHD-diagnosis phenomenon is a big and complex topic, full of surprising twists and turns.  
       For example, sometimes the partners of adults with ADHD go a bit ballistic when the diagnosis finally is made. This typically occurs when they've long struggled to "explain the inexplicable" and "manage the unmanageable" around a partner's unrecognized ADHD symptoms. 
       When they finally learn that not only did their partner's problematic behavior have a name it also had a solution, their reaction might be akin to a psychological pressure-cooker blowing its lid. They think back to all the years of frustrating therapy sessions, of futile accommodations, of being blamed by their partner for being "too controlling" or  "fill in the blank."  They might finally understand how they developed a drinking habit to compensate. The resentment might ratchet up by an order of magnitude if they are also suddenly expected to be their ADHD partners' support system while receiving no acknowledgement of past hurts or any focused therapy to address their own trauma. All of these are common scenarios.
      Another equally possible scenario for Jack is that his wife's dysfunctional behaviors had long flown under the radar screen and had in fact been lifetime problems for her; he simply had been too "disconnected" to notice before marriage or after.  With treatment, though, he was noticing and dynamics were shifting.
       Last month's post drew a comment from Katy, who writes about Adult ADHD at the 18Channels blog. She explained how her ADHD diagnosis had a similar bad-news effect on the relationship but a good-news effect in the end:

Bad news: It was one catalyst for the end of the relationship I was in when I was diagnosed...but that relationship wasn't a good fit for me or him anyway. He was a nice guy with a little toxic caretaking streak that even pre-diagnosis I didn't need imposed upon me. And frankly, some of my ADHD quirks were a little stressful for him to live with...duh :) He was far too rigid in his routines for me to be able to accommodate.
        My diagnosis process made him appreciate me as someone who was working hard to take responsibility for their whole selves...but that didn't change the fact that my whole self wasn't a good fit for his whole self. Plus, he was using my eccentricities to hide behind, so he didn't have to deal with his own...!
       I think we're both better off having split up. I got tired of being "the person with the problem" and he got tired of stepping over the garbage can to get to the front door (hey, what can I say, I need visual cues).



Good news: I met the love of my life (sappy, sappy, sappy...but TRUE!) after breaking up with the other dude. He has ADHD too. We absolutely adore each other, and aren't one bit annoyed with each others' ADHD quirks. Half the time we don't even notice each other's ADHD quirks, the other half of the time we're delighted with them.
      I find it highly amusing to watch him wandering around doing some of the exact same funny things that I do to myself all the time, it's so funny to see it from the outside! Ex: today he tore the house apart from top to bottom, looking for his W-2. He says "I just know that I put it somewhere allegedly safe, and I have no idea where that might be!". Every year I lose my W-2's, tear apart the house, and say exactly the same thing. We really need to stop putting things in safe places! I just gave him big hug :)

       As Katy's story illustrates, one person's ADHD diagnosis and treatment can "level the playing field" in the relationship.  In other words, it allows the couple to more clearly assess compatibility beyond the obvious level of, for example,  "I'm disorganized and he's very disorganized." Moreover, it ups the ante on the other partner "copping" to any dysfunctional behavior of his or her own instead of, as Katy points out, hiding behind a partner's dysfunction.

When The "Partner Of" Does Have ADHD, Too

Using the term non-ADHD partners to describe the partners of adults with ADHD  never made sense to me.  For starters, what if they have ADHD, too?  Happens all the time.
       But what if they don't yet know they have ADHD? Given the millions of adults with  undiagnosed ADHD, of course it's possible. Moreover, it figures that the partner with the most obvious or extreme ADHD symptoms will be diagnosed first while the other might come to it only years later. Or never.
       Over the years of moderating support groups for partners of adults with ADHD, I've often wondered about certain members who over long periods of time continue to report no progress on the home front. They also tend to be the ones who keep repeating the same problems and asking me the same questions, never seeming to internalize the information and take action. Could they possibly have ADHD, along with their partners? (Side note: I also see this phenomenon among some parents of children with ADHD who don't seem to notice they might have ADHD, too.)
       Some eventually do figure it out. But, from what I've observed, it typically happens  months or even years after a partner's treatment starts to stabilize. When the dust finally begins to settle—when they're not constantly being drawn into a partner's ADHD-related crises and dramas—they (or their therapists) can more clearly perceive their own contributions to the problems in the relationship. Finally, they can start separating years of poor coping mechanisms (in reacting to a partner's unrecognized ADHD symptoms) from their own lifelong challenges.  
        I receive many letters from readers of my book, Is It You, Me, or Adult A.D.D.?  As you would expect, many are written by the partners of adults with ADHD. Surprisingly, though, most letters come from adults with ADHD. Peter started out in the former category but over time also found himself in the latter. To read excerpts from his series of notes to me (posted with his permission), click here.

What The Research Tells Us

The anecdotes from Katy and Peter above are just that: anecdotes. They are not statistical probabilities; they are simply possibilities. And when it comes to the mental health of partners of adults with ADHD—newly partnered or in longstanding relationships—anything is possible. That hasn't stopped the pundits, however, from issuing often-repeated stereotypes about the partners' psychological makeup or personality, including
  • They have ADHD, too
  • They have low self-esteem
  • They are "sadistic and controlling"
  • They are boring "muggles "
     Trouble is, such certainties are based purely on bias and conjecture even when issued by alleged experts, as they regrettably often are.  
     First, consider this: ADHD affects an estimated 10 to 30  million adults in the U.S., it is a syndrome with highly variable traits, and there's much more to a person than ADHD symptoms.   In short, we cannot make any one-size-fits-all pronouncements about adults with ADHD. How then can we possibly do that for their partners, past or current?
      Second:  We cannot assess the partners' psychological characteristics without also considering the end result of living with a mate's undiagnosed or untreated ADHD symptoms—sometimes for decades and sometimes while also raising children with ADHD. Sure, we can make anecdotal observations how the partners typically seem now, a few months or a few decades into these often high-stress relationships (and this, it seems, is what the alleged experts do).  But what were they like before a few spins around the ADHD Roller Coaster? And what about the partners we don't see in support groups?
      Research is extremely limited on this topic, yet there are two small but important published studies from well-known researchers that shed some light. And there is the ADHD Partner Survey, which examined this topic from several angles.  First the published research:
  1. The psychosocial functioning of children and spouses of adults with ADHD found that "overall, spouses of ADHD adults show no more lifetime and current psychiatric disorders than spouses of comparison adults, challenging the concept of selective mating. They do, however, report more psychological distress on the SCL-90-R and less marital satisfaction. "
  2. The marital and family functioning of adults with ADHD and their spouses – found that the spouses of adults with ADHD did not differ from the control group in terms of psychiatric health.
      The ADHD Partner Survey asked respondents about the state of their mental health both before and during the relationship. The goal for this part of the survey was to differentiate between baseline mental health-conditions (prior to relationship) and the psychological impact of living with a partner's unrecognized ADHD symptoms.  The picture that emerges (see chart below; for larger image, click here) is of a diverse group who bring to these relationships very different backgrounds and mental states. No surprise there.
      It seems the only accurate description we have for the partners of adults with ADHD is this: They live with (or used to live with) a partner who has ADHD. After that, anything is possible and no one-size-fits-all characterizations are useful.






How about you?  Are you in a "mixed" relationship  -- meaning, for example, one of you has ADHD and the other depression or bi-polar disorder? Or maybe you both have ADHD but different sub-types? If so, when were you diagnosed -- before the relationship, during, or after? Please share your thoughts and experiences.


7 comments:

  1. Wow, meaty post.

    Well thank you for giving my relationship air time here this month...obviously we are an ADHD-squared relationship. However, I am clearly a hyperactive ADHDer and my fiance is NOT. He is of the hilariously slightly inattentive type.

    What strikes me as interesting about my partner is that he is actually VERY conscientious and attentive to others. He's always looking for ways to do thoughtful things for people...and it makes me wonder about nature vs. nurture.

    What part of that impulse is the personality traits he was born with, and what part is him overcompensating for his inattentiveness? Hmmm? Because there are certainly times when I say something and he forgets and I have to repeat myself a few minutes later. And maybe again the next day. Times when he is forgetful about certain kinds of things, or loses track of time.

    Knowing that there's a reason though, and from the start of our relationship, makes a big difference. I don't have to speculate that there is intention of some kind behind his oversights...nor does he need to wonder that with me. I know it's ADHD and as such, I just repeat myself if it's something important, remind him if I notice that he forgot something, and let him know (if I notice before he does) if I think we may need to reorganize our time management plan for the day/evening.

    He does the same for me...we kind of take turns.

    The biggest obvious difference between us is my hyperactivity...late at night I start bouncing off the walls like a maniac...and I fidget like crazy all day long and have a hard time slowing my brain down. I also have READY opinions, where he tends to take time to think things out but has terrific insights when he's ready.

    One factor that may be a determinant in some relationships is degree of impairment. I can't say that we're not impaired, but I CAN say that we are both ADHDers who are also extremely organized and we have both developed some really good coping skills in our own right, before ever meeting. We are able to interdepend and help each other, and I feel we are coming to the table with comparable ability to contribute as partners to the relationship. We do not have identical skills, though some are very similar, but between us we have complementary skills.

    Not every relationship has this, ADHD or not. It does seem though, that many partners of ADHDers feel like the scale is balanced more heavily in their direction, when it comes to dealing with life's practicalities. I can see how, over time, this could frustrate someone if they are living in the absence of a logical explanation.

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  2. Thanks so much for your thoughtful contributions, Katy!

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  3. OMG!!! Katy, I started getting teary-eyed bc reading this shows me how I could look at my ADHD and smile and laugh as you seem to do INSTEAD I kick myself when I realize its the ADHD and other times I forget (deny?) its the ADHD and STILL kick myself. My boyfriend of 11 years has most of the same symptoms as me minus the panic attacks yet he has been undiagnosed bc he doesn't want the label or illness (who does, right?)I'm going to show him this article :0

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  4. Kenyetta -- Please stop kicking yourself! :-)

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    1. He wouldn't get help I left sad have not been ms since this book ishelping me to understand it wasn't me and imoff the coaster but devastated by all the horrible behavior

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  5. I don't find ADHD hilarious at all - my ADHD dude is/was so impulsive and oppositional/defiant, he chronically tries/tried to provoke or abuse me, sometimes thoughtlessly, sometimes to try to manipulate me. Then add alcohol (him.) Jekyll and HYDE - on a dime!

    Now in the process of getting OUT of this relationship!

    I'm now traumatized/healing from it, and I'm a VERY strong person. I was able to let go of some of his worst behavior/ past WRONGS and drama when I thought he was trying to work on it, but he's not serious about doing the honest work it would take to treat me fairly. He's just lying and denying. I would run for the hills if I found out my next partner were undiagnosed ADHD. Or even if diagnosed, if they weren't solidly pro-active about being a better person with it / to me. These people can be like roller coasters with no brakes or maintenance - and no warning :(

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    1. I well understand your experience, and am sorry you are living it.

      ADHD takes all shapes and sizes, and it commonly has traveling companions that exacerbate problematic behavior (e.g. depression, anxiety, bi-polar disorder but also conduct disorder, antisocial personality disorder, etc.).

      Please do what you need to do to take care of yourself.

      best
      g

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