An important issue in the therapy of people with ADHD is to take into account gender differences in the course of the disease in women and men and the frequency of suspected diagnoses.
Gender differences in the course of ADHD and their impact on therapy
Many years ago, many women, especially young women, came to therapy with a suspected borderline diagnosis. Typical symptoms: risky behavior, severe domestic violence and trauma stories, high level of mobility, lack of experience of one’s own limits of endurance, especially physical, the need to test oneself to the point of unconsciousness, extreme sensations, including sensory ones, and striving for them. It could also be sexual, so borderline was often associated with addictions and perversion in general. Especially related to blood. In short – > challenges are needed at the motor level. The frequency of drug use, foolish openness to experiences and a certain level of psychoticism, which manifested itself in a tendency to dissociate, depersonalize, etc. Despite a fairly certain heteronormativity, the bisexual theme became apparent. Rarely lesbian. Often, these patients did not see themselves as good people. They should have believed in this, namely, that a bad person with possible many lifetimes comes to therapy.
All of them complained of experiencing inner emptiness, strange dreams, the need for sexual retreat or fantasies or atypicality in experiencing their own drive, as well as depressive and anxiety disorders and suicidal thoughts. Occasionally, suicide attempts occurred.
Currently, apart from the borderline, it is evident that ADHD diagnosis should be part of their diagnosis.
How it can manifest itself: inability to cope with tensions created as a result of trauma. The lack of support, the lack of the so-called mirror in which they could see themselves when they were experiencing something strong or threatening (lack of reflection), they also did not experience empathy or protection. Rather, they complain that they were only made to make demands. They were often beautiful, calm girls who were demanded too much and used various types of violence.
Tensions related to hypermobility, the genetic basis of which was difficult to determine, even if there was a similar disease in the family. They were certainly patients with DDA and DDD syndromes.
Unaware of the fact that this is not just about self-destruction, they created a self-fulfilling prophecy. I have to be angry, I have perverse sexual preferences, I need risk, I am prone to addiction, I will not be a good girl, but it is better that no one in the family knows about it. They were also supposed to be perceived as those that were successful by the family.
(To some extent, this was successful, until they were affected by high levels of fatigue and a tendency to fall into depressive states).
These were patients who endured therapeutic processes for a long time, with awareness of their own suffering, not always with an internalized need for change, and also had a high scale of lies and creating illusions, but in therapy they tried to be as honest as they could afford it. Many of them finished therapy with a resolution, creatively solving the problem. However, the theme of self-destruction remained not fully captured. Why this tiredness in a person who knows no boundaries of fatigue and diligence or falling in love. Therefore, the main reason for concern was not their experiences from the psychotic or personal level, but their own denials built on their resistance to the ideal self and the self from the cursed ego, from which they nevertheless derived a certain perverse pleasure (the experience of power) as well as a reason to self-flagellation (because I consciously manipulate, so it’s bad) through some elements or types of self-destruction.
o the organic level associated with ADHD, (we already have the second and third diagnosis and even 4) (including DDA/DDD syndrome, i.e. initially adaptation disorders, personality spectrum disorders, ADHD, and a tendency to addictions, including depressive and anxiety disorders and neurotic states, including psychosomatics). They were also patients with unusual abilities or interests. Standing out in the crowd, very elegant young women. Probably also with female autism or mild Asperger’s syndrome.
Borderline and ADHD – differences in diagnosis and symptoms
It is a story about ADHD and autism or Asperger’s, that these new stories highlight the need for new diagnoses and liberation from thinking only in terms of personality disorders, such as borderline or narcissism, and a return to orthodox psychoanalysis and psychodynamic therapy on a theoretical but not necessarily practical level.
ATEM: If the patient does not have a typical course of borderline, it is not worth thinking only in terms of this personality disorder.
So how to help if the level of disorders is so wide and deep (if we have such a multitude of diagnoses for 1 person)
Due to the fact that both ADHD and autism, including Asperger’s, are disorders on an organic level or to some extent organic, patients of this type should be prepared for long-term therapies at least once a week and pharmacotherapy. Often with an addiction therapist and a sexologist at the same time, including a psychotherapist assuming long-term support.
Nevertheless, women are definitely luckier when it comes to ADHD diagnosis, and more of them have a chance to finish their studies, develop their passions, or keep a job for a long time, or find a monogamous satisfying relationship, usually heteronormative, compared to men with this diagnosis.
Trauma and its impact on the development of co-existing disorders with ADHD
The very feature of people with ADHD and autism or Asperger’s creates a basis for always returning to thinking about narcissism and borderline, the common effect of which is some kind of sociopathy (simply for example: it builds bonds and relationships only from which I derive profits and strive for a kind of unanimity, I fight for territory, I look for power and domination, I build a kind of social network, but these are still apparent contacts that bring strong emotions, and they strive for hegemony, because they are supposed to look good, and it also assumes damage to bonds at some stage or in some area of them -> according to the IPSK theory, these are personalities after trauma, apparently adapted and prone to risky/addictive behavior).
Since it is still difficult to talk freely about psychopathy and sociopathy, or to find unambiguous diagnoses and differences, and both diagnoses can be feared in therapy, for the purposes of this article the distinguishing features of sociopathies according to the IPSK method.
- Looking for social bonds and the tendency to damage them (we examine the extent and depth of quasi-unconscious resentment towards ourselves or other people),
- a high scale of lies on the outside (inside the experience that you have to find a way to do everything and I have to manage it somehow, so everything is allowed), we also examine the scope and depth of such an assumption,
- apparent customization,
- emotional expression in women for show, in men shallowness of reactions (an effective despot with whom nothing can be planned or done spontaneously). Also to study the scope and depth of such behaviors.
Usually, such a sociopath lives according to certain parameters, is sensitive to new elements of behavior, especially if he is not wanted (attempts to analyze the social mirror and the group). He is afraid of rejection, but he also needs to be left alone, so he can be a rejection himself. It is very difficult for him to change, he easily falls into a breakdown or crisis if some foundation of his life is undermined. He looks for support in groups, he tries new things many times. He is emotionally unpredictable, you don’t know what mood he will be in. However, typical for such a person, especially a man, is a shallow affect, hence it encourages the so-called reading his thoughts, feelings and intentions because he himself does not express much (narcissistic omnipotence and borderline expectation because he is clearer and unusual).
Let’s remember that the cohabitation of ADHD with other diagnoses understood in this way is a factor regulating them from severe depression, unless it is actually a clinical picture.
Sociopathy, which may be associated with such a consolidation in several diagnoses, gives rise to a lot of anxiety, but to some extent they can be normal and safe for relationships. It is simply the result or co-occurrence of certain features in most patients after trauma or with such multiple diagnoses.
However, if there is deep sociopathy, then in fact, apart from using others, such a person is unable to love or care for anyone, not even himself, and puts others in danger. It may not grow out of it either. He can also be a mean parent with a tendency to violence and self-violence, acknowledging power and trying to build a false image of himself, looking for social relationships that will confirm his opinion.
It will also seek to exclude novelties and exclude changes in a recognized parameter. It also doesn’t carry too much. He may also have suicidal tendencies.
However, due to the personal base built on malignant narcissism, apart from vindictiveness and envy, it is also understood at the level of guilt and compassion, because what he fears most is being left alone with his problems. If they don’t know someone or don’t know the rules, they won’t be able to cope. He is easily lost and helpless, hence depressive and anxiety disorders. With extremely deep sociopathy, you have to be very careful, because he is a really serious perpetrator of violence of various types. He subordinates everything to the search for an advantage in building such social networks that confirm his opinion or beliefs (Internet forums, incelism, sects, various types of groups, access to pornography and misunderstood sexual openness at the level of communication are very conducive to this type of structure, not to mention computer games, which, by eliminating empathy and compassion, increase reflexes and experience of one’s own effectiveness). It is a matter of the need to achieve triumph over another person, whose support networks are being weakened. They can do it behind their backs, apparently also using various types of forums and the Internet.
That’s why it’s not worth switching to you in therapy. We will never immediately diagnose someone who creates appearances that we may not expect. Such people can also damage the therapist himself, in therapy morality is not an end in itself, but increasing the well-being of the person, reducing tension and removing suffering and its causes, including leaving pharmacotherapy. Therapy is treated as an opportunity to reduce costs, nothing more.
An extremely important suggestion for novice therapists to take into account the risk of co-occurrence of multiple diagnoses at once as hypotheses to be verified, so that they do not feel obliged to think in terms of long-term therapy after 3 consultations. This should result only from the patient and his motives for therapy along with the experience of suffering. The therapist should only grasp the nature of suffering, and thus try to diagnose the suffering not only of the patient.
Typical ADHD patients (I invite you to ADHD therapy), the men described in this section, are people who show a whole cross-section of society, from atypical specialists who can’t get bored, to people who don’t keep a job for more than a few weeks and the only thing they need is a multitude of changes and stimulants.
This is also where the area of personality disorders appears, mainly borderline and narrism.
They are often open to experiences in a way more focused on the unknown, discovering excitement, and they also try to make their lives full of experiences and strong emotions. On the other hand, it is also typical to avoid physical suffering, especially to reduce the risks and experiences of trauma, as well as the image of the trauma itself. They strive for reinforcement from the group, but they also need to be alone for a while (a bit of an ambivert).
Female autism spectrum and ADHD – diagnoses at the intersection of many disorders
When you are diagnosed with autism or autism spectrum, such as Asperger’s syndrome, then the problem with relationships begins, also at the level of communication, but they still talk about themselves in terms of sensitive emotionality. At least that’s how they present themselves. They also try to be precise and expert in the industry they are interested in.
So we will recognize them by:
- difficulties in functioning in routine, but also striving for it,
- tendency to stimulants or addictions,
- a tendency to manipulate others or power at the level of unanimity of beliefs,
- seeking power and influence,
- consent to perverse sexual behavior, but also not always real sexual activity (trouble in realization on a sexual level in a relationship),
- cutting themselves off from everything if they are interested in something, they have focuses,
- lack of keeping an eye on normal duties, it is difficult for them,
- repetition of bad habits,
- intentional social exclusion (because they themselves were excluded because they were atypical or emotionally incompatible, after a while they learn how to gain the approval of others by guarding one established and accepted structure or norm),
- They treat a problem with a sense of humor, a smile or a joke as shame or embarrassment or surprise.
If we suspect such types of diagnoses, it is worth planning approx. 15-30 meetings and then check the patient’s real needs again, i.e. how much he is in contact with his suffering or what motivation he has for therapy.
A patient who does not suffer will not endure therapy anyway, as well as a patient who lies that he is not addicted. It is also about behavioral addictions.
And let’s not ignore the element of psychoticism, which must not be reinforced. If we have a hunch about something, we check reality, we must not dissolve in something that cannot be realised or proven in some way (they have many false beliefs confirmed by a group of strangers but active forum members). Here there is usually an element of risk in the form of experiencing oneself without limits and one’s own omnipotence. You must not do this, because with this type of diagnosis, it can already be an invitation to live in a world that cannot be proven or seen. (e.g., let’s not say that we know so much about the Nile River just from a textbook and a few photos or a few stories we have heard). These people have a problem with reality in general, because they also have their own internalized parameters, which they may not name out loud. Such a way of thinking can create a delusional state of reflection, including on relationships with others, which is further strengthened socially.
Remember, belief, opinion, hunch, and instinct and intuition supported by knowledge and experience are completely different things.
Paulina Kubś, MSc, author of the IPSK method
