Author: Georgia Macdonald-DanversThis article is for all of my neurodivergent friends who menstruate. 'Aunt Flow' is notoriously the least favourite visitor of every month, with the cramping and the PMS. But for people with ADHD, it is a whole other problem. PMS is often not an experience people with ADHD have, instead it usually manifests as premenstrual dysphoric disorder (PMDD). PMS and PMDD share symptoms of; breast tenderness, bloating, change in appetite, mood swings, low concentration, and over 150 others. Where PMS and PMDD differ is that PMDD is a bit more strict in the diagnostic criteria. While it is separate from other mental disorders as it is directly linked to menstruation, PMDD specifically is distinguished by an abundance of symptoms, one of which has to involve mood dysregulation. Aside from symptoms, the intensity of them must be causing functional impairment. So, when we think of PMS, that is the typical light cramping and hormonal moodiness that can come before your period. PMDD is a hormone-related mood disorder (another example of a hormone-related mood disorder is postpartum depression). To begin, mood-related symptoms are already more common for women with ADHD (often experiencing more anxiety & depression). This puts neurodivergent women at especially high risk for this disorder. In a study, they found that 45.5% of women with ADHD experience PMDD versus the 28.7% prevalence rate in the general population. The symptoms of PMDD spread beyond the week of a period. Often symptoms are between weeks 2-4 of your menstrual cycle, making it an incredibly overwhelming and somewhat long-term problem almost if not every single month. The diagnosis process of PMDD is simple but long. To be able to accurately diagnose this hormonal mood disorder you need to have a very complete examination of your mental and physical health. For diagnoses, it is important to have recorded medical history, lab assessment, and pelvic examination. The medical history should be detailed and also should include any previous or current medications to be able to take substance abuse into account. In the lab, your hormone levels, blood chemistry, and cell count can be looked at to give more insight into your patterns and symptoms. Along with these, a pelvic exam is required as it is important to look for and rule out any other physical illness. There are many ways to treat or more so manage PMDD symptoms. SSRIs like Zoloft can be used to treat the issues with mood associated with the disorder. Professionals recommend lifestyle changes to assist in being able to cope with PMDD. These include; dietary changes and supplements, regular exercise, and keeping stress levels as low as possible. Sources: Expert Guidelines for the Treatment of Severe PMS, PMDD, and Comorbidities: The Role of SSRIs by Meir Steiner, Teri Pearlstein, Lee S. Cohen, Jean Endicott, Susan G. Kornstein, Carla Roberts, David L. Roberts, & Kimberly Yonkers Prevalence of hormone-related mood disorder symptoms in women with ADHD Farangis Dorani, Denise Bijleng, Aartjan T.F. Beekman, Eus J.W. van Someren, J.J. Sandra Kooij Understanding and treating PMS/PMDD by Penelope M. Bosarge Author: Allison Cooke // CW: Disordered Eating Unfortunate as I was to discover that commonality of comorbidity of mental illnesses, the relation in symptoms leads to a relation in treatment, meaning although one problem may be presented in different ways, the aid is also found in one way but can be applied to a variety of symptoms. Personally, I survive through a diagnosis of Bipolar II disorder and generalized anxiety, as well as ADHD which this article pertains to, however an illness I have not been officially diagnosed in is Anorexia Nervosa. The concept of diagnosis in the mental health field as a way of validation of sickness is privileged in the simplest of terms. The accessibility of a doctor capable of diagnosis is not universal even within a singular country or in my case the particular province I live in. I identify as surviving through both ADHD and Anorexia Nervosa. I do not need a doctor to tell me, and validate that I have significant problems with eating. Due to the physical ramifications of an eating disorder, a self-diagnosis is accepted as fact. In general, studies have suggested that there is a significant gendered factor to Eating Disorders, including the entire spectrum from Bulimia Nervosa to my own self-diagnosis of Anorexia Nervosa. On the topic of gender and following the topic of diagnosis is the matter of a huge population of girls and women who remain undiagnosed with ADHD due to the DSM-5 criteria and its bias towards symptoms that fall more on the male side of the disorder. Studies have shown the current levels of ones ADHD, recognizing that symptoms can at times be much more prevalent than other times, are fasting related. Furthermore, the concept of a peak in ADHD behaviours can be related to feelings of impulsivity and a general lack of control that can come to prevalence regarding food and consumption. Binge eating, which is characterized as consuming a large quantity of food in a short period of time, is closely related to the impulsivity that is so recognized as a part of ADHD. The logic behind this relates to the hyper-focus on a particular topic that accompanies a lack of concentration of a subject unrelated to the particular fixation, resulting in an intended or unintended fast; the body responds when finally given the fuel it was deprived of by consuming all within sight. From my personal perspective, I understand that controlling my impulsivity plays a role in my eating disorder. I find peace in the control I take over my ADHD mindset and predisposition to binge eating by starving myself of not only nutrients by joyous foods and food-related activities. Generally speaking, the activity of eating is a break for most people, with their lunch break signifying a rest time during the workday. My mind has two functions; stop and go, meaning I have a hard time stopping an activity for a break to eat, and fall into holes of restricting and bingeing. On the eating disorder side of this comorbid combination is a dreadful shame that accompanies the binges, and fuels my desire to prolong the restriction phases. This is a spiral that the longer you restrict, the less control you have when you finally binge, and then the eating disorder voices tell you to compensate by restricting longer and harder, only to inevitably trigger another binge. This may look grim, but one of the benefits of comorbid illnesses is the treatment is also comorbid, or occurring at once. With treatment of my impulse control, I can target both the ADHD and ED behaviours. Furthermore, in relation to eating disorders, there is no medication that will cure you, however in my opinion eating disorders are commonly a symptom, or better phrased a coping mechanism to another illness, meaning that the impulsivity that enables binge eating can be treated on its own, and thus have a positive effect on the binges, although not directly treating. It is important to remember that eating disorders are mental illnesses and cannot be treated through physical means alone, meaning treating the psychological symptoms will result in physical benefits, like better coping strategies than starving yourself for control. Sources: Ptacek, Radek et al. “Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced.”Dove Press Journal Neuropsychiatric Disease and Treatment. 2016. Sala, L et al. “Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients.” Eat Weight Disord. 2018. Yao, Shuyang et al. “Associations Between Attention-Deficit/ Hyperactivity Disorder and Various Eating Disorders: A Swedish Nationwide Population Study Using Multiple Genetically Informative Approaches.” Society of Biological Psychiatry. 2019. Author: Georgia Macdonald-Danvers Welcome back! After an (unplanned) hiatus we are back with all of the information you love. This time, we're talking about interests and hobbies! This topic is one I have been wanting to dive into for a while since interests can be so complex for the ADHD mind. To start, let's talk about hyperfocus. Think about those times where you're sitting down to work on something, after a few minutes when you decide to stop you look up to realize those few minutes were actually HOURS, when you need to learn everything there is to know about that new thing you are interested in. Those are the moments of hyperfocus that impede the life of people with ADHD consistently. This is a term that is going to be important when thinking about interests and hobbies (and everywhere else, loved ones should take note of this one). Hyperfocus is an ADHD symptom that can be described as long-lasting and highly focused attention. It can even be described as falling into a hypnotic spell. Through research we have seen that hyperfocus is most commonly brought on by hobbies, being on a computer, and watching TV! Something to note for women and girls with ADHD, we are more likely to feel the need for perfectionism, a less than ideal accompaniment with hyperfocus. Next, we get to talk about 'Hobby Jumping', which manifests itself in women with ADHD incredibly often. 'Hobby Jumping' is the tendency for people with ADHD to move from or collect multiple hobbies at a rapid pace. This often looks like a cycle of gaining interest, lots of research, hyperfocus (or the hobby becoming a hyper fixation), to then be left feeling uninterested and bored once again. If you're neurotypical and reading this, that is right, most people with ADHD are gaining and losing passions for things all the time. This symptom has been looming in the back of my mind since the day I started ADH-She. I love this site and I am afraid of waking up one morning to lose the spark I feel for it now. In saying that, it's been a wonderful few months of growing and although I have moments where I think I may want to give it all up I feel as though this is a project that will stand the test of time (unlike when I wanted to be an actress, influencer, baker, or learn the ins and outs of making jewellery). I say that because although jumping interests can be hard and can feel like nothing will ever truly stick, but that is not always the case! So, whether you're on hour 6 of your favourite video game or spending your days researching the mysteries of outer space... the world of hobbies, interests, and hyper fixations are for everyone (especially in the ADHD community)! Continue to share your art, knowledge, and skills with the world around you, even if that project never gets finished or if that topic starts sounding boring. There is no shame in being passionate about something right here, right now! Sources: Living "in the zone": hyperfocus in adult ADHD by Kathleen Hupfeld, Tessa Abagis & Priti Shah ADHD in Girls: Why It's Ignored, Why That's Dangerous by Maureen Connolly & reviewed by Sharon Saline, PSY.D Understanding ADHD in Girls: Identification and Social Characteristics by Janice Grskovic & Sydney S. Zentall Author: Georgia Macdonald-Danvers Often, when looking at symptoms of ADHD, we expect the "hyperactive rule-breaker" that is associated males. But, have you ever noticed you or your loved one has less control of their emotions, has regular mood swings, and is easily irritated? Well, that is the hallmark ADHD symptom of emotional dysfunction. As someone who struggles with this symptom personally, it is not as intimidating as it sounds. Emotional dysregulation can be defined as the inability to control emotional responses to stimuli. It is especially common among adult women with ADHD, so this is an important topic to cover over here on ADH-She. Researchers also often equate emotional dysregulation with emotional impulsivity which is characterized by; lack of patience, a quick temper, overreaction, becoming excited with ease, and being easily irritated. These symptoms of impulsivity are also prevalent in women with ADHD, making emotional dysregulation something that can become a more impairing issue (example: unhealthy coping). First, advice for my neurodivergent friends! Below are some tips on how to manage emotional dysregulation in your own life: 1. Check your Facts!: ask yourself these 4 questions when you feel things are escalating emotionally; "what event triggered my emotion?", "what interpretations or assumptions am I making about the event?", "does my emotion and its intensity match the facts of the situation?", and "does my emotion just match my assumptions of the situation?" 2. Focus on positive activities & events: examples of small positive activities are having a nice meal, visiting a friend, listening to music, or going on a walk! 3. Be prepared!: dreading the possibility of entering a situation that might be a bit emotionally stressful? Make an escape plan to ensure whatever emotional triggers arrive, you can distance yourself. Another way to be proactive with emotional dysregulation is to schedule times to vent and recharge! Next, for the support system (you're so important) there are some things (and advice) you can do for your neurotypical loved ones to make their experience even easier: 1. Your loved one ≠ their emotional response: emotional challenges come from your brain, and the ADHD brain has some difficulties with brain connectivity networks that are in charge of carrying emotional information. Remember that although these outbursts may be challenging for you both, they are not representative of your loved one. 2. Allow your loved one to feel safe: often emotional outbursts can be a sign that something is being perceived as emotionally dangerous (even if that is not the reality). This perception is what brings on the 'fight or flight' response we so classically know leads to outbursts and RSD. 3. We need you: not only does ADHD require multiple forms of support, but a positive support system helps build emotional resilience. As well, having a present support system can build emotional security. The people around us play a massive role in the journey to controlling emotions. In all, feelings happen to everyone! For my fellow ADHD'ers, a massive challenge can be figuring out how to regulate our own emotions and reactions. Self-work mixed with the support of loved ones can alleviate the stress and minimize the impacts of emotional dysregulation. Sources: Emotional Dysregulation from the Psychology Care & Healing Center Is emotional dysregulation part of the psychopathology of ADHD in adults? by Salvatore Corbisiero, Rolf-Dieter Stieglitz, Wolfgang Retz & Michael Rösler How to Deal with Emotional Dysregulation from Alvarado Parkway Institute 21 Emotion Regulation Worksheets and Strategies by Courtney E. Ackerman, MA 9 Tips for Managing ADHD Mood Swings reviewed by Timothy J. Legg, PhD 7 Truths About ADHD and Intense Emotions by Thomas E. Brown PhD Author: Georgia Macdonald-Danvers My fellow ADHD-er's! Do you ever feel like everything and everyone is against you? That any time you speak someone is going to react with hostility and judgement? Are you getting anxious, upset, or even angry at those around you? You are definitely not alone in this experience, you're having rejection sensitive dysphoria (RSD). Let's start with the basics. What is RSD? It can be defined as; "the disposition to anxiously expect, readily perceive, and intensely react to rejection". The disappointing reality for the reading this is, not only do women experience higher rates of rejection sensitivity but also teens and adults with ADHD. So, majority of the people here reading this has experienced this feeling at least once. Now, the former paragraph was not to downplay the experience of rejection sensitivity, in fact 1 in 3 people describe it as the hardest part of the disorder. Instead, I want to prove to all of you that although it is a struggle, you are not struggling alone. RSD can look different for everyone! Some signs of RSD include:
Now that the facts are laid out, here is my first hand experience and advice on how to manage RSD & how to navigate relationships that involve RSD. Since there are no clear therapeutic methods to resolve rejection sensitivity, there has to be some work between the individual with ADHD as well as the counterpart in the relationship. First, let me address my fellow ADHD-er's. RSD is something that will occur sometimes but your thoughts, feelings, and actions will never be a genuine representation of yourself and your character. In a more clinical sense, your rejection sensitivity is your nervous system overreacting, setting off an extreme stress response. This is something you cannot control in the moment. Two things that can help you reduce your symptoms of RSD (1) take time to work on emotional regulation to be able to deal with rejection in a healthier, and positive way. (2) Practicing self-care and no... I am not saying you have to throw on a face mask and do the typical "self care day". Making sure your necessities are taken care of (sleep, diet, exercise) is equally valid as self care. Making sure you are at your healthiest can reduce your stress levels and reduce your chances of a "RSD episode". For the loved ones, my only piece of advice to you is to watch for these symptoms. Being aware of when these behaviours and symptoms arise can help you practice patience. Take a moment to remind yourself that this is not your loved one reacting, it is your loved one's condition and their perceived notion that you are upset with them, leaving them, or going to hurt them. Although you may not be met with immediate trust, a simple affirmation of reassurance can be extremely helpful. Some examples are;
Sources: Rejection Sensitivity and the Rejection–Hostility Link in Romantic Relationships by Rainer Romero‐Canyas, Geraldine Downey, Kathy Berenson, Ozlem Ayduk & N. Jan Kang (2010) Rejection Sensitivity and Depressive Symptoms in Women by Ozlem Ayduk, Geraldine Downey & Minji Kim (2001) What Is Rejection Sensitive Dysphoria? Reviewed by Smitha Bhandari, MD (2020) Author: Georgia Macdonald-Danvers Welcome to the first post on ADH-She, a blog dedicated to providing women and girls of all ages accurate and impactful information in terms of their Attention Deficit Hyperactivity Disorder (ADHD). I believe the first place to start is here; "Do I have ADHD?" I think this is generally how most peoples journey begins. The complication for women is that many professionals do not have the right answer to this question! Entering the 21 century, research indicated that there is about an equal amount of men and women with ADHD. If that is the case, why is majority of research done on boys and men? (see Sexism & Mental Health) Here is where we can start, the basics. The DSM-5, an outline of diagnostic criteria for mental illness and disorders. Their criteria for ADHD is as follows: Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level
To break it down even further we have to ask; "What type of ADHD classification do I fit under?" ADHD has 3 sub-classifications to which you can fit under, which fit nicely into the DSM-5 criteria. First being Predominantly Inattentive, as you can assume, that would suggest that you exhibit majorly the inattentive symptoms as described above. Next would be Predominantly Hyperactive, again, suggesting you fit more into the hyperactive criteria. Last, there is Combined Type, suggesting that you express a combination of both types of symptoms more equally. Now, the information that is important to females would be that most female patients fall into the Predominantly Inattentive category. Why is this important you may ask? Because often, in research and diagnoses, professionals are looking for hyperactive symptoms (i.e. the symptoms that are most common in men). This can often leave women being misdiagnosed with various other disorders (such as mood or personality disorders) that may leave women with inadequate support. Last, I have to guide you to "What can I do with this new found knowledge?" Well everyone, with knowledge is power. Knowing what symptoms you may be exhibiting as well as what type you may fall under can be a helpful tool in your diagnoses journey. Express your concerns and what specific problems you may be having and make that direct connection to ADHD to your doctor or mental health professional to allow an accurate assessment. Sources: ADHD and Female Specific Concerns: A Review of the Literature and Clinical Implications by Nancy L. Nussbaum (2011) Diagnostic and statistical manual of mental disorders (5th ed.) by American Psychiatric Association (2013) |