ADHD In Adults: The Havoc Visited On Spouses

Dear Ed,

Thanks for sending this!

With increasing frequency, I see new light shed on the damage done to adults with ADHD --- and the interpersonal damage done by them.

Here is my blog post "turnaround"of the article you sent, with a brilliant summary of adult ADHD  from "Sanctuary Counseling" in Douglassville and Audubon, Pennsylvania. https://paxonbothhouses.blogspot.com/2018/10/adults-with-adhd-have-many.html

In my own experience, I notice that adults with ADHD are loathe to acknowledge the vast scope of their "syndrome" and ignore the wide-spectrum therapeutic work that needs to be done. 

I think this reluctance to "engage the therapeutic process" is because they already see themselves as overburdened (particularly by the neverending distractability of ADHD) -- and consequently, feeling compelled to "run at full speed just to keep up" -- they cannot bring themselves to acknowledge the sustained focus -- and hard work -- required to get this monkey off their back.

"Better the devil we know, than to fly to the devil we know not."

Why upset a precariously "balanced" apple cart?

But mostly, why embark another endeavor when I'm already crushed by my current burdens?

Although adult sufferers of ADHD often find ways to "get by" in their anxiety-driven professional lives, ADHD investigator Gina Pera (who is married to a high-performing ADHD scientist) observes that the "condition" is responsible for all manner of relationship wreckage, particularly in the lives of ADHD sufferers' spouses (who, curiously, often experience their afflicted partners' dis-ease as sources of psycho-pathological contagion).

If you are not aware of Pera's work with adults suffering ADHD, she's superb!

Check out this 4 part video by Pera. (If you want to cut to the chase, start with her summary in Part 4.)

Part 1: https://www.youtube.com/watch?v=cZvZazXRCiY 

Part 2: https://www.youtube.com/watch?v=8iAwt1rA7B0

Part 3.) https://www.youtube.com/watch?v=IW0L3Md7SZU

Part 4.) https://www.youtube.com/watch?v=-f0fC_lS8oY 

From my vantage, this video review of ADD's "Top 10 Relationship Challenges" strikes me as spot on.

You don't have to read much ADHD literature to realize that the syndrome in adults -- and the devastation it visits on spousal relationships -- is widespread. 

Furthermore, ADHD in adults is routinely misdiagnosed because many of the syndrome's "component parts" overlap with other psycho-pathologies.

Thanks again for the New England Journal Of Medicine's spotlight on adult ADHD's co-morbidities.

Abrazos

Alan

PS The ADHD literature also reveals the very peculiar finding that friends of the "afflicted couple" often believe that the NON ADHD spouse is the person responsible for the relationship's wreckage. In large part this seems attributable to the fact that the spouse who suffers from ADHD has long experience covering up their "pathology." Furthermore, sufferers are so blindly certain that they are the offended party that "outsiders" tend to accept this "big lie" and routinely believe the "perpetrator." The "tragedy" in this is that the ADHD sufferer gets confirmation rather than therapeutic "direction." 

On Wed, Oct 17, 2018 at 12:45 AM EM wrote:

Hola Compa —  NOT a subject I usually pass on to you — Only need to read the first paragraph, but I’m blown away by the expansive correlation ....

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Adults with ADHD Have Many Comorbidities
http://response.jwatch.org/t?ctl=42F5E:B79A8C01EB71785AF38328DB5584AEFBD2B71D9A95FA21D3&?query=topic_diabetes&jwd=000003014730&jspc=GP
[SUMMARY AND COMMENT | PSYCHIATRY]

Joel Yager, MD reviewing Chen Q et al. PLoS One 2018 Sep 26
Adults with attention-deficit/hyperactivity disorder had roughly nine times higher rates for various psychiatric disorders and twice the rates for metabolic disorders as the general population.

Attention-deficit/hyperactivity disorder (ADHD) has long been associated with vulnerabilities to psychiatric and substance use disorders. To learn more, researchers examined data on four psychiatric disorders and two metabolic disorders in 5.6 million adults (age range, 18–64) from Swedish national registries; 1.1% were diagnosed with ADHD in adulthood according to International Classification of Diseases criteria.

Analyses adjusted for sex and age. Prevalence ratios (PRs) of comorbid anxiety, depression, and substance use disorder (SUD) were approximately nine times higher in individuals with ADHD than in the general population, PR of bipolar disorder was 20 times higher, and PRs of type 2 diabetes and hypertension were doubled. Among people with ADHD, rates for comorbid mood and anxiety disorders were higher in women than men, whereas men had higher rates of SUD, diabetes, and hypertension. In a subanalysis of 1.7 million older adults (age range, 50–64), ADHD prevalence was 0.29%, and associations with comorbidities remained significant.

Comment
This is the first study to evaluate associations of metabolic disorders with ADHD. We don't know how many study participants receiving ADHD diagnoses in adulthood also had ADHD in childhood or whether comorbidities preceded or followed onset of ADHD; attentional difficulties following other psychiatric disorders could be sufficient to merit independent ADHD diagnosis. ADHD associations with diabetes and hypertension might reflect common underlying genetic vulnerabilities, lifestyle factors, or, occasionally, effects of psychiatric medications.

Clinicians seeing adults with ADHD can expect comorbidities. Determining suitable treatment requires clarifying the age of ADHD onset and the temporal sequencing of attentional symptoms and comorbid states. Treating comorbid conditions first might improve ADHD symptoms.


Editor Disclosures at Time of Publication

Disclosures for Joel Yager, MD at time of publication

   Editorial Boards Bulletin of the Menninger Clinic; Eating Disorders Review; International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry

Citation(s):
   Chen Q et al. Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: A population-based cross-sectional study. PLoS One 2018 Sep 26; 13:e0204516. < http://response.jwatch.org/t?ctl=42F62:B79A8C01EB71785AF38328DB5584AEFBD2B71D9A95FA21D3& >
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