How to clarify mental health issues
July 11, 2016 10:35 AM   Subscribe

I have a lot of trouble with executive function skills and some other stuff that could have several different root causes. I would like to figure out what the real cause(s) are, to hopefully improve my coping skills.


-Age 30, female
-ADHD diagnosed a few years ago and seems accurate (I'm pretty textbook ADHD-PI, and nearly every other immediate family member has also been diagnosed including both parents) but I think it is not the only issue involved.
-Supporting this, ADHD-specific coping strategies and meds help somewhat (after extensive troubleshooting - most ADHD meds did not help at all) but by no means eliminate the majority of the problems I have, and sometimes even make my anxiety/social-related problems worse.

Some things that I appear to fit the description of very closely:

-ADHD-PI (with a few hyperactivity symptoms as well)
-Aspergers (particularly descriptions of women with Aspergers)
-Sensory/auditory processing disorder/"highly sensitive person" (if that's even a real thing)
-Anxiety (particularly social anxiety); also very strongly introverted and shy (which are not the same thing, but there's overlap...)
-OCD (only some elements, so probably not really)
-depression (only motivation/fatigue/self-hatred elements, not sadness/anhedonia elements, so probably not really)

So, there's clearly a lot of diagnostic overlap (and comorbidity) between these things, and I'm well-aware that specialists will tend to diagnose you with whatever their specialty is. I'm working with a psychiatrist who specializes in ADHD, but his expertise isn't particularly convincing for me even in that realm. He's mostly just a source for meds (I'd love to get a different doc, but referrals are tricky here, you can't "doctor shop" like you can in the US, so I can't easily get a better one). So I can ask him about this stuff, but I'm not very hopeful about that angle (have talked about the anxiety a bit already, but he seems to think it's fine as long as it isn't keeping me up at night or giving me panic attacks).

My main issues:

-out of sight = COMPLETELY out of mind (forgetfulness, easily distracted, not thoughtful about others)
-absolutely terrible at multi-tasking, except for a few rare occasions when I'm totally on focus, have a system nailed down and I'm doing great at it (until someone comes to chat and breaks my focus, anyway...)
-major problems getting started on difficult/unpleasant/boring tasks (staying on track once started is also a problem, but much less of one)
-major problems prioritizing/getting overwhelmed/seeing big picture instead of little details/perfectionism
-can't focus on work if I'm distracted emotionally (new relationships, personal conflicts, sad events, worrying, etc) or physically (itchy clothing, heat, cold, hunger...). I HAVE to fix the problem first, or spend hours obsessively googling it if I can't fix it.
-can't focus on work if I'm distracted by thinking of one of my current obsessions, which I will again spend hours obsessively researching, making beautiful spreadsheets, etc
-very uncomfortable and awkward in social environments (less in very small groups of people I know very well, extreme with strangers)
-issues with even moderate noise (can't focus on anything else, can't understand speech, get very anxious/overwhelmed, eventually shut down/lose control if forced to stay)
-emotionally overloaded by conflict very easily, particularly when noise is also a factor (will break down crying even when angry but not sad, to my great dismay)
-exhausted easily in social events, especially when noisy (very draining to "perform", feel like I'm faking normal interaction, even though I barely talk)
-persistent, fairly severe, irresistible skin-picking issues (also resolved issues with self-harm, an attempt to control overwhelming emotions)
-hygiene/grooming issues: much improved but still remain a struggle (I'm not bad enough to be noticeable anymore, but still less clean/polished than average, and basic things like brushing teeth/showering/combing hair are still an effort I only force myself through so I won't be's just so boring/pointless)
-slow "processing speed", particularly when verbally communicated (overwhelmed by rapid information; anything remotely complex or longer than one simple sentence MUST be written down before I understand)
-very sensitive to how others are judging me, but not great at reading people (so I'm constantly worrying about, and often surprised by, others' opinions of me)
-often offend people without intending to or realizing it (I've greatly improved with this, mostly by staying quiet until I know people very well)
-extremely lazy. I know I know, "adhd isn't laziness", but trust me, I am very. lazy. Also very selfish, while we're being brutally honest.

Complicating factor 1: I am fairly successful from an external perspective (people view me as intelligent, completed a challenging graduate degree, have a couple good friends and a good relationship, fairly healthy physically, maintain adequate appearance/tidiness, fairly happy, etc). I have developed some coping strategies (hence the apparent success) - very strong dependence on routine/writing things down, some social skills learned after much effort researching/practicing, strong habit of observing others before doing anything in any new situation (so I can copy them), rarely leave the house unless absolutely necessary, only attend small social gatherings and only when I push myself, close friends/family are aware and somewhat forgiving of my terrible social skills/low social energy/forgetfulness etc.

Complicating factor 2: some of these issues may be caused by upbringing, as I was raised in an isolated area by a mother with incredibly severe, unmedicated ADHD (as well as depression and anxiety), and a father with similarly obvious Aspergers I grew up in neverending chaos and did not learn things like basic personal hygiene/social skills/organization/"normal executive function" etc etc as a child, and have had to slowly pick them up as a teenager/adult (and yes, school was hell in the meantime).

But despite much improvement, many of these issues are still causing big problems for me (very high level of stress, constantly letting people down, constantly embarrassing myself, trouble making/maintaining friendships, not as successful career-wise as I could be, unable or too scared to do many things I'd like to do, etc). I would like to get better. Can I? How? And how can I figure out what the actual underlying cause(s) are? Would a more accurate diagnosis even be helpful, or should I just keep focusing on the specific problems I have? Would it be helpful to try to get referred to an autism-spectrum specialist for evaluation?
posted by Ceci n'est pas une chaussette to Health & Fitness (6 answers total) 21 users marked this as a favorite
It sounds like you have some limitations on how you can get treatment, but would it possible to add a psychologist/therapist to the mix?

You mention a lot of issues relating to other people, which is something psychotherapy can help with. The added advantage is that the therapist can weigh in on which angles you should prioritize with the psychiatrist and help figure out how everything ties together.
posted by duoshao at 11:18 AM on July 11, 2016 [1 favorite]

My best-beloved has ADHD and significant sensory processing issues - she can't handle loud noise, cross-talk, etc. One of the things that has helped a bunch is *telling* people that - folks are often totally willing to accommodate (by picking a quieter restaurant, meeting up at someone's house instead of a bar, letting her sit on the end of a table instead of the middle, etc.) It's also simply astonishing how many people respond by saying "Oh, no problem, I have some hearing issues too, that'd be great for me."

Other things that have worked: Habitica, a quirky but effective wardrobe (everpresent jacket because she runs cold, pants with no heavy seams/irritating fabrics, etc,) a benzo for oocasional anti-anxiety use, and a variety of medications including Adderall, an SSRI, a (most recently) gabapentin. Also a *lot* of talk therapy.
posted by restless_nomad at 11:19 AM on July 11, 2016 [3 favorites]

Join some online gifted lists and seek out 2xe resources online. You can start with Hoagie's Gifted Page. There is a lot of info there.

It helped me and my kids enormously to look into nutritional approaches. Back when I was on Autism lists and the like, I saw studies that showed that supplements had a better track record than drugs. I am not anti-drug. But I am all for finding the best possible solution. We treat a lot of these type issues nutritionally these days.

Magnesium has a track record of helping reduce noise sensitivity. I learned that on some autism list and have experienced it first hand and seen it help my oldest son.

posted by Michele in California at 12:08 PM on July 11, 2016 [1 favorite]

A lot of the symptoms you list are consistent with Autism Spectrum, and a diagnosis can be helpful. You'd need to see a doctor who has experience in diagnosis of adult ASD. Someone who only has experience with children is not suitable.

Micro-nutrients can help with anxiety issues.

If you get an ASD diagnosis and you seek the help of a therapist, get one with experience in adult ASD - anything else will be completely useless.

The great value of an accurate diagnosis is that it helps target interventions accurately.
posted by HiroProtagonist at 9:20 PM on July 11, 2016

You sound a lot like me. I went to my state vocational rehab for an autism assessment. They insisted on giving me an IQ test and the MMPI and said that would be adequate to diagnose autism. They ignored all the online autism assessments I had done, and also ignored my lengthy explanations of my own lived experience from childhood on.

I didn't get a diagnosis. They think my issues are psychological, not neurological. So I can tell you what NOT to do--don't go to your state rehab for the test. Find an adult autism specialist. I'm pretty sure I'm on the spectrum, and that was one of the most invalidating experiences I have ever had.
posted by Beethoven's Sith at 6:27 AM on July 12, 2016 [1 favorite]

If you're willing to shell out a bunch of money, you might be able to find a neuropsychologist in private practice who could do a full assessment on you.
posted by EarnestDeer at 1:54 PM on July 12, 2016

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