I want to fix myself - where do I start?

February 23, 2023 3:50 PM

I would like to make some progress in understanding myself better, and addressing some issues with increasing anxiety, intrusive thoughts, and mildly obsessive behaviour. Based on some comments I've had on other questions here, I might want to look into getting assessed for ADHD and/or being on the spectrum - though since I sleep quite poorly, it's also possible that my issues ultimately stem from that. So - what kind of professional should I start by approaching?

I feel like much of the advice I see online assumes that the reader suspects a single 'thing' that is going on and getting assessed for that, rather than trying to untangle several possible root causes (and of course, ADHD, autism, anxiety and/or sleep disorders often co-occur...).
I am in Barcelona, and so far my only experience with therapy has been to address burnout symptoms during grad school.

posted by jlibera to Health & Fitness (9 answers total)

I would suggest looking into a therapy program that's based on RO-DBT: https://www.abct.org/fact-sheets/radically-open-dialectical-behavior-therapy/
posted by skwm at 4:18 PM on February 23, 2023

I was considered "hyperactive" as a kinder gardener. Was on Ritalin as a child. Not as an adult. Pretty sure I am still pretty ADD. And sleep is a big part of how I regulate/act incoherent. I'd look for a sleep assessment, and find a standard therapist. Start the processes. Get some baseline data. Move forward.
posted by Windopaene at 5:05 PM on February 23, 2023

Best answer: Rule of thumb, go through and attempt to treat physical symptoms before getting to suspected psychological differences.

So in this case, yes, poor sleep could be causing all those issues, or could be in addition to them.

So, go over the sleep issues with your GP/Dr, because there can be physical issues, like sleep apnea contributing, etc.

I also recommend getting a sport watch that tracks sleep - waaay easier to have hard data, and see what might be helping, especially if you do have adhd and therefore trouble tracking things like that.

Next, it's more a matter of opinion -
This isn't the same pathway others would suggest, but I think:

If you have adhd, because the medication is so effective for many people, that's kind of like a treatable physical condition. But, diagnosis is usually either very intensive time wise, or money wise. So weirdly, I would try out something like an adhd coach, and see if it *makes you* less anxious or stressed when you have more systems in place that work with that set of strengths and weaknesses.
Also adhd specialists tend to have experience that crosses over into accommodations for autism spectrum, like using loop earplugs for auditory sensitivities, setting up appropriate fidget tools for stimming etc.


If that helps, then head down the adhd diagnosis route.

If it doesn't help (like, within 3 sessions), then scrap the coaching, and go down the route of finding a therapist who can help with anxiety and occasional obsessiveness. This loops back into your GP, because there are a lot of medications that will help with this, and the combo of therapy + meds is most appropriate.


Having tried it the other way, talking to a therapist when the issue is caused by adhd executive dysfunctions was pretty ineffective, and yet I persisted for years because that's what I was recommended. 🤷🏻‍♀️
posted by Elysum at 5:16 PM on February 23, 2023 [2 favorites]

Oh, also, ask adults who knew you as a child what you were like, and/or see if there's any childhood report cards in someone's attic - neuro diversity has symptoms from childhood, which helps tease apart cause and effect.


I didn't mention being on the spectrum, but same order, but just look for a therapist who kind of knows about autism spectrum even if they don't specialise in it, because:

There's no specific meds for being on the spectrum, and from friends experience, if you're functioning highly enough at life that you've made it to adulthood, there's no resources that diagnosis will unlock that you can't get yourself (like therapy and coaching), and you can mask well enough to make diagnosis... trickier?

And unfortunately again, friends have experienced a lot of therapists without spectrum experience who, because they're meeting in one on one sessions and they aren't seeing them out in the world, interpreting them as just say, being socially anxious, rather than having *correctly* evaluated that they have somehow socially offended someone or put them off, but they can't figure out *why*.

And multiple therapists who have straight out told friends they don't work with people on the autism spectrum. 😒🤔

So, if something practical like adhd coaching partly helps, and you've got some childhood history reports, and then you work with an at least spectrum-informed therapist, then the therapist should be able to help even if it isn't spectrum, and if it is, then there is enough context that they should slowly be able to tell you if that's a route worth pursuing further.
posted by Elysum at 5:38 PM on February 23, 2023

I’d recommend starting with a therapist. There are so many possible causes for the symptoms you mention that it only wastes your time and money to presume your diagnosis. Begin with some behavioral tools and approaches. I recommend a therapist who is really multi-modal (uses a lot of different techniques) and has lots of referrals to specialists they can make. You can ask them about that on your interview call.
posted by Miko at 5:40 PM on February 23, 2023

Drink four glasses of water a day. Take 5-600 mg of calcium in the evening along with 1500 meq of vitamin D. Take no stimulating beverages after 11 AM. Eat your final meal early in the evening. Be kind to yourself by relaxing before bed, read until you want to sleep. Turn off media 2 hours before bed. Turn off your phone when you go to bed. Feed yourself, first thing in the morning, then do what you have to do. Arrange your schedule to let this happen. The beginning and the end of days are important for feelings of hope and fulfillment. Take care of simple services to yourself so you are cared for, it is calming. Make an evening routine which allows you to relax into sleep. Keep tbings around you that make your home, homey and pleasant for you.
posted by Oyéah at 7:15 PM on February 23, 2023 [1 favorite]

In case you are not aware of this already, sleep problems are very common for neurodivergent people.
posted by Zumbador at 7:28 PM on February 23, 2023 [2 favorites]

Best answer: Well, if Oyeah's comment makes you freeze up with overwhelm as much as it did me, you might have ADHD!

More seriously, I would also focus first on sleep. It makes everything else more tractable. There are therapists who specialize in insomnia, might be worth a try. But being able to function only so long as your routines and system are flawless - "I got only 6.5 hours last night so I'm missing my appointments and lost all my impulse control, but if I just get 8.5 uninterrupted flawless hours it's fine" - is also not having solved the problem, so if you get sleep under control but find that you can't keep it that way, or that you're still on the edge, look into help with some of the other symptoms.
posted by Lady Li at 12:42 AM on February 24, 2023 [1 favorite]

Here’s a video that explains a bit more about the strong connection between sleep issues and ADHD. It talks about your specific question, too— it’s also difficult for researchers to untangle whether sleep disruptions contribute to ADHD or vice versa. At the moment, the best available theory is that they may intensify each other and they may also be related to an underlying common cause.

The video also notes that melatonin has shown promising results, with studies indicating that it both improves sleep and reduces ADHD symptoms for those who use it. Melatonin doesn’t require a prescription, so it’s something you could try before or in addition to seeing a specialist.
posted by ourobouros at 4:06 AM on February 24, 2023 [1 favorite]