ADHD, anxiety, and perfectionism: A tangled web

I was diagnosed with ADHD when I was 30. For many people — perhaps especially women, whose ADHD symptoms are often overlooked — an ADHD diagnosis can clear things up. When diagnosed as adults, they might look back with relief and think, “That’s why I was struggling.”

But for me, the ADHD diagnosis was confusing. I was a straight-A student and star athlete. I’ve had success in my professional life, too. How could I have ADHD?

Over time, though, the ADHD diagnosis has brought pieces of my life into perspective. I discovered challenges behind the perfect grades and awards. And I learned that ADHD often doesn’t look like what you think it looks like.

Getting diagnosed: First anxiety, then ADHD

In my late 20s, I started going to therapy. Through therapy, my struggles with anxiety became clear. My therapist pointed me to a psychiatrist. And he prescribed anti-anxiety medication.

I hated that I needed to take it. I felt defeated — like somehow I’d messed up because I couldn’t handle my anxiety without medication.

But the medication was life-changing. Before taking it, my feelings had no rhythm. They were chaotic. Suddenly, with the medication, it was like I had a metronome for my feelings. I could finally “hear” when something was off pace.

That’s how I came to notice what made me anxious: I had so much trouble getting started on big tasks. Or I’d start them but struggle to get them to the finish line.

To compensate, I’d give myself fake deadlines to pressure myself into getting things done. I was essentially creating stressful situations to make myself hyperfocus.

I mentioned this to my psychiatrist. He responded with a specific question: “Do small noises distract you to the point of completely derailing you from work?”

“Yes!” I exclaimed. How did he know? I thought.

He then suggested an ADHD evaluation, which shocked me. At that time, I didn’t know about the link between ADHD and anxiety. Or that ADHD made it hard to manage emotions. Plus I was doing well at my job.

I agreed to the evaluation nonetheless. Eventually, he diagnosed me with ADHD.

In disbelief, I sought a second opinion from another psychiatrist. He confirmed the ADHD diagnosis.

Looking for “proof” of my ADHD

When I got the diagnosis, my first instinct was to look for “proof” of my ADHD. I pulled out my old journals from high school and started poring over them.

I gasped when I saw what I’d written.

There, clear as day, were page after page of entries about how frustrated I was with my inability to focus. Some entries were simply the word “Focus” scribbled over and over again in various sizes.

Around this time, I heard something that made the whole thing click for me. I went to a conference where an ADHD expert named Tom Brown spoke. He described how some kids with ADHD manage to perform well when they’re not treated for ADHD: They either need to be highly interested in the task, or they need feel like “there’s a gun to their head” to get it done, he said.

That couldn’t have been truer in my case. Growing up, I was so afraid of making a mistake, afraid of not being perfect. I’m sure this was at least partially due to my anxiety.

That fear drove me to battle through distractions at lengths no child should have to. I often barely slept. I scribbled thoughts on sticky notes and stuck them all over my bedroom walls, so I’d have a record of them before they slipped away.

If you’d seen my flawless report cards back then, you never would have guessed I was dealing with attention issues. But looking back, it’s clear that I was struggling. I got the good grades — but at what price?

The role of perfectionism

I recently spoke with my good friend and neurodiversity expert Amanda Morin on an episode of my podcast, ADHD Aha! I teared up when she said this:

“Perfectionism and ADHD for women is one of the most common things that happen together. It’s a control thing. […] I have to be in control of my image. I have to be in control of everything I’ve got lined up. I have to do it best. I have to make sure I’m not failing in any kind of way. […] When you feel like on the inside that you’re failing, even though other people can’t see it, you have to work harder and harder to keep up with your own expectations. And it becomes perfectionism.”

Now that I’m an adult and being treated, it’s emotional to visit my childhood home and reflect on what I went through as a teenager.

Framed awards and newspaper articles about me cover the walls of my childhood bedroom. When I see those awards and clippings now, I can’t help but wonder what would have happened if I’d been treated for ADHD, anxiety, or both when I was younger.

Maybe I wouldn’t have been so anxious about being perfect. I might not have beaten myself up so much about my trouble with focus.

Maybe I would have eased up on myself and won fewer awards. And maybe, for me, that would have been a good thing.