Is it ADHD after all?

I'm starting to have doubts that ADHD is the only long term mental health issue I have

This might come as an anti-climax for many of you loyal readers, but I’ve started wondering if it’s actually ADHD that I have, or if it is something else. In other words - I’m starting to question if ADHD is the ONLY long-term mental health issue I have, or if there might be something else at play as well.

Let me explain. Before I go ahead, I should mention that the only long-term mental illness that I have an official medical diagnosis for is ADHD. So what I’m writing here is absolute and pure speculation. However, I have good reason to strongly suspect that there is more to it than just ADHD.

Feelings

Over the last couple of months I’ve been seeing a therapist. The major insight I’ve had through these sessions is that I am completely unable to identify my feelings. Frequently my therapist asks me to describe my feelings at that point in time, after we have discussed something. And almost every time I’ve been unable to give good answers to this question.

In my analysis of my life between sessions I’ve found that a lot of my poor decision making happens at times when I’m not able to identify or appreciate my feelings. And then once I start feeling those feelings I start regretting my decisions.

My inability to identify feelings means I’m unable to identify potential feelings in the future as well, which means I take on much more than I can actually handle. For example, at 2 pm I might agree to meet someone for “9 pm drinks” without realising how tired I might be at 9 pm. And then I regret my decisions. During phases of life when I’m depressed, I constantly retrospectively question my decisions.

Empathy

A friend who has also been officially diagnosed with ADHD and is a reader of this newsletter told me recently:

You've mentioned in your newsletter that you lack empathy and claim that it is a symptom of ADHD. That annoyed me quite a bit as in my experience, lack of empathy is not a symptom of ADHD, but it is almost certainly a symptom of autism.

The strongest indicator that I do not have significant level of autism is that when I am on ADHD medication, any symptom of lack of empathy disappears completely.

For me, it doesn’t. When I am on ADHD medication, I am able to focus much better. However, I don’t feel suddenly empathetic. What my ADHD medication (methylphenidate) allows me to do is to become much better at work. I can calmly finish tasks that would otherwise require me to get into frenzy.

It does nothing for my empathy. I might APPEAR mildly more empathetic when I’m on my meds, but that is because they are allowing me to concentrate better, meaning I can focus better on what the other person is saying and then respond to it more appropriately than I otherwise would. I don’t empathise better.

History

Back in 2017, a few months after we had had our daughter, my wife had been anxious and gone to see a therapist. The thing with some therapists is that they not only diagnose you, but also suggest diagnoses for your close family members, such as parents, children and spouses.

This therapist, through the course of his sessions with my wife, suggested that I might have Asperger’s Syndrome, which in DSM-V has been subsumed into the autism spectrum. For whatever reason, at that point I didn’t choose to do anything with this information (such as getting a proper diagnosis). However, since then, both my wife and I have been unable to “unsee” this.

I had brought this up with my psychiatrist earlier this year (or last year), but she mentioned that there are no tests that she can do to conclusively identify me (as an adult), and that there is no specific medication for it, and I should just stick to my ADHD medication.

However, the recent evidence of both my inability to identify feelings (either in myself or in others), and my friend’s comment that lack of empathy is more of a autistic trait than an ADHD trait, have revived belief that there is some truth to my autism spectrum diagnosis.

It’s like this 2017 comment by my wife’s therapist was a Bayesian prior, which I’ve then updated based on the findings from my own therapy, and what my friends say. Now it is even harder to ignore this possibility.

Back to the present

Unfortunately, my therapist also said she cannot conclusively diagnose my being on the autism spectrum since she is “not a clinician” and hence not authorised to do so. And like my psychiatrist had said a few months ago, she added that even if she were to diagnose me, our conversations would not be very different from what they are now - where we are trying to work on my feelings, and how I can identify them better and take action accordingly.

Of course, given that mental health is a little more “experimental” than physical health (any of you who has been medicated for anxiety or depression will know that your doctor would have “tried” medications on you to see what actually works), you tend to self-diagnose a bit more in this field. And when it comes to mental health, a lot of self-diagnosis can happen through questionnaires. So I’ve duly taken a bunch of Aspergers / autism spectrum questionnaires.

The results are expected but also interesting. To summarise:

• Any test that simply tests for “autism spectrum” or “Asperger’s”, I’ve passed with flying colours. If a diagnosis is to be based on any of these questionnaires (it isn’t), then I’m surely on the spectrum

• There are more specific tests. For example, there are some which test you on how empathetic you are. I’ve very comfortably “passed” these as well, indicating that in terms of empathy I’m very far from neurotypical

• One of the features (or bugs?) of being on the autism spectrum is your extreme need for order and systems. There are tests which test for this. I’ve taken a couple and what I find is that I’m not at all on the spectrum by these measures. While I like a routine and have my precise ways of doing things, my need for orders and systematisation are by no means extraordinary.

• Hypersensitivity (to touch, sounds, etc.) is another sign of being on the spectrum. While I’m quite sensitive to sounds (working in open offices is a huge challenge for me), and can feel claustrophobic when people sit too close to me, I’m quite okay on the touch front.

Again I’m not a medical professional (and neither is my wife), so I don’t know what to make of these survey “results”, but from what I see, it does appear that ADHD is not the only long-term mental illness / disorder / superpower / abnormality that I have. That said, being on the autism spectrum / Asperger’s is highly correlated with ADHD diagnoses, so I’m not that surprised as well.

Life

In terms of my immediate life, nothing really changes, though I would want to find a professional who can test my hypothesis that it is not ADHD after all. That apart, it is only about the mundane aspects of getting on with life.

The main challenge remains around decision-making. Through my therapy, what I’ve found is that a lot of poor decision-making comes down to not feeling feelings. Not feeling feelings means that I need to “work out many more things from first principles” which is cognitively extremely taxing.

Blog

This blog will continue, in its present form and name. My wife told me recently that after her therapist had told her that I might have Asperger’s, she had read up a lot about the syndrome and most of it was written from the partner’s point of view.
”There were very few accounts from people going through it themselves. And relying on third party accounts meant that I may not have got an accurate picture of what it entails”, she said.

And so this blog will continue, as a “first party account” on how it feels. No pun intended, obviously!