How to Cope with an ADHD Diagnosis

You'll need to grieve an imaginary version of yourself.

May 23, 2024

Dear Pooja,
I’m 34-years-old and I just got an ADHD diagnosis for the first time. I’m starting medication soon, which I’m excited about. But, I feel so frustrated and angry, like I wasted years of my life and could have been so much more accomplished in my career had I known this sooner. I feel like I should be relieved to have a name for what I’ve felt for so long, and that I’ll finally get it treated. But instead, I feel like this anger is eating me up inside. How do I start to come to terms with all of this?
-“Lost in Time”

Hi “Lost in Time”

First let me reassure you that what you are feeling is completely normal. Every time I make a new diagnosis with a patient I hear a version of what you described above. Actually, I hear multiple versions of it, for months, and usually it comes back up when there is a new stressor, a dose change, a setback. What you are describing is a normal emotional reaction to getting a new lifelong diagnosis.

In reading your post my brain went immediately to the word grief — and then it went to betrayal. It’s okay to grieve the fact that it took so long to find this answer. I want you to be able to sit with this grief and I want you to hold another equally important feeling — betrayal.

You may feel:

Betrayed by the medical system: Maybe it took until your 30’s to find (or, to afford) a psychiatrist or a medical professional who could accurately diagnosis you (or, one that you clicked with so that you could stay long enough to uncover the diagnosis). This sucks. It’s not fair and the betrayal is rooted in the inequities and brokenness of our healthcare system.
Betrayed by parents or family of origin: Every patient I’ve had who gets a later in life ADHD diagnosis has some feelings towards their parents about this. You can hold those feelings while also recognizing that your parents did the best that they could with what they had.
Betrayed by a patriarchal system: We know that it often takes little girls much longer to get a diagnosis because girls are more likely to have the quiet sub-type of ADHD (inattentive— day dreaming in class) and little boys are more likely to have the disruptive sub-type of ADHD (hyperactive— unable to sit still in class).

You’ll need to address the feelings you have about these betrayals.

And, I also want you to hold another line of inquiry.

The majority of what you see online are stories of people who say they got a diagnosis of ADHD, started medication, and then everything was better. Medication fixed their brain. Their new life began.

The reality of what I see as a psychiatrist is NOT that. To be clear, I very strongly believe in treating ADHD — I suffer from it myself. But, we know that the internet is bad at nuance. And, the reality is that pharmacological treatment of ADHD is only one tool. There’s also psychotherapy, lifestyle modification, adjusting your expectations (ack, but, true!), exercise, diet, coaching. All of this, in conjunction, is what helps someone manage ADHD. The ADHD does not poof, go away. Your brain is still wired differently. Our workplaces and social systems are not set up for neurodivergence, so you will still have work to do, unfortunately.

I hope this doesn’t come off as minimizing your grief. Your grief (in the form of anger, rage, sadness, loss) is real. You need to process it and will keep needing to process it as it comes in waves, like I mentioned earlier.

But, as you are moving along in your treatment, I want you to keep in mind that you may have also created a fantasy version of who you might have been if you were medicated earlier. Some of this fantasy might be true. Your life probably would have been easier in some ways. But, probably not as much easier as you might think it would have been. This fantasy version of your younger, perfectly diagnosed and medicated-self is not real. She only exists in your imagination. And, she’s a construction of your grief.

It’s kind of like what can happen when you’ve been single for a long time, and you’re dating all the wrong people, but project their “potential” onto them. None of the people you date live up to your fantasized potential of them because that fantasy person only exists as perfect in your mind.

It’s okay to grieve that imagined version of who you could have been, but also recognize that that person only lives in your brain as a fantasy.

One last thing that’s also important. Whenever we discover something new and intimate about ourselves, it can cause a re-litigation of all our memories and accomplishments. A diagnosis like ADHD is bound to impact our identity and sense of self because the symptoms of untreated ADHD can be significantly disruptive to life at school, life with friends and loved ones, life at work. It’s natural, psychologically, for you to go back and re-examine all of the peak moments in your life — and also the low moments in your life — with this new information. It won’t change any outcomes, but you also can’t stop your brain from doing it.

Right now you're in the very acute space of taking stock of everything from the past and putting it through a new lens — this diagnosis. You're feeling these things for the first time and so the volume of the feelings high and intense. You might even be questioning who the “real” Lost in Time is — the one who lived for 34 years with undiagnosed ADHD, or the one who will emerge next?

Over time, however, these feelings will become less angry and less confused, and more like background noise. Your new diagnosis will add nuance and texture to your memories. Over time, what you lost will feel less like a catastrophe and more just like another ebb and flow in your journey.

And, slowly, you’ll integrate the “new” you with the “old” you, and recognize that both (and all) versions of you are (and were) real. And, then, you’ll find out what the “new” real you needs to feel good.

You may still wince, but it won’t be as painful.

xo,

Pooja

Other things:

Last week I gave a virtual keynote for Booz Allen Hamilton worldwide employees as part of the 2024 Unstoppable Together Summit Series. My Booz Allen keynote was on self-empathy in the workplace. I’m currently booking virtual and in-person speaking engagements for Fall 2024 and Spring 2025. Reach out through this form if you’d like to hire me to come to your group.
Next week I will be sharing an interview I did with someone whose life and work has impacted me deeply. I’m sure she has impacted many of you as well. I can’t wait to share this interview with you.

From the Real Self-Care Archives

If you found today’s newsletter helpful, you will enjoy these companion pieces. Paid subscribers get full access to the archives. If you are a free subscriber, you’ll see a brief preview.