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Dr. Hallowell's Blog

The Deep Anxiety Differential

Matthew J. Kaplowitz, PhD

When the impulsive self goes against the responsible self, life gets complicated.

A lot of ADHD people try to compensate for this, and are determined to stay on track and work hard to overcome the deficit. As Dr. Hallowell advocates in his strength-based approach, many of the underlying attributes of ADHD can ultimately be leveraged as strengths rather than deficits.

Unfortunately, the same cannot be said of anxiety.

When the anxious self goes against the responsible self, it usually wins.

That’s because anxiety creates a distortion of reality.  Anxiety is not the same as fear. Fear is realistic, and keeps us safe. Anxiety is paranoid, and drives us nuts.

Fear responds to a realistic situation that is threatening, for example the sound of gunshots. Anxiety is more complicated, driven by an internal not external disturbance (e.g., I’m scared my boss must think awful things about me).

While fear alerts us to realistic dangers, anxiety raises the premonition of danger, keeping us on edge indefinitely with an internal, diffuse signal of an imagined threat. Sometimes these premonitions come true, sometimes they do not—sometimes we make them come true, as in worrying so much about a project for work that we can barely focus on the project, and little gets done.

Therefore, central to dealing with ADHD is also dealing with anxiety.

If you have a nervous system at risk you will get anxious. It’s impossible to have a neurological-based issue without anxiety as an accompaniment, given the impact on normal functioning. As a child, issues like ADHD will at minimum get the adults in the environment stirred up. The stirred-up adults will then give anxious feedback to the child, so immediately they’re being labeled with a problem, which in turn makes the child anxious. How do you then differentiate which parts of the problem are caused by neurology, and which by anxiety?

To make matters more complicated, anxiety can cause the same symptoms of distractibility and restlessness as in ADHD.

In fact, if you get anxious with an intact nervous system, that can still have a distracting effect.  Meaning, in certain cases, what appears to be ADHD is not that at all, but really deep anxiety.

Since there is no one-size-fits-all approach in treating either ADHD or anxiety, each person must figure out exactly what work they need to do to move from deficit to strength. Doing the wrong work, despite the level of effort you put in, will not change anything.  Part of discovering the right work involves understanding anxiety, meaning: 1) how anxiety interacts with your ADHD, and 2), to what extent (if any) anxiety is at the root of some or all of your ADHD symptoms.  These are critical discernments for you to make along the path from deficit to strength.

Matthew J. Kaplowitz, PhD
Dr. Kaplowitz is a licensed psychologist. At the Hallowell Center, he provides psychotherapy and career counseling for adults and adolescents. He also offers an array of career development services, including comprehensive professional assessments that may include differential diagnosis. Dr. Kaplowitz worked for many years as Expert Therapist and Clinical Researcher at the Anxiety Disorders Clinic at Columbia University Medical Center/New York State Psychiatric Institute, where he received special training in a variety of empirically validated treatments that have proven efficacious for anxiety disorders and ADHD.

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