The Root Cause of ADHD - Chemical Balance? Anxiety? Dissociation? Or something else?
An exploration
Welcome to a new section of my newsletter that I’m calling Therapy Thoughts. This section is meant to provide a little snapshot about some of the mental health-related issues that I spend time thinking about and exploring when I’m not in the therapy room.
Consider this section to be a little snapshot of what a therapist might be reflecting on and thinking about in between sessions.
To be honest, this is one of my favorite things about being a therapist — being curious and asking questions of “Why..?” and “What about…?” and then experimenting in sessions to see what works and what doesn’t work.
Of course, if this section is not of any interest to you, you can always opt out and continue to be subscribed to other sections of my newsletter.
ADHD: It’s commonly diagnosed with school children nowadays and there’s a lot of varying opinions about the root causes.
Some connect it back to some genetic-related issue. Some connect it back to some nutritional/dietary issue. Some connect it back to trauma. Some connect it back to anxiety.
For this article, I’m not going to get into the potential nutritional and dietary causes because that is not what my training is in (though, I’ll admit it is a bit of a hobby of mine to educate myself on that as well).
In many of the somatic therapy circles that I’ve been in, I’ve generally heard practitioners share that it is related to anxiety in some way. That the person is going into a flight response and is, therefore, struggling to maintain attention.
I will admit, for many years I’ve suspected this to be the case as well. This is mostly because the clients I’ve had with ADHD have described anxiety-like physical and emotional experiences that emerge when they have trouble focusing. I’ll commonly hear reports like “I forget XYZ, and then my heart starts racing” or “I have a really hard time sitting still and I can’t remember what I intended to do”.
Therefore, whenever I’ve done somatic work and Brainspotting with these clients our tendency has been to focus on the anxiety part in hopes that it will also improve the focus and attention.
In addition to that, I have also generally assessed for the client having an inner critic. In other words, does the client say anything to themselves about themselves when they forget something? Some people have this, some don’t, and some have one that is there but not nearly as strong as it is for others. But it is something that I definitely assess for because if there is an inner critic present then it can certainly enhance the anxiety and make one’s ability to focus much harder.
Though anxiety and the inner critic have been my two main areas of focus when someone presents with ADHD symptoms, I’ve recently been finding that there’s likely more to the story.
Recently, we’ve been experiencing the Adderall shortage and it’s definitely impacted my practice. The clients that I’ve been seeing who have been on Adderall for months or years are now unable to take it. So I’m now able to see these clients without that added medication impacting their experience. I can see how they are without a chemical impacting their brain and body. And, because I’m now seeing them without the medication, I can now get a clear picture of how the medication has been impacting them.
Fortunately, some of these clients I’ve been seeing for years at this point. So we’ve worked through and have reduced the anxiety part. We’ve worked through and have reduced the inner critic parts.
So even though it’s really unfortunate on a collective level that we are in the midst of an Adderall shortage, for some of my clients and my work with them this is a bit of a blessing in disguise. Why? Because when the difficulty focusing is one of the handful of issues still lingering around, not taking the medication is making it far easier for me to get a clear picture of what’s going on.
Something that I’ve found particularly interesting in these sessions that I’ve been having without clients taking Adderall, is that the reports of anxiety coinciding with the lack of attention has been lower, if not totally non-existent.
Interesting.
A coincidence? Maybe, maybe not.
But it’s been leading me to wonder: What if the root of ADHD is actually a dissociation issue?
(For those that don’t know, dissociation is a defense mechanism that all human beings have. It’s essentially a state of “zoning out” or feeling “out of body” in order to protect yourself from something in your environment that might feel dangerous in some way. One easy example of this is someone dissociating when they are in a car accident because their brain and body immediately responds with “This experience is too much so I’m tapping out of here”. This is why if someone is asked to recall details from a traumatic event the details in their memories can be incorrect — because they dissociated during the experience.)
Sounds kind of wild, right? Here’s my thought process that I’ve been mulling over for the last few months…
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