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5 Signs Of High Functioning ADHD (Explained by a psychologist) | Dr Mark Rackley

Dr Mark Rackley is a psychologist specialised in ADHD with more than two decades of experience helping Neurodiverse people with their mental health. He’s back by popular demand to deep dive into the struggles of ADHD and to help you understand yourself. 00:00 Trailer 02:36 What is high functioning ADHD 07:32 The mask of overcompensation 11:52 What high functioning RSD looks like 14:31 Is high functioning ADHD a coping strategy for RSD 17:36 Can being high functioning delay a diagnosis 20:54 High functioning loneliness 23:23 Tiimo advert 30:43 What is low functioning ADHD 35:24 Link between high functioning ADHD and addiction 41:01 Audience questions (washing machine of woes) 45:09 A letter to my younger self Find Dr Mark on Instagram 👉 https://www.instagram.com/drmarkrackley/?hl=en Get 30% off an annual Tiimo subscription 👉 https://www.tiimoapp.com/offers/adhdchatter Buy Alex's book entitled 'Now It All Makes Sense' 👉 https://www.amazon.co.uk/Now-All-Makes-Sense-Diagnosis/dp/1399817817 Producer: Timon Woodward  Recorded by: Hamlin Studios Trailer Editor: Ryan Faber DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Dr. Mark RackleyguestAlex Partridgehost
Nov 4, 202546mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 2:36

    Trailer

    1. MR

      High functioning ADHD, it's an appearance. It's what appears in terms of this person having ADHD and what their life looks like. It doesn't give you the reality of what's going on behind it. So it's very much face value stuff. Your life would suggest, yeah, despite the challenges of ADHD, he does really well. However, they don't see the hidden struggle behind it.

    2. AP

      Dr Mark Rackley is an ADHD specialist-

    3. MR

      With more than two decades of experience-

    4. AP

      Helping neurodiverse people with their mental health

    5. MR

      He's back by popular demand to deep dive into the struggles of ADHD-

    6. AP

      And to help you understand yourself

    7. MR

      We know ADHD and addiction sadly can go hand-in-hand. But with high achieving, it might not seem so obvious in terms of it being an addiction. It can lead people to becoming workaholics. If they're high achieving or trying to overachieve or overcompensate, they could then become that type of workaholic, which is constantly trying to spend more time in the office or being very consumed with their jobs, overly worried. They're trying very hard to be conscientious, but that comes at a huge price.

    8. AP

      How extreme can masking get in someone with ADHD?

    9. MR

      That's the truth of it, which is-

    10. AP

      Five signs of high functioning ADHD.

    11. MR

      Yeah.

    12. AP

      And I think it's a topic I wanted to cover because I've been called high functioning before. I've spoken to many people who have been called high functioning, and for me, it feels like a bit of a, an invalidation towards the, the, the struggles that can come.

    13. MR

      Yeah.

    14. AP

      So I looked up high functioning and it said that y- you seem to be able to get through your day without any struggle, but I think the more I thought about it, it's you can get through your day without any struggle from the perception of others.

    15. MR

      Mm-hmm.

    16. AP

      But from your own point of view, there are significant hidden challenges and struggles that-

    17. MR

      Mm

    18. AP

      ... are invisible to other people.

    19. MR

      Mm.

    20. AP

      And I think, as an example, my... If I go to a meeting, I could turn up to that meeting and be present and engaged and focused, but what they don't see is that I've been waiting in my car for two hours-

    21. MR

      Yeah

    22. AP

      ... because I'm so scared of letting them down-

    23. MR

      Yeah

    24. AP

      ... and being late.

    25. MR

      Yeah.

    26. AP

      Or if I have, like, a Zoom meeting in the afternoon at 4:00 PM, again, I can be very alert, very focused in that meeting, but what they don't know, what they don't see, is that I have been waiting all day and unable to do anything else before that meeting.

    27. MR

      Yeah.

    28. AP

      And I guess that's the, the point of this conversation is to really shine a light on what it really means to be someone with ADHD and, and to quote-unquote, "hi- high functioning." So I suppose

  2. 2:36 – 7:32

    What is high functioning ADHD

    1. AP

      my first question is-

    2. MR

      Mm

    3. AP

      ... how would you define high functioning ADHD?

    4. MR

      Yeah. I, I'm so glad we're talking about this, 'cause these conversations are the nuances of ADHD. 'Cause obviously, you know, we can talk about the, the, the very obvious symptoms a lot, but the nuances like this are so important because that's the day-to-day lived experience that people will struggle with but, but not necessarily talk about. Or it's not, um, maybe so obvious that this is ADHD. And, and that's the kicker with this high functioning ADHD label. Now, just to clarify that, that's not a clinical diagnosis. I don't think I've ever said that to a patient, "Hey, you've got high d- high functioning [laughs] ADHD." I've never said that. And, uh, but I've heard it, and I've often heard, um, my patients say to me, "Oh, I've been told I have high functioning ADHD." So we need to break that down. What is that? What, what does that person mean? So high functioning, then we think of, okay, well, that means that your, your level of kind of functionality, whatever way you're describing that, is high in the, in the space of having ADHD. Which if you think about it, like, it, it kind of makes no sense, 'cause one of the big symptoms and problems of ADHD is a problem with executive functioning. So how can you have exec- problematic executive functioning and high functioning [laughs] at the same time?

    5. AP

      Right.

    6. MR

      Like, it just doesn't, it doesn't, it, it, it doesn't align, hey. So high functioning ADHD, it's an appearance. It's what appears in terms of this person having ADHD and how, what their life looks like. But it's exactly what you just said. It's an appearance. It doesn't give you the reality of what's going on behind it. So it's very much face value stuff, let's say, with you, where you're a, you are a very successful man. Appearance. You do amazing things with your life. What people don't see, well, what goes on behind that. So I'm not, not surprised you get, you get that label. "Oh, well, Alex Partridge is, uh, is, has high functioning ADHD," 'cause, yeah, y- you, you, your life would suggest, yeah, despite the challenges of ADHD, he does really well. Yeah? However, they don't see the hidden struggle behind it. So for me, w- a high functioning ADHD, like, I kinda wanna call it out really, 'cause I don't see that as a positive. And, and we will talk about that a lot today hopefully. That, um, it, it's, it's not necessarily a compliment to the person who hears it. If, in fact, if anything, it can be seen as pressure, which is, "Oh, okay, you, you th- think I'm like this."

    7. AP

      Mm.

    8. MR

      And of course, for somebody with ADHD, then the pressure can be, "Well, then I have to then sustain that. I have to then keep that kind of impression going," which of course can put huge internal pressure on them.

    9. AP

      It's so true. I feel like if someone calls someone with ADHD high functioning, they don't mean that you've made your ADHD easier for yourself.

    10. MR

      Mm-hmm.

    11. AP

      You've made your ADHD easier for everyone else around you.

    12. MR

      Yes. Yeah. [laughs]

    13. AP

      And you-

    14. MR

      I love that. Yeah, yeah

    15. AP

      ... you... I mean, it was really-... quite an emotional way of putting it. Because y- yes, you can appear, the perception of yourself can be hardworking-

    16. MR

      Yeah

    17. AP

      ... high achieving.

    18. MR

      Yeah.

    19. AP

      But you're inside in a, in a state of overwhelm, anxiety, always on the brink of burnout.

    20. MR

      Yeah.

    21. AP

      And I think it's exhausting, right? Like-

    22. MR

      Oh, absolutely. Yeah

    23. AP

      I suppose how big a conversation if we go to the first sign of ADHD-

    24. MR

      Mm. Mm-hmm

    25. AP

      ... high functioning, masking. Like, how... 'Cause that's really what it is, right?

    26. MR

      It is, yeah.

    27. AP

      Uh, high functioning-

    28. MR

      Yeah

    29. AP

      ... we could probably just rename it as high masking.

    30. MR

      High masking or even the other word I would use is overcompensating. Yeah.

  3. 7:32 – 11:52

    The mask of overcompensation

    1. AP

      into tears.

    2. MR

      Mm-hmm.

    3. AP

      Like, how extreme can masking get in someone with ADHD?

    4. MR

      Very extreme. Again, I love the way you describe that, 'cause the, that's the truth of it, which is it is, um, it is that person massively trying to adapt and keep it all together, um, so that they can function and that they can manage their, their, their life. Now, the other thing I would say as well, Alex, is, um, where, and again, w- which is why the overcompensating com- piece comes in, is we know with ADHD that, that, that lots of people with ADHD, they struggle with being different, they struggle with very strong feelings of shame. So a lot of the times it's trying to offset that. It's, it's to blend in. It's to not be, uh, too much. Yeah. So constantly adjusting, constantly adapting, constantly trying to give the people what they want. But that's very much to kinda like, to, to hold everybody else at bay so that you can then feel okay. So, so it's, it, it comes at a huge personal strain-

    5. AP

      Mm

    6. MR

      ... to you. So let's, let's think about kinda what might be happening inside of that person then. So they might be constantly overthinking, having to rehearse what they're going to say in meetings, having to l- read the email 17 times so that they can reply to it properly. It's having to, um, always trying to stay a step ahead, be really conscious of the RSD not kicking off. So it's exhausting.

    7. AP

      Mm.

    8. MR

      It's just exhausting. And also, if you put into that as well being on time for things, um, having the, the conversations where you're not going round the houses and oversharing, or staying on point.

    9. AP

      [laughs]

    10. MR

      It's all of that stuff. So if you think of it, if you're trying to keep all that at bay and then the appearance is it's all, you know-

    11. AP

      Mm

    12. MR

      ... I've got all this, then the struggle to hold all of that, and like you said, like then the, the, the, the moments where, like say if you're in the, in the office where you go into the toilets and you're like, "This is-

    13. AP

      Mm.

    14. MR

      "Like, I'm done." And then you have to go back out and do it all over again. Or when you get home, like you said, and you're on the other side of your door and you're, you're bursting into tears and it's, it's so, all the overwhelm is coming out. That, that, that's the, that's the price of it. Yeah. But externally, it looks like, wow, this person's got it all together. 'Cause you're b- you're blending in. You're, like you say, you're masking. So it's very much at a, a very high price for your body and your nervous system and your brain to do that all the time. Which of course is why as well it can lead-

    15. AP

      Mm

    16. MR

      ... to burnout. Yeah.

    17. AP

      It feels like you show up for everyone else apart from yourself. You said the reading an email. I can read an email with my eyes-

    18. MR

      Mm-hmm

    19. AP

      ... so many times, and my brain is just not reading it.

    20. MR

      Yeah, yeah. Yeah.

    21. AP

      And the same with books.

    22. MR

      Yeah.

    23. AP

      My thoughts, my brain is... I, I describe it like fireworks. You know, I've just said before, it's like 10 highly caffeinated squirrels barreling around-

    24. MR

      [laughs]

    25. AP

      ... but it's, it's, there, there's no chronology of time in my mind with my thoughts.

    26. MR

      Yeah.

    27. AP

      It's like a firework display. Like, a thought will go off and it will last for five seconds max-

    28. MR

      Yeah

    29. AP

      ... and then another one will go off-

    30. MR

      Yeah

  4. 11:52 – 14:31

    What high functioning RSD looks like

    1. AP

      get a rejection-

    2. MR

      Mm

    3. AP

      ... is someone with high functioning ADHD s- hypersensitive to rejection?

    4. MR

      Yeah. I, I, I think, again, that can be the real sting in the tail, which is if, um, like if, if you're constantly doing it for everybody else, so you're, you're, you're, you're doing all of this for the validation or again, just to, to not, to not feel the shame or to expose yourself as being different, then you're not validating yourself.So it's very much about the external praise. It's very much about that the, the external validation makes you feel safe, and it's like, "Well, I'm doing okay here. This is okay." Like, um, but of course, you're kind of... I- it's a risky strategy, Alex, because you're, you're banking on the external validation kind of that's gonna keep coming, which of course is unrealistic. So if you do get a, um, a, some kind of negative validation or somebody kind of calls you out, and I've heard you talk about this before, it's that kind of, you know, the email or the, the, the, the, the, the person saying, "Can we have a quick chat later?" Like, that's not a, "Oh, okay." That's a, "The world is falling apart."

    5. AP

      Mm.

    6. MR

      "The sky is falling on my head. It's catastrophizing." Like, oh, my God, like, it's, it's huge. It's huge.

    7. AP

      Yeah.

    8. MR

      So, so that's the kind of awful side of it, which is, well, yeah, it's, it's grand as long as it's all, it's all okay and you feel safe and, and you feel like, "This is, this is working for me." But then, of course, you've no control over that. And as soon... So, so that's why it's such a risky strategy because then if something comes at you, it can all fall apart very quickly, and it can spiral very fast. And the, again, just, and, and with, if, once the kind of RSD kicks off, then the e- emotional dysregulation will kick off, which can lead that person to certainly in some of the, the cases I treat, uh, and it's awful. It's a full-blown anxiety and panic attack.

    9. AP

      I got very anxious just hearing you say-

    10. MR

      Mm

    11. AP

      ... "Can we have a quick chat?" [laughs]

    12. MR

      [laughs] Triggering.

    13. AP

      Without the context-

    14. MR

      Yeah

    15. AP

      ... like I'm gonna get fired, or your partner says it-

    16. MR

      Yeah

    17. AP

      ... and it's like, oh, the relationship's doomed.

    18. MR

      Yeah.

    19. AP

      I mean, there's, there's a serious side to it though because I think i- is, we know rejection is so painful. We know criticism can feel like a punch to the stomach.

    20. MR

      Yeah.

    21. AP

      And, and we can, we, we see it where, when it's not even real, like-

    22. MR

      Yeah

    23. AP

      ... the, the perception of it, which-

    24. MR

      Yeah

    25. AP

      ... in that example-

    26. MR

      Yeah

    27. AP

      ... if your boss wants a quick chat, you're probably not gonna get fired, but you take that and you perceive it to be that you are.

    28. MR

      Yeah.

    29. AP

      And it creates that anxiety. It creates that staying up all night dreading that meeting.

    30. MR

      Yeah.

  5. 14:31 – 17:36

    Is high functioning ADHD a coping strategy for RSD

    1. AP

      Is high f- being high functioning, is it a coping strategy? Is it a compensation for RSD?

    2. MR

      Yeah. I feel it is. I feel it is, definitely. I feel not, not just for RSD but also for, um, that person trying to, um, manage big feelings of shame and difference, yeah. So it's, it's, it's almost like the, it's, it's the, it's the chameleon. It's the blending in.

    3. AP

      Mm.

    4. MR

      It's there's nothing to see here, that I'm like you. So yeah, that, and that will protect you from the RSD but also, um, for coming back to the overcompensating piece, for, for, for some, and not everybody, and of course, I, I don't want to generalize this, but for some people with ADHD, what that can lead to is it can lead to perfectionist traits. So they are holding their standards so high, which again comes back to the high-functioning piece, Alex, that they, they hold their standards so high. And again, the reason they're doing that is because they're desperately trying to elevate the standards so they can get that validation, but also that's to ward off any anxiety that, um, I am not good enough. So it's a problem with self-esteem. It's a problem with feeling, uh, not, not good about yourself. So what you're doing there is you're, you're overcompensating there, high functioning perfectionism. Like, and you see this, like I certainly see this with some of my patients. Like again, if we look at what they do, they, they smash their A levels. They get into the best unis on the best courses.

    5. AP

      Mm.

    6. MR

      They get these enormous promotions, which is wonderful, but interestingly enough, when they achieve it, the terror kicks in. It's like, "Oh, God, I, I have to do it now."

    7. AP

      [laughs]

    8. MR

      "And I have to succeed." And it's like, it's great, like they're ex- like this is wonderful, but then what kicks in then is, uh, I, I, I've got to actually, I've, I've, I've got to, I've got to nail it now. So you get this huge disparity between what it looks on the outside like, oh, my goodness, this is an... And it is an incredible achievement. Of course it is. But the person that has to live it-

    9. AP

      Mm

    10. MR

      ... and that's when the reality kicks in, which is, well, that's pressure of being able to now live up to that promotion or I, that I am going to head off to this really prestigious university, and I'm gonna, I'm gonna cope okay, and I'm gonna be able to look after myself. So like, which again is why you can't go on the appearance. Like it's-

    11. AP

      Mm

    12. MR

      ... just, it, it's not telling you the full story.

    13. AP

      I guess if you've got ADHD and you're high functioning, you can achieve amazing things. But when you get there-

    14. MR

      Mm

    15. AP

      ... when you get over the finish line, you don't feel any sense of accomplishment.

    16. MR

      Yeah.

    17. AP

      You just kind of flip, oh, it's done-

    18. MR

      Yeah

    19. AP

      ... because it's so stressful trying to maintain that level of perfection. If, if shame is motivating you-

    20. MR

      Yeah

    21. AP

      ... to maintain this level of perfection and, and function to a standard that is high enough for you to pass-

    22. MR

      Yeah

    23. AP

      ... as a neurotypical-

  6. 17:36 – 20:54

    Can being high functioning delay a diagnosis

    1. MR

      Yeah

    2. AP

      ... can that delay people getting diagnosed, picked up as potentially-

    3. MR

      Yeah

    4. AP

      ... having ADHD?

    5. MR

      Massively so. Massively so. And I'm so glad you said that as well because again, if we're going on kind of what we see, like, which kind of obvious- I mean, when you're diagnosed with ADHD and you're looking for it, yes, you are looking for the kind of very obvious signs. But one of the things we, we, we have to remember with ADHD is we have, yes, the external ADHD, but we have the internal ADHD as well. And if we don't think about internalized ADHD and we only go on externalized ADHD as in, okay, is this person struggling to function, i.e. can they, um, hold down a job? Are they going to school? What's their, what's their general behavior like? Then we can g- we can use all of that stuff. But if that's all okay because the person is air quote "high functioning" or overcompensating, then you won't see any of it.And it will all look, it will all look like very, very neurotypical f- for the, for want of a better word. But that person could have huge internalized ADHD, and so it's all happening inside of them in terms of all the masking and the overthinking and the RSD is all kicking up. But they're, they're, they're, they're, they're not showing that. But what that can show as is anxiety or depression, or it will show in another symptomatic way. So it can be very subtle, and it can look like, "Well, that's not ADHD," 'cause it's not so obvious. But you can't get, you can't go on that. 'Cause if it's more internalized ADHD, then it's, it's all happening inside. And y- y- you have to ask the right questions, and you have to explore that. So coming back to what you just said there, that's how, yeah, it doesn't get picked up because these are the A grade students. These are the people who are doing really well in organizations-

    6. AP

      Mm

    7. MR

      ... and getting promoted. But I know certainly from some of my patients, when they get promoted, it's the last thing they want.

    8. AP

      They could be flooded with compliments-

    9. MR

      Mm

    10. AP

      ... the person with ADHD who perhaps is high functioning. But y- what you can't see is that they're at that chronic state of approaching burnout.

    11. MR

      Mm.

    12. AP

      Yes.

    13. MR

      Oh, massive. Massive. Or they don't feel it. Like, other people are feeling it more than they are. Like, they're all celebrating, "Isn't this wonderful?" Like, one of the things I hear all the time, and it's really sad, is like when, when they achieve so much, they're, "I just feel empty."

    14. AP

      Mm.

    15. MR

      "I feel empty." And that's a awful feeling, awful, where they just can't connect to that, that external, uh, achievement because internally they're empty 'cause their self-esteem and their self-worth is on the floor.

    16. AP

      I feel like it can be really isolating-

    17. MR

      Mm

    18. AP

      ... really lonely if there is the separation between the external you-

    19. MR

      Mm

    20. AP

      ... which is this perceived high functioning person-

    21. MR

      Mm

    22. AP

      ... and the int- inside p- version is really struggling.

    23. MR

      Mm.

    24. AP

      It can be like you're living behind a glass wall.

    25. MR

      Totally.

    26. AP

      There's a separation between what's going on in your head-

    27. MR

      Yeah

    28. AP

      ... the internal chatter, those-

    29. MR

      Yeah

    30. AP

      ... highly caffeinated squirrels-

  7. 20:54 – 23:23

    High functioning loneliness

    1. AP

      whatever it is. Like-

    2. MR

      Yeah

    3. AP

      ... how much of loneliness can that impact someone-

    4. MR

      Oh-

    5. AP

      ... in this story?

    6. MR

      ... massively so. One of the things I was thinking of as you were talking there is, um, you know that idea of imposter syndrome?

    7. AP

      Mm.

    8. MR

      So for somebody with kind of high functioning ADHD, that's, that's, that's sitting in there, is, "I am going to be found out. I am going to be exposed. Somebody is going to see that this is all, um, a, a, uh, a, a massive mask because I'm, I'm not going to be able to sustain this." So the loneliness piece is, is, is exactly that. It's because the, the, the, the not, that f- that connection to one's self where you have that self-esteem, where you have that self-confidence, then that, that gives you a sense of, "I'm good enough, that I, I, I validate myself." But if that's missing, then you're already without this, this... I'm gonna go down a psychological road here [laughs] which is relevant. Um, but you're already in a lonely relationship with yourself because you're, you're not in a, a relationship with yourself where you fee- you're able to feel that sense of, "I am good enough. I, I, I have value." So when that goes outside, that's why it doesn't land. So yeah, you can have all of this praise, but y- you feel lonely because that just doesn't, that doesn't connect with you. So it's that idea, isn't it, where, you know, loneliness isn't just about the absence of people. So you can be surrounded by people, but the, the loneliness piece is d- you're just not connected to them. And for people with ADHD, unfortunately, because again, they're living in neu- neurotypical world that isn't designed for them, then there's already that sense of disconnect anyway. So if you add in this piece, then it just intensifies the disconnection, which then can feed that loneliness. And it's very sad stuff. Like, this is, like, this stuff is terrible for your mental health.

    9. AP

      Mm.

    10. MR

      And like, that's why, like, with ADHD, it can then facilitate people having, unfortunately, mood disorders, where in these kind of circumstances people can get very depressed because there's no con- It's, it's, it's all very difficult. Or can get very anxious because they're just trying, they're trying to sustain all of this high functioning performance.

  8. 23:23 – 30:43

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    1. AP

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    2. MR

      Yeah.

    3. AP

      Because you wanna have your true self, the internal self seen and validated.

    4. MR

      Mm.

    5. AP

      But like you said, you can be in a room full of loads of people, and if you're putting on a character-I've said before, I think people with ADHD are the world's best actors-

    6. MR

      Mm

    7. AP

      ... we're really good at playing this character called normal.

    8. MR

      Mm.

    9. AP

      Um, but as a consequence, we don't put our true self out there. How severe can that loneliness get? Can it turn into depression?

    10. MR

      Yeah. What we know about loneliness is, yeah, absolutely, like, the, it can, it can cause depression, but also it can cause people to be suicidal, that they don't wanna live any longer. So it's really serious. And there was that really interesting study as well that came out, I'm not sure h- how they did this in terms of the impact on health, but they, uh, this particular, um, study showed that, uh, the impact of loneliness has the same impact as if you were to smoke 15 cigarettes a day on your, on your body.

    11. AP

      Wow. Hmm.

    12. MR

      I think it was, came out of Colorado, I think.

    13. AP

      This is interesting, and I wanna dive into-

    14. MR

      Mm

    15. AP

      ... a, a potential solution if there is one.

    16. MR

      Mm.

    17. AP

      If someone is feeling lonely and there is this disconnect between what they're putting out into the world-

    18. MR

      Mm

    19. AP

      ... and the internal version of themselves-

    20. MR

      Mm

    21. AP

      ... how do they close that gap?

    22. MR

      Yeah. Great question. So first of all, you gotta recognize that you're f- you're feeling lonely. And lone- now, that's not an easy thing to, to, to, to, to recognize because obviously, like, uh, it, i- if you're somebody who, say, is masking and you appear to be really, really, uh, uh, extroverted, then it's going to be very hard to then say, "Actually, I, I'm, I'm, I'm really struggling here." So I think it's very important that you, first of all, recognize that this is the reality of what's going on, but then you identify somebody you can say that to who's not going to judge you and is going to support you to be able to then talk about what that feels like. The other thing I would say as well, don't assume you understand what that lo- what that loneliness means for that person. Listen to them. Because we can assume, oh, loneliness is just the fact, oh, you need to hang out with people more or, you know, that you need to do more things. It, it's not that. It c- that might not be what- what's, what's missing for that person. It could be the fact that they feel desperately, um, sad or they fee- they're sitting with very strong feelings of inadequacy or shame. It can be all of those things. So let the person talk and get into the feelings because it's very, it's very easy to go on what you see, which is, well, this, this person doesn't, doesn't come o- come off as if they're, they're lonely. But this again is internal. So you gotta listen to what, what they're saying, what their thoughts are, what, what their thoughts are, what their feelings are, and then you can then, then support them once you know what's actually going on for that person. So it's creating that space and really not judging that person or not going in with solutions, obvious solutions, which might have nothing to do with what is happening for that person.

    23. AP

      ADHD masking was described to me once as like a swan on a lake.

    24. MR

      [laughs] Yeah, yeah. A swan-

    25. AP

      So-

    26. MR

      I was th- [laughs] thinking something similar. Yeah. [laughs]

    27. AP

      It's such a nice visual-

    28. MR

      Yeah

    29. AP

      ... and I think it's so true, like a swan on a lake-

    30. MR

      Graceful

  9. 30:43 – 35:24

    What is low functioning ADHD

    1. AP

      ADHD. What does low functioning ADHD look like?

    2. MR

      I would see that more, Alex, as kind of maybe unmanaged ADHD, if we were to give that an-I don't know. So where the person isn't managing their ADHD very well for whatever reason, so say if some- something's undiagn- if, say, the ADHD's undiagnosed and that person isn't, say, um, seeing a psychologist or in a, in a... Not only that, isn't i- in some cases, if, if we think about w- what we do to treat ADHD, hey. So I'm gonna use an example of I see lots of teenagers. So when, when I have a teenage patient with ADHD, then we pull in an enormous support system. So the- I have m- big conversations with the parents, I will have conversations with the school if need be, and then the person is seeing me. We may be medicating that young person. So all of these things are managing the ADHD for that young person so that then they can have that stable environment where everybody knows what's going on, the medication is doing its thing if that's what's necessary. So we create stability, we create the, the environments to stabilize that person. Whereas if it's unmanaged, then we don't have any of those things in place, which means then that person is hugely struggling to navigate life with an ADHD brain, which is when you can see it being a bit more chaotic. But essentially what's happening there is that the person isn't being supported enough to be able to stabilize. And, and that's a big ask. Like, if you have undiagnosed ADHD and you're trying to cope with that yourself, and it's, like, really kicking off, then, like, the per- you know, that person's probably doing their best to try and-

    3. AP

      Mm

    4. MR

      ... cope with all of that. But without any of these additional support systems in place that we know work, we know this stuff works 'cause it- it's, it's, um, it's what that... And it's bespoke, it's what that person needs. But if you've none of that, then you'll have unmanaged ADHD, which is, um, which again is, is, is hugely problematic, yeah.

    5. AP

      Why do some people develop coping strategies and essentially become a high masking or-

    6. MR

      Mm

    7. AP

      ... high functioning person with ADHD-

    8. MR

      Mm

    9. AP

      ... and, and someone else might not? What... Is there a difference in the journey of those two people?

    10. MR

      Yeah. It's a very interesting question. I... 'Cause one of the... I was thinking about, uh, when we were, when you said we were gonna talk about high functioning ADHD, and one of the, one of the things I, I kind of thought I'd need to talk about this, um, because, again, it might sound quite obvious, but sometimes it's overlooked, is, um, you know, there isn't an ADHD personality. That doesn't exist. Your personality is, you're Alex Partridge. Like, this is, this is... Your personality is unique to you. You might have the same diagnosis as somebody else, you have ADHD, but they're not gonna have the same personality as you because that's their personality and [laughs] that's, that's unique to them.

    11. AP

      [laughs]

    12. MR

      So, like, a big part of this would be personality. It's the-

    13. AP

      Mm

    14. MR

      ... the, that, that person's own identity and what excites them and the things they like and they find easy, and their strengths and their weaknesses which are unique to them. So wi- wi- with personality, we, we kind of break it down into, um, the acronym, it's called, it's OCEAN. So the big five traits of personality, uh, open, OCEAN. Openness, conscientiouness- conscientiousness, uh, extrovertism, let's see, no, O C... Extroversion, um, agreeableness, and the N is neuroticism. People with ADHD, they, they're very high in, uh, uh, in terms of their personality trait, they're high on neuroticism. Now that might sound like, oh, that's a negative thing, and to be neurotic is not a, a negative thing. But neuroticism is they'd be pro- more prone to worry and anxiety, they're over thinkers. No surprises. Um, they might be a little bit more kind of emotional because of the, uh, emotional dysregulation of the RSD. So yes, you can kind of see personality traits that might be a bit more present in ADHD, but what you also have as well as a unique personality, a unique support system. So some people have amazing support systems, their people around them are great. We spoke about this off-air, you'll have other people that say, "Well, that's not a thing. We're all about ADHD, you're just lazy."

    15. AP

      Mm.

    16. MR

      We're going to be really critical, which of course will be horrendous for their RSD. So the, the, the, the combination of personality, of social supports, but then also as well, um, the unique psychology of that person will all be at play in terms of then, um, how they function.

  10. 35:24 – 41:01

    Link between high functioning ADHD and addiction

    1. MR

      Yeah.

    2. AP

      Is there a link between ADHD, high achieving, and addiction?

    3. MR

      Yeah, that's a very interesting question 'cause, um, we know ADHD and addiction sadly c- can go hand in hand, um, for lots of reasons to do with, um, the dopamine receptors, but also, uh, impulsivity and then just kind of trying to cope with stuff. But with high achieving, it might not seem so obvious, um, in terms of it being an addiction, but, um, it can lead people to becoming workaholics. Now, when we say that, it's like, it kind of, oh, God, yeah, well, that kind of sounds obvious now, doesn't it? Which is, well, if they're high achieving or trying to overachieve or overcompensate, then especially in the workplace, then they could then become that type of workaholic which is constantly trying to spend more time in the office or being very consumed with their jobs, overly worried, always trying to appear to be, uh, on top of everything, or that, again, they're, they're, they're trying very hard to be conscientious. But that comes at a huge price, 'cause somebody who's a workaholic is prioritizing their work, is not necessarily taking care of their wellbeing or their, their sleep or their diet. Lots of things can go out the window. And so if you're labeled as a workaholic or somebody calls you a workaholic, sometimes that can be seen as a badge of honor, which is, oh, well, you're just really, really committed to your job.And it's not actually a, a healthy thing because somebody who's a workaholic is addicted to their job. But that addiction is, like any addiction, it's problematic. So that can lead to the obvious things, burnout. It can also lead to things like their relationships can fall apart 'cause they're just not present. Um, but also it can lead to huge anxiety, stress, and worry because they're constantly trying to overachieve and over-perform in their job. And what you can also see as well is that if there's any kind of structural changes or, say, they get overlooked for a promotion or somebody gets brought in as their boss, then everything starts to fall apart because now the person feels threatened in a space that was rewarding them or they were addicted to, and now it's, um, it, it doesn't feel safe. So, um, did an amazing study actually, it was back in 2014 in Bergen, in Norway, in the University of Bergen, where, um, they, there was over 16,000 people they, um, uh, sampled. And they built a questionnaire to identify people that would show traits of being a workaholic. So they kind of pulled that, pulled that sample of people identified as workaholics from the bigger sample. And what they looked at then is, okay, well, well, what kind of, uh, maybe underlying conditions did these people have? And in that sample, the highest condition of people who identified as workaholics, no surprises-

    4. AP

      Hmm

    5. MR

      ... was ADHD. Over, over 33%. And of all the conditions that they looked at, ADHD was the highest.

    6. AP

      If you're a different type of addict, if you're like a drug addict, right, you're chasing the high, the feeling you get from taking that drug.

    7. MR

      Mm-hmm.

    8. AP

      As a workaholic, what, what are you chasing? Are you, are you chasing the, the, the praise?

    9. MR

      Yeah. So y- it's, again, it's the same reward system. Some of your dopamine system will reward you for all kinds of things. So the reward can be ego, that it's about, uh, how you're viewed. So you're viewed as somebody who gets lots of praise because you're, you're the one that's in first thing in the morning and you're the last one [laughs] to leave. Or your s- whatever, your sales figures are through the roof, or you get the, the highest bonuses, whatever. So it's all external validation. It's all external validation. So but that feeds a sense of self-worth if, uh, helps the person feel good about themselves, but it comes at a price. Because if you want to keep having that feeling, then you need to keep engaging in the behavior that's providing you with that feeling, and that's where the addiction takes place.

    10. AP

      Hmm.

    11. MR

      So the interesting thing with addiction is we can get addicted to all kinds of things. We can get, you know, the obvious ones, we get addicted to alcohol and drugs and food. But we, the- these more behavior-based addictions, um, gambling, uh, workaholism, absolutely the same, yeah.

    12. AP

      And does RSD come at the center of all of this? Because if you get a praise, that's almost silencing your RSD.

    13. MR

      Yeah.

    14. AP

      Can pushing RSD away be addictive?

    15. MR

      Y- yeah, more, I suppose, with that one, Alex, it's probably more managing and overcompensating with the RSD. So sort of the obvious one there is the people-pleasing. So if you want to kind of push the RSD away, and of course the big feeling in RSD is shame, then you're the person that always says yes.

    16. AP

      Mm-hmm.

    17. MR

      So, "Will you do this project?" "Yes." "Will you work late?" "Yes." "Will you go into that meeting?" "Yes, yes, yes." And of course, the yes, then you have to kind of, you've gotta follow through, which means then you kind of have to, you have to stand over that. So if you're trying to offset the RSD by people-pleasing, overcompensating, oh, my goodness.

    18. AP

      Hmm.

    19. MR

      Like that's the stuff that's going to lead you to burnout because you're going to have to then deal all the stress that that's going to cause you in terms of being able to deliver on all of that. And you have to deliver, 'cause if you don't deliver, your RSD's gonna kick off.

    20. AP

      Hmm. Truly fascinating,

  11. 41:01 – 45:09

    Audience questions (washing machine of woes)

    1. AP

      Mark.

    2. MR

      Mm.

    3. AP

      Thank you very much. I want to move on to my favorite part of the show, which is the ADHD agony aunt section.

    4. MR

      [laughs]

    5. AP

      Which, as you know, is called-

    6. MR

      [laughs] The washing machine of woes

    7. AP

      ... the washing machine of woes.

    8. MR

      [laughs]

    9. AP

      Um, because I always leave my clothes in the wa- in the washing machine after every, every cycle.

    10. MR

      [laughs]

    11. AP

      So if anyone's listening, might be a good idea to check your washing machine. [laughs]

    12. MR

      Yes. [laughs]

    13. AP

      But I have been using the Tiimo app, which is the sponsor, and uh, I'm getting better.

    14. MR

      Oh, good. Yeah.

    15. AP

      Uh, this week, Mark-

    16. MR

      Yes

    17. AP

      ... in the washing machine, someone has written in and asked, "One moment I feel like I'm fine and able to function well-

    18. MR

      Mm

    19. AP

      ... even efficiently with ADHD."

    20. MR

      Yeah.

    21. AP

      "The next I have a full-blown burnout and breakdown."

    22. MR

      Yeah.

    23. AP

      "I almost feel bipolar. Could it be bipolar?"

    24. MR

      Ooh, do you know, I, I, it's f- it's serendipity, huh? I had this conversation at my clinic this week. [laughs] So it's fresh in my head. Um, so they are very, two very separate things. A, uh, bipolar disorder is in the depressive disorders. It is defined by periods of very, very, very bad depression, which is not just, um, say, occasional. It's where the person goes through a proper depressive episode which can last weeks and months, and then, uh, very kind of manic highs as well which last a number of weeks also. So it's very extreme in terms of the, the, the mood that it creates. So that's a kind of separate thing. And we have bipolar disorder, and we've got, now we have bipolar 2. And so bipolar 2 is still a bi- bipolar disorder, but a, a more milder form than the original-

    25. AP

      Hmm

    26. MR

      ... kind of one that was more kind of, uh, extreme. What I think this is, is more it's the emotional dysregulation and then trying to navigate the very, very quick, um, emotion, emotional, uh, instability that can happen with ADHD. So let's take RSD. I know we come back to RSD all the time, but I feel it's-Like you said, at the core of lots of this stuff. So in RSD, if that kicks off, then your mood will destabilize in nanoseconds. It'll be so fast.

    27. AP

      Mm.

    28. MR

      So fast. But the awful thing about RSD is it doesn't stabilize quickly. So it's not like you're in RSD for a couple of seconds and you're back out of it again very fast, so you bounce. You don't bounce. You fall into it, you stay in it, and then however long it takes, that could be da- uh, hours, it could be [laughs] days-

    29. AP

      Mm

    30. MR

      ... you'll come back out of it. So while you're in it, your mood is going to be down, and then it will come back up again when you're kind of out of it again. So like w- w- with that, that's not bipolar disorder. That's the, the, the instability, that's the dysfunction that happens within ADHD which can seem like if you're looking at it, well, that looks like you're having mood swings. Well, y- y- you kind of are, yeah. But your mood swings are not bipolar disorder. Your mood swings are the symptoms of ADHD that are happening in that moment. And of course, the thing as well, especially with RSD, is, um, like you can't predict that. That will happen organically. So that, and that doesn't even need to be variable. That can be somebody that looks at you a certain way and you interpret that look as, "They don't like me." And then the thinking spirals and then the overthinking kicks in, and then you're in this place of feeling rubbish about yourself, and then your mood drops.

  12. 45:09 – 46:22

    A letter to my younger self

    1. AP

      ... every week the guest writes a letter to the younger version of themselves-

    2. MR

      Oh

    3. AP

      ... with some advice.

    4. MR

      Yes.

    5. AP

      And I'd like to deliver you the letter that the previous guest wrote to themselves-

    6. MR

      Ah, lovely

    7. AP

      ... for you to kindly read out.

    8. MR

      Oh. Haven't done this before.

    9. AP

      No, this is a new one, right? Yeah.

    10. MR

      Yeah. What a privilege. Right. And this person has very kindly written it in, uh, handwriting that I can read, which is great. "To my younger friend, you don't know this yet, but you truly are special. The way you cry, the way you smile, even your messy handwriting is truly special. So keep going and don't forget to love yourself because you'll see why very soon."

    11. AP

      Wow. A powerful reminder-

    12. MR

      That is-

    13. AP

      ... for all the listeners, I think

    14. MR

      ... that's lovely. That is, whoever wrote this, this is, um, this is-

    15. AP

      Dr. Jacob-

    16. MR

      This is-

    17. AP

      ... from the US was the previous guest. He was fantastic.

    18. MR

      Yeah.

    19. AP

      And what a lovely letter.

    20. MR

      What a lovely letter. Yeah. Uh, it's, it's very validating.

    21. AP

      Mm.

    22. MR

      And also it's full of hope. Yeah.

    23. AP

      Dr. Mark, once again, thank you so much.

    24. MR

      Thank you so much for having me, Alex. Loved the chat as ever. [upbeat music]

Episode duration: 46:23

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