ADHD, or Attention-Deficit/Hyperactivity Disorder, is perhaps one of the most well-researched disorders relating to childhood and adolescent mental health in the world. And while we know so much about this disorder now, not too long ago there were plenty of gaps in our understanding. One of those gaps includes how ADHD presents itself in women, since women with ADHD were often misdiagnosed or completely ignored because ADHD was initially believed to mostly affect men.
Since ADHD was believed to mainly affect men, for decades the scientific research focused on symptoms of ADHD in men, particularly in young boys, completely overlooking the effects that this disorder has on young girls and women. Today however, we know that ADHD is not primarily a “male” disorder, but that on average, men and women simply show different symptoms.
To start off, ADHD is a behavior disorder that is typically characterized by either hyperactivity, impulsivity, the inability to concentrate, or any combination of these symptoms. Symptoms usually begin to appear by the age of 7, often when the pressure to concentrate begins to increase as a child goes through elementary school.
With the correct diagnosis at an early age, treatment that is tailored to an individual’s age, medical history, symptoms, and other factors can greatly decrease the severity of symptoms and therefore decrease how much their behavior interferes with their life and development. Early diagnosis and treatment basically reduces the life impact that ADHD has on someone, and since young women are often missed when it comes to screening, they are at a greater disadvantage when it comes to managing ADHD.
The Different Types of ADHD
There are currently 3 major types of ADHD according to the Johns Hopkins Medicine center. They are:
ADHD, impulsive/hyperactive type. This is perhaps the least common type of ADHD, consisting of both impulsive and hyperactive behaviors without any other behavioral symptoms.
ADHD, inattentive and distractible type. This type is characterized by difficulty remaining attentive and being easily distracted without any impulsive or hyperactive behaviors. It is also commonly referred to as ADD, or Attention-Deficit Disorder.
ADHD Combined. ADHD combined is the most common form of ADHD and is a combination of the above two types of impulsivity, hyperactive behavior, being inattentive, and easily distractible.
Although specialists still are not 100% certain of the root cause of ADHD, the research that we currently have on it suggests a genetic link may be the cause for the disorder. Low levels of the neurotransmitter dopamine is a common physiological indicator among children with ADHD, and some studies have indicated that the parts of the brain responsible for attention, social judgement, and movement, have a lower metabolism in those with ADHD.
The Common Signs of ADHD in Young Girls
Here is a list of some of the most common ADHD signs and symptoms experienced by young girls and women. Keep in mind that because of the different types of ADHD, it is unlikely that someone will experience every single one of these symptoms, and experiencing one or two of these symptoms may not automatically indicate that ADHD is the underlying cause. The common signs are:
Being withdrawn
Blurting out things without thinking or interrupting others frequently in conversation
Requiring extra thinking time to process information or directions
Constantly shifting focus from one activity to another
Appearing to get upset easily
Appearing shy
Crying more easily than others
Struggling to complete tasks
Having poor time management
Appearing messy, both in terms of appearance and their physical space
Often slams doors
Seeming to make “careless” mistakes a lot
Exaggerated emotional responses (this is part of hyperactivity)
Extremely talkative, with an infinite amount of things to say
Is a bad listener
Is extremely sensitive to noise, emotions, and even types of fabrics
Forgets things a lot
Seems unmotivated
Is easily distracted
Frequently daydreams
Any girl who has ADHD may experience a range of the above symptoms, however it is important to keep in mind that every individual is different. Not all people with ADHD act in the exact same way, so while it may be easy to spot someone with the stereotypical symptom of hyperactivity, history has shown that it is all to easy to overlook someone whose symptoms make them more withdrawn, as has been the case for women for a long time.
Signs of ADHD in Women
Your desk at work is piled with clutter and your home is disorganized. And even after cleaning, it is difficult to maintain order before things become messy once again
Working at an office is difficult because of the noise and people around you
You avoid parties and social gatherings because the noise is overwhelming and the experience makes you feel shy
You struggle to stay focused during conversations when you are not talking, or when the topic is something that doesn’t excite you
Social rules may seem complicated and hard to understand
You have a long list of unpaid bills and struggle to organize your finances
You use your shopping habit to compensate for other problems, like buying new clothes because you have no more clean ones
You spend lots of time trying to organize yourself, however it doesn’t seem to work
You avoid inviting guests to your house because of the clutter
You feel you can’t keep up with society’s expectations of you as a woman, like remembering birthdays and organizing your kid’s lives
Crowded places overwhelm you, and activities like grocery shopping are difficult because you struggle to organize a list. This can include regularly forgetting key ingredients for your meals while out shopping
You know that you are just as smart as the people you went to school with, however you feel that you haven’t been able to complete as many things as they have
It is difficult to relax
You get overwhelmed with life easily
Why ADHD in Women Is Often Not Diagnosed
Whether it is ADHD symptoms in young girls or in grown women, what has happened frequently in the past is that the symptoms of ADHD are simply understood as being part of that individual’s character and personality rather than as part of a behavior disorder, or are misdiagnosed as being part of a depression or anxiety disorder.
A young girl may be labeled as simply being a chatty person, or a dreamer, or someone who is constantly distracted or disorganized and will often not be identified as being ADHD when compared with a child who is hyperactive and impulsive. This is also because, while boys with ADHD are much more likely to experience the combined type of ADHD that includes all of the symptoms of hyperactivity, impulsive behavior, distractibility, and inattentiveness, girls are more likely to experience the inattentive type of ADHD that includes inattentiveness and distractibility without the hyperactivity and impulsive behavior.
A common experience of anyone with ADHD, be they male of female, is the eventual feeling of being overwhelmed and exhausted. This can include feeling like they have no control over their lives, like even small tasks are huge obstacles, and having low self-esteem and high levels of stress. While those who are successfully diagnosed with ADHD will have these experiences attributed to their disorder and will have access to medications and therapies to help, women in particular who are not diagnosed and who seek professional help for feeling overwhelmed will often be misdiagnosed with depression or anxiety.
This will in turn lead to the prescription of medications and therapies that do not successfully target the root of the problem and can leave women feeling like they have even less control over their lives, leading to higher levels of stress.
Because of the historical focus on ADHD in boys, the general awareness of what ADHD looks like among the public consists of behaviors relating to hyperactivity and impulsiveness, which understandably misses out the more common symptoms experienced by women with ADHD.
Additional Effects and Co-Occurring Conditions of ADHD
Women who grow up without being diagnosed as ADHD will obviously bring all of their childhood and adolescent behaviors with them. This can often include low self-esteem which can lead to mood disorders such as depression, anxiety disorders, eating disorders, and even obesity.
Young women with undiagnosed ADHD are also at a higher risk for things such as smoking and substance abuse disorders as well as teenage pregnancy. Later in life, women with ADHD often won’t get the chance to be diagnosed until one of their children presents symptoms that require an expert opinion. A woman with ADHD has a 50% chance of passing the disorder onto their children, and as grown women, they are also more likely to go through divorce and become single mothers who have to raise their likely ADHD children alone.
Combine this with the fact that women with undiagnosed ADHD are more likely to experience financial crises and underemployment, and we can begin to see the effect that ADHD has on the lives of women who do not receive a diagnosis for their disorder.
If the above descriptions match yourself, a family member, or someone that you know then it may be a good idea to speak with them about how they are feeling and consider whether talking to a specialist may be the right decision.
Narcissism has been talked about for a long time as a general personality trait, like the self-absorbed somebody who is so focused on their own appearance and self-admiration that it becomes annoying. But did you know that Narcissistic Personality Disorder (NPD) is a legitimate disorder that involves more than somebody who suffers from a general dose of vanity?
While the causes for NPD haven’t been pinpointed to an exact cause, it is understood that the cause for the disorder is complex and could largely revolve around parent-child relationships involving excessive amounts of praise or punishment, inherited genetic characteristics, or even a neurobiological basis.
What we do know is that the narcissistic personality disorder is a condition where an individual presents with an inflated sense of self-importance and high levels of self-admiration, a need for constant attention and admiration from others, trouble forming and maintaining relationships, and a general lack of empathy for others. What lies underneath that mask of projected self-importance a lot of the time, however, is a fragile self-esteem that relies on external messages from others and the environment to maintain their notion of self-worth.
When we come across somebody who displays narcissistic qualities, it is good to ask: are we simply dealing with someone who has a selfish character? Or someone who has NDP? An understanding of their behavior allows us to navigate interactions with them more effectively.
Like all types of personality disorders, there are different types of NPD that come with their own nuanced behaviors. Malignant narcissists are often regarded as having the most extreme form of NPD, and while they will have the regular qualities of someone with narcissistic personality disorder, their self-absorption and self-obsession is accompanied by some darker behaviors as well.
Learning how to identify malignant narcissists, what their motivations are, and how best to handle them and interact with them can help you in the long run to avoid any unsavory encounters.
So, What Exactly Is Malignant Narcissism?
As well as all of the regular behaviors associated with NPD, malignant narcissism also involves antisocial behavior, sadism (deriving pleasure from the pain or suffering of others), and a paranoid orientation. This can be contrasted with other common types of NPD, such as grandiose narcissism which generally requires excessive amounts of attention and praise, and vulnerable narcissism which generally involves feeling vulnerable, defensive, and requiring support from others.
The term “malignant” in this case refers to being “aggressively malicious”, as defined by the Merriam-Webster dictionary.
Malignant narcissism often involves a combination of internal fragility, aggression, and general suspiciousness of those around them. They are known for being manipulative, and the lack of empathy for others often means that they will do what they must in order to get what they want. Professionals often use the terms malignant narcissist and psychopath interchangeably.
Some of the most common behaviors and symptoms of malignant narcissism include:
Only seeing things as black or white, such as whether someone is a friend or an enemy, or whether or not someone wronged them
They show zero remorse for harming someone, where someone with a different type of NPD may feel guilty after harming someone for self-gain
They will do anything that it takes to get what they want, regardless of the harm it causes others
They may feel empowered by hurting or harming others
They rank relationships and other people based on superficial standards rather than emotional qualities
Obviously, just because someone has no empathy or is self-absorbed doesn’t make them a malignant narcissist or even someone with NPD. However just because someone who has some of these traits isn’t diagnosed as a malignant narcissist doesn’t mean that they can’t do any damage. This article therefore may help you in other interactions as well.
When we interact with malignant narcissists, it is common for people to feel intimidated, anxious, and fearful of someone with this condition. Malignant narcissists may leave an impression that makes people feel like they are jealous, petty, hateful, and cunning.
There are other signs and symptoms that we can look out for as well that are also found in other forms of NPD, and may provide indications that someone is a malignant narcissist. They include:
Focusing on fantasies regarding their beauty, success, and power
Blaming other people for their bad behavior
Having a weak sense of self and lots of hidden insecurities
Taking over conversations and bullying people who they think are below them
Believing they deserve the best from everything and everyone and expecting that to be how things work
Never experiencing remorse or feeling like they need to apologize unless it is for their own benefit
An inability to self-regulate their emotions
Having an inflated sense of self
Lack of empathy for people and animals
Being heavily focused on their appearance and superficial aspects of themselves
Lashing out at others when they feel wronged or emotionally exposed
Taking advantage of people to achieve their own goals
Being unable to take criticism from others
Malignant Narcissism in the Mental Health World
Although malignant narcissism is genuinely considered to be a manifestation of NPD, with experts agreeing that it is the most severe form of the personality disorder, it isn’t recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Even though it isn’t listed as a formal diagnosis, psychologists and other mental health experts still use it as an effective term for describing a set of characteristics in people affected by NPD. The reason why it hasn’t been classified as a formal diagnosis is because malignant narcissism is essentially at a crossroads between multiple disorders. It combines aspects of NPD with Antisocial Personality Disorder (APD), aggression and sadism, and paranoia.
Antisocial Personality Disorder
Because of many of the shared similarities between APD and malignant narcissism, it is helpful to understand this type of personality disorder so that it may shed light on some of the characteristics of malignant narcissism. Someone with APD will show some of the following symptoms:
Zero regard for their own safety or that of others
An inability to follow social norms and laws
Impulsive behavior
Being aggressive and irritable
Showing zero remorse for their actions
Lying and manipulating others for their own amusement or to achieve their own goals
Consistent irresponsibility and an avoidance of taking responsibility for their own actions
Dealing with a Narcissist
Whether you have to deal with a loved one who has NPD, or even malignant narcissism, or if it is someone outside of your family like a co-worker or your boss who you can’t avoid, know that there are some approaches and general rules that you can follow to maintain a safe interaction:
Acknowledge that dealing with them won’t be easy. People with NPD generally have poor perceptions of boundaries; however, it is important that you establish and maintain them and acknowledge that it may take some effort to do so. This may involve establishing physical space between the two of you, or maintaining personal boundaries if they repeatedly ask for favors from you.
Don’t expect them to change. Because this is a personality disorder, these kinds of behaviors and aspects of their personality sit at such a core level within them that trying to change them will likely just leave you (and them) frustrated. This is not the same as correcting bad behavior in a child who will learn from the experience, so be prepared to leave them be.
If you challenge them openly and directly, they may fight back. This may not involve physical violence. However, they may try to either manipulate you in retaliation to challenging them over something, or they may manipulate other people against you in an attempt to win and gain dominance. This is an important rule to remember, especially when setting and maintaining healthy boundaries. Sometimes instead of outright saying no and creating a confrontational atmosphere, it can be a good idea to find less confrontational approaches to maintaining boundaries. You don’t have to agree with everything they say or go along with everything they ask, but focus on maintaining a friendly atmosphere and kindly suggest alternatives to them if you really need to.
If confrontation is unavoidable, don’t do it in front of a crowd. If, no matter how hard you try, a confrontation can’t be avoided, doing so in front of spectators will only make them feel like they need to protect themselves more in order to save face in front of a crowd. This can lead to even heavier retaliation. It can be a good idea to pull them aside beforehand, and let them know that you don’t want to challenge them in front of other people as a favor to them.
Let your friends know and surround yourself with supportive people. After any interaction with a malignant narcissist, it is a good idea to keep the people who you trust in the loop regarding what happened so that if anything bad happens that negatively affects you, you will have people around you who are not so easily manipulated who can stand up for you when you are not around and can support you and help protect you if needed. That way you won’t be fighting any battles alone.
Dealing with someone with NPD can be a difficult task, and if they have malignant narcissism, it can be even harder. Remember to try and keep as much distance as you can between them and yourself, however we realize that if they are a family member or someone who you have to regularly interact with then this can be hard. You can reach out to a mental health professional to get access to some great tips and coping methods to ensure that you stay safe and can confidently navigate any future interactions you have with them.
We are the same as every living thing – in that our environment shapes us. In fact it will shape us to the extent that we either grow to our full wonderful potential or we can fade and die.
An analogy that makes it plain to understand how vital our environment is to us is to realize how we care for plants in our garden. We know it is essential to have the correct soil, to keep the soil in the best conditions possible by ensuring it has enough water and nutrients, that the plant has sufficient sunshine and doesn’t get too hot or cold.
We know that if we neglect any of these, the plant will wilt and if left uncared for it would eventually at some point die. The environment we live in is just as vital to our wellbeing.
This means not only our home, but also the community and even country we live in. Our environment needs to be a sanctuary and provide what we need to grow and thrive.
Mental, emotional, spiritual and physical
Human beings are social creatures. We were made that way, as part of our survival as originally we didn’t have so much to protect us as many animals do, such as long sharp fangs or pointed claws.
Likewise we don’t have fur to keep us warm. Then there is the fact that human babies are born far more underdeveloped than almost all animals.
For the first 12 months a human baby is totally dependent on the adults around it for food, shelter and warmth as we can’t even walk for usually around nine to 12 months old. Yet, most baby animals can walk within days and sometimes hours.
A human brain doubles in size in the first year. So it’s growing rapidly – and the environment around it will influence how it develops.
Negative consequences on our cells of being in a frequent or continual state of alert at real or perceived dangers has been scientifically proven. Stem-cell biologist and author Dr Bruce Lipton has explained how the trillions of cells in our body are either growing and maintaining our health or in a defensive mode when they cannot grow as they should.
Being in a damaging environment like this means we’re more likely to become ill – that can be in a mental, emotional or physical sense. Increasingly, experts such as Dr Lipton and physician, author and trauma expert Dr Gabor Maté are stating how mental, emotional, spiritual and physical aspects of us are all inextricably linked.
Disconnection is a major part of all mental health problems. Frequently, people who are suffering from such as addiction, anxiety or depression will feel alone and disconnected from other people.
So the world around us and the people in it are vital to our wellbeing. We need to feel connected.
No main is an island
Renowned psychologist Carl Jung (1875–1961) used another plant analogy that explains this so well. Talking about a plant’s rhizome, which is its stem that is continuously growing underground, he said: “Life has always seemed to me like a plant that lives on its rhizome. Its true life is invisible, hidden in the rhizome.
“The part that appears above ground lasts only a single summer. Then it withers away – an ephemeral apparition. When we think of the unending growth and decay of life and civilizations, we cannot escape the impression of absolute nullity.
“Yet I have never lost a sense of something that lives and endures underneath the eternal flux. What we see is the blossom, which passes. The rhizome remains.”
So underneath the soil there are roots, there’s the soil, there are nutrients in the soil, and vital things for the life of the plant happen in the soil when it rains. Then above and around the plant there’s the air and oxygen, the sunshine, the rain, night and day…
If the plant ignored all of these other parts of it, and relied solely on itself, it would soon wither and die. It can be said that’s the same with us if we ignore connections around us.
The war on drugs
Portugal’s decriminalization and changed policy on illegal drugs in the past decade proves this point. Instead of spending money on the “war on drugs”, the country – that had one of the highest number of drug users in Europe – started to spend that money on rehabilitation and to allow users to integrate in society again.
For instance, a group of three people who’d been carpenters until their drug use had put them out of action, were encouraged – with financial help – to start up a small carpentry company to do their work around their community. This gave them a connection again.
There’s a strong point here that for many addicts the connection they have with their drug replaces any other connection. It becomes their number one and sometimes only “relationship”.
Within a few years of this new policy Portugal saw a huge improvement. For example, Portugal’s drug death toll plummeted to three per million compared to the European average of more than 17 per million.
People need people
It’s also one of the reasons the Twelve Steps group meetings and regular one-one-one therapy both work so well. There’s connection between people – and what they think and feel.
Sometimes when people have grown up in an environment, their home and/or community where there was little positive and loving connection, therapy might be the first time they have ever felt validated and valued as a person. Feeling unloved as they may have in this way leads to all sorts of emotional and mental health problems.
Of course, if the environment someone has grown up in – or it could be they presently live – is one where abuse and aggression is commonplace, it is bound to have negative consequences.
So while a great deal of recovery is about working on inner feelings and beliefs, the external environment has to be considered as it certainly plays a major part in someone’s wellbeing.
Today while there are more ways of connecting than ever before, there is actually less real connection. Communities were stronger in the past and all generations of a family used to live closer to each other.
In general, people had more time for each other even including those in their household. There was more connection.
It is like if we took a piece of coal from a glowing fire… on its own without the warmth of the fire the piece of coal would soon go out. People need other people: we need connection and relationships.
“Psychiatrist” derives from the Greek words psukhe meaning “soul” and iatros meaning “healer”. So “psychiatrist” actually means – and originally meant when it was first used around 170 years ago – “soul healer”.
Yet so much of 21st Century mental health treatment focusses only on the mind. Could it be that one of the reasons rates of what are known today as mental health problems have increased so dramatically is because we ignore the spiritual aspect of being a person?
As renowned motivational speaker and one of the world’s bestselling self-help authors Dr Wayne Dyer put it: “We are not human beings in search of a spiritual experience. We are spiritual beings immersed in a human experience.”
Since the Industrial Revolution started in Europe in the 18th Century, the Western world has put increasingly less emphasis on spirituality. Nations and their people look to the material world as a reason for living and the way to happiness.
But striving for material gain has led to much more pressure and stress in life. Now, for instance, it is a necessity that both partners work full-time whereas until relatively recently that was not the case.
Power of Connection
In a recent talk entitled The Power of Connection, physician, trauma expert and author Dr Gabor Maté said: “There are mental illnesses that develop originally really as compensations against stress and trauma.
“Now we have the GDP, the Gross Domestic Product. This is how we measure success. It’s how much wealth.
“In a materialistic society, we measure success by the possession or the control or the production of matter, of materials. It’s materials that matter.
“But is that really the true measure of a human society? Well, it’s one measure.
“But is it a true measure of a successful society? Can a society be called successful because it produces, controls or owns more matter than some other society?
“An equally important measure, at least as important measure of a society and culture, is to what degree does it meet human needs? How well does it promote healthy human development and to what degree and ways does it undermine it?”
Maté talks about disconnection caused by our modern Western system playing a major part in both physical and mental illnesses. Connection with others can be seen as a spiritual aspect of the human condition.
Feeling disconnected from others is a major part of many mental health illnesses, including conditions such as addiction and depression. We live in a world today that despite us being more connected than ever before through technology, there is often less actual connection.
A large part of recovery is about restoring connection. That is to other people – but also for the person seeking help to reconnect with their true selves.
Spiritual matters
In the past century, science has also risen as a more powerful force of reasoning than spirituality. The fact is proof of something is easier to believe if we can see it.
But spiritual matters often cannot be directly seen. Although spiritual people will say the consequence and effect of spiritual things can be seen everywhere.
They might liken it to television signals. Nobody can see the movie traveling from its source but you can see it on your television screen.
Many people connect spirituality to religion. But there are also many who are not part of any religious group who live spiritual lives.
In fact in the Alcoholic Anonymous “Big Book” chapter entitled “We Agnostics” it is all about this and says: “Something like half of us thought we were atheists or agnostics.” This was written in the 1930s when church-going and a spiritual life was much more the norm than it is now.
So AA membership today – estimated to be more than two million people worldwide – is likely to have an even larger percentage who identify as atheists or agnostics when they start the Twelve Steps recovery program.
Step Twelve of this program says: “Having had a spiritual awakening as the result of these steps…” Therefore, the point of the Twelve Steps is to have a “spiritual awakening” – this is what has been shown for more than 80 years now to help people formerly considered by most doctors and psychiatrists to be hopeless cases.
That is not just those addicted to alcohol, but also to drugs and people with behavioral addictions too. Such a “spiritual awakening” has been seen to work for those identifying as atheists as well as for those who identify with one of the world’s religions.
Esteemed psychologist Carl Jung played a forceful part in the formation of AA. It was one of his clients – business executive Rowland Hazard – who was told by Jung that his only chance of beating an addiction to alcohol was a “spiritual or religious experience – in short, a genuine conversion”.
This filtered back to a New York stockbroker called Bill Wilson who was battling his own alcoholism. Wilson went on to become one of AA’s co-founders.
Shakespeare on disease and divinity
We can also look further back to great literature to see that a spiritual solution was seen as the cure for what today are mostly seen as mental health problems.
In Shakespeare’s tragedy Macbeth, Lady Macbeth is agitated, anxious, unable to eat, rest or sleep. She is irritable, restless and discontent.
Macbeth sends for a doctor to cure his wife. When the doctor arrives he swiftly recognizes the source of Lady Macbeth’s problem.
He says: This disease is beyond my practice… More needs she the divine than the physician.
So the debate about mental health illness and spiritual sickness is ongoing. Although there are many people who are today regarded as having important knowledge – such as Carl Jung, Gabor Maté and Wayne Dyer among many others – who talk about a spiritual solution at least being a part of the answer to many of today’s mental health problems.
