ADHD and Empathy: A Study, Book Excerpt, and Empathy Defined

ADHD and empathy
What is the connection among ADHD, empathy, and dopamine? That’s what this post is all about.

I’ve noticed a remarkable phenomenon over the last 20 years: Stimulant medication enhances empathy for many adults with ADHD. How is this possible?   In this post, I’ll tackle the topic from three angles:

1. Defining empathy (it’s not what most people think).

2. Excerpting a passage on empathy and relationships from Is It You, Me, or Adult A.D.D.?

3. Sharing details from yet another study pointing to a connection between dopamine and cognitive empathy. (I’ll define cognitive empathy  in a minute.)

A sneak preview of the study:  Stimulant medication often enhances empathy in people with ADHD.

But wait. This happens not because the medication creates empathy. Rather, the medication enhances dopamine transmission. That, in turn, allows some people with  ADHD to focus on and access this “higher-order” brain function. In fact, it is one they have always possessed—but haven’t been able to reliably access.

Low Empathy and Narcissism: What’s the Connection?

It’s important to understand: Low empathy sometimes increases with ADHD medication. Until individuals and couples—and mental-health professionals—understand this, the risk is a far more permanent label: narcissist.

My friend Taylor J. wrote of her concerns about her daughter here. ADHD and Empathy: Was I Raising A Narcissist?

We can think of low empathy as fertile ground for narcissistic behavior. Traditionally, narcissism has been seen as a very poor prognosis—that it, it does not respond to treatment. That’s one reason I am sharing important research on that topic.

It is hard for me to over-state how commonly mental-health professionals see narcissism—or even Narcissistic Personality Disorder—where there is instead poorly managed ADHD.

Empathy sounds simple. But it’s really a complex phenomenon. In fact, some people with ADHD have trouble reining in their empathy; medication often helps them, too. It’s all about the self-regulation:  not over-doing, not under-doing, but finding the middle ground.

Hang in there. The concept should become more clear as you keep reading.  And be sure to read the comments for some illuminating first-person insights.


ADHD, empathy, and dopamine

Empathy is Not Sympathy or Compassion

We often confuse empathy with other behaviors—sympathy, kindness, compassion, and the like. Empathy is not those behaviors or traits—though it might accompany them.

The most commonly accepted understanding of empathy is this: the quality that lets us “get in another person’s head.” When we empathize, we momentarily step outside of our own needs, thoughts, and desires.  We contemplate what another person might be feeling.

There is a difference, though, between empathic and “relating to.”

For example, if you’ve been in a bad car accident, for example, you are probably better able to relate to the experiences of other people who survive crashes. You “know how it feels.” But what if you’ve never been in an auto accident? What is the mental process that allows you to imagine what it is like for someone else?

That is a very simple example, but it is meant to drive home the point: Empathy is what allows us to imagine what another person is feeling, even if we’ve never been in that situation ourselves.

Moreover, empathy can allow us to step back from our own emotions, in trying to understand the mindset of a person who is disagreeing or even opposing us.

The cognitive scientists have terms for various types of empathy. But the one we’re most familiar with is called cognitive empathy. It simply means: Imagining how the other person feels and what they might be thinking. It’s also called perspective-taking. Walking in another person’s moccasins.

To recap:

  • Empathy is not compassion or kindness, not exactly. And it’s not sympathy.
  • Contrary to widespread misperception, having empathy for a person doesn’t necessarily mean forgiving that person or letting someone off the hook.
  • On the simplest level, empathy is simply being able to “understand where that person is coming from. “




Book Excerpt: ADHD and Empathy Regulation Impairments

Being able to empathize is key to successful negotiations, including in personal relationships. It can also help us understand why humans do some of the horrible things they do—and, with any luck, helping them to act in more humane ways.

Impaired empathy often destroys relationships where ADHD symptoms go unrecognized or unaddressed.

But deficits in empathy cut both ways in ADHD-challenged relationships. Typically, both partners become more mutually empathic, once they both start learning about the causes and varied manifestations of ADHD.

Consider this excerpt from my book, Is It You, Me, or Adult A.D.D.?.  In it, I name “low empathy” as one of three common ADHD-related deficits that can derail relationships.

Low empathy: “All take and no give”

“My wife seems to have empathy for movie characters, stray animals, or the grocery store clerk,” Alex offers. “But when it comes to her husband and teenage daughter, she often acts downright self-centered.”

Actually, empathy involves two sets of skills, according to [psychologist Robert] Brooks:

  • The ability to take the perspective of another person
  • The ability to understand and identify emotions

Yet, for many people with ADHD, the world can seem so chaotic and their focus so erratic, they don’t even know what they feel, much less what someone else feels.

Even if an adult with ADHD possesses both sets of empathic skills listed above, the person’s impulsivity or rigidity might obscure seeing the world through another’s eyes.

“And if a person is lacking in empathy,” Brooks adds, “he or she is likely to misread a situation and misunderstand the intentions of others. They often expect others to adapt to them, but they aren’t as willing to change themselves.”

It could be that change seems impossible—and the resulting feeling of powerlessness frustrates them even more.

In general, we can’t assume that all humans are capable of “normal” levels of empathy. Empathy is largely a function of the brain, and we all have different capacities.

Treating ADHD with medication often enhances the ability to act empathically. Certain coexisting conditions, however, such as Asperger’s Syndrome, complicate the picture.

[Don’t worry! Elsewhere in the book, I address the empathy deficits in the partners of adults with ADHD. But remember, some of them have ADHD, too. Moreover, empathy distributes on a continuum among humans; there is no one-size-fits-all.]

The Recent Study: Dopamine and Fair-Mindedness

The study from the University of California, Berkeley, published in Current Biology, isn’t the first to examine the effects of dopamine’s effects in the brain when it comes to empathy.

For example, 0ne 2014 study, The dopamine D4 receptor gene shows a gender-sensitive association with cognitive empathy: evidence from two independent samples, showed that gender plays a role in cognitive empathy.  Interesting, eh?

This study is particularly relevant to ADHD because this D4 gene variant has been associated with (but is not exclusive to) ADHD.

Women carriers of a certain gene variant (the 7R-allele) scored higher in cognitive empathy than female noncarriers. In men, however, those with the 7R variant scored lower than than men who did not have it.

The UC-Berkley researchers took a different approach in their paper: Dopamine Modulates Egalitarian Behavior in Humans.

Study Details: Follow the Money

Study participants, on two separate visits, received a pill containing either a placebo or a medication called tolcapone.

(Tolcapone prolongs the effects of dopamine, a neurotransmitter associated with reward and motivation in the brain. Stimulant medications such as Ritalin and Vyvanse also target dopamine; they slow the re-uptake of dopamine at the synapse, the gap between neurons. Tolcapone works a bit differently. This FDA-approved drug is used to treat people with Parkinson’s disease, a progressive neurological disorder affecting movement and muscle control, which are also affected by dopamine.)

This double-blind study of 35 participants, including 18 women.  Neither participants nor study staff members knew which pills contained the placebo or Tolcapone.

ADHD, empathy, and dopamine

Participants then played a game in which they divided the money among themselves and an anonymous recipient.

The result: Participants receiving Tolcapone divided the money with the strangers in a fairer, more egalitarian way, compared to participants who received the placebo.

Medication Increased Sensitivity to Inequality

According to the press release at the UC-Berkley website, “Altering brain chemistry makes us more sensitive to inequality”:

By connecting to previous studies showing that economic inequity is evaluated in the prefrontal cortex, a core area of the brain that dopamine affects, this study brings researchers closer to pinpointing how pro-social behaviors such as fairness are initiated in the brain.

“We have taken an important step toward learning how our aversion to inequity is influenced by our brain chemistry,” said the study’s first author, Ignacio Sáez, a postdoctoral researcher at the Haas School of Business. “Studies in the past decade have shed light on the neural circuits that govern how we behave in social situations. What we show here is one brain ‘switch’ we can affect.”

The researchers also say that future research may lead to a better understanding of the interaction between altered dopamine-brain mechanisms and mental illnesses, such as schizophrenia or addiction, and potentially light the way to possible diagnostic tools or treatments for these disorders.

“Our hope is that medications targeting social function may someday be used to treat these disabling conditions,” said Andrew Kayser, a co-principal investigator on the study, an assistant professor of neurology at UC San Francisco and a researcher in the Helen Wills Neuroscience Institute at UC Berkeley.


This is a small study, one that remains to be replicated.

(I’m not sure what to make of the fact that it was jointly sponsored by the school of business and the neuroscience center, with funding from sources including the Defense Department.)

But the study adds to the increasing body of research around the role of dopamine and so-called “pro-social” behaviors such as fair-mindedness and empathy.

For More On Empathy

To learn about another angle on empathy, read Empathy and Mirror Neurons, Or, Monkey See, Monkey Yawn


My husband and I will be watching a TV show. Suddenly, there’s a surprise twist—a car bashes into a tree, a bullet lands, a fist flies into a face.  Instantaneously, I will react as if that action happened to me. Because, in a sense, that’s how it feels.

Reactions vary: I might yelp or my arm will jump. Whatever my reaction, it both annoys and amuses my husband.

I can suppress this empathic response if I am prepared for the action. But I can hardly anticipate a surprise, right?

Apparently, my mirror neurons are making themselves known.

Now, what about you

What has been your experience of empathy as it relates to ADHD?

If you have ADHD, or if your loved one does, have you seen empathy impairments or enhanced abilities to empathize with medical treatment?

Or maybe you’ve seen something else entirely.

Please leave a comment. There are no annoying codes to deal with.

—Gina Pera

112 thoughts on “ADHD and Empathy: A Study, Book Excerpt, and Empathy Defined”

  1. Is there a reason for a 13 year old boy with untreated adhd to find himself becoming very angry when others pick on someone who means a lot to him (girl). To the point that he becomes so angry and distracted by this issue that he can’t focus on anything else. Then he thinks that convincing himself he doesn’t care about the person anymore is the best way to regain focus? Only to discover that didn’t work yet come back only to do it over and over again in these moments of being overwhelmed by worry and fear for the person?

    How can I help him process this?

    1. Hi Kriste,

      Well, there are probably plenty of reasons, some of them involving ADHD and some of them involving being offended by bullies. 😉

      But, as you point out, it seems to be beyond this….”distracted by this issue that he can’t focus on anything else.”

      ADHD commonly has a common of emotional dysregulation. There can also be difficulty transitioning — from one activity or even from one thought to the next.

      When the anger he feels actually gets that adrenaline pumping and helps him to feel more “clear” and energized….it can become almost like an addiction.

      If your son doesn’t have a better strategy to transition out of this state, he’ll come up with the best he can — i.d. convincing himself he doesn’t care about the person anyway. One extreme to the other….also common with ADHD. The challenge? Finding the middle ground. That requires more complex focus and thought.

      I’m not sure it’s an issue of “processing” so much as treating his ADHD.

      With ADHD, we talk about the problem not being “not knowing what to do” — but “doing what you know.” 🙂

      At 13, he probably realizes this is not the best strategy. But maybe he has trouble “doing what he knows.”

      I hope this helps.

  2. Hi Gina,

    I have been dating a guy who is 40yos. He was upfront about his ADHD (diagnosed this year) but I didn’t really know anything about ADHD as I went in and continued the relationship. He has also been honest about past relationship fails and his longest only being (tumultuous) two years.

    A week or so in he started comparing our relationship to his past. There were a few occasions that he and I hit a wall of frustration both trying to express ourselves. I didn’t think too much of it but I didn’t know how to deal with it. His frustration seemed more intense than mine.

    After four weeks he said he needed to take two weeks to see where he was at with everything. Basically a two week break.
    We stayed close, talking as much as usual but I was cautious to respect his request and boundaries. We laughed and joked so much like we had through the dating time. And lengthy phone calls continued.

    In this time I started doing a LOT of researching on ADHD. (Purchased your audio book) And quite a few behaviors make sense. And a lot of it doesn’t bother me but makes sense – the lateness/time management, his disorganization, forgetfulness.

    Then I read about hyperfocus and quickly realized that’s what he had done with me. And now I feel like this is the root of some of his present issues.

    A few days before the two weeks ended I wrote an in-depth letter about why I thought he was such an amazing guy and how much I love and respect I had for him and what he did for me. But more so, after the two weeks he tried to talk to me about the relationship but could only give reasons why it wouldn’t work. I tried to turn the reasons around and justify how it could work but he continued to be defensive. Communicating about relationship is obviously an issue for us.

    Later that day we joked and laughed over the phone and I told him the conversation wasn’t over because he really hadn’t heard what I had to say but he insisted it was. And before we ended the call he mentioned he couldn’t stop going on Tinder. This hurt me but I knew we aren’t dating and appreciated his honestly with me.

    Three days later I saw him and he was incredibly standoffish. I tried to engage with him but it felt forced and unnatural. I stopped by his house to drop off the toaster oven for him to borrow. He mentioned he’d ran out of pet food. Then he had to quickly leave to go to a meeting.

    I followed into the weekend with a text messages, purchased food for his pets and left it at his house , called a couple of times (only to get a missed call back and a 5 min long voice mail sounding like he was at a bar) I also
    sent an email saying I was worried about him. Only to be ignored.

    Then today I saw his car parked on the street where I was running errands and tried to engage in phone calls or text messages to no avail. I tried his door and saw him on the balcony so I messaged him but he ignored me. I felt a bit obsessed and started feeling a bit stalker-like paranoid. So I left and called as I was leaving only to leave a voicemail hoping he was alright.

    He called me some hours later. Still standoffish. I told him I was worried about him. He admitted he was very overwhelmed at the moment, really focusing on getting his projects done. He was also annoyed with work and people and friends – and everyone really – it sounded like he was really down on life. And then he said he was packing to stay at a friends house and he was planning on staying with her for the rest of the week.

    I feel really heartbroken but also frustrated and confused. I really want to be there for him, support him in anyway, because I deeply care for him. He’s done so much for me in that short time. I want to reciprocate. But it feels like he is pushing me away. And now I’m scared I’m coming across as an obsessive stalker because maybe I’ve done too much research and I’m trying too hard.

    So my questions are: what do I do? Do I give him the letter I wrote about all the reasons I feel we should be together?

    Or do I continue to text often to let him know I’m thinking of him and care about him, be patient and compassionate and hope we come out best on the other side?

    Or not? do I just let go? Am I sounding like an obsessive stalker? Does he really just want to date after we had such a strong connection? I really don’t know.. I can’t tell. I’m still emotionally invested but now I feel anxiety driven.

    I would be so grateful for your advice.

    1. Dear Sarah,

      You both are in such a painful situation. I feel for you.

      I’ll point you to two sentences early on in your post:

      There were a few occasions that he and I hit a wall of frustration both trying to express ourselves. I didn’t think too much of it but I didn’t know how to deal with it. His frustration seemed more intense than mine.

      That last bit is the key, I’m thinking.

      For you, this is a one-time thing. For him, this is a lifelong pattern. Time after time, hope for a new relationship crashes on the rocks. Again and again. And he doesn’t know how to get past it. So, he moves on to the next one.

      I imagine more than a few of his past girlfriends felt as you did — they want to help him. And that might just push him away faster and farther. I imagine he doesn’t want “help”. He doesn’t want to be pitied or the “one down” in the relationship. He just wants a relationship of equals.

      The hyperfocus phenomenon is part of the pattern, yes. And maybe he is one of those people who will just go through life chasing romantic shadows, not knowing why the “thrill is gone” after a few weeks. And not caring.

      But it seems like he might care, given his “intense” frustration. He just doesn’t know how to break the pattern. In fact, I am writing about this right now for my online course. Breaking the pattern involves some serious effort made toward ADHD treatment and developing new mindsets and strategies.

      A significant part of my readership is 50-something men with late-diagnosis ADHD who finally came to realize that the common denominator in all their failed relationships was….them. And the culprit seemed to be their poorly managed ADHD.

      You don’t mention if he takes medication. For many, medication is the singlemost effective treatment strategy — the foundation for other strategies.

      So, when you say “Communicating about relationship is obviously an issue for us”, I’d say not likely; maybe that is only the tip of the iceberg. So much of couple therapy and relationship books emphasizes “communication” as the key to everything. But what you are dealing with is not something that will improve with better communication, in my opinion, but only with earnest ADHD treatment. Then, the fine-tuning with communication.

      Definitely, it sounds like you are obsessed and maybe even a bit stalker-ish. 🙂 But I understand it.

      It’s such a nagging mystery in your mind, it’s hard to stop. You feel there is so much good potential for you two, you are willing to work with him on the ADHD issues (such as you understand them), and he’s just shutting you out. At the same time, you feel for him, his frustration that another promising relationship didn’t work out. You want to help him, and you want him to know that. But I would not advise sending your letter yet. Not until you know more about what might be required.

      I encourage you to go back to my book and read closely the Three Success Strategies. That is, the third part of the book, which details treatments and ADHD-friendly strategies.

      Then think about if you are really ready to take up this mission, including access to local expertise, financial resources for treatment and medication, etc.. He has 40 years of poor coping responses honed into a well-oiled machine. It takes effort and desire to start changing counterproductive coping responses into more productive, positive ones.

      Also, you say that his being late, etc. doesn’t bother you — that it’s a minor issue. But I can assure you, those behaviors are all part of a piece. And, over time, they can grind you down to a nub.

      You don’t mention anything about his attitude toward his ADHD diagnosis—how much he’s read, what he’s read, what he’s done to begin managing symptoms better. That is really the key.

      I’m sorry if this is not the advice you were hoping for. But it is my sincere best advice, given years of experience and observation.

      Best of luck to you. Take care of yourself.


    2. Hi again Gina,

      I may not have been initially very clear because feeling helpless but:

      I’ve never met anyone else that I’ve enjoyed being with as much as him and I have never been able to be myself as much as I can with him. And I feel it is the same for him – our connection is strong.

      We spent hours and hours talking about everything. Our record was a four hour phone call. We share secrets with each other, we share thoughts we both hadn’t ever told other people before. We have so much fun together.

      Yes, he is taking medication. I understand he’s been on it for three months. ( I don’t remember the medication name.) And he seems very comfortable talking about his ADHD diagnosis (to me but I’m not sure about others). He has done some research because it was he who suggested to doctors that it was ADHD. But I’m not sure the extent of research or strategies. He is aware of some and had asked/trusted me to manage his finances – and we had discussed but hadn’t had the chance to implement.

      You are 100% about him thinking it’s a lifelong pattern. He’s voiced it. Often. And this is where my frustration came in trying to convince otherwise. (also hence the letter).

      Also after the two weeks he said he wanted to be “besties” and always wanted me in his life.. so I feel that is a positive?

      So I’m a minute into part three of the book and hearing themes of:

      The positives are from showing strength and as well as strategies. (I’ve not stopped – I’m continuing on but this stood out for me)

      But this is about of what I suggest in my letter to him that I had to write the letter because he would not listen to what I had to say. And I feel I deserve/respected to be heard. So do you still think I should hold off with giving it? Or could it possibly be detrimental?

      Also – do you think I’d benefit from your online course?

      And what about him? Do you think it would hurt our situation any further if I shared the link with him?

      I don’t want to loose him. He is the most incredible person I’ve ever known. Yes, now I feel ashamed of my “stalker/obsessive” actions – but it was from feeling so helpless. It also came from a scared place of loosing him. So thank you for calling me out.

      So with that do you think there still any hope for us? Do I give him space and continue to hope? Or is it too far gone?

      I’m so grateful for this opportunity to discuss as I didn’t have anywhere to go and I tried to see a therapist to discuss but I can’t get in for two weeks more weeks.

    3. Hi again, Sarah.

      First, to be clear. I was not “calling you out” on the stalker bit. I said that I understand it. The connection and then his contrary behavior have set up a huge puzzle in your mind, and the impetus is to solve the puzzle.

      Second, “he is taking medication” really means little.

      1. Is he taking it during the times of interaction?
      2. Has it been carefully “dialed in”?
      see my medication chapters for more on that.
      3. Is he sleeping? What are his health habits?
      All these play a bit role in how well the medication works.

      Yes, I believe my course would benefit both of you. That’s why I’m working so hard to finish it. But it’s not available yet. In the meantime, my book is available. So you’ll want to read it closely.

      I don’t know what to tell you about the letter. I haven’t read it. 🙂

      But from what I am picking up here, I think it’s always wiser to let emotions cool a bit. Sit on it and revisit next week or so.

      You say that “he would not listen to what I had to say.” But maybe you aren’t hearing what he is telling you — that is, this is too hard, he needs to back off, he doesn’t know how to transition from a rather intense beginning to a stable ongoing relationship, or he has simply lost interest. That kind of intensity is exhausting to keep up.

      Whatever you have to say is not going to change how he copes with ADHD—or doesn’t. It’s not about “respecting” you. It’s not about whatever you have to say. It’s about him being caught in old habitual patterns, it seems. There is no “one right thing” that you can say that will fix this situation as you hope.

      I would also suggest, you do sound very desperate to continue the relationship. Desperation is never a good motivation. It could scare him away entirely, that you seem to have so much riding on the relationship. But also for you, maybe this is a good opportunity to step back from the emotions and think about reality going forward. For example, he has asked you to manage his money and yet you two don’t have a stable relationship? I find that a bit concerning, especially that at 40 years old he cannot trust himself to manage his own money. Outsourcing it to you can be a real setup for disappointment and conflict, for both of you.

      I encourage you to give yourself and him some space to relax a bit and get your bearings.

      Take care,

  3. Hi Gina,
    thank you so much for this article.

    Recently I was talking to a guy I’ve been seeing for about five years now. He ended up telling me that I always talk about myself, and I’m never attentive to his needs or aware of how he is feeling during our conversations. He said that when he tries to tell me something I just don’t have the attention span to listen and so he doesn’t tell me things and just tells his other friends instead. He said he loves me anyway, but he just doesn’t talk to me about himself. Meanwhile, I was feeling like every time I ask him something he always responds with short answers, and I feel I have to fill the silence so I end up just talking about myself (maybe because somewhere along the line he decided he couldn’t talk to me)…

    I have to say, this was a shock and it really broke my heart to hear. First of all that I don’t have a long enough attention span to listen but also that he doesn’t feel heard and he doesn’t feel like he can talk to me.

    After that, I confided in my roommate about our discussion and she lovingly told me that she also feels like sometimes when people are talking to me or telling me something I tend to respond by turning the conversation back to myself and relating whatever story was said on a time that I had felt that way and she said it throws people off and makes them feel like they aren’t being heard… She said I don’t do it too intensely and it’s not a huge deal but it is present.

    Since then I have found it really hard to communicate with other people because I catch myself wanting to respond by relating all the time and not knowing how to be empathetic in other ways. Another friend also confirmed that I do this tonight so I’m realizing and reevaluating all my friendships and relationships and how I make everyone else feel.

    I would like to think that I am caring and mindful about others and I thought I was a good listener… I am a yoga teacher and I’ve been working on yoga, meditation, and trying to be a self-aware human for quite some time and I have always thought of myself as being compassionate and deeply wanting to find a way to help others in life and I guess I just feel so sad that I can’t actually portray this… And I do feel as if I some of my relationships would be closer if I didn’t do this.

    Now I feel like shutting down and not talking to anyone so I don’t make those mistakes while communicating… But I also know that’s not a solution.

    There were times in the past where I felt highly empathetic towards others, and I remember being able to really help I felt more caring as well. I think sometimes my capacity to tap into that ebbs and flows but I would love to make it more of a constant as I think it feels really good to help others and hold space for them.

    I did recently lower my Concerta dose because I felt some chest discomfort while on the higher dose. I think it did help me be more empathetic, but now I don’t want to raise my dose again due to the side effects, but I also want to be able to hold space for others and that’s deeply important to me as well and especially after reading some of the comments, I definitely do not want to come off to anyone as self-involved or narcissistic. I really want to work on this.

    Thank you for reading and listening and sharing this article. Sometimes its really hard to hear about the things we need to work on or be aware of as an ADHD person and it’s nice having supportive people out there to help!

    Thanks again,


    1. Dear Adrienne,

      Thanks for sharing your experience.

      I’m reminded of my 7-year-old friend who has learned in his school to talk about a “growth mindset.” 🙂 He used to be very self-conscious of criticism ….a bit of a perfectionist. But now he’s learned that he can grow and has power over changing behaviors, etc. that are causing problems for him.

      So, kudos to you on your “growth mindset.” You read an article that led you to question just how empathic you were being with a boyfriend and roommate — when inside you feel very empathic. That has to feel a bit shocking.

      Some people with ADHD react to my writing about ADHD and empathy challenges by getting angry with me and attacking me (“shoot the messenger”). They have told themselves that people with ADHD have superior empathy.

      But it’s not so simple, is it?

      From where I sit, you’ve shown admirable maturity, self-reflection, and true empathy—even in the face of information that could have very well resulted in defensive reactions.

      That’s the good news. And it’s certainly not time to “shut down.” Rather, it’s time to expand in a “growth mindset,” right?

      You have a lead on an issue that seemed to have been causing discomfort for you even if you couldn’t identify it.

      re: Concerta issue….some thoughts:

      1. Is it brand or generic? That can make a BIG difference. So you want to rule out that potential factor.

      2. Have you also been assessed for anxiety, depression, etc.?

      Most adults with ADHD have one co-existing condition. And half of adults with ADHD have two.

      Too often, the person receives only a stimulant. It might help with ADHD symptoms but a stimulant can exacerbate other neurobiological vulnerabilities (to depression, anxiety, etc.). And these can manifest in mental or physiological symptoms.

      Many adults with ADHD report the best results from taking 2 medications. I know….that is seldom what anyone wants to hear. But just putting it out there.

      Chest discomfort can be an indicator of anxiety. If you are consuming caffeine, that can be a catalyst with the stimulant, so you might want to cut that out or try green tea instead.

      I hope this helps. Take care of yourself!

  4. Hi Gina,
    Thanks for your help. When I read your book a few weeks ago it was one of the largest paradigm shifts I ever experienced. I related so deeply to the other partners of ADHD mates. My partner has been in treatment for a few months (with an ADHD specialist) and has been taking meds for about two weeks.

    I am struggling with what I perceive as a new deeper realization that my partner may never be able to know what I want/need at a particular time and be able to provide it. That she is so completely absorbed with the chaotic emotions in her head, that she cannot really put herself in my head and anticipate, or even appreciate, my emotions.

    We specifically discussed the story in your book about the husband who swings his arms around while telling a story, hits his wife, she says ‘ouch’ and he gets angry for her overreacting and making a big deal about nothing. A day later we lived out almost the exact story.
    My partner responding with aggressive defensiveness from hearing my ‘ouch’, without any time in empathy, makes me feel terribly alone. When it doesn’t get better even after calm discussion and I hear the defenses of you are overreacting, or you are trying to make me seem crazy, or you are starting a fight for no reason… I feel resigned.

    I love my partner very much, and, at the same time, I want to have a relationship with someone that has the brain capacity for another perspective. I accept that it may not be physically possible for her and I am not angry at her but that makes me feel even more alone. I alone now must decide if this is a life I want to live with. Where showing reaction to what I perceive as a hurtful comment can cause days of anger and defensiveness. I wish I could talk about it with her.

    1. Hi Mike,

      Sorry to be late in approving your message.

      I’m glad my book has been helpful in “shifting your paradigm.”

      Until we know what is afoot (the various potential contributions of poorly managed, unrecognized, etc. ADHD), we can remain in a befuddled, foggy, even frozen state. The conflicts and disagreements can seem so bizarre, we (the “partners of”) might keep telling ourselves…”surely, I’ve misunderstood, mis-heard, miss….something.”

      The “aggressive defensiveness” can be a complex phenomenon. But unraveling the complexity starts with understanding ADHD, as best we can. But it doesn’t end there.

      ADHD is considered a highly treatable syndrome. But unfortunately, too few prescribers/therapists know how to treat it. So, both we and our ADHD partners are left to struggle, often thinking, “well, this is as good as it gets.”

      Being able to take another perspective can be a critical component of human relationships…even of being a happy, self-fulfilled human.

      It’s only been two weeks since she started taking medication? (And who knows how competent the prescriber.)

      Symptoms can improve quickly with proper treatment. But it can take much longer — and takes effort — to start revising old dysfunctional mindsets and automatic responses.

      I am writing about it right now for my online training. Wish I could produce the training faster. But reading my book closely should help.

      take care,

  5. I am 79 yrs old and never diagnosed with ADHD but it’s obviously me. I was expelled from nursery school age 3. I was fuzzy brained at times. Would have glimpses of eternity when I could see forever after I was put on amphetamines for weight control at ten. I can still remember when my fuzzy brain cleared. I trained myself to make lists to know where to begin. A teacher once commented on my inability to explain how I arrived at math answers. “It just came to me” made him angry. I am also an empath. I have always identified with unfairness and written about it, fought it. Always inventing shortcuts to the finish. Depression I learned to redirect into curiosity. Have I cured myself or just invented ways to go around the problems and take advantage of the good parts…

    1. Hi Jana,

      I did not know toddlers were being expelled from nursery school 70 years ago.

      To think you had to take “weight-loss speed” to find clarity. I wonder how many women experienced that in those times. Lots, I bet. But they were probably told, “Well, sure, speed does that!”

      You ask, “Have I cured myself or just invented ways to go around the problems and take advantage of the good part?”

      Only you can answer that. But in my experience, every individual with ADHD has a different experience of living for many decades without benefit of diagnosis. Some do well. Some do poorly. Some can adapt. Some cannot because their challenges are too big.

      take care,

  6. Jennifer Hall

    I am an empath and have ADHD. It is hard seeing articles like this especially when we are being boxed in and classified the same way. Has anyone done any scholarly journals on the ADHD individuals who feel others emotions so strongly to the point that it is sometimes unbearable? If so please share.

    1. Hi Jennifer,

      Thanks for your comment. I’m sorry that you seem…disappointed (?) with this post.

      I’m puzzled as to how you see this article as “we are being boxed in and classified the same way.”

      No ADHD advocate and expert has emphasized ADHD is not “one size fits all” more than I have. For years. Seriously, the last thing I do is put my friends with ADHD (and even people with ADHD I don’t know!) into boxes.

      Did you maybe miss these parts?

      —Empathy sounds simple. But it’s really a complex phenomenon.
      In fact, some people with ADHD have trouble reining in their empathy; medication often helps them, too. It’s all about the self-regulation:  not over-doing, not under-doing, but finding the middle ground.

      —Impaired empathy often destroys relationships where ADHD symptoms go unrecognized or unaddressed.

      But deficits in empathy cut both ways in ADHD-challenged relationships. Typically, both partners become more mutually empathic, once they both start learning about the causes and varied manifestations of ADHD.

      You ask for research from a “scholarly journal” and I thought that’s exactly what I have provided.

      Did you notice this part:

      This study is particularly relevant to ADHD because this D4 gene variant has been associated with (but is not exclusive to) ADHD.

      Women carriers of a certain gene variant (the 7R-allele) scored higher in cognitive empathy than female noncarriers. In men, however, those with the 7R variant scored lower than men who did not have it.

      Is this proof that women with ADHD are more empathetic than women who do not have ADHD? No.

      This study was about one gene—which is not exclusively found in individuals with ADHD.

      ADHD is a highly individual condition. There are many aspects of personality on top of the variable symptoms of this variable condition.

      Moreover, many genes have been associated with ADHD—hundreds, in fact—and all of them are associated with human traits. That means people with ADHD are not a separate species. 🙂 Rather, their human traits are more extreme or greater in number –and causing problems for them. That’s the basics of the diagnosis. If there’s no impairment, there is no diagnosis.

      I wonder if what you describe is necessarily empathy. You describe “feeling others emotions so strongly to the point that it is sometimes unbearable.” That, as I mentioned, can be more of an issue of emotional self-regulation.

      I’ve always found it tricky to attempt to mind-read others, to know what they are feeling. I can try to empathize, but I check with them as to how well I’m doing.

      In other words, I don’t assume I am feeling others’ emotions accurately. In fact, one well-known poor coping response to growing up with unrecognized ADHD is called “mind-reading.” It’s assuming that we know what others are feeling, and it can get us into trouble.

      When it comes to the term “empath,” I worry that it is convincing people with ADHD whose emotions can get the best of them… that this is their “personality” rather than part of ADHD emotional dysregulation. That is, something they can better manage.

      The term “empath” seems to have come out of nowhere to being a popular SEO keyword. 🙂

      It describes a race of people on Star Trek, and as far as I know, that’s the only official usage.

      I’m very familiar with Elain Aron’s work (Highly Sensitive Person), and I’m familiar with how it’s being misappropriated by bloggers and others. Especially vis a vis ADHD.

      I bet if you read some of the comments, you’ll hear from other women who share your experience.

      Empathy is a wonderful thing. I wish more people had it. But empathy is often misunderstood.

      Take care,

  7. I don’t know if I’m ADHD (getting an eval soon) but I think a lot of this speaks to me.

    I try really hard to be empathetic and and do right by people, but I often come across as self-centered and uncaring. Apparently it’s because I try to fix problems through actions and active problem solving instead of through active listening and showing genuine concern. For example, if someone is overwhelmed with work, I’ll try and lighten their load by helping with their work if I can, or doing another task or chore so they don’t have to. If someone is sad, I’ll listen, agree with what they’re saying, and ask if I can do anything to make things better (like doing something fun or buying a treat). What I don’t do is provide emotional support or follow up on how the person is feeling, and overtime my support seems more superficial than a genuine desire carry any kind of emotional burden.

    I’m also told that I’m not inquisitive of others and attentive to what’s important to them, and that this comes across as me being selfish, unempathetic, and uncaring. The thing is that I do care, and do want to know about people, but it’s like there’s a million questions are constantly flying through my head and I never seem to actually follow up with these questions and actually vocalize them. I can never seem to consistently make an effort to learn about what makes people tick and make it feel like their interests and emotions are important to me. I’ve spent years trying to make a concerted effort to do this better and to be more emotionally supportive of people, but I get so lost in my mind and the daily chaos of trying to manage my own life, and before I know it months have passed and I’ve made no progress.

    I’m so lonely and this pattern of behaviour has hurt my friendships and my relationship. I feel so selfish for not doing what should be an easy task, and I’ve let down people I care deeply about. It’s like there’s a disconnect between the love, caring, and curiosity that I carry in my heart and how I actually outwardly enact those feelings.

    Not sure if this makes sense, but I hope it’s something I can work out.

    1. Dear David,

      You absolutely do make sense. And I know you aren’t alone in being mystified by an apparent “disconnect” between your intentions and outcomes.

      I’m not one to make hard-and-fast generalizations about “the sexes” but the evidence suggests that what you describe first is at least more common to men than to women. Men are expected (or expect themselves to) “take action.” Solve problems! Not so much on the emotional support part.

      So, this is something you can learn about and take steps to avoid jumping in with problem solving without asking first, “How can I help and support you?” You might find this article interesting:


      And yet a lot of people don’t know how to listen to someone venting. Usually, people take one of two attitudes. Option 1 is to jump in and give advice — but this is not the same as listening, and the person doing the venting may respond with “Just listen to me! Don’t tell me what to do.” Option 2 (usually attempted after Option 1) is to swing to the other extreme, and sit there silently. But this doesn’t actively help the person doing the venting to drain their negative emotions. Consequently, it is about as rewarding as venting to your dog.

      The next part you describe…superficially could describe ADHD-related challenges in selecting a plan of action, following up, etc. But it could also reflect your confusion about how to best express your good intentions.

      The balance might tilt toward ADHD if you experience other typical ADHD challenges in the rest of your life. My first book could help you sort this out — and then know how to proceed:

      I hope this helps. Good luck!


    2. Greetings Gina, David and others,

      David, your reflections are thoughtful and well articulated, and actually show a lot of personal insight. Don’t be too hard on yourself, there are many factors influencing this pattern. Dopamine isn’t the only thing on the scene, its important to consider oxytocin, anandamide and other love/ bonding/ feel good molecules. This topic is extra interesting to me, like two mirrors facing each other it can get confusing. I recognize a part of your story as the struggle of someone who is empathic to a fault and probably was never educated about how to utilize and field this skill. (probably more of an embodied empathy and less cognitive)

      I think sometimes to jump to fix or solve is a learned reaction, which can be related to literally feeling what the other feels, causing an anxiety to resolve the feeling. But because we are not that other person, our instant reaction can often be self serving. My education as a counselor, meditation/yoga/ creative expression practices helped me and help me cultivate the capacity to be uncomfortable with others. I feel thats sort of key with listening. Allowing others to have their difficulties and pains without needing to solve them ourselves is a powerful boundary. It also opens up space to choose to step in when requested and agreed upon.

      Now about this topic in general: I have been seeking out information that can help me understand my own experience with medication this last year. I am 30, taking ritalin for the first time as a prescription, though I got it from friends throughout my undergraduate program and a bit in high school. What I have found to be the most significant is my increased SELF-empathy and my ability to recognize and act on imbalances in my social relationships. I will research more about this prosocial behavior fostered by sustained levels of dopamine in the frontal cortex… I’ve been trying to understand how medication helps me serve myself more instead of being such a people pleaser. It seems to faciltate more healthy narcissism for me (paying attention to self and self needs, even as simple as hygiene). I feel when we have biochemical balance internally, we reach far less to aquire it externally.

      Many layers. Thanks for the interesting and supportive site Gina.

    3. Beautiful said, Rose. Thank you!

      Yes, self-empathy!

      I responded to another readers this way:

      The fact is, whether we have high empathy or low empathy, we function best in life when we are more capable of MANAGING that quality.

      With high empathy, we need to create boundaries and structures so that we can remain emotionally and physically healthy, taking care of ourselves.

      With low empathy, we need to learn actions that help us to stay connected to others. (And there are plenty of people with ADHD who are low empathy, too.)

      ADHD presents challenges in self-regulation; that is the core. So, it makes sense that your son is better able to regulate his emotions, with Concerta on board.


  8. Hello. So I’ve read about this years ago and I knew I was an empath and I am an adult with ADHD. What’s fortunate is I am one of the few selected that has the multiple levels of empathy and can control them all. Things can get a little crazy and over whelming. Just can’t be in a room with a bunch of people with distress written all over them. When I take my medication for ADHA it’s like I wanna help everyone I come across because as you know stimulants can increase the power of empathy. I’ve learned to shut it off. Sometimes it’s not easy. Everything I’ve read in here is 100%. Alot of thing i commonly do everyday. From reading this, I had no idea was related to being an empath. It’s funny because some of the research that I found in this website I knew I had because I had a(feeling) and to read exactly what I was already feeling is an amazing feeling lol… Anyways thanks for helping me realize that I’m not crazy. I love it!

    1. Dear Steven,

      Thanks so much for writing. Any day that I’ve helped someone to know they’re not crazy is a good day. 🙂

      I’m curious, though…yes, taking a stimulant medication can improve the ability to empathize for some folks with ADHD. But for others who are “overly empathic,” medication can help them to better regulate those feelings and reactions — gain a little distance from them.

      So, if the stimulants make you less able to handle your empathic feelings, I wonder if you’re taking a stimulant that is unsuitable for you.

      For some people, Adderall (for example) can create a type of tunnel vision. It can amplify whatever they target. And that’s not a good thing.

      Anyway, I’m happy for your discovery!


  9. Hi Gina,

    I’ve been with my 38 year old husband for five years, and in January I was looking for advice for our problems online when I realized he likely had ADD. He got evaluated, and, sure enough, he scored 97% on the inattentiveness scale. He’s a mechanical engineer by profession, so he’s been rewarded by society for certain ways of being, as you mention, but has no concept of what empathy could be like.
    I’m hoping he and his doctors will figure out medication (just started very low Ritalin this week), but that can’t fix this problem, and, quite frankly, he dislikes being in any way uncomfortable (feelings, schedules, listening to me talk about myself, letting me have my own life because his feels out of control).

    My question is, I guess, whether adults can make the same kinds of progress as kids on empathy. It feels like there are a lot of defense mechanisms preventing empathy from getting through, and I’m so near the end of my rope exhausted, as I have chronic illness and am thus reliant on him for a lot of things he can’t manage.

    I feel so sad that I’m the first one to see this and suggest that he gets assistance, but I’m also losing it from what feels like parenting a sociopathic 6 year old who has excuses for everything and lies all the time.

    Hope that makes sense


    1. Hi J,

      Yes, you make sense. I understand perfectly.

      You are correct, at least to a degree, in suggesting that lifelong habits are not easily overcome, even when the underlying psychiatric condition is recognized and treated. The therapeutic model for ADHD is based on cognitive-behavioral therapy, and it helps the person break down old assumptions and reflexive thought and actions — and replace them with new, healthier thoughts and actions.

      As far as the medication, for some people with ADHD, the stimulant medication can definitely improve empathic feelings and actions.

      For others, there are other issues that contribute to low empathy—autistic spectrum disorders, for example. The fields of engineering and science are sometimes seen as fitting the “autistic profile.”

      Autism researcher calls autism “extreme male syndrome” and associates it with “high systems” skills such as math, science, architecture, etc. At the other end of the polarity is empathy. The empathy-systems polarity. Men in general are higher in systems, though some women are higher than some men. Women in general are higher in empathy, though some men are higher than some women.

      The “high systems-low empathy” profile can be hard-wired. That is, not responsive to medication.

      It’s early days for your husband’s treatment. I strongly encourage you to get involved; don’t leave it up to him and his doctors. Too much can go wrong.

      At least read the medication chapters in my book, to see how the medication “dialing in” process should go:

      Good luck,


  10. I have a lovely friend who is ADHD, he has all the hallmarks plus his son is too. I have worked with ADHD children so i can spot the traits quite quickly. If i try and explain I’m upset about something (recently because he seems to be hyperfocusing so I don’t hear from him for ages), he just puts his own side (quite defensively) and sets out his own boundaries very quickly without taking mine into account. He is a very kind and loving person in many other ways but does blurt stuff out which is quite hurtful sometimes. Lots to love but hard to swallow the hurt sometimes. I’m very laid back and forgiving but find the relationship hard work sometimes. Empathy is not a strong point for him I’m afraid.

    1. Hi Suzanne,

      This is a very common manifestation for people with poorly managed ADHD. Perhaps especially in men.

      I encourage you to avoid “swallowing the hurt” because after awhile, that can become an unquestioned pattern.

      Being “laid back and forgiving” can create a world of hurt in the long run.

      Please take care of yourself,


    2. Thanks Gina, yes i know i have to set better boundaries. I think i have probably been too understanding, probably because i have to be in the work i do and avoid taking things personally. I’m taking a break from the relationship for a while now, see how i feel in a few weeks perhaps.,


  11. I have adhd myself and although I am very empathic in general I definitely have some issues with intention empathy. I’m not terrible at It but sometimes I really don’t know where to put myself when people talk about certain things that are emotive to them. I have learnt this because i don’t usually know what is the best way to empathise without giving an opinion which may not be truly helpful or the best way. I almost feel like the lights are on but no one is home sometimes when it comes to intentiinal empathy I think about it logically instead I have realised my only way to try to be empathetic is to challenge there beliefs I think i do this because I can’t really get in there head completley and this is my subconscious way of taking another stab at it. Sometimes I miss the full depth of there intentions and have difficulty with the guidance to know what I should say or not say it is a bit tricky so sometimes i give advise that maybe should have been more diplomatic or i should have just listened and said little. Sometimes I am too quick to give an opinion I see where they are coming from but I am not completley in tune with the whole picture. I can give advise that everyone is thinking but I am most likely the one to say it and it is probably because of this. I always feel bad afterwards and regret some of the things I say.

    1. Hi Lemmy,

      I remember years ago reading a book on male-female romantic relationships. The author said that, “Women want men to listen to their problems, and men want to fix them.” 🙂

      Maybe that’s what you’re talking about. A male thing. Not an ADHD thing. 🙂

      I used to date a man whose “empathic” response was to challenge my beliefs. I learned a lot from him.

      Maybe you can practice reining in the advice. But it sounds like it comes from a good place, and it might actually be helpful! 🙂


  12. I would bet money that my husband has undiagnosed ADHD. After reading Is It You, Me or Adult ADD? He fit so much of it. The hardest thing is the lack of empathy and what comes off as self centersness. There is never any thought for me or what would help me or make my day easier – it’s always me catering to his needs and being thoughtful. Whether it’s me taking our daughter out or distracting her so he can have plenty of alone time or just time to do things around the house. He’s always taking “breaks” when he’s at home. He very rarely joins us for family outings and certainly doesn’t show any initiative to set up something to do as a family, whether it’s as simple as eating out together or a little more complicated such as taking a family vacation. Forget even going to a movie. You can see the thought of “Why so they want to inconvenience me and take up my time?” And he doesn’t “see” how that affects us. Certainly me I feel like I lack support in many crucial areas. So much burden is on me because he thinks he works (and probably tries really hard to be a good employee), that excuses him from other responsibilities (unless it’s yardwork which he enjoys). And forget him listening to my feelings – he will stonewall, blame, get irrationally angry and cal me names and cuss if I inisiat on taking about any “problem” that makes him feel like I am “lecturing” him or complaining.” I certainly don’t have someone I can even dream about the future with – he can’t seem to have any introspective conversation of any kind. How I wish I could get him to see that he has an issue that needs to be addressed. He relies on various substances too – they al seem benign but nicotine was the worst and he quits and starts, quits and starts, and quits … but he doesn’t listen even when I point out that he’s clearly self medicating. He just doesn’t won’t admit that he needs to see a doctor about anything… what can I possibly do?

    1. Hi Bunny,

      I’m sorry to read of your situation. It’s an all-too-common one.

      You say you read the book. It’s a very dense book. Many people benefit from multiple, careful readings.

      This time, go back, closely read the “getting past denial” chapters, and try putting those strategies into action, one by one.

      Sorry to say, you probably will continue to beat your head against the wall if you only continue to point out that he’s self-medicating, “needs a doctor,” etc.

      good luck!

    2. You are describing my former marriage to a T. I got him to go to marriage counseling where he told the counselor he was there to witness him telling me the things I was doing wrong. 30 years later he’s married again and decided I wasn’t so bad after all. My cat died just before he moved out. I still miss that cat.

  13. I am female with adult adhd and I’ve always been very empathic. After medication, Im still empathic, but I just take the time to appreciate others and give more love because I realize that it feels good to make other people feel good. I didn’t always have the energy for that awareness prior to meds.

    1. Hi Sarah,

      Great point.

      It’s easy to see why some people with ADHD who feel empathic become very hurt when accused of not acting empathically.

      Big difference between feeling and acting. It takes more cognitive effort and higher-order brain processes, for sure.


  14. Pingback: On the Deeply Spiritual Nature of Empathy – All Is Love

  15. WOW !!!! When I go back into some of these comments with a bit more attention to them, ( ahem, ADD) I feel so sad. There are so many people out there suffering !!! Going forward in total darkness and trying !!
    Gina, I’m going to read your info now, I probably should have done that before I posted above .. But….. Reading some more of these comments just gets me right in the “emotional gut” I can’t wait to see what you have to say and some of the strategies you recommend !!
    To some of the people that say “Gosh, I got left out of the empathetic gene pool.”
    I don’t necessarily know if that’s the case? I’m just wondering if these people aren’t just “unknowingly” protecting themselves from something that just feels like too much to handle. Whether their aware of that feeling or not. Almost like subconsciously doing it ? ( just like many of us self medicated because we just couldn’t figure it out )
    Anyhow, once again big prayers going out to all of those that are suffering so badly. This too shall pass, and be ok. You have to believe that in your heart, even on the most difficult days. And there is nothing “wrong” with anybody on here. We are all different. I just hope that each person eventually finds their way of walking tall and feeling good. There are billions of people out in this world, that’s what helps make it so unfathomable and unique !!!
    Alright, enough hyper focusing , hahaha !!
    Bye for now.

  16. I have scrolled through many of the comments here, I have not yet gotten to your article, ( just not that far yet on this site ) The thing that attracted me here was the correlation to ADHD medecine and the empathetic part of our brain or the correlation between them. But…. I find it really surprising that I haven’t seen much about being an “Empath” ? Everybody hang in there on this one with me, ok ? It tends to come across as sounding a bit “New Age” or to some, possibly just “a little bit out there”
    For years and years , I was called selfish, inconsiderate, high strung, difficult, and sassy,,, mostly during younger years. I have been on medication the majority of my life due to various diagnoses such as ADD, OCD, PTSD, and a “Depression that has never seemed to get better” no matter what has been tried, etc. And believe me, over the years I have tried !!!
    Biofeedback, hypnosis, meditation, medications, light therapy, etc… it seems I’ve been open to any suggestion a psychologist would make that might help.
    It wasn’t too long ago, about six months, my niece stumbled across an article she sent me. It was titled something like “Are you an Empath ?” So I read it.
    HOLY COW !!!! There I was,, on paper,, me,, the majority of the traits (now as an adult) I could so readily relate too. And it seems I’m reading ,in many of these comments, some of the same behaviors !!! As a child I would have never been able to connect with this theory, nor understood it. But, I DO know that as a child I shut inward towards myself, craved alone time, and found people to be just generally overwhelming, so I would act like a negative child towards them ( hence seeming selfish ). I was often unexplainedly exhausted and would go nap or sleep for long periods of time.
    ( hence lazy ) T.V., especially the news, music, and media have always impacted me strongly.( possibly the reason for the label “difficult child” ) Here might be one possible reason, ( keep staying open minded with me, ) Let’s say for example, that as a child your parents watch the news, and it’s on when your around, no one thinks any big deal about it, right ?
    As an adult and even more recently, I’m realizing this couldn’t be further from the truth !! especially in today’s society where we are bombarded with visual, audible, constant media. When you are about in public there are things all around you that you simply don’t get a choice as to whether you intake that information or not !! ( Anyone had to deal with their child acting so badly that you finally had to leave where you were ?) I bet more of you have than not. As a grown woman I can now choose to not watch the news or certain things on T.V. , and I have been doing that for a long time now, because I just can’t take the overwhelming feelings I get when I see it. I actually “feel” the other people’s pain . I couldn’t have expressed that as a child. But, some days I would cry for no reason and feel like the whole worlds weight was on my back. Making me not the easiest child to be around.
    Now that I have read about being an Empath and I have put some of its theory’s into practice, I find my life all of a sudden getting much “lighter” and “easier” to deal with. I am now seeming to come across more and more people ( They are easy for me to spot ? ) that I am able to somewhat help with the “being an Empath” theory. And I know, I know, it sounds a bit way too deep or weird. But, I bet that many of you parents out there have experienced “intuitive” behaviors from your child that made you say “Hmmmmmm?”
    Before I knew anything about this “theory” I knew my young daughter was probably going to have some of my behaviors. I was so angry with my genetics !!! I was very sad that she feels so sensitive about things, that she ruminates over and over about things that bother her or things she feels fearful of. Here is one of those intuitive stories– At four years old she told her dad and I that she didn’t want to eat meat. We though it was probably a texture issue but gosh darn it , we eat meat in this house for our protein !
    So, further on in time, she keeps saying or mentioning that she really doesn’t want to eat meat with every dinner. She is now almost seven. So her dad and I said “ok, but you have to be willing to go to the store with us and pick out some different kinds of beans and other things to get your protein, AND be willing to try them more than once. She was so happy to have her needs heard and went to the store and picked out choices she thought looked interesting. ( Another thing I bet many of you parents out there know, is empathetic or not, your child is highly intelligent ,sometimes more so when it’s something they “want” verses “needs” to do ) So her father and I finally let her have a say in what she ate. She is 100% happier and I find that I am no longer nagging her to eat. The whole point of that long story is, that if you read about Empaths, they can actually “feel” or be “sensitive” to the energy that comes from food. If any one has read the book “The Secret” it supports a theory that energy is all around you. What you think is what you will attract. It makes me wonder sometimes if instead of ADHD, or Depressed, or OCD, or “Difficult”, that some people are just way more sensitive to the energies put out there in the world by media, people, animals, the list is endless. I’m NOT in any way invalidating any diagnosis on anyone !!!! Let me be very clear about that. I just find it interesting since I started to learn about being an Empath more and more things have kind of “clicked” together, and started to make some sense . Now, I am only just beginning to explore this realm. So my knowledge is only to a certain extent right now. I do feel that a child would not be able to fully understand this “theory” of energies and empathy, but I do however feel that a parent ( who’s trying to “survive” this diagnosis or behavior ) might possibly benefit from looking into it. If you have some time to read,and are willing to be open minded about it, I don’t think you would have anything to lose. It seems to me that if someone is taking a dopamine enhancing medication, ( I take one myself ) that these “feeling” pathways would be more “wide open”, in regards to how you feel about someone or something or any stimuli.
    The more I study about being an Empath and the more I practice the actions it suggests, oddly …… The easier my life and my daughters life have become. I know to many people out there I probably sound crazy. And that’s ok too, but please don’t leave hateful or negative feedback, because I think as parents of… And being, “one of the diagnosed” any information could possibly be a benefit. If you feel it isn’t for you, then move forward with what works. I have nothing but prayers for every parent and person that has made a comment. Some days feel like a battle that won’t end until death !! Some days I still want to just crawl into bed. All I want to say and do, is let people out there know about something that is helping me. And I felt it somewhat relates to medecine and empathy and just how hard it is sometimes to put your finger on “why ???”
    Why do they act like this ? Why do I feel like this ? Why doesn’t this or that help ?
    I know this post is a million miles long, but if it could possibly help — one — person, then it is totally worth every word. ” I feel ” that it’s definitely something to consider. I don’t think, and I’m definitely not saying that people should be without their medications, (myself included ) but there are behaviors and practices in this theory that have helped me . I just want to thank anyone who took the time to read this.
    And to end it ” Dear Gina, I find it odd that the study was supported by the Defence Department and the others as well !! Ha.
    Also, I apologize to anyone that DID talk about “Empath” because looking back on these comments I see some people have touched base on it !!!
    Nowadays , anything is possible, we are moving forward and discovering new things at an alarming rate. Hopefully many of those things will be used for the better !!!!! Much Love,

    1. Beautifully said, Julie. Thank you for joining in the discussion.

      I think the “bottom line” here is that some people with ADHD “feel more empathy than is comfortable” for them and find it hard to manage. Other people with ADHD are so distracted/impulsive, they can’t pay attention to the empathic feelings they might possess.

      Either way, the core issue is about “managing feelings” — including being able to feel them without being overwhelmed. Being able to discern when it’s a useful point of empathy (a loved one, a real person in need, etc.) or when it’s a manufactured point (a sad commercial on TV). 🙂


    2. Undiagnosed Adhd empath
      + Covert Narcissist.
      I didn’t know this until very recently…
      2 kids and 12 years later….
      I want to help. Any advice for the adhd at 31. I lose everything. Forget what I’m saying if Interrupted, and miss critical info while I’m looking right at you. Did this all happen because she felt alone? Did I forget too many special days? Did she ask me to do something…..and I do 6 other things Instead? Maybe even 1 for a neighbor or friend. Did I shut off her love for the world?

  17. OMG! Finally the missing piece! I’m over 50 and my ADD is SOOO bad now. I was writing off a lot of my obsessions with just being hyper focused. I get so worked up over Trump as if its my personal duty in life to alert the innocent and ignorant and bring awareness to his evil deeds. Just today I stumbled on the word “Empath” and it was the same light bulb when my sister reminded me (at 40ish) that as a child I had ADHD but my Mom didn’t like the “zombie” effect. So she took me off the meds. It was suddenly so obvious, the years of struggling in Jr. & High School and the struggles all my life. Then late 40’s it was really causing havoc! Then I thought oh no, ADHD & Empath. And discovered this.
    Well, it doesn’t fix me but somehow it reassures me a little bit.

    1. Hi Laura,

      I’m so glad you found your “missing piece” here on the ADHD roller coaster. 😉

      It’s so unpredictable…..what will be the “linchpin” that ties everything together.

      It’s different for everyone, but this piece certainly spoke to many people.

      Keep up the good work about Trump! haha!


  18. Hi Gina,
    Thank you for this page – article and comments.

    Could you please comment on…
    a) is mirroring body language a way to transmit “empathy”.
    b) could there be a reinforcing loop of a dopamine self-doping, empathy-seeking behavior?
    c) is “b” helping us feel good, protected when in large groups?

    Thank you,

    1. Hi Adrian,

      You asked:

      Could you please comment on…
      a) is mirroring body language a way to transmit “empathy”.
      b) could there be a reinforcing loop of a dopamine self-doping, empathy-seeking behavior?
      c) is “b” helping us feel good, protected when in large groups?

      A: I’m afraid I don’t have good answers for you, or maybe I don’t understand the questions. Mirroring another person’s body language is sometimes used as a way to help a person feel what the other is feeling, but not very reliably, I would think.

      B: Perhaps you are asking if a person with ADHD might “self-medicate” by acting compassionately or empathically toward another person? I suppose that’s possible. It’s a “good” feeling to be helpful sometimes, and to connect with another person through compassion.

      C: You mean, if you focus in on listening and “being present” with one person in the group, that can help prevent a feeling of overwhelm from being in a crowd? I suppose that’s possible, too. 🙂


    2. adrian amariei

      Hi Gina,
      B) we all meet people that complain; about small things or about important matters. Is complaining (sometime) a way to elicit empathy? And then, when the complainer receives empathy… is that a dopaminergic event with an echo in the Nucleus Accumbens?

      thank you,

    3. Hi Adrian,

      You ask: Is complaining about small things or even important things sometimes a way to elicit empathy?

      Seems like a very complex question to me!

      Some people are chronic complainers. It’s just what they do.

      Some people with depression or anxiety complain about many things, because they are seeing the world through the depression/anxious filter. Some people with ADHD “self-medicate” by always searching the horizon in order to identify pending catastrophes. Or they complain as a habit, a way to stay engaged. The same way that some folks with ADHD keep asking questions during a presentation, to stay engaged and not have their attention wander.

      Then there are people who simply feel overwhelmed and alone, and might have plenty to complain about. They might share the litany of things with anyone who will listen, so they can connect, feel “seen” and understood. Less alone. Perhaps that’s what you might call a “dopaminergic event” but I have no idea where it echoes. 😉 Or perhaps it more involves oxytocin.

      Of course there are many more possibilities than those above.

      It’s important to point out, though, the differences among empathy, sympathy, and compassion. This writer contrasts the terms:

      Sympathy is the heightened awareness of another person’s plight as something to be alleviated (Lauren, 2005). The emphasis here is awareness i.e. coming into the knowledge that there is another person’s whose situation is deserving of your attention and that there is some element of pain/suffering that that person is experiencing. From there, care and concern are shown towards that person. It typically sounds like this, ‘I’m sorry for your loss’ or ‘I hope you are coping well.’

      Empathy is the attempt of one who is self aware to understand and even vicariously experience another person’s situation and emotional state (Baron-Cohen, 2006). Most people refer to this as ‘being in another person’s shoes’. Literal examples include wearing your other half’s shoes or a husband putting on a pregnancy suit to see how the wife’s mobility is affected carrying a baby. The emphasis here is experience i.e. being able to almost feel what the other person is going through. It typically sounds like this, ‘It sounds like you had a bad day at the office and you probably need a break’.

      Compassion is taken a step further, where a person feels empathy and then a desire to help alleviate the suffering of the other person. The emphasis here is on action i.e. wanting to help.


      I hope this helps.

    4. adrian amariei

      Hi Gina,
      related to A), I have found in “The Age of Empathy: Nature’s Lessons for a Kinder Society” by Franz De Waal:

      “This is precisely where empathy and sympathy start—not in the higher regions of imagination, or the ability to consciously reconstruct how we would feel if we were in someone else’s situation. It began much simpler, with the synchronization of bodies: running when others run, laughing when others laugh…”

      Is mirroring body language something that people with ADHD manifestations do?

      kind regards,

    5. Hi Adrian,

      De Waal’s is an interesting notion. But I think he’s out on his own limb there.

      Some people will mirror body language (e.g. hunched-over shoulders, head tilted down, etc.) in order to approximate feeling what the other person is feeling. But this is definitely a very limited method of finding empathy.

      I find the work of Simon Baron-Cohen, an autism researcher, very interesting in regards to brain-based empathy. You might want to look into it.


  19. Great subject!

    I’ve been re-reading “The Selfish Gene” by Richard Dawkins recently, and I began pondering about the fact, that my personal empathy for animals, especially dogs and horses, is abundant and always in favour of their reasoning for their behaviour, in other words, I always take their side, whereas with people and my empathy towards them, I tend to get a bit more “skeptic” of their agenda and tend to focus on the “holes in the cheese, not the whole cheese”, which sometimes makes me seem like I don’t have any empathy, which is certainly not the case, IMO.

    What do you think? Recognise any of this or am I just babbling?


    1. HI Peter,

      I’ve met quite a few people who feel as you do toward animals and people.

      I suspect it’s because animals can’t talk. And so one’s own feelings can be projected onto them.

      Also, animals don’t have complex needs. As people do.

      Figuring out people calls on higher-order brain processes, which might be problematic for some folks with ADHD.

      So, they err on the side of “friend” or “foe”—sometimes quite inaccurately and to their detriment.

      Great book The Selfish Gene.


  20. Pingback: ADHD, Empathy & "Raising a Narcissist" - ADHD Roller Coaster with Gina Pera

  21. I don’t know my mother, I, and my 30 year old daughter, and 2 of her sons have Add, the 3rd son has a anxiety disorder.
    My mother didn’t seem to have much empathy though she could pretend very well. She was also bipolar and didn’t emperthize with her children’s emotions at all.
    I was just the obsolete , not that I wanted to be I just was..also a intuitive person and can feel other emotions. To this day I am overly sensitive to any injustice or pain in this world. I am not bipolar.
    My daughter diagnosed adhd, learning developmental disabled, occ, has bipolar our problem is she is cold to me and her children but nicely, nice to all others, unless they refuse her what she wants.
    When she was n adhd medicine as a child she was so sweet. But stopped in high school and started attacking her teachers, she wound up at butler mental hospital. They tried to restart her medicine but her dad showed up signed her out,said you don’t need that crap! Well fast forward to now she’s 30, as said 3 boys, 1 anxiety disorder.. I remember when he was 5 he told her he wanted to throw her computer out the window because he feels invisible. I wanted to cry for him. She screamed her head off at him. I seem to over identify with him and she seems like a 3 hour a week mom only. Now. The two youngest 8,7, are going though IEPs for add and she’s freaking out on them. And threatening there dad to go after full custody if he even try’s to put them on medicine for it. She did so well on it herself but has a whole different played out story in her mind of how she was victimized, I feel really sad because we can’t have a relationship. She attacks me for not agreeing or doing things for her. She is jealous of the attention I give her son’s and stops my visitation rights because of it. I had to call dcyf because her son was being molested by his dad’s brothers son? She called the investigator and said I made it all up because I don’t like there dad? They closed the case.
    Meanwhile her son was peeing and pooping his pants regularly at the age of 7-8 when he was trained by me at 3 with no problems. My question is this me? Is it her. ADHD, bipolar, or mom covered up for my uncle who molested me and my siblings. So I see a repeat pattern. At this point I just want o move out and try to see the boys when I can. I know she will punish me for leaving but it’s to upsetting to live this way. I’m always worringing about her boys and if I say one thing she attacks ruthlessly, with lies about my character, her childhood, whatever she feels will work in the moment?? I am so alone and confused. They should have books on how to deal with people like this?

    1. Hi Sissy,

      I can’t imagine how painful this must be for you. I don’t know how you can continue living with her and retain your sanity.

      It’s a huge problem, parents whose own ADHD+ goes poorly managed while their children are given IEPs, etc. The whole family deserves treatment.

      As for this: “She did so well on it herself but has a whole different played out story in her mind of how she was victimized.”

      You can see this same phenomenon play out in comments to various articles online about ADHD. Adults who were treated in childhood form some of the most vehement critics of “drugging children.” Granted, many received poor medical care and very little attention was paid in teaching them about their ADHD and “owning” it. So, one can hardly expect good long-term results. But others simply resented being treated for a “disorder” they don’t believe they have. They want to blame the rest of the world. To their detriment.

      There are probably books that address dealing with people like your daughter (as you describe her). But I’m not sure how far they go toward protecting your sanity. The degree of concessions you’d have to make — and constantly holding your tongue instead of countering her distortions — that might be hard to take.

      One that might be helpful is called “Walking on Eggshells.”

      Good luck,

  22. I think of it this way. Those of us with ADD feel empathy the same way anyone else does. The problem is, we don’t always notice when someone requires it. It’s like how a toddler might try to help an infant who is crying, but not one who is giving off less intrusive distress signals.

    If I notice that you are in pain, I want to help you. But sometimes I just don’t notice. Combine that with my emotional disregulation, and I might end up mad because of your out-of-character behaviors, when all you want is a hug.

    Thank goodness for ADD medication.

    1. Hi Josie,

      Great analogy. The partners of adults with ADHD report that, when the situation is “serious” or “acute,” their partners often pull through. But when the situation is more chronic (needing ongoing support), no effort is seen.

      And, of course, empathy is variable thing in all humans, including those with ADHD and those without.

      Yes, I agree…thank goodness for ADHD medication. Much of the public simply has no idea…..


  23. I have ADHD and thanks for this post. This post (rant) will take me ages to type but here goes.

    I have been reading (actually listening to) your book. I am in the “ADHD and Sex” chapter. Your book has convinced that my girlfriend of 6 years might most likely also have ADHD.

    I also read Thomas E. Brown’s book on ADHD and watching Dr. Barkeley’s videos on youtube.

    Now coming to what I wanted to say:

    After reading Dr. Brown’s book and half way through your book I feel extremely depressed and angry. I WANT to feel normal, I WANT to know what it feels like to be a normal person for a day (as they call them: NeuroTypical). I am angry at the cards I have been dealt with :(. I feel bad about how I have made myself isolated from planet earth. I have no friends.

    I spend all my time at work, which thankfully is understanding of my ADHD needs and pays well and I am also thankful that I have been extremely conservative with my money. Having money made me “ok” with myself for an year.

    The only thing that taught me to empathize was strattera, but it KILLED my sex life (I think permanently). Even with meds that I can live with (adderall), I dont know what I feel, and I am just about realizing the ENORMOUS price I have paid. No family ties, no long term friends.

    I dont know where to start. Just feel down and out. Feel like liquidating all my assets, quit my job and do something crazy, but thankfully I dont have the attention and patience to go through with that crazy plan.

    1. Ach Lokesh, let’s hear it for lacking attention and patience to go through with that plan. 🙂

      I’m really sorry you feel angry and depressed half-way through my book. I’ve devoted the last 16 years to supporting adults with ADHD, often without pay, so that is surely not my intent. For adults with ADHD, I usually recommend starting with the Success Strategies, so they don’t get so discouraged. Please skip ahead to the medication chapters and see if the medical treatment you received bears any resemblance to what you SHOULD have received.

      Are you sure Strattera is not viable? Maybe a lower dose? Too many docs start too high.

      The issue of sex and ADHD is so complex. I just wrote a very involved chapter on it for my new book (for therapists treating ADHD-challenged couples). Some late-diagnosis adults with ADHD have developed the “poor coping strategy” of dealing with every emotion by using a sexual outlet. Then when the medication “normalizes” their sex drive, they think they’ve lost it.

      It’s very tricky to find a sex therapist who understands ADHD, but it might be worth looking.

      You obviously express yourself well, you are smart, and you desire greater empathic capacity. You have much going for you. Please don’t give up on finding better help.


  24. Pingback: TDAH, empatía y dopamina | Dra. Elena Díaz de Guereñu

  25. Wow i always thought i was empathetic, but now i’ve read this perhaps not.
    During arguments or cross words, i have often been told “its not all about me” these words greatly upset me as for the life of me i can never understand what i have done to make people think like this, well i can see now i must have missed out when the empathy cells were installed. 😉
    I am cursed with Bipolar as well as ADHD (plus anxiety too).
    Lel.. middle aged female.

    1. Hi Lel,

      It must be very hard to bear, this seeming disconnect between your intentions and what the people around you reflect back. Knowledge is power, though.

      Bipolar, ADHD, and anxiety combined….. I hope you have a good MD.


  26. This is me – so much so I’m a little freaked out by how accurately it has described why my brain works, thinks & acts in ways that people look at me like I’ve just touched down from Deep Space! My whole life has been a roller coaster of emotional confusion & constant self evaluations where I frantically search my brain’s memory vault for the evil thing I said or did that resulted in me losing another friend. I have anxiety/panic attacks when my son or husband come down with a cold or sick because no matter how hard I try, caring for them triggers something in my brain that makes me treat them like they’re sick just to spite me & inconvenience me. I tend to use anger & nastiness as my emotions of choice if I’m under extreme stress or worried, sad or nervous. It confuses everybody around me who just can’t understand why I act the way I do & say the things I say. Frustration with myself for not being able to control these feelings & thoughts, soon becomes depression which results in shutting myself up at home (locking doors, turning off phones & ignoring everybody for days/weeks) & I jump into my imaginary safe place in my head & escape from life/reality indefinitely. I function only to collect my son from school, cook dinner, wash uniforms only & as soon as I know family have left for school/work, I return to my happy place. Bills are left unpaid, appointments get missed, groceries run down to nothing, important things are forgotten without a second thought or concern. Suddenly I come back to life ready to go another few rounds with reality & find the nightmare & serious dramas I have inflicted upon my family when I ran away AGAIN! Enter my team of psychiatrist, psychologist, job assistance counsellors, etc etc to hastily repair the damage i’ve caused yet again & pulling all their strings to get me out of the hole I keep digging for myself. Occasionally, I actually make tiny steps of progress & the timeframe between my “episodes” gets longer & longer. I still trip over & screw up but everyday I’m finding it a little bit easier to snap myself out of it & mentally lock the door to my happy place so I’m forced to deal with my problems rather than freak out. I’m beginning to believe that my fellow Tuckshop Mothers really DO like me & consider me to be one of their friends, which is something I’ve never experienced before in my memory – the “emotional bond” of genuine friendship has been such a mind blowing eye opener for me – I guess the butterflies & nervousness we feel when we experience our “first kiss” or accomplish something like being elected School Captain or acceptance into university. For the first time since I was diagnosed (not only ADHD but severe depression & anxiety – can’t have one without the others) 1000yrs ago – apparently it was actually 11yrs, I’m believing not only in my head but in my heart as well (I now understand what people are on about when they refer to things “coming from their heart” – I put it down to instinct or “gut feelings”) that I can beat this thing – ok maybe not beat but fight enough to scare the crap out of it & leave me alone for a while! Years of denial, frustration, helplessness, loneliness & even acceptance of having no fight left in me to be of any value/use to anybody or anything. I believe without any shadow of a doubt, that it was at this point that Divine Intervention took control & removed any of the “mental triggers” that convinces people with similar mental & emotional despair to end their lives as nothing else will ever stop the pain of living. I remember hating myself because I didn’t even have the guts to consider suicide as an option. Now I look back & can’t comprehend how my life ever became THAT bad – the answer is simple – nobody cared enough or stopped long enough to think that I might have something wrong with me – other than just being a cold hearted selfish bitch! I could never understand why people would think of me in that way because I had & still do spend my whole life desperately trying to do the right thing & be a good person worthy of a crumb of happiness (just once)?but never seeming to achieve it. It’s been the biggest struggle of my life to get to where I am today – I am proud that I can allow myself to really see a tiny speck of light at the end of the tunnel & finding enough inner strength to take baby steps & move closer towards it – rather than automatically thinking it’s a trick & run away. With my amazing team of doctors, family & FRIENDS, I am tentatively letting go of them holding my head above water & learning to swim on my own. I’m still terrified of the event that might trigger me to fall into the abyss again but so far, I am not allowing the paranoia & fear to sit & fester anymore. Empathy is not something we should ever take for granted – it is the key to our survival as human beings & enhances all of the good & positive actions we do everyday without thinking about it. I can’t wait to see what I am capable of next!

  27. I just read your article regarding empathy and ADHD. It really resonated with me on many levels. I was diagnosed with ADHD 18 months ago after I saw all the hallmarks in my middle child. My psychologist spoke with me about it and I have been on medication for the last 18 months. The article was so insightful because my ex-husband would say that one of the biggest struggles in our relationship was my self-centeredness. Since being medicated, he has noticed that i am better able to see his point of view and work with him when we have conflicts. I am excited to follow this line of research, especially as a former researcher.

    1. Hurrah for your psychologist, Cris. Many have yet to receive the ADHD memo.

      Yes, the research is interesting, isn’t it? Especially with the UC-Berkeley study, being jointly sponsored by the school of business and the neuroscience department….hmmmm.


  28. Myself, my husband, and one of our sons display ADD and ADHD symptoms. This empathy thing is a huge part of how we interact with each other and the people beyond our family. At times we have so much empathy, mostly for people outside our family, while with each other we tend to be harsh and easily irritated. My husband and son struggle with the negative self talk and my empathy is non existent during pms. My husband noticed a great deal of difference when he first started taking stimulant medication. Commenting often how he could feel things he never felt before. Unfortunately the negatives overtook the positives and he is not able to take the medication. We all continue to struggle with this. At least this article gives me a little perspective.

    1. Hi Penny,
      I’m sorry that your husband felt he had to abandon medication. I encourage you and him to re-consider.

      The “negatives” of medication are typically due to physician error (assuming the patient takes it as directed).

      Sometimes the dosage is too high or it’s the wrong type of stimulant, or co-existing conditions (that is, depression, anxiety, bi-polar disorder) are overlooked and thus made worse by the stimulants.

      I really hope that you find a way to struggle less and enjoy life more. Just remember that all prescribing physicians are not created equally.

  29. The challenge with having so much empathy for others is in trying to keep from feeling so intensely that my feelings then become negatively affected too.

  30. i found this very interesting. I am 35. Never been diagnosed with adhd. But from what some others hv said I think I need to see a dr. I am really emotional. When I’m alone. I’ll cry watching the dumbest things on t.v. But then my son can do the smallest thing and I get so mad so fast. I think I definitely need to see a dr. Thanks for the artical

    1. Hi James,

      You’re most welcome.

      “Emotional dysregulation” is a common feature with ADHD, with various degrees of it.

      Then again, “depression” can manifest as you suggest in men. There tends to be more of an irritable component than there is with women, so I’m told by experts. (Though “depression” can make women irritable, too. “Depression” being serotonin-related issues.)

      Good luck sorting it out.


  31. This is something I have looked at in myself trying to sort out for the last few years.

    I have always been highly empathetic to the point of it making me a very over involved “caretaker” personality, even at a very young age.

    I quickly learned as a tween that hearing world news was not good for my emotional health. It was too easy for me to put myself in other’s situations and become overwhelmed with emotion, feeling helpless that I could not do something to help in someway, with everything I heard about. It was depressing, anxiety making and overwhelming.

    Yet, in the last 10 years, since I was dxed ADHD, I struggled for a long time wondering if I was in fact NOT an empathetic person, but just conditioned to be a sympathetic caregiver person having been raised by a narcissistic and alcoholic mother who essentially abandoned any motherly day to day behavior toward me past the toddler stage in my life.

    My 18 years as a “latchkey” kid from 5 yo on at home, involved me becoming the “mother” to my younger brother, stand in wife to my father as far as home management with cleaning and cooking went, and constantly catering to her teenage like ego and histrionics.

    It was survival mode as basic as it gets in an abusive situation. I learned to read her fast just by tapping into her energy before she even spoke a word to avoid the verbal and physical abusive.

    It took me a long time to realize that my strong empathy is what made me a survivor. I could quickly feel where she was going and head it off at the pass to avoid the utter emotional chaos she sought to fulfill her needs.

    But my “nurture” then left me doubting people when my empathetic nature allowed me to get involved too easily with people who would abuse that quality in me and use me. ( friendships to relationships)

    This confusion for me was compounded by the fact that being ADHD and swinging over into the Autism Spectrum- I have been accused all my life of talking too crass and harsh with people, and being to matter of fact and cold.

    In my own personal relationships I was often accused of lacking empathy and being unable to put myself in other people’s shoes. ( mostly when I’m PMsing..with lower estrogen when I am most UN-empathetic)

    It was hard to be accused of one thing but feeling the complete opposite inside most of the time. it was the basis for most of my debilitating anxiety in my 20’s. Obviously regulating/balancing that was an issue that I never considered to be part of my chemistry makeup, which I was years away from know was an issue.

    My husband has always joked that he is the “woman” and I am the “man” in our relationship, because he wants to talk things out and I want to “fix things”

    I am a very logic minded thinker and science and fact based problem solver. This made me a great leader and manager in jobs over the years. I’m the one who doesn’t panic when a fire breaks out in a locker room and it needs to be put out, or someone has a heart attack in the store.

    I am able to have that matter of fact-ness and personal distance needed in being a manager of workers. But, when it comes to my ADHD and ASD kids, I empathize with them a lot more than I pull back and be the parent, which caused arguments with my husband in parenting, because it left him “being the bad guy”.

    I worked through a lot of my inner struggles with understanding my own empathy and realized that I AM a highly empathic person, and my desire to help others is genuine, not a built in survival technique I learned in my first 18 years.

    But, I still have to be very mindful of where I direct my empathy and when, and be sure that the intentions of others who receive my empathy is genuine as well, because otherwise it can become toxic fast.

    Often my husband has to remind me I’m being to “Data” and I need to be more ” Deanna Troy” in a situation, because either from conditioning or chemistry ( or both) I have shut down my highly empathetic ability in that situation when empathy would bridge the gap and help find a solution easier and faster.

    It’s exhausting!

    Such a complex thing, isn’t it!

    Thanks for sharing this article Gina! It was well worth your time, I think.


    1. Hi Ril,

      My brain was spinning just from reading your eloquently told story. What a Hero’s Journey life has been for you thus far. And now you do so much to help others.

      Talk about complexity; you had so much to “de-tangle”—never easy when we have only other imperfect human beings, with their own inherent biases and blindspots, as our mirror. Not to mention unrecognized ADHD in the picture.

      The Star Trek reference is apropos…I used to call my husband “Commander Data” and he called me The Empath. In reality, I am also a problem-solver who has little patience endlessly hashing over emotions. Emotions are important, we must pay attention to them, but not too much attention, imho. I was probably a CBT therapist in my past life. 😉

      A funny story…from when our friends Rick and Ava Green were visiting. They were telling us about a technique they learned, wherein one person in the couple asks the other person, “Tell me what you need right now.”

      I turned to my husband and said, “Tell me what you need right now.”

      He said, “I need for you to shut up.”

      Then we both cracked up laughing. Ava and Rick were politely quiet, though wide-eyed. 🙂

      We’ll talk about the important stuff when we need to, rest assured.

      Thank you for joining in the discussion!


  32. Yup this is me alright but as a female, I could argue that during PMS my empathy is even higher than normal as I can get emotional, so not only do I have big empathy for all the things, but I will be crying too! I will go on a crusade of championing causes :p

    1. Jennova – It might be that your ADHD (assuming you have it) intensifies during your periods, leaving you less able to manage the beneficiaries of your empathy.

      Dr. Patricia Quinn (one of my top, top favorite ADHD experts) has long suggested that women with ADHD might need a little higher dosage of stimulant during their periods, to compensate for the estrogen drop.


  33. Kathy Adams-House

    Facinating, Gina, especially in light of yesterday’s presentation by Bailey and colleagues. I sent your article on to him.


    1. Aren’t you proud of your boy, Kathy? It is no mean feat to understand all that science-y stuff! 🙂


  34. Jennie Friedman

    Wonderful article, Gina. As always, it was thorough and well though out. I enjoy reading all you have to share especially when you tie the science into it. You have a real knack for making yourself easily understood. Keep up the awesome work you do!
    Jennie Friedman

    1. Thanks so much, Jennie.

      It’s pretty tricky to be accurate and thorough without being boring and pedantic ——all in the recommended short length of a blog post.

      I do try, though. And, when I’m lucky, the folks reading bring comments that richly expand the topic.

      Thanks for reading and the kind words.

  35. My husband and teenage daughter and son all have ADHD. My daughter, who is inattentive type, is an emotionally mature and empathetic person overall. My husband and son on the other hand, are more “ring of fire”, combined type. Both struggle daily with empathy with personal relationships. Yet at times can be overly empathetic. This often occurs when watching movies and in my husband’s career. As an advertising executive, I believe it give him a big leg up in understanding his clients and target markets. But it has also caused him severe problems with personal bondaries with co-workers and those he manages. Thanks for the fascination article.

    1. And thanks for reading and your comment, J.

      I love the discussion this has sparked! So interesting.


  36. HI LuAnn,

    Thanks for sharing your story. Yes, that’s very interesting about the 7R repeater allele, eh? That it confers more empathy among women but not among men.

    Autism expert Simon Baron-Cohen has done some interesting research on what he calls the systems-empathy polarity, with extreme systems being autism. He calls autism “extreme male syndrome” and points out the problems when one is all systems but little empathy.

    Conspicuously lacking, at least to me, was the problem with extreme empathy and little systems (in other words, more of a “extreme female” syndrome). Empathy can run amok, leading to too much self-sacrifice, sometimes to the point of endangering health and welfare.

    I think adding ADHD to high empathy would create a challenge just as you describe: poor boundaries.

    Helping others is a noble aspiration. It’s also highly rewarding, if not monetarily than in the connection it brings. At least that’s how I feel about it. I am very rich in connection. But then, there’s the balance, right…taking care of ourselves so we can continue to have something to give. 🙂

    Take care of yourself!

  37. Truly a fascinating article, thanks for writing and posting it! I have a much stronger appreciation and understanding for my son’s struggles now. Penny Williams, in her comments above, took the words right out of my mouth. My (ADHD, possible Aspergers) son, 16, has always exhibited a big heart and kindness towards others. He is very sensitive so I have always said he has a lot of empathy, when perhaps what I should be saying is that he shows a lot of compassion. He does have impaired perspective-taking abilities which causes misunderstandings when he mis-interprets the underlying intent of another’s words or actions. He has paid a huge price in the loss of friendships over the years due to this lagging skill. I wonder if this is something that can be learned and acquired over time with the correct interventions and practice or is a person blind to cognitive-empathy forever like someone who was born color-blind? I suppose we will not truly know if all the years of therapy and social skills training has paid off until that frontal lobe completely matures.

    1. Hi Shannon,

      I’m very happy that my article has helped you make the connection for your son.

      My own husband presented a similar situation: being kind-hearted but sometimes acting in ways that were anything but. Then being down on himself, disappointed in himself, and entirely dejected.

      I definitely think there are things your son can learn. But also, as i wrote, the medication really can help many people with ADHD to “access” their innate empathy, and to better use it in relationships. Reciprocity, cooperation, turn-taking…these can all be problems for people with ADHD, no matter how empathic. So, the more he is able to strengthen his Executive Functions in this area, the more his kind heart will jibe with his actions.

      There is a great book by psychologist Michele Novotni, written for people with ADHD: What Does Everyone Else Know That I Don’t. Check it out on Amazon.

      Also, you might want to read autism expert Simon Baron-Cohen’s book, The Essential Difference.

      Good luck!


    2. Thanks for your return comments and reading recommendations Gina, I will look into these books. BTW, Methylphenidate XR combined with Strattera has made a world of difference in targeting my sons ADHD symptoms.

    3. Hi Shannon,

      Glad to hear it. For my husband, too (except Concerta).

      Seeing the positive changes that my husband has made in his life fuels my energy to help others make similar changes. Healthier, happier, more fulfilled in his career. What’s not to like!


  38. Hello Gina,
    I’m a bit confused about your stance on empathy and ADHD – in this article you’ve stated “That, enhanced dopamine transmission often enhances the innate ability of people with ADHD to feel and act with empathy.”, yet you go on to write “Consider this excerpt from my book, Is It You, Me, or Adult A.D.D.?, where I name “low empathy” as one of three common ADHD-related deficits that can derail relationships: …”

    Am I missing something? Thanks in advance for setting me straight on this.

    1. Adding to my previous post: your use of “innate” is where my confusion lies – do you consider empathy to be innate in ADHD, as you’ve stated?

      Thanks again.

    2. Hi Deborah,

      Sorry, I was unclear. I was trying to be concise, and these are complex subjects.

      What I mean is that empathy is not a human constant. It is a highly individual trait. Humans have it in varying degrees.

      Some people with ADHD might be into the autistic spectrum, and so their “innate” empathy might be lower than average. Some people with ADHD might be very high in empathy, but ADHD symptoms interfere with the expression of it.

      But no, I do not– and there is no evidence to support — that people with ADHD have higher degrees of empathy than the rest of the population.

      As LuAnn points out, in the genetic study I cited, some women with the 7R repeater allele (which has an association to ADHD but is found in other people, too) were found to have more empathy than women without this genetic mutation. But the men were found to have less.

      In general, I view people with ADHD as I do everyone else: as individuals, with their own unique personalities.

      I find no sense in dumping 10-30 million people (in the U.S. alone) into some kind of simplistic category. Hardly seems fair, or logical.


    3. Hi Deborah,

      I understand your confusion, and I tried to be more clear in my response to your other comment.

      The bottom line: Even people with ADHD who have innate empathy (that is, the brain-based capacity for empathy, which is variable among all humans) might not be able to access it.

      ADHD symptoms such as impulsivity, hyperactivity, distractibility, etc. can interfere with the type of “new brain” reflection that lets them process such “higher-order” capacities such as empathy. And ADHD symptoms can also interfere with the “actions” associated with empathy.

      One simple example: 20 years into marriage, a husband begins medication treatment for his ADHD. That day, he notices his wife’s eyes are streaming tears as she chops onions in the kitchen. He says, “Here, let me do that for you, honey.” She about fell on the floor, as he hadn’t displayed such empathy toward her since their courtship.

      I write about this in more detail in the book.


  39. My two adolescent sons and I all have ADHD and we are all hyper-empathetic. It is painfully too easy for us to walk a mile in another’s shoes. It often impairs our lives and creates debilitating anxiety. My boys have especially noticed this at school. Where other teenagers may need to be shocked out of apathy (for example, when learning about the holocaust or WW1), they must shield themselves from too much detail because they will become drawn in so deeply and will be tortured by their level of empathy.

    My eldest son has actually noticed an ability to have a healthier detachment since he has been taking Concerta. The empathy is still there, but he seems more able to step back and not be drawn in so deeply. I always attributed this to his tendency to be overly emotional and sensitive, a common trait with ADHD.

    I am wondering if this hyper-empathy could be more associated with OCD, which we all also have. Interesting.

    1. Oh wow, Lori. Thank you for sharing your and your boys’ experience.

      It harkens to LuAnn’s, another commenter.

      The fact is, whether we have high empathy or low empathy, we function best in life when we are more capable of MANAGING that quality.

      With high empathy, we need to create boundaries and structures so that we can remain emotionally and physically healthy, taking care of ourselves.

      With low empathy, we need to learn actions that help us to stay connected to others. (And there are plenty of people with ADHD who are low empathy, too.)

      ADHD presents challenges in self-regulation; that is the core. So, it makes sense that your son is better able to regulate his emotions, with Concerta on board.

      As for your question about OCD and hyper-empathy, I haven’t heard of any such association. In the scenario you describe, I’d wonder if it is more the OCD quality of being overcome by obsessive thoughts that is more the problem. And that would be separate from your high empathy. If that makes sense. In other words, someone with OCD could also be low empathy and could become obsessed about how the world doesn’t do enough for him/her. 🙂

      Thanks for writing.

    2. You may all be level 1 “invisible end” of the Aspergers spectrum. I’m level 1 ASD, ADHD, the works. Comes with Hypersensitivity and “sensory amplification,” as my psychiatrist calls it. Meds like clonidine or guanfacine are great for this. Also, an ADHD med can decrease sensitivity but might take trying different ones. Everything EXCEPT Vyvanse made me MORE sensitive–but Vyvanse has made me WAY less sensitive.

  40. I have always been frustrated by the fact that my 8 year old ADHD son has seemed to lack empathy and acts self-centered. It has been difficult to understand because my two older children (from a different father) have always been the exact opposite. Now, I’m understanding that, to some extent, this is not his fault or mine. I’ve blamed myself, thinking I’ve done something wrong even though he’s been in counseling and I strive to expose him to and discuss with him situations in which we could/should show empathy. I just wish there was something more I could do to help him. Thank you for this article. It has relieved some of the guilt I feel and helped me understand what’s happening with my son. Hopefully, continued research will result in some practical ways to help ADHD children and adults relate more sensitively with others.

    1. Hi Mary,

      Yes, it’s so important to know that many of our “human” qualities aren’t evenly distributed. And, empathy is one of them. Even though you are mother to all three children, the different fathers (“genetic donors”) can of course make a huge difference. But the same can happen with the same biological parents: it’s a roll of the genetic dice.

      Of course, there’s a role for parents to play in teaching the “behaviors” of empathy, in drawing out capacities. But some children definitely will have an easier, or a harder, time with it.

      But if your son has ADHD, the good news is that medication treatment might enhance his capacity for empathy. So, we already have good knowledge about this.


  41. I have the ability to understand and identify emotions. It is so strong in my members of myself and family members that I call us empathic. We are great at sales.
    My ability to take the perspective of another person was groomed in law school. Perhaps our rigidity hinders seeing other’s perspectives or it is not as strong in my family.

    1. Very interesting, Angela. I had never thought of law school as an exercise in perspective-taking, but that makes perfect sense.

      In that case, it might be fostering “cognitive empathy” but not “emotional empathy” — a slightly different creature.


  42. g,
    Love your new site!

    One interesting additional point that connects empathy and executive function – from my halcyon days as a youth studying psychoanalysis back in the early 70’s:

    Empathy is a higher order function, more evolved with effective PFC activity than sympathy. Why? Sympathy indicates a certain subjective, feeling level, ability to emotionally reach across the room and identify with the pain of another. The only problem for those practicing sympathy is that, more often than not, they only take that first identification step, and too often get stuck in the other person’s pain. They can’t leave, and become emotionally lost over there.

    Empathy, on the other hand, requires good PFC Executive Function, with a metacognitively active two step process: 1. Trial identification with the other, and 2. Return to one’s full self for objective management of the other’s challenges. Good next-step advice doesn’t often arise from sympathy, but does often arise from empathetic considerations more objectively managed outside of a purely emotional reaction.

    Fairness required objectivity.

    These activities arise from good PFC activity on an objective level, thus supporting this interesting report.
    Thanks for sharing.
    Dr Charles Parker
    Author: New ADHD Medication Rules

    1. Hi Chuck,

      Thank you SO much for that clear explanation.

      That’s how I understand it as well, but obviously didn’t explain it as clearly as you have!


    2. Dr. Parker, thank you for your description of the two-step process. I don’t think I’ve ever heard it described quite this way, but I can immediately apply this to situations in my life that were confusing, but now make sense. This is very good insight. I think if more people understood this, they might be more patient with people who seem very naive and unable to return to their original state in order to be useful to the other person. It also explains why some people who might be considered cold or detached might actually be simply more practical in solving the problem because, while they have tender feelings, they also have the ability to compartmentalize in order to remain productive.

    3. Exactly, Jenni.

      This kind of information can help us distinguish between what someone “feels” and what someone “does” — and help to bridge any gap.


    4. That is probably the best explanation of the difference I’ve seen. Thanks for sharing! The fact that it’s still relevant shows how solid it is too.

  43. I was also wondering if this could be a problem with regulating empathy? In a case of to much at times for situations that don’t seem to merit this? I’ve just started reading “Smart but Stuck” by Dr.Thomas E Brown and I’m amazed that emotions and ADHD are just now being recognized. Thanks ,Dan Wheatley

    1. Hi Dan,

      Absolutely, I think it can be an issue with self-regulation, which Dr. Barkley maintains is the core of ADHD-related challenges.

      There might be too much empathy or not enough empathy — the challenge is, like Goldilocks, finding the “just right.”

      This kind of calibration of higher-order thought requires a strongly functioning prefrontal cortex.

      Thanks for writing,

  44. This was an interesting article because I was diagnosed with ADHD at the age of 17 and 16 years later, I am still filled with empathy. I have had medication management on and off over the years as well. I have worked with children in schools with ADHD, Aspergers, and I am currently a Masters level clinician for drug and alcohol counseling. Empathy has always played a role in my life- I deeply feel the emotions and connect with others. In my field, I have learned to manage empathy and I am excited to see future research about helping addiction. In my relationships, I feel and try to fulfill the emotional needs of my partner, but do not or cannot recognize my own. And sometimes I feel really overwhelmed- flooded- and i want to retreat! Thank you for this article.

    1. Hi Leslie Anne,

      As you describe yourself, you are exactly the person I had in mind when I read psychologist Simon Baron-Cohen’s fascinating book, The Essential Difference.

      As I wrote in another comment reply, he talks about the hazards of what he calls being “extreme systems.” That is, having a high aptitude for science, math, the “hard sciences,” but little aptitude for empathy, reading facial expressions, etc.

      High systems/low empathy people can be rewarded greatly in society (engineers, scientists, architects, computer software engineers, etc.), but their relationships and sense of human connection often suffers. Sometimes they don’t care, though!

      But I was reading the book, thinking…okay, where is he going to talk about the problems with “high empathy/low systems” — that is, the people who feel too much for others (mostly women, but not always) and lack the “systems” ability to engineer their lives, their money, their work life, etc. That is a great risk, too.

      Perhaps because Baron-Cohen is an autism researcher, he wasn’t as focused on that. But there’s a very real cost, as you describe.

      I wish you the best in sorting out your own emotions (which might not be as “interesting” to you, eh?) and taking care of yourself.


  45. What a huge light bulb moment. I created a nickname for the behavior that goes with it, a long time ago. Save the world syndrome. I have been obsessed with justice and fairness my entire 45 years of life. Have been ADHD aware for 20 plus years but is never ceases to amaze me how much new there is to learn to go along with it. This information is very helpful for myself and my 11 year old mini me. THANK YOU!
    This also contributes to my own psychology experiment I love to study. Red mind-Blue mind. It is mostly biology folks! 🙂

  46. I am an ADHD adult, this was a very interesting study, and a realistic one, the more I read the more it became obvious, because looking back before my medication days…., I always wondered why people found me distant or didn’t like me some of the time. I have always been kind and I am often thoughtful, but I did lack empathy…..but since being on my medication, I have seen a change concerning my empathic side. ….so I need to blurt out …..I feel so bad for my kids I raised before my medication days.

    1. Hi Jean,

      I imagine that was quite the puzzle for you—and could have turned you off to the whole idea of “other people.”

      If they didn’t see as the person you felt you were (kind and thoughtful), then it would be easy to conclude: to heck with them!

      The world is confusing enough, especially in our first few decades of life. That would seem to have added another layer of confusion.

      I’m glad you have some answers now.


  47. I can document at least three generations of ADHD/ADD in my family and I can see the empathy-deficit as explained in your article. What’s more, the less understanding of ADHD there is, the less empathy!

    It is often difficult to elicit empathy from our children or to suggest to them our empathy with whatever is going on with them.

    The lack of empathic response and the rejection of empathy leads often to a painful break in connections in our wide-spread and disjointed times, making connections even more tenuous.

    Luckily medication helps! Recognition, understanding and acceptance are difficult to acquire as to ADHD/ADD. Your article makes empathy easier to “learn”! Thanks!

    1. Thanks so much, Ted.

      I debated if I should take time out of my work to write this post.

      Knowing that it makes a difference for you and others means a lot.


  48. HI Penny,

    I’m glad you found the information helpful.

    Yes, it’s tricky to see how one who might be tender-hearted or have a kind nature might not necessarily be empathic.


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