ADHD, Empathy, & Dopamine: A Study, Book Excerpt, and Definition

ADHD empathy dopamine
What can a published study — and an excerpt from my first book —  explain about ADHD, empathy, and the neurotransmitter dopamine? That’s what this post is all about.

I’ve noticed a remarkable phenomenon over the last 20 years: Stimulant medication, which targets dopamine, 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 — at least it’s more complex).

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. They might call themselves empaths, as I explain below.  Stimulant 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 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”.

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. “


empathy adhd dopamine


Book Excerpt: ADHD and Empathy Regulation

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.

Poor 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.

Stimulant Rx for ADHD Can Enhance Empathy

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.]

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

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

What About Empaths?

It’s worth noting: Women carriers of a certain gene variant (the 7R-allele) scored higher in cognitive empathy than female non-carriers.

(I wonder if this might explain the folks who call themselves empaths.   As far as I know, the only empaths are the telepathic Betazoids, on Star Trek.  But I see the term bandied about a lot these days, applying to regular humans.  In my opinion, we only very cautiously assume that we know how another person is feeling. Sometimes this springs from over-confidence and grandiosity—and trouble picking up the signals in more direct ways.)

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.

Dopamine Modulates Egalitarian Behavior in Humans.

Boost Dopamine — Increase Sensitivity to Inequality

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.

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

Andrew Kayser MD PhD
Andrew Kayser MD PhD, UCSF School of Medicine

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.  See Kayser’s lab website: The Cognitive NeuroScience of Self-Regulation


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.

empathy dopamine medication

Two More Posts On Empathy

ADHD and Lacking Empathy: Was I Raising a Narcissist?


My parents are horribly mentally ill, and they refuse treatment. Instead, they blamed everyone else for their troubles—and drowned their sorrows in alcohol, drugs, and pity parties. Even when I was in the hospital—sick or with a new baby—my parents could only talk about themselves. I found their utter lack of empathy horrifying.

When married and starting a family of my own, I vowed to be different. Yet, in raising my first-born child, the oldest of four girls, I watched helplessly as every lesson about empathy I tried to impart seemed to bounce cleanly off her soul.

What do I mean by that? Well, for one thing, she would exploit others. She would set up games where everyone had to treat her like a queen visiting from another planet—or convince friends to “share” their favorite toys and clothes. Forever.

I even caught her in an elaborate kindergarten “protection racket” at one point: taking her sister’s money to keep monsters away. (She’d already made 6 dollars!)

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.

More on ADHD Relationships

You’ll find many more posts on Adult ADHD here, from all angles, including relationships:

Breaking out of ADHD Relationship Dysfunction — After Not Breaking a Fall

Adult ADHD and the Automatic No — And Automatic Yes

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.

—Gina Pera

130 thoughts on “ADHD, Empathy, & Dopamine: A Study, Book Excerpt, and Definition”

  1. Hi, I’m listening to your book. I absolutely loved it but the bit about ADHD and empathy really felt, scant, slightly ummm, how to say un-responsibly handled in comparison to the rest of the book … and… well a bit un-empathetic… (I know its not coming from that place but it scared me… as i want to share this book with non ADHD people so we can both be on the same page more… I yearn for a more mutually empathic world)…

    Once upon a time I wouldn’t have said those negative comments here… for fear of upsetting you… I feel things very strongly… I hate the idea of hurting others… and while I know confusing my own experience of hyper sensitivity with empathy (which I have done in the past) (rejection sensitive dysphoria has helped me understand myself and others in my family) … I know my past habit of thinking I was protecting people from feeling rejected, by avoiding saying certain things that might hurt them, and confused this with being empathic (it both is and isn’t) like you said having had an experience and relating is not empathy…

    But I think caring enough to try and protect others … is a clear sign of the roots of cognitive empathy. And something that is core to who I am is wanting everyone to get along and feel happy and understood, (dysfunction was rife in my family growing up, adhd has given it context… but as a result the very heart of what makes me tic is wanting to understand what makes others tic, to avoid miss-understandings). But when others couldn’t understand me, or didn’t want to share… in the past this is where I seemed un-empathic to them in my overwhelm, because I couldn’t let it go… ADHD re-frame… I wanted us to explain every inner working of our mechanics, get it all on the table and find strategies… I was begging for mutual empathy… but it was making others see me as un-empathic… maybe they wanted space, or they couldn’t speak as much as me… etc… My intentions were there but my methods were from my perspective… An ironic and painful bind for me… that i’m moving past with the deep work I’ve done. (though conciseness is still a challenge so apologies for a long message).

    I have been reading much more about the Double Empathy deficit and as soon as I did, it was so familiar to me… it was the thing I’d known was there but no-one else did, when I tried to explain, during misunderstandings. I think it relates to ADHD just as much as ASD.

    You say you go onto discuss partners, and their inability to empathise with ADHD, in your book (impulsive so writing this before having got there yet)… But that brief intro to people with adhd regarding lack of empathy was for me the low point of the book… it left me feeling cold, and yet again unseen and unsafe, a feeling at odds with the rest of your book… which has has me smiling laughing and nodding…

    The internet and culture in general is literally smeared with links between low empathy and ADHD as well as other conditions (many that form when adhd is not diagnosed and treated like ODD and BPD)… And the more I research the more I really feel that this double empathy deficit is at play. But that too many are getting out their toxic people and narcissist stickers and slapping them on people… therapists included. (an ironically un-empathic and narcissistic thing to do?)

    My fear is that as a culture, who is only just learning about psychology, neuroscience etc (a field in it’s infancy) we’ve therefore got so much catch up to do with deeper understanding and nuance of people, their behaviour and importantly their intentions (we are like a world moving from, the world is flat, to OHHH it’s round, in our sophistication of ‘getting’ human nature)… I think that anyone seeking to represent the confusion that ADHD can cause… could take real OTT care to go into AS MUCH detail, or really spell out, as clearly as possible about empathy strengths of people, or of many people with ADHD to protect them from the stereotyping that, merely gliding over the potential and existence of empathy in an ADHD person, reinforces with an often ignorant general public (who have their own lack of cognitive empathy when it comes to difference) I think great care needs to be taken not to fuel this ignorance and the stereotypes that stop people being seen, and hinder mutual empathy.

    To highlight an example of how empathy lives in me… I am called super Nanny by my sister, I can pacify children and old people like no-one else. Screaming overwhelmed excitable kids, leave them with me and they’re calm and focused, seen and heard. They don’t want to do their homework? I’ll make it into a game show… this is why I always identified as an empath… and I do believe you need deep empathy to relate to children… but the funny thing is… children and elderly people are two populations who are facing their own executive function deficits, something I inherently can empathise with… and before learning about ADHD, these groups always made more sense to me than other people. But, I don’t just understand them I can feel them… every thought I can guess it and I know what to say to make them feel understood… and with children, I protect them too, from the confusion and judgement I grew up with.

    Similarly a grieving, distraught person, I get that… it’s how something I can relate to… but… here’s the kicker… when I need those people to get my overwhelm, they often told me my lack of ability to calm down is a lack of empathy for them… ummmm?

    But (brain scans are showing that actually the bits of the brain needed to calm down are impaired… so, them asking me to calm down, isn’t it a bit like me asking someone with a broken toe to stop limping… I mean don’t get me wrong I have calmed down in the past, more often than not, by forcing a behavioural shift… but not by altering or tending to my internal needs… so instead by totally disconnecting with myself… not because I was actually calm… But I empathised and heard their needs, internalised the shame… and I damaged myself in the process, and when that got too much I periodically couldn’t calm down, and at these points others told me I was not empathising (or implied that essentially)…

    So non ADHD people in my past, as well as people with adhd traits that clashed with mine (again adhd reframe, I think both my parents have it… and this has helped heal rifts)… so, e.g, someone being hyper when I cant process etc and visa versa caused misunderstandings … and as I hate misunderstandings I would get deregulated and find it hard to be able to let things go, I hyper focused on wanting to fix it… so would seem un-empathetic to them… and they to me; The double empathy deficit…

    But even at my most distraught… I always felt and thought about what they were thinking and feeling… it’s just that often, knowing what I knew about myself and my reasons for doing or not doing things, I felt that their reading of the situation and of me was … wrong and unfair. I knew what I was up against, even if it didn’t have a name… and they were telling me I was bad.

    This of course… would make me hurt…

    what I needed to know was it wasn’t their fault they couldn’t empathise with me, and they needed to know more about what I was experiencing…

    Seeing impairment, before behaviour…

    In order for me to be able to act upon my empathy this stuff needed to be there for us. For me, it was a sense of injustice that at times (when my emotions got too much) stopped me being the bigger person, (though I tried as often as I could) a weight that felt like it was always expected of me.

    If you feel you simply have a crap brain, and someone is shaming you for forgetting their birthday (just an example), when you’ve been reminding yourself all month that it’s coming, due to fear of hurting them, but still manage on the day not to remember, caught up in the chaos of your difficult undiagnosed ADHD life

    … and yet you’re always letting them off the hook for the sorts of mishaps you yourself make (because you’ve reasoned that’s empathy)… then it’s going to put a dampener on your willingness to act on your empathy in that moment when they tell you you don’t care about them. And when the same sorts of misunderstandings happen in reverse the same is going to happen… Now, with insight… I can say, im so sorry I tried to remember all month please know I care very much, and I totally understand why you’d assume I don’t… but really its my brain, not a reflection of how I feel… the efforts i’m making to attempt to overcome my brain deficits are the reflection of how I feel.

    ADHD awareness allows me to know what’s in the room… what’s gone wrong… and tell the other person… but I always empathised… I just knew that doing so, without any one acknowledging my side, left me on the back foot…

    I spent a long time in really damaging therapy being (after a lifetime of this already) labeled and clearly read as un-empathic… I have daily ruminating memories of this and feel deep pain about that therapy (I was re-traumatised by it). The psychoanalytical style of it (where they did that blank faced mirror technique) left me terrified and dysregulated… But I was still feeling them, feeling every inch of their micro expressions, searching for them, seeing them as feeling people within their eyes, even when they were trying to look blankly at me… I wanted shared empathy, but with no context of who they were as whole people, or why they were staring stone cold at me, and the echoes of authority figures judging me from childhood… I had no chance of empathising with them (because they were being intentionally ‘neutral’) so I had nothing human in the interaction to ground me… I now know DBT which is often used with ADHD patients speaks against all the methods they used… as does trauma therapy…

    So it feels unfair… that I came out of that therapy i’m sure with endless notes about a lack of empathy and no hint of them seeing or explaining to me about ADHD —-

    me: ‘sorry I was late, I got up early but just before leaving I had 10 mins to spare and I zoned out, I have no idea how it happening… then I ran all the way here’ Therapist: ‘ a part of you clearly didn’t want to be here’

    me: ‘can you please send me that regualr appointment time YOU re-arranged for another time, by letter so I don’t forget it’

    therapist, with short voice ‘I think you are more than capable of getting a pen and writing it down’ (implying I was being entitled)

    And my subsequent reactions to this, getting overwhelmed and crying – i’m sure was noted as a further lack of empathy

    Only… the whole time I was well aware and analysing both cognitively as well as sensing them, tone of voice, expressions etc… I was empathising, putting myself in their shoes… but that was the problem I empathised that they didn’t empathise with me… I thought I had a condition that no-one had discovered yet… I couldn’t understand what was going on, I never knew what ADHD actually was! And then I did… and then it all made sense… But it took me hell bent on working out what was causing the double empathy deficit (not my therapists) they assumed it was me lacking empathy…

    so… what was missing then? if it wasn’t my empathy…

    here’s what I think:

    knowing why they weren’t understanding me… (the double empathy deficit)

    An ability to communicate the misunderstanding (eg… saying, I know you might feel I am being rude… but I am asking for you to send a letter, because the appointment is over a month away, and I will just have to hold the appointment time in my head by obsessively ruminating on it everyday, in order to attempt to remember it, and still… I might forget, which causes stress and shame, and I also can’t trust myself not to lose the paper I write it on, or forget that I saved it on a note and even if I set a reminder for everyday in the week running up I might not even look at it when my alarm goes off, by habitually swiping it away… but if you send me a letter the event will be more memorable and official and that will help me remember etc) (I now have tools and other ways to take notes of appointments… but at the time I was lacking adhd tools or awareness…) I was doing my best…

    SO, in the absence of tools, and with a brain prone to dy-sregulation, the inability to calm down, in perceiving being miss-understood was an ever perpetuating barrier to… caring more or equally about them… than me in that moment of overwhelm…) and please know i’m someone who literally forced myself to keep my emotions inside with many people, by detaching, much of the time… but later crying in the toilets or being so exhausted I had no life etc… to the point of breakdown.

    I know what you wrote regarding empathy… wasn’t intended negatively. I see you have the line about ‘some with ADHD have a problem reining in their empathy’ but I do think there’s an issue in all this. I think it has to do with the responsibility of knowing the audience, and society as an audience don’t have much time for seeing ‘lack of empathy’ as nuanced… which is ironic…

    I wonder if for me… it is in SPS, I believe I have ADHD and also the SPS trait… (ive seen people say sometimes SPS looks like ADHD but I have too much literal ADHD symptoms for that… But I think they create a tug of war in me… and I want it to be known that its a lonely place to be in what I do view as a world lacking in the right info to create better mass cognitive empathy much of the time…

    … and even lonelier when you think professionals, will label you with just the right label, for an ignorant public audience to write you off… or If new doctors see notes, that say anything related to ‘low empathy’ I’m doomed before we’ve started our interactions… if someone reads about ADHD and no empathy… and I try and get on the same page by saying hey I have ADHD… again I’m doomed before we’ve started… so I think its an area to tread really carefully in… people need to know it’s complicated, but they need that spelled out and they need to see its a two way street, and they need that spelling out… Simply brushing past it, isn’t going to get it in many peoples’ heads. it’s going to take time, and I think people like you can champion that much needed space to say ‘its complicated’ so more people really hear… x

    I do thank you for your book though xxx

    1. Dear Amy,

      I appreciate your taking the time to thoughtfully detail your reasons as to why that few paragraphs about empathy in my book didn’t sit well with you.

      I do understand. I have been the beneficiary of much kindness from my friends who have ADHD.

      Did you read L. Frieson’s essay here? I think you’ll find it speaks to the spirit of your comment here—and “Double Empathy”.

      I am too tired to make this short, but I felt you deserved an answer as thoughtful as your comment.

      Here goes!

      My Mission

      One reason I took up this mission is the thought of vulnerable people affected by ADHD people seeking mental-healthcare. “Luck of the draw” doesn’t begin to describe it.

      I imagined these people, alone and confused, seeing therapists and psychiatrists who would project onto them all kinds of harmful psychological narratives. I’d met these therapists and psychiatrists when I ventured into early psychiatry discussion forums.

      For twenty years, I have emphasized self-education and self-advocacy. Most people don’t want to believe it….they even get angry when I suggest it….that the average therapist knows little to nothing about ADHD. Same for prescribers. But that’s the truth.

      Requirements for Understanding ADHD: Intelligence and Empathy

      I’ve always said it takes enormous intelligence and empathy to begin to understand ADHD. And that is what I’ve always tried to bring to this topic: intelligence and empathy — and a keen ability to navigate gray area.

      ADHD is a highly complex syndrome — though we’d never get that from most of the Internet. A major marketing strategy is to maximize site traffic by using the popular keywords that lump all people with ADHD into one stereotype: ADHD Brain, Rejection Sensitivity Dysphoria (a blog post topic for another day), etc. (I’ve seen the data when I finally analyzed my site’s traffic, in comparison to others on Adult ADHD. Shocking. And the public largely has no clue.)

      I believe if you go back and re-read the passages on empathy, you’ll find that I wasn’t being un-empathic but truthful. I do believe that truth is important. So did the top ADHD expert I quoted in that chapter, Robert Brooks, PhD.

      Many adults with ADHD have told me that my book provided a much-needed breakthrough about empathy. For one, they finally understood the lifelong criticism of “You’re not empathic” — and understood that maybe treating their ADHD could help with that, along with overall ADHD symptoms. Their loved ones also wrote to thank me for helping them to better understand adults with ADHD.

      Moreover, I did indeed explain in the book, again and again, that ADHD is a highly variable syndrome.

      The Importance of Knowing Many People with ADHD

      Given this great variability, it’s a hard topic to write about with any level of accuracy. Especially when half of the dominant themes online are at best inaccurate, at worse harmful.

      I’m curious. How many adults with ADHD do you know? I mean personally.

      The thing is, many people with ADHD don’t know many other people with ADHD. Maybe a few. But, for the most part, most know only what they read online. This can be useful, if one vets sources wisely.

      Overall, the big mistake they make is assuming that everyone with ADHD is like them. More commonly, masses of individuals with ADHD relate to certain parts of others’ experience.

      Maybe you know, in person, many adults with ADHD. But I’m pretty sure I have a much wider and deeper and longer view of adults with ADHD as individuals. You can’t sit in a room with 25-40 people (newcomers and veterans) every month, for 15 years, and not see the clear differences among the individuals who have this highly variable syndrome. I also know this from the 10,000 partners of adults with ADHD who have come through my online discussion group.

      I also have a strong command of the literature and the consensus issues among highly placed experts.

      The Cultural Context in Which I Wrote the Book

      When I was writing this book (published in 2008), precious few experts were publicly (as opposed to academic circles) talking about many of the issues I covered, in the context of relationships, in particular. Especially not in the popular culture, which was filled with a certain psychiatrist’s blockbuster marketing message: “ADHD means you’re the life of the party and can start an airline!” marketing tropes.
      (This was largely before the Internet took off, so it was newspaper and magazine articles, “Dr. Phil” appearances, highly compensated conference lectures, etc.)

      Yet, many of the adults with ADHD who were attending my local discussion group, here in Silicon Valley, were confused! They found that that this marketing message created discomfort and anxiety.

      What if they were socially anxious? What if they couldn’t remember a joke? What if they hadn’t achieved anything close to the career success they’d imagined — much less started an airline?

      Did that mean they failed at having the “good kind” of ADHD? What kind of empathy was being shown to them?

      Is it better to be truthful — and therefore truly helpful — or is it better to blow narcissistic smoke up the skirts of adults with ADHD, and gaslight their loved ones? The media love “contrarian” ideas. Hence, this idea that “ADHD isn’t a disorder, it’s a gift” sells.

      The appeal for some is obvious: To hear that a major figure say they weren’t the equivalent of boring “Muggles” — that they were in fact more gifted, more special, more creative than “neurotypicals” — filled a deep hole inside marked “less than” by years of living with unrecognized or poorly managed ADHD symptoms.

      But, it’s still narcissistic supply. It’s not going to elevate their lives, for the most part. It felt dishonest to me.

      The clear message was: Their neurotypical-partners should stop harping about “You forgot this” and “Do you remember our conversation about X?” They should expect little in the way of day to do cooperation, chore-sharing, and attention from these superior “gifted” people with ADHD. They should instead resign themselves to a life of neglecting their own needs so they could serve as the executive assistant to their ADHD partners.

      Meanwhile, as I mentioned, I had also been leading discussion groups for the partners of adults with ADHD. I saw the devastating real-life impact of these “denialistic” marketing messages on group members. In person and also online.

      That was the context in which I was writing. Against a toxic tide of “Giftism.”

      Then, just at that time, the 2008 economic meltdown happened. People in general had a more sober viewpoint of job security, etc. after that.

      When the book came out, however, the people marketing “happy stories” to adults with ADHD slammed my book as “negative” and said many untrue things about it and me. It was very ugly, and I haven’t forgotten these people. (I also have noticed that many have co-opted the concepts that I spent many years studying and developing and writing about.)

      If the book had not had such a warm and grateful reception overall, I would have been crushed. Because they were the opposite of empathic. They were vicious and devious.

      Twelve years later, the book is still highly popular. Including with adults who have ADHD. I think that says something.

      About The Two-Way Street

      To your point about two-way street: Yes, I think I understand.

      It’s one thing, however, to be understanding of and patient with a friend’s tendency to get extremely emotional and “overwhelming.”

      It’s another thing to survive another person’s dysregulated behaviors every day, in every way. It’s unsustainable.

      There seems to be this idea that, because a person does not have ADHD, the person should be a font of limitless empathy for the person who does. But we should remember: Our human brains are not designed for two. 🙂

      There’s a difference between being empathic and enabling behaviors that aren’t doing a person any good — and probably much harm.

      I try to clarify that difference.

      Thanks for writing,


  2. Hello Gina,
    41 year old here. I just got diagnosed with ADHD a few weeks ago. My partner, of a tumultuous 6 years, recommended I get a psych eval because of the difficulties I have with communication & empathy & honesty with them and my hyper sensitivities to sounds and smells and a whole bunch of other stuff.
    A problem has occurred twice this week, where I have misspoken and caused a lot of hurt and trouble.
    The first event – I talked about a past collaborator (a woman) and although I did not intend to collaborate with this person in the future I described a hypothetical situation in which I would collaborate but I would invite my partner over and we could all have dinner.

    In hindsight, i didn’t need to say ANY of that. I just needed to say – There is this woman who I used to collaborate with, and I have no intention of collaborating with them ever again and they pose no threat to our relationship.
    The second problem – the discussion about the collaborator cause a lot grief for my partner and triggered them because in the past I have been unfaithful and a liar about my collaborations with women. So my partner saw this as an attempt at me being underhanded, tricky and manipulative. Unfortunately, my words totally support her suspicions but my intention was literally the opposite.

    I feel like I fumble with my words in a high stress situation.

    The second error on my part, came a few days after that. My partner and I had been making up, discussing and processing my fumble (about the collaborator) and had had many intense days of my partner voicing their anger and yelling at me. We did make some headway though and things were starting to calm down. We averted a break-up.
    BUT then I forgot to tell my partner that I had been invited to my friend’s , lets call him Dirk, party. And instead of inviting my partner to Dirk’s party, I said ‘I’m going to Dirk’s party tonight, but you probably wouldn’t want to go anyway’.

    I TOTALLY FUMBLED. i knew that my partner wants to be invited to events with my friends, and i did have opportunities to mention it, but because of all the high-stress situations, yelling and processing I couldn’t find the time to actually form and state the sentence ‘Do you want to come to Dirk’s party with me?’.

    Now we are at an impasse again, my partner feels like they can’t trust me, and that I don’t want to bring them around my friends and that I’m embarrassed of them.

    The saddest and most infuriating thing for me is that i did want to bring them to the party but I literally had not formulated that thought in my mind until I blabbed and fumbled the statement that ‘they wouldn’t want to go’.
    I’m feeling a bit hopeless but also I do think and feel that this is due to what ADHD does to my brain. Sometimes I can’t formulate, or speak the most simple thing, especially when I’m highly stressed or feeling attacked…

    On the flip side I have been showing my partner lots of care by cooking, cleaning, doing repairs and gifting them things they need weekly.

    It is like I can come through with the Physical Tasks but I can’t come through with the Verbal Tasks.

    What would you recommend I say to my partner?

    What would you recommend I do to help me with my verbal tasks and processing of thoughts before I speak….

    1. Dear Oscar,

      Ouch!!! I feel your pain. And your partner’s pain.

      Her survival instinct must be on the watch, lest the past repeat itself.

      You are trying new behaviors, and you need optimism and positive reinforcement.

      If you read/listen to my first book (Is It You, Me, or Adult A.D.D.?), you’ll learn about how ADHD sometimes means having a weak “internal voice.”

      You’ve heard the expression, “I don’t know what I think until I see what I say?” Probably uttered first by an adult with ADHD. 🙂

      A stronger internal voice means we can “rehearse” what we plan to say and think it through, revise, before laying it on the recipient.

      You don’t mention medication. Is that in the cards?

      By improving internal communication, stimulant medication can often improve what you describe. It can help you have more forethought, less blurting. Even in “high-stress situations.”

      Compared to many physical tasks, mental tasks are much more complicated. Because they require our neurons “communicating” clearly with each other about complex and sometimes unforeseeable factors. (I talk about that in a chapter on medication.)

      Still, it can also take active “revising of old scripts” — well-honed over the years of living with unrecognized ADHD.

      Scripts such as “mindreading” — where you assumed you knew how your partner would react to an invitation.

      Also “avoidance” — perhaps you feared your partner’s negative reaction (e.g. “Dirk the dirtbag? Why would you think I’d want to go to HIS party? yadda yadda yadda”). So, you just skipped it.

      I write about all this in the book, and I expand upon these concepts in my new online training. Available soon!

      Please be sure to subscribe to my blog here, so you’ll be notified.

      Good luck!!!


  3. 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.

  4. 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,

  5. 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!

  6. 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,

  7. 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,

  8. 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,

  9. 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.


  10. 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!


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