ADHD & Fear-Based Management: The Risks

My husband, prior to ADHD diagnosis at age 37, called his best coping tool Fear-Based Management—fondly referred to as FBM™.  Yet he, along with many other adults with late-diagnosis ADHD, often learn this: The strategies that seemed to help them prior to diagnosis can be destructive in the long-term.

Let me explain, briefly. Then I’ll share with you an extremely insightful essay about the dangers of relying upon our brain’s “primitive” limbic system to lead us, to motivate us, through life.

In a very basic sense, we can think of ADHD as a see-saw. On one side sits the heavy limbic system; the other, the much lighter rational brain. Let’s call it the Prefrontal Cortex, or PFC.

The Limbic System is all powerful, primitive instincts—fear, pleasure, greed, anger, reward, lust. Without a balancing influence from the PFC, the limbic system gets carried away.

Living with someone who’s Limbic System dominates their brain can be life-draining. The constant negatives. Constantly simmering anger and irritability. It’s hardly fun for that person, either, who can seldom relax and simply feel pleasure or happiness. And it’s certainly not conducive to safe driving, steady work performance, and effective parenting. Or a happy life.

ADHD fear-based management

“Great Instincts”—Or Stimulating Fear Reactions?

My husband swears that FBM™ got him through graduate school. Here’s how it worked: He nurtured thoughts of disastrous consequences if he didn’t finish that paper on time and complete that research project. In other words, he stoked the limbic system fires in an effort to goose the rational brain into action.

Sure, lacking any better options at the time, FBM™ may have helped him to earn a tough advanced degree in the hard sciences. No easy feat!  But, looking back now—with the advantage of ADHD diagnosis and treatment—he sees now that “self-medicating with fear” wreaked havoc with his nervous system. Moreover, it pretty much decimated his ability to relax and enjoy life.

Here’s another example.  I hear from individuals with ADHD who claim they have “great instincts.” I don’t doubt them.  But sometimes it seems they are confusing “great instincts” with being fearfully distrustful of everyone and everything. Sometimes on the slimmest of evidence. That, too, can be the Limbic System’s out-of-whack fear-protection response.  Feelings don’t always represent facts.

Obviously, over-reliance on our brain’s “fear center” comes with risks.  The limbic system is more complicated than that, of course, but fear definitely lives there.

Fight Or Flight—Online And In  Social Media

If you’re like me, you get the feeling that we’re all relying a little too heavily on FBM™ and the rest of our brain’s “fight or flight” system—especially online and in social media:

  • Being a little too quick to react and with anger, without fully taking in details
  • Being a little too willing to let our “primitive” and fear-based brains overpower more deliberate, rational thought

In fact, we’ve learned that entities such as Facebook and other “social media”  manipulate us to promulgate these fears.   I live in Silicon Valley, where manipulating the human brain (through clickbait, videogaming, etc.)  is insanely profitable.

This is why learning to cope better with ADHD depends on questioning the old counter-productive coping responses—and writing new, healthier scripts.



This topic weighed on my mind when I ran across a very wise and compelling essay called Tigers, Tigers. It’s written by Susan Schorn, author of Smile at Strangers and Other Lessons In the Art of Living Fearlessly. She graciously allowed me to reprint below.

Enjoy—and check out the video above.  Susan shares fascinating and an often wittily told journey from a “small child with a small personality” into a powerful writer and martial-arts instructor who teaches violence prevention.

Tigers Tigers

by Susan Schorn

Ever since I turned forty, I’ve forgotten how to sleep. That is, I can fall asleep with no trouble, but I have a lot of trouble staying that way. Instead, I wake up in the middle of the night for no apparent reason. And when I say “wake up,” I mean that I WAKE UP. As Russell Hoban described it, “like a man trapped in a car going over a cliff.” My heart gives a spasmodic lurch and I’m instantly wide-eyed and alert, listening, muscles poised. It can take hours for my pulse to subside and my brain to admit that there’s really nothing much to worry about at the moment.

My husband is accustomed to these episodes, but I suspect they’re taking years off my life. I know too that I make things worse on these nights by humoring my nervous system, lying there and mulling over everything that might have caused me to awaken in full-on berserker mode.

There is nothing more fruitless than confronting your worst fears when you’re sleep-deprived and pumped full of surplus adrenaline. Yet I do it anyway. I replay contentious office meetings and analyze dark alleys I might have to walk down in the future. Fun stuff, but not very soothing.

ADHD Fear-Based management

Rather than inducing me to slip back off into dreamland, this kind of antagonistic thinking gets me even more riled up. It takes the erroneous chemical message that some glitch of physiology dumped into my bloodstream and converts it to rational thoughts. It leaves me with mental images that tend to heighten my sense of powerlessness and persecution.

In short, when I lie in the dark and dread things, I’m allowing my limbic system to exploit and bully my rational mind. And I don’t like bullies.

The Limbic System Keeps Us Alive

Still, it’s not entirely my limbic system’s fault.

The hindbrain, as the limbic system is sometimes called, consists of the hypothalamus, the amygdala, and quite a few other highly specialized but not especially well-understood parts of the brain. Together they control our physiological response to stress. That is, they stimulate or suppress our hormones, regulating our heart rate, dilating our pupils, and elevating our blood sugar levels.

In a crisis, all these physiological changes increase our odds of survival by helping us fight, flee, or freeze. The limbic system keeps us alive in the most primal way imaginable, and it does so with very little input from the cognitive centers of the brain.

ADHD Fear-Based management

But, as I’ve learned, you can’t overindulge it.

I spend way too much quality time with my limbic system. I don’t get into many dangerous situations requiring immediate fight or flight, but imagining catastrophe in minute detail is a hobby of mine. As hobbies go, this is slightly less destructive than heroin addiction but worse than say, karaoke, which I have seen cause considerable strain in other people’s marriages.

When your default thought patterns are a non-stop dress-rehearsal for disaster, you spend far more time fighting within yourself than you do addressing outside threats.

Whether I’m awake or half-awake, I:

  • Devote an excessive amount of mental energy to refighting old battles and gaming out potential ones.
  • Bring dead conflicts back to life over and over again, even when there’s nothing more I can learn from them.
  • Extrapolate about possible future conflicts out of sheer habit.
  • Have to be very careful that I don’t skew my worldview in the process.

But The Limbic System Isn’t Very Smart

Because the hindbrain, while dependable in emergencies, isn’t very smart.  Quite often, it’s my analytical, speculative musings about danger that fools itself into perceiving an actual threat.  My body will start reacting to the imagined crisis as if it were real: Elevated pulse, rapid breathing.

ADHD Fear-Based management

And unfortunately, the limbic system remembers physical stress responses whether they were warranted or not. It aggregates them and uses them to predict future potential threats. Perhaps that is why I wake up in the middle of the night as if I’m crouched in a foxhole on the Western Front. My mind and body remain stuck in a feedback loop where hypothetical danger has been nurtured as an academic exercise. Hypothetical is mistakenly treated as the real thing. Both instincts try their best to keep me safe. But they actually make things worse.

It’s something I’m working on—I’ve found that it gets better when I spar regularly—but I know I’m not alone in feeling caught in the middle between my “thinking” and “reacting” brains. It’s a common problem in the peculiar environment we now live in.

The Trouble With Being Sensitive To Tigers Begins
When There Are No More Tigers

Carmel, a social worker who trains at my dojo, gave me this explanation of how our limbic systems are supposed to keep us safe:

  • If you live near tigers, you’ll quickly become attuned to environmental cues that signal the presence of tigers.
  • You’ll be sensitive to growls, for example, and the color orange, and stealthy movements in the underbrush.
  • Those cues will trigger immediate defensive responses—running, hiding, grabbing a torch.
  • You won’t stop to think about these responses.
  • They are instinctive, reflexive physical reactions to sensory information, and if you give them free rein they’ll keep you alive.
  • Problems can arise if you move somewhere new where there aren’t any tigers.
  • When you get there, your limbic system is still wired to react to the old cues.
  • You may know, in your rational brain—the one that bought the train ticket to the tiger-free neighborhood—that there are no more tigers in your vicinity.
  • But your rational brain didn’t have the primary responsibility for keeping you alive when you lived with tigers.
  • The neocortex is not a first responder.
  • That burden fell to your hindbrain, the feeling and reacting brain. And that part of your brain doesn’t “know” that tigers are out of the picture now.

ADHD Fear-Based management

If you’ve experienced prolonged exposure to hungry tigers—or if you’ve served in combat, or survived rape, or been traumatized as a child—your hindbrain may become hypersensitized to certain cues.  Loud noises, specific locations, voices, words, and other stimuli can trigger a full-on stress reaction—even if the actual threat is no longer present. When people have extreme forms of this sensitivity, we call it post-traumatic stress reaction or sometimes disorder

Still, Imagining Tigers Everywhere

My overactive hindbrain isn’t anywhere near as bad as PTSR; I’ve never (knock on wood) had anything particularly awful happen to me. Which I’m quite happy about, thank you. Yet I find myself imagining tigers everywhere.

What I’ve discovered in teaching self-defense is that a lot of other women do too, in the form of stalkers, and rapists, and masked gunmen. All of which do exist in the real world, just as there are real tigers out there. But some of the women I’ve talked to, like me, spend extraordinary amounts of time and energy obsessing about these threats, given the odds that they’ll actually encounter any of them.

Why do we do this? I think it’s because there’s a new kind of threat in our modern environment. And, it is much harder for us to recognize than a tiger. We live in a culture that uses fear to manipulate people, that exploits and abuses our survival instincts, and prevents them from working as they should.

In the normal course of events, a hypersensitive hindbrain can be rewired. Yet, it learns to relax much more slowly than it learns to scream “Run!” It can’t think through problems rationally. It can’t take the cognitive shortcut of looking at a map and realizing “No tigers here.”

Unlike our “thinking brain,” the limbic system requires experiential knowledge, repeated patterns of this-happens-then-that-happens. (I see orange, but it’s only my neighbor’s marigolds, which don’t eat me.) After trauma, the hindbrain usually regains an even keel if given time and space and a little peace and quiet.

Sometimes it’s more complicated—if there is physical injury to the brain, for example. But for most people, once they’re in a tiger-free environment and experiencing repeated cycles of seeing-orange-not-getting-eaten, the limbic response to the old triggers gradually cools down.

ADHD Fear-Based management

Fear Dominates the News Cycle—and “Entertainment”

But look at the culture we live in. Like my hyperactive imagination, it throws potential dangers at us from every direction, nonstop. Then it spins them out into detailed narratives. Gruesome crimes are lovingly resurrected years after they were solved and turned into hour-long television shows. Missing white women dominate the news cycle for days. We’re hyper-sensitized to threats, via television, movies, news, advertisements, and office gossip. There’s no tiger-free region for us to move to, no way to escape from the danger. It’s a closed system, a feedback loop, and it’s very destructive.

What’s the result? People buy guns, and mace, and next-to-worthless home security systems, trying to calm their fears. They, for example:

  • Buy overpriced homes in gated communities, in the hope that a five-foot brick wall will protect them.
  • Buy gasoline to drive themselves everywhere because they don’t feel safe walking.
  • Spend money their rational minds could tell them they’re wasting, in an effort to appease their hopelessly duped limbic systems.

Trust Your Instincts—Within Reason

“Trust your instincts,” we tell people in self-defense workshops. It’s good advice. But be careful too, about what you feed your instincts on. The hindbrain and the neo-cortex often come into conflict when we have to make complex choices about safety. Because the limbic system issues our most basic survival instincts, it’s accustomed to getting its way. That is why the less scrupulous elements of our culture have learned to appeal to it.

ADHD Fear-Based management

If we do not want to be bullied or manipulated, we must consciously keep our threat responses in proportion to the actual threats we face. We can discipline our fighting instinct in the sparring ring. Get out of the car and walk somewhere. Look for reliable information about risk, or turn off the TV. And if we wake up in the middle of the night, we can do ourselves a favor by telling the hindbrain it’s off duty—and counting sheep instead of tigers.

As always, I welcome your comments. — Gina Pera

An earlier version of this post appeared September 18, 2o17


27 thoughts on “ADHD & Fear-Based Management: The Risks”

  1. Thank you for this hugely interesting and insightful post. My son is in crisis mode – a young adult struggling without any accessible support or understanding of his a-adhd either on the NHS or privately . His current hyper focus is he’s dying, It’s interesting reading the parallels of other people’s experiences so thank you too for those too.

  2. When you have gotten rid on one tiger reaction say your tiger is a balloon and you do all the tiger process. How being adhd when you have stopped reacting and responding to the ‘dangerous balloon’ how do you stop finding a new thing to become the next tiger so ballon is no longer getting the thrills or the kicks I’m going to start on lamps and process repeats. I find I’m anxious about one object for ages become unaxious and lessen the reaction then straight away often without gap start on the next no matter how much my rational mind is screaming stop this rediculious anxiety over petty objects or feelings. Any advice. I do have to add you have given me much reassurance as I have never read anything so close to my own lived experience it has helped my own understanding of myself and my adhd I just wish I had more help to apply this learning to me Im doing this solo

    1. Dear Claire,

      [I just responded to your e-mail. I’m adding my response here.]

      I’m glad to know this article resonated for you.

      I aim for the deep but little talked-about topics, and this felt like one.

      To answer your question, I’d say that for many people with ADHD, medication treatment will be the game-changer.

      It will be the thing that lets you stop focusing so much energy on consciously changing dysfunctional behaviors — and using that energy to do the things you WANT to do in life. The things that give you pleasure and gratification.

      Maybe you’re already tried medication and found it lacking. Unfortunately, that is a too-common experience.

      Optimizing medication is something that, unfortunately, many folks with ADHD have to do on their own. Their prescribers just can’t, won’t, or don’t have the time.

      It’s why I created Course 2, to empower people affected by ADHD to take charge of their own health and medication approach.

      I hope this helps.
      Good luck!

  3. What a phenomenal article and comment section, thank you so much Gina and to everyone who commented for sharing their vulnerability. It goes so far beyond what I can express and though you might not see this, I pray it reaps sweet rewards for you all.

    I have recently realised I have ADHD symptoms and feel like in my 24 years of life have finally come up for air. Everything makes sense and as much as the diagnosis can be daunting it is also very liberating.

    I have been ineffectively fighting an invisible giant my whole life and now feel validated and hopeful- I can manage what I understand.

    FBM might as well have been my initials, it is only now during my MSc- a long term project that I have seen the disastrous effects of using the limbic system to survive has had on me.

    For the first time I don’t feel like I have to fear my way through life and instead have hope to discover systems that work with me instead of using the giant that is FBM to work which inevitably has exhausted me. Even on days when I didn’t need it, I constantly feared it’s guaranteed return as I would need it to, well, live.

    Anyways, I didn’t particularly have a question. Just wanted to say thank you, this matters so much and I am so thankful for people like you!

    Be blessed.


    1. Dear Minnie,

      You are most welcome. I’m grateful you found the post and validated the experience for others here.

      Some of the things I come up with….they aren’t on any standard Top Ten ADHD meme list. ;-). They come from me observing, learning, and piecing together puzzles.

      So thanks for validating my post on this topic.

      take care,

  4. So, I was diagnosed with ADHD as an adult. I also got through graduate school using fear to propel me forward, not hold me back. My therapist suggested recently that I could have anxiety too.

    At first, I laughed because it seemed so off.

    But, she was 100% correct.

    I cannot relax. I overplan everything. I am constantly worried that something won’t perfect. I won’t begin to my house unless I can do a deep clean. Even showering is exhausting because it takes me so long to get ready.

    Life has felt like a constant struggle for energy, and this explains why.

    My biggest concern is that I have 1 of the 2 variants believed to cause late-onset Alzheimer’s. If my brain is constantly “on-duty”, it’s like a really old car that rarely had oil changes–it’s probably going to fall apart soon.

    1. Hi Darren,

      I think there’s a lot of fear to anxiety, right? It’s that “anxious” fear that if we don’t do XYZ, we will screw up badly.

      In my observation, the highest-functioning adults with ADHD are those who also have a significant amount of anxiety.

      That works for a while. But over time, they get tired. Using anxiety as fuel is exhausting.

      Pursuing effective treatment means they can still get things done but without that exhausting anxiety or fear — as the case may be.

      I have one of those variants, too. I don’t worry about it. Instead, I try to focus on getting enough sleep, eating well, avoiding inflammatory food choices (not always succeeding!), and getting exercise.

      Most genes are not destiny. They are proclivity – or vulnerability. There is much we can do to off-set the risk.

      For you, it might be that your current method of coping with ADHD is creating cortisol that is not good for your brain.

      You don’t mention if you are treating your ADHD symptoms, but I hope you can get on top of that. You will feel better. Trust. me!

      take care,

  5. Seriously, it is so hard to learn stuff and yet even inner terrorism doesn’t really work, It is disheartening.

    1. Hi Nora,

      “Inner terrorism.” That just sounds horrible.

      Most people have no idea…

      Take care,


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  7. I think that Tiger Tiger is a great article. After reading the other comments, I want to state something I think is important here in another way.

    People with ADD are always getting blindsided with things that others see and they don’t. That creates anxiety. When you don’t know where the next bullet is coming from, which way do you run? There is no relief because they have to get through life and play by others mysterious rules – getting thrown out of groups and never told why, always being given the wrong reason for what is actually wrong with them, not being able to motivate themselves for what has to be done, and sometimes outright failing because of it, penalized for doing things they have to do because of a combination of physical and mental needs, such as running around the room as a child.

    I worked with a man in his 40s who had to do high kicks in the back of the room during meetings to be able to stay in the room until I got him medicated. Is it odd? Yes. But should he be thrown out if he has to do it to burn off energy so he doesn’t explode ~~~

    If your girlfriend doesn’t want to spend more time with you because she can’t keep up with you and, of course, won’t tell you why, you might feel a little rejected.

    It is all anxiety. Then, when you add the factor of, when people are treated with the appropriate medication, they can’t tell when it is wearing off and to what degree and, worse yet, what do they need to do to compensate and yet sleep that night, life becomes nothing but a question mark and you didn’t see the sentence.

    People with ADD, early in life, learn that adrenaline allows them to think better. So they are more open to adrenaline and in some ways, it serves them well. Some get carried away enough with it that they develop ODD, Oppositional Defiance Disorder, where they oppose everything because fighting allows them to think and actually sometimes solve more problems early in life. (Fortunately most get through it as they get through childhood but I had to deal with a man today in his 40s who still suffers from it.)

    Many ADD people, not just with ODD, are so “involved” with adrenaline that they suffer ADD burnout, typically in the late 30s and early 40s and have to take small doses of thyroid medication because of damage to the adrenal glands.

    So, for many people with more severe ADD, and also some with more minor ADD, adrenaline is a dangerous, but useful tool. So every ADD person has to face the question of “How much anxiety do I need in my life to succeed?” Even the question provokes anxiety.

    Then when you add the fact that others can see what ADD people do wrong but the ADD person doesn’t and can’t see it, (ADD people are always the last to know they have it.), the whole issue exceeds the capability of the human brain to process it.
    And then people wonder why depression always seems to happen in ADD people – because they fail and ADD people can’t see why they fail so the depression clouds things even more.

    I think the world of ADD has become too dependent on methylphenidate and we are not looking further hard enough. There is a researcher at Stanford, the same man who found Parkinson’s shaking can be treated with brain stimulation in a certain area of the brain, has found that he can stimulate a nearby area to treat ADD.

    It is now in the testing stages and, last I heard, he has treated over 600 people so far.

    Strattera and Provigil are also better directions for some. But a disease that affects so many people, causes so much pain and disruption and costs society so much money needs more research into new areas and not just a new form of methylphenidate.

    Statistics I have seen say that 54% of the people in prison have significant ADD and 50% of the presidents of Fortune 100 companies do as well. That indicates that, if ADD is successfully treated, it can be very useful. Or it can be very dangerous. With such strongly juxtaposed outcomes representing the results that ADD people must face every day, and face with blinders on, is it any wonder they have anxiety?

    1. Dear Alan,

      Thank you for that incredibly moving and all-too-accurate-for-many essay.

      I read a study recently confirming what I’ve always observed: That people with ADHD who also have anxiety (not as a side effect of ADHD but as a co-existing neurochemical condition) tend to function better. Their anxiety propels them. Before it exhausts them, that is.

      Thank you, Alan.


    2. Hi Alan,
      You just explained my life. My anxiety had gotten so bad at work, feeling like I was about to do something terrible to ruin my life, again, after doing so well for so many years, I sought help from a mental health professional.
      Long story short, I had a long simmering idea I had ADHD and tried to treat it holistically, It worked a little but after 47 years untreated I needed real help. They confirmed I have it. I take Strattera everyday. Life is a lot easier. Now I am dealing with the Anxiety and physical havoc ADD has beat me down with my whole life.
      Alan, you hit it on the head with your analysis. I had been living on my Limbic System my entire life. It sent me to prison for 10 years of my young life. Thank God I got some coping skills while there. Meditation, CBT, Narcotics Anonymous, and some education. Enough to finally allow me to make a semi normal life. An early diagnosis and meds as a kid and I am sure I would have been a CEO somewhere.

    3. Dear James,

      Thanks for your comment.

      Even after all these years and hearing so many stories, I am still staggered on a daily basis…..the human and societal cost to ADHD going unrecognized.

      I’m glad you’re feeling better.

      I imagine there is a reason you’re taking only Strattera and not a stimulant. But just FYI — Strattera works well for an estimated 25% of adults with ADHD. For the rest, stimulants are clearly the better choice.

      It might be that a stimulant, if you can take one, would help with the anxiety (which might be cognitive in nature, related to ADHD, and not an Anxiety Disorder).

      Some people do well on a low dose of Strattera (25-40 mg) and a stimulant. This is an accepted idea in the ADHD medical literature.


  8. I understand that the limbic system is about flight and fight, but where does love come from? It certainly doesn’t have anything to do with reason. I ask because I spent the weekend with my grand-niece and love is the best way to describe it. She’s 3 months old. She smiles. She likes being held. She fell asleep in my arms. It was all emotion. The really nice kind.

    Sure, it might not be good to depend on the limbic’s system of pressure, pain, and fear to get things done but love is not so bad. Maybe the limbic system keeps us alive in other ways as well.

    1. Hi Matt,

      No one’s suggesting getting rid of the limbic system. 🙂

      The point is that, especially with untreated ADHD, the limbic system can overpower the underpowered prefrontal cortex. That means more primitive instinct than reason. We need a balance of both.

      I’m not sure about your question, where does love come from? Are you saying that the baby loves you or you love the baby?

      I’ve read a bit about “love and the brain” and it’s complex, because there is not one type of love. Most of the research seems focused on “romantic” love. It involves many “brain parts” and neurochemicals.

      This study found that “different parts of the brain fall for love. For example, unconditional love, such as that between a mother and a child, is sparked by the common and different brain areas, including the middle of the brain. Passionate love is sparked by the reward part of the brain, and also associative cognitive brain areas that have higher-order cognitive functions, such as body image.”


  9. Am I wrong here or is her article describing various forms of anxiety and panic disorder?
    It is my understanding that anxiety can be primary or secondary to ADHD. By that I mean, anxiety is often secondary to ADHD as a result of poor executive functioning. Thom Brown, PhD has presented his model on ADHD and executive function deficit at numerous CHADD conferences over the years. He has written many articles and books on the topic.
    Since we all know that ADHD has a nuerobiological basis in most cases, brain functioning works differently in those with ADHD than the average person. Signs of poor executive function includes difficulty initiating and shifting tasks, managing time and materials, planning ahead, regulating emotions…. If a person with ADHD has never learned any compensatory executive function skills or appropriate coping skills and one factors in the above symptoms, guess what… will be in constant chaos which causes anxiety. Typical organizational strategies often fail because they don’t take into consideration how the ADHD brain functions. And its NOT intentional! Thats why its imperative that ADHD gets appropriately treated.
    While medication is a personal decision between a patient and their physician, behavioral therapies typically won’t work if the ADHD is not well controlled. Think about it, if a person is distracted, hyperactive/restless both physically/mentally/emotionally, and impulsive….how would any therapy be effective?
    However, anxiety can also occur as a primary stand alone diagnosis not associated with ADHD. For example, post traumatic stress due to war or victimization or having a specfic phobia (fear of bees, flying, outside, enclosed spaces) are not caused by ADHD. Primary anxiety is treated differently as far as both medications and therapies.
    The Tigers article seems to surmise that fear is intentional in those with ADHD and that bothers me. Its almost saying that those with ADHD or ADHD and anxiety can not tell the difference between a hypothetical threat and a real one. While that may be true in severe cases and ADHD can be a traumatizing experience depending on how it’s handled, keep in mind that many of those with ADHD have a unique propensity to notice certain details often overlooked by the average person. Many of us are highly intelligent and are acutely aware of whats going on around us And may even know it before others.
    The point is important because the treatments may be different depending on whats driving the anxiety. Guessing and applying the wrong treatment could be disasterous and make symptoms worse, not better. For example, if anxiety is caused by poor executive functioning due to ADHD and one would blindly apply desentization therapy based on a belief that person has a fear or is a result of a other person projecting their own fears onto that person……I woukd hypothesize that this would cause a seperate primary anxiety that wasn’t there and be disasterous.
    Obviously, a healthy lifestyle impacts both primary and secondary anxiety and ADHD, but its considered more or an adjunct therapy not to be relpaced with scientifically proven strategies.
    The brain is a marvelously complex organ and varies from person to person. I would be hesitant to simply make the connection of ADHD to fear as intentional and easily controllable or minimize the perseption of someone with ADHD as being less than. That simply isn’t true.

    1. Hi Gwen,

      Thanks for taking the time to outline all those points.

      I wouldn’t say your wrong so much as you haven’t put this article in context.

      This is a blog about ADHD. That means topics are presented via the ADHD lens.

      I’m pretty sure everyone reading this blog knows that anxiety can exist on its own, unrelated to ADHD.

      The point here was not to provide a treatise on all the things that look like or actually are anxiety. The point also wasn’t even to present the myriad ways in which anxiety can present in people with ADHD. That would take a tome.

      Thep point was to hone in on the particular ways in which many people with ADHD “self-medicate” with fear—without even realizing it.

      As for your statement: “keep in mind that many of those with ADHD have a unique propensity to notice certain details often overlooked by the average person. Many of us are highly intelligent and are acutely aware of whats going on around us And may even know it before others.”

      I wouldn’t agree that a “unique propensity to notice certain details” exists among people with ADHD. In my 20 years of experience and study, I’d say that this tendency more involves misdirected attention, often missing the big picture and focusing on the most “stimulating” and anxiety-producing detail. Many people with ADHD are convinced that their “instincts” are reliable—about people and situations—but it’s often the case that they are confusing strong feelings with accuracy.

      At its core, ADHD is a condition of poor self-regulation. And that includes “allowing” (without choice really) the limbic system to hold sway over perceptions and decisions. Medication can strengthen the capacity of prefrontal cortex functions to “check” limbic-system-driven emotions.

      Some people with undiagnosed ADHD have been treated, for decades, as wrongly suffering from anxiety or depression. While ADHD and anxiety/depression can co-exist with each being neurobiologically primary, untreated ADHD can also “look like” anxiety or depression.

      If you were familiar with my work, you’d know that I never attempt to reduce people with ADHD to one stereotype in any direction. Human brains are like snowflakes: no two alike.

      ADHD traits are human traits. It is the number and severity, in combination with impairment in life, that makes the diagnosis. People with ADHD aren’t a different species. 🙂

      My husband was attempting to manage his unrecognized ADHD in the only way he thought he could: By drumming up a lot of fear about consequences. That’s how he made consequences more meaningful—and motivating.


  10. Hi Gina,

    How often I’ve struggled with the benefits versus the damage caused by FBM. I’ve noticed that those who use fear tend to get more done but suffer often with anxiety and overwhelm. Those with adhd who experience more depressive symptoms tend to struggle mightily with activity.

    I recall a talk by R. Barkley, where he talks about the executive pathways of how internal and external commands get executed. A typically functioning executive system takes place in the forebrain and follows a typical course of, command to execute and things get done. In the adhd brain, the command to execute dies prior to execution. The body has a secondary pathway for execution and it is found in the limbic system This limbic pathway is one used for short term super efforts. A crisis management system that utilizes a great deal of energy over a few weeks of crisis.

    This secondary pathway is available to those with and without adhd I suspect at one time or another everyone when faced with emotionally charged deadlines and when the task is accomplished only then does the burnt out tiredness overweahelm a person

    I have become very aware that the primary executive pathways fail me on a daily basis such that I can see no way around utilizing the more emotionally activated secondary pathway. As I get older, the toll using emotion as a motivator does woŕry me. What physical toll is it taking? How many years is it taking from my life?

    Having been medication intolerant for many years now, I don’t see a solution to FBM. It’s either that or getting not nearly enough done and my financial survival is compromised.

    Depression seems to compromise even the use of the emotional executive pathway. Medication can help but more often than not It’s no magic bullet.

    Lastly, the person speaking about human tigers, really speaks to my experience. It doesn’t seem to matter if the tiger is expectations from a loved one, an employer, a friend, or a teacher. There are consequences to not meeting expectations. How often have we heard ‘s/he self managed for a few weeks but then went back to the old annoying ways.’ In my experience a super effort was made, the limbic pathway was activated and because it cannot sustain long term it poops out after a few weeks leaving you drained a and potentially worse off than before because you personally failed to meet long term expectation.

    It’s not possible to expect much in the way of understanding because It’s so difficult to understand an unconscious process simply not working. Even if a person does understand, the consequences remain and they can be unbearable.

    I don’t mean to sound overly dramatic or even pessimistic. I am grateful for this secondary pathway, even if it only gives me short term access to executing an action, even if it takes a massive toll, because It’s served me even as It’s cost me.

    Perhaps workplace and social culture expectations have increased, or are using emotional manipulation to activate this super effort pathway, for the average person and they are also being taxed to I’ll health. Hopefully some good will come out of it.

    Please forgive me if my thoughts are disorganized. It makes sense to me but that doesn’t always translate to others. 🙂

    1. Hi Lori,

      I’m pleased to hear from you. It’s been a while.

      Your thoughts here seem very organized to me. I hadn’t recalled Barkley describing the phenomenon in that way, but it does make sense. And it does sound exhausting.

      I hope that you can find ways to build in “environmental supports” so you can do what needs to be done without undue taxing of your nervous system.

      take care of yourself!


  11. An old Human Anatomy and Physiology Book By Elaine Marie, Kathy Hoehn,(Pearson) , states that the “CNS” (Central Nervous System) “is the integrating and command center of the nervous system. It integrates sensory Input and dictates motor responses based on past experience, reflexes, and current conditions. ”
    This and other articles of your blog have said as much in many ways.

    Too often we focus on the “statistics”, as leading us to the “cause”, rather than as the results of multiple reasons, or more likely the interactions of multiple causes, some leading to different and/or similar reasons for the end results observed.

    With my version of ADHD, fear, worry, anxiety, over thinking, over planning, being on constant alert, seems, all too often, necessary and occasionally profoundly problem causing. But always tiring.

    If I do nothing, the tigers stay away. But living ends. With my past experiences, whenever I strive forward, the tigers, often in human form, have managed to find me, or those surrounding me, leaving me alone to defend myself, as I can, at my expense, and their benefit, or my “owned” (unintended) peril.

    Too often in the media, and even in ADHD circles, a single paragraph, statement or other description, leads to stereotypes and undeserved simplifications.

    These “past experiences” and “fears”, as Susan Schorn has written, are a well justified exception.

    I have had safe zones, but they seem to continuously disappear. Most people wouldn’t recognize ADHD as the cause. But they also don’t seem to see themselves as the tigers, and hyenas of my and others’ worlds.

    1. Dear Paul,

      You’ve eloquently taken this topic in a very profound direction. I’m especially moved by this:

      “With my past experiences, whenever I strive forward, the tigers, often in human form, have managed to find me.”

      and this:

      “But they also don’t seem to see themselves as the tigers, and hyenas of my and others’ worlds.”

      Thank you.


  12. Dear Gina, the FBM really resonated with me. I self diagnosed myself as ADHD after having gone through 50 years struggling. Like your husband, it was FBM that got me through my academic years right up to university. I attributed the fear to not having a decent life without any university education and the fear to let my parents down, especially my Father, who worked so hard to provide us good education for our future.

    I struggled so much in the last 2 years at work that I really had to quit. While I may have a Low esteem of myself, I have always been proud of my strength to be able to to have that instinct, to be able to “anticipate problems” and introduce measure to pre-empt. Or when things get really bad, I am always the one standing up and being counted.

    But sadly, you article brought me back the reality that this is not a strength but the malfunctioning of my brains.

    I need solutions to help me solve and take control of my thoughts. I am afraid of taking medication because of the side effects. As I get older, (51 now), I fear that I don’t have the energy to manage and worse still, getting Alzheimer or dementia…

    Any suggestions on how we ADHD people can get back control of our brains?

    1. Dear Shavanas,

      Thank you for your thoughtful comment.

      The reality of blog posts is that they are necessarily narrow in focus. I needed to “make room” for Susan’s essay, which is the real star of the show here. So, I gave a very short intro.

      What you describe is reminder to us all that a weakness can be a strength — and vice-versa. The difference depends on circumstance and the ability we have to control it. And that’s where ADHD can be a problem: by limiting the ability to control or assess when to let fear wisely guide and when to check the fear as outsized.

      All I know is that FBM seems like a very tiring way to go through life. My husband is so much happier now. Probably happier than he was ever as a child, too.

      I’m sure there are other cognitive approaches to managing FBM. If ADHD is mild and one has a strong philosophical framework. But oh, how much work that would be, and at what cost?

      I strongly encourage you to consider medically treating ADHD. It might very well help to balance that “new brain” and “critter brain” — so that each can contribute to keeping us alive and making that life worth living.

      Notice that you said you were afraid of medication. Why, that sounds like one of those limiting … fears. 😉

      In my first book, I write about FEAR – False Evidence Appearing Real.

      Wednesday night was my monthly adult ADHD group in Palo Alto. Almost everyone in that group has experienced profoundly positive change in their outlook and lives thanks to medication. It’s not always a miracle-worker (though in some cases people rightly describe it as such). But it can truly make a difference in providing a sense of peace and contentedness that isn’t permeated with the compulsion to keep looking for that dark cloud on the horizon. 😉

      I encourage you to examine that “false evidence appearing real” around medication.

      It is true that some people experience side effects. But sometimes side effects simply provide more data that helps to fine-tune the type and dosage of medication.

      Remember that trying medication is NOT like cutting off a leg. You can always stop. 😉

      And if you follow the logical approach in my book, you greatly minimize the occurrence, amplitude, and duration of any side effects.

      Check it out.

      Good luck!


  13. Great article! I always felt my former partner w ADD would conjure up the worst case scenario to be prepared fir the worst. It did ultimately lead to serious overreactions and became dangerous to me….i felt my sanity, peace of mind and trust were too severely compromised . Our “us” / relationship could not survive the angst and “oil on fire” monents when rational thought and safer responses were necessary.

    1. Thanks for your comment, Jane.

      “Self-medicating with disaster scenarios” is a very scary habit. But it’s easy to fool oneself in believing it’s actually prudent.

      The lies our brains tell us. 🙁

      I’m glad you are safely away from that situation.


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