ADHD Psychiatrist: 3 Signs You Might Have ADHD, Why It’s More Than Focus & the Emotional Symptom Most People Miss

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And I was like, excuse me. What does it mean to be too sensitive? I look at emotional sensitivity as a neurological phenomenon. You're wired to process emotion differently. You feel your emotions before your logical side can kick in and be like, "Okay, this actually isn't that big of a deal." For someone that's struggling with self-worth, what's your number one piece of advice? Just understanding your brain takes away so much shame and so much guilt. What are the top three signs that someone has ADHD and just doesn't know yet? You're not going to like my answer. One. How do you know if you actually have ADHD versus you're just distracted all the time? Here's the day-in-day out. People come to my office and that's what they complain of. They complain that I just can't focus. To them, I say, not being able to focus at times absolutely part of the human condition. What you have to look at is that if this is a constant and chronic pattern from childhood, you need to look a little bit deeper. Usually you're looking at patterns over time. When you say not focus, I guess there's different ranges of that. For a long time, I've always felt like I couldn't focus and then when I found out about the term ADHD, I think me, like a lot of people were like, "Oh, that's me." Then later I did find out that I actually do have ADHD, but where is that range? I think the way we talk about ADHD just in general is kind of stupid because I think that when we talk about ADHD first, it was really the criteria was built for hyper-young boys, which doesn't encapsulate a great majority of the population or the presentation of ADHD right now. Our criteria is already skewed and our criteria really hammers on just the focus component. To that, I would say, with ADHD when you're looking at it just comprehensively, it really is more about a dysregulation of things. It's hard to regulate emotions, it's hard to regulate sleep, it's hard to regulate appetite, all of that is included. That's so interesting. As I was doing research and watching some of your content, I picked that up, but I was actually quite surprised. That actually made me realize, oh wow, some of the other patterns that I have are associated with ADHD when I simply thought that it was all a lack of focus, but it's more than that. Why is there not more awareness around that? Oh my God. The problem is that we're only as good as the tools we're given. If our criteria is they decided at some point, this is what it's going to be, then you have to go by that. That's what doctors are saying, this is how you're going to get diagnosed. The thing with psychiatry is that overwhelmingly, it is just change is so glacial. The only time you really see things change in psychiatry with terminology or with criteria or with access is if there's a public outcry for it. I just don't think people are talking enough about this phenomenon because I'll tell you, looking at ADHD like a regulation disorder, that's not just something that I came up with. And this is from the influences of so many brilliant people around me, and you look at how ADHD is treated and looked at across the board, like you're up changed its criteria in 2019 to include emotional regulation into the criteria. We just haven't done anything with it. Now I'm sure people listening are like, well, I wasn't sure if I had ADHD. And now I'm even more confused because there's so many other criteria. So what are the top three signs that someone has ADHD and just doesn't know yet? You're not going to like my answer because I think it's so highly personalized. But here are some of the things that if I see this in my office, I will always ask about ADHD afterwards. One weird thing that I don't think many people ask about, but I think it's so important, is if you've had a huge history of failed antidepressants, because a lot of times people who have that emotional dysregulation with ADHD, they go in, their doctor is like, you've got anxiety, you've got depression, you've got this, they start medication, they continue on medication. Okay, this medication isn't working. Okay. Let's move to the other one. Let's move to another one. After a while, they're like, I think something else is going on. I don't think this anxiety and depression. Maybe let's look at ADHD. And to that, the doctor will say, hmm, but we haven't treated your anxiety and depression. So we can't look at ADHD right now. So you get caught in this loop. That's one huge thing. And I've had people who have come to my office who have been on 10 different antidepressants with no relief. So if someone is feeling anxious or depressed, they're on anxiety or depression medications. They've never taken a test for ADHD and nothing is working for them. Do you suggest that that person goes and gets tested for ADHD? It's one of those pieces where if you failed, numerous, numerous medication trials and your presumptive diagnosis is anxiety or depression. If you failed so many medications, it stands to reason that maybe your diagnosis isn't totally correct. So then it really prompts, let's do testing, figure out what the right diagnosis is. And let's be comprehensive this time. Let's not just look at anxiety and look at depression, but maybe we need to include ADHD in this. So is there an actual ADHD test someone can take that tells them if they have it or not? No. And I'll tell you why. Part of getting the ADHD diagnosis is its equal parts ruling in an ADHD diagnosis. And again, that's based on criteria which I don't love, but also equally important is ruling out the other stuff. Anxiety needs to be ruled out, depression needs to be ruled out, thyroid illness needs to be ruled out. Some other metabolic underlying thing, autoimmune stuff, trauma, like there's so many different things that need to be sorted out and distinguished. So yeah, you know, I've had people who are like, I took this online test and it says I have it. I'm like, well, I don't think that's giving as much clinical data as we think. It's a good starting point to ask questions, but it's not diagnostic. So go back to the three most identifiable ways. So one is that there's so many other things that it could be. Yeah. And even anxiety and depression may not be that. It could be stemming from an underlying ADHD condition. What is number two? I think number two would be if someone comes into my office and they are saying, I got my kid assessed for ADHD and they have ADHD and now I'm curious about it. That's one of the things that I look into because ADHD is so highly heritable. It runs in families. It is highly genetic. So if you have, usually by the time a mom or a dad is picking this up and typically I say mom because adult women, they're diagnostic, the time they get diagnosed is so much later than males. By the time they're picking it up, they're taking their kid to get assessed. The kid has ADHD. They're sitting in the assessment and they're like, all of those sound like me. And then that's when you kind of start thinking about that. And then if you actually do the work, start thinking about like, my mom had stuff, my grandma had stuff and you can see it. Is there some sort of self diagnosis that someone can do to figure out if they have ADHD or not? I don't think it would be accurate. I mean, so I tell people like the best place you can go as of right now to look at criteria is the DSM, the diagnostic statistical manual, which is how we diagnose things in psychiatry. It's literally this huge manual and you have the different diagnostic criteria. That in and of itself, I think is tricky because it doesn't rule out stuff and that's typically why you need a trained mental health professional or someone with a skilled eye to be able to tease out those things because I've had a lot of people come into me and they are, you know, they went down the algorithm and they've been fed all the videos and they're like, this is 100% describes what is happening. But I know that's how they feel and I don't want to diminish that because to some degree, I think the fact that they felt so strongly is the thing that drove them to get care, which I love. So I think it's very important for driving conversation and providing language for your internal environment. I think that's wonderful. But where I start to draw the line is that when number one, when people get too entrenched in a diagnosis, but I think this story is important because, you know, I've had situations where patients have come in, they have been dead set. I have ADHD. That's what's going on. My focus is so fragmented. My emotions are all over the place, but then you talk to them and they're in the midst of an abusive relationship. And so their life feels very chaotic and it's difficult and yes, there's the possibility that ADHD is underlying it. But you look and you ask all those other questions to kind of tether what's the actual cause of this fragmentation of focus and you get a trauma. It's not an underlying ADHD. When did this start? It started. When, you know, my relationship progressed to this, did you have it in childhood? No. So you're making different, you're helping with timeline and understanding and trying to figure out what what's the cause? So number one is there could be a lot of other things involved. Number two is that it's often hereditary. So if someone in your family has it, what would you say number three is? Number three, when I see it in practice and I think about ADHD, which is a little bit counterintuitive and slightly related to number one but I think it's important is the emotional regulation side because that's something we never talk about. But I will say when you do this longitudinal research, when you look at international papers, when you look at how literally, and actually I'll turn this around and you know, when I'm saying this stuff, let me know if this sounds like you, but for a great majority of a lot of ADHD people's lives, especially if you know they're higher achieving or they're capable of like blossoming under traditional metrics where they look successful. Usually those are the people who can delegate or they can hack their way around things or they thrive on urgency and they really lean into this hyperfocus to get done with creative projects in this blaze of glory. But if something emotional comes along the way, it completely stifles productivity. Because you can delegate and you can hack your way through focus, but you can't do that with emotions. Definitely sounds familiar. One of the things that I've talked to my wife and I've learned about myself because I'm always on a journey of self discovery and trying to figure out how we can get better every single day. And I notice that sometimes like when I need to be in the middle of writing a script, I need to be super focused. And let's say that my wife wants to come in and like chat for a few minutes about something. I'm such an empath, right? Like whatever someone else is going through, I always fully absorb those feelings. And so she's had a long day or something's a matter. I used to say like, hey, no worries. Let's chat for a few minutes, right? But what I realize is if I take that break when I'm in the middle of some project that I'm focusing on, as soon as I know that something is wrong, and by the way, she could even not say it. I could just see like a look or I could feel it. I will not be able to focus on whatever I was. So I'll have to now say like, babe, I'm so curious about your day and I want to know everything about how you're feeling or what happened. But if I could just please wrap up this project and then I will give you all the time that you need. Yeah. And even then it's a little bit hard because then in the back of my mind, I'm like, what is going on? What is going on? Right? So that's interesting. Does having ADHD necessarily mean it's a bad thing? No, no. I think with ADHD, so here's my problem. I think looking at ADHD is purely a negative. That's really hard for me to swallow. And it's something I've done for a big portion of my life, especially when I was going through medical school. I'm like, look at all my peers. They're sailing past me. How could this possibly be a positive? And then as I kind of grew and developed, then you kind of got introduced to this flip side of things where people were trying to rephrase this as just ADHD is super power. And it is like you should be so grateful. Not everybody has this capacity. And what they're referring to is like those moments of hyper focus and that creativity and the ability to think outside of the box, all positives. Still like you got some negatives in there. I think the best way to look at ADHD is it's just a thing. It's neutral, right? They've got positive. It's got negatives. But I think if you have a realistic view about it, you can work with that instead of just like gaslighting yourself into thinking that this is the best thing in the world or like being despondent because you're like, I'll never get better because it's the worst thing in the world. And we don't talk about this enough, but what are some of the positive aspects of having ADHD? Well, the one that I've been talking about and I feel so strongly about is the hyper focus is one of them. This because of that dysregulation of focus where a lot of people have this kind of sequential almost like battery for focus. People with ADHD, I think they have an interest-based nervous system. So they're driven by interest and urgency and novelty. If something is clicking in that, you can just run with something and get done with a tremendous amount of work and do it really well. Really well. And so that's why being in this weird world of social media, it's like I've been around people and all of them have ADHD because it's like, this is like slightly more on the impulsive side. So instead of like just overplaning content, they're like, I'm just going to do it. I'm just going to make it. I'm just going to put it out there and see what happens. And then as they get instead of like worrying about like, what if this goes wrong? What if this goes wrong? It's like, I want to do it. I'll learn on the fly and then they get better and better and better instead of shooting themselves on the foot. I think they people with ADHD tend to be very creative. And just that's because they're taking a tremendous amount of input, and they have to filter and organize that information. And sometimes it goes in, sometimes it doesn't. And so you have to think of these unique ways to get around problems to fix things. And those I will tell you a lot of times, that's the best way to possibly fix it. And then the one that I think I'm biased because I feel like this is the best part of my ADHD is probably the connection with the emotional side to it. Because I think that not that you have to have ADHD to be emotionally sensitive, but I think a lot of people with ADHD are highly emotionally sensitive. And for people who are highly emotionally sensitive, I think that capacity to feel empathy, that capacity to sense something in the room has changed, to look at my kids' faces and to know what has happened. Like, I think that makes me a better parent. I think it makes me a better doctor. I think it makes me a better partner. I think it makes me a better daughter. I think it just at all around, I've really, I've really held on to that because I think it's a beautiful advantage. Meet new groupie setting mist from Maybelline New York. Gel to mist technology locks in your look for up to 24 hours, with flexible all-day comfy grip. Just plump, dewy, hydrated skin, that still feels like your skin. Try new groupie setting mist from Maybelline New York. Maybe it's Maybelline. I can really relate to what you're saying, because when I become passionate about something, no matter how much my plate is full, it suddenly becomes like the most important thing that I have to get done and I magically found all this time and I will get it done so rapidly quick. In my opinion, to such a high level where it's almost shocking to everyone, so I'll just give you an example. I've been really just behind on work lately and it kills me when I'm behind on work because I like to always be ahead of my deadlines. I mean, blowing people away, it's like how fast I turn things around, but just this happens to be one of those weeks where I'm just trying to play catch up. I can't catch a breath. I had this meeting this morning with this brand and the call went so good that I was so energized and excited by it and they were like, okay, well, how quickly, you know, we'd love to work with you. How quickly can you turn around to proposal? Yeah, on the call, I said, tomorrow, and you know, most big brands, they're used to like, you know, give us a month, give us a week or so. And I was like, I'll have a suit tomorrow. I could not think about anything after the call. So I spend the next two hours, vigilantly focused on typing out this great proposal. So I sent over like a 10 page pitch within two hours of the phone call. And I mean, the brand was shocked that they turned it around so fast. But for me, I was just like, wait a minute, I'm so behind on all these different things, but I couldn't even focus on anything else because I just suddenly got this like abundance of energy that I need to get this done right now. So that could be one of the choices. And when you feel that it's like, it's almost behooves you to ride that wave. Like, I know this is going to benefit me. Like, yes, other things might suffer. And I should be doing other things. But I know what's going to come out of this is going to be a blaze with a glory. So I'm just going to ride this wave. And you know, I will say because I know there's a lot of people here that are just self-development enthusiasts and, you know, trying to get to that next level in their career. I used to think of my sort of to-do list as, all right, well, I got to go in some sort of chronological order. And I go based on deadlines and all things are sort of weighted the same. But, you know, as I've gotten further in my career, now I realize that a lot of times it actually quite makes a lot of sense to fall behind on certain tasks and to move up what's important. And so I would say it's almost like priority stacking, right? And I stack based on sort of the weight of the opportunity. So how I look at it, there's actually something called like a T-shirt exercise that you can do for anyone that's ever stuck. So how a T-shirt exercise works is that you look at all the different opportunities, right? And this can work for work. This can work for self-care, for fitness, for spending time with your loved ones, for any aspect. You can look at, here's all the different opportunities that are available to me. Here's how difficult that task would be to achieve. And then here is how much of an impact that task would actually make. And so in this instance, right, I'm just going to put dollar amounts on things to make it easily measurable. I have 10 different things on my to-do list. And each thing is worth $10 and takes two degrees of effort, two hours of time. And then suddenly I get an opportunity that's worth $100 and takes one hour of my time. Well then suddenly that becomes the most important thing. And I raise it all the way to the top. So it's almost like the Pareto principle, right, the 80/20 rule. We spent 80% of our time sometimes focused on things that drive 20% of our results. I also think about how can I spend the most amount of time focused on the things that drive the most meaningful results. So as I talk to you guys openly about my issues, I just also want to say that there's a little bit of sanity behind the madness and that at times it actually might make sense to do things out of order or to change up or to miss deadlines and certain instances. And I understand that not everyone is their own boss and we're all responsible for certain things, but I would say is someone who manages a lot of team members. If someone who came to me and said, hey, Dar, like, I know I had this deadline for today, but suddenly this higher priority task that has so much potential came up, would it be okay if I worked on that first and I fell behind in this other deadline? I would be like, thank you for bringing that up because so many of us like feel stuck in like I kind of have to do whatever my day demands of me versus like, how can I optimize for like the best pops back up? Sorry for this total tangent. What you're saying is actually really interesting because what you're doing is you're describing how you work with your own neurobiology. If you're saying my brain is wired for hyper focus because of that underlying dopamine dysregulation or whatever is happening inside that makes my nervous system only really activate with urgency and interest and novelty. You know that in whether or not you knew it at the time or you're like you've been implementing strategies that really capitalize on that movement and I think that is one of those things that does really make people with ADHD successful. When you stop kind of like forcing yourself into a mold that you can't always fit and that for me, I feel like that was such a limitation for me because I kept trying to study like my peers. I kept trying to work in the hours that they worked. I kept trying to like stuff that wouldn't light up my brain or make me motivated. I would just like almost like punish myself to do. Whereas really I could have like if I just leaned into things where I was more interested in focusing and I could just start from a different area. Start from a different side and just like ride those waves of momentum and then I would get those other things done. That was a lot more eloquently said than how I described it. So thanks for having it that way. I also now just want to kind of get into your backstory because you have such a fascinating backstory, but you know not only are you one of the you know world's top experts when it comes to ADHD, you've also openly talked about having it as well. And I believe you first came to know, well maybe you didn't know at the time because I'll let you tell that story. Your parents may not have been as forthcoming, but you first discovered something was wrong in the fourth grade. How did that happen? So fourth grade, I literally organized a coup in my classroom and there was substitute made all the kids stand up on their desk. It was it was non to especially like since you're a parent, like how do you get kids to stand up on their desk and what amazing leadership quality person, right? I don't know. Maybe it's the narcissist thing. It was one of those things where and like I have no recollection of like how it actually went down. I remember being like very acutely embarrassed when my parents, because the substitute talked to my teacher, my teacher talked to my parents and they were like she has ADHD. I don't even care if we're not allowed to diagnose. That's what's happening. Go to a doctor and like my parents trying to like retell the story to me even to while they were retelling it. It sounded so unbelievable and I was like there's something wrong. But so I started this is in the 90s. Yeah. Okay. 95. So there's not as much awareness around. There was nothing. And especially not for girls. Okay. So still seeing is this like boy centric thing. Oh, I don't think that change. I still think at places, it hasn't changed, but it was not talked about in girls at all. I only knew of one other person who had ADHD and it was this super hyper boy in my class. And I was like, I'm not that guy. So I didn't know my and my parents, I mean, it was just a weird kind of spot to be in because I grew up. I was going to private school in the middle of Santa Barbara where it was predominant or the area that I was in and the school I was in was predominantly white. I was the only person of color at that time. Your Pakistani, your parents were born in Pakistan and then okay. And then I went to the school and then they I got diagnosed and luckily, my mom's and pediatrician took me to one of her partners. They were like, yes, we all know. Then I was started on medication. But at the time, ADHD wasn't explained to me. I didn't know it was medication. It was just kind of couched as like, this will help you with school. So what were they telling you when you went in for these appointments? It was like, it was like part of my physical. I just didn't think about it. I've thought a lot about it. I'm like, why did I not pick up anything? Well, you're in fourth grade because I would have to get like refills of the medication. And I would just be seen. And I was like, I assume people get seen every three months. But yeah, and see, you know, they would, I would, you know, I just, I don't know. I guess I never thought it was weird. And also like, I was always at my mom's office waiting for her to see patients. So it would be like at the end of the day. And so sometimes it felt like very casual and but I, I didn't know. Did you grow up with a lot of pressure on you? I mean, given that your mom's a doctor, your brown. Yeah. That doesn't help. You know, my parents, like my dad would always say, what does your dad do? My dad was a CEO of his own company. Okay. Well, that didn't help. But he was like, I expect excellence. But you can get there whatever way you want. Like, I just need you to bring up the community. I need you to bring up yourself. I need to bring up your family. And so for me, I knew from a young age, I saw how happy my mom was in medicine. I wanted to do medicine. Did well enough. I got into a medical school right out of high school in a combined program. You were 18 years old. 18. And I mean, that is so rare. Like, I know, maybe not in your family. But yeah, they all grew up internationally. It's really on the internet. And did you feel like, hey, you know what? I am that kid. Like, I am the shining star. I did. And then I got there and I was like, oh, wait, I'm not the shining star. Literally, everyone else is exactly like me. But they were in their 20s, right? No, no, no, no, no. Oh, this school is natural. Okay. But now you're in like, this elite, you know, I'm guessing like group of like 1% of 1%. So you're competing against people that are at the top of their game. But you were comparing yourself to them and feeling like you were not enough. And I was not enough because literally the minute I got there, I lost my medication. And I like couldn't do anything. What do you mean lost it? Like physically lost it? Yeah, like, it didn't know where it was. Like I'm somewhere in the unpacking. Did you know that it was medication for ADHD at that time? No, I thought it was just something to help with school. And it was a vitamin. And I was like, whatever. Can't be that big of a deal. It was that big of a deal. Yeah. I then, you know, go through my schooling. I was doing really badly. And my dad was like, you know what? Have you been taking your medication? And I was like, no, I haven't. I don't even know where it is. And he's like, it's for ADHD. You need to take it. That was the first time you heard about that. And did your dad realize like what he was telling you and dropping this bomb on you? Or was it just, I think my parents made that concerted like decision. Because especially at a time where I wasn't talked about. And with an extremely sensitive kid who felt very other than already. Because I did. I felt like I was different all the time. Growing up is like the only brown kid or yeah, I felt a lot better when I got into public school. I loved public school. But like when I was in that private because my parents grew up in British schooling and they were like, this is the best type of schooling we'll do. Like we'll replicate this. And it was so difficult for me to like find my landing. And so when I moved to public school, I felt so much better. But I was still taking this like vitamin medicine. So I think my parents did know like we should have had this conversation. I don't know like how we could have couched it. And I just eventually did so poorly that, you know, they tell me I was on medication. I rebel against it. I'm like, there's no, there's no, because I was sitting back to that kid in fourth grade. I'm like, I'm nothing like that guy. So I was just like, I'm not doing this. I can't believe this happened. I really, really, really, really tried to buckle down. I'm studying with my peers. I was drinking like going to coffee shops and like drinking energy drinks. So like one in the morning to keep studying like really trying. I go for my neurology exam, which is all visual, which is kind of my jam. Like if it's visual, most of the time I get it. I go into the test. I'm like, this is rookie hour. I got this. Go through it, sail through it. I'm literally the first person to hand it in, walk out. I'm like, this is going to be so wonderful to shove into everyone's face. The next day they post the grades up on on the thing. I go to the board. And I'm like, okay, I'm looking for my A D number. I'm looking at all like the random numbers of the scores. And I was like, oh, somebody got a 32. Keep going, keep going. Go back up. And I was like, it was me. I was the 32. I was like, what happened here? And I go. And I like hunt down my professor. And I was like, I know, I know I got a perfect score on this. And he's like, you didn't do the back of the sheet. I didn't turn it over. And so I was like, I'll do it orally. Like I will, like I will finish the test. Just test me. And he's like, no, you need to learn from this. You need to be careful and cautious and look. And I was like, I'll learn nothing from this. So I talked to my dad. And he's like, just come home. And let's go through ADHD. And like if it's not ADHD, we'll figure out what's going on in your brain. and let's figure out a plan. And so I came home and then we just went to the library. My mom got in on it, my dad got in on it. It was like, it was like a complete, for however they handled. And I can't like being a parent. I can't look back and look at, like I think it should have been handled, like bringing everything into the open, but parenting was different times were different. Like, so I don't blame them for that at all, but how he handled it afterwards was spectacular because it was so judgment free, so shame free. It led with curiosity. It made me feel like I had agency over my brain and like everybody was on the same team. And then I think it still wasn't easy. I had to like climb out of that hole and figure out like, do I do medications? What medications do I do? What's gonna, like some of them I wouldn't eat, some of them I wouldn't sleep. It was just like difficult finding my footing. And then I got into psychiatry residency. And then I was fine. No, and then and then I was surrounded by literally psychiatrists and therapists at all times because that's my training. And they went through and like literally built me back up into a human, like worked on the behavioral stuff. There were like turns out you're not a great sleeper. I was like, yeah, I'm not. It did like when did you eat less? When did you drink less? And like getting me back into my own body and my own brain. And that's when I really started understanding my brain and that's what really led me to wanting to study and teach ADHD more. Meet new grippy setting mist from Mabelie, New York. Gel to mist technology locks in your look for up to 24 hours with flexible all day comfy grip. Just plump, dewy hydrated skin that still feels like your skin. Try new grippy setting mist from Mabelie, New York. We often think about how do we diagnose ourselves? Do we have ADHD? But also I would say even more importantly, or just as important is the likelihood that someone listening to this has someone in their life that has ADHD and trying to figure out how do we connect with that person? How do we help that person? It seems like your parents handled it so beautifully. So what's the best way to handle a relationship with someone who has ADHD? Like one of the kindest things you can do as a human is to be curious. Like ask things instead of like pointing out like flaws or assigning, for example, like if someone with ADHD is late to something or if they forget to text back or things like that instead of assigning blame right away or writing them off, approaching it with curiosity. Like I've noticed that you're always five minutes late. Is there something like is there something going on? Is there something we can talk about? 'Cause I've been waiting, you know, things like that approaching it with curiosity and allowing the other person to kind of talk about it. And just couching it kind of like you're a safe person to problem solve this with I think is hugely beneficial. And I'm saying that coming from the weird perspective of being someone who has ADHD and also treats ADHD. So it's interesting to see things from like both sides. - How does ADHD affect relationships? - Okay, so if we go backwards and we start thinking and talking about ADHD as a dysregulation kind of thing, then you can kind of look at it more comprehensively, especially in the scope of relationships. Because if you look at ADHD as a fragmentation and a dysregulation of attention and of motivation and of energy and of emotions specifically, when you're dealing with like romantic relationships and things like that, it's such a vulnerable spot to be in. And it's such a difficult, like objectively, relationships are hard. But if you have ADHD and you're already in a situation where you don't totally trust your own emotional calibration or emotional sensitivity to things, people have previously told you you're making a big deal out of things or you don't handle conflict well, you might get into patterns where you start to avoid it. And that gets weird in relationships, right? If you avoid the big stuff, you miss the big stuff and then you get locked into a relationship that you don't know how to navigate, you can get into situations where maybe communication breaks down because it's much easier to just stay quiet or potentially, you can also go the other way because of that emotional dysregulation. It becomes very combustible where there's a lot of conflict and a lot of attention. And that breaks down communication where that really kind of just is a hard stop to a relationship progressing. You can have things that stem from this pattern that you see a lot where it's almost like this perentified child dynamic where one person who might not have ADHD falls into this parent role and the person with ADHD almost falls into this childlike role. And there's just like this incredibly efficient way to cause a lot of resentment because then the person without ADHD is like, why can't you do any of these things? And the person with ADHD is like, why are you treating me like a child? And so it's just, it becomes very contentious very quickly. - For someone who has ADHD, why might it be easier to communicate through texts or through email rather than having a conversation? - 'Cause I think that's a low impact way of entering conversation. Like for me, when I do beef with my husband, I feel like in those moments, I'm so dysregulated emotionally in the first place. Like I'm hurt and I'm scared and I'm angry and I'm like every emotion under the sun and usually it's hard for me to sort that out in real time. So we fall into this pattern and it's not great 'cause if we try to have this conversation, what happens is I just vomit everything out that I've ever thought about in my entire life and it's very disorganized and difficult to keep track of. And it's like hard to process and some of the time I'm really upset so I'd be crying and then his response, it's so overwhelming for him in that moment when some of that stuff happens is either he shuts down or he's like trying to console me when I'm like trying to get out what I need to get out. So what I found is that if I write what I need to say, not only am I actually using emotional regulation because it's not the first draft I send him. It's like the fifth draft. By the fifth draft, I've gotten locked up with like I'm very eloquent and it gets straight to the point and it's not unnecessarily wordy or weird. Then send it to him. He sent him an email, then text him that I sent him the email. Then he reads the email. He prepares food. I come into the kitchen, we eat this food together and then he either, he'll respond back via email and then we'll talk about it at that point and after we've had time to digest or he'll talk about it with me at this point. I went through your email, let's go through this and usually it's my bullet point. And he's like bullet point number one. It's like very civil and it's just much easier. It's much easier and it's kept peace for now. - So when you guys are actually having an argument, will you say I'll email you? - Oh, yes. I'm like I can't do this right now 'cause I feel like I'm gonna burst out crying right now. I need a second. And sometimes it'll be his idea where he'll be like, it's usually like me chasing around the house and I'm like, "And another thing I forgot to say." All across the house. So usually like if I've chased him into one or two rooms or if he's like, okay, this is the direction we're going. He's like, let's take a break. I'm gonna go and get the kid's food ready. You can write and then we'll come back. There's been times where he's written first to me. So it's just, that's how we enter the dialogue 'cause then we know like, we know what's. For me, it feels much easier for me to process. Once I know I've gotten out my peace. Like I'm not fighting for time or making sure that I'm being heard. I just, here it is. Digestic, come on back to me. - Is that an important part of this process? The fact that like you guys will share a meal while having this conversation? - I don't know. I've never thought about that. I guess I never thought that we're up, but we always do it. That always is discussed around food and it's always him cooking something. - Yeah. - Well, you know what's interesting, the reason I ask this, I think this is gonna help so many people because I run into this problem too and I think a lot of people in relationships do, right? Because as soon as something sets you off, naturally, we have so many feelings, we're processing those feelings while we're trying to communicate them, right? Like being able to just, I guess have the safety, right? Of being able to say, I need a minute or someone even else suggesting that because almost it's like, you've got this window of time, you need a sort of word vomit, like everything you want. And also if the other person, 'cause especially with me, like going back to how, as someone ADHD, when I know something is wrong with someone else, I have to hear it, I have to resolve it. I can't sit in sadness or I can't sit in conflict, but now I realize that my wife does so much better if she actually has a little bit to sit like in her feelings. So now we've actually gotten to a point where we have a similar discourse as well. I mean, it's taken us 11 years of being in a relationship together. We don't have such a formal process in place, but I actually had, now that you mentioned it, I feel like it's worthwhile exploring one. But so we'll often say like, you know, I'll send you a text, I'll send you an email, I'll let you know when I'm ready to have this conversation. Some of the problems that we would run into while we were trying to get here, which I'll throw out as we get into the nitty gritty of anyone trying to implement this at home, is that when she was processing her thoughts, sometimes, times I would feel very unloved, right? So it's like one of those things of saying like, all right, hey, did you want to talk? No, I'm not ready to talk right now. Okay, well, I'm going to work. So I'll see you later. I love you. Good morning. Have a great day. Silence. And then it's like, okay, we had to realize that during that time of processing, it's still important to try to express love to the person. And it's also on the other side, okay, to understand that if someone feels a little bit off, don't take it so personally. It's like an internal thing that's happening. But our equivalent of breaking bread is actually me sitting on the floor to have a conversation with her. That has been so much more effective. And when you sit on the floor, it's almost like you're seeing eye to eye, especially me, I'm six, two, and she's five, two, right, like what we're standing. There is a natural like non-equalness, but we sit on the floor, we're on the same level, but also there's just a certain calmness that's associated with it. You're almost like, you realize that you're in this position that you're normally in, and it's a way to consciously remember to like be calm and to be a good listener. - Basically grabbing. - Exactly. Because what I admire about what you're saying, and I'm sure for the people listening, it's like, sure, you could establish a process with your partner or your child or your friend or whoever and say, "Hey, whenever we don't see eye to eye, "why don't we give each other the opportunity "to process those thoughts, put it in writing, "then when we actually go to sit, "we're gonna do it over a meal, "we're gonna do it while we're sitting on the ground." That still I think is the easy part. The hard part is when someone is telling you their feelings, how not to take a personal react to it, right? Because again, like what I love about this idea is that you described it as having five different drafts of that message, because I'm sure V1 of that would be so much more tricky because it'd be like, "You did this, you did this, you did this." - It's all with you. - And then V2 is sort of like, "Well, I feel, and V3 is probably like, "I probably could have done this better, "but I noticed that, right, "you just kind of get better as it goes on." And side note, I use AI, actually, to be such a better communicator with my partner because it just takes the emotion out of it. And so all often put, like, "Hey, here's our conversation." And my V1 of going into AI is like, "Tell me a way to word this message "for everything she did wrong." And it'll respond back and be like, "Well, that's not gonna help resolve this problem." I think what your wife is trying to say is that, she feels like this, and maybe if you acknowledge her feelings first, and it really actually helps frame that whole conversation from taking place. So by the time you get to that V3, V4, V5, I think it really helps to draft a message that the other person is not gonna feel triggered by it, but how do you, is it just that you got lucky and you have a partner like this, or has it ever been challenging? Like, how do you have a relationship where you can even talk about problems and not feel judged or upset the other person? - I am the luckiest person in the world 'cause he's quite literally built a front. Like, I just, he's incredible. But I also think that there was a learning curve, especially when we first got married. He's like, "I've never had someone come out and tell me immediately that their feelings are hurt." Usually I would get silent treatment, or I would get, you know, like, immediately get into fighting, but he's like, you're literally incapable of fighting one emotion you're having. And so I think that actually is kind of an advantage in that if you are pairing that complete incapacity suit, like hide what's happening on my face. Like, if I'm hurt, I look hurt. If I'm embarrassed, I look embarrassed. Like, I can't mask it very well. The fact that he is, he can read that on me and actually wants to handle that gently, I think, is of winning pairing. - Can two people with ADHD actually have a relationship together? - Yes, yes. And I think they are really fun, really fun and like exciting and spontaneous. I think when you look at ADHD just as like a dysregulation thing in totality, you also have to look at nuance in terms of everybody's ADHD looks a little differently. You don't have the same type of ADHD replicated perfectly in one person versus the other. And that is part of what makes it kind of a challenge to diagnose and to treat sometimes. But when you're dealing with two people, I think what's more important than whether they have ADHD or whether they don't have ADHD is whether they're going to be willing to compromise on communication styles and find a system that works for both of them. Because some person might be more conflict driven. Like, for me, I'm simultaneously scared of conflict, but if something hits me in my feels, it needs to be resolved right now. Like, right at this second, my husband, he needs time to process. And I don't want any time to process. I want to deal with it now. I want you to tell me it's going to be perfectly okay and you were wrong. That's what I need in that moment. And so it's been a bit of a learning curve to kind of move past that. So if you have someone who wants to like immediately resolve it versus someone who wants to sit in it and take time and process it appropriately, both sides being willing to understand this is how we navigate this emotional landscape and making space for that. I think that's the more important thing. - Satocuriosity, what percentage of time are you right and what percentage of time are you? - I feel like 100% of the time I'm right. - No, I think what's annoying is that he's got his finger on the pulse and he's able to see stuff honestly from like a bird's eye view a lot of times. And there's stuff that he sees that I can't see for a while later. He's just like a dude. - All right, switching gears for a second. You've got this new book that just came out called Two Sensitive, which I'm so excited to chat with you about. So for my first question, what does it mean to be Two Sensitive? - I will counter that with another question. Have you been called Two Sensitive? - A lot. - Okay, all right, then we're talking to the right people. In this book, I look at emotional sensitivity as a neurological phenomenon, which I think is an interesting viewpoint because for a long time people have just thought the way that they handle emotions is just their personality or something they were born with or a quirk. And I am kind of saying, no, it's truly, it's because you're wired to process emotion differently. And so in order to figure out like what is Two Sensitive, you first have to understand like, what is emotional sensitivity as a spectrum? Is that if you're looking at the center of that spectrum, like if something emotional happens, these people, they feel the appropriate up and down with emotion. Okay, when you look on one side, an apathy, something emotional happens, and they don't move up or down very much. It's kind of like a blunting or an emotional numbness. And then you look at this end of the spectrum where there are you and me probably live. And that is where you feel emotions quickly and deeply and for a long time. And so the way you actually, neurobiologically process emotions is different. So these are the people who have been called Two Sensitive because they quite literally feel things very deeply. Is being too sensitive a good or bad thing? It depends on how you process that emotion and how you navigate it. 'Cause I think being sensitive is a wonderful quality. I think it makes you more empathetic. I think it makes you more conscious of other people's emotional climate, which makes you a really good leader, a really good, like as a psychiatrist, I think there was a huge advantage. I think it makes you just a person that other people come to for emotional trials and tribulations. So I think they're incredible positives. I also think that if emotions are incredibly overwhelming, they continue to feel overwhelming unless you have the right tools for it. - When someone's going through an emotional spiral, what's the quickest way from other stopping that spiral or to climb out of it quickly? - So I think in order to answer that question, we need to understand a little bit about the neurobiology behind it. So the neurobiology behind that kind of emotional spiral is that there are two parts of the brain you need to think about. The first one is that make the lids. It's this little almond-shaped structure that is the emotional threat detector in the brain. And so that's a little bit hyper-reactive. Then you have the frontal lobe, the prefrontal cortex directly under the forehead, which is in charge of judgment, processing, decision-making, and it's like the very smartest part of your brain. It's under-reactive, hyper-reactive emotional side, under-reactive logical side. The connection between the two is weak. So you feel your emotions before your logical side can kick in and be like, okay, this actually isn't that big of a deal. So once you understand that neurobiology, then you can start to say, okay, what can I do? So I can calm down this emotional part of the brain and I can get this logical part of the brain back online. And so with that, like with too sensitive, there is an entire section of the book where we go through 12 tools. And there are every single one of those you've heard before. You've heard about, like, and you do, you do some of this like meditative practice with like deep breathing and like, sitting on the floor and grounding yourself and stuff like that. You probably use movement. You delay your reactions. You challenge negative, like, it's all stuff. Someone has probably told you at some point to do. The difference is how and when to apply those tools and how to practice it when you're not in a dysregulated state. 'Cause if you're telling me to take a deep breath while I'm spinning out, not only am I not gonna do that, but I'm gonna punch you in the face. Like, I don't, like, I don't wanna hear it. So I need to be able to practice these tools so that I can reach in that toolbox and use what I mean. need. And I think the most effective way to get out of a spiral is to understand what your body is doing and then use the tool that feels most aligned. Like for example, if there's a time where you feel like sometimes when I get overwhelmed with like rejection or criticism or something, like something with my husband and I and I start spinning. There are times where I am so over activated. It's like it's like my muscles are on fire. I'm getting up and I'm pacing and I'm walking around and I'm just like, so if someone were like, just take a deep breath and comment, I don't know if I could do that. I don't know if I'd have to because my body physically feels like I need that kinetic motion. And in that case, I'm like, okay, well, I know it's going to feel really hard to take a deep breath. Instead, I'm going to lean into movement. I'm going to do something to physically and purposefully move my body, push that oxygenated glucose to my front aloe. Get that back online. And within a couple of minutes, I should be able to settle a little bit more. And it works every time. So it's kind of knowing what your body is doing and then reaching for the right tool. If someone's having an emotional spiral, what are the three top ways someone can climb out of it? The first one I would say would be movement, which, you know, the goal is that we're trying to get that oxygenated glucose up into that frontal lobe so that the logical part of your brain is working the way it should be and allow that hyperactive amygdala to calm down. You don't have to do something heavy duty, but taking a walk or doing squats where you are or just I literally don't know any other exercise. Doing jumping jacks in your spot, being able to use a little bit of movement just shifts your usage of resources and you can get some clarity through that moment, especially if you're in that activated state. Another way that I feel like, again, listening to your body is that if you are in the space where you can calm down that spinning process from happening that amygdala overreacting, do those rounds of deep breaths like belly breathing and actually get those deep breaths in your system and pull from lower levels of your stomach musculature to again, populate more oxygen in to stop that amygdala from freaking out in the moment. And then the last one that I love is just and I can't believe that I didn't it took me this long to figure this one out is delaying your response. I feel like there's so much urgency when you're dealing with conflict or conversation or things like that that you have to resolve it right in the moment. But I think sometimes if you just purposefully delay your response, you're allowing that amygdala to stop spinning slightly and you're allowing that front of lobe to come back on and then you are able to handle the situation at hand with so much more clarity. For someone that's struggling with self worth, what's your number one piece of advice? I think just understanding your brain takes away so much shame and so much guilt and I could say this both as a psychiatrist and I could say this as someone who has struggled their whole life to kind of encapsulate and figure out my own self worth in this journey. I think once I understood, hey, you know, a lot of this is due to ADHD or a lot of this is due to emotional sensitivity and it's quite literally how I was wired. Then you start to build from that and you can work with that and instead of being like, this is just me, it's never going to get better because it's one of the best things about the brain. And this is why it's so awesome to be a psychiatrist is that we have the capacity to change our brains, like we are still neuroplastic and we can make those changes in long last and that's amazing. This has honestly been a true honor. It's been so fun. I've learned so much. I'm sure I'm going to be watching this with my wife, but I can't wait to see the comments for how many people enjoy this episode. So thank you so much for being here and two sensitive. It is out now. So go check it out. Meet new grippy setting mist from Mavily New York. No tightness, no stickiness, no residue, just plump, dewy hydrated skin that still feels like your skin. Try new grippy setting mist from Mavily New York. Maybe it's Maybelline.