Is it Anxiety, Stress, or ADHD? Thoughts From an Anxiety Therapist in San Francisco
Common questions people struggle with are ‘What is going on with me?’ and ‘Why do I feel the way I do?’ That it could be any number of things can be daunting and stop people from getting help. ‘I’m anxious, but it’ll go away.’ ‘I think I have ADHD, but isn’t everyone kind of ADHD?’ ‘I’m just stressed out, it’s fine.’
The thing is, each of those possibilities is worthy of attention. You are worthy of attention. Whatever it is, you do deserve to feel better. Although the information in this blog doesn’t constitute a diagnosis, it might help clarify things. Each of the possibilities – anxiety, stress, or ADHD – has both overlapping qualities and symptoms, and specific distinctions, so let’s take a look at them.
Stress:
Stress can be mental and/or physical. Basically, it’s what happens to you when the demands on you exceed your ability to cope with them. It can be due to something abrupt, like a sudden layoff at work, or chronic, like a deadline to turn in a project, or practicing many more hours per day than usual for an upcoming performance. More likely than not, stress comes from something that’s external to you.
What it’s like:
· Generally, people under stress know what is causing them stress and why.
· Usually, once the stressor has passed, you return to your regularly scheduled program. That feeling of ‘Whew!’
· Symptoms can be:
o Physical – muscular tension, headaches, or an upset stomach.
o Emotional – feeling nervous, anxious, depressed, irritable, or edgy.
o Cognitive – having a hard time concentrating, making decisions, not thinking clearly.
Triggers:
· Triggers are anything that causes you to have an emotional or physical reaction. Almost anything can be stressful to anyone, but some common ones are too much work squeezed into too little time, financial insecurity, relationship conflicts, and life transitions like graduating, moving, or getting a divorce. Even boring and unchallenging work can be stressful. Let’s also not underestimate the stressful impact of the world situation. Sometimes triggers don’t have to involve us directly to have an impact.
What you can do about it:
· Recognize you’re a human being, not a robot. We all have limits that we can’t override.
· Look for the things that contribute to stress that you do have some control over. Do you give up your daily walk when you’re stressed? Do you subsist on diet soda and fast food, and then a couple of drinks in the evening to decompress?
· Consider going back to the basics – get enough sleep, stay hydrated, and move your body.
Anxiety:
Anxiety is essentially an internal experience. What tends to light a fire on anxiety are triggers which can be externally based, like a particular song, or a certain location, or they can be internally based, like negative self-talk, or physical sensations.
Though it may or may not have external triggers, the hallmark is your interpretation of the trigger. So, what’s triggering to one person, isn’t to another because the meaning is different.
What it’s like:
· The main feelings surrounding anxiety are dread, worry, and fear.
· Anxiety is future-oriented, characterized by the thought ‘what if?’
· Often, it’s about control and the fear of losing it. That could mean circumventing situations such as avoiding people (or avoiding being separated from particular people), places, things, or situations that carry this threat for you. It can also mean ruminating on situations perceived as threatening. Ironically, like a double secret reverse, the attempts to control anxiety in this way lead to increased feelings of being out of control.
· As with stress, the manifestations of anxiety can be
o Physical - shallow or rapid breathing, racing heart, sweating, and tingling sensations in your extremities.
o Behavioral - as mentioned above, can be avoidance of specific people, places, or things, or possibly avoidance of being separated from those that are ‘safe’ or ‘comforting’. You might also have poor sleep because your mind won’t shut off.
o Cognitive - over analyzing, negative predictions of the future usually without evidence, and ruminating or going over and over the same thing.
Triggers:
· As we saw with stress, anxiety triggers can be almost anything - health, work, family, finances, social situations, or public places like being in an elevator or in a crowd.
What you can do about it:
· It’s very hard to expect yourself to go it alone when suffering from anxiety. In part because it’s a very internal experience about things that have personal meaning to you, and in part because your thoughts are the problem and are essentially feeding you a bunch of garbage without meaningful reply. Seeing a therapist from a CBT (cognitive behavioral therapy) perspective and a mindfulness-based approach can be very helpful to help decrease those negative thoughts and increase your ability to handle what comes up in a healthier way.
· Break the rumination and overanalyzing with grounding and mindfulness exercises, such as moving out of your head and into your body by naming several things you can see, hear, feel, and taste.
· Discover how your mind is working against you by identifying what cognitive distortions are at work. A cognitive distortion is a thought pattern that’s biased or irrational and skews your perception of reality. Think of wearing sunglasses indoors; everywhere you look, the world would seem dark. That’s the impact of a cognitive distortion.
· Develop some self-compassion. Suffering from anxiety is painful and it’s often accompanied by self-critical thoughts or judgements. Rather than getting down on yourself, recognize your common humanity and treat yourself as you would a close friend.
ADHD:
The ADHD brain is simply wired differently than a neurotypical brain. The cliché is ADHD or attention-deficit/hyperactivity disorder, is about distraction, that it’s typified by the memes of ‘Oh shiny!’ or ‘Squirrel!’ Yet, that’s only a very small and very simplified part of the picture. In reality, ADHD is a chronic neurodevelopmental condition impacting executive functioning.
Executive functioning refers to the skills you need in daily life. Examples of executive functions are the ability to plan, set goals, prioritize, get started on tasks, organize your time, focus, and regulate self-control (not just about your behavior, but also your thoughts and emotions).
ADHD is really a misnomer in that it’s more a problem of attention regulation, not deficiency, and it impacts so many areas other than attention.
What it’s like:
Having a chronic condition that’s poorly understood in one’s school, work, and social life often results in lifelong stress due to a lack of accommodations and constant masking. Masking is an attempt to fit into a neurotypical world and is quite simply exhausting. The fear that things will fall apart or become unmanageable creates both stress and anxiety. There can be a lot of internal critical dialogue, ‘Why can’t I just do the thing? Why do I forget to pay my bills? Why can’t I be like other people?’
Triggers:
The triggers tend to be anything that requires executive functioning or taxes the abilities in those areas, such as doing your taxes, remembering things to get at the grocery store, getting started on a project for work, or putting the laundry away.
What you can do about it:
· Getting a formal ADHD evaluation can be helpful, especially if you’re interested in pursuing medication as part of your treatment plan.
· Seeing a therapist or coach who is well-versed in understanding both executive functioning challenges, as well as the impact on your self-esteem.
· Trying specific strategies, such as using visual timers, going to a coffee shop instead of always working at home, or getting an accountability buddy, can all help with executive functioning challenges.
If any of the above descriptions sounds like you, you don’t need to go it alone. You might be feeling overwhelmed, scattered, or just plain stuck. I help adults in San Francisco and throughout California with a variety of approaches and strategies tailored to your unique self and needs. If you’re ready for some greater clarity and support to decrease self-criticism, increase your self-understanding, get practical skills to help in your day-to-day life, and feel better about yourself, don’t hesitate to call. Schedule a free 20-minute consultation by emailing me at lisa@lisafrankfortmft.com or calling (415) 379-3615.