The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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About a month ago, I posted about my realization that my family dynamics are abnormal and not a classic case of a generational/cultural disconnect I suspected them to be, but that my parents are in fact emotionally unstable. At the time I was pissed and believed that my relationship with them has fallen to rock bottom, but little did I know that was not the case quite yet; I still had the residual baseline of respect for my narcissistic father on the basis that he is my biological father who raised me, who when on an emotional high freed of all discomfort in life, can actually behave decently. I clung onto the idea of what could have been if he sought help. I was willing to be polite with him from a distance, if only I could move out and catch my breath. Even that is no longer the case.
I most likely have inattentive ADHD, and on the off-chance that I don't, there certainly is something else on board. The fact that I am not hyperactive, have always performed well on exams until high school, have always been described as an analytical person with a vocabulary above my grade level, and have seldom inflicted any difficulties unto my teachers or peers means that no teacher has entertained the idea that ADHD could be the issue at hand. Some teachers have flagged that I may have Asperger's, though usually the justification for that has always been weak (e.g. I knew Africa was a continent and not a country at age 5 when most of my peers didn't, in 9th grade I struggled to make friends when navigating a language barrier in a country notoriously difficult for socialization, etc.). My parents never went ahead and did anything with that information, not because they believed I didn't have Asperger's, but rather because they were too prideful and didn't want some naive pedagogues be the reason I land on a mandatory autism registry that does not exist. They still weaponized the notion that I did have Asperger's against me in arguments, using autism as an insult at times if I said or did something they didn't like. The overlap that I did have with autism was that my coordination was poor, and I was curious about subjects most people my age were not. That said, my niche interests have never been a monomaniacal obsession I needed to force onto others, but rather a tool for synthesizing ideas and finding ways I can apply them. On the contrary, the demonization of autism that I've constantly heard from a young age have led me to be hypervigilant about people not picking up that I know more than what's expected of me in a certain subject, though thankfully my inhibition has now gone down considerably after attending church for the past year and meeting people who I know value me for who I am with no strings attached.
When I recently heard somebody say that when teachers give a student the "you're not realizing your full potential" line, there's often a high probability the student has undiagnosed ADHD, I began to investigate the symptoms further. I've always felt a constitutional incapability of being neat and organized, teachers have often observed a delta between my oral participation and performance on formal examinations vs. my output on a regular assignment/project, I am capable of hyperfocusing in one subject and go down a rabbit hole of Substacks and academic articles, while one I've never been passionate about such as biology may simply not click with me and I will be unable to initiate the process of studying to a point of near-paralysis. The posts I've made about my paranoia when making advances with women, that's likely rejection sensitivity dysphoria. Handing a woman my number over DMs knowing damn well it may get left on delivered is even more draining for me, I did it today so we'll see how it goes. For the same reason, I also get more pissed when I see a misrepresentation of my reasoning or any uncharitable behavior when trying to have a constructive discussion online.
Well, the other day, I mentioned to my father that I am in the process of pursuing a formal diagnosis for inattentive ADHD. He accused me of taking the easy route (I guess brushing off academic performance beyond my caliber, settling for poorer educational institutions and workplaces, and refusing tools that facilitate my success is the difficult route per his contortions). He justified his skepticism towards the medication by mentioning one anecdote of my younger brother taking Concerta with no discernible effects, saying that he'd rather not take any mind-altering chemicals as his output would then not be entirely his own doing. I asked him why he wears glasses, another tool that allows people to maximize their success and eliminate a tractable disadvantage, and he told me it's an apples-to-oranges comparison as glasses are a physical object and not medicine. He told me that there are many things I can do before taking medication, such as improving my sleeping schedule, managing my screen time, eating more, as if it isn't a Catch-22 problem. What I find most disconcerting is the fact that my younger brother who is at an age where he's not quite as analytical and self-aware will have to endure this negligence and disregard for his well-being for another few years. In the end, I got despondent and was visibly agonized, and my father had the audacity to tell me I'm the one gloating over this. He was always capable of treating me in a very undignified manner, but it was typically calculated and subtle. For him to brazenly invalidate my medical needs is a new low.
If all goes according to plan, I'll be out of this house in a couple of weeks, and now that I see him for all that he is, I will unhesitantly be cutting contact with that prick. I remember when I was 13 or so, I watched a video adaptation of several sci-fi novels by Phillip K. Dick on Amazon Prime. One of them was The Father-thing, where an alien eats a child's father and perfectly replicates his external appearance. Relating to its plotline was not on my bingo card, but here we are.
It is entirely possible you do have ADHD. Based on what you've described, the clinical suspicion is at a degree that warrants formal assessment, and pursuing one is a move I would happily encourage.
That being said, I wince at anyone invoking "rejection sensitivity dysphoria," which in this context strikes me as a rather useless pseudo-diagnostic label that pathologizes being a Sensitive Young Man.
RSD appears in neither the DSM-5 nor the ICD-11, has no validated measurement instrument, and the term traces back mostly to one enthusiastic clinician in the 90s rather than any systematic research program. The construct it gestures at (emotional dysregulation in ADHD) is real enough, and the DSM-5-TR now acknowledges overreactive emotionality as an associated feature. That is very different from being a core feature, or being helpful in terms of narrowing down the differentials. Feeling terrible when a girl leaves you on delivered is not a neurological syndrome. Young man, that's the human condition, plus youth.
I used to be one, you know. Which is to say young. I'm still a man. In terms of sensitivity? Mostly I've just become increasingly willing to tell people to go fuck themselves, or more politely, to stand up for myself when I'm clearly in the right. There was a time when being left on read would have felt like the end of the world to me. These days I shrug and move on, or at worst wince slightly and forget about it by the next week. This will happen to you too, and it will manifest as external confidence. People can tell when you've got it, and they act accordingly. Time and reps, mostly. No pill need popping for that particular problem.
At best, marked rejection sensitivity might point toward a comorbid anxiety disorder, which is worth mentioning to whoever assesses you, since the comorbidity rates between ADHD and anxiety disorders run somewhere around 25-50% depending on the sample. But as a diagnostic marker for ADHD specifically, it offers little.
Now, I am a psychiatry trainee, and I do have ADHD. And my life has interesting parallels:
My dad, despite being a good doctor, was loathe to acknowledge that his son(s) have mental health issues. I'd blame it on him being from a different generation. When I was older and telling him about my problems again, he mentioned episodes around my age that sounded awfully like depression to me, except he hadn't had the vocabulary at the time, and more importantly, he had managed to push through and flourish anyway. In his eyes, a son who was clearly intelligent, academically and professionally successful, couldn't possibly be mentally ill, let alone chronically. He flinched away from the notion. In his cosmology, that's the realm of the insane and the delusional, and if you're objectively succeeding, everything must be fine upstairs.
I wish that were true.
On that note, I'd be careful bandying accusations of narcissism about. Not because you're necessarily wrong, but because I remember being around your age and being quite mad at my dad, and the heat of the moment is a poor time to hand out cluster B diagnoses to family members. Hold that belief lighter than currently feels natural. You can always revisit it when you're older and know better. That would the kind of statement that would have annoyed me when I was younger, but it's true nonetheless.
Pragmatically speaking: stimulants work on just about everyone. This has been known since we gave dextroamphetamine to entirely normal prepubertal boys in 1978 and watched their motor activity drop and cognitive performance improve, a finding replicated in normal adult men. That makes "I took Adderall and functioned better" a poor confirmation of the diagnosis, in the same sense that telling someone who perks up after a cup of coffee that they're "caffeine deficient" is a suboptimal diagnostic framework. Scott's essay on Adderall covers the gatekeeping problem well: attention is a normally distributed trait, the diagnostic cutoff is somewhat arbitrary, and most psychiatrists and possibly the majority of patients knows it.
Even more pragmatically:
ADHD is associated with a life expectancy reduction that is more alarming than I originally remembered. This paper found an apparent reduction of about 6.8 years for men and 8.6 for women, and Barkley's earlier estimates are thereabouts too. The mortality rate runs roughly double the general population's, pushed up by accidents, substance use, and the general downstream consequences of poor impulse control and executive dysfunction.
And treatment works! A Swedish registry study of around 150k patients found medication initiation associated with a 19% reduction in all-cause mortality over two years, concentrated in deaths from unnatural causes. The usual observational-study caveats about confounding apply, and the follow-up window is short, but the direction of the evidence is consistent across studies of injuries and hospitalizations too.
That's why I don't much care about gatekeeping this diagnosis as zealously as some do. The failure mode of slightly over-prescribing a well-tolerated medication with fifty years of safety data is considerably less bad than the failure mode of leaving a disorder with those base rates untreated because your dad is a dum-dum. I care about results uber alles, and I care even more about the fact my disease is comparatively mild. The medication changed my life for the better.
I wholeheartedly appreciate you taking the time to write such a conscientious response with your experience and the statistics you've included! I don't have much to add, but one thing I will tell you is that the suspicion of narcissism has been present for a while. It was certainly not triggered by this alone, though this sure as hell adds insult to the injury. Without getting too personal, I began picking the suspicion up after spending time reading literature, observing healthy family dynamics in movies, having dinner at my pals' houses, etc. and recognizing that something was off about my family. Obviously I ought not to take them as the gospel, but have researched what medical professionals had to say as NPD and have delineated the concrete exchanges I've had with my father to Claude. I provided some examples of the behaviors exhibited by my father a few Wellness Wednesday threads ago, which I've linked in my response to another person replying to my post.
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