October’s ADHD Awareness Month is a useful occasion to examine a persistent diagnostic gap: a substantial number of women reach adulthood, sometimes well into their thirties, forties, or beyond, before receiving an ADHD diagnosis that, in retrospect, explains struggles present since childhood — a delay largely attributable to a diagnostic picture built around how ADHD tends to present in boys.

Why the Standard Presentation Misses Many Girls and Women

The hyperactive-impulsive presentation historically associated with ADHD — visible disruptive behavior, difficulty sitting still, impulsive interruption — is more common in boys, while girls more frequently present with the inattentive subtype: difficulty sustaining focus, disorganization, forgetfulness, and an internal experience of mental restlessness that does not necessarily produce visible behavioral disruption. Because this presentation is quieter and less disruptive to others, it was historically far less likely to prompt an evaluation, even when it was causing significant internal struggle and functional impairment.

The Cost of Compensation

Many women who are later diagnosed in adulthood describe having developed elaborate compensatory strategies throughout childhood and early adulthood — extensive organizational systems, substantial extra effort to appear as organized and attentive as peers, and a pattern of working considerably harder than others to achieve comparable results. These compensatory strategies are often effective enough to mask the underlying condition from teachers, parents, and sometimes from the individuals themselves, at a significant and largely invisible cost of sustained extra effort.

Why Diagnosis Often Comes After a Capacity Threshold Is Crossed

Many women receive an ADHD diagnosis for the first time during a period of significantly increased life demands — a new job, a first child, a health crisis — when previously effective compensatory strategies finally become insufficient to manage the increased cognitive load. This timing can create the mistaken impression that the ADHD is new or situational, when in fact the underlying condition was present all along; what changed was the demand placed on a set of compensatory strategies that had reached their functional limit.

Common Misdiagnoses Along the Way

Because inattentive ADHD symptoms overlap considerably with anxiety and depression, many women are treated for years for one or both of these conditions without the underlying ADHD ever being identified or addressed, sometimes with treatment that provides partial but incomplete relief, since it is not targeting the actual driver of the difficulty. Some women cycle through several rounds of this incomplete treatment before an evaluation finally identifies ADHD as the underlying factor.

What Diagnosis and Treatment Offer

For many women, an accurate ADHD diagnosis in adulthood provides significant relief simply through reframing — years of self-criticism about being “lazy,” “scattered,” or “not trying hard enough” can be understood instead as the visible effects of an unaddressed and undertreated neurodevelopmental condition. Treatment typically combines appropriate medical evaluation for medication options with therapeutic work addressing executive functioning strategies and the accumulated impact of years of unaddressed struggle and self-criticism, since the emotional residue of years spent misunderstanding one’s own struggle rarely resolves through medication alone.

Reclaiming an Accurate Narrative

A late ADHD diagnosis does not erase the years of difficulty that preceded it, but it does offer the opportunity to build a more accurate, more compassionate account of what was actually happening throughout. Many women describe this reframe as one of the most significant outcomes of diagnosis, independent of any treatment that follows it.

R. M. Andrews & Associates offers therapy in Portland for adults navigating ADHD diagnosis and treatment, including women identified later in life.

Domestic Violence Awareness Month is an occasion to look beyond the forms of abuse most readily recognized — physical violence — toward a pattern that is equally serious but considerably harder to identify from the outside, and sometimes even from within the relationship itself: coercive control.

What Coercive Control Actually Involves

Coercive control describes a pattern in which one partner systematically restricts another’s freedom and autonomy through a combination of tactics that may include isolating the person from friends and family, monitoring their communications or movements, controlling access to money, undermining their confidence in their own perceptions through persistent contradiction and denial, and enforcing rules about dress, behavior, or daily activity that the controlled partner must follow to avoid conflict or punishment. No single tactic, viewed in isolation, may seem severe; the cumulative, systematic pattern is what constitutes coercive control.

Why This Pattern Is Often Missed

Because coercive control frequently lacks the visible markers most people associate with abuse — bruises, police reports, dramatic incidents — it can go unrecognized by friends, family, and sometimes by the person experiencing it, who may sense that something is deeply wrong without being able to name it in terms that match their understanding of what “abuse” looks like. The isolating tactics that are part of the pattern itself often specifically reduce a person’s access to outside perspectives that might otherwise help them recognize what is happening.

Why Isolation Is Often the First and Most Important Tactic

Reduced contact with friends, family, and other sources of outside perspective tends to be an early and foundational element of coercive control, since it removes the checks that would otherwise help a person recognize the pattern and access support. This isolation is often introduced gradually and with plausible justification — concerns about specific friends, framing time together as more important than outside relationships — making it difficult to identify as part of a larger pattern until it has already substantially progressed.

The Effect on a Person’s Sense of Reality

Sustained coercive control, particularly when it includes persistent contradiction of a person’s memory or perception, can produce a genuine erosion of confidence in one’s own judgment — a person subjected to this pattern over time may begin to doubt their own read of situations that they would have assessed accurately and confidently before the relationship began. This effect is a recognized consequence of the pattern itself, not a preexisting vulnerability that made the person susceptible to it.

Why This Is Taken as Seriously as Physical Violence

Coercive control is now recognized, including in some jurisdictions’ legal frameworks, as a serious form of abuse in its own right, independent of whether physical violence is also present, because the pattern itself produces substantial psychological harm and because it frequently precedes or co-occurs with physical violence when it does escalate. Treating it as a lesser concern than physical abuse significantly underestimates its actual impact and risk.

What to Do With This Information

Recognizing this pattern, whether in one’s own relationship or in a friend or family member’s, is a critical first step, and reaching out to a domestic violence resource or a trauma-informed therapist for guidance on next steps is a reasonable and safe way to begin addressing it. Safety planning with a knowledgeable resource, rather than acting alone, is generally the wiser path when leaving a controlling relationship is being considered.

R. M. Andrews & Associates provides trauma-informed therapy in Portland for individuals navigating current or past experiences of coercive control. If you are currently in an unsafe situation, the National Domestic Violence Hotline is available 24/7 at 1-800-799-7233.

What Emotions Help Your Life Satisfaction?

A new study suggests it is okay if we are not always happy. In fact, investigators discovered life satisfaction is a product of experiencing both negative and positive emotions.

In an international study, researchers discovered people may be happier when they feel the emotions they desire, even if those emotions are unpleasant, such as anger or hatred.

“Happiness is more than simply feeling pleasure and avoiding pain. Happiness is about having experiences that are meaningful and valuable, including emotions that you think are the right ones to have,” said lead researcher Maya Tamir, Ph.D., a psychology professor at the Hebrew University of Jerusalem.

“All emotions can be positive in some contexts and negative in others, regardless of whether they are pleasant or unpleasant.” Continue reading →

5 Counseling Tips To Help You Through The Day

Meditate or take some quiet time by yourself regularly, everyday if possible.

If you don’t meditate, you might try sitting with a cup of tea for 5- 10 minutes as you look out the window. See what it’s like to be quiet without doing anything else. Continue reading →

When Your Partner Has Had a Loss

It can be hard to know what to say.

It can be heartbreaking watching someone you love suffer through a tragic loss.

The loss can take many forms – a death in the family, the passing of a beloved pet, a career setback, a miscarriage – but the aftermath is fairly universal. Your loved one grieves. Sometimes they grieve HARD.

And, as their partner, it’s not always intuitive to know what you should be doing in that situation, particularly if the person you love seems to be spiraling down deeper into their despair.

You can offer condolences, but what’s your role supposed to be in the grieving process?

Are you supposed to be their cheerleader? Are you supposed to be their drill sergeant?

Should you actually be trying to do ANYTHING during their grieving or do you need to just sit back and let it happen?

But sitting back isn’t always an option, especially if your loved one is having problems with coping with the grief on their own. And, OF COURSE, you want to be doing something constructive. This is someone you love. You want to help. Continue reading →

9 Ways to Promote Gratitude in Your Life

Gratitude is good for us every way you look at it.

According to Sonja Lyubomirsky, PhD, professor of psychology at the University of California in Riverside, gratitude boosts our happiness levels in a number of ways: by promoting the savoring of positive life experiences; by bolstering self-worth and self-esteem and thereby helping to cope with stress and trauma; by building social bonds and encouraging moral behavior; and by diminishing negative emotions and helping us adjust to new situations.

Gratitude has a number of physical health benefits as well. “Research suggests that individuals who are grateful in their daily lives actually report fewer stress-related health symptoms, including headaches, gastrointestinal (stomach) issues, chest pain, muscle aches, and appetite problems,” says Sheela Raja, PhD, an assistant professor and clinical psychologist in the Colleges of Medicine and Dentistry at the University of Illinois in Chicago.

But how do we get there? For some folks, gratitude is much easier than for others. I, for one, have to work really hard at it because my cup usually appears one-third full. With a few exercises, though, I can become a more grateful person and promote gratitude in my life, which brings many emotional and physical gifts.

1. Go Ahead and Compare

I constantly compare myself to people who are more productive than I am (have more energy and need less sleep), who go to a doctor once a year, and who are resilient to stress. “Why can’t I be like her?” I ask myself. And then I remember Helen Keller’s quote: “Instead of comparing our lot with that of those who are more fortunate than we are, we should compare it with the lot of the great majority of our fellow men. It then appears that we are among the privileged.” Continue reading →

The Four Greatest

Psychological Discoveries of 2016

Yes, you have had a lot to deal with in 2016. Your job, your family, your finances, and the election, to name a few.

While your attention has been focused on all of these personal and societal challenges, scientists have been working behind the scenes to learn what you can do to become happier and healthier in 2017 and beyond.

Here are four impactful studies that offer valuable information that can guide your decisions and focus in the coming year. Continue reading →