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Relationship Balance for the AD/HDer

(Published in The ADHD Challenge, July/August, 2001)

The effects of AD/HD on school and work performance are well known, but it also affects self-identity and romantic relationships. Based on my work as a clinical psychologist, I have found that certain people with AD/HD are more likely to wind up in dominating or abusive relationships. The key lies in how they view and handle problems in their lives.

People with AD/HD, especially if it isn't diagnosed until adulthood, are used to being blamed for things that they had no idea about (e.g., "I don't remember you telling me to take out the garbage, but there have been other times that I didn't remember, so maybe you did ask me."). There are two general ways of dealing with a conflicted situation like this one-internalize it or externalize it.

Internalizers and Externalizers

When something goes wrong, we look for answers as to why-what caused this? How we deal with setbacks has enormous implications for how we feel about ourselves during these difficult times. Some people take the responsibility onto themselves-"it must have been because of something I did or didn't do." We can call these people internalizers because they internalize the responsibility. This can lead to feelings of depression if one's self-esteem takes too much of a beating. However, sometimes there is also the promise of a brighter future-"maybe I can do this differently next time so it turns out better." Other people are more likely to place the controlling factor outside of themselves-"it must have been someone else." We can call these people externalizers. In some cases, they will act out in anger over a bad situation. Externalizing frees them of any feelings of self-criticism or guilt, but it also leaves them powerless over the situation unless circumstances change. So, the price they pay is that they don't learn anything new.

Of course, it is most helpful to think of a spectrum between internalizing and externalizing. The extent to which we do each varies over time and across situations (e.g., I may get angry with myself for forgetting to call someone back, but have little difficulty placing responsibility for a lost medical claim on the insurance company). Just as with every other group, people with AD/HD fall all along this spectrum. People who grow up successfully with AD/HD are those who are a combination of both (as are most people). That is, they internalize and accept responsibility for their actions in an effort to do things differently next time and learn from their mistakes. However, they also externalize their disappointment and frustration-blaming either their AD/HD or chalking it up to being "kind of spacey like that sometimes." However, through this all they maintain a positive self-image, despite their flaws. They take responsibility for negative outcomes within their control, but still have enough successes to feel good about themselves.

Some people with AD/HD hit real difficulties if they internalize too much blame and see themselves as incompetent and therefore deserving of the bad things that happen to them. These are the people who are most vulnerable to finding themselves in dominating or abusive relationships, which is the focus of this article. Let's call these people Maladaptive Internalizers. "Lisa" (all names have been changed in this article) knows well the effect of "the constant messages I, an undiagnosed AD/HD young adult, had received a million times a day, from every caring adult in my life (and peers as well) since birth"-there must be something wrong with her. In fact, people feel relief from finally being diagnosed with AD/HD because it explains why they are different from their peers-it gives these Internalizers something to externalize their frustrations onto.

People who externalize a great deal tend to be more the abusers in relationships, because they are constantly projecting blame onto others. This robs them of the benefits of balanced intimate relationships, but spares them the pain of having to admit that they are less than perfect. Let's call these people Maladaptive Externalizers. (Incidentally, some of these people may qualify for a diagnosis of borderline personality disorder. That's another article, but for more information, check out This externalizing may take the more subtle form of being the helper in the relationship, but still all the blame and incompetence is the other's.

Couple Complementarity

Couples come in all shapes and sizes, but the pairing that is most relevant to this discussion is that of the Maladaptive Internalizer (often an AD/HDer) and the Maladaptive Externalizer (could be AD/HD but doesn't have to be and often isn't). This pairing is stable because, when something goes wrong, the Externalizers have a willing target to dump the responsibility onto. Although this gets the Externalizers off the hook for the painful feelings that might result, it proves ultimately unproductive because they can't do anything about it. Meanwhile, the Internalizers take one more hit to their self-esteem and sink further into depressed feelings of incompetence. Round and round this goes with the Internalizers trying harder and harder to do something right. "Once married," Lisa notes, "my husband continued sending messages that my feelings, behavior, dreams, etc. were unacceptable. I did not see it as 'his' problem-I'd been getting these messages since birth."

So why do internalizing AD/HDers stick around?

There are probably as many answers to this question as there are unhappy relationships. If you are consistently unhappy in your relationships or find yourself unable to break away from a bad one, a therapist may provide the answers that are specific to you. However, the following reasons tend to be more relevant for folks with AD/HD in the kinds of relationships discussed in this article.

Familiarity. Some Maladaptive Internalizers may stick around because they are used to feeling blamed-it may not feel good, but it is familiar. Compared to others, people with AD/HD may be more tolerant of being blamed if it matches their prior life experience. Specifically, they may be more used to being "informed" about what they did wrong-it's that whole forgetting-to-take-out-the-garbage thing all over again. As a result, they are more vulnerable to accepting Maladaptive Externalizers' exported responsibility.

Hard Fought Validation. Hard to please Maladaptive Externalizers present quite a challenge, so making them happy becomes the Holy Grail. Other people are easier to please and therefore not much of a victory. However, if you can please a Maladaptive Externalizer, then you really know that you did something impressive. Those rare moments in the relationship that the Maladaptive Externalizer is happy are like hitting the jackpot-and what keeps the Internalizer coming back. Rob dated many Maladaptive Externalizers and found that "they triggered in me a longing to be understood. They fulfilled this temporarily." Sometimes the ability to hyperfocus is just the thing to avert disaster in a crisis and sometimes rewards follow, even if the insight gained doesn't really help prevent the next emergency.

Thrill Seeking. There is rarely a dull moment with extreme Maladaptive Externalizers. The constant need to keep your antennas up for potential landmines can be very exciting. For those folks with AD/HD who bore easily, there is little danger of a slow period. There is also often a mutual desire for variation-to have a quickly changing life that avoids boring routines. As Meredith describes life with her mother, "I felt I was always at a Defcon 5 emergency alert status at all times I was around her."

In addition to the above reasons, there are several other generic ones that can apply to other unhappy relationships, as well. For some people, there is a fear of a messy separation, especially if kids are involved. It may also be that the partner provides at least some support, be it financially or by helping out sometimes. And finally, there's good ol' fashioned hope-it's got to get better than this.

Now That You Know ...

For all parents, it is a very fine line between helping your children feel good about themselves while at the same time helping them learn from their mistakes. The biggest challenge in parenting children with AD/HD is re-directing them without nagging away their self-esteem. Therefore, in order to avoid the future relationship difficulties discussed above, parents should try to not be Externalizers, even though an AD/HD child can try your patience. Constantly communicate positive regard for the child, even if you aren't happy with the actions. Work with them on finding ways to overcome their shortcomings-just like we all need to learn. Help them become successful in their chosen pursuits, help them find pursuits where they can be successful, and model an appropriate balance between internalizing and externalizing when you yourself make mistakes. This will buffer against the inevitable failures that they will experience, perhaps more often than their non-AD/HD friends will. A good rule of thumb is this: if you're hosting a barbecue, you can blame yourself for not buying enough hot dog buns, but not for the weather. Granted, a rainy day will be disappointing, but that's different from getting down on yourself for picking the wrong day.

For adults, remember that relationships should add more positives than negatives to your life, so choose relationships that are balanced, where each person takes responsibility for his/her actions. If you're currently in an unbalanced relationship, then work for equality by not accepting responsibility for what isn't yours or at least be willing to discuss it. Deal with relationship difficulties as with any other difficulty-give it your full attention and do your best. If the time isn't right to talk, then make a point of bringing it up later and address it in a planned and functional way. Finally, don't stay with something just because it's familiar.

Embrace professional help. This means the common tactic of medication to help you be more effective and thereby feel better about yourself and less likely to accept another's externalized abuse. It also means therapy which can be extremely beneficial in helping people understand themselves better (both strengths and weaknesses) so that they can feel better and have more control over their lives. For those ADHDers with ravaged self-esteems, therapy may be especially important-the past may have been troubled, but the future can be much better.

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