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Overcoming Distractions-Thriving with ADHD, ADD
Uncovering Emotional Dysregulation in Women with ADHD with Dr. Gilly Kahn
00:36:50
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- [00:08]
A
I'm Dave Greenwood and this is Overcoming Distractions. If you are an adult with adhd, a busy professional, an entrepreneur, a high achiever, or just need some strategies to navigate your adult adhd, you're in the right place. Who am I? I'm an entrepreneur with ADHD and the author of two books, Overcoming Distract and Overcoming Burnout. I coach and mentor people just like you, and together we navigate the ups and downs of adult adhd, from getting out of our own way to helping people just like you thrive in the workplace. That's what I do. Want more info on working with me? Hit overcoming distractions.com ready? Let's get to today's podcast. Hi, gang. Welcome. Welcome back to Overcoming Distractions. It's Dave. We're actually recording on Friday. I was just telling my soon to be introduced guest that my brain is scrambled, so I'm sure it's something you can relate to. So. So, yeah, so I want to, I want to do a quick disclaimer. And this is to all the guys out there, okay? So we're going to talk about ADHD in women, emotional regulation, dysregulation, but I don't want all you guys out there to just kind of click off and go to another show, okay? There's something we can learn about this discussion no matter who you are. So I want to make that perfectly clear. I always think there's something we can take away from these discussions, even if they're not exactly geared towards your specific circumstances. So there's my disclaimer. So, and that's. We're going to talk about today ADHD in women and the, the emotional aspect of it. I have Dr. Gilly Khan. She is a clinical psychologist, an ADHD specialist, and Dr. Khan has released a new book called Allow Me to Interrupt. And I don't know if that kind of resonates with any of you. I'm sure it does with me. So, and the, the book addresses this. I, I guess she would describe it as a kind of a critically under recognized role of emotional dysregulation in women with adhd. And again, guys, hang with me, all right? Everybody hang with me. So I would argue, and I think many experts, that ADHD does revolve a lot around our emotions, how we feel about certain things, how we react to certain circumstances, environments in our life. And we're going to dig into that in just a second, but allow me to interrupt. It tackles that overlooked symptom in women, that emotion dysregulation. I know it's something that comes up when I meet with a lot of you one on one, when we're kind of trying to tackle issues in the workplace, etc. Etc. That like procrastination, there's always some kind of negative kind of thought that enters our mind when we decide not to do something. Right. So. So we're going to dig into this. So, Dr. Khan, welcome to Overcoming distractions.
- [03:34]
B
Yeah, I'm so happy to be here. The other thing I want to say too is that emotional dysregulation is so very relevant to men as well.
- [03:43]
A
Oh yeah.
- [03:44]
B
And yeah, it just so happens that this book is focused a bit. It will a lot more on women. But I also want to say that initially when I wrote the book, it was not sex specific. Like it was not just focused on women and then it ended up becoming focused on women. And yeah, if and when you do read it, you'll probably see that because I've had a lot of men read the book and also write that it's not specific. It's not so siloed as you would think from the title.
- [04:17]
A
Yeah, yeah. No, I think, you know, when it comes down to it, the, the ADHD is somewhat of an emotional.
- [04:24]
B
Yes.
- [04:25]
A
Dysregulation or challenge with that. Right. And that's what kind of, kind of, I hate to say it, but kind of gets in our way of doing the things we want and thriving, etc. Etc. So I know I, I want to go back to the women because I have had countless conversations, and I'm sure you have too, about, you know, because I work with those busy professionals with ADHD and somebody books a 15 minute call me to see if we're a good fit, to see if we can kind of, you know, I can help them and we do some problem solving, etc. Etc. But I cannot tell you how many women we get on a call and they may be in their 40s or 50s and they say, I just got an ADHD diagnosis.
- [05:09]
B
Exactly. Yes.
- [05:10]
A
Right. So can we kind of discuss maybe kind of the basics of like how ADHD maybe presents differently in women compared to men, especially in your, your area of expertise? Because I always like to say that, I've said this a million times, is like, you know, us boys were ripping apart the classroom. Right. And we got the attention and, and the girls might have just been kind of staring out the window. Right. It presents itself differently. Right.
- [05:44]
B
You just made me angry.
- [05:45]
A
Oh my goodness. Okay, we're real here, so let's go.
- [05:50]
B
Yeah, yeah. Because that's, that's the kind of. The stereotype. Right.
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A
Is it really? Yeah. Okay.
- [05:58]
B
Yeah. So. So let's start with this. Okay. Because I'm gonna. I mean, there's like, there's a well written rant in my book. I'll just say, but. Yeah, but the ADHD criteria is written mostly for and on boys, you know, so it's not even. It doesn't represent men well either because it's focused more on children. But it's definitely biased in terms of like the sex that's represented and the sample that was used to develop the criteria. But then also this, the public image of what ADHD actually is is skewed. And the criteria and our training as coaches and mental health professionals also contributes to that misperception. And you know, there's well intentioned research that's conducted to better understand ADHD in girls and women versus ADHD and boys and men.
- [07:07]
A
Yeah.
- [07:07]
B
The problem is that the first domino in the row of dominoes is flawed because the criteria are biased toward man.
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A
Right.
- [07:19]
B
So, you know, whatever research is being conducted, it's being conducted with instruments that use the criteria to develop the instruments and that therefore those instruments become biased as well. And then we're trying to draw conclusions or trying to understand what the condition looks like in girls and women, but the initial domino is skewed.
- [07:48]
A
Yeah, but that goes to like, that original question is like, how does it present differently? Because it does look different. I mean, it looks different from male to male and female to female as well. But. But it does present a little differently in women. Right. I mean that. And I think that's why. And again, I'm not a doctor and I make that perfectly clear. But again, talking with so many women, is this like they, they, they were not diagnosed till later in life?
- [08:22]
B
Exactly. Yeah. And so the research does show is that girls and women display more of the inattentive presentation of adhd. And you know, girls are basically like, society has this concept of females being like meek, you know, and better behaved. And to a certain extent that is true because, you know, look at a classroom of girls and boys, you know, there will be differences in behavior for sure. But at the same time, you know, deciding based on, you know, this criteria and the measures that are biased, that this is how it looks in girls, that it's more of the daydreamer looking outside the window, then that's kind of unfair. What might be more helpful moving forward is kind of starting from scratch and asking. I mean, if we're thinking about adults asking women what their experiences are so now there's more and more research that's called, that's qualitative, meaning it's like more. The researchers use more interviews and open ended questions asking women about their experiences and, and then they code based on the information that women freely share about their struggles with adhd. And so, yeah, I think that's where a lot of the confusion lies. And I think what is frustrating like for a lot of women and why a lot of them are getting late diagnosed because we've been kind of put into this category of being daydreamers and the ones who are impulsive or who do emotionally react, they're just called rude. Or in my book I use the Taming of the Shrew. William Shakespeare is like a point of reference, say that, you know, we're basically identified as shrews. Right. It's a personality flaw. It's not adhd because you don't fit within the category of the daydreamer.
- [10:42]
A
But I think that that goes to the awareness that maybe some women may have about themselves. Is that kind of an accurate statement where they don't think ADHD is, is a possibility? Right. Because of, because of what you just described. Right. And I think maybe some women are, are kind of surprised when they actually do hear that. Right?
- [11:08]
B
Yes. 100. Yeah. Even for me, I'm a psychologist and I was confused and waited until I was in my 30s before I got a diagnosis and I went, I went and sought out the diagnosis like a lot of women are doing right now. They're going and they're seeking out a diagnosis or they're self diagnosing because they just decided like, well, what's the point unless you want to go and seek out medication. But yeah, it's still confusing because I think as long as, like I said before, like as long as the criteria remain as they are and they're not representative of women too, and adults generally, then there's going to continue to be this like chain reaction of misunderstanding because even the providers are confused.
- [12:01]
A
Yeah. So many people who listen to this podcast are that, that busy professional, that it's men and women, it's everything or everybody from a CEO, a business owner, an entrepreneur, anywhere in between the management structure as it comes to women and being a busy professional, someone in a demanding career. In your experience, how do you, how do you see this presenting itself? I mean, obviously I want to make it clear that there are positives as we know as to how our brain works in terms of, you know, creativity, problem solving, all those types of things. But but we do get into situations when we're in a demanding career, men or women, that we start to have some challenges. So as far as women, how have you kind of seen this present itself in. In that setting?
- [13:03]
B
Yeah, I think that's. That's a really great question, a really important topic, because, you know, there's the cultural or the societal, you know, experiences of being a woman, and then there's also the biological experiences of being a woman. And both of those interact and speak to what makes things difficult for us professionally. So one is the more obvious one, like, the biological differences. Like, women go through a lot more hormonal changes throughout their lives compared to men. And so, you know, like, they start out, and like men, you know, in adolescence, they go through puberty, but then once they start getting a period, then their hormones start to fluctuate every month. And basically, the way that the menstrual cycle works for people who want to understand it is there's sort of like. I call it like, two phases of a video game. There's the fake things are looking really good, and you're really well. Right. And then. And that's the follicular phase, and that's where your body is preparing to get pregnant. And then there's the luteal phase, which is the last two weeks of the month. And that's where things start to go downhill, because your body's kind of like, fuck you because you didn't get pregnant. Then, you know, your period comes along if you're not carrying a baby. And during that time, you know, your hormones are going up and down. So estrogen and progesterone are the two main hormones, and they're both really important to adhd, especially estrogen, because estrogen, the sex hormone, is also related to how much dopamine you have. You. You have, like, in your brain.
- [14:58]
A
Yeah.
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B
And because they're kind of like best friends, they rely on each other. And so when estrogen goes up and then you have more dopamine, and we know that if you have low dopamine, then that exacerbates. That's kind of like the main hormone, the main neurotransmitter that we know is involved in adhd. And it's. It's not just dopamine, by the way, but that's the. The main one. Um, and so in the beginning, the first two weeks of the cycle, estrogen is increasing. But then as you're getting into the luteal phase, the last two weeks, then your estrogen is decreasing. And so if you have ADHD already, then that's going to look like you're going to feel like more of a mess compared to the average.
- [15:41]
A
So. So ADHD can present itself differently.
- [15:46]
B
Yes.
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A
At different times of, you know, the month, Right?
- [15:51]
B
Yeah, exactly. Yes. Even so, for me, for example, I'm a woman with adhd and I'm sorry, this is tmi, but this is how women are at a certain point.
- [16:00]
A
Like, hey, we lay it all out here.
- [16:04]
B
Menopausal yet, but I'll get there soon and we'll talk about that too, because that's also relevant. But like, I'll go, you know, the first two weeks of the month with my focal in that I take and I feel really good and productive for the most part. You know, it's never amazing. Right. Having ADHD is like, there's always this underlying sense where we're, like, something is just not quite right. It's not, you know, it's tough. But then the. As I get toward, like the end of the month, I feel like something's off. And sometimes I, I'm not even sure, like, what part of the month I'm in because I have ADHD and my brain doesn't work like that. And, and then it, like, it hits me and I'm like, oh, that's why the past two days I've been emotional and unproductive and fidgety and unable to sit down and read a sentence. You really notice a change, an exacerbation of your ADHD symptoms, your ability to pay attention, to remember things, your emotion regulation. Research shows that women with adhd, they struggle more with PMS symptoms, like mood issues before their period. Then we go into getting pregnant. There are some more hormonal fluctuations there, of course. Yeah, struggle more.
- [17:27]
A
And I know that. And I'm a guy.
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B
Postpartum depression, which I had, I'm like, textbook stereotype. And then you head toward perimenopause. And, and a lot of women now are in perimenopause, and that's when they're getting diagnosed because it's hitting them especially hard. So maybe there was a diagnosis. A diagnosis or, sorry, maybe they had ADHD before, but it just wasn't detected. And now that they're in perimenopause, like, their symptoms are times 100. And so they're, they're saying, oh, my God, yes, this is me. And they also think back on their childhood and, you know, the rest of their life, and they can apply these symptoms. So, yeah, there's, there's that. And then there's the actually having kids. And that produces another. You know, if you're a businesswoman or, you know, you're, you're a working mom, it's really tough because if you have adhd, it's, it's hard enough to care for yourself now. You need to care for, you know, one plus more little humans.
- [18:36]
A
Right. And I think that's. You're describing, I think you going back to how we started, where, know, there's myths, there's misconceptions about adhd. I mean, they're just all, they're all over the place. Right. But I think some there, there's those myths, you know, at surface level is like, you know, oh, you just try harder or get a to do list or, or, you know, or, you know, this, this person is distracted or they're late or they lose their car keys. Right. You're describing a much more complex, hopefully understanding of adhd. Right. Is that. That every week isn't the same for a lot of people. Right?
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B
Exactly.
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A
Yeah, yeah. And how do we manage that? And then like you say, you're, you're in a, you're in a demanding job or career, you're running a business, maybe you have young kids. Yeah, right. And. And that's why there isn't that. That one size fits all description or approach to managing adhd, because everybody's circumstances are different. And, and you're describing another level where women have to navigate what you just described, right?
- [19:54]
B
Yes. And then to make things even worse, there are certain conditions ADHD exacerbates or it makes you more at risk for chronic pain and for other, like, health issues. And for women, for example, a lot of people don't know this, but women with adhd, and this is just women also, in general, women are more likely to struggle with migraine or to men, but it's highly debilitating. And women with ADHD are even more likely. The risk goes up if you have ADHD to struggle with migraine. And when you think about the biology of it, it makes sense because migraine, like having a migraine attack, is also associated with estrogen.
- [20:44]
A
Oh, really?
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B
Yes. Yeah. So, and it's so interesting and Attitude has a podcast called the ADHD Experts Podcast, and they had a. I think she's a neurologist. Come on and talk about the overlap between migraine and adhd. Her name was Sarah Shayet.
- [21:07]
A
Oh, yeah, yeah. She's been on here several times.
- [21:09]
B
Oh, really?
- [21:10]
A
Oh, yeah, yeah, yeah. I haven't had her on in a couple years, but yeah. Her and her husband are both. I think her husband's a neurologist too, a pediatric neurologist or whatever it is. But I may have that wrong. So I apologize. But yeah, yeah, she's done some really good work. Yeah.
- [21:25]
B
Yes. So if she hasn't talked about migraine and adhd, like, it's such a fascinating topic because, you know, there's the environmental piece, you know, that's kind of similar to what we're already talking about, and the behavioral issues that are just rooted in adhd. Like, we don't sleep well, we don't eat well, you know, we're not very organized, our schedule's all over the place. All of that is going to make it more likely that you'll get a headache, you know, and migraine is more than just a headache because there are all these other symptoms involved.
- [22:02]
A
Yeah. Is there an argument for, I guess, chronic stress if we don't, men or women, if, if we don't kind of start to manage or, or get the support we need? I mean, I'm imagining, you know, the stressed out days and the stressed out weeks, but operating in a, in a mode where. And I think Tony Robbins I saw recently, like, just continuing to manage circumstances. Right. Just ends up in chronic stress. Right?
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B
Yes, absolutely. Yeah. Stress also exhausts. And if we have adhd, then that's baked into ADHD in a sense.
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A
Right.
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B
Stressed out a lot because we put things off or things are just overwhelming. They just seem amorphous and like, big, you know, to us, and then that makes it harder to do and then we just don't do it and then that bites us in the ass. So like.
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A
And then it does.
- [23:01]
B
Yeah.
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A
This domino effect of things piling up and. Yeah, so.
- [23:06]
B
So I was going to say with the chronic pain. Right. And with migraine, it makes it even more difficult to go and, you know, go into your job and a demanding job, you know, and also juggle that and show up and appear competent with, you know, with whatever you're feeling physically, plus the adhd, plus the time of the month or whatever part of life you're in and, you know, knowing, having in your mind, I need to pick up my kids from extracurriculars or from school at this time and, you know, maybe over the weekend the schedule changes and so it's just a lot.
- [23:46]
A
Yeah. What in your experience over the years, what does, like, an effective strategy, treatment, whatever you want to call it, for that emotion, dysregulation, like an ADHD look like? Does medication work? Therapy, coaching? Is it Working on the mechanics of adhd, is it everything? Again, I know everybody's different, but in your experience, how do we, how does somebody listening who kind of really resonates with what you've been saying, how do they start that, that process? Because I know medication isn't for everybody, Therapy isn't for everybody. Some people just need to, you know, some people need to kind of work out strategies to how to get done. Right, okay, but so in your experience, what does that kind of effective treatment of strategy look like?
- [24:47]
B
Yeah, so that's a big question because one, it depends on the person and what they're struggling with. But, and you know, and then the other thing is it, you know, it, it's difficult. Like it's a difficult puzzle to solve when you're a woman with adhd. But in terms of more if you, you know, if you have hormonal issues, right, or because for example, like I didn't even mention pcos, polycystic ovarian syndrome, like that's more common also for women with ad. So that basically what that means in a nutshell is that your hormones are out of whack and they're all over the place. And so it's unclear when you're ever going to get your period. Maybe after 40 days your cycles are different. So that brings me to say that like a lot of women with adhd, they benefit from taking birth control continuously. And so that's something you would speak to your OB GYN about. Right, but that's one possible solution. And for, for some women, you know, using like an iud, it might be more beneficial. I think finding the right birth control and like because of the estrogen, that's really the purpose. Yeah, finding the right one that works for you, depending on how you function and what your body is like that can be really helpful. You know, outside of medication. The other thing is just self compassion and thinking ahead. So during the weeks when I'm feeling like I'm doing well, I capitalize on that time and I make sure I actually do my work because I can. And then during the, you know, few days where it's harder for me, I'm allowed to take it easy because I've already done the difficult stuff, right. So just, you know, I guess like work smart, like, and I know that the ADHD gets in the way, but if you've made it as far as to become a CEO or you know, like you've got something in you to be able to make it work and sometimes it's a make it Work moment.
- [26:58]
A
Right. And, and, and you know, I, I've talked to a lot of people where they, they kicked ass in their career for a number of years. And then things changed. Whether it was like young kids came into the mix or other kind of life, maybe they were caregiving for an aging parent, you know, the dynamic changed. So ADHD didn't necessarily present itself prior to present day, and now they have these challenges. So, so, so life changes, right? We gotta kind of, we have to, we have to, we have to adjust or navigate our ADHD according to exactly what's going on in life, right?
- [27:50]
B
Yes, absolutely. Yeah. And so in those kinds of situations where like the environment presents a stressor, then, you know, and you're really struggling with the status quo, then you may need to change your life a little bit. If, you know, if you can afford a nanny, that's helpful. If you can't and you have family in the area, getting family to help, sometimes it takes a tribe or takes a village to help. If that's not possible, you may need to adjust your hours in your job because I think it's, and, and it's complicated. Again, it depends on the person. But it may be better for you to cut down on your hours or to change the obligations of your position so it's less stressful. So that way you can do a good job at what you're doing rather than risk making a huge mistake and getting fired.
- [28:43]
A
Right, Yeah, I hear what you're saying. I think in some cases that's a little more challenging for people. You know, depending on the mix of their circumstances. You know, they may be raising young children, maybe their parents fell ill, they're still in that demanding role, so to speak. So that's, that's a big kind of thought process or decision for many people. Right. I mean, you know, what, what do I, do? I have so much capacity, right? In, in a certain 24 hour period. How, how do I, how do I not become burned out or chronically stressed or, or ill myself? Right. Because of the circumstances. That's a, that's a big, that's a big question for many.
- [29:37]
B
Yes. Yeah. And I, I mean the. Okay, so it's like you can either stay in that position. Right. And that's a good place to start and try to use coping strategies. Right. And you said some people don't want to go to therapy, but like it's either the status quo with no therapy, no help, or you get help either. It's, you get help and you guys try to figure out some Strategy, day to day, you know, living strategies or ways to deal with stress or burnout or it's shaping your environment. I still think, because in that kind of situation where a parent falls ill, you may still want to hire a caretaker. Like, because you, you have a demanding position and you insist on keeping the position, then you have to show up for your job and who's going to take care of your parent? So something's got to give.
- [30:30]
A
Yeah. So if I'm hearing you, you've got to figure out how to control your situation, your present situation. Right. You've got to exert some agency over your present circumstances instead of. Because I think a lot of people with adhd, regardless of male, female, whoever, we just respond to certain things rather than try to be a little more intentional. Correct.
- [30:57]
B
Yeah, exactly. Yeah. It's about, I guess it's about like, like a make it work moment. Right. You sit down and you have to carve out that time, too. When am I going to sit down and think about this? But you think like, okay, this is not working right now for me. What part of it is not working? What do I have control over? What don't I have control over? What can I do to make the situation easier while still maintain my happiness? Like, if this is a job you really love, that you're really passionate about, then it may be better to hire someone if you can, you know, to help you so you can still maintain and keep that job. But if this is a job you could never stand, maybe this is your moment to.
- [31:40]
A
Yeah, you're right. You know, I've been looking for an out. Yeah.
- [31:43]
B
Like it.
- [31:43]
A
Yeah.
- [31:45]
B
But, you know, but keeping things as is, like, especially if you've been trying for a while and you decide like, this isn't working for me, you can stay unhappy or you can like, make a plan.
- [31:57]
A
Yeah.
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B
Change things.
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A
Yeah. This obviously could be a much larger and longer discussion. But as we wrap up, what is something I didn't ask you about? Emotion regulation, emotional regulation in women that we really need to reinforce and get out there. I mean, what's that big kind of takeaway or aha moment that you want listeners to. To kind of understand and. And walk away from this podcast to. To think about.
- [32:30]
B
Yeah. So I think in professional roles. One thing I write a lot about in my book is rejection, sensitivity, dysphoria, rsd and relatively new concept that was popularized by a psychiatrist named Dr. William Dodson and research on RSD now. And basically the idea behind that that he noticed in his patients is that people with ADHD tend to display this extreme sensitivity to perceived or actual criticism by others. And I found that professionals especially can really relate to that. And it becomes even harder in a workplace where, let's say you're visible and you're in a cubicle or you're working in a glass office, like with, well, there's like no privacy. And if let's say you just got like a negative annual review or you were criticized by someone for an assignment that you did, or for maybe doing something incorrectly or not in the way that it's expected, then you might feel that backlash or that emotional response more intensely than someone who isn't neurodivergent. Neurodivergent, Sorry. And that, you know, I think it's really, first of all, really helpful to know that that concept even exists and that so far, like, research does show that this is a significant problem for people with adhd. But then also to, you know, just have some self compassion and be aware or try to gain awareness, you know, when that is the thing that is really bothering you and give yourself a chance to step away. Because in those kinds of environments, again, you don't have privacy. And if you struggle with regulating your emotions and with executive functioning issues, then you're going to need privacy. Finding a time to go to the bathroom or step outside or sit in your car and just decompress and allow your big emotions to come down and then decide, like we were talking about before, what don't I have control over in this situation? And what do I have control over in this situation? And is this a situation where I think it's worth it to, you know, change anything or to like, exert control in the way of, like, should I problem solve and do something about that? I leave this be because I think.
- [34:59]
A
A lot of us in the situation you described, that would literally like, control us for two or three days, right After a. After a bad discussion with a boss or a client or something like that. And it's just like, you know, you're just ruminating on and it's completely taken up too much space in your head. Right. So, you know, as you're saying, it's like, it's important to like just hit the pause button and really kind of think that through. Right?
- [35:27]
B
Yeah. Or even just let yourself feel your feelings.
- [35:30]
A
Yeah. Yeah. Cool. So we will put a link to the book in the show notes, as us podcasters say. All right. How else can people find you?
- [35:43]
B
You can find me by reaching out through my website, which is Dr. Gillicon.com. and I'm also active on Instagram, and my handle is at Dr. Gillicon.
- [35:53]
A
Cool. All right, we will, we will put those links in there. So thanks for coming on, and I'm sorry I got you angry in the beginning, but this is what we do. We talk things through, right? I mean, this is, this is what I, I, I, I set out at the beginning of putting this podcast out is we have conversations, we challenge each other, we want people to learn from the myths and the misconceptions and etc. Etc.
- [36:20]
B
So it was appropriate because the episode is about emotion regulation.
- [36:24]
A
Right? Exactly. So I think, I think that's cool. We should, we should challenge some of these things in this world of adhd. Right? So cool. All right, thanks again.
- [36:39]
B
Okay, thank you.