"Unspecified Attention Disorder"-- is this "real" ADHD?

[Jadfre]

Hi all,

In brief, I sought treatment for depressive episodes about a year ago, and after a few months meeting with the psychiatrist, an ADHD packet, etc, he gave a diagnosis of "Unspecified Attention Deficit Disorder; Unspecified Depressive Disorder", and started me on Methylphenidate. I now take the extended release (Concerta, 54mg) daily with Bupropion ER (300mg), and it has helped somewhat (i.e., I can focus for longer, but it hasn't helped with procrastination, being increasingly late to things, and getting fixated on an emotion, especially when it's one of guilt/shame at failing another task, making it difficult to do anything until I can break out of the mood [normally something external breaks me out of it]).

I had never really entertained the idea of actually having ADHD, even though the medications are helping, but I stumbled upon information about Adult ADHD online about three weeks ago, and it felt as though someone had secretly tape recorded my life and transcribed it on a page. It explains nearly every single problem I have been having to a T, and the aspects of emotional hypersensitivity and rejection sensitivity dysphoria (RSD), neither of which I knew existed, nor knew were connected with ADHD, seem to explain the "depressive" episodes that brought me in to the psychiatrist in the first place (i.e. they never come unprovoked, and always start after I am frustrated at myself for failing to do something, or grow out of increasing frustration and stress over not completing a very simple task like writing an email, or if I somehow convince myself that someone important to me will be upset at or disappointed in me for some reason--the latter can be debilitating for a while, sometimes).

However, when I went into the psychiatrist a few days ago, he was not receptive to changing the diagnosis, and kept saying that he still thinks there may be some sort of anxiety or depression going on. While this certainly may be the case, and I definitely want to continue meeting with him to try and figure it out, I am feeling somewhat uneasy about not having a concrete diagnosis.

Although the ADHD symptoms I have seen feel like they explain a lot, and the techniques they suggest seem like they would help, I can't help but feel like I would be 'hypocritically' assuming someone else's condition. Whereas thinking, "Ah! This issue today is explained by ADHD such-and-such," which would help ground me and give me a platform to begin fixing it, when I try to think that way now, it is undermined by the thought, "Ah, but you do not have an ADHD diagnosis! You cannot apply this logic to your situation, you should not assume the mantle of another's difficultly as your own!"

I realize that this is largely an issue of formalism, and functionally, since I am getting the medicines I need (psychiatrist was open to trying to add on medications that have been successful in combination with stimulants for ADHD, such as Alpha-2 Agonists, etc), if the techniques work, then they work and I should use them.

I still cannot shake this worry, though, and really feel uneasy without a concrete diagnosis-- "unspecified" feels rather... false, as it were.

To that end, what are your opinions on the "unspecified" diagnosis? Is this "real" ADHD? I would very much like to read your honest opinions-- if I can get an accurate idea of how the community feels about this sort of thing, I know that it will help me re-center my thoughts, and have more confidence to deal with the nagging doubt that makes it difficult to implement corrections and new techniques.

If you do not think that it qualifies, though, please do say so as well-- this will help me uncouple myself from the "ADHD" label, and be open to exploring other ways of thinking about my condition.

Thank you all for your help, and I look forward to reading your opinions!

Best,

Jadfre

[Birdwatcher19]

Hi Jadfre. “Unspecifed” simply means that you have several ADHD symptoms that cause “clinically significant distress or impairment,” but you don’t meet the full criteria, according to the DSM-5. This could simply mean having 4 symptoms rather than the 5 that are required for diagnosis in an adult, or even that “there is insufficient information to make a more specific diagnosis”—i.e., your psychiatrist still has some doubts. However, as you said, it’s entirely possible that you have ADHD *and* anxiety or depression. The DSM is imperfect. What you’ve described certainly sounds like ADHD, and if the medications and strategies are helping, in the end, that’s what matters. (I do appreciate the desire to know for sure, though: Despite my diagnosis, I still find myself doubting and wondering, “But is it really, really, really ADD?”) Good luck, and try not to get too caught up with the technicalities of the diagnosis!

[Ashfaren]

if u can pm me ur symptoms in brief i can help u wid that. I too have the attention problem which is unspecific or not related to anything or does not fall in any criteria,but i have researched a lot on this and i am sure will help you with that.

[Netjester]

First things first. Find yourself a psychiatrist who only does ADHD. There is usually one of these types of focused clinics in many metropolitan areas. Secondly, many ADHD symptoms can be easily explained away as a part of depressive and bipolar disorders. It’s critical to go through a full diagnosis process. You mention much of what we consider to be the bad part of ADHD, but what about the good symptoms? In my family, we call these our super powers and we make sure to take advantage of them. Have you ever gone into hyper-focus mode? What triggered it? How about resiliency? How quickly are you able to bounce back from rejection or failure?

Something I didn’t read was any talk of impulse control. Does that exist and does it affect you negatively?

You mention your hypersensitivity and possible rejection dysphoria? When does that occur? Have you ever heard of the term rebounding? These are symptoms of your medication wearing off to early. Things that help with this are proper medication dosage, exercise and nutritional supplements geared towards you. Your psychiatrist should be working on those to.

I’m curious if your psychiatrist had and dna test performed for you? How about other assessment tools? Here is a good article on tools to help with assessment: additude.com/adhd-assessmen...

Obviously you aren’t me, but there are many things that work together to help me overcome my obstacles and it’s constantly a work in progress. Medication is only a part of it. I also have a therapist and a life coach that focus on adhd adults. I take supplements based upon my dna and inability of my body to generate needed dopamine. I exercise often, but not to “get in shape”. I exercise as a way to tire myself out and snap my brain back in order. Fast hiking does that and doesn’t necessarily drop the pounds. I meditate a couple times per day for a small amount of time. All I need is 10-15 minutes. The main thing to focus on here, outside of your medication is “self care.” Put together a list of things you like about you and what you don’t like about you. See if you can group them under specific umbrellas and then prioritize them. Mentally build fences around those you don’t like and document daily what you do to prevent them from happening. Do the same for those you like? Eventually you start finding your trigger points. When you do, watch out for “a surprise ending.” At least that happened to me.

I wish you the best and want you to make sure you take it slow because this is the rest of your life that you will need to change. I am an executive at a high-tech company in Silicon Valley and that didn’t happen until I made the commitment to fight for myself and the changes I needed make happen to overcome these obstacles. Daily I struggle, but at least I now know how to overcome them.

Good Luck.

[Jadfre in reply to Netjester]

Netjester,

(No need to respond if you are busy-- reply is rather long)

Thank you for the thoughtful reply! With regard to your first point, I am looking into more complete tests, so hopefully I can get some better information in that regard soon.

-->I definitely have the hyper-focus, when a particular subject of study is terribly interesting, I can work for several hours without really noticing the time passing. I'll also sometimes get sucked into things right before I was intending to do something else, and find it difficult to pull away. I definitely agree with this being a "super power," as it were-- I'm trying to find a way to more reliably engage it to work for me.

-->It's difficult to say for impulse control, since I'm starting to notice or put together things I haven't before when I look at the context of "ADHD." I don't really snap at people or sell the cow for a satchel of beans, per se, but I do launch into long-winded 'conversations' (read: 'lectures') on relatively little provocation (and find it difficult to stop, even when I realize I'm talking too long, and it has made me reticent to make phone calls, as I always end up extending them from 10 minute chats into a 90 minute marathon), and can get fixated on some new purchase I want to make (generally some interesting or new thing), either buying it or spending unnecessary amounts of time looking into it/convincing myself not to buy it, etc. I had always chalked these up to personal traits or personal moral failings, and they certainly are not (of themselves) causing great distress (i.e. I haven't gone into default on a credit card, etc--though they do feed into the other issues in the above post).

-->With regard to resiliency, I am not sure-- I know that the "depressive" episodes will last for several hours at most, but once something distracts me from them, they're more or less over (except the underlying frustration at whatever failing cast me into that state). I don't know if this is "resiliency," though-- I don't as of yet have a great deal of information on that characteristic. I wouldn't immediately say that I seem to have more than the average person, though I'll confer with family if the topic comes up-- I'm not the most perceptive individual, so they may have observations that I do not.

-->With regard to rebounding, it certainly is harder to "pull out" of the focus on a negative emotion when the medication wears off, but it does not happen consistently. It seems very tied to whatever the trigger is-- whatever failing or frustration sets it off. I will say that when the medication wears off, I feel like I have less mental energy to deal with it. Other than that, I do not notice any particular effects of the medication wearing off-- the doctor has been steadily increasing the dose, and not much seems different (other than being able to sustain longer concentration (once I can start) during the medication's effective period).

-->I have not looked into the DNA test, but I am seeking the full neuropsych workup.

-->Thank you for the advice! This seems to be a productive route to investigate, and I get the sense that it will likely help a great deal. Your honest and helpful reply is also quite reassuring, as well. Hopefully, this will make it easier to implement some of these techniques you discussed!

I hope you keep well-- I will also strive to do so!

Sincerely,

Jadfre

[gphill56]

Netjester covered a lot of good info. Anxiety and depression are frequently co-morbid conditions with ADHD, such as for myself. I didn't get a diagnosis until I was 59, and BOY did it explain a lot about myself and my life. I was actually relieved to have found an explanation (not excuse) for many of my issues, behaviors, etc. I had to "argue" the debilitating part of it for the psychiatrist to agree to make it a diagnosis, but in my case I pushed only because that was the only way to get insurance to cover treatment and medication. As I focus on the ADHD, the anxiety and depression seem to be getting addressed as well. Does that mean I don't have anxiety and/or depression? Who knows, but if things are improving, that's what counts. I, too, "discovered" RSD, and shared the info with my psychiatrist. She had not heard of it, but agreed to look into it when I informed her that I felt it definitely applied to me. I'm not sure I want yet another medication, but I would like to know her thoughts after she researches it more, as I value her opinion. I also agree with the exercise points made by Netjester. There are also a lot of studies showing just getting outside into natural settings is beneficial.

Lastly, if you haven't already done so, look into ADDitude.com. It has an enormous amount of information that I found ver helpful in understanding myself better. There are also adult ADHD support groups in larger urban areas, if that is an option or interest for you.

If any of your hyperfocus occurs regarding a potential interest area of others as well, it then is a hobby, you are an afficianado, and everyone you meet in those environments feels the same. Think about anyone really into their hobbies...fishing, Star Wars, homebrewers, etc. etc.

You are not alone! We are allnegotiating these things on an ongoing basis. Hang in there!