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This Isn’t Anxiety, It’s ADHD — Transcript

by HealthyGamerGG · 2,806 words · 412 segments · language en · Watch on YouTube

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0:00So for a neurotypical person, the more
0:02important [music] something is, the more
0:06it sinks in. But for ADHD, if we don't
0:09ever hear it in the first place, it
0:11doesn't matter how important it is
0:13because we never heard it. That when we
0:15are relaxed, something can go wrong.
0:18When we are relaxed, something will go
0:21wrong. And so, how do we correct against
0:24this? Being relaxed doesn't work for us.
0:26So, we start to become paranoid. You
0:29cannot rely on your mind to remember.
0:32ADHD feels like waiting for an email
0:34that says you're in big trouble and
0:36everyone's mad at you. Hello, Dr. K. I
0:38really enjoy what you do and I've
0:39watched many of your videos,
0:40particularly those about ADHD. Is an
0:42autistic man with an a lot of
0:44overlapping symptoms. I saw an Instagram
0:46post that read, "Add feels like waiting
0:48for an email that says, "You're in big
0:50trouble and everyone is mad at you."
0:52That line hit me harder than I expected.
0:53It captures this constant low-level
0:56tension I carry, especially in
0:58professional settings. It rarely shows
1:00up in my personal life. Thankfully, I
1:02feel secure with the people that I care
1:04about. But in contexts where composure
1:06matters more than content, I'm always
1:07waiting for a mistake with my name on it
1:10to surface. Um, no matter how organized
1:12I try to be, there's this quiet dread
1:14that something slipped through the
1:16cracks, a form I missed, an unanswered
1:18email, and one day it'll all come
1:20crashing down. Part of me thinks this is
1:22just adulthood. Nobody points out small
1:24errors anymore. They just accumulate
1:26until they become something big. So I
1:28overcorrect with perfectionism. Not
1:30because I need perfection, but because I
1:32can't tell what actually matters. Okay.
1:34So let's talk a little bit about this.
1:36So often times people with ADHD grow up
1:39with this sense of constant dread. this
1:42kind of like baseline paranoia that
1:45something is going to pop up and it's
1:47going to screw me over and I'm going to
1:48be in big trouble and everyone's going
1:50to be disappointed in me. So where does
1:52this feeling come from and how do we
1:54protect against it? So the first is that
1:56we have to understand if we think this
1:58way there's a good reason for it. Okay.
2:00Now I want y'all to understand what it's
2:02like to grow up with ADHD. So this was
2:04my constant state when I still have
2:06nightmares about it's it's hilarious.
2:08Like I had a nightmare about 2 years ago
2:10that I forgot to turn in an assignment
2:13in high school. And since I forgot to
2:15turn in an assignment in high school, I
2:16didn't pass the class. And someone found
2:18out that I didn't pass the class, which
2:20means that I never graduated from high
2:21school. And since I never graduated from
2:23high school, that invalidated my college
2:25degree because I never finished high
2:27school. So college is invalid. Since I
2:29never went to college, that invalidated
2:31my medical degree, which invalidated my
2:33residency, which means that I'm no
2:35longer a psychiatrist. So this is like
2:36some weird like what what is this? Like
2:39what is going on? So here's what we got
2:41to understand. If you have ADHD, you
2:43grow up in a situation where you cannot
2:46rely on your mind. You cannot rely on
2:51your mind to remember. Now technically
2:54it's not me remembering. Technically it
2:57never goes in in the first place. So
2:58let's remember that memory is stuff
3:00getting stored to the hard drive and
3:02being recalled to the hard drive.
3:04there's an intentional component where
3:05whether it ever gets written to the hard
3:07drive in the first place and then it has
3:09to be pulled out. So, a lot of people
3:10with ADHD think they have memory
3:12problems. They don't have memory
3:13problems. Memory is actually perfectly
3:14intact. It never gets written down in
3:17the hard drive in the first place. You
3:18weren't paying attention, so it didn't
3:20sink in. It's not that you forgot, it's
3:22that you never knew. Now, the practical
3:25result of this is that if you've got
3:26ADHD, you walk into school one day and
3:29you're not worried about anything. And
3:31then you discover that you forgot an
3:34assignment. So, I was not worried and
3:36I'm in trouble. A week later, I walk
3:38into school not worried. Get in trouble.
3:41Oh my god, I forgot I had a test. So,
3:43over time, what happens with ADHD is we
3:46learn that when we are relaxed,
3:50something can go wrong. When we are
3:52relaxed, something will go wrong. And
3:55so, how do we correct against this?
3:58Being relaxed doesn't work for us. So,
4:00we start to become paranoid. We start to
4:02have this low level of dread always at
4:05the back of our mind because we have
4:07learned time and time and time again
4:09when we are relaxed, things go wrong.
4:12Now, there are a couple of things that
4:14are different about people who don't
4:15have ADHD, people who are neurotypical.
4:18They too forget things. The problem is
4:20that they don't forget things nearly as
4:23much and oftentimes the consequences
4:25aren't so severe. And I want y'all to
4:27really think about this for a second. So
4:29the problem with ADHD is it is a sensory
4:33attentional disorder. So for a
4:35neurotypical person, the more important
4:38something is, the more it sinks in. But
4:42for ADHD, if we don't ever hear it in
4:45the first place, it doesn't matter how
4:47important it is because we never heard
4:48it. So people who are neurotypical will
4:50also forget things. They won't pay
4:53attention 100% of the time, but they
4:55don't forget exams. They don't forget
4:57projects. They don't forget weddings,
5:01right? They don't forget like the big
5:02stuff. So some of that stuff is intact
5:04in neurotypical people. So everyone will
5:07forget, but it doesn't happen as often
5:09and the consequences are not as severe.
5:11Once the consequences are severe and it
5:14happens often enough, we turn on this
5:16dread mode, this paranoia mode, because
5:18we can't trust ourselves when we are
5:22relaxed. When we are relaxed, we make
5:23mistakes. So, let's constantly be in a
5:26state of dread. There are a couple of
5:27other features here that are really
5:29important to understand. Two other
5:31neurodedevelopmental aspects that are
5:32important. The first is emotional
5:34regulation. So people with ADHD
5:37experience emotions more rapidly and
5:39more intensely and have difficulty
5:41regulating their emotions. So a
5:43neurotypical person when they feel a
5:45little bit of worry or paranoia, their
5:47ability to calm themselves down is
5:49naturally more robust than someone with
5:51ADHD. So some people have even
5:53hypothesized that there is an emotional
5:55disregulation
5:57subtype of ADHD. So we think about
6:00attention deficit disorder, attention
6:01deficit hyperactivity disorder. There's
6:04a subtype that has that's the H right
6:06that has hyperactivity or not. And then
6:08there's a third subt type of ADHD
6:10attention deficit disorder with
6:12emotional dysregulation as a primary
6:14feature. So this is not so much about
6:16the dread being justified but your
6:18ability to control the dread is going to
6:20be impaired. The last thing is
6:22impulsivity. So I don't know if this
6:24makes sense but the idea that you forgot
6:27something is actually an impulse. So,
6:29you're going about your day d
6:32and then there's an impulse. Oh, oh my
6:34god, you forgot something. And you're
6:35like, wait, what did I forget? I didn't
6:36forget anything. Let me think. I can't
6:38think of anything. Goes away. Oh my god,
6:41you forgot something. So, I I don't know
6:42if this makes sense. It's not just that
6:44you learned that you can't trust
6:46yourself. It is that your brain is more
6:48vulnerable to repeated impulses of dread
6:52and has more difficulty regulating those
6:54repeated impulses of dread. So, how do
6:56we fix this? This is where the reason I
6:59talk about these other
7:00neurodedevelopmental aspects is if you
7:02go to treatment for ADHD, then hopefully
7:05they will help you with some of these
7:06things. So when I made the ADHD guide, I
7:09tried to list out a bunch of stuff that
7:11you can do. Everything from organization
7:13and planning to make sure that things
7:15don't fall through the cracks to
7:17emotional regulation stuff. Okay? So all
7:19that stuff is laid out there. So the
7:21most important thing that I do with my
7:22patients is teaching them damage
7:24control. And what I'll do with them is
7:26we'll say they're worried about
7:27something going wrong. And so what we'll
7:29actually do is utilize a couple parts of
7:31the brain that are actually quite robust
7:33in ADHD. Number one is your sensory
7:35circuits. So often times people with
7:37ADHD will have diff difficulty with like
7:39being overstimulated. We'll have
7:41difficulty with like you know arid like
7:42symptoms where certain textures really
7:44bother them, stuff like that. So sensory
7:46sensitivity is very high. We can use
7:49that to our advantage by giving
7:50ourselves sensory inputs. So literally
7:53what I'll tell my patients to do and I
7:55think this works better on pen and paper
7:57than on a on a electronic device.
7:59There's certain neuroscience mechanisms
8:01for that as well. Anytime we write
8:02something, it slows down our thought
8:04process. We have to concentrate on that
8:07a little bit longer which means it sinks
8:09in a little bit deeper and the act of
8:11writing somehow commits things to memory
8:13a little bit better. There's just some
8:16connections there which just the way
8:17that our our brain works. Okay. speaking
8:19by the way. So anytime we generate
8:22something from our mind, that thing gets
8:25locked into our head a little bit more.
8:27So if you have ideas in your head, but
8:29you speak them out loud, you're more
8:31likely to remember them. Okay? So what
8:33we'll do is I'll I'll tell my patients,
8:34look, just grab a piece of paper and at
8:36the end of every day, write down what
8:38you forgot. Just write down what you
8:40forgot. You're going to forget stuff.
8:41Oh, you're dreading this stuff. You're
8:42going to forget things all the time,
8:43right? Just write it down. So we
8:44discover a couple of really important
8:45things. First is that sometimes they
8:47forget things, which is totally fine.
8:48often times their fear of forgetting
8:50things is actually far greater than the
8:53actual amount of stuff that they forget.
8:54Right? Once you're paranoid about
8:55something, the likelihood of it
8:57happening is lower than what you think
8:59it is. That's very common. Okay, so this
9:01does a couple of things. It actually is
9:03quite reassuring because now you're
9:04getting sensory input. Okay, I'm not
9:07screwing things up every day. That in
9:08and of itself is so soothing for your
9:11mind. But you will say, "But Dr. K, what
9:12about the days that I forget something?"
9:14Great. When you forget something, write
9:17down what you did to handle it. And this
9:19is what's really cool. You know,
9:20sometimes I'll have patients come into
9:22my office with ADHD and they say, "Oh my
9:24god, my life is so chaotic. Everything
9:26is chaotic and I hate it. I can never
9:28rest. I can never relax." And what I
9:31find when I talk to these people is that
9:32they do really well in chaos. If you
9:35take a chaotic environment, you drop a
9:36neurotypical person into it, you drop an
9:38ADHD person into it, the ADHD person
9:41will outperform the neurotypical person.
9:43The really interesting thing, what's
9:44really scary is you may be dreading that
9:46you make a mistake, but usually people
9:48with ADHD are really fast at managing
9:50them. So, they're actually quite good at
9:52damage control. And why are you quite
9:53good at damage control? Why are you good
9:55at writing a paper really, really
9:57quickly? Because you forgot about it
9:59until 45 minutes before class, you sat
10:02down, you started writing furiously. You
10:04have so much more practice with chaos
10:07because you're forgetting things all the
10:09time and you're creating it all around
10:10you. So, what I'll tell them to do is
10:12even if you forget something, write down
10:13what you did to fix it and what that was
10:15like. And then we discover something
10:17really important. And this is what
10:19really gets the dread to disappear. The
10:21moment that you realize that you can
10:24handle things going wrong, you don't
10:26need to be paranoid about it anymore.
10:28You only need to be paranoid about
10:29problems that cannot be handled. This is
10:32why we have ICUs, intensive care units.
10:35What's the purpose of an ICU? ICUs are
10:38where we send the sickest patients. They
10:40have the highest ability for something
10:43to go wrong, but we have a better
10:46nursing to patient ratio. We have
10:49constant monitors. We have telemetry.
10:51We're doing checks all the time. There's
10:53a far larger team. There's a
10:55specifically trained someone called an
10:57intensivist, a pulmonary critical care
11:00doctor who specializes in ICU care. The
11:03only reason you need to be paranoid is
11:04if your damage control capability is not
11:06good enough. Not if things go wrong.
11:08Things are absolutely going to go wrong.
11:10You will not remember everything. You
11:11will not pay attention to everything.
11:13Things will go wrong. Now, this isn't
11:15going to fix everything 100%. But if you
11:17do these things, if you actually start
11:19measuring how often you forget things,
11:21and you start really paying attention to
11:23how good you are at damage control,
11:26hopefully these two things will help you
11:28with this kind of paranoia. What
11:29questions do you all have? Does this
11:30ADHD dread that comes from g from
11:33getting and punishment can stem from
11:34trauma as well? Absolutely. So this is
11:36what I want you all to understand. So
11:38when a patient comes into my office with
11:39ADHD, they have some degree of
11:41depression or trauma until proven
11:44otherwise. So if you look at the
11:46causitive relationship between mood
11:49disorders like major depressive disorder
11:50and ADHD, what you find is that there's
11:52a one-way street. If you have ADHD, the
11:56likelihood that you will develop
11:57depression is way higher compared to if
11:59you have depression, the likelihood that
12:00you develop ADHD is quite low. Okay. So,
12:03what this means is that that original
12:05thing, the original dynamic of you not
12:07being able to trust yourself, the reason
12:10you get programmed is because it's
12:12traumatic. Let's understand what trauma
12:14is. Trauma is not a disorder. This is
12:16why trauma is so hard to treat. It's not
12:18a disorder. PTSD is a disorder, but
12:21generally speaking, a traumatic
12:23experience against the body is not a
12:25pathology. It's not something going
12:27wrong. Getting sick is damage to our
12:30body, but our body adapts. Our body's
12:33immune system actually improves after an
12:36infectious trauma. Does that make sense?
12:37I don't know what the word infectious
12:38trauma after an infection. Let's just
12:40call it that. So, the reason trauma is
12:41so hard to beat is because it is our
12:43body's adaptation mechanism. It's what
12:45it's wired to do. So, I want y'all to
12:48think about this for a moment. If you
12:49didn't think that you forgot something
12:51and you forgot something, that's bad.
12:54And your body's like, "hm, how do we
12:55prevent this from happening again?" And
12:57then you forget something again and then
12:59you're you're like, "Oh my god, I didn't
13:01realize I forgot this. Now I'm screwed."
13:03So then our brain is sitting there and
13:04it's like, "Well, this guy relaxes and
13:07then forgets things." I've got an idea.
13:09How about we never let him relax because
13:11that's what the experience is. We're
13:12constantly in the jungle. There could be
13:14a tiger behind every tree and every
13:17bush. So, we're going to be on a
13:18constant low level of alert. This dread
13:21in the back of the mind is absolutely
13:24trauma-lated in the sense that we have
13:26negative experiences that hurt us,
13:29activate our negative emotional
13:30circuitry. And anytime our negative
13:32emotional circuitry activates, we're
13:34talking about the amygdala and the lyic
13:36system. What's sitting right on top of
13:38it? The hippocampus where we learn. So,
13:41learning and negative experiences are
13:42very tightly tied together. Right? If I
13:45meet an animal for the first time, if
13:47you guys have ever seen like a rescue
13:48dog or rescue cat that have has has had
13:51negative experiences with with humans,
13:53they are adapting. Trauma is an
13:55adaptation, not a pathology in its most
13:57basic sense. It can become pathologic
13:59when the adaptation is maladaptive or
14:01happens too much. But great question.
14:03The tiger everywhere system. Well said.
14:05Hey y'all, hope you enjoyed today's
14:06video. We talk about a bunch of topics
14:08like this on the channel, so be sure to
14:10subscribe for more. If you're already
14:12subscribed, GG and we'll see you in
14:14chat.

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