Which Anxiety Are We Treating?
Anxiety with ADHD can be difficult to assess and quite refractory to treat. Often whatever medications are tried, just don’t work effectively, and many can significantly contribute to emotional deterioration with impulsivity and depression. The most frequently overlooked anxiety is ‘cognitive anxiety’ and the reason it is overlooked is simple: descriptively, on the surface, it looks like OCD – obsessive compulsive disorder. Obsessions can be a part, can be a symptom, but let’s look more deeply at the cause.
And don’t be surprised if your doctor doesn’t agree with these next remarks, they are not yet in the standard diagnostic text.
7 Tips To Recognize Cognitive Anxiety:
- Look first for Worry, for ‘Unmanageable Cognitive Abundance.’ Anxiety presents in our offices when it becomes unmanageable, when life becomes frozen with indecision. Thinking too much can result in three repetitive outcomes discussed below.
- Remember Cognitive Anxiety is Subtle, and if you don’t look you won’t see it. Many have so much cognitive anxiety they simply don’t recognize it. If you ask the simple question: “Are you anxious?” the most frequent answer is negative. Word the question like this: “Do you worry, do you think to much and too often about small things and find yourself thinking so much you can’t get things done – that you feel overwhelmed?” This form is the most frequently missed form of counterproductive thinking.
- OCD is Not the Only Cognitive Diagnosis: Don’t ask the question only looking for OCD, – yes, OCD can be associated with cognitive abundance. But OCD can present as a symptom for a ‘spectrum of disorders,’ not only ADHD. Use the history to tease out the ADHD details over time. ADHD most often has an academic history except with the Decisive Form below.
- A – The Stuck Form: One form of ADHD with cognitive anxiety becomes stuck on the details, and presents as overwhelmed and indecisive. They think so much, about so many details, they simply can’t decide. They need a life partner to decide the next moves. These folks start falling apart in the 5th, 6th, or 7th grades, most often the 6th because the work load changes.
- B- The Decisive Form: This form of ADHD is compulsively decisive, a hard worker, shows no ‘inattention,’ but rather runs around fixing and making decisions to preclude thinking to much. They often decide quickly, often do it well, but come in because they too are overwhelmed with micromanagement and picky details thinking they are the only one who can ‘do it right.’ These individuals often do well all the way through school, become professionals, and have no idea what is driving their ‘compulsive’ work driven motor. They can’t stand trash in their mind.
- C- The Combo Form; Some individuals with pervasive cognitive anxiety wax and wane between these latter two subtypes. At work they can be strong and decisive as they understand the context and have mastered that game. At home they may have trouble with family, with errands and lack of structure. The spouse often wonders why they are so effective over there, but so ineffective here.
- Cognitive Anxiety Treatment Considerations: If the cognitive anxiety is primarily ADHD in origin, it should be carefully treated with stimulant medications. See the details in my many other Therapeutic Window Articles here regarding dosage strategies. As noted above, watch for SSRI reactions, and drug-drug interactions outlined in detail on my website below if the diagnosis includes depressive elements. SSRIs aggravate ADHD when not combined with a stimulant strategy.