Silence Your Harshest Critic — Yourself

No matter what we accomplish, adults with ADHD are still plagued

by self-criticism — which can hold us back and bury us in a
mountain of shame. Start being nicer to yourself today, using these
strategies from an ADHD coach.

An ADDitude reader recently wrote: “I am a 41-year-old

emergency room doctor. I know that I am good at what I do, but I
am always waiting for the other shoe to drop, for something to
happen that will show everyone that I am not good enough. In med
school, I used these negative emotions to motivate myself to do
things. When I graduated, I remember thinking, ‘Everyone’s a
doctor. No big deal.’ So to distinguish myself, I decided to
specialize in emergency room medicine. Now I realize that I was
trying to prove something. The joke around hospitals is that all ER
docs have ADHD, but no one really knows the challenges that
ADHD presents. I was diagnosed when I was 39, and I’ve never
told anyone about it. My colleagues, although nice, would lose
respect for me if they knew. My ADHD makes me feel like a fake
sometimes. It is exhausting. What can I do about this?"

The Good News — and the Other News

You have chosen a career that capitalizes on your ADHD
strengths. You thrive in the emergency room because it is
stimulating.

Every patient brings a new set of challenges and requires you to

adapt. You are never bored at your job.

Like many high-achieving professionals with ADHD, you are using

shame to motivate and manage yourself. You feel that there is
something wrong with you. Shame tells you, “I am a failure” and “I
am bad.” It threatens your well-being. You spend the day trying to
hide your flawed self from others, and you are fearful that you will
be found out.

Neurotypical people have prefrontal cortexes that act like a butler.

“Sir,” the butler calmly says, “your keys are on the table.” Or
“Madam, you must leave now if you want to be on time.” Many
individuals with ADHD, having limited access to their prefrontal
cortex, rely on their emotions to make decisions and to motivate
themselves. Shame provides a well of negative emotions from
which they can draw.

So instead of a tranquil butler, ADHDers have an angry neighbor

threatening them with his shoe. “If you lose your keys again,” he
yells, “I’ll throw this at you!” They feel bad and create emotional
cues to help them remember their keys. They begin to listen for
that angry neighbor to “help” them remember their keys. They
learn that shame improves their performance. In med school, you
probably learned that you could use your strong negative emotions
to motivate yourself academically. To live more peacefully with
yourself — and to be more productive — you have to find ways to
challenge your shame.

Spotting Shame
The first thing to do is to look for signs that shame is overtaking
you. Here are three that many ADHDers should be on the lookout
for:

> Unworthiness. Do you feel unworthy and believe that when you
make a mistake, it is evidence that you are worthless? There is a
big difference between humility and feeling unworthy. Humility
allows you to accurately assess your strengths and weaknesses;
unworthiness leads to belittling yourself in your head and around
others.

> Fear. You said, “I am always waiting for the other shoe to drop,
for something to happen that will show everyone that I am not
good enough.” You think that things will eventually go wrong and
that it will be your fault. Do you fear that you are a fraud and that
others will discover that you are secretly disorganized, careless, or
not as smart as you appear?

> Avoidance. When ADHDers’ emotions are dominated by

negative thoughts, we avoid doing things that cause us pain. What
are you avoiding? Are you attending to details at work, but putting
off things in your personal life because they feel negative or aren’t
interesting?
Tip: The first place to look for shame is in your conversations with
your colleagues and friends. Listen closely to what you say — you
will be surprised at what slips out. When shame shows up in your
language and thoughts, you need to challenge it. Ask these
questions:

Is this shame-based thinking?

What lies am I telling myself?
What would my life look like if I were to let go of this thought?
What do I need to do to move in the right direction?

Stay Out of Other People’s Heads

Hospitals are known for their competitive, political environment.
For example, there are rivalries between specialists, and
disrespect between teaching doctors and their research
colleagues. Because of the shame you feel, you are sensitive to
criticism and harsh comments, seeing negativity in messages —
even where there isn’t any. Take a step back and look at social
structures before assuming anything. Then ask yourself if there is
anything of value in what anyone is saying about improving
processes.

Tip: As you listen to a person speak, summarize what they are

saying: “He is saying that…” or “She is asking me to....” As you
summarize, don’t allow your feelings of shame to color the other
person’s words. Thoughts like, “He probably thinks I’m an idiot” or
“She thinks that I can’t do this” will not help you succeed. As a rule,
you can only be held responsible for your own thoughts, so stay
out of other people’s heads.

Avoid the Perfection Trap

When you finished graduate school, you commented that you
thought “everyone” was a doctor and that it wasn’t a big
achievement. Believing that earning your M.D. isn’t a major
achievement is a sign that you are using perfectionism to keep you
motivated and to achieve bigger goals. Many individuals believe
that a drive for perfection is due to their type-A personality, when it
is really due to their feelings of inadequacy and shame.
Perfectionists with ADHD will often dismiss their achievements in
order to motivate themselves to complete more tasks. They
believe that they can motivate themselves by being overly critical
in their self-evaluations, focusing on their flaws rather than their
achievements. So no matter how well a task is done, there is
always a sense of failure that it wasn’t done even better.

Tip: Instead of demanding perfection, teach yourself to value daily

accomplishments, no matter how small. Ask yourself, “Do I give
myself appropriate credit when I finish something? Or am I
embarrassed and disappointed because my accomplishment
doesn’t seem to be enough?” In doing that, you will begin to
monitor your use of time and energy.

Watch for the times when you may be getting caught on the small,
unimportant details in life. Ask yourself, “Would there have been a
difference (spending this extra time, say) that would have been
significant in the long run?” Answer that question as honestly as
possible. Rather than siphoning your energy to pay the perfection
meter, imagine how much better your resources could be spent,
meeting other challenges. Ultimately, chasing perfection will hold
you back in your life.

Don’t Invite Shame to the Party

Listen for those times when you talk negatively to yourself. If you
use phrases like, “I should have…” or “I’m sure I will mess this
up…,” you are tapping into shame. Your self-talk is damaging, and
it needs to stop in order for you to develop healthier self-esteem.

Tip: Shame needs to be confronted. Tell your angry, shoe-bearing

neighbor to stop. Some of my clients say out loud, “This is shame,
and it isn’t helping me.” One of my clients has even named the
angry neighbor. When negative thoughts pop up in his head, he
says, “No, Frank. Not now.”

It takes courage to confront shame. One client of mine said, “I

never thought I used shame, I just thought it was there to live with.”
He felt that he deserved his harsh inner critic, and adds, “I am so
much happier when I deal with it.”