I wasn’t terribly surprised this morning when my client with ADHD, whom I’ve been working with on and off since last spring, told me that her job search had lapsed since I last met with her in June. Given the state of the economy and the particular competitive field she is in, it’s not exactly fun and motivating to look for employment right now. She has the best of intentions, but it just hadn’t been happening.

The problem is, she has a family to help support and she’s seeing strains in her relationship with her partner. When I asked what her thoughts were about how her partner might be feeling about her underemployment and lack of drive in searching for a new job, I heard a lot of “should” statements: he thinks she should have a better job, he thinks they should have more in savings, he thinks she should be doing more to contribute.

All of those are legitimate feelings.

But…he also has a partner with ADHD, and employment issues are a tricky subject. Just ask Zoe, one of our resident ADHD experts here on Psych Central, who has written several great posts on work from the perspective of someone with ADHD.

When your partner is not feeling well, it’s natural to become reactive, doing whatever it takes to get through the current crisis of the moment, and hoping this is the last time.

Taking a more proactive approach to managing the symptoms of your partner’s illness, however, is more effective and empowering, both for you and your partner as individuals, and for your relationship as a whole. Working together to identify a “What Works” list that can be referenced when the illness appears eliminates confusion, frustration, and the feeling of helplessness.

This technique works no matter what illness your partner has. Both of you should work together to create this list, and agree that when the illness appears, both of you will reference this list in order to figure out how to stop the cycle.

Sleep is one of those things that we take for granted when it’s going well, and spend a lot of time complaining about when it’s not.

Sleep issues are one of the top complaints my clients have when talking about what’s not going well in their lives. It’s estimated that 65-90% of people with depression experience insomnia, while on the other end of the spectrum, people who are in a depressive phase of bipolar disorder report hypersomnia (excessive sleeping).

How well your partner with a mental illness sleeps can have a huge impact on their day-to-day functioning. Problems with sleep are one of the diagnostic criterion for depression, anxiety, and bipolar disorder, and not getting enough–or getting too much–can cause real havoc for someone with a mental illness. An added bonus: by following these tips, you might sleep better too!

At a recent Grand Rounds lecture I attended at Duke, the speaker told us that he had asked some statisticians to look at the diagnostic criteria for depression listed in the DSM-IV-TR.

Given how the criteria is described in the bible of psychiatric diagnoses, they determined there are 1,099 different combinations of symptoms that can lead to a diagnosis of depression.

So, if you sometimes look at your partner and wonder if what you are experiencing as the partner of someone who has _______ illness is the same as every other partner of someone with the same illness, chances are good that the answer is, “Not necessarily.”

My previous post on what people with depression would like their partners to know was quite popular, so I thought perhaps I’d give a voice to patients who struggle with other mental health concerns. This time, we’re going to hear from the folks with adult ADHD.

Adults with ADHD are often misunderstood by others around them–after all, there’s still the widespread perception that ADHD is a kids thing, and really, shouldn’t an adult have better control over their behaviors?

Or, how could an adult have made it this far in life and not have a diagnosis already? It’s got to just be their personality, right?

Not necessarily.

It’s an easy trap to fall into: “I’m bipolar”….”My partner is OCD”….”She’s anorexic”….”He’s borderline”…

Describing your partner as the illness, instead of as having an illness, can make a subtle (or sometimes not so subtle) impact on both your and your partner’s perceptions of them, their capabilities, and their hope for recovery. It implies that the illness is woven into the fabric of your partner’s being, and that things will never improve.

Saying your partner has bipolar, has OCD, has anorexia, or has borderline personality disorder, etc., puts the situation in perspective: they have an illness, and in many cases, the illness can be cured or at least put into remission.

Last week, Part 1 of this entry had some quick facts about adult ADHD, and discussed two of the four top issues that affect the relationships of adults with ADHD: relating to others and success at work.

Today covers the remaining top issues adults with ADHD have in relationships: contributing equally at home and sexual functioning.

3. Contributing equally at home: As mentioned in the previous post, having a partner with ADHD can often feel as if you have a child to be responsible for, as opposed to an adult partner who can take care of business themselves. Collaborating to create a system that divides the responsibilities and reminds your partner of what needs to be done when, and communicating effectively about your concerns may help. Many people recommend hiring an ADHD coach who can help your partner identify helpful strategies to organize their life, including home responsibilities. Working with a couples counselor who specializes in ADHD is another idea. This article about being married to a partner with ADHD might also offer some insight.

Your partner forgot to pick up the kids at daycare, again.

The dinner with friends was going great until your partner suddenly made a blunt comment that hurt your best friend’s feelings.

You try to have a conversation with your partner, but always feel as if their attention is elsewhere, or they get up abruptly and walk away when you are mid-sentence, or they fiddle with whatever is within reach and wiggle in their chair like they are a child again until you give up and stop talking.

Such is life with a partner with untreated ADHD.

Some quick facts about ADHD in adults:

• Although ADHD is often diagnosed in childhood, it’s estimated that 30-70% of adults still have symptoms. Many adults were never diagnosed as children, or they were misdiagnosed with other disorders, such as learning disabilities, depression, anxiety or bipolar disorder. As a result, adults with ADHD sometimes do develop depression or have low self-esteem because they were not treated appropriately or were called “stupid,” “lazy,” or “unmotivated” because of their ADHD-related behavioral patterns.
• Forty to sixty percent of adults with ADHD also have a child with ADHD (Waite, 2010).
• To be given a diagnosis of ADHD (for the first time) as an adult, the symptoms must have been present during childhood. If the symptoms first appear in adulthood, it is likely that the symptoms are related to a different disorder.
• The pharmacological treatments for adult ADHD are similar to that for children–namely, stimulants and sometimes also antidepressants–but these medications may work differently in an adult than they would in a child.
• ADHD is recognized as a disability under federal legislation (the Rehabilitation Act of 1973; the Americans With Disabilities Act; and the Individuals With Disabilities Education Act). Appropriate and reasonable accommodations are sometimes made in the workplace for adults with ADHD, which help the individual to work more efficiently and productively.

If you look at most ADHD-related websites (see below), they have a special section dedicated just to how this disorder manifests in adults.

A few posts ago, I wrote about whether you should keep your partner’s illness a secret. Chances are that you have some pretty strong feelings one way or the other about how much disclosure is necessary, and who needs to know about your private life. But no matter what level of sharing about your partner’s illness you feel is appropriate, you still need support and other social outlets. Connecting with others is part of your self-care strategy to prevent relationship burnout.

Common excuses for why healthy partners avoid connecting with others when their partner is ill:

• My friends/family/coworkers will judge me or my partner if they know what’s really going on.
• My partner will get jealous or feel resentful if I go out and have fun without them.
• I have too much to do since my partner isn’t taking care of their share of the responsibilities.
• My partner wants me to keep their illness a secret.
• I can handle what’s going on–I don’t need anyone else in our business, and we’re doing fine, thanks!

You absolutely have the right to privacy, to not be judged, and to make your own decisions about how to handle having a partner with mental illness. But in case you are feeling somewhat isolated and alone in this, and want to know more about how to handle the above situations, here are some points to consider.

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When you look at the list of symptoms for various mental illnesses, they can sometimes parallel the traits we generally do not desire in a partner, such as:

• lack of interest in activities
• mood shifts (often unexpected)
• elevated self-esteem
• impairment in completing activities
• irritability

How do you know if your partner’s behaviors are truly due to mental illness or if they are just personality characteristics? And what do you do if you suspect that your partner is blaming their behavior on their illness when that is not the real reason it’s happening?