Adult ADHD and Perfectionism
Perfectionism has appeared in a couple studies as a common cognitive distortion in adults with ADHD. In one case it was the most common1 and in a more recent study, it ran a close third place.2 A case has been made that front-end perfectionism, such as waiting for things to be “just right” or to be “in the mood” for a task, might serve as a justification for avoidance due to the nature of ADHD.
An independent study examined the connection of experiential avoidance (EA) and perfectionism in a sample of college students. Over 3700 students from six public universities completed an ADHD symptom checklist, a measure of EA, and a measure of perfectionism.4
The results showed that higher overall ADHD symptom scores (including inattentive and hyperactive/impulsive symptom scores separately) were associated with higher levels of perfectionism. In turn, these scores were associated with higher EA ratings.
The influence of perfectionism is particularly interesting and relevant to the lives of adults with ADHD. The findings indicate that higher ADHD symptom scores were associated with lower levels of perfection for “orderliness” or strategies for managing tasks, and lower performance “standards” or expectations for the quality of work produced. This finding translates as those students rating themselves as having higher symptoms of ADHD setting low expectations for what they will achieve but correspondingly insufficient plans for completing tasks.
Consequently, the fact that ADHD symptom scores were also associated with high levels of negative self-judgment when still falling short of personal expectations created a no-win scenario: They expected less but did not have rigorous enough standards for doing tasks that were sufficient to meet these lowered goals, and so were still harsh toward themselves when falling short of their modified standards. As the title of the research article proclaimed, “Low standards yet disappointed.”
These are the sorts of internalized double standards often addressed in treatments for adults with ADHD, particularly psychosocial treatments like cognitive-behavior therapy. ADHD is a performance problem, not a knowledge problem. Interventions have focused on setting realistic expectations as well as developing time management and organizational coping skills necessary for engaging in actions that will bring about desired outcomes—for example, helping college students keep up with academics. It is a delicate balance of accepting the nature of ADHD and how its symptoms can cause frustrations alongside customized coping strategies and realistic expectations during the change process.
On the pathway of change it is important that clients recognize and give themselves credit for incremental change and ultimately achieving their desired objectives.