Stigma and Defending Yourself in ADHD

"Everyone is a bit like that."

I have heard this sentence a lot since the diagnosis. It was almost always said with good intentions. The person saying it is building closeness, trying not to leave me alone.

But what I hear is something else: what I just told them being treated as invalid. For the first time I am saying openly a difficulty I hid for years, and the answer that comes is a sentence that means "forget it, there's nothing like that."

This is how stigma often looks. Not hostile, but unaware.

It works in two directions

The review by Mueller and colleagues (2012) shows that stigma around ADHD works both at the level of society and inside the person.

From outside. The diagnosis not being taken seriously, the use of medication being judged, behavior being put down to character. The labels "lazy," "messy," "irresponsible" usually come down this arm.

Internalized. These judgments turning into your own voice over time. The study by Masuch and colleagues (2019) reports that internalized stigma is found at a measurable level in adults with ADHD and goes together with the expectation of discrimination.

The second is, I think, the heavier, because there is no one to answer it. You can argue with a sentence that comes from outside; to argue with a sentence said in your own voice you first have to notice that it is not your sentence. In the glossary under internalized stigma.

You can answer the sentence that comes from outside. Answering the sentence said in your own voice takes years.

Commonly heard sentences and the real situation

"Everyone is a bit like that." Everyone sometimes forgets, scatters, procrastinates. What is decisive in ADHD is frequency, duration and the loss of function it causes. Exactly this stands at the center of the diagnostic criteria: the symptoms having continued since childhood, being seen in more than one setting and really making life harder. My answer is usually this: "Yes, everyone has it. I have it enough to affect my work."

"You are looking for an excuse." An explanation and an excuse are different things. An explanation says what is happening, an excuse lifts responsibility. The diagnosis did not remove my responsibility; it changed what I do and how. Since the diagnosis I make fewer promises and keep more of the ones I make.

"Those pills are addictive." One of the most common pieces of wrong information. The World Federation consensus statement (Faraone et al., 2021) states that the safety profile of ADHD medication used under a doctor's supervision and at an appropriate dose is good, and that there is no evidence that the risk of substance use is increased in people who are treated. Use and follow-up are the doctor's job; but this sentence is not true as it stands. I covered the details in the article on whether ADHD medication is addictive.

"ADHD has gone out of fashion." Awareness rising and the number of diagnoses going up do not mean the diagnosis is made up. I discussed this in detail in the articles on whether the diagnosis is exaggerated and whether ADHD is a real condition.

"But you are so successful." This sentence is usually said as a compliment and it closes a door. It touches me most, because it looks at the visible result and ignores the cost behind it. What stands behind it is called masking.

"I'm probably a bit ADHD myself." This sentence is not said in bad faith but it reduces the subject to a personality trait. As a reply, instead of entering a debate I prefer to ask a question: "What happens with you?" Sometimes a real conversation opens, sometimes the subject closes by itself.

The invisible cost of stigma

Stigma does not only upset you; it changes your decisions.

Its most marked effect is not asking for help. Someone who expects to be judged puts off going to the doctor, does not ask for a simple adjustment at work, does not tell a friend why they are late. In the years before the diagnosis I never said "I find this hard to do" anywhere. The reason I could not say it was not ignorance; it was that I could predict what I would hear when I said that sentence.

The second effect is overworking. Going more prepared than everyone else to head off judgment from the start, checking twice, overdoing every job. This works for a while and then comes back as burnout.

The third is silence. Someone who hides difficulty starts to hide what is going well too, because both are parts of the same story. After a while no one knows how you work, and you become unable to explain it to anyone.

The reason I write these is this: the sentence "forget it, what people say does not matter" never helped me. It mattered. Once I accepted that it mattered I could decide what to do.

Ways of replying

Do not enter a debate, state your experience. Answering the sentence "everyone is a bit like that" with statistics rarely works. Telling a concrete result does more, because it leaves nothing to debate.

Not replying is also an option. You do not have to educate everyone. In the glossary, advice fatigue describes exactly this: constant explaining is tiring and not every setting deserves this effort. I was late in learning this; for a time I explained at every table as if giving a presentation and I was worn out in the evenings.

Prepare a sentence that closes the subject. A sentence like "I don't want to talk about this" or "this is a settled matter for me" ends the debate without enlarging it.

Look at who it comes from. A sentence from someone close deserves a conversation, because that relationship will continue. A sentence from a distance usually does not.

Take the setting into account. The cost of a reply at work is different from one at a table of friends. Whom, where and how much to open up about the diagnosis is a separate decision; I covered it in the article on disclosing your diagnosis.

Get ready to hear the same sentence a second time. Preparing a two-line reply in advance for a sentence you often hear stops you from going on the defensive at that moment. When you have a ready sentence the conversation does not wear you out, because you do not have to think at that moment.

Working with the voice inside

Internalized stigma is more stubborn than what comes from outside. A few things have worked for me.

Asking for its source. Whose sentence is the one you say to yourself? Often a teacher's, a manager's or a comment on a report card. Once the owner of the sentence is known, its power lessens.

Moving to person-first language. There is a difference between "I am ADHD" and "I live with ADHD," and for some people this difference is real. In the glossary: person-first language. For me both are right when the time comes; I decide which to use according to what I need that day.

Collecting evidence. The voice inside me says "you can't finish anything." I started writing down the jobs I finished. The list was not short, and seeing that turned the argument in my favor.

Finding people on your side. Talking with someone who has gone down the same road has been the thing that weakened internalized judgment fastest. Someone saying "my keys get lost too" did what no article could.

What I try to remember

Stigma does not usually come with bad intent, and that is exactly why it is tiring. You can be angry at a sentence said in bad faith; you cannot be angry at one said in good faith and it stays inside you.

The idea that has helped me most is this: not every sentence is a task. Some I correct, some I let pass, some I do not answer at all. I decide which by looking at my energy that day, and just knowing that I can make this choice is a relief in itself.

I also wrote separately in the diary about where shame comes from: What we do in embarrassment: why we feel shame.