ADHD is a Woman’s Condition Too: A Conversation with Scholarship Recipient Julianne on Nursing, ADHD, and Women’s Healthcare.

October is ADHD Awareness Month, a time to share knowledge about the disorder as well as celebrate and support individuals who have ADHD. One way to celebrate ADHD is to have conversations with those who have the disorder about how it affects and enhances their lives, relationships, careers, and so much more. So, it was fitting that I had the opportunity to speak with Dreamzilla’s second scholarship recipient, Julianne, about her experience with ADHD, her nursing career, and how women often face more obstacles in healthcare than men.

Julianne is an incredible and deeply empathetic woman, which is especially seen in her nursing career. As a nurse she has worked in several different departments but has spent the most time in the labor and delivery and forensic departments. Additionally, she was a traveling nurse during the COVID-19 pandemic. This autumn she started graduate school to get her master’s in nurse midwifery. Along with being a nurse and student, she is a wife and mother of four.

Julianne was diagnosed with ADHD when she was around twelve years old. She recounts this time by saying, “I don’t remember a ton about being diagnosed, and I think that’s because it wasn’t really a big deal at the time. My parents had me tested primarily because both my father and my older brother have ADHD so they thought that I might have it too, and sure enough I did. But it wasn’t a big hindrance to my life as a child which may contribute to why I don’t remember it too much.” Julianne spoke about how after she was diagnosed with ADHD she developed coping mechanisms to help her be successful in daily life. There was even a period of years where she thought she may not actually have ADHD because of her successful use of coping mechanisms. “Back then I remember thinking that I just had to figure it out since that was often the message communicated to me at school. So, I just buckled down and tried my best to do better.” Julianne is not alone in how she experienced and handled her ADHD as a young person. Developing coping mechanisms at a young age to handle or mask ADHD symptoms is a common occurrence in females who have the disorder.¹

It wasn’t until later in her life when Julianne received validating care for her ADHD. Unfortunately, the psychologist she initially saw cycled her through different antidepressant medications that failed to work. Julianne describes this experience as “I felt like the psychologist I was seeing wasn’t really taking me seriously, so I decided to see my primary care provider instead to see if she could better help me. I brought up to her that I thought my struggles could be attributed to my ADHD, and she said, ‘Alright, let’s try something to treat that.’ And now here I am appropriately medicated, and my life is significantly less difficult.”

Going into college, Julianne knew she wanted to pursue a degree in the science and/or healthcare fields. So, she originally set out to study chemistry. But she soon discovered that her calling was to study nursing. This switch was for many reasons, one being, in Julianne’s words, “Chemistry just isn’t people-y enough for me. I like to have interactions and form meaningful relationships with people.” But a bigger reason Julianne became a nurse was because of her mother.

Throughout Julianne’s life, her mother experienced fluctuations in her health, namely during the summer before Julianne started college. “That summer I called an ambulance for my mom three or four times since she was experiencing shortness of breath. In the ER, the doctors would evaluate her only to continually tell her that nothing was wrong with her and that ‘It was just anxiety.’ They basically made her feel like she was crazy.” Thankfully, her mother’s primary care provider suggested that they seek further medical advice which turned into having a cardiac catheterization done to rule out cardiovascular complications. “The day after she had the cath, she had open heart surgery. From the cath, they had found a 98% blockage in one of the vessels in her heart. If my mother had followed the inadequate direction of the ER doctors, the blockage could have killed her instantly.” In regard to how this experience affected Julianne, she stated, “This experience shaped the kind of nurse I wanted to be because I wanted to be the person who hears what people are saying and takes the time to investigate when things don’t seem right. My mom wasn’t heard; a lot of the providers she saw didn’t get to know her and didn’t see that what was going on was completely abnormal and out of character for her.”

Post college, Julianne worked in a few different nursing departments before deciding to stay in labor and delivery. She said that her ADHD plays a role in her career because “Nursing has positive and negative qualities for someone with ADHD because you could work in so many different departments. If you get bored in one department or if it’s not the right fit for you, it’s fairly easy to move to another. But on the other hand, that can make it harder to settle down in one department.” During the pandemic Julianne worked as a traveling nurse in the labor and delivery and forensic departments and was sent to hospitals in Nebraska and Pennsylvania.

Julianne currently works as a forensic nurse where she treats people who have been victims of assault, abuse, and violence. While all nurses are heavily trained, forensic nurses are specifically trained to help individuals in crisis or who have experienced trauma. I asked Julianne to talk about what it’s like to be a forensic nurse since it may be a position that many are not familiar with. She replied, “As a forensic nurse, it doesn’t matter what people tell me. If it doesn’t make sense or sound right, that doesn’t matter. And when I say it doesn’t matter, it's because it’s my job to believe people, to make them feel like they've been heard, and to validate what they’re going through. That’s what matters, and that’s why trauma informed care is so important. My goal is to start patients on their healing journeys which may look like connecting them with other resources in the community so they can continue processing their trauma.” While it’s clear Julianne has such a gift for working in forensic nursing and providing empathic care, she also noted, “It’s a pretty mentally taxing job, and it’s something I know I can’t do long term because of how emotionally draining it is. Knowing this is what caused me to decide to return to school to get my masters.”

This autumn Julianne started at Frontier Nursing University to earn her masters in nursing midwifery. “I decided to study midwifery because when I was in labor and delivery I loved taking care of families. I wanted to find a way to keep doing that but to also be able to do more for my patients. The midwifery model of care really resonates with me because it’s very patient focused and not as intervention focused like other forms of medicine are. Often pregnancy is looked at as a problem that needs to be solved but midwifery is really about treating problems if they arise. I want to be able to give patients and their families all of the time, energy, and care that they deserve.”

Likewise, Julianne and I discussed the similarities between care women receive for their physical health and the care they receive for their mental wellbeing, including accurately diagnosing mental health conditions or disorders like ADHD. Julianne said:

There is such a social and cultural pressure for how women have to be everything for everyone. To remember all the things, to do all the things, to take care of all the things, to have a successful career regardless of what they struggle with. A lot of the time you don’t see the struggles that are affecting women. Eventually women who are overwhelmed with all of these responsibilities get to a place where they can no longer cope because there are just one too many things and then everything implodes, leading to a horrific mental health breakdown. On top of all that, women get shamed when they’re not able to do everything. There’s this mentality of “Oh, you can’t do it all? Then you’re not a good mom, you’re not a good wife, you’re not a good human.” One of the biggest things to recognize is that this happens, and therefore it’s crucial to hold the space for women so they can share what struggles they’re experiencing before it becomes this monumental problem. Luckily, I feel like there is a solid cultural shift coming which will include people asking for help as well as people recognizing that these are valid problems. And I love that. I hope people continue to lift each other up and tell each other “It’s okay you if can’t do all of these things.”

While Julianne spoke broadly about struggles that many women face, she also stated, “Because women are expected to do so much for everyone, it’s easy to miss how ADHD outwardly affects them and makes it hard for them to function.” Julianne’s thoughts are echoed in studies that show that females with ADHD are more likely to be diagnosed with other mental health conditions instead of or in addition to ADHD. This happens for a myriad of reasons but a major one is that females are more likely to go undiagnosed because they are “not meeting stereotypical expectations of ADHD behavior. Instead females may be more likely to attract a primary diagnosis of internalizing disorders or personality disorders, in turn delaying diagnosis and appropriate treatment.”² This can result in negative implications “for long-term social, educational and mental health outcomes.”³ Furthermore, it’s recorded that “mental health impairment, severe mental illness, and admissions to in-patient psychiatric hospitals in adulthood” are more common in females than males with ADHD.⁴

Similarly, Julianne and I talked about how it’s a common misconception that only males have ADHD. She commented, “There’s this stigmatized attitude that ADHD is not a woman's concern, but of course that’s not true. ADHD is absolutely a woman’s concern.” Dismissing ADHD as only a disorder males can have has led to generations of undiagnosed ADHD in women, accumulating in additional stress and hardships.

Julianne expressed that she’s always felt emotions, predominantly more negative ones, very extremely. “It showed up in ways that were really embarrassing to me or at least felt really embarrassing, especially when I was younger. If anybody wanted to have a serious conversation with me or give me any kind of criticism, nine times out of ten it would cause me to cry.” Feeling emotions differently, deeper than others, or even being overwhelmed with or by emotions can be actually a symptom of ADHD. These experiences are known as rejection sensitivity dysphoria (RSD) and highly sensitive person (HSP). Neither of them are official medical conditions but that doesn’t take away from their realness and prominence in peoples’ lives.^{5, 6}

RSD is explained to be the “experience [of] severe emotional pain because of a failure or feeling rejected.”⁷ RSD is more common in people with ADHD because of their differences in brain structure to neurotypical people.⁸ Some of the main traits and behaviors of RSD are easily feeling embarrassed or self-conscious, having trouble containing emotions, and outwardly losing control of emotions.⁹ On the other hand, HSP is described as “a personality trait… to describe someone with a deep sensitivity to the physical, emotional, or social situations and information around them.”¹⁰ Some of the common traits of HSP are avoiding violent TV shows and movies, easily becoming overstimulated by bright lights or uncomfortable clothing, and having a rich inner life.¹¹ It’s understood that “‘Highly sensitive people are built more deeply, emotionally, and mentally than most people’” and “‘HSPs can pick up on the needs of others.’”¹² HSP can even occur in conjunction with ADHD or other mental health conditions.¹³ Julianne has never had anyone mention to her that she may have RSD or HSP, but she has heard of them and thought “Well, those experiences sound familiar!”

Although experiencing over sensitivity can be painful and overwhelming, it also has some beautiful components that can make these feelings feel like superpowers. For Julianne, this shows up significantly in her career. “I’ve always felt like I’m very perceptive to the emotions and feelings of others. This is especially helpful for working in labor and delivery and forensic nursing.” She further connected her perception to peoples’ feelings to her career by stating:

“I work with and care for primarily women, so I see their pain and experiences every day. I’ve learned that women are constantly being told that they have to act or be a certain way. So, I think being able to pick up when what someone is telling me isn’t necessarily what they’re feeling is crucial. I am able to take cues from people and know when I need to ask everyone in the room to leave in order to have a conversation with the patient. And then I ask them, “Is this really what you want to do?” What some patients are telling me is correct, but with others I can feel that it isn’t what they want but it’s something someone else wants them to do or someone telling them that this is what they have to do. Part of my job is to empower people through those questions to advocate for themselves.”

Because of beautiful ways Julianne is able to support, connect with, and care for others, it’s evident that her life experiences with ADHD and her perception of others' emotions are truly priceless gifts. She said, “The life experience that I’ve had where I haven’t been necessarily understood or tolerated for who I am has given me the perspective to be able to hear other people when they are not being accepted and tolerated for who they are. It’s really opened me up to people who are different than me or have been marginalized far more than I have.” Reflecting on Dreamzilla’s tagline, Julianne believes that she is her biggest, baddest self since she has the power and resources to achieve her goals and to help validate the needs of others.

Moving forward, Julianne said that her long-term goal is “finishing my masters in midwifery so I can be in the position to have the power and autonomy to change the experience people have with healthcare providers. I want to learn and grow and help others do the same. There are already healthcare warriors out there helping to start the much needed cultural shift in healthcare, and I want to be a part of it.” Julianne would like to get involved with organizations that promote better healthcare structures and legislative processes that advocate for change regarding how healthcare, namely midwifery, is practiced in the U.S.

Sources

1. Manisha Madhoo and Patricia O. Quinn, “A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis,” Prim Care Companion CNS Discord 16, no. 3 (2014), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/.
2. Susan Young S, Nicoletta Adamo, Bryndís Björk Ásgeirsdóttir et al., “Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women,” BMC Psychiatry 20, 404 (2020), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422602/.
3. Young, Adamo, Ásgeirsdóttir et al, “Females with ADHD”
4. Young, Adamo, Ásgeirsdóttir et al, “Females with ADHD”
5. “Rejection Sensitivity Dysphoria (RSD),” Cleveland Clinic, last modified 30 August 2022, https://my.clevelandclinic.org/health/diseases/24099-rejection-sensitive-dysphoria-rsd.
6. “What is Highly Sensitive Person (HSP)?”, Cleveland Clinic, last modified 20 January 2023, https://health.clevelandclinic.org/highly-sensitive-person/.
7. Cleveland Clinic, “Rejection Sensitivity Dysphoria (RSD).”
8. Stephanie Watson. “What is Rejection Sensitivity Dysphoria?” WebMD, last modified 2 May 2023, https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria.
9. Cleveland Clinic, “Rejection Sensitivity Dysphoria (RSD).”
10. Cleveland Clinic, “What is Highly Sensitive Person (HSP)?”
11. Cleveland Clinic, “What is Highly Sensitive Person (HSP)?”
12. Cleveland Clinic, “What is Highly Sensitive Person (HSP)?”
13. Cleveland Clinic, “What is Highly Sensitive Person (HSP)?”