Megan is a 20-something woman who arrives at her first therapy session complaining of “ADHD” and mild “anxiety.”  She gets easily distracted studying for her college classes, can’t seem to complete tasks on time, and gets a bit panicky when she fears failing in any way.

She does recognize that she avoids conflict and is unassertive in many ways in her life, especially with family members.

When we start to explore her conflict avoiding patterns, she is able to note that she does not want to hurt the feelings of others, so she often chooses not to speak up.

Since we learn our relationship patterns from our family of origin, I have her try to remember how she related to her parents. Her father is described as “depressed and sat on the couch all day.”  She describes her mother as “having ADHD,” being very impulsive, and not listening to Megan when she talks. With some exploration, Megan recalls that as a child she had to accommodate her mother’s needs first, rather than her own. Clearly, Megan felt emotionally disconnected from her parents who did not attune to her needs and concerns in a consistent and empathic way.

Frequently, when children do not feel “heard” as children, they grow up overly concerned about the needs of others. Children are naturally approval seeking, especially with caregivers, so if that approval is not forthcoming on a regular basis, they may “turn up” this tendency and become highly sensitive to rejection and overly eager for connection.

This much is well known in psychology. So, how does this affect anxiety?

Megan’s fears of conflict and reluctance to be assertive are related to her desire to not hurt the feelings of others. If she considers speaking up or does speak up, this triggers feelings of guilt, along with somatic symptoms of stomach aches and headaches and general anxiety.

Guilt and shame are prosocial emotions that can be healthy, in that they help us conform to social norms.

But Megan, and others like her, are hypersensitive to offending others and feel guilty even considering being assertive. This can lead to negative, critical, or self-doubting thoughts about herself: “I am too mean,” “I am not a good person,” “I should be more tolerant,” “I don’t have the right to speak up,” or “Maybe I shouldn’t have said anything, because now she is mad.”

To the brain, these self-critical thoughts trigger the limbic system and the “fight-flight-freeze” response, resulting in “anxiety” aka fear.

Fear is the most powerful of human emotions because it is survival related, making it a very “sticky” emotion, meaning we easily remember fear-provoking experiences. (This was a way to help us to remember things like: “Don’t go near the watering hole, because that is where the lions hang out.”)

Raised by rejecting parents, Megan quickly learned as a child not to be “difficult” or “emotional” or “demanding” by expressing her needs.

As an adult, she avoids conflict in service of not offending others, but also in service of not triggering guilt in herself, along with the accompanying anxiety.  If a person feels she cannot speak up assertively in self-protection, it can lead to fear. In contrast, setting boundaries with others provides a feeling of safety.

The solution is to observe in a mindful, nonjudgmental and accepting way how conflict makes you feel. Try to discern to fear and guilt/shame as connecting emotions, and the resulting conflict avoidance.

I coached Megan on assertiveness skills to speak up calmly and appropriately to those in her life. This can improved a sense of empowerment that reduces anxiety or fear.

So many of what is now labeled as a “mental disorder,” like “ADHD” and “anxiety,” are really just normal human reactions gone a bit overboard. And the experiences of guilt and shame consistently pop up as the real reasons for anxiety, depression and other “mental disorders.”

…be kind to yourself!


“ADHD” is Not a Disease

Anger: A Sign of Fear of Conflict

Conflict Management Using Assertive Silence



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