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When the Analytic Patient has Attention Deficit Hyperactivity Disorder.

Stephen B Bernstein

    Journal of the American Psychoanalytic Association
    |April 30, 2015
    PubMed
    Summary

    Adult patients with attention deficit hyperactivity disorder (ADHD) present cognitive deficits that can mimic psychic conflict. Recognizing ADHD

    Area of Science:

    • Psychiatry
    • Psychoanalysis
    • Cognitive Psychology

    Background:

    • Attention deficit hyperactivity disorder (ADHD) is increasingly recognized in adult patients, often persisting from childhood.
    • ADHD is characterized by cognitive deficits impacting affect regulation and behavioral inhibition.
    • The manifestations of adult ADHD can resemble intrapsychic conflict, complicating diagnosis and treatment.

    Purpose of the Study:

    • To explore the complexities of treating adult patients with attention deficit hyperactivity disorder (ADHD).
    • To examine how cognitive deficits in ADHD can be misinterpreted as transference resistances in psychoanalysis.
    • To highlight the impact of intertwined cognitive and psychic conflicts on the analytic process and countertransference.

    Main Methods:

    Keywords:
    analytic framecognitive deficitconflictcountertransference confusiondevelopmental deficit

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  • The study reviews psychoanalytic theories and clinical presentations of adult ADHD.
  • It analyzes how misinterpreting ADHD symptoms as solely psychic conflict can negatively affect patients.
  • Case vignettes illustrate technical considerations and countertransference confusion in the analytic treatment of ADHD.

    • Main Results:

    • Failure to acknowledge the cognitive component of ADHD can lead to patients feeling misunderstood and defective.
    • Confusion in the analyst's countertransference is common when cognitive deficits and psychic conflict are intertwined.
    • Analysts may inadvertently compartmentalize cognitive and conflictual aspects, missing crucial patient dynamics.

    Conclusions:

    • Psychoanalytic treatment requires acknowledging and addressing the cognitive deficits of ADHD alongside psychic conflicts.
    • Appropriate interventions may include guiding patients toward resources for executive functioning limitations.
    • Understanding the interplay between ADHD and psychic conflict is essential for effective analytic work and avoiding countertransference pitfalls.