When intense feels normal: ADHD and abusive relationships

Research shows that girls with ADHD are significantly more likely to experience intimate partner violence.

Dr. Emily Rothman, who recently published a study on dating violence in neurodivergent youth, joins Cate to talk about what the research actually shows.

They discuss why ADHD symptoms might make it harder to recognize abuse. They also cover how to tell ordinary relationship conflict from patterns of coercive control.

Cate and Emily talk openly about why leaving is rarely a single decision, and how to support a friend or family member who’s trying to get out. They also get into the uncomfortable fact that there are higher rates of ADHD among abuse perpetrators.

This episode discusses domestic violence, coercive control, and sexual abuse. If you or someone you know needs support:

• National Domestic Violence Hotline (24/7): 1-800-799-7233

• RAINN National Sexual Assault Hotline: 1-800-656-4673

• Love Is Respect (dating abuse), call or text: 1-866-331-9474

• Watch: ADHD, toxic partners, and “losing your sparkle” (Reddit Reactions)

• Watch: ADHD gaslighting and chasing new relationship energy (Reddit Reactions) | Sorry, I Missed This

• Watch: ADHD impulsivity and saying yes to sex too fast| Sorry, I Missed This

Dr. Emily Rothman: So many of the neurodivergent people that I have worked with have grown up being told, sometimes explicitly, "The way that you conduct yourself or the way that you behave is wrong." And that creates this fundamental distrust of self or an unwillingness that when somebody else comes along and is like, "I'm perfectly fine, you're the one who's messed up," or "You're crazy," to go like, "Well, that makes sense. I've been told that before."

And so it absolutely can make it very difficult to know, "I'm not being treated right."

Cate Osborn: That's Dr. Emily Rothman, a professor at Boston University. She's the chief of the Department of Occupational Therapy, as well as a professor in the School of Public Health. Today, we are talking about domestic violence, intimate partner violence, and its connection to people with ADHD.

Hi, everybody, and welcome back to "Sorry I Missed This," the show where we talk about all things ADHD and its relationship to relationships, sex, intimacy, communication, and more. When we talk about ADHD and relationships, we often talk about healthy relationships. One of the more serious, more upsetting, and more sobering facts about people with ADHD is that we are also more likely to be involved in relationships that include domestic violence, intimate partner violence, and sexual violence.

In fact, a study by the "Journal of Abnormal Child Psychology" found girls with ADHD were five times more likely to be victims of physical intimate partner violence than girls without ADHD. This is a really serious topic that impacts a lot of people with ADHD that often gets swept under the rug because it is uncomfortable and difficult to discuss. And that's one of the reasons why I'm really excited to have Dr. Emily Rothman on the show today.

Her public health research has focused on the understanding of where violence comes from and how to prevent intimate partner and sexual violence. She's developed interventions to prevent sexual and intimate partner violence for neurodivergent people, and she is also an appointed member of the Massachusetts Governor's Council on Sexual and Domestic Violence. In putting together this episode, we wanted to walk a very fine line.

We wanted to name and acknowledge some of the struggles and challenges that come with leaving an abusive or coercive relationship when you have ADHD. But we also want to make it abundantly clear that if you are a person who is experiencing these things, it is not your fault, and it is certainly not because you have ADHD.

Another uncomfortable thing that comes with these conversations is that when we look at statistics around intimate partner violence, we see that people with ADHD have higher likelihoods of being the people committing that violence, being the perpetrators of violence on other people. I am a big believer in once we can name something and start unpacking the hows and whys of why things happen, it helps us not only become better advocates for ourselves, but better advocates for each other and for the community as a whole, and to ultimately create safer and healthier relationships for everybody, regardless of whether or not they have ADHD.

If you or someone you know is experiencing domestic violence, help is available. The National Domestic Violence Hotline offers free, confidential support 24/7 at 1-800-799-7233, or you can text "START" to 88788.

(03:32) Defining domestic abuse and its connection to neurodiversity.

Cate: Dr. Emily Rothman, welcome to the show. Thank you so much for being here today.

Emily: Thank you for having me.

Cate: One of your recent studies, you looked at trends around elevated dating abuse victimization among young people with mental health and neurodevelopmental conditions. That's such a mouthful. But can you break that down for us and just what your findings have shown? And then just why that information is so important for us to know about?

Emily: Yeah. So we collected data from 846 youth in the United States. They were between 11 and 21 years old. And it's a unique study because it was a nationally representative sample. It wasn't just people who happened to respond to some internet survey. We recruited them purposefully to be nationally representative.

And what we found: 77 percent of the youth with ADHD who had had a dating partner in the past year had experienced dating abuse, compared to 67 percent of all the youth. And we did define dating abuse pretty broadly, including emotional, physical, sexual abuse, cyber abuse. And experiencing one or more incidents meant that you counted.

So the fact that it was more prevalent among those with ADHD really was noteworthy. We also looked at perpetration: "Have you done any of these things to a partner?" And again, it was slightly higher among those with ADHD than the general population. And so there's a lot to really think about there about "How do we support people — all people — getting healthy relationships education?" and "Can we understand more about what's going on for those who are neurodivergent?"

Cate: How do you as an expert distinguish between ordinary relationship conflict — things like unhealthy behavior or reactive behavior — and then patterns of abuse and coercive control?

Emily: Whether something is abuse or unhealthy behavior, I think what matters most is just the fact of how it's affecting that person and what are the consequences for them. And it's weird, but it can be context — dependent. So I think the most meaningful thing, especially when you're trying to help people that you care about or who are reaching out to you, is "Are you feeling safe? Do you feel like you have the freedom to make the choices that you want to make? Do you want to remain in this relationship? Do you have the freedom to decide whether you are going to remain in it or not? Do you have the resources that you need to exit the relationship safely if you want to?"

And that really matters a lot. So if somebody doesn't feel like they're in it because they wake up and they're choosing every day to be in that relationship because they want to be in it — even on the tough days — then that starts to look like a problem and something I would worry about.

Cate: I also see a lot of times trends in the questions that I get from people where they don't necessarily know all of the ways that abuse can look like. Can you just outline the different ways that abuse can look like that may not be the stereotypical versions that we see presented in the media?

Emily: So there's some big categories, which would be like physical abuse, sexual abuse, emotional abuse, which is related to but different from verbal abuse. There's stalking and there's cyber abuse. Some people include financial abuse or spiritual abuse as well. But these are some big categories or big buckets.

But what ties it all together is being controlling and trying to exert power over the other person. That's at the base of all of these behaviors typically. And there's a lot of unhealthy behaviors that people may use to take advantage of somebody else or exploit them or hurt them that don't sound exactly like one of those categories on the surface of it.

Like subtly putting down all their friends until they don't want to hang out with their friends anymore, and now they're just dependent on that person. Or guilt-tripping them into spending all of their money — or a lot of their money — on something that the abusive person or unhealthy relationship behavior person wants, rather than thinking about what's financially helpful for themselves. There's lots of little subtle ways that somebody can chip away at who you are or how you move.

Cate: So, dear listeners, you know that your girl loves a good study. And one of the studies I looked at when it came to preparing for this episode talked about girls with ADHD. And about 31 percent of the ADHD group had experienced physical intimate partner violence, compared with about 6 percent of the comparison group who didn't have ADHD.

And there was another study done a little bit later on college-aged women, where they found that sexual victimization of women with ADHD was about 84 percent higher. And that is a marked difference. And so when we're looking at these studies, we know that people with ADHD are disproportionately likely to experience intimate partner and sexual violence. Can you talk a little bit about why and how that happens?

Emily: The first thing that I think about is that rejection sensitivity and how if you've been rejected numerous times in your life, or if you have a sensitivity to rejection, it could make you all that much more fearful that somebody is going to leave you. And you could stay in relationships because you think, "Well, I'm not going to find anyone else," or "I'm not worthy or I'm not deserving of love from somebody else." And that really makes you vulnerable.

Somebody could exploit that if they sense that they can get away with unhealthy behavior and that then they may be more likely to do that. Another thing that's interesting is that often people give us little warning signs about who they are. And it's as little as they decide always where you go on dates, or they don't even ask you what you want to watch on TV. They're the one who chooses the movie or whatever.

You can just see their attitude towards control and whether they care about your opinion. But you have to be really paying attention and clued in to these little micro-signals. And I wonder if it becomes complicated for people with ADHD who are processing lots and lots of information. And if their attention gets divided or if they're unable to take in some of those micro-clues at various stages, then they might not be screening out people as quickly who others might be like, "Oh, that person seems like they have some warning signs."

Cate: I'm curious about that bright line: "I can't be treated this way." Because ADHD doesn't make somebody abuse you. It is not your fault if these things have happened. But it is true that ADHD can create vulnerabilities that these abusive people can choose to exploit.

A lot of women with ADHD are told that we are wrong about our own lived experience. We are told over and over that we are being dramatic or we're overexaggerating. And so I think that experience alongside something like rejection sensitivity can make it so much more complicated because a lot of abusers are able to present themselves to the world in a very different way.

So it's like, "Oh, but he's such a great guy. Oh, he's so wonderful. You're just being overly sensitive. You're just being dramatic." And then at home, the story is completely different.

Emily: Yeah, people may notice stuff, but they may override themselves.

(11:23) Identifying subtle forms of control and executive dysfunction as a tool for abuse.

Cate: Often with ADHD, there's legitimate relationship conflict, right? Like, "Oh no, I forgot to pay the bill," or "I had to pay a late fee because of the thing because I forgot to do this thing," right? How would you make the distinction between a partner assisting you with an accommodation and a partner taking away your autonomy? The idea of like, "Well, you forgot to pay the bill, so now I have to monitor your bank account," that kind of stuff.

Emily: It is all about the communication and the negotiation between the partners. So does the person who could benefit from the accommodation feel like they had an equal say in what is getting rolled out and why it's getting rolled out? Or was this something they didn't have a choice about and they didn't have any input? It really boils down to that. Is it an equitable conversation? Is it an equitable negotiation? Is it something desired by both parties? And if it's one-sided, that's not healthy.

Cate: I'm curious about the small places where an abusive partner might gain some control without it ever really feeling like you're ceding that much. Do you see those kinds of behaviors as well in the work that you do?

Emily: Yeah. I can think of a couple of examples where people told me stories that sounded exactly like that. And I think it can be really debilitating, again, when somebody's chipping away at either your freedom or your sense of self or your sense of confidence in your own capacity and capability of doing things for yourself.

It's easy to lean into that and just say like, "Oh, they must be right," or "They're doing such a good job," or "This comes so easily to them. I guess I can just let them do it." And then start to buy into this idea that you can't do it for yourself, and you can kind of get stuck. But I will say that I have seen people successfully exit from such situations as well. And it can take a little ramp-up time to get that confidence back or to get those muscles back, but I have definitely seen people do it.

Cate: Do you think it's possible for an abusive partner to functionally create executive dysfunction to keep somebody in a state of crisis, to keep somebody from feeling like they have the cognitive ability to exit an unhealthy relationship?

Emily: Absolutely. I mean, some of the clearest examples that I can think of this is when if there's a marriage that heads to divorce, and somebody purposefully is like, "I'm going to bombard this other person with documents and things to fill out," and just basically paper somebody over until they're paralyzed.

So that same kind of thing can happen in lesser extreme situations. Just throwing a whole lot of stuff somebody's way where they now have to make decisions or they have to handle it, and kind of knowing that they're not going to be able to keep up with that demand. You basically could snow somebody under pretty easily with all that stuff. Yeah.

(18:31) Strategies for supporting loved ones and safely exiting unhealthy relationships.

Cate: So I want to talk a little bit about leaving or ending a relationship and the practicalities of that, especially when you add the secondary difficulty of navigating all of this with ADHD. So one thing that I will confess was something that I genuinely struggled with when I started learning about this was this idea of leaving being just one singular decision. You either decide to stay or you decide to leave. Can you talk a little bit about the fundamental misunderstanding of that?

Emily: Yes. It is fairly difficult to just wake up one morning and decide, "Okay, I'm out of here." That isn't how it works for most people. For people who you've been dating for a while or are cohabiting or married or something like that, it's often a complicated decision, a difficult decision, and people kind of chew over the implications for quite a while before they're ready.

It's a natural thing to have to try on the idea of leaving and what would it look like. And sometimes takes two steps forward and then take one step back. I think that's why it can be so frustrating for friends or family members who are trying to support somebody who they can see is in an unhealthy relationship.

And so the best thing that we can do as friends and family members and supporters is just understand that it's going to take a few rounds. It's going to take numerous tries sometimes before somebody's able to engineer their exit in a way that will work.

Cate: What are the things that are actually needed that you require cognitively and logistically to exit these relationships?

Emily: The first thing that you need is you need a bright line inside of you that gets crossed where you are like, "Okay, I absolutely know I am not supposed to be treated that way. Like, that is not okay, and I can see that clearly."

So you have to be able to recognize that something has happened that it isn't your fault, you don't deserve it, and you do deserve better. And then from there, it's pragmatic stuff about "Now that I have recognized that I deserve better or I don't deserve to be treated this way, how do I untangle?"

And that answer to that is going to depend a lot on how committed this other person is to stalking you or being with you or remaining controlling. Basically, how obsessed with you are they? You have to gauge that and figure that out. It can be dangerous to just abruptly leave somebody if they're really going to stalk you and threaten you and harm you.

So figuring out how difficult it will be to exit the relationship in terms of that stuff. And then there's all the usual stuff that you would have to think of in any break — like "Where am I going to live? Where am I going to put my stuff? Who's going to get the dog?" Whatever it is, figuring out all of that stuff, which can be all the more challenging if you're at the bottom of your energy source rather than your best self.

Cate: That's one of the things that is so frustrating — that idea of on top of this awful thing that is happening, I have to muster extra executive functioning to exit this relationship, or even just the stress of having to keep this all secret as I make these plans. It's just such an added element of stress, especially when you add ADHD into the equation.

So let's talk a little bit about helping and supporting folks who are going through this. So if your friend, daughter, whoever, tells you that she is trying to exit out of an abusive relationship, what is the best way to support that person without necessarily removing more of their autonomy and making them feel even worse?

Emily: So the first thing that you can do is you just thank them for telling you. Say like, "Thank you for trusting me enough to tell me about that. Thank you for sharing that. I'm here for you." And I think you believe them and support them. You are not there to litigate anything that they are saying.

Even if they're saying something that isn't true, that you know isn't true, which sometimes can happen — I'm not saying that it often does or anything like that. But even if it did, it doesn't matter. Your job is still to say, "I'm here for you. I'm your support." It just isn't the time and place to be like, "Well, but isn't it also true that you did kind of..." No.

So if you've decided, "I'm in the role of supporter," that means you're going all in. You're going 100 percent in to the role of supporter. And you're going to be patient when they ping-pong back and forth, when they say something and then take it back. I think there's a lot of embarrassment and stigma and shame about feeling like you've chosen the wrong person or that you made a bad choice and people are going to judge you for that.

So if you let down your guard and you tell your friend, "My partner did this and I'm upset," and the other person starts dog-piling on them with you, then you feel embarrassed. Especially if you decide that you like them and want to stay with them longer, now you might backpedal and almost retreat from that friendship because you're so ashamed or so afraid of your friend judging you for being weak and remaining with the person who you said all these horrible things about and they agreed with you.

So it's a really tough job to be the friend of somebody who's going through a break — especially an unhealthy relationship kind of break — but I think your job is to just try to flow with whatever it is that they're saying and pivot right along with them. So if they're like, "I'm mad," "Now I'm not mad," "I'm leaving," "No, I'm not leaving," just keep pivoting with them. Keep showing up for them and be that strong, steady presence until they get through it.

Cate: With that idea of maybe staying, maybe going back, I think sometimes for people who don't understand, it can be easy to interpret that as indecision. Can you talk about maybe a better way to interpret that, or how you could support somebody through that "Oh my god, she's going back to him, I can't believe it" that frustrates me as the friend, what you do in that situation?

Emily: Yes, of course. People are complicated, right? I think just allow some grace for the fact that these are really complicated situations, even if on the surface of it, from everything that you're being told, all the evidence seems to stack up on one — like, "Of course you should just leave this person because I'm hearing all these bad things."

These decisions are often extraordinarily complicated and they're hooked into the deepest layers of somebody's psychology and who they are and how they grew up and what they need from the world and what they need from their relationship. So I just urge a lot of patience and a lot of generosity towards one another as we make these incredibly complicated decisions.

(24:26) Addressing the complexity of ADHD as both a risk factor for victimization and perpetration.

Cate: Based on the research that you do, the work that you do, what do you think parents should teach their ADHD kids about relationships and autonomy and that kind of thing?

Emily: That's a great question. I feel like parents need — all parents need to teach their kids: "You deserve to feel safe. You deserve to feel respected." That is different from "You deserve to have everything go your way all the time." But at a fundamental level, I hope that the parent treats the child in a way so that at the end of the day, they know what it feels like to have their boundaries respected and what it feels like to be able to resolve conflict in a container, in a home where things are safe and where that can happen in a safe way.

And that they have a choice about who they're in relationship with, and that they should feel like they have a choice, and that relationships are supposed to be fun and should make you happy. One of the things that I found as a parent that I had to work against a little bit was glamorization of unhealthy relationships in certain romance novels or movies or whatever.

And it was the same when I was growing up, too, but I think maybe even more so now, there's a real emphasis put on normalizing flat-out unhealthy behavior. Like I think one of my kids said to me once, "Oh, well, every relationship involves fighting" or something like that. And I was like, "Every relationship may involve conflict or may involve moments where people have disagreements, but not necessarily fighting."

And that's really important to demonstrate that and make sure that they remember the whole point of a relationship is not fighting and struggling and going to couples counseling. It's having a good time together.

Cate: So one of the things that I'm particularly interested in is there's also uncomfortable research around the fact that we see higher rates of people with ADHD being the perpetrators of intimate partner violence and bullying and sometimes being unkind in those ways. So how do parents talk with their ADHD kids about being the one doing the harm?

Emily: A lot of that is about how do we teach empathy? How do we encourage our kids to try on a different perspective? And for some neurodivergent people, perspective — taking can really be challenging. For very young kids, using things like social stories or using even books and movies that can help you imagine yourself in somebody else's shoes is a way of growing that muscle of projecting yourself into somebody else's experience.

And then really talking about how their behavior might make someone feel. I think there's so much shame that comes with that right away that it has to be immediately followed up with, "And here's how we make a repair. Here's a way to apologize that feels solid and real and genuine. And here's what you do when someone accepts your apology, and here's what you do if somebody will not accept your apology, which sometimes happens." And trying to model that healthy repair when you have conflicts in the home.

Cate: If one of our dear listeners is kind of listening to this going, "Wow, some of this really sounds like my relationship, and maybe it is time for me to take that step," what is the first thing that you as the expert here want them to know or do or think about as they move forward?

Emily: There are some great free resources. So I would say step number one: there's three different hotlines that I might recommend. And one is the National Domestic Violence Hotline, which is 1-800-799-7233. There's also a sexual assault hotline, RAINN, which is 1-800-656-4673.

And then there's a dating abuse hotline, which you can text or call. It's called Love is Respect, and their number is 866-331-9474. So these are great places to start because unlike talking to a friend or talking to a family member, you don't ever have to talk to this person again and you can kind of bounce what you're thinking or your ideas off of them.

But also they're connected to resources, local resources. So if you're like, "I really need to get out of here and I need somewhere to stay," they can connect with local systems that can help you figure out next steps. It's not just places to stay; they also have mental health counselors or other kinds of things that you could ask for.

Cate: Dr. Emily Rothman, thank you so much for being here today. We really appreciate you raising awareness and the work that you are doing.

Emily: Thank you. It was very meaningful to have this discussion today.

Cate: Thank you for listening. Anything mentioned in the episode will be linked in the show notes with more resources. Have a question, comment, burning story you'd like to share? Email us at sorryimissedthis@understood.org.

This show is brought to you by Understood.org. Understood.org is a nonprofit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. If you want to help us continue this work, donate at understood.org/give.

"Sorry I Missed This" is produced by Jessamine Molli and edited by Jessie DiMartino. Video is produced by Calvin Knie, our theme music was written by Justin D. Wright. Production support provided by Andrew Rector. Briana Berry is our production director. Neal Drumming is our editorial director. From Understood.org, our executive directors are Laura Key, Scott Cocchiere, and Jordan Davidson. And I'm your host, Cate Osborn. Thank you so much for listening, and I'll see you again soon.