Relationally, what is true of couples contending with ADHD is true of most couples generally, except with more frequency and intensity of symptomatic behaviors than non-ADHD couples. Emotional dysregulation is a core component of ADHD (Beheshti et al. 2020), with its prominence a key factor in the dissatisfaction and termination of romantic relationships. Regardless of symptom intensity or severity, emotional intelligence (EI) remains the key determinant for whether or not a couple do well together. EI encompasses the ability to appraise, regulate, and express emotion as well as effectively utilize emotions on behalf of problem solving (Mayer et al. 1990; Pollack et al. 2017), along with other key factors for this description. Women and men often have differences in ADHD behavioral traits, let alone subjective experiences of their disorders. Clinical experience indicates that most over-identify with their disorder, may show little interest in differentiation of self from symptoms until relational issues are significant enough to bring the individual, couple, or family to therapy.
Stress:
I was recently reading about the optimal versus suboptimal levels of stress in our lives and began reflecting on the biological aspects of the suboptimal levels. I was reminded of the
Hypothalamic-Pituitary-Adrenal axis (HPA). HPA “is the main stress response system. It is the neuroendocrine link between perceived stress and physiological reactions to stress” (Breedlove and Watson, 2013). The primary function of the activated HPA axis is to release glucocorticoids that activate short-term physiological responses to stress. While some stress is necessary for salubrious — simply stated: healthy, pleasant — development and aging, when an individual exists in a chronic state of stress their ability to cope is compromised by dysregulation of HPA-axis and other peripheral physiological functions. The acute stress response is initiated by short-term stressors and enables short-term behavioral and physiological coping mechanisms.The effects of long-term chronic stress may manifest not only in an overall decline in fitness or immune health, but also in neurodegenerative brain disease linked to HPA-axis dysregulation (Esch et al., 2002).
According to the American Journal of Medicine, “Effective treatment for HPA axis dysfunction begins with a strong therapeutic relationship. Many patients come to integrative care feeling misunderstood or dismissed, leading to frustration, isolation, and hopelessness.” Ring (2025) goes on to sayhow “[c]reating an atmosphere of trust and empathy, validating the patient’s experience, and demonstrating genuine commitment to their healing sets the foundation for successful care. This supportive environment empowers patients, fostering active engagement in their therapeutic journey and significantly enhancing treatment outcomes.”
I couldn’t have written it or said it better. What operates within the individual may be supported and improved through relationships, in this case medically &/or clinically. Two heads can be better than one on behalf of regulating our stress-responseshealthfully again.