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Waska, R. (2015). Object relational disturbances that may underlie the diagnosis of attention-deficit disorder in adults. Int. Forum Psychoanal., 24(3):143-152.

(2015). International Forum of Psychoanalysis, 24(3):143-152

Object relational disturbances that may underlie the diagnosis of attention-deficit disorder in adults

Robert Waska

Extensive case material is used to show how some adult patients who have been diagnosed with and medicated for attention-deficit disorder (ADD) may be actually suffering from underlying unconscious object relational conflicts that interfere with their ego-functioning, creating an inhibition of basic concentration, focus, expression, and learning. Early childhood experiences of trauma and neglect can create destructive patterns of projective identification based paranoia, guilt, and intense anxiety. The author proposes that these patients have to sacrifice their own identity, psychological organization, and ability to learn or teach in order to keep the peace with others. In order to avoid conflict, difference, and uncertainty, these patients do whatever they can to placate, please, and not disturb the object. However, they often end up extremely resentful, oppositional, and passive-aggressive in reaction. The overwhelming anxiety these patients experience in relationship to the object and to their own internalized demanding critic blocks their ability to learn and grow. In addition, new knowledge, mastery, and creativity are seen as dangerous, forced upon them, or bringing unsafe attention to them. So, in defense, they adapt an inert, scattered, or formless way of living to keep under the radar. This paper advocates the psychoanalytic treatment of such internal conflicts over the popular diagnosis of ADD. Difficulties of learning, attention, concentration, and organization can be better understood and treated as a set of core psychological issues open to gradual working through and healing rather than neurological defects that can only be controlled or managed with strong medication and behavioral exercises.

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