Rarely do I discuss topics that overlap ADHD and PTSD, but this one is a doozy. A loaded topic with lots of variables and risk factors, burnout is detrimental and dissipating for a survivor with PTSD and/or ADHD, but it can also take a toll on the survivor's loved ones.
The "H" component in ADHD stands for "hyperactive," as in (grossly simplified): go, go, go, go, go. As one is "often on the go" or "driven by a motor", the energy level starts to wind down. Couple that with the hyper-arousal cluster of PTSD symptoms, and the risk of burnout skyrockets. ADHD is always co-morbid with something, and if your survivor has both PTSD and ADHD, the risk of burnout is especially something to watch closely.
I recently came across an article written by Gunilla Brattberg (Stress and Health, 2006) on this very topic of burnout when PTSD and ADHD take center stage in the survivor's brain.
Risk of burnout
There is a specific correlation between the type of trauma a survivor faces and the risk of burnout. Remember, PTSD is the result of constant feeling of being on alert because of a threatening situation out of the survivor's control. Brattberg postulates that, "there is a great probability that trauma, particularly sexual assault and ‘severe human suffering’ (a term used in the LEC, Deykin et al., 2001) in some cases with accompanying PTSD, is an underlying factor of burnout" (p. 6).
On the ADHD side, the risk of burnout lies in the hyperactive/impulsive side of the spectrum. "ADHD in childhood often stays with the individual into adulthood and makes her/him extra vulnerable to stress, which can result in burnout" (p. 7). What the article doesn't necessarily discuss is the presence of different types of ADHD symptoms. Medically speaking, three types of ADHD are documented: the inattentive type, the hyperactive/impulsive type, and a combined type—incorporating symptoms of inattentive and hyperactive-impulsive types. Most adults with ADHD have a combined type of ADHD. One of the flagship symptoms of the hyperactive-impulsive type is the feeling of "on the go" or "driven by a motor". This is the area of symptoms that increase the risk of burnout in ADHD survivors.
Comingling of PTSD and ADHD
There's no doubt that the comingling of PTSD and ADHD increase the risk of burnout, especially if the survivor's PTSD is based in a particular trauma centered around human suffering (including themselves). Brattberg hypothesizes that, "Burnout includes a hyperactive phase which can be difficult to differentiate from the hyperactivity due to ADHD" (p. 7). What seems more plausible to me; however, is that the hyperactivity due to ADHD actually facilitates the hyperactive phase of burnout. ADHD's hyperactivity and PTSD's hyper-vigilance play a crucial role in beginning the burnout process, as we'll see later.
Defining and Recognizing Burnout
There are three stages of burnout that occur in a nearly sequential pattern. First is the stress arousal stage. Persistent irritability, anxiety, insomnia, headaches, inability to concentrate, all comprise this phase of burnout. Perhaps not coincidentally, a lot of these are physical and mental manifestations of ADHD symptoms.
Second is the energy conservation phase. Here is the actual stage that burnout takes hold: procrastination, decreased libido, social withdrawal, missing deadlines, inability to concentrate; these are all indicative of burnout taking hold.
Burnout is preventable at any phase, but it's not often noted until phase three: the exhaustion phase. This is where depression, fatigue (both mental and physical), suicidal ideation and/or planning, desire for distance among attachments take hold. It is where most people really see that something is wrong.
Hopefully it is clear that there is some serious overlap between ADHD, PTSD, and burnout. The hyper vigilance of PTSD, the hyperactivity of ADHD, and the irritability, anxiety, and other arousal symptoms of burnout all can go hand-in-hand. Social withdrawal, procrastination or the inability to concentrate might be mistaken for avoidance in PTSD or inattentiveness in ADHD, but they also might be the onset of burnout's energy conservation.
How to cope
For our family, often the key to dealing with burnout is recognizing it on the present path before it actually happens. Prevention is a great deterrent to actualization. This isn't necessarily easy, since burnout is a sequential process that isn't often realized until it's too late. However, remember that burnout can be stopped at any point during the cycle.
Over time, you and your survivor will learn the cues of approaching burnout, and taking steps to prevent burnout from occurring will come more naturally. Start by looking at the stress arousal stage. Is your survivor overcommitting himself/herself? Is your survivor not sleeping well or constantly irritable? This might be the hyperactive part of ADHD, or the hyperarousal part of PTSD, but it also might be the onset of burnout's stress arousal.
Is your survivor missing deadlines at work? Is there some unexplained social withdrawal? These might be the avoidance symptoms of PTSD, but they also could be the onset of energy conservation due to approaching exhaustion. The weight on your survivor's shoulders is a constant one that causes your survivor to struggle with their symptoms on a daily basis (even when they're asleep). The best thing, I think, is to strive to cultivate safety and trust by open communication and careful, active listening. Keep your survivor's needs at the forefront, and foster an atmosphere of open communication. This will help both of you recognize burnout in the early stages, and will allow you both to help prevent it from getting worse.
