Posts in category: Dating Tips, Guide and Advice

You’re the one who always gets it done. The one who color-codes calendars for funsies, takes on that last-minute assignment and nails it, and volunteers to handle whatever task is thrown your way. 

You earn recognition for most of it—it’s who you are, and people love you for it. Then, one day, you sit down for a second and realize… Wow. I am so tired. And perhaps, when your plate is really full, your “unstoppable” nature comes to a screeching halt. Your brain feels foggy, your motivation has flatlined, and even rest doesn’t feel quite so restful anymore.

This, my friend, is burnout.

What Is Burnout? 

Burnout is when you’re emotionally, mentally, and physically exhausted and overwhelmed due to prolonged stress and overwork. It’s often paired with a general loss of motivation, a sense of malaise, a quickened temper, and even disconnection from the things that used to bring you joy. 

“Burnout occurs when we’re constantly stretched beyond our capacity, and we know that we can’t meet all of the demands on our time,” says Corrine Low, PhD, an associate professor at the University of Pennsylvania and author of “Having It All.” “We react with almost a survival mechanism of numbing ourselves to those pressures, of withdrawing from the experience of our lives. We feel exhausted, depleted, and disconnected.

The Pressure of Perfection

Anyone can experience burnout, but it’s especially common in perfectionists and those who strive to have it all together. High achievers put enormous pressure on themselves to do it all.

“They certainly have high expectations for themselves, and as they climb, there is often a fear of leveling out or falling back and an intense desire to keep pressing ahead, no matter the cost,” explains Gail Saltz, MD, associate professor of psychiatry at the New York Presbyterian Hospital Weill-Cornell School of Medicine. 

She adds that they may feel a need to impress those around them and harbor deep insecurities about making a mistake or failing. This underlying fear can add to chronic stress levels.

“Much like a duck on a pond, they may appear serene and to have it together as they glide along on top, but underneath they are paddling their legs as fast as possible to stay afloat,” Dr. Saltz says. “They may work very hard to not show anyone how stressed they are, or how much they may need help.” 

Signs of Burnout in High-Achievers

So what might burnout look like in a person who’s seemingly fine above the water, but treading fervently below? 

• Feeling numb and exhausted 
• Feeling like you’re “living to work”
• Sacrificing personal needs (sleep, hobbies, relationships, exercise) 
• Struggling to keep up with a never-ending to-do list
• Doomscrolling in your off-time because it requires little energy
• Having an intense fear of failing or making a mistake
• Becoming more self-critical (negative self-talk, low self-esteem)
• Worrying about “backtracking” on your successes 
• Over-identifying with your job or productivity
• Overcommitting even when you’re stretched thin 
• Experiencing physical issues like headaches, backaches, and stomachaches 
• Having trouble sleeping
• Feeling irritable
• Feeling negative, cynical, sad, or depressed

“For high achievers, instead of burnout manifesting as not delivering on something, we end up letting down ourselves,” Dr. Low says. “We do this by sacrificing our sleep, our joy, and our capacity for connection. When we’re so focused on making ends meet in our time budget, we cannot experience and enjoy life.” 

How to Prevent and Manage Burnout 

Recognizing that you might be dealing with perfectionist-related burnout is a huge step. When you feel ready for a change, here’s what you can do. 

Make Leisure a Priority

First things first: you need a break. As hard as it might be to pull away from your work or your tasks or your family, you’ve got to sit back and rest. 

“Pay yourself first with leisure time,” Dr. Low says. “If leisure is ‘leftover’ time, it will always be low quality—we’ll always be so depleted by the time we get there that we’ll end up just vegging.” 

She says to block out some high-quality leisure time on your calendar just like you would an important meeting.

Reassess Your Work Load

Take stock of your workload, both at your job and in your personal or family life. Dr. Saltz recommends limiting after-hours work, taking a vacation, and talking to your boss about rearranging and offloading some of what’s on your plate.

In your family life, you might sit down with your partner and reallocate responsibilities. Even the smallest changes—like giving up on your wilting plant collection— can bring incredible relief. 

Get Comfortable with Delegation 

Next, ask yourself if there are any jobs you’re “hiring yourself for” that you should actually hire someone else for, Dr. Low says. This isn’t always economically feasible, but if it’s possible to rejig your budget, then consider doing so. Maybe that means hiring out landscapers for weekly yard work, having cleaners come once a month or so for a “deep clean,” or using a meal delivery service during your busiest weeks to take dinner off your plate (literally). 

In your work life, consider delegating some tasks elsewhere. Your boss may be able to help you with this.

“Recognize that your job is not the purpose of your life, but rather a tool to earn money that can be used to purchase things that bring us stability, joy, and happiness. Realign your commitment to your job with the role it plays in the ultimate purpose of your life, and the values that are unique to you,” Dr. Lowe says.

Work With a Therapist 

They say Rome wasn’t built in a day. Well, perfectionism isn’t solved in a day, either! And often, we need someone on the outside to help us pinpoint what’s going on, why we’re striving so hard, and how to make changes.

“If [your burnout] is severe, see a psychologist or psychiatrist for evaluation,” Dr. Saltz says. “In addition to offloading, you may need treatment, and you may need to work on your perfectionism.”

People with ADHD experience hormonal changes due to menstruation differently from those with non-ADHD brains. ADHDers who menstruate also have an increased risk for other complications, including premenstrual dysphoric disorder and endometriosis.

How Menstrual Hormone Fluctuations Affect ADHD Symptoms

People with ADHD who menstruate have fluctuations in their ADHD symptoms associated with the hormonal changes of their menstrual cycles.

During a typical menstrual cycle:

• Estrogen and progesterone are lowest at the start of the menstrual flow (day 1).
• Estrogen starts rising after a week, peaking just before two weeks, with ovulation (release of an egg from the ovary) on day 14. It then falls but has a second peak about a week before menstruation begins.
• Progesterone rises after ovulation, peaking around 10 days before menstruation unless a fertilized egg implants in the uterus.

Clarissa Harwell, LCSW, an AuDHD therapist in private practice, shares, “Although not all people who menstruate experience changes in their ADHD traits and symptoms, it is commonly stated that hormonal fluctuations related to menstruation impact ADHDers in approximately 40% of women.”

“A notable difference is that many people who menstruate experience an amplification of their ADHD traits and symptoms,” she said.

Research about the relationship between sex hormones and ADHD symptoms is limited, and existing studies show contradictory information. However, these effects have been noted:

• Symptoms worsening: Studies have emerged in recent years showing that the neurotransmitters that impact ADHD symptoms respond to hormonal changes of the menstrual cycle, with ADHD symptoms intensifying during the premenstrual and menstrual phases of the cycle.
• Less response to stimulant medication: Hormonal fluctuations impact how the body absorbs and responds to stimulant medication, further exacerbating symptom changes. Stimulant medication is less effective during the premenstrual and menstrual phases of the cycle.
• Menopause effects: Menopause (cessation of menstruation for at least a year) has also been tied to an increase in ADHD symptoms, including executive dysfunction and working memory issues.

It is important to note that there is a long history of sexism in the medical field and stigma surrounding menstruation. People who have periods can experience discrimination by medical providers, including downplaying or disregarding the challenges they experience as a result of their hormonal fluctuations.

Personal Experiences of People With ADHD and Hormonal Fluctuations

Lara, who uses they/them pronouns, shares, “My ADHD symptoms heavily vary depending on where I am in my cycle. During the last phase (at least one week before menstruating) of my cycle, I feel my brain getting more and more ‘foggy.’ It feels like I have to drag every thought and memory through a dense fog, not knowing what the surface I am walking on looks like, and every thought also has a large boulder attached.” 

They also notice significant emotional changes around their cycle, “Every other cycle, I experience this intense feeling of loneliness and feeling abandoned by my partners and friends. I need a lot of reassurance during these phases, and it takes a huge toll on relationships because I constantly mistrust that I really am loved by my partners, even if they say so and show it to me. It’s exhausting.”

“Abby,” who uses she/her pronouns, is a trans woman who asked to be referred to by a pseudonym. She does not menstruate, but she experiences cyclical changes in her ADHD symptoms since starting cyclical gender-affirming estrogen replacement therapy.

She shares: “Emotion regulation and executive function are more challenging at the end of my cycle, but it’s also caught up in gastrointestinal (GI) issues (low motility, exacerbated irritable bowel syndrome). My working memory is usually bad during these periods.

“I usually compensate with higher doses of stimulant ADHD medication, or by creating room to work on different things and have different expectations of myself for a few days. Stimulant medication often seems like it’s about a 30% weaker dose at the end of my cycle, like drinking coffee on a hangover.”

ADHD, PMDD, and Endometriosis

People with ADHD are at increased risk for other disorders associated with the menstrual cycle:

• Endometriosis is a condition where tissue similar to the uterine lining grows outside of the uterus. It can cause debilitating symptoms, including pain, fatigue, and gastrointestinal issues, and require surgery to remove the excess tissue. ADHDers are almost twice as likely to experience endometriosis compared to non-ADHDers.
• Premenstrual dysphoric disorder involves severe and extreme premenstrual symptoms, including mood swings, pain, and changes in cognition. Mental health symptoms of PMDD can lead to suicidal ideation. PMDD impacts approximately 10% of the population who have menstrual cycles and 31% of ADHDers with menstrual cycles.

How Can You Manage Hormonal ADHD Symptom Fluctuations?

Managing the symptoms that come with ADHD is challenging on its own, and when your symptoms fluctuate in response to hormonal changes related to your menstrual cycle, it can be even harder to cope. 

Lara shares that they plan their responsibilities around their cycle: “At work, I give 130% during the first half-ish of my cycle to compensate for the fog-boulder-dragging part, where I am only able to give 80%. It’s like burning myself out in the first half only to be able to beat myself up for not showing up in the last part.”

Abby tracks her cycle to predict when she will need extra support. She found that Tenex (guanfacine) helped manage symptoms when her stimulant medication was not fully addressing symptoms.

Clarissa also recommends managing expectations and workload: “I typically collaborate with clients to identify areas in which they can do less. That’s the mantra during the most intense time of the cycle—Do Less! We look at where they can cut corners, make things easier, reduce the day-to-day tasks that require the most executive function, and increase supports and self-compassion.”

She acknowledged that this is not always possible: “I talk with clients about this, because internalized ableism can lead people who experience this to feel like they are failing, like it is an individual character flaw, rather than a biological and neurological issue combined with systemic issues.”