Psychodynamic Model - ADHD

Prerequisite

Before studying this model, please first read the psychodynamic model of the healthy personality. This is necessary to understand the model of the ADHD personality.

The ADHD Structure at a Glance

In ADHD (Attention Deficit Hyperactivity Disorder), a particular constellation emerges in the psychodynamic model. The disorder has both neurological and psychodynamic components that mutually influence each other.

The EGO Structure in ADHD

The Particular Features

Impulse Control

The EGO’s ability to control ID impulses is reduced. Impulses are let through more quickly.

Defense Mechanisms

The defense mechanisms (A) work less effectively in filtering impulses.

Stimulus Processing

The EGO is often overwhelmed with processing stimuli.

Energy Balance

The defense energies (C) are unevenly distributed.

The ID-EGO Dynamic

In ADHD, a particular dynamic emerges between the ID and EGO:

The Impulse Breakthrough

The ID impulses (E1, E2) press with high intensity against the EGO. Due to the reduced impulse control, these impulses can break through more easily than in a healthy personality.

This leads to the typical ADHD symptoms:

• Impulsivity - Acting without prior reflection
• Hyperactivity - Excessive urge to move
• Attention problems - Difficulties with focusing

The SUPEREGO Structure in ADHD

The Three Pillars

Pillar I: Conscience

The conscience is fundamentally normally developed, but:

• The connection to the EGO is delayed
• The conscience “kicks in” too late
• Guilt feelings come after impulsive actions

Pillar II: Ego Ideal

The role models and ideal objects can:

• Be fragmented due to shifting attention
• Be difficult to internalize
• Lead to frustration when not achieved

Pillar III: Ideal Self

The ideal self can:

• Be unrealistic (“I should be able to do this”)
• Lead to a large ego discrepancy
• Be a source of feelings of inferiority

The Pressure on the EGO

The Double Burden

In ADHD, the EGO experiences pressure from two sides:

1. From below (ID): Strong, difficult-to-control impulses
2. From above (SUPEREGO): Expectations that are hard to meet due to impulse control problems

The Self in ADHD

The Components of the Self

1. Self-image - Often negatively shaped by failures and criticism
2. Self-awareness - Can be weakened by repeated reprimands
3. Self-esteem - Frequently impaired (“I am lazy/stupid/incapable”)
4. Social self - Can be burdened by negative feedback

The Ego Discrepancy in ADHD

The Gap Between Wanting and Ability

The ego discrepancy (IS) in ADHD is often enlarged:

• The ideal self corresponds to societal expectations (“sit still,” “work with focus”)
• The real self cannot meet these expectations
• The discrepancy leads to feelings of inferiority

The Defense Mechanisms in ADHD

People with ADHD often develop specific defense patterns:

Compensation

Weaknesses in one area are balanced by strengths in others (e.g., creativity, spontaneity)

Avoidance

Situations requiring concentration are avoided

Rationalization

“That’s just the way I am” - justification of behavior

Regression

Retreat to more childlike behaviors under stress

The Legend to the Model

EGO Structure

Symbol	Meaning
A	Defense mechanisms of the EGO - less effective
B1	Forces from Pillars I and II on the EGO
B2	Forces from Pillar III on the EGO
C	Defense energies - unevenly distributed
A+C	Defensive action - delayed or insufficient
D	Rigid connection to the Self
E1, E2	ID impulses - strong and difficult to control
G	Inversive joint

Self Components

Symbol	Meaning
SB	Self-observation - can be inconsistent
S	Comparison of social self with Self
SE	Self-knowledge
SF	External image transition into the social self
SR	Self-regulation - impaired
SS	Influence of social self on self-esteem
IS	Ego discrepancy - often enlarged
VI	Comparison ego ideal versus ego ideal

SUPEREGO Structure

Symbol	Meaning
VI	Comparison ego ideal / ideal self versus ego ideal
U	Primal imprints through the parental imago
B1	Total force from Pillars I and II on the EGO
B2	Total force from Pillar III on the EGO

Particularities in ADHD

The Role of Neurobiology

Biological Basis

ADHD has a strong neurobiological component (dopamine/noradrenaline dysregulation). The psychodynamic model shows the psychological consequences of this foundation and how secondary psychological patterns develop.

Comorbidities

People with ADHD frequently develop secondary psychological problems:

Depression

Through repeated failures and negative feedback

Anxiety Disorders

Through the expectation of failing again

Addiction

As an attempt at self-medication

Personality Disorders

As a developmental consequence of untreated ADHD

The Significance for Therapy

Multimodal Approach

The treatment of ADHD should consider both levels:

1. Biological: Medication to improve impulse control
2. Psychodynamic: Therapy to address:
   • Negative self-image
   • Ego discrepancy
   • Defense patterns
   • Relationship patterns

Understanding the psychodynamic model helps to comprehend the psychological consequences of ADHD and to treat them specifically - even when the underlying disorder is biological in nature.

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Further Reading

• Psychodynamic Model - Healthy - The foundation
• Psychodynamic Model - Depression - Frequent comorbidity
• What is ADHD? - Overview of the disorder