“How could you forget that you agreed to pick Kayden up from softball practice today? Again!” yells Cathy to her husband Zach. “You promised me! I can never rely on you. What's wrong with you?”

“You're a million miles away,” says Mike to his wife Stacy over a plate of chicken marsala at their favorite restaurant. “I thought coming here would make a difference, but it doesn't. I work, I cook, I clean, I put the kids to bed, I do my fair share. More than my fair share. But I guess I just don't rate your attention, do I? What the hell does it take for you to pay a little attention to me? To us?”

Both of these marriages are in trouble. Aside from the usual problems of too much work, not enough time, and too many missed connections, however, there's an invisible villain insidiously eating away at the love that exists between them.

While no two people with ADHD are exactly alike, one characteristic they have in common is difficulty with willfully managing their attention. Difficulties with executive functioning may also lead to trouble with organization and time management. They may lose and forget things like keys, wallets, and appointments.  They often have a hard time setting and following through on long-term goals, and they frequently miss important details.

Given their difficulties, it is no surprise that many adults with ADHD are also haunted by a kind of low-level anxiety, a dread that somehow, in some way, they’re going to screw up today and somebody is going to notice it and call them on it in a humiliating or scornful way. What they perceive as criticism, rejection, or humiliation hurts them in an almost visceral way. A criticism that might be felt as constructive by someone else, or else just roll off their back, a person with ADHD may experience as a painful attack on their very nature.

This low-level anxiety is something many people with ADHD are not even aware of. It’s so much a part of their daily lives that they don’t notice it, but accept it as just the way life is. They may even have learned to cope with it by adopting a happy-go-lucky exterior. But it can result in task avoidance when that task is challenging and raises anxiety.

Those with the inattentive presentation of ADHD can seem maddeningly indecisive and even hyper-cautious. They can get lost in the world of their thoughts, somehow unable to translate those thoughts into action.

For individuals with every presentation, ADHD can cause a lot of little problems that by themselves wouldn’t be a big deal, but together make a major, life-hindering issue. They can be baffling and frustrating to themselves and other people. They seem to be people who can never “get it together.”

Haunted by “failure”

Neither Zach nor Stacy were ever hyperactive. “Everyone thought I would become a doctor,” said Zach. His high intelligence allowed him to breeze all the way through grade school and high school, even though he never wrote a paper or studied for a test more than a day in advance. But the challenges of a competitive college caused him to crash and burn in his freshman year and stay away for almost a decade.

Eventually he went back and became a paramedic. While he still feels that he's let down his parents and himself by not achieving more, in truth he loves his work and is extremely good at it. He's the go-to guy when an accident or disaster has left multiple people severely injured.

Stacy became a software engineer—or “super-nerd,” as she called it, work she greatly enjoyed. Her skills with people (especially for her field) led her to be chosen as a project manager for a large team, with all the extra stress, paperwork, and politics. That was bad enough. But then came a merger, and suddenly higher-ups were pressuring her team to do twice as much. It was slowly burying her.

She’d never been good at “domestic duties” before, but soon she couldn't do any of them. Every ounce of her energy was consumed by her work. Yet the more she did, the more she felt she was falling behind. Sometimes she felt so overwhelmed by everything in her life, her brain would go on strike, and she would hide in her office and play computer games for hours.

“Mike is right,” she said. “I've been a failure as a wife, and a failure as a mother, and now I'm failing at my job too. I feel like one big fat failure.”

“You obviously don’t care”

Zach and Stacy illustrate two of the ways that ADHD, when not understood and recognized, can begin to tear a marriage apart.

“He doesn’t have any trouble remembering things that matter to him,” Cathy said furiously. “He does what he wants. The truth is, he’s just selfish. He says he cares, but actions speak louder than words. He just doesn’t care.”

“But I do! I do care!” said Zach.

“Then how could you leave your daughter sitting there for a half an hour wondering if anyone was going to pick her up?

“I don’t know!”

When Zach promises to pick up his daughter, he fully means it. But the critical brain functioning that allows him to register and hold onto what’s important—and therefore, what’s absolutely critical to remember—doesn’t kick in. Later in the day, that information may fall off his radar screen despite the important commitment made nine hours earlier.

Neither Zach nor Cathy knows this, however, and Zach begins to wonder in despair whether he is, deep down, the horribly selfish person his wife is telling him he is.

Zach’s ADHD shows up as a bias toward the strongest stimulus—meaning what’s loud, what’s immediate, what’s urgent, what’s new, or novel. What’s intrinsically interesting or exciting— automatically gets far more attention than what’s important. Past and future barely exist; all that matters is now. This is not a conscious choice.

Situations filled with high intensity and urgency, such as the ones he faces in his work, turn his mind into a 16-cylinder, well-oiled machine, and he makes life-and-death decisions in split seconds. But when the stimulation is gone his mind becomes like a two-cylinder engine, and he’s barely able to find his wallet and car keys. Asking his help to plan for a future event is like asking him to run a triathlon.

This quality of Zach had always baffled Cathy. “Zach is by far the smartest person I have ever known. I’ve always known he was absent-minded, but sometimes he just acts, well… really dumb.” She shook her head. “It doesn’t make sense.”

But it does when you understand the ADHD brain.

“I can’t reach you”

Stacy was overwhelmed.

That in itself was nothing new. “Overwhelmed” was practically her natural state, a feeling so common she accepted it as the way life had to be.

But this was different. This was soul-sucking. She had always lived with the secret feeling that she was some kind of strange alien, that she was just pretending and getting by, and that no one really knew her or liked her.

Now she was feeling constant dread that everything in her life was falling apart. Yet she didn’t want anyone—even, or perhaps especially, Mike—to know she was feeling that way. So she coped by avoiding everyone and everything, and by turning inward, into the recesses of her mind.

Because she has so much trouble with monitoring her own efforts and comparing them to the demands of the situation, she often does either not enough at work or way too much. And since her ability to concentrate (except when adrenalized) is easily exhausted, she takes frequent “goof-off” breaks. Then she makes up for it by working two, three, four, or more hours longer.

Stacy was in a frenzy, unable to read her situation or feel safe with anyone, feeling both indispensable and as though she could be fired at any instant. She stayed at work far into the night, forcing her husband, who also had a demanding job, to single-handedly raise their three young children. Whenever Mike brought up the situation to her she would get defensive.

As her stress grew, so did her remoteness. When there is too much stress, or, conversely, when there is too little structure and stimulation, many adults with the inattentive presentation of ADHD get even more wrapped up in the world of their own thoughts. Stacy sometimes gets engrossed in brilliantly creative thoughts and ideas, but to everyone else in his or her life, she seems to be living in a fog, behind a thick mental wall. The simplest request to do something can require multiple reminders.

Stacy’s offbeat, creative nature used to be part of her quirky charm. But now Mike was feeling almost chronically angry and frustrated. Stacy protected herself from his “overwhelming” anger by walling him off.

What can you do?

Cathy and Zach were caught in a vicious cycle: Whenever he acted in a way that was “unreliable,” she would bring it to his attention. Faced with another inexplicable failure on his part, not knowing how to change it, and seeing her upset as criticism, Zach would angrily dismiss the seriousness of her feelings, or try to justify or explain away what had happened. This would make Cathy even angrier and more upset, and they would begin yelling at each other. Inside, Cathy was feeling desperately alone and lonely. Zach was feeling more and more anxious around Cathy, like the “third child” that Cathy accused him of being, and was avoiding being around her. Without being aware of it, the anxiety—as it can for some people with ADHD—was making his symptoms worse.

Learning about ADHD helped both of them. Cathy slowly began to accept that Zach’s unreliability was not because he didn’t care, but resulted from a glitch in the way his mind worked. Once Zach understood what was happening, and as Cathy reacted less angrily and explained things to him more calmly, he began to understand and face how his forgetfulness and lack of family focus was impacting Cathy and his kids. He wanted to be more reliable. He bought a smartwatch, and he and Cathy set many reminders to go off at critical times. He went to his doctor and decided to go on a low dose of an ADHD stimulant as well.

One day, he told Cathy that he understood what he had put her through and how much he didn’t want to make her feel that way anymore. Though he had said similar words before, to Cathy it felt like the first time he really understood and felt what he saying. Filled with relief, she started to cry, and he held her.

Mike learned to see Stacy’s remoteness not as rejection but as a sign of her anxiety. Stacy in turn worked to understand that Mike’s attempts to reach her were not evidence of her failure, but came out of a genuine desire to be with her, and a real concern for how overworked she was. He made an effort to approach her more calmly; she made an effort not to immediately get overwhelmed and panic (or to tell him if she did). As the tension between them abated, and as he understood more how she felt inside, he became less judgmental of the ways she couldn't “pull it together,” and, not surprisingly, she got better at those things (though she still was no Martha Stewart). They began to look at the chaos that had taken over their lives as a common enemy and started to tackle it together.

People who have adult ADHD can be intensely defensive because deep down they know something is wrong but they don’t know what it is, and they definitely don’t think they can change it. Learning how adult ADHD works, and learning that indeed it is possible to make improvements, changes everything.

Adult ADHD can tear a marriage apart. But with love, understanding, and the right treatment, most marriages affected by adult ADHD can become the loving bonds they started out as, and are meant to be.

Larry Letich, LCSW-C, works with adults with ADHD, with a special emphasis on those who discover they have ADHD in adulthood. He is also a certified emotionally focused couples therapist who integrates an EFT focus into treating couples where one or both spouses (and frequently their children) are dealing with ADHD. His offices are in Frederick and Rockville, Maryland, and he can be reached at lletich@frederickcounselinginc.com.