ADHD and Perfectionism: Why High-Achievers Often Go Undiagnosed the Longest

There's a common misconception that ADHD looks like chaos, the disorganised child who can't sit still, the student who never finishes anything. This is one presentation. But for a significant number of people, particularly women and those socialised as girls, ADHD looks entirely different. It looks like perfectionism.

If you've always worked harder than everyone around you to achieve the same results, if you re-read every email three times before sending it, if you manage your reputation for reliability meticulously because you know what happens when you don't, this might resonate.

The link between ADHD and perfectionism

ADHD affects executive function, the brain's ability to regulate attention, emotion, planning, and impulse. When this is undiagnosed and unsupported, many people develop elaborate compensatory strategies. Perfectionism is one of the most effective, and one of the most costly.

The internal logic goes something like: if I make everything perfect, no one will see that something is wrong. Or: if I work hard enough, the symptoms don't show. Or simply: the consequences of getting it wrong are too severe.

Rejection sensitivity dysphoria, common in ADHD, often feeds this. The fear of disapproval, of being seen as a failure, of not being enough, drives a level of self-monitoring and standard-setting that exhausts the person living with it.

The hidden cost

The cost of perfectionism as a coping strategy is high. It keeps you safe from criticism but never from self-criticism. It enables achievement but prevents rest. It keeps you going but rarely lets you feel like you've done enough.

Many high-achieving adults with ADHD describe a persistent feeling of fraud, that they're only as good as their last performance, that one slip will expose them, that the effort they put in to appear capable is a secret no one else is working this hard.

What changes in therapy

In therapy, we can start to gently unpack where perfectionism came from, what it was protecting you from, and whether it's still serving you, or whether it's become its own source of suffering.

This isn't about lowering standards or becoming less capable. It's about finding a way to be capable without it costing you your nervous system.

If you've spent years being described as driven, high-achieving, or ambitious, and you're also exhausted in a way that doesn't make sense, it might be worth exploring what's underneath.