Is our Anxiety Primary or Secondary?

In assessing anxiety, I always ask the question of whether this is primary or secondary. Secondary to being a “Fish out of water”.

Do they have a personality style or cognitive style that is mismatching their environment or context creating unhealthy level of stress?

Answering this question correctly will give one more clarity on how to move forward especially from a counseling point of view.

It can empower them to seek and/or create with more clarity, a better fitting context for their personality and cognitive style compounding over time.

My quick way of screening for ASD and ADHD

When I screen for ASD/ADHD/Neurodivergence, I often see it as 3 domains of maladaptations or mismatch to the school and family systems in the younger years — a “fish out of water” experience.

1. Domain 1 is about whether you are an extreme “Thinking-biased” or “Feeling-biased” individual. Perception and/or action is more biased towards objective variables rather than more feeling-based variables. If you are 50:50, 40:60, or even 30:70, then there’s probably not too much of a problem. But if it’s more extreme, like 90:10, then there may be more adjustment issues with tension.

2. Tactical, Operational, or Strategic. In the early years, our parents and schools prefer us to get tasks done — hence, more “operational.” So if someone is more extreme in being tactical or strategic, with blind spots in getting the everyday stuff done (operational), then adjustment issues with tension are likely.

3. Are we inner-compass or outer-compass oriented? Outer-compass is biased towards doing what works and what makes others happy. Inner-compass is more about doing things that are in line with our own thinking and values, despite the outside world. Our schools and parents tend to reward outer-compass orientation more in the early years.

So if someone is extreme in all 3 domains, then adjustment challenges will be very high, and anxiety might be the result — which complicates things further. Fish out of water.

Here, I would be suspicious of ADHD/ASD with secondary anxiety due to adjustment issues.

If extreme in domains 1 and 3, then I’m more suspicious of ASD.

If extreme in domains 2 and 3, and there are maladaptations, then I’m more suspicious of ADHD, with nuance in the various subtypes.

So metaphorically speaking, a “fish out of water” is going to be very troubled. It’s not the fish’s fault nor the environment. It’s the mismatch that is the problem.

The strategy is to understanding, self acceptance, maintaining self worth and seek/create the right environment.

ADHD-I (Hyperactive/impulsive type) - The Tactical Problem Solver

I am curious about something.

One of my screening questions for ADHD-I is that I ask my patient to identify themselves as a Tactical, Operational, or Strategic problem solver:

1. Tactical – Solves problems in real time. Best in crisis situations and managing the acute problems in the “here and now.”

2. Operational – Functions like a machine with routine. Loves structure and consistency.

3. Strategic – Plans for the future with follow-through over weeks, months, or even years. Not great with surprises or routine operations. 

They often pick the “extreme #1” (Tactical).

Of course, schools and the early stages of one’s working career tend to favour type #2 with a good dose of #3. As a result, this can create maladaptation for the extreme #1 type—leading to poor adjustment, stress, confusion, misunderstandings, and low self-esteem.

I wonder if you have observed this too? 

How to change

In counseling work, for some folks, it’s about helping them to shift their thinking/framing in order to shift their feelings/stories/identities and actions.

For some, it’s about shifting their identities/mindsets/stories in order to shift their feelings, thinking and actions.

For some, it’s about shifting their actions in order to shift their thinking and feelings/stories/identities.

Each have preferences like right handedness or left handedness.

Most of the time, especially with the “difficult stuff”, we have to use all of the above strategies at the same time in order to pivot into another more helpful mindset/identity/story/thinking/feeling and action depending on context. This can then lead to a more helpful outcome.

I think this is CBT Cognitive Behavioural Therapy/ACT Acceptance Commitment Therapy, DBT Dialectical Behavioural Therapy in a nutshell. Simple but not easy.

It’s like unlocking a very difficult lock at times. It can seem so far and impossible but yet, so close and possible.