Psychotherapist Phillip Ellington shares his article on masking, drawing on personal and professional experience, where he discusses what causes people living with ADHD to feel the need to mask, and what can be done to allow them to feel able to unmask.
This article is a longer version of Phillip’s article in Therapy Today. Shared with permission from the author and Therapy Today.
Since coming to identify myself as ADHD some years ago, I’ve noticed a marked rise in the number of clients who also identify. Perhaps coincidence, but more likely is the 400% increase in UK referrals since 2019 (Phillips, 2026). Training as a psychosynthesis psychotherapist helped me work through how ADHD had impacted my own life, but left gaps in the theoretical and clinical frame around working with ADHD clients. In and of itself, being ADHD doesn’t help in that regard. Like any shared experience between therapist and client, it’s only valuable if it’s been processed enough to use rather than be acted out. There are thousands of books and millions of online pages on ADHD from influencers, therapists and self-helpers. But academic sources are comparatively thin on the ground especially where the focus is on psychotherapy rather than pharmacology. That gap has prompted this article which will use a combination of my own experience and academic sources to reflect on therapeutic approaches.
Using the Self as Data
My ADHD is what the DSM calls ‘predominately inattentive. I have difficulty holding focus and resisting scope-creep. To constrain these natural tendencies, I aim to focus this article on ADHD masking. Masking is the effortful performance of a self that is more socially acceptable than one’s actual experience might allow. Whether conscious or unconscious, neurodiverse people learn to suppress, hide, or camouflage their natural neurological responses and behaviours to appear more neurotypical. That it is effortful is well established from studies of autism where the concept was first documented (Hull, et al., 2017). Masking is not an aspect of the ADHD world; it is that world. Yet, it remains relatively underexplored in the literature. It bears a close relationship to the psychosynthesis concepts of the survival personality and subpersonalities. But these concepts are grounded in an implicitly normative human neurotype that presupposes certain capacities for self-reflection, narrative continuity, and internal observation that may themselves be neurotype-dependent. Whether these concepts translate meaningfully across neurological difference, or whether they need substantial reworking to do so, is an open question that I will explore later.
Using my own experience as primary data is a bit like a fish investigating water. And who better? If only the fish could step back to get some perspective. Perhaps it is only when they are hooked out on a line that they really come to understand the nature of their world. So too, my subjective lens must focus on moments when my mask is most exposed. To that end, I’ll analyse two moments from my life. This first is so early with so little narrative context it can act almost like pure data. I am around two years old at the time, the youngest of five children.
The toffee sharing.
We’re all sitting together watching Mum reach down a tin of toffees to share one
to each. I’m wondering if I’m to be included in the sharing.
Actually, the ‘wondering’ whether or not I might get a toffee was less like, “will I be included” and more like, “am I one of the ones that count”. And, although I’ve written ‘wondering’ as if recalling a conscious thought, it was never so cognitive. The trace left on memory is physical and chemical, like a sensory imprint and sharply painful. What makes it hurt still is recognising in it that long before a capacity for self-reflection could yet have developed the boy already carries the taint of outsiderness. His hoping for a toffee tacitly acknowledges his prior learning that sharing is contingent. Too young yet to be consciously masking to secure a toffee, his uncertainty represents the felt substrate of masking. It’s a response to the question “am I one of the group?”, asked repeatedly and answered in the negative.
This moment doesn’t signify any non-typical neural development. It only indicates that some attachment trauma was already laid down before the moment of the toffee sharing. This illustrates the difficulty in distinguishing adverse childhood experiences from non-normal neural development.
A starting point in isolating childhood trauma is birth itself. I was thirty two hours in labour. In her last days, mum told me that she’d thought she might not survive and had been furiously exasperated at my reluctance. Perhaps her one sided reading of herself as a passenger while I presented an existential threat affected our earliest attunement. It’s conjecture, but there is evidence of ongoing attachment rupture. Although I slept at home, much of my first three years was spent with a neighbouring family who had a boy the same age. We were living on the West coast of Scotland. The neighbours were working-class fisherfolk. From them, I learned to speak with a thick Scottish accent that marked me out from the rest of the family’s received pronunciation. Mum sometimes called me ‘Guttersnipe”. That does feel suggestive of attachment trauma.
Donald Winnicott uses ‘impingement’ (1953) to mean a child forced into reacting to their environment rather than simply being. As the infant learns to comply to the care-giver’s agenda, they create a false self that manages the relationship while their true self goes into hiding. This bears striking similarity to the origins of masking but doesn’t necessarily implicate ADHD. It also echoes what John Firman and Ann Gila call The Primal Wound (1997), some empathic failure which produces a ‘survival personality’, shaped to navigate the social space in place of the more vulnerable authentic self that lies beneath. Whether the cause is a specific empathic failure or as existentialist Soren Kierkegaard suggests, is more of a foundational alienation arising from a ‘dizzying anxiety’ of finitude (1980), most commentators agree that the creation of an inauthentic self is a universal aspect of the human condition. Evolutionary theory suggests that what is universal must have been useful. And Winnicott tacitly supports that position when he argues that some degree of empathic failure is structurally necessary if we are to develop the capacity to metabolise wounding (1953).
Whether good or bad, wounding or tempering, it seems that the ruptures in emergent selfhood that lead to the construction of a false self are a normal neurodevelopmental process. So, is there any significant difference between the masking behaviour associated with neurodiversity and similar survival personality behaviours that are neurotypical? There’s another memory from when I was about twelve years old which wraps a little more context around masking. Unlike the toffee sharing moment, this memory carries all the attendant risks of retrospective rationalisation. Although it embodies the same sickening physical and chemical signature, it comes with a lot more data which I have worked through in my own therapy. What meaning I made of it at the time is no longer available to me, beyond some residual shame at my own weirdness. How I understand it now is a reconstruction and so, unavoidably a distortion. This complicates analysis, but the memory is still useful despite these caveats. As we’ll see later, ADHD memory is characteristically emotionally vivid if sequentially unreliable. I can recall the feeling of the event intensely though I have no idea how or why it happened. I don’t think mum liked pantomime particularly and I dreaded audience participation then as much as I do now. Still, for some reason there we were, at the theatre. Just the two of us. I can’t be more reliable about the facts than that. But, I hope to show that what the earlier memory only suggested had since developed into unambiguous masking and in doing so describe some of the general aspects of masking behaviour.
The pantomime
I’m sitting with mum in a theatre watching Aladdin. Mum is too conspicuous in her fur coat among the dowdy Saturday matinee crowd and I’m embarrassed. Widow Twanky is on stage whipping up the kids who, released of all constraint, are jumping on their seats and screaming. Mum is so composed she seems perfectly indifferent. She glances sideways at me, and I know she wants me to join in the pandemonium. So I mime shouting, knowing she can’t hear that I’m not making a sound. These kids. I have the feeling they all know each other.
The memory has a vaguely surreal quality. Perhaps because it is my performing being a normal person at a performance. And not just any performance. This is pantomime, a frivolous, mockingly hyperreal theatrical confection explicitly delivered for audience participation. Reflecting now, I imagine that despite the frivolity being there must have felt like being in the Lord of the Flies. People losing restraint is always unnerving for me, even in fun. Perhaps especially in fun. But mum’s own composure made joining in impossible. Under her impassive eye I was required to let myself go without actually letting myself go. It was her that triggered the masked miming. Because masking doesn’t happen alone, it is triggered when someone needs you to be a certain way. And mum needed me to be both lost in the pandemonium and politely well brought up. I can see now how her composure and her fur coat, were class-markers, signifiying a certain social status that she felt very comfortable owning. For me, they were embarrassingly conspicuous while I was anxiously in disguise. It was the conflict between masking as one of the crowd and masking for my mum that makes this memory so, well, memorable. Perhaps the most ADHD adjacent aspect of all is that strange feeling that all the other kids formed a single group. Not that they literally knew each other, but that they were in something I wasn’t. I’ve not had a single ADHD identified client who hasn’t shared instances of the same feeling that others belong to a club they are not a member of.
Before I leave this memory I’d like to note that although ADHD wasn’t a thing back then, had it been, I’ve no doubt mum would have scored off the charts. Of her seven children, at least four present as ADHD, two inattentive type and two hyperactive type. Unabashedly grand at that time of greater social deference, mum would have felt quite safe being there but not being of there. Still, she wore her furs. Meanwhile, I was in the remedial class at the local secondary modern school where class differences generated open hostility. Our relation to each other as much as to the people around us determined the masks we each wore.
At one level this “chameleon effect” (Chartrand & Bargh, 1999), is an unconscious mirroring of the postures, speech patterns and behaviours of those around you. Deeper still and the entire personality construct can become so relationally mutable that the whole identity is entirely diffused (Maté, 1999).
Masking and the Therapeutic Framework
A conventional psychosynthesis reading of masking might equate it with subpersonalities, those semi-autonomous aspects of ourselves that step up to act out a predictable response to a given situation. Both frameworks are adaptive responses to environmental pressure, but despite the similarities, they serve a different purpose and may be experienced quite differently. An activated subpersonality involves an ontological shift into a reduced version of self; assuming of course, that we haven’t worked through our subpersonalities in therapy. We become the people-pleaser or the inner-critic and act from that position. Essentially, subpersonalities are survival strategies initiated in response to childhood wounding that get promoted in adulthood to full-blown personality structures. Masking, as understood in a neurodivergent context, is a concealment of one’s natural traits in order to better fit social expectations. They play a more explicitly performative role, self consciously and effortfully acting out whatever looks most normal in any given situation.
The neurotypical gaze
Thinking about how to describe the lived experience of masking brought to mind how Laura Mulvey explains the male gaze (1975). She describes how being watched restructures women’s internal sense of self as well as their outward behaviour. In time, that surveilling presence becomes fully internalised. John Berger neatly puts it in Ways of Seeing (1972, p. 47), “Men watch women and women watch themselves being watched.” The male gaze maps very closely onto the ADHD experience where the constant self-monitoring needed for successful masking becomes embedded as a continuous internal auditor even when no immediate social threat is present. It has extra resonance in ADHD women, who must manage the double whammy of the male gaze and the neurotypical gaze. This further complicates ADHD masking for women who are already expected to embody gendered expectations like being organised, empathetic and compliant which are already frequently in conflict with natural ADHD traits. Perversely, their relative experience in effective masking may be a factor in women having been historically underdiagnosed (Attoe & Climie, 2023).
The continuum of awareness
I don’t mean to assert that masking is always conscious or that subpersonalities never are. The kind of subpersonalities that show up at work for instance, the super-competent, super-server can be an entirely conscious performance played out exactly like masking. Equally, masks that begin as a conscious mirroring of normative behaviour can become so habitual they disappear from conscious awareness and operate much as subpersonalities. I only suggest that in general, masking and subpersonalities occupy different positions on a continuum of awareness. Masking sits closer to the conscious performative end, while subpersonalities seem closer to the unconscious automatic end, subsumed as aspects of identity. This split between surface and substance, between the presented self and inner experience comes at a cost. Findings from autism research shows that masking consumes enormous cognitive and emotional resources. And, as Firman and Gila argue, the energies invested in maintaining the survival personality are unavailable for genuine development.
Both frameworks locate the origin of the problem not in the person but in the mismatch between the person’s authentic nature and what their environment would tolerate. They may appear similar on the surface, but are significantly different in origin:
The survival personality in the psychosynthesis framework is a response to relational trauma and empathic failure. Neurodiverse masking is not, per se, but is more of a compensation for differences from the dominant norm. These are not the same thing, though they can of course, co-occur.
In psychosynthesis therapy, the dissipation of the survival personality might begin with the question “What happened to you and how did you learn to protect yourself from it happening again?”. The assumption is that once the primal wound is metabolised and the original wounding properly located in the past, the armour can be safely removed. With masking, the wounding environment is not in the past but remains ever present. By unmasking, an ADHD person is likely to reexperience the social and professional consequences of their neurological differences. By way of illustration, I’ll offer a couple of examples of this important difference.
Two examples of masking
Interrupting. The natural verbal impulsivity that causes ADHD people to interrupt while other people are speaking is strongly disapproved of. Masking, perhaps by running an internal mantra of “don’t interrupt, don’t interrupt”, is not only extremely taxing but also makes active listening impossible. The risk is that by the time the thought is finally delivered the conversation has moved on and the thought falls flat. A less socially risky masking strategy might be to stay quiet, but this also has a social cost. Masking the urge to over-share means constantly auditing the conversation. In talking groups, like open forums, the social penalty of taking up too much time is made very clear during tea breaks! Being normal in this situation is extremely effortful.
Fidgeting. The prevailing view of fidgeting from ADHD and autism research is that it represents a self-regulating stimulation that supports cognitive processing (Rotz & Wright, 2005). Unfortunately this is not how it is received by parents, school teachers and colleagues. Years of negative feedback result in masking behaviour designed to limit fidgeting in public. Holding that physical restraint is exhausting in itself as well as further compromising focus range and attention span. Even in a therapy session, fidgeting is likely to be read through a specific modality-driven lens. It might be interpreted as a non-verbal signal of incongruence, a somatic indicator of blocked energies seeking outlet, or perhaps the unconscious discharge of survival energies. Although fidgeting is less well documented in ADHD research than stimming, a similar behaviour from autism research, both have a natural compensatory dimension that reframed might be seen as less a symptom and more, a function.
Both these examples are masking at the conscious end of the continuum of awareness. Where, the subpersonality and masking come together is when masking stops being conscious and moves from social strategy to survival personality. It’s at this point that what may have started, for instance, as a social anxiety around interrupting becomes an automatic, self-silencing effacement. While both frameworks locate the origin of the problem in environmental failure, their very different neurodevelopmental contexts bear on how we conceive the therapeutic goal.
Subpersonality work focuses on internal integration. The aim, broadly speaking, is to help a client soften their defensive structures and reconnect with the deeper self below. We might imagine this as removing a suit of armour that is no longer needed. With masking, it’s not a matter of having outgrown childhood exigencies or removing defences. The threat remains extant in the neuro-normative social context that makes masking necessary. The goal then can’t be to dissolve masking but rather to expand a client’s capacity to choose if and when to mask. This different therapeutic approach implies a critique of neurotypical social norms as the ongoing problem that forces masking into existence. The political context is quite different. And this is where I need to develop those earlier thoughts on whether the psychosynthesis model fits unchanged into a non-neurotypical context.
Are we ready for ADHD?
Like every twentieth century therapeutic model, psychosynthesis was built on an implicitly normative human neurotype. The concepts of subpersonalities, disidentification, even the witnessing I, presuppose capacities for self-reflection, narrative continuity, and internal observation that are in themselves neurotype-dependent. Since it is relational expectations that shape the ADHD mask, and since the expectations embedded in psychosynthesis concepts are inherently neuronormative, the therapist may never actually meet the ADHD client but only ever encounter their mask. In that sense, the entire enterprise of insight-based therapy might be sailing against a neurological headwind. Having said that, I do believe there are areas where the concepts that underpin psychosynthesis practice might be adapted to better meet the expected tide of ADHD clients. Here is where I would suggest adaptation is most needed.
Narrative continuity and time-blindness.
One aspect of ADHD which challenges the temporal scaffolding that most therapeutic models assume is what Russell Barkley calls time-blindness (Barkley, 1997). This refers to a functional impairment of the working memory; a neurological inability to experience oneself as a coherent self moving through time. Barkley argues that for ADHD people the present moment is vividly intense, the past is unreliably retrievable and the future has no psychological weight at all. Life is lived as a non-continuous, episodic flow that admits only two measures of time, now and not now. The weight psychosynthesis gives to the narrative construction of the self presupposes exactly the kind of coherent self moving through time that ADHD impairs. The transpersonal model of advancing towards self-actualisation by progressing through time towards a future synthesis, or ‘wholeness’, rests on our capacity to hold past and future in reflexive dialogue with the present. This is precisely what ADHD can compromise.
In day to day practice, the concept of time-blindness reframes the struggle ADHD clients can have with boundaries set on session dates and running times. While not necessarily accommodating those patterns, we might accept this as ADHD related rather than as passive avoidance, resistance or as character flaws.
Introspection and interoception.
I’ve already discussed the ADHD propensity for internalising a surveilling other. This shows up clinically as poor interoception (Barkley, 1997); reduced “inner body sense”. Limited capacity to experience a first-person perspective makes identifying with an authentic self more difficult.
Rather than being inside an experience, the ADHD person is more likely to watch themselves being inside. Not surprising then is one of the questions that appears routinely in ADHD communities, “who am I without the mask?”. What might help in this regard is less emphasis on a biographical self and more on present-centred experience. People with ADHD often report an exceptionally vivid experience of the present moment; being in flow, having peak states and moments of intense aliveness. This all points to working in vertical rather than the horizontal depth; exploring the present moment rather than looking at lived-experience over a lifespan.
In practice, I’ve found that the core concept of disidentification, learning to observe one’s thoughts and feelings as if from an outsider position is useful for ADHD people. Interoceptive awareness may be compromised but it isn’t absent. It’s even possible that the ADHD client’s own internal auditor might be suborned to a new role, though after years of negative feedback they tend to be harshly punitive and hypervigilant in their continuous, third-person audit. The disidentification process may offer a respite that helps to turn down the volume on the self-policing and allow space for a more inside-out experience. It is important to recognise though that interoceptive capacity is very state-dependent and may come and go.
Internal multiplicity.
The psychosynthesis concept of subpersonalities also maps well onto the ADHD experience of internal multiplicity and inconsistency. Subpersonality work might be effective with ADHD masking in loosening the grip of any single narrative though the assumption of an ‘I’ position, capable of orchestrating these various parts may not be appropriate. Again, this is about interoceptive capacity that ADHD specifically disrupts.
Where making a clinical distinction between a mask and a subpersonality might be difficult, my earlier proposition of a continuum of awareness might offer a useful diagnostic tool. I would suggest that to the degree that a behaviour is presented as conscious or unconscious it should be treated as if it were mask or subpersonality. This is a clinical observation that I believe warrants further empirical investigation.
Will and motivation.
Across therapeutic traditions, the question of how a client mobilises their own agency tends to sit at the centre of the work. For ADHD clients, the conventional demand for engaging willpower, imposing self-discipline, time management, enforced routines, is not merely difficult but often neurologically unsustainable. The aspect of the will that presents as more immediately useful with ADHD clients is the skilful will, working with the grain of one’s nature rather than against it. And, given that ADHD people struggle with motivation that is externally imposed, helping someone connect with authentic sources of meaning is doing something neurologically appropriate, even without framing it in that way.
Conclusion
What has been described here implies a critique of neurotypical social norms as the ongoing problem that forces masking into existence. Unmasking is not simply a personal process, it requires a social context that can receive what is unmasked. That also points to an altered stance within the therapy space. Masking is triggered because someone needs us to be a certain way. So, how might we make sure the therapy space is not itself a masking environment and the therapist not another surveilling other? I have only made tentative suggestions here as to what changes might begin to address the issue. Working more in the moment than with personal histories, for instance. And, acknowledging the limitations of some of our conceptual frameworks. This also points to the question of appropriate boundaries. If our frameworks are neuro-type dependent, perhaps the boundaries they depend on are too. I would also suggest some fleshing out of the concept of the continuum of awareness as a diagnostic tool.
What I haven’t yet begun to consider is the intersection of ADHD with trauma, the whole question of medication and how it interacts with masking and the realities of unmasking in other intersectional contexts such as social class, gender identity and racial heritage, for example.
Finally, I would add that wherever they are in the process, the ADHD client will be inconsistently receptive in a way that may challenge the model of an ongoing, deepening therapeutic process. We may have to let go of the notion of progress in any normative sense. It is also worth remembering that ADHD people are usually exhausted by having to rebuild their selfhood every morning to meet the demands of a world that assumes they are on the inside just as they appear on the out. The ADHD client in the room is not just out of their comfort zone. They are in a very visceral sense, a fish out of water.
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References
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