Sometimes the treatment was right. It just wasn't built for your brain.
You understand the plan. You agreed with it in session, maybe even felt hopeful about it. Your therapist explained why the exposures matter, or why regular meals help, or why the thought records are worth doing. Then the week happened. The worksheet is still in your inbox. You meant to practice on Tuesday, and Tuesday became Friday. By the next session you're apologizing again, and quietly wondering whether you're just someone therapy doesn't work for.
I hear some version of this a lot, especially from adults who've already been through a round or two of treatment for anxiety, OCD, or eating struggles. Sometimes the phrase "treatment resistant" has come up. Sometimes nobody said it out loud, but the person has started to believe it about themselves.
When I hear that story, one of the first things I wonder about is ADHD.
What "treatment resistant" is supposed to mean
The term has a real clinical meaning: someone received a solid, evidence-based treatment, delivered well and for long enough, and didn't respond the way most people do. That happens, and it's worth taking seriously.
But the label sometimes gets applied before anyone has asked whether the treatment actually fit the person receiving it. A lot of good therapy quietly assumes you can remember the plan between sessions, start a task without a deadline, hold your attention on something uncomfortable, and recover quickly when your emotions spike. Those are executive function skills. They're exactly what ADHD makes unreliable.
So the treatment may have been right for the anxiety or the OCD. It just wasn't built for the brain doing the work. Undiagnosed ADHD, particularly in women and in adults who did fine in school, is one of the more common reasons I see good treatment stall.
Where this shows up
In OCD treatment
Exposure and response prevention (ERP) is the best-supported therapy for OCD, and it depends heavily on practice between sessions. You have to notice the trigger, remember what you planned, choose to lean into the discomfort, and then not do the compulsion. Every one of those steps asks something of working memory, initiation, and emotional regulation.
Someone with ADHD can understand ERP completely, believe in it, want it to work, and still not practice. From the outside that looks like low motivation. Usually it isn't. It's a mismatch. What often helps is shorter exposures, more structure around when and where practice happens, more frequent check-ins, and direct work on the emotional flooding that ADHD tends to bring along.
In eating and body image work
Therapy for binge eating or ADHD-related overeating often includes some structure: eating at regular intervals, noticing patterns, trying small experiments between sessions. ADHD makes all of that harder, not because you're ambivalent about change, but because planning, time awareness, and getting started are the very things that are hard.
If you keep missing the meals you planned, forget to jot anything down, or come back with nothing to report, a clinician might read that as resistance and spend more time on motivation. That rarely helps, because motivation was never the problem.
There's also shame. ADHD often comes with intense emotional reactions, including a sharp sensitivity to criticism or feeling like you've failed. When that gets set off by a hard eating day or a tough session, it can lead to avoidance that looks like the eating problem talking. ADHD shame and eating shame overlap, but they aren't the same thing, and they don't respond to the same interventions.
Signs ADHD might be part of your picture
You understand the treatment well and still can't make it happen outside of session.
Sessions feel productive, but progress doesn't match how engaged you are.
You do noticeably better when life has outside structure, and fall apart during transitions or open-ended stretches.
There's a long history of starting things with energy and not finishing them, in many parts of life.
Your emotions come on fast and strong, and it takes a while to get back to baseline.
No one has ever actually assessed you for ADHD, even though some of this has been true since childhood.
None of these proves anything on its own. Together, they're worth a conversation.
What I'd do differently
The first step is a clearer picture. That might mean a formal ADHD evaluation, or at least a careful look at your history with someone who knows how ADHD shows up in adults, especially women who learned to compensate early.
In the meantime, therapy can be adjusted whether or not there's a diagnosis yet. In my work that usually means fewer between-session tasks that are more specific and more doable, planning the bridge from session to home instead of assuming it, building in some outside accountability, and making emotional regulation part of the treatment rather than a separate project.
Medication is a question for a prescriber, not for me. But if ADHD seems likely and you've never had a medication evaluation, it's worth raising with your doctor. It won't fix everything. It can lower some of the barriers that have been keeping therapy from working.
If you've been told you're hard to treat
You may not be. You may have been getting the right treatment in the wrong shape. I work with adults whose ADHD overlaps with OCD, anxiety, and eating struggles, by video in Arizona and Colorado. Read more about ADHD therapy, or book a free 15-minute consultation to talk through what hasn't been working.
