🧩 ADHD and Perfectionism: Why "All or Nothing" Thinking Takes Over. By Charles Thornton, PMHNP-BC — ADHD Philadelphia
Perfectionism is common in adults with ADHD—not because you expect too much, but because your brain fears mistakes, overwhelm, and uncertainty. Learn why ADHD fuels “all-or-nothing” thinking and how to break the cycle.
People often assume ADHD means being careless or distracted.
But for many adults, ADHD actually leads to intense perfectionism.
Not cute or quirky perfectionism —
but paralyzing perfectionism that makes starting, finishing, or sharing anything feel risky.
At ADHD Philadelphia, we help adults across Pennsylvania and Delaware understand why ADHD so often leads to “all-or-nothing” thinking — and how to break free from it using neuroscience-backed strategies.
🧠 Why ADHD Creates Perfectionism
1️⃣ Starting is Hard — So the Task Must Feel Perfect First
Adults with ADHD struggle with task initiation due to low dopamine activation.
When a task feels overwhelming, the brain uses perfectionism to avoid discomfort.
Your brain says:
“If I can’t do it perfectly, I shouldn’t start yet.”
This protects you from feeling:
frustration
confusion
overwhelm
fear of failure
But it also blocks progress.
2️⃣ Emotional Intensity Amplifies Mistakes
Research from Barkley and Wilke-Deaton shows that adults with ADHD experience emotions more intensely, which makes mistakes feel disproportionately painful.
A small error → feels like a big failure.
This causes:
rewriting emails over and over
delaying projects
avoiding criticism at all costs
3️⃣ Working Memory Makes Projects Feel Bigger Than They Are
With limited working memory, tasks feel:
vague
scattered
overwhelming
ADHD brains prefer certainty, so they lean into perfectionism to reduce ambiguity.
“If I plan every detail perfectly, I won’t get overwhelmed.”
Except… planning becomes the trap.
4️⃣ Rejection Sensitivity Makes Feedback Feel Dangerous
Many adults with ADHD experience Rejection Sensitive Dysphoria (RSD).
Perfectionism becomes armor:
“If it’s perfect, no one can criticize me.”
But this creates impossible pressure and burnout.
🔧 3 Ways to Break the ADHD Perfectionism Cycle
1️⃣ The 70% Rule
Aim to complete tasks at 70% quality, not 100%.
This retrains the brain to accept “good enough” instead of “perfect or nothing.”
Your productivity skyrockets because you’re no longer battling paralysis.
2️⃣ The “One Pass” Method
From executive function research:
Do one pass through a task without allowing revisions.
Examples:
Write the email once
Clean the room once
Outline the essay once
Revisions happen after completion, not while you're doing it.
3️⃣ Break Tasks Into "Micro Wins"
Per Nowell and Dawson, dopamine increases with early success.
Micro wins create momentum.
Try:
Write one paragraph
Tidy for 60 seconds
Read one page
Respond to one message
Small wins override perfectionistic shutdown.
💊 How Medication Helps
ADHD medication improves:
task initiation
emotional regulation
fear response
overwhelm during tasks
This reduces the anxiety that fuels perfectionism and helps you move forward without overthinking.
🌱 You Can Escape “All or Nothing” Thinking
Perfectionism isn’t a personality flaw — it’s a survival strategy for an ADHD brain trying to protect itself from discomfort, uncertainty, and emotional pain.
With treatment, tools, and practice, adults learn to work more flexibly and confidently.
👉 Schedule your ADHD evaluation today
Now serving adults across Pennsylvania and Delaware via telehealth and in-person care.
🔄 ADHD and Rumination: Why Your Brain Replays Everything (and How to Stop It)By Charles Thornton, PMHNP-BC — ADHD Philadelphia
Rumination is common in adults with ADHD—your brain replays conversations, mistakes, and worries on a loop. Learn why ADHD increases rumination and how to break the cycle using neuroscience-backed techniques.
Do you ever replay a conversation from three days ago?
Or obsessively think, “I should’ve said this differently”?
Or lie awake at night replaying moments you wish you could edit?
This is rumination, and it is extremely common in adults with ADHD.
It isn’t overthinking in the traditional anxiety sense — it’s a neurobiological loop tied to executive function, emotional regulation, and dopamine imbalance.
Research from Barkley, Nowell, and Wilke-Deaton shows that ADHD brains struggle to shift thoughts once activated — which makes rumination sticky and persistent.
At ADHD Philadelphia, we help adults across Pennsylvania and Delaware understand why rumination happens and how to quiet the mental noise.
🧠 Why Rumination Happens More With ADHD
1️⃣ The Brain Can’t “Let Go” Easily
The ADHD brain has difficulty with cognitive shifting — moving from one thought to another.
Once a thought activates, the prefrontal cortex struggles to disengage.
You don’t stay stuck because you want to…
Your brain gets locked in.
2️⃣ Emotional Intensity Fuels the Loop
Adults with ADHD feel emotions more intensely, which makes certain moments emotionally charged.
Strong emotion → More mental replay
More replay → Stronger emotional memory
And the loop continues.
3️⃣ The Default Mode Network (DMN) Hijacks Your Mind
The DMN — the mind-wandering network — becomes overactive in ADHD.
When this network takes over, the brain:
Replays conversations
Analyzes past mistakes
Imagines negative future outcomes
This is why rumination often hits at night or during downtime.
4️⃣ Low Dopamine Creates “Mental Static”
Rumination increases when dopamine is low because the brain struggles to shift into goal-oriented thinking.
This leads to:
Mental replay
Over-analysis
Getting stuck in “why did I do that?” loops
Rumination is often worst when you’re tired, bored, or overwhelmed.
🔧 3 Research-Based Ways to Reduce Rumination
1️⃣ The 90-Second Reset
Emotions last 90 seconds unless we feed them with thoughts.
When rumination begins:
Pause → Breathe → Redirect
This allows the emotional surge to pass before the loop takes over.
2️⃣ Use “Cognitive Offloading” to Break the Loop
Write the thought down.
Rumination loses power once it’s moved out of your head and onto:
A notes app
A journal
A sticky note
A voice memo
This technique is recommended by both Nowell and Wilke-Deaton.
3️⃣ Use Pattern Interrupts
Rumination is a mental loop — so break the loop physically.
Try:
Standing up
Splashing cold water
Changing rooms
A 20-second stretch
Starting a simple task
This sends a “reset signal” to the nervous system.
💊 How Medication Helps
Medication improves dopamine stabilization and reduces DMN overactivation, making it easier to:
Shift thoughts
Control emotional loops
Stop replaying conversations
Transition into sleep at night
Many adults say medication makes rumination feel like “background noise” instead of the main soundtrack.
🌱 You Can Quiet the Mental Replay
Rumination doesn’t mean something is wrong with you — it’s a brain pattern that can be changed.
With the right tools and treatment, adults with ADHD can finally:
Let go of past moments
Stop replaying conversations
Reduce nighttime overthinking
Feel mentally lighter
👉 Schedule your ADHD evaluation today
Serving adults across Pennsylvania and Delaware.