Will therapy and medication really improve empathy?

It has recently become very clear to both my husband and myself that my husband has ADD.  He will soon be 'officially' tested, but neither of us has any doubt after the reading we've done.  My main concern is the lack of empathy in our marriage (and god knows I have many concerns about his behavior but this tops the list).  I don't see how any relationship can be successful at fulfilling emotional needs with the lack of empathy I have seen from my husband.  We're talking jaw-dropping examples that border on mental cruelty....but which strangely don't seem to gel with who I really believe him to be.

So...from those of you further down the line than I am at dealing with ADHD in your partner....have you seen improvements in empathy levels as a result of medication and therapy?  Seriously, I want the 'real' answers, not the 'make me feel better' answers.

I don't know if I can stay in a relationship where the only empathy comes from learned responses suggested by a therapist..."when your wife is in serious pain, you should look concerned"!  Will medication change the way his brain functions to the point where he can truly show empathy and really feel it?

Miss Behaven's picture

ADD does NOT cause someone to

ADD does NOT cause someone to lack empathy. Period. It can cause an ADDer to express empathy differently than a nonADDer. But it does not rob us of the ability to feel for others, to empathize and sympathize.

Even my hubby who has a tendency to emotionally disconnect from things that are difficult for him to deal with or process, still has those emotions. Even when he wishes he didn't have to deal with them.

Common comorbids found alongside ADD are Aspergers (mild Autism) and personality disorders. It is possible that your hubby has one of these with his ADD. Or does not have ADD but has one of these. Aspergers and ADD often get misdiagnosed as each other and are often found together.

Or it could simply be that from your perspective of hurt and wanting him to express things a certain way it appears he lacks empathy. My female nonADD friends often accuse me of being "unfeeling" because I do not express or verbalize my feelings the same way they do, and therefore expect me to. But I can assure you I do have those feelings.


(PS wish me luck. I am due to give birth any day now)

Good luck with the birth! 

Good luck with the birth!  Thanks for taking the time to respond.

All very good points you raise.  His father clearly has (undiagnosed) Aspergers - both my husband and I have said that for years.  So the genetic component is certainly there, but honestly after dealing with Aspergers close up for a long time, my husband's symptoms are very different in all respects other than empathy, where I can see some similarities, but by no means a total overlap (obviously I'm comparing with one other individual with Aspergers which isn't representative of the range of potential levels of severity it might have for different people).

I gave an example in a response to someone else that an example of lack of empathy would be expecting me to carry in the suitcases to the house after arriving home from hospital after a c-section because he was 'too tired'.  Given numerous examples like this, I can safely say that it's gone beyond my perspective of how I want him to express empathy being out of touch with how he chooses to express it. 

It will be interesting to see what a decent psychiatrist has to say.  It wouldn't surprise me if there's a comorbidity.

Thanks for your response.  Really appreciate it.

Hey Chicago

The empathy thing is challenging, my ADD spouse is not always aware of my personal issues unless they relate to him directly. The meds have taken the edge off anger issues and the empathy is a bit better. If I play up the drama, I can get a little more feeling from him but not always enough to move him into any action. I've been at this for a very long time and have become quite detached and independent. It's frustrating to see him respond with great compassion about a story on tv or call attention to his own personal "plight" yet, I get ignored. The meds gave him the ability to complete his thoughts and come to a proper conclusion. He is more aware of me now (as long as he isn't too distracted) and is more willing to be involved. He'll even ask me if he can help with something but, I usually say no unless it is a very simple thing that's not that important to me. 

Gosh! I'm really tired and feel like I'm rambling. I'm trying to say there is some hope but, you'll have to wait and see how he responds to any medication. That can take a while sometimes to figure out.

Miss Behavin' my experience is different from yours and I do find your view interesting. I sure hope all goes well for you and your family and your precious new baby! :D

Miss Behaven's picture

Missing social cues is not a

Missing social cues is not a lack of empathy, it is missing the social cues, it is a lack of knowing empathy is required.

TV shows have dramatic music and over acting that tell you how you ought to be feeling. Sometimes I wish everyone had a sound track to clue me into how they are feeling right then and there!

NO where in the DSM does it state that ADDers lack empathy because we don't.

If your hubby lacked empathy due to his ADD he would not get emotional over anything, let alone TV shows.

Empathy, which literally translates as in feeling, is the capability to share another being's emotions and feelings.

ADDers are quite capable of sharing other's feelings, if we are clued into the other person's feelings and if we can find a way to express our empathy in a manner that is "acceptable" or understood.

You shouldn't have to "play it up" when you are feeling something. Why can you not simply tell your hubby straight out how you are feeling? Or is your ability to communicate with each other to poor for that right now?

ADDers are not unfeeling freaks who don't give a damn about other people.

Communication would help

and if hubby wanted to do more than just take his medication he might go to counsel and learn about something that might work. Often when I do tell him how I am feeling he will just tell me I shouldn't feel that way. Then I might go on to tell him that I still feel that way at which point he'll tell me I'm being unreasonable or defend someone else involved or tell me I'm too picky or the ice queen or whatever derogatory name seems appropriate to him at the time. He never seems to be on my side. Until he wants to kiss and hug and tell me he loves me. He certainly has the capacity to feel and experience emotion, but it is usually missed or inappropriate when interacting with me.

hehe, it might be kinda fun to have a little background music for my life!

To respond to "why do you

To respond to "why do you have to play it up" to get empathy from her husband.  My ADD husband is the exact same way.  I have to be extremely dramatic to get his attention.  He won't take me seriously unless I cry.  Literally.  When I tell him my concerns and how he makes me feel (which I'm back to doing again since my husband stopped taking his meds last week-I explained that in my other post) he will NOT take me seriously or believe me and will sometimes just laugh at me.  Problem is, our whole marriage, I have learned that I have to be overly dramatic and weepy for him to listen to me and take me seriously.  So now he sees me as this drama queen and doesn't believe a word I say.  We've been married 6 years and he was diagnosed only about 6 months ago.  So...to the original gal, I hear ya....nice to see I'm not the only one.


I am sorry to disagree, but I communicate very clearly and specific with my husband whether it's about us, work and/or school. He is so cold, distant and indifferent. The more I approach him about "feelings" the further he pulls away. Empathy? I have literally fallen down and he heard me yell and nothing!!! I seriously don't get it.  I know he's got it (empathy), because he shows it with the dog and others, but when it comes to his wife the person he lives with day in and day out-nothing!!

I am trying to be patient but this is by far the most difficult situation I have ever been in.

To Clarity - thanks for the feedback

Thanks this is useful. 

This sounds familiar....it's not that he's incapable of empathy...it's just highly situational and tends to be when it doesn't involve him changing his behavior or making an effort.  So he can make all the right noises at times, but if it involves him actually doing something then forget it.  I'll give an example...after the birth of second child I returned home after a c-section.  No surprise I could barely walk.  My husband informed me he was very tired after the drive and would I mind unpacking the suitcases from the car.

Huh?!!  I mean, just staggering behavior.  Plenty of examples like that. God forbid I have been ill and needed him to step up and help out with the kids...illness is met with anger.  Or was, until he went on anti-depressants and stopped drinking which has really calmed him down. 

I know what you mean about being detached and independent.  That is just how I have been describing my state of mind recently.  There has never been a sense of being 'looked after' when you are desperately in need of it.  And as a result, you really do harden over time.  He's been so much better since he quit drinking and went on anti-depressants, but I can't work out if he's now really feeling empathy or is now listening to my request that he show empathy and 'training' himself to respond appropriately.  Is it 'real' or not?  Not sure yet.

Thanks to everyone for their thoughts in response to this question.  Wonderful to have all your perspectives.


Being looked after?

I'd feel like a princess! I don't even have a sense of partnership. I hope you left those suitcases in the car! Sounds like you have young kids. Mine are grown and all that added distraction is over with but, I faced the same anger when I got sick, just like you said "We're talking jaw-dropping examples that border on mental cruelty... but which strangely don't seem to gel with who I really believe him to be." I know my spouse is a moral, well meaning guy with compassion for others when he's around them. It seems he has the capacity for empathy without the ability to provide empathy appropriately towards me. The medication alone has helped my ADD hubby to organize his thoughts better and become more aware of me and my needs but, I'm sure counseling, therapy or coaching would help him understand that I am not provoking or attacking or trying to take advantage of him, I just need an act of kindness. If a therapist could actually train someone to provide a learned response on cue it would be a bit Stepfordy... but hey, I'd take it!

I told him exactly where he could shove the suitcases :)

So yes, the suitcases were indeed left in the car.  Instead he just came in, made himself dinner without offering me any and proceeded to get blind drunk.  Ah, the joys of having a baby with non-diagnosed ADD + alcoholism spouse.  It's just a beautiful image isn't it?  I swear that through my physical pain and mental disbelief I was dreaming about someone putting divorce papers in front of me because without a moment of doubt I would have signed them.

So now, yes we have some learned responses and they are indeed WAY better than what I had before, so I should be extremely grateful!  I feel for you, I really do.  Now when I'm sick he actually doesn't look at me like I've done it on purpose to annoy him, and even takes over with the kids sometimes.  You could knock me down with a feather.  It's a far cry from the 'What are you doing lazying about?' when I'm sleeping after a miscarriage (and other such examples)!!!  God he sounds like such a monster and yet truly isn't.

Would your husband even consider therapy?  Does indeed sound like a third party needs to intervene and point some of this stuff out so you're not being the 'bad-guy'.  Also sounds like while the medication has helped in many ways, it certainly hasn't cured everything....not necessarily the empathy but the open attitude needed to 'hear' what you are saying without feeling defensive.

Right now I'm in a great place where hubby is frantically reading books on ADD and trying to understand himself and what the next steps will be - it's all a very new realization for us as of last week.  And he now believes that when I say something in his behavior has been problematic in the past, er, I'm probably right and not just trying to be a nagging wife with some sinister motives!   Long may this continue.....

And though he's committed to changing as best he can, he can never understand what he's been like to live with.  I'm still in shock as I look back on the last 10 years and link it all up to his symptoms.  It's quite overwhelming.  There I was thinking I was married to a former alcoholic and actually it's something else altogether.  I can't work out which self help books to read first...hmm, would that be 'wife of a recovering alcoholic', 'codependent no more'....or any of the others from the stack?  It's so bad I can actually see the funny side. 

Consider therapy?

Why go see someone to just talk? He can do that all by himself! I will warn you all that hyperfocus on the diagnosis could be like another courtship. Starts out fantastic then... you know... Any book you can find to read would be good but I would think Melissa's latest, "The ADHD Effect on Marriage" sounds like a good one! I'm wishing you the best!

Lack of empathy

Firstly, I agree with Miss Behaven that people with AD/HD can have empathy.  My husband is an extremely empathetic person usually.  Naturally he has moments where it doesn't immediately connect for him whether caused by his ADD or his being a male, I have no idea :)   With him it seems to be related to the severity of the situation.   I had 5 friends die in a plane crash--he was fully empathetic for months and months & even took over all tasks that overwhelmed me whether he liked to do them or not.  My grandmother died--empathetic, but we expected it and I didn't need help to the same extent.  My brother and his kids moved away--fully there for me. 


Smaller things he is more likely to miss.  When he can truly see and feel and partially experience a loss himself, he is 100% there for me, but when it is something that wouldn't be a big deal to him, he might overlook that and not realize right away that I am hurting.  I am fortunate in that once he realizes that I am hurting, for whatever reason it is, he will hold me and be sympathetic/empathetic to the extent that he can, and he will rarely say "Babe, it just isn't worth feeling upset over" or  "Why you are crying about something so silly"  But he has said these things--much less frequently than some friends' husbands who do not have AD/HD which is what leads me to believe some of it is just gender differences.

I do somewhat disagree with the statement that you can both be empathetic and not know empathy is required.   Isn't not knowing that empathy is required somewhat a lack of empathy??   The definition I have of empathy is to feel someone else's pain in your own body, so if you are not aware that your loved one is in pain then you are not currently empathetic toward them.   This is painful to them.   Communicating with your mate about the pain you are in might enable him/her to understand the situation in a different way and then that will bring forth his/her empathy for you and the situation, hopefully. 


So you might have to do more communicating to help him understand your feelings as he clearly does not naturally have the same ones.    This is one of the reasons that it is good to have a lot of ppl in your life.  Sometimes, for me, it is more of a girl thing and I talk to my mom or my sisters or a good female friend because it just isn't something my husband would really understand. 


But he is empathetic to me and it is often enough for him that I am hurting to bring it forth...even when he doesnt' fully get why.  Sometimes I don't fully get why.  It is PMS week for me and I was weepy yesterday after an awesome day spent with girlfriends.  Why?? I have no idea.  I just wanted to be held, so he held me and even though neither of us know what my problem was, I got what I needed and it passed. 


I'm trying to think of a situation where his empathy developed for me over something he didn't immediately understand, and I can't think of a good one but here is what I got.   We lived about 4 hours away from eachother when we were engaged and clearly one of us was going to have to move.  He was making fabulous money in the city where he lived while all my family lived here in the rurals where I have grown up.   He was much less connected to his community and he loves to move (while I hate it).  Because we both think ppl are more important than stuff  and because we were going to both have more opportunities for volunteering here and because I hate city living, we agreed that he'd move.  If he couldn't get a job that would support our life and goals, then we had a cutoff date where we'd have to flip it around and I would be the one planning to move.

We were getting close to the cuttoff date, and he wasn't getting workable job offers.  Places wanted him, but he'd have to both take a pay cut PLUS drive 1.5 hours to work daily each way and other untenable options, so we had been talking a bit about my moving.  Of course I was willing to move as I loved him and I understood he was trying to get a job here, but I was getting more and more stressed.  I was VERY close to my 2 year old niece and she was going to get a sister within a week of our returning from our honeymoon, and the idea of not seeing them all the time and bonding with the new baby was more than I could stand to think about.

My soon to be husband knew I didn't want to move so far from my family (I'd be moving about an hour away if he moved down), but until our final talk about it, he didn't really feel the pain of moving for me.  He prefers to live a few hours from his parents, he had 1 niece who he loves and likes to play with, but if he didn't see her for months on end it was not a big deal to him.  When I burst out in tears about not knowing the new baby and being able to just have her stay over my house the way I could do regularly with the older girl, it really became real to him.  Before that he only sympathized--he knew it would be hard to move for me and he was supportive. 

After he really understood how painful it was to me, he said he was going to do EVERYTHING HE COULD to not put me in the position of moving.  He started interviewing a lot more and put much more effort into finding a job here.  He ended up getting really creative and took 2 part time jobs (one in his computer field and one in a new field he actually works more in now than in computers).  One was a day job and one was nights, so he had several nights free per week and several days free per week, so we were both able to volunteer more.   He ended up making more money than before, with more free time than before, our rent was less than half of what he was paying in the city, and all this was pre-ADD diagnosis.


Just wanted to say that I hope everything goes very smoothly with the new addition you are about to have in your family!

Miss Behaven's picture


"I do somewhat disagree with the statement that you can both be empathetic and not know empathy is required.   Isn't not knowing that empathy is required somewhat a lack of empathy?? "


That should be the capacity or ability for empathy. You can be capable of empathy but not know that it is needed right now.

Defining empathy

I have a difficulty with the word empathy, it seems there are different definitions.  Firstly, I understand it to mean having a "phenomenological" view point i.e. understanding another's point of view, feeling or motive as they, themselves understand it.  It is not about putting yourself in someone else's situation. i.e. I would feel like that if I were them because I'm NOT them.

My ADD wife is very good at "identifying" with people, she knows exactly what it would feel like for her to be in someone else's situation and she feels the pain she would feel.  She calls this "empathy". However she doesn't appear to have idea about how the actual person feels themself.  Unfortunately, this is another example of how (she is aware) that my view of her conflicts with her own view of herself, which she feels threatened by.  She calls this harming the integrity of her core self.

Whatever she thinks, the effect is that I don't feel that she recognizes or gives any validity to my feelings, so even if she is being empathetic, I don't get it.

However, I am only just looking into ADD and empathy, it would be good if it were possible for her to be genuinely empathetic.  It may be that she isn't because she isn't anyway, many non-ADD ppl I know aren't empathetic

I don't buy it

I don't believe that there is a link between ADD and empathy. 

<start sarcasm> However, if there were a link, why is it assumed that the ADD'er is lacking in empathy?  Maybe the Non-ADD'er requires to much empathy.  Is there a link between not having ADD and being a needy drama queen? <end sarcasm>