You’re successful. Driven. Disciplined. But you’re always exhausted—and beneath that polished exterior, you’re running on fumes. Could what looks like ambition actually be your brain’s way of outrunning emotional chaos?
In this powerful reflection, Dr. Sanil Rege, consultant psychiatrist and founder of Psychiatry Simplified, explores a form of ADHD that rarely gets the attention it deserves: the high-functioning, masked, emotionally overregulated type common among high achievers.
The Mask of Competence
ADHD is typically associated with chaos - distraction, hyperactivity, forgetfulness. But in high-performing adults, especially professionals like doctors, lawyers, creatives, and entrepreneurs, it often hides under layers of structure, overachievement, and hyper-productivity. These individuals manage their symptoms not with treatment, but with relentless doing.
Behind this mask lies a cycle of procrastination, panic-fueled deadlines, avoidance of rest, and an inability to enjoy downtime. Holidays feel empty. Admin tasks feel impossible. And success? It’s not satisfying—it’s simply a way to quiet the emotional noise.
The Neurobiology of the Hustle
At the heart of ADHD isn’t just attention—it's regulation: of emotion, of effort, of arousal. Dr. Rege explains that disrupted dopamine pathways in both emotional (mesolimbic) and cognitive (mesocortical) regions create a brain addicted to urgency, novelty, and stimulation. This creates a phenomenon called delay aversion—a discomfort with low-stimulation states that fuels the last-minute rush.
When you succeed, it’s not because you’re calm and in control—it’s because you’re panicking just enough to override your brain’s dysregulation.
The Addiction to Achievement
Achievement becomes self-medication. It regulates restlessness and numbs emotional pain. But the cost is high. When you stop moving, you don’t feel peace—you feel guilt, agitation, and shame. This isn’t laziness, Rege says, it’s withdrawal from the stimulation of doing.
And the paradox?
This drive for success is born from fear, not joy. The fear of failure, of not being enough, of being exposed. This isn't ambition. It's emotional survival.
Arousal Dysregulation: The Constant Mismatch
ADHD is also a disorder of arousal regulation. You’re wired when you’re meant to rest, and flat when you need to rise. Many adults with ADHD—especially undiagnosed women—spend their lives at 120%, not because they want to, but because slowing down is terrifying.
This constant override creates allostatic load: the cumulative wear and tear of chronic stress. And success doesn’t protect you—it adds to the load. More pressure, more expectations, more internalized drive.
According to Dr. Rege, the brain is a prediction machine. When our predicted outcomes continually mismatch our reality (e.g. “I should feel satisfied, but I don't”), it leads to chronic activation and burnout. That’s why the high-functioning ADHD brain often burns out not despite success, but because of it.
Women and the Quiet Chaos
This pattern is especially common in women. They’re more likely to internalize symptoms, mask their struggles, and get misdiagnosed or missed altogether. Instead of bouncing off walls, they bounce between burnout and guilt—quietly.
They’re called “moody,” “emotional,” “perfectionistic”—never “ADHD.” But the neurobiological dysregulation is the same.
The Shame-Driven Loop
When the fuel for achievement is fear—of rejection, criticism, failure—you enter the shame cycle. Shame fuels overwork. Overwork leads to burnout. Burnout leads to shame. Round and round it goes.
What Now?
Dr. Rege doesn’t offer a simplistic solution, but a compassionate reframe:
Exhaustion is not failure—it’s a signal. Your brain has been in survival mode, not performance mode.
Seek understanding. Sometimes this means a clinical ADHD assessment, psychoeducation, or cognitive strategies.
Medication may help, but it’s not the only answer. Regulation—not stimulation—is the goal.
Let go of the idea that your worth = your output. Peace is not the enemy of productivity. It’s the foundation.
Key Takeaway
Achievement is powerful when it comes from alignment, not avoidance. When expectations match outcomes, the brain feels satisfied. But when success becomes an escape hatch, it breaks us.
Burnout isn’t a badge of honour. It’s a brain crying out for balance.
[Adapted from High Achiever but Always Burnt Out? Hidden ADHD… or Survival Mode?]
About Dr. Sanil Rege
Dr. Rege is a psychiatrist, educator, and founder of PsychSceneHub and Psychiatry Simplified. He has become a sought-after voice in mental health education, known for distilling complex neuroscience and psychiatry into relatable, humane explanations. His body of work reflects a deep commitment to making psychiatric knowledge accessible—and to reframing mental health through both scientific rigour and compassion.
You can find his work on:
YouTube: Psychiatry Simplified
Website: PsychSceneHub
LinkedIn: Dr Sanil Rege
