Who Am I, Really? Distorted Sense of Self in ADHD and Autism

By Tim Aiello, MA, LPC, NCC, ADHD-CCSP, ASDCS

Clinical Director, Myndset Therapeutics

There’s a quiet kind of ache I see over and over again in the neurodivergent adults I work with, and I know it personally too. It’s this heavy, persistent question: Who am I, really?

For many of us with ADHD, Autism, or both (what’s often called AuDHD), the sense of self isn’t a steady, clear thing. It’s often fractured, blurred, or shaped by the expectations of others. It’s not just about feeling unsure—it’s about feeling unknowable, even to ourselves. And that can be incredibly painful.

But this struggle isn’t a flaw in character. It’s not because we lack insight or emotional maturity. It’s the result of chronic masking, trauma, nervous system dysregulation, and living in a world that often demands performance over authenticity.

Masking, Camouflaging, and Identity Confusion

Let’s start with the basics. Masking—intentionally or unconsciously hiding traits to fit in—is a survival tool most neurodivergent people learn early. Autistic adults often camouflage their natural behaviors and preferences to avoid judgment or rejection. ADHD adults may downplay their impulsivity or adapt their personalities depending on what feels “acceptable.”

Over time, this creates a disconnection between the outer self we present and the inner self we barely get to know.

Research has shown that this kind of long-term masking is linked to higher levels of anxiety, depression, and identity confusion. In a 2019 study, Cage and Troxell-Whitman found that camouflaging in Autistic adults was closely associated with distress around self-concept and a reduced sense of authenticity. For many, masking becomes so second nature that they forget what unmasked even feels like (Cage & Troxell-Whitman, 2019).

And in ADHD, this shows up as chameleon-like behavior. We adapt constantly—to please others, to avoid criticism, to meet demands we’re not neurologically built for. If every part of you is trying to keep up or be “good enough,” it leaves very little room to ask, “But who am I underneath all that?”

Executive Function and Interoception: The Inside-Out Disruption

Neurologically, both ADHD and Autism impact the very systems responsible for self-awareness.

In ADHD, the prefrontal cortex—where executive functions like self-reflection, regulation, and future planning live—develops differently. This contributes to difficulties with sustained self-monitoring and meta-cognition, meaning we often act before we reflect, or lose track of how we’re feeling until we’re already overwhelmed (Arnsten, 2009).

In Autism, studies show altered activity in the default mode network, a part of the brain involved in self-referential thought and identity processing (Lombardo et al., 2010). This means that some Autistic people may experience the concept of self differently or less consistently across time and social settings.

Both conditions also involve differences in interoception—the ability to sense and interpret internal bodily signals. When you struggle to feel hunger, fatigue, or emotion in real time, it can be incredibly difficult to answer even the simplest identity-based questions like, “How do I feel right now?” or “What do I need?” (Mahler, 2017).

Without that internal feedback loop, we often look outside ourselves for guidance. We watch how others respond, mimic what seems “normal,” and slowly lose our internal compass.

The Harsh Mirror: How a Distorted Self Breeds Self-Judgment

One of the most painful consequences of a distorted sense of self is how harshly we learn to view ourselves. Many of us internalize the criticism we’ve received our entire lives and begin to see ourselves through a distorted, judgmental lens.

We become our own harshest critics. We replay mistakes in our heads for hours. We hold ourselves to impossible standards. We downplay our needs and convince ourselves that everyone else is handling life better than we are.

This isn’t just low self-esteem. It’s a trauma response.

When your identity has been shaped around avoidance—avoiding rejection, avoiding failure, avoiding being “too much”—you begin to equate worth with performance. If you're not being productive, if you’re struggling with emotional regulation, if you miss a deadline or need to cancel plans, your brain may automatically label you as lazy, flaky, selfish, or weak.

But these labels don’t come from nowhere. They come from years of trying to function in systems that weren’t designed for our brains. From teachers, parents, peers, and employers who misunderstood our challenges and saw them as character flaws. From internalized ableism that tells us being different means being broken.

And so we judge ourselves—relentlessly. We think we need to work harder, be better, mask more, try again. But that judgment doesn’t lead to growth. It leads to shame, burnout, and deep disconnection from who we really are.

The Nervous System’s Role: Living in Performance Mode

Let’s talk about what this feels like in the body. Because this isn't just a cognitive issue—it’s a nervous system issue.

According to Polyvagal Theory, when we don’t feel safe—emotionally, socially, or physically—our autonomic nervous system shifts into survival states. Fight, flight, freeze, or fawn. We become hyper-aware of threats, even if those threats are just perceived disapproval, unpredictability, or sensory overload (Porges, 2011).

This is often the baseline for ADHD and Autistic adults. Not because we’re dramatic, but because our nervous systems are finely tuned from years of having to scan the environment for signs that it’s not safe to be ourselves.

That constant state of alertness keeps us in “performance mode.” It’s exhausting. It’s why so many of us collapse at the end of the day, feel socially hungover, or dissociate during high-stress interactions.

And in that state, it’s nearly impossible to connect with the authentic self. The nervous system doesn’t prioritize self-reflection when it believes survival is at stake.

Reclaiming Identity: A Gentle, Human Process

So how do we reconnect with a self that feels scattered, hidden, or distorted?

We start by slowing down. By creating safety, inside and out. Because authenticity doesn’t emerge in chaos—it needs warmth, space, and nervous system regulation.

Here’s what I often explore with my clients:

1. Safe unmasking. Not all the time, not with everyone, but in moments. With people who get it. Or even alone. Start noticing what you do when no one’s watching. What music do you love? What movement feels natural? What thoughts arise when you stop performing?

2. Polyvagal-informed practices. Gentle breathwork, co-regulation with a trusted person or pet, rhythmic movement, or even humming can help bring your nervous system into a more grounded state. From there, clarity comes more easily.

3. Parts work. Using modalities like Internal Family Systems (IFS) can help identify the inner “selves” we carry—the achiever, the masker, the rebel, the shutdown part—and get curious about their purpose. These parts aren’t bad. They’ve just been over-functioning to keep us safe.

4. Interoceptive awareness. Tracking physical sensations, even just once a day, can help rebuild your internal connection. Ask yourself: Where do I feel tension? Am I thirsty? What emotion is trying to speak through my body?

5. Rewriting the narrative. Identify the old stories you’ve been telling yourself—like “I’m lazy,” or “I’m too sensitive”—and replace them with affirmations rooted in truth. Not toxic positivity, but grounded, compassionate truth. You are trying. You are doing your best with a brain that functions differently. That matters.

6. Rest and quiet. Sometimes, the most radical thing we can do for identity healing is stop. Stop performing. Stop people-pleasing. Just rest. Let your nervous system come down from survival mode so your authentic self can surface.

Final Thoughts

If you’ve ever felt like your personality changes from room to room, like you’re made of mismatched puzzle pieces, or like you’ve spent most of your life auditioning for approval—you are not alone.

And there is nothing wrong with you.

Your sense of self may feel blurry, but it is not broken. It has simply been layered with the expectations and pressures of a world that doesn’t yet know how to honor difference.

Beneath the masks, the perfectionism, the self-doubt, and the overachievement, there is a real you. Still here. Still worthy. Still waiting to be fully seen—not just by others, but by yourself.

References

• Arnsten, A. F. T. (2009). Toward a new understanding of the pathophysiology of attention-deficit hyperactivity disorder. CNS Drugs, 23(S1), 33–41. https://doi.org/10.2165/00023210-200923000-00005

• Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts, and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911. https://doi.org/10.1007/s10803-018-03878-x

• Lombardo, M. V., Chakrabarti, B., Bullmore, E. T., et al. (2010). Shared neural circuits for mentalizing about the self and others. Journal of Cognitive Neuroscience, 22(7), 1623–1635. https://doi.org/10.1162/jocn.2009.21287

• Mahler, K. (2017). Interoception: The Eighth Sensory System. AAPC Publishing.

• Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. W. W. Norton & Company.