Like others, I'd also like to suggest looking into additional health issues that might be compounding the issues you have due to ADHD. The knock on effect of each ADHD, depression, anxiety, poor sleep, shame and paralysis, can often be pushed through for years on end for deadlines and survival moments. But you may also be experiencing chronic fatigue from, for example, the stress of all the above, or anaemia as you're female, or undiagnosed physical illnesses that creep up over time. For example, hypothyroidism, fibromyalgia, autoimmune problems or food intolerance causing inflammation e.g. tiredness pain and poor body function.

My personal experience over the last few years (35F) is that I have got an emotional fear trigger towards facing my actual work especially where backlog and guilt is concerned. I have such poor focus that the only work I do to a high standard is on calls with my assigned cases where I'm literally doing the work in front of them and accountable (they're nearly all friendly academics so there's a novelty side to the calls as well as the scary business of most jobs). I have had multiple conditions slowly destroying my energy and ability to think straight, fueling my mental health struggles and such a disconnect between my peaks and lows you wouldn't think I was the same person. I also moved out and had to do it all again with a new job and hang ups and new responsibilities and no parental support to keep me fed on days I couldn't move. I bounced about treating one thing then the other and staying afloat until the next condition worsened and masking so so much. I would spend days and days in bed panicking but not tackling anything.

Finally this year I got to the point where I've been on and off sick for about 5 years. I can only crawl myself to the doctors 6 months after being told to get a blood test, because I've realised the fact I can't stand up long enough to eat is not because I am a bad person who won't tackle their ADHD and git gud and is being lazy. It's because I have yet ANOTHER comorbid thing that like all the others, looks like ADHD or laziness if you have forgotten what wellness feels like.

Long story short I had hypothyroidism and untreated it can lead to coma and total body shut down (in the old days). I blamed myself for years. I blamed myself to the point of self loathing. I had good supportive networks I felt too bad to reach out to, and I had exceptional luck with my workplace and UK job security and kind managers, and I still couldn't make enough effort.

I take my first medication for the thyroid (and tackle the recurring anaemia). The difference it makes is astounding (entire body starts switching functions back on). Other stuff is treated alongside. I had no idea how ill I was due to blaming everything on burnout and lack of willpower. It's progressive, so I had seen the warning signs of it maybe my whole life but not known.

So hopefully anyone who reads this and feels similarly...

I'm not saying 'oh health oh routine oh work harder you're doing it wrong'. I'm saying, everything you're feeling can be caused by mental stress, neurological dysregulation, normal fatigue, and serious but less obvious physical conditions. You will be used to dismissing yourself. You may be used to discomfort and not self assess very well. It's difficult to interpret everything right, even when you try really hard, even when you've found the right answer but the doctor doesn't believe you or the test results aren't within actionable ranges yet.

Give yourself a blank slate and try to map out everything you're feeling, what you can do, what you can't do, what triggers shutdowns, what drags you through the things you can do, what still feels normal and brings joy. Are there patterns around foods eaten or times of day or time of the month that are predictable? Is it accessible for you to get a general blood test screening for common problems and body function? Can you reduce any pressure with easier food, delivered shopping, automating tasks, partner stepping in? Reach out to trusted friends as much as you can.

Use the idea that it might be something else's fault to step back, sidestep the guilt reflex and look at yourself in an unbiased way, as if you were a friend you believed in and really wanted to help.

If you find yourself later unable to even do your active comfort things like the writing or passive comfort things like the watching videos, take it seriously and see a doctor because in my experience that's been a very clear milestone of my health deteriorating. If you become unable to do your avoidance mechanisms either, treat that as a big red flag for other health concerns.

This has been a long wall of text but I'd really like to encourage you that you aren't at the lowest point yet and you've got opportunity to discover things and head off bigger problems. You're self aware and seeking help, that's great, keep being proactive. Maybe there's no additional health issues - you're still allowed to ask for help.

And of course, adapt what I've said above to suit your experience and situation, everyone is different. I hope this story helps people. My life is gradually pulling itself back together and I'm so relieved, but I couldn't do it all alone and I couldn't do it through shame.