Diagnostic Evaluation of ‘But First’ Disorder: The Epidemic

It was a joke between my father and me. It was a collection of observations we made over the years. Many of our family members actually praised the organizational skills of my father. My mother frequently noted wistfully how much more disciplined I am that she. Dad and I knew what it was. It was the ‘but first’ disease.

The ‘But First’ disease is a remarkably prevalent disorder in the general human population. There are acute and chronic versions. It is a degenerative disorder and can become more chronic and severe with age. Here is a general case study of the criteria for this common disorder as described by an anonymous sufferer and disseminated to the internet in the early BBS days:

“I call it ‘But First’ Syndrome.  You know.  It’s when you decide to do the laundry.  So you start down the stairs with the laundry, but then see the newspapers on the table.  OK, you’ll do the laundry.

BUT FIRST you decide to put the newspapers away.  So on your way in to put the newspapers away, you notice the mail on the table.  OK, you’ll put the newspapers away.

BUT FIRST you’ll pay that bill that needs to be paid.  So you look for the checkbook.  Oops…there’s the baby’s bottle from yesterday on the floor. OK, you’ll pay the bill.

BUT FIRST you need to put the bottle in the sink.  You head for the kitchen.  Darn it, there’s the remote for the TV.  What’s it doing here? Okay, you’ll put the bottle in the sink.

BUT FIRST you need to put the remote away.  Head for the TV room.

Aaagh!  Stepped on the cat.  Cat needs to be fed.  Okay, you’ll put the remote away.

BUT FIRST you need to feed the cat…

So, here’s what happens at the end of the day: Laundry is not done, newspapers are still on the floor, bottle is on the table, bills are unpaid, checkbook is still lost, and the cat ate the remote control …

And, when you try to figure out how come nothing got done all day, you are baffled because …..you KNOW you were BUSY ALL DAY!!

That’s the ‘BUT FIRST’ Syndrome.”

~author unknown

I have for years blithely watched as various family members struggled with deadlines and due dates and arrivals and departures. There was always the last minute scrambling that occurred before heading out to any planned event. I always marveled at the frantic actions that accompanied any scheduled departure. I was baffled at the inability of so many to actually have a “To Do” list and yet fail miserable to get any item on it “Ta Done”. I believed myself to be immune to the plague from which so many suffer.

And then it hit. I’ve never really known whether it was age or stress or various life events that activates the “but first” disease, but it has hit me… with a vengeance. Along with the described progress of the disorder above, there is an accompanying cognitive disruption that culminates in a glorious confusion that prevents you from remembering exactly what you were even supposed to be doing or where you might be on the vaunted “To Do” list. I now find myself in the mortifying circumstance of mirroring the behaviors and symptoms previously regaled. I will share with all of you, my dear readers the criteria for this sad epidemic in our midst.

“But First” Disorder Diagnostic Criteria


Cognitive Disorders vs Stress Induction Disorder


Many theories have been introduced to explain this disorder, however at this time there is much controversy whether this disorder is a biological result of the progression of aging or whether environmental contributions have an impact. Additionally, there has been some speculation about the genetic contribution to the manifestation of symptoms. The increased occurrence with chronological age has led to it also being referred to as Age Activated Attention Deficit Disorder (AAADD). Further research is needed.


The symptoms of But First Disorder generally present at some point during adulthood. There is a broad range of ages in victims of this disorder; however parenthood appears to contribute somewhat to early onset of the illness.


Two or more symptoms, each present for a significant portion of time during acute attack periods

  • Highly distractible even with specific purpose, intent, and initiation of action (source of disorder name, “but first…”)
  • Tangential communication resulting derailed train of thought, often in the middle of the sentence resulting in frequent inquiry of “What the @#$% was I just saying?”
  • Motor function devoid of active cognition, as evidenced by walking purposefully into another room of the house and finding that no conscious reason for said journey is evident
  • Memory reengagement function creating unnecessary physical movement, as evidenced by returning to previous room in house and sitting down only to remember why the previous journey was made
  • Finding at the end of any given day five or more open tasks/projects with no significant progress or action accompanied by significant physical fatigue


  • Acute
    • This is generally an onset that accompanies a day planner/activity calendar that has no empty spaces
  • Chronic
    • BFD that occurs periodically with some regularity, usually when there is a large amount of tasks to accomplish and only a short duration in which to accomplish them (see paid time off deficiency)

‘But First’ Subtypes

External Distraction Type

  • Often found in (but not restricted to) new parents or parents of young children
  • Inability to finish sentences due to phones ringing, children requesting attention, pet challenges, text messages, instant messages, etc.
  • Appearance and nutrition frequently impaired due to interruptions in normal routines in these areas sometimes resulting in arrival to work with shoes of different colors or un-brushed hair, or possibly forgetting whether any food has been consumed during the day

Hyperactive Type

  • Designated by frantic activity and larger numbers of initiated tasks generally with no evidence of completion after several attempted initiations

Procrastination Type

  • Designated by long lists of tasks to be completed that have no decrease over time accompanied by other initiated activities
  • Designated task days derailed by the irresistible urge to watch the entire Netflix collection of Murder She Wrote


The most important part of treatment is allowing time and environmental cues to clear the mind of the sufferer, a reset, if you will. This can best be accomplished with a relaxing night out with an enjoyable companion. Spa treatments and massages are also beneficial. For extreme cases, more intense treatment is required. Oceanic cruises or at least a long weekend by a large body of water or other peaceful environment and application of appropriate beverages and nourishment can often significantly improve symptomology almost to complete remission. However, if symptoms re-present, repeat the aforementioned treatment.


There is currently no permanent cure for BFD. However, with proper alleviation of environmental factors and regular treatment, as above, the individual can learn to cope and improve social functioning. Additionally, appropriate treatment can prevent exacerbation of the disorder into full-blown CRS (Can’t Remember $#!%).

More research is needed to fully understand the condition and fully explore the most effective treatments… Actually, I think I’ll get on that exploration. *Hey, barkeep!…*

But First Syndrome http://www.funpages.com/butfirst

Daily Dose of “The Funnies” http://kcbx.net/~tellswor/butfirst.htm

2 thoughts on “Diagnostic Evaluation of ‘But First’ Disorder: The Epidemic”

  1. Ummm, so, I think, yeah, ummm, so, I think I have this syndrom thingie. But first, I must say….now, what was I going to say. Oh yeah! I remember…it gets worse, this “But first” syndrom. I can still get places on time. But, cleaning the house? Round & round in circles, like a dog chasing my tail.

  2. You should right a blog on what I call the hand in the book bag syndrome. It is when you are told to do something right when you are starting to do it anyway, and say , Fuck it, I am not doing now that I have been told to, because you can’t tell me that.

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