ADHD and Anxiety in Women: Understanding the Overlap, Differences, and Connections
Navigating adulthood with ADHD, anxiety, or both can be a complex and overwhelming experience. These conditions frequently coexist, and their symptoms often overlap or appear similar on the surface, making it challenging to distinguish between them. As a therapist, I work with many women who face this confusion, and understanding the unique mechanisms behind each condition, as well as how they can influence one another or contribute to misdiagnosis, is crucial. By identifying these differences, individuals can move beyond feelings of overwhelm and shame, building a foundation for a more effective and compassionate approach to managing symptoms and fostering meaningful change.
In this post, we'll explore the distinctions and connections between ADHD and anxiety, diving into brain structure, root causes, physical symptoms, and key indicators to help you gain a clearer understanding of what you might be experiencing.
Prefer video content? Below are also other great resources to learn more!
How ADHD & Anxiety Can Appear Similar
Although ADHD and anxiety are distinct conditions, they often seem similar at first glance, leading to confusion or lack of understanding about the underlying mechanisms driving their symptoms. This overlap can result in misguidance regarding individual needs and effective management strategies. Both ADHD and anxiety may manifest in the following ways:
Difficulty focusing and maintaining attention
Avoiding tasks or social situations
Restlessness or difficulty sitting still
Procrastination
Physical discomfort
Challenges at work and school, or in the home
Perfectionism
Shame and self-criticism
Low self-esteem and self-doubt
Difficulty making decisions
Difficulties falling and staying asleep
Sex or intimacy issues
Overstimulation or sensory sensitivities
Strained relationships
The Key Differences: ADHD vs. Anxiety
Now that we’ve explored how ADHD and anxiety can appear similar at first glance, it’s essential to delve deeper into their unique characteristics. Understanding these distinctions is crucial for effective diagnosis and tailored treatment. Let’s examine the key differences between ADHD and anxiety to better appreciate how they shape individual experiences:
Neuroanatomy
ADHD: This condition primarily involves differences in the prefrontal cortex, a critical brain region responsible for executive functions such as planning, decision-making, impulse control, emotional regulation, and organization. Individuals with ADHD often exhibit structural and functional differences in this area, which can affect their ability to prioritize tasks, manage time effectively, and regulate their emotional responses. (WATCH: What is ADHD? or The Neuroscience of the ADHD Brain or 2-Minute Neuroscience: ADHD)
Anxiety: In contrast, anxiety is associated with an overactive amygdala and catastrophizing or misinterpreting stimuli in the cortex and, the parts of the brain that processes fear and responds to perceived threats. When the amygdala is hyperactive, it can lead to a constant state of vigilance, where the individual is on high alert for potential dangers. This heightened state can trigger the fight-or-flight response, resulting in physiological symptoms like increased heart rate, sweating, and rapid breathing. (WATCH: The Anxious Brain: Amygdala Versus Cortex Based Anxiety or Sympathetic Nervous System: Crash Course Anatomy & Physiology)
Neurotransmitter Dynamics
ADHD: Individuals with ADHD typically experience dopamine deficiency, which plays a significant role in motivation, reward processing, and attention regulation. Dopamine is crucial for reinforcing behaviors that lead to pleasurable outcomes. When dopamine levels are low, individuals may struggle to maintain focus on tasks that do not provide immediate gratification, leading to difficulties in completing assignments or managing daily responsibilities.
Anxiety: Anxiety is often linked to serotonin imbalances, which can affect mood stability, emotional regulation, and stress responses. Serotonin is a neurotransmitter that helps regulate feelings of well-being and happiness. When serotonin levels are low or imbalanced, individuals may experience heightened anxiety, irritability, and emotional instability, making it challenging to cope with stressors.
Onset and Development
ADHD: This condition generally manifests in childhood, with symptoms often observable as early as preschool. ADHD is considered a neurodevelopmental disorder, meaning it arises from atypical brain development and is typically persistent throughout a person’s life. Early intervention and management strategies can significantly improve functioning and quality of life for individuals with ADHD.
Anxiety: Unlike ADHD, anxiety can develop at any point in life, often triggered by stressful events, trauma, or significant changes in one's environment. While some individuals may have a predisposition to anxiety due to genetics or past experiences, others may develop anxiety as a reaction to life stressors, such as job changes, relationship issues, or health concerns. This variability in onset makes it essential to consider an individual’s unique circumstances when assessing anxiety.
Behavioral Patterns
ADHD: Individuals with ADHD face consistent challenges across various settings, whether at home, work, or school. This means they may struggle with initiating tasks, following through on projects, or maintaining organization in their daily lives, regardless of the environment. This pervasive nature of symptoms can lead to frustration and a sense of inadequacy, especially when compared to peers who do not experience these challenges.
Anxiety: In contrast, anxiety symptoms can fluctuate significantly, often depending on specific triggers. For instance, someone may feel perfectly calm at home but experience intense anxiety in social situations, during public speaking, or when faced with performance-related tasks. This variability can lead to avoidance behaviors, where individuals steer clear of certain situations to prevent overwhelming feelings of anxiety, further complicating their social and professional lives.
Motivational Drivers
ADHD: Difficulty with task initiation in individuals with ADHD is primarily rooted in executive dysfunction. They may find it challenging to get started on tasks, especially if those tasks feel overwhelming or lack immediate rewards. Interestingly, individuals with ADHD might experience hyperfocus on activities they find engaging or enjoyable, such as hobbies or tasks that spark their interest. This intense concentration can lead to neglect of responsibilities or chores that they perceive as tedious.
Anxiety: In contrast, avoidance behaviors associated with anxiety are driven by fear and worry about negative outcomes. Individuals may procrastinate or avoid tasks not because of disorganization but due to a deep-seated fear of failure, judgment, or not meeting expectations. This fear can be exacerbated by perfectionism, leading to a cycle of avoidance and increased anxiety, ultimately hindering personal and professional growth. Additionally, anxiety can manifest as hypervigilance, where individuals remain excessively alert and attentive to potential threats in their environment, further amplifying feelings of stress and anxiety.
When It’s Both: How Anxiety Can Develop from ADHD
For many women and girls, Attention Deficit Hyperactivity Disorder (ADHD) can lead to anxiety. This connection arises not only from ADHD’s direct challenges but also from trauma and societal expectations.
How ADHD Leads to Anxiety
ADHD often manifests as difficulties with focus, organization, and emotional regulation. These challenges can be overwhelming, especially when trying to meet high societal standards. Women and girls, socialized to excel, may feel intense pressure to conform. When they struggle, feelings of inadequacy and shame can trigger anxiety, creating a cycle where anxiety worsens ADHD symptoms, making everyday tasks even harder.
The Role of Trauma and Society
Environmental factors, including past trauma, also play a significant role. Many women and girls with ADHD have experienced emotional or psychological trauma, which can heighten feelings of insecurity and fear. Additionally, social conditioning encourages girls to be caretakers and perfectionists, leading them to mask their ADHD symptoms. This pressure can result in chronic stress, exacerbating anxiety and making it difficult to break free from these expectations.
Challenges in Diagnosis and Treatment
Diagnosing ADHD and anxiety in women can be complicated. Many women learn to hide their symptoms to fit societal norms, leading to underreporting during assessments. Often, anxiety is diagnosed more frequently than ADHD, creating a cycle of misdiagnosis that can cause confusion and frustration.
It's crucial to work with a provider who understands these nuances. Clinicians should focus on the root causes of symptoms rather than offering generic solutions. Simply trying different treatments without a tailored approach is neither effective nor compassionate.
For lasting change, it’s essential to address both symptoms and the underlying issues—like societal pressures and personal history—that contribute to mental health struggles. By understanding each individual’s unique experiences, we can create treatment plans that empower women to regain control over their lives.
Examples in Action: ADHD & Anxiety, Alone & Together
To better understand how ADHD and anxiety manifest differently, here are examples of each in isolation and when both are at play:
Just ADHD: Maria has ADHD and struggles to stay focused during meetings. While her colleagues discuss project details, she finds her mind wandering, and she often jots down unrelated thoughts instead of engaging in the conversation. As deadlines approach, she becomes overwhelmed with the number of tasks she has started but hasn’t finished, leading to frustration and a sense of inadequacy.
Just Anxiety: A woman experiences anxiety at work, particularly when it comes to presenting her ideas during team meetings. Despite having great insights, she worries excessively about how her colleagues will perceive her. This fear leads her to overprepare, but even then, she might avoid speaking up altogether, fearing she will be judged or criticized.
Both: A mother of two young children often feels overwhelmed by household responsibilities, shaped by an upbringing where her parents expressed frustration over her disorganization, forgetfulness, and messiness—symptoms of her undiagnosed ADHD. This environment led her to internalize feelings of inadequacy, believing a perfectly tidy home was essential to being a good daughter, reinforced by societal expectations. Now, as an adult, she struggles to prioritize home tasks and often feels paralyzed by where to start. The resulting clutter leaves her feeling like a bad mother and partner, compounded by anxiety about what others might think of her messy home. Caught between her desire for a perfect household and the challenges of her ADHD, she grapples with shame and the weight of unmet expectations.
Moving Forward: Seeking Help and Support
If you suspect that you may be dealing with ADHD, anxiety, or both, it's important to take steps toward understanding your unique experience and finding appropriate support. Here's how to start:
Track Symptoms: Pay attention to when and where symptoms arise. Are they present across multiple settings, or are they tied to specific stressors? Is your procrastination due to challenges with executive function (ADHD), a fear-based response (anxiety), or both?
Self-Reflection: Reflect on how perfectionism and shame influence your behaviors. Are they driving avoidance or creating additional anxiety around performance?
Seek Professional Assessment: A comprehensive evaluation by a mental health professional can help distinguish between ADHD, anxiety, and co-occurring conditions. Understanding whether executive dysfunction or fear-based responses are driving your struggles is key to accurate treatment.
Explore Treatment Options:
Medication: Treatment for ADHD often includes stimulants, which can sometimes exacerbate anxiety. However, they may improve functioning by enhancing self-management. Non-stimulant options or SSRIs for anxiety may be necessary depending on the individual’s response.
Therapy: An integrated approach that targets both ADHD and anxiety is essential. Therapy may focus on executive functioning skills (like time management and planning) alongside anxiety management strategies, such as cognitive restructuring, mindfulness, and emotional regulation.
Lifestyle Modifications: Regular exercise, mindfulness practices, and good sleep hygiene benefit both conditions. For ADHD, these routines help regulate the nervous system, while for anxiety, they lower stress hormones and promote relaxation
Finding the Right Support
If you suspect you may have ADHD, anxiety, or both, seeking a comprehensive evaluation from a professional experienced in these conditions is essential. Understanding the interconnected nature of your symptoms allows for a personalized treatment plan, reducing self-blame and fostering a more compassionate, values-aligned way of living. Therapy, medication, and lifestyle adjustments are most effective when tailored to your unique needs and experiences.
By taking proactive steps to explore these conditions, you can gain clarity, relief, and a pathway forward that aligns with your values and goals.