Why ADHD in Women Is Frequently Mistaken for Anxiety

For many women, undiagnosed ADHD isn't just a distraction it can feel like constant mental chaos. Olivia Dreizen Howell, a Long Island resident, describes her experience as a nonstop internal dialogue, with commercial jingles and scattered thoughts running in the background. It wasn't until 2022 that she was diagnosed with ADHD, after previously being treated for anxiety for years.

This scenario is common. ADHD is often misdiagnosed as anxiety, and vice versa. Women, in particular, tend to be overlooked due to differences in how symptoms present. Understanding these distinctions is crucial for getting the right diagnosis and treatment.

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition with symptoms that persist from childhood into adulthood. While its exact cause is unknown, genetics and environmental factors, such as lead exposure, can increase risk, according to the Centers for Disease Control and Prevention (CDC).

There are three types of ADHD:

• Inattentive Type: Difficulty following instructions, frequent daydreaming, losing things, and struggling to complete tasks.

• Hyperactive-Impulsive Type: Trouble sitting still, excessive talking, and acting impulsively, such as interrupting others.

• Combined Type: A mix of inattentive and hyperactive symptoms.

Women are more likely to have the inattentive type, which may not be as obvious to teachers, parents, or even doctors.

Why ADHD Is Often Missed in Women

ADHD is more frequently diagnosed in men than women, but research suggests this is due to historical biases and differences in symptom presentation rather than an actual disparity in prevalence. Several factors contribute to underdiagnosis:

• Focus on Hyperactivity: Early definitions of ADHD emphasized hyperactive behaviors, which are more commonly seen in boys. Girls with inattentive ADHD may appear quiet and daydreamy, leading to a missed diagnosis.

• Social Conditioning and Coping Mechanisms: Girls are often encouraged to be more organized and people-pleasing, which can mask ADHD symptoms. Many develop coping strategies that allow them to function well, even while struggling internally.

• Late-Onset Symptoms: While boys tend to show signs of ADHD earlier, girls may develop symptoms later, sometimes not becoming noticeable until adolescence or adulthood. This can conflict with diagnostic criteria that require symptoms to be present before age 12.

A 2019 study in Psychiatry Research found that ADHD diagnostic criteria are often based on male-centric studies, leading to an underrepresentation of female patients in clinical research.

The ADHD-Anxiety Connection

Many symptoms of ADHD and anxiety overlap, making it challenging to differentiate between the two. Both conditions can involve trouble concentrating, restlessness, and difficulty managing responsibilities. However, the root causes differ:

• ADHD and Attention Issues: A person with ADHD struggles with focus because their brain has trouble regulating attention.

• Anxiety and Focus: Anxiety-related focus issues stem from excessive worry and overthinking, making it difficult to concentrate.

Both conditions also impact self-esteem and social interactions. A 2014 review in ADHD Attention Deficit and Hyperactivity Disorders found that adults with ADHD often develop lower self-esteem due to repeated negative feedback from peers and family. In contrast, anxiety-related low self-esteem is driven by feelings of inadequacy and fear of failure.

It’s common to have both conditions. Research from the Anxiety & Depression Association of America shows that about 50% of adults with ADHD also have an anxiety disorder.

What to Do If You Think You Have ADHD

If you suspect your anxiety diagnosis may be missing the full picture, it's important to seek a comprehensive evaluation. A proper ADHD diagnosis requires:

• A detailed history: A clinician will assess past and present symptoms and how they impact daily life.

• Assessment tools: ADHD rating scales and structured interviews help clarify whether symptoms are due to ADHD, anxiety, or both.

• A differential diagnosis: This process ensures symptoms aren’t due to other conditions, such as depression or a learning disability.

Self-diagnosis is tempting, especially with the rise of online quizzes and social media discussions, but experts warn against relying solely on these tools. A trained healthcare provider can provide an accurate assessment and recommend appropriate treatment.

How ADHD Is Treated

The good news? ADHD is highly treatable. Most treatment plans include:

• Medication: Stimulants like Adderall and Ritalin are common, but non-stimulant options are also available.

• Therapy: Cognitive-behavioral therapy (CBT) helps individuals develop strategies for managing time, organization, and emotional regulation.

• Lifestyle Changes: Exercise, sleep hygiene, and mindfulness techniques can support ADHD management.

Getting the Right Diagnosis Can Be Life-Changing

For Olivia Dreizen Howell, finally getting diagnosed with ADHD was a transformative experience. “My focus is very different. I don’t hear constant noises and discussions in my head all the time,” she says. Simple tasks that once felt impossible like completing projects now feel manageable.

If you suspect ADHD might be affecting your life, don’t hesitate to seek professional guidance. Many women go decades without a diagnosis, but it’s never too late to get the support you deserve.

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