“Do I have anxiety or ADHD?” ADHD and anxiety can be surprisingly hard to differentiate. As a psychologist, I have often treated adults with previous diagnoses of anxiety disorders where it turns out that undiagnosed ADHD has played a central role in that anxiety.  In this article, we will discuss how to tell the difference between ADHD vs anxiety in adults.

Although there has been an uptick in diagnosis rates as more is known about Adult ADHD, the rates are still fairly low in the overall population, ranging from 2-7%.  One study by Kessler and colleagues (2006) estimated a 4.4% prevalence rate.

In contrast, anxiety disorders are much more prevalent in the overall population.  The National Institute of Mental Health (NIMH) estimates that 31% of adults will be diagnosed with an anxiety disorder at some point in their lives..

Also pertinent is the discrepancy in comorbidity rates.  Approximately 50% of adults diagnosed with ADHD also have anxiety disorders.   On the other hand, while there is limited data and variance in samples, estimates are between 10 and 27% of people with anxiety disorders also have ADHD.

What do these statistics mean?  They tell us:

• It is more common to have anxiety vs ADHD.
• It is more common for people diagnosed with ADHD to have an anxiety disorder than the other way around.

Many people experience symptoms of anxiety in their lives that would qualify for one of the anxiety disorders.  We review this generally in the section on anxiety disorders that follows.  On the other hand, ADHD is understand to be related to structural differences in the brain.  This type of neurodiversity is less common in the population.

Additionally, if you already have Adult ADHD, you are much more likely to have an anxiety disorder than someone with an adult with an anxiety disorder is to have ADHD.  This is due to certain features of ADHD that make it more likely to be anxious.

Let’s first discuss the basics of anxiety disorders and then ADHD.  In explaining the features of each, we’ll help you be able to tell the difference between ADHD vs anxiety.  We’ll help you understand how ADHD can be misdiagnosed as anxiety.  As part of this discussion, we’ll explain why people can often have ADHD and anxiety, not one or the other.

We’ll then examine ADHD and anxiety in women, particularly by reviewing how ADHD can present differently in women.  We’ll consider how gender stereotypes lead to underdiagnosis of ADHD in women, and overdiagnosis of anxiety in women.  As a spotlight of this discussion, we’ll differentiate between GAD vs ADHD in women.

Finally, we’ll move from diagnosis to treatment, and cover how to treat ADHD and anxiety in adults.  In doing so, we’ll cover treatments for ADHD and anxiety, as well as ones that work better for one or the other.

Anxiety Disorders: What You Need to Know

Although there are many distinct anxiety disorders in the DSM-V, three frequent features include some or all of the following:

• Somatic symptoms – symptoms of increased physiological distress (e.g. elevated heart rate, sweating, blushing, stomach clenching).
• Cognitive rumination – frequent worry and mental preoccupation with a particular area of concern.
• Affect dysregulation – runaway emotional distress and emotional lability.  Although there are different types of emotional dysregulation, with anxiety disorders the person feels fearful and emotionally ‘flooded’ as they think/worry about a particular topics(s) or stimulus.

Anxiety often involves anticipation – whether physical, mental, or both.  When something unpleasant or traumatic happens, people with anxiety disorders often become highly guarded against it happening again.  This involves hypervigilance against stimuli, avoidant behaviors, and a rapid and intense reaction when presenting with these cues. You can think of this as a protective mechanism on steroids.

There is also a practical ‘if it walks like a duck and talks like a duck..” quality to anxiety.  When someone is often anxious, their family and friends really ‘feel’ the anxiety in their day-to-day interpersonal interactions.  It’s hard to say someone doesn’t ‘have’ anxiety when it looms large in their lives.

On the other hand, as we discuss ADHD, it will become more clear how ADHD can actually be the ‘driver’ of anxiety.  Because there are misconceptions about ADHD, people often don’t understand the similarities and difference between ADHD and anxiety.  As a result, ADHD is often misdiagnosed as anxiety.

ADHD Misdiagnosed as Anxiety

In the DSM-V, the main diagnostic criteria of ADHD are a ‘deficit of attention’, (e.g. hard to pay attention); and hyperactivity, as seen as excess amounts of energy and hyperactive behavior.  While these criteria may be present in adults with ADHD, they are not the central component.

Restlessness

Perhaps surprisingly, most adults don’t display hyperactive behavior, in contrast to certain kids with ADHD.  Rather they may have an overactive ‘internal motor’, as seen through restlessness and a creative drive.

Inconsistent Attention & Hyperfocus

Further, when it comes to attention, the main problem isn’t attention deficit but rather attention inconsistency.  Adults with ADHD can be  under-focused or over-focused, depending on the moment.  And when they are hyperfocused, they have intense zones of attention.  Said another way, in such moments, these adults are ‘locked in’ or ‘in the zone‘ with whatever they are focused on.  In these periods, it is incredibly difficult to change focus and shift attention.

Emotional Dysregulation & Reactivity

Another predominant characteristic of ADHD in adults is emotional reactivity.  People with ADHD feel deeply and have intense emotional responses.  These can often come on quickly and intensely, and recede just as quickly, once the focus has shifted.  To someone without ADHD, these emotional responses can feel more intense than the average person’s feelings.

Executive Dysfunction

Finally, and perhaps most importantly, executive dysfunction is a significant aspect of ADHD, and not treatable with medication.  People with ADHD have structural differences  from others in the frontal cortex regions of their brains.  They have more difficulty proactively planning tasks, and have a hard time organizing and prioritizing the order of these activities. This can also involve difficulty resisting controlling impulses and delaying gratification and reward-seeking behavior.

Can ADHD Show up as Anxiety?

Now let’s come back to our understanding of anxiety.   Often, ADHD is misdiagnosed as anxiety because there can be a hyperfocus on an anxiety-producing stimulus and emotional reactivity to related cues.

Also because people with ADHD have trouble organizing themselves and delaying reward-seeking activities, they are often out of rhythm and ‘playing catch-up’.  They are trying to compensate for not having done the thing they should have done first.

For example, if you focus on a relatively minor task that seems interesting in the  moment and forget another task that has a deadline, you will be anxious when you discover that you have missed the deadline.

Do I Have Anxiety or ADHD?

The question ‘Do I have anxiety or ADHD?’ is a misleading one.  The real question is ‘do I have ADHD and anxiety’?  If you do, chances are the ADHD has been misdiagnosed as anxiety.  That means that your ADHD was not diagnosed earlier in your life, which is the case with Adult ADHD.  It also may mean that you have high-functioning ADHD, where the impact of your ADHD is minimized because of your ability to be successful in other aspects of your life.

Step back and think about this for a moment.  Anxiety is observable and more commonly understood than ADHD.   Yet someone with ADHD can be emotionally reactive, hyperfocused, and suffering from executive dysfunction, all of which increases the likelihood of intense anxiety.

As a result, for adults diagnosed later in life with ADHD, there has been a long opportunity for narratives of anxiety to take hold, e.g. ‘I am an anxious person.’  This is not to minimize the legitimacy and reality of anxiety disorders.  But the role of ADHD in anxiety is often misunderstood and minimized.

ADHD and Anxiety in Women

Although the prevalence rates are roughly equivalent by gender, Kessler and colleagues (2006) found in an empirical study that ADHD is diagnosed almost 70% more in men than women (5.4% in men vs. 3.2% in women).  Another study by Mowlem and colleagues (2019) found that ADHD is more likely to be missed in women during the diagnostic process.  ADHD and anxiety in women can often present differently than with men.  We noted earlier that in adults, the ‘H’ in ADHD does not typically present as hyperactivity, but rather as restlessness.

Interestingly, women with ADHD often did not display hyperactivity as girls either.  Rather, this comes across as talkativeness.  These girls – and later women – may present as more talkative than others.  This is due to the difficulty in self-regulation that manifests with ADHD.

There are also gender stereotypes about women and anxiety.  Because women may be more vocal about their anxiety, women are often incorrectly perceived to be more anxious than men.  This effect can be magnified in women with ADHD and anxiety, because of the reasons described above.

Spotlight: GAD vs ADHD in Women

Generalized Anxiety Disorder (GAD) is a type of anxiety disorder that features frequent worry and rumination about a variety of topics.  Unlike phobias, there is not a specific area of fear, but rather general worry.

GAD and ADHD can overlap in their presentation.  Although GAD has more of a general focus than other anxiety disorders, a common feature is mentally ‘locking in’ on a particular area of worry.  When something elicits concern, people with GAD can become quite fixated in their worry and associated somatic symptoms of anxiety.

This type of mental fixation and rumination resembles the hyperfocus of ADHD.  As we discussed above, people with ADHD can become particularly hyperfocused on something that captures their attention, including areas of fear, worry, and concern.

There are also areas of difference between GAD vs ADHD.  For GAD, there may sometimes be an underlying and consistent theme to the seemingly unrelated general worry.  For example, fears about bad weather and fears about driving may have the common element of death anxiety.  This may in turn be related to negative early experiences around death and loss, coupled with an anxious disposition (e.g. hereditary component).

With ADHD, on the other hand, the emphasis is on the mechanism of attention – e.g. the hyperfocus.  This hyperfocus can be on anxiety-provoking material or experiences, but it is not intrinsically related to them.

As with many other anxiety disorders, GAD tends to be overdiagnosed in women as opposed to men, due to gender stereotypes.  As described above, ADHD in women is poorly understood in the general public.  Thus, the combination of GAD and ADHD in women can lead to negative stigma.  Women with GAD and ADHD may be ‘written off’ as anxious when there are underlying reasons for the anxious focus and vocal activity in expressing these experiences of anxiety.

How to Treat ADHD and Anxiety in Adults

There are a number of pharmacological and therapeutic treatments for ADHD and anxiety.

Please note that I write below about pharmacology from my vantage point as a psychologist who provides therapy services for many clients with ADHD and/or anxiety who take medication.  I am not a psychiatrist and do not purport to have medical competency in pharmacology.  My knowledge on this subject comes from the accumulated disclosures of my clients about their experiences on medication and from my own study of literature on the subject.  (Read More: Should I See a Psychiatrist or Psychologist for Anxiety?)

Let’s look at a few treatment highlights for ADHD vs anxiety in adults:

Medication can make a big difference, but how you respond to medication can reveal a lot about your actual diagnosis.

The first-line pharmacological treatment for ADHD are stimulants.  There are different types of stimulants and dosage levels which should be determined and carefully overseen by a psychiatrist.  In theory, if ADHD is the main driver of the anxiety, the anxiety symptoms may not be negatively impacted by the stimulant.  If anything, one might expect the anxiety to improve because the ADHD is improving.

On the other hand, if there is an underlying anxiety disorder that is independent from the ADHD, anxiety symptoms could worsen on a stimulant.  How someone with ADHD responds to a stimulant can tell us a lot about the nature of their anxiety.

As an interesting comparison, from an anxiety standpoint, most people will see an immediate decrease in anxiety symptoms from an anxiolytic medication.  However, there can be a number of side effects and issues resulting from taking these medications long-term.  These medications also do not address non-anxiety symptoms that stem from ADHD.

One area of potential promise is the use of certain SSRIs ‘off label’ for both ADHD and anxiety.  Some of these medications can effectively treat symptoms for both disorders, although the ADHD-related symptom improvements do not have as large of an ‘effect size’ as stimulants.

Therapy that teaches clients how to identify triggers for overreactions can be helpful for both ADHD and anxiety.

One shared treatment emphasis is on teaching clients how to identify the start of an emotional overreaction and learn how to take a time-out.  This might involve visualizing a ‘stop’ sign or removing oneself from a stressful situation.  Techniques to rapidly calm after the timeout and re-focus are also part of this process.

Therapeutic affect regulation strategies are beneficial for both ADHD and anxiety disorders. 

These might include different types of deep breathing strategies; somatic grounding and parasympathetic activation techniques; visualization and sensory-based relaxation approaches.  Carolyn Daitch, PhD, the Director of the Center for the Treatment of Anxiety Disorders has written books on affect regulation strategies and calming techniques that can serve as good resources. (Read More: Who Can I Talk to About My Anxiety?)

Exposure therapy can be helpful for treating anxiety for people with anxiety disorders and people who have ADHD with anxiety – but for different reasons.

Exposure therapy is an empirically supported treatment approach for many types of anxiety disorders.  It works by extinguishing the fear response that is generated by the pairing of a stimulus that has become associated with anxiety.

For example, you liked dogs but then you  had a traumatic incident with a friend’s dog and now are afraid of and avoid all dogs.  The idea is that as someone has more innocuous interactions with dogs, the original traumatic pairing loses it’s intensity in the person’s mind – the fear-based response is ‘extinguished’.

This principle can also apply with anxiety that comes from ADHD.  However, an ADHD-specific explanation is that the novelty and hyperfocus of the feared stimulus becomes less novel and thus less focused-upon with repeated exposure.  It becomes less dopamine-producing with exposure.

Insight-focused therapy also has a role in the treatment of anxiety and ADHD – but that role can differ depending on the diagnosis.

Sometimes the anxiety is a symbolic recreation of a past trauma or unresolved psychological issue.  Anxiety therapy that focuses on understanding the underlying issues behind the anxiety can be very helpful.  In contrast to the CBT approaches described above, psychoanalytic or attachment-focused therapy can be helpful in eliciting insight that can lead to more meaningful changes.

With ADHD, on the other hand, insight-focused therapy will not resolve the core symptoms of the disorder.  For example, it can’t improve some of the dysregulation around focus or the executive dysfunction.

However, it can be very helpful in increasing self-awareness around emotional reactivity that can help with managing it.  It also can be of use in working through shame and other chronic emotions that have become a part of a person’s self-concept and self-esteem from living with ADHD.  This can help a client with ADHD become more self-aware and have a better relationship with themself and others.

Meditation and hypnosis are also helpful for ADHD and anxiety. 

For ADHD, research shows that meditation can improve dopamine levels and short-term focus and executive functioning.  The induction phase of hypnosis can engage the frontal cortex functions for attention.  While frontal cortex activity is ‘dampened’ during longer hypnosis, the process can be helpful in activating other parts of the brain that can compensate for ADHD-deficits.

Both meditation and hypnosis for anxiety can be helpful in creating calm and resetting the nervous system.  Cognitive hypnotherapy can also apply some of the CBT approaches described above in a hypnotic state for added effect.

Exercise and sleep play important roles in decreasing symptoms of anxiety and ADHD.

Exercise produces short-term boosts in dopamine, which helps with symptoms of ADHD, and serotonin, which helps with mood.  It can also help lead to better sleep, which will also improve mood and self-regulation.

Coaching and Apps work well for ADHD, but are not as important for anxiety disorders without comorbid ADHD.

Coaching and apps are helpful for building executive functioning skills in adults with ADHD.  This helps with time management, organization, and prioritization, all of which are areas that are effected by the executive dysfunction that comes with ADHD.  On the other hand, executive functioning isn’t understood to be impacted by anxiety disorders alone, so these activities are not as vital to someone who has anxiety vs ADHD.

ADHD vs. Anxiety: Conclusions

ADHD and anxiety symptoms can overlap, but the two disorders are unique.  Understanding symptoms of ADHD vs. anxiety in adults will help you know which disorder may be impacting your life more prominently.  We also provide  some general treatment recommendations in this article for treating ADHD and anxiety in adults.  If you have more specific questions, you might wish to consult with a psychiatrist or psychologist about an evaluation and treatment.  At Attune, our psychologists offer comprehensive online psychological testing for ADHD in adults.