How are ADHD and anxiety related?

Life with attention-deficit hyperactivity disorder (ADHD) can be challenging at times. When you have an ADHD comorbidity (another mental health condition that occurs alongside ADHD), there can be even more challenges to navigate.

Research shows that anxiety is one of the most common conditions that affects people with ADHD. Living with comorbid ADHD and anxiety can be a challenge because the symptoms of each can feed into each other, causing a vicious cycle. Symptoms of anxiety can also cover up ADHD symptoms  in some people, which may lead to a misdiagnosis.

Fortunately, there are therapy methods that can help you manage both ADHD and anxiety, as well as how self-esteem can be impacted with these conditions. 

The link between ADHD and anxiety

Anxiety isn’t a recognized symptom of ADHD, but many people with ADHD experience feelings of anxiety because of the way ADHD affects their lives. 

Researchers have found that anxiety disorders are some of the most common mental health conditions that co-occur with ADHD. Some studies show that over 50% of adults with ADHD may also live with an anxiety disorder.

Although people with ADHD can experience symptoms of any anxiety disorder, the three most common types of anxiety disorders in people with ADHD are:

• Social anxiety disorder: Experts estimate that up to 70% of people with ADHD also have social anxiety. This may be explained by the way ADHD can affect social behaviors. For example, you might interrupt others or find it hard to manage your emotions. 
• Specific phobias: People with ADHD are also more likely to have specific phobias. In fact, this condition affects around 30% of people with ADHD.
• Panic disorder: 8.9% of adults with ADHD also have panic disorder (episodes of panic attacks). This is thought to be due to additional worries related to time management, difficulty with speaking before thinking, and hyperfocusing on details. 

Can ADHD cause anxiety, and vice versa?

One of the main reasons that ADHD and anxiety co-occur so frequently is because life with ADHD is, in many ways, inherently anxiety provoking. You might feel overwhelmed with life’s daily responsibilities. For example, you might find it hard to keep up with important tasks, like paying bills on time or staying focused at work, which can cause life to become chaotic.

Understandably, it causes stress and anxiety to always feel like you’re constantly “behind.” Both your mind and your physical space can also become cluttered when you live with ADHD, which can add to feelings of anxiety and overwhelm.

Sometimes, anxiety symptoms can also feed into ADHD. For example, one symptom of generalized anxiety disorder (GAD) is difficulty with concentration. If you already live with ADHD-related inattention, co-occurring anxiety could make it even harder to focus.

This doesn’t mean that one condition causes the other, nor vice versa. The causes of both ADHD and anxiety are complex. Having one condition is one risk factor, among many, that can contribute to the development of the other. In addition, other risk factors (like childhood trauma) may apply to both conditions.

Five tips for managing ADHD and anxiety

If you live with co-occurring ADHD and anxiety, it’s essential to get professional treatment. But some lifestyle changes and self-help habits may make it easier to live with these conditions.

1. Manage your stress. We all feel stressed sometimes. But stress — especially long-term or chronic stress — can make both ADHD and anxiety worse. Learn healthy ways to keep your stress levels down, like connecting with loved ones, spending your leisure time doing activities that you find relaxing, and setting strong boundaries at work.
2. Move your body. Physical exercise is one of the most powerful ways to improve your overall mental health, and it can be effective against both ADHD and anxiety symptoms. One review found that physical exercise helped improve symptoms like inattention, impulsivity, and inflexible thinking.
3. Avoid alcohol and drugs. People with ADHD and anxiety may be more likely to self-medicate their symptoms using alcohol and drugs. Although using substances can feel like it’s helping in the short term, the impacts that they have on your brain can actually make symptoms worse in the long run. In addition, both anxiety and ADHD put you at higher risk for developing a substance use disorder.
4. Prioritize restful sleep. Sleep has a major impact on mental health, including both ADHD and anxiety. Both of these conditions can make it harder to get restful sleep, and if you live with both, getting a good night’s sleep may feel impossible some nights. But sleep and these mental health conditions can get trapped in a vicious cycle. The less you sleep, the more severe your symptoms may become. And the worse your symptoms become, the less you’re able to sleep. A healthcare provider can connect you with sleep interventions if necessary.
5. Try to let go of shame. People with ADHD and anxiety often have low self-esteem because of the impact that these conditions can have on their lives. For example, if you’ve masked your ADHD symptoms until later in life, you may have developed intense feelings of shame. You may have been labeled as “lazy,” or you may have been told you were “not meeting your full potential.” Remember that ADHD and anxiety aren’t your fault, and they aren’t signs of weakness or laziness. Try to validate your feelings and experiences. Going to therapy can help with this.

Co-occurring ADHD and anxiety symptoms

If you live with co-occurring ADHD and anxiety, you’ll experience symptoms of both conditions.

This includes symptoms of ADHD, like:

• Hyperactivity or restlessness
• Being easily distracted
• Executive dysfunction (having a hard time planning and organizing)
• Impulsive behaviors

In addition, you’ll have symptoms of an anxiety disorder, like:

• Excessive worries and fears
• Physical tension
• Difficulty relaxing or winding down

Risks of combined ADHD and anxiety 

Research shows that people who have ADHD in addition to anxiety tend to have more severe symptoms than people with anxiety alone. This is because of the way that ADHD and anxiety can feed into one another. 

According to research, some unique risks and symptoms that can come with having both ADHD and anxiety include:

• Higher levels of suicidality: Studies find that people with co-occurring ADHD and anxiety are more likely to experience suicidal thoughts than people who live with just one of the conditions. This combination can also make you more likely to have attempted suicide in the past.
• More anger: People with ADHD live with emotional dysregulation, which means that you may have a harder time managing your emotions. Research shows that if you live with both ADHD and anxiety, you’re more likely to experience intense emotions (especially anger). 
• Higher rates of hospitalization: Because of the severity of their symptoms, people with co-occurring anxiety and ADHD are more likely to be hospitalized than people with only one or the other.
• Difficulty with education and employment: People with both ADHD and anxiety experience lower education and employment rates than people with only one of the conditions.
• Worse memory and cognitive functioning: An older 2006 study found that children with both anxiety and ADHD had worse cognitive skills, like working memory, compared with children who only had either ADHD or anxiety.

These may sound like grim outcomes, but there are strategies and support available if you live with co-occurring ADHD and anxiety. Treatment is key for managing any mental health condition. With the support of a mental health professional, you can better manage the symptoms of both ADHD and anxiety.

Misdiagnosing ADHD as generalized anxiety disorder

Because ADHD and anxiety appear together so often, people often confuse them for each other. More specifically, people (particularly girls and women) with ADHD are often diagnosed with anxiety alone, with ADHD symptoms flying under the radar until well into adulthood.

This is in part because girls and women are more likely to internalize ADHD symptoms. Instead of expressing symptoms externally, like misbehaving or having outbursts, they may experience internal turmoil. This can look like excessive worrying, daydreaming, or low self-esteem. These worries can often be what initially brings people into treatment.

In addition, women and girls are better at masking (or hiding) their ADHD symptoms. Societal stigma plays into this because girls are typically expected to be quiet, demure, and polite. This is another reason why professionals may notice anxiety before ADHD in some people.

Unfortunately, not having the correct ADHD diagnosis can delay adequate treatment and make symptoms of both anxiety and ADHD worsen through the years.

Differences between ADHD and anxiety

Although the two conditions are sometimes confused for one another, many differences between ADHD and anxiety can help you tell them apart.

Here’s a table that lays out some of the differences in symptoms, as well as places where they may overlap.

Symptoms of both anxiety and ADHD include:

• Lack of focus
• Restlessness
• Trouble sleeping
• Forgetfulness 
• Fatigue
• Irritability 

Symptoms that only occur with ADHD include:

• Impulsivity
• Hyperactivity
• Disorganization 

Symptoms that only occur with anxiety include:

• Excessive worrying
• Stomach problems

Treating ADHD and anxiety

Professional treatment — which can include therapy, medication, or a combination of both — is essential when you live with co-occurring ADHD and anxiety. Both of these are chronic health conditions that aren’t likely to go away on their own. But, with treatment, you can learn to manage your symptoms and live the fulfilling life you long for.

The first step is to get the correct diagnosis. If you’ve been diagnosed with anxiety but believe you also have ADHD (or vice versa), then talk to your provider. There are complicating factors that your provider will need to consider when creating a treatment plan for both conditions. For example, some medications for ADHD can make anxiety worse, which your provider will need to think about when deciding on the best treatment options for you.

Your mental health provider can help you prioritize whether you need to address your ADHD or anxiety first, or if you can work toward managing both. Some treatment approaches that can help you with both conditions include:

• Cognitive behavioral therapy (CBT): This therapy method can help you identify and change irrational or unhelpful thinking patterns that both of these conditions can cause. CBT can also help you improve your self-esteem and practice healthier behaviors.
• Mindfulness-based therapies: Mindfulness is an ancient practice that’s now widely used throughout Western medicine. It can help you slow down your thoughts and be more aware of the present. Mindfulness can also reduce stress, which can be helpful for both anxiety and ADHD.

With the right treatment, you can learn to manage both ADHD and anxiety, even though the journey might be a bit more complicated.

Find care with Rula

Life with both ADHD and anxiety can undoubtedly be a challenge, but there’s hope. Therapy can help you manage your symptoms, improve your self-esteem, and work toward your goals. Rula can help you find affordable, quality, in-network therapy. Book your first session in just a few minutes, and meet with someone from the comfort of home as soon as tomorrow.

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