February 6, 2023

ADHD vs. Anxiety

by | Feb 6, 2023 | ADHD & ADD, Anxiety

While they may seem very different on the surface, ADHD and anxiety share similar features, and can often be difficult to differentiate. It is also not uncommon for someone to meet criteria for both these diagnoses, but it is important to understand them in order to effectively manage them. 

Let’s first look at the typical diagnostic criteria for both anxiety and ADHD:

Anxiety

  • Difficulty managing feelings of worry 
  • Restlessness or difficulty achieving relaxation
  • Sleep difficulties
  • Concentration challenges
  • Physiological symptoms like a rapid heartrate, sweating, shaking breathing changes
  • Frequent panic or fear
  • Feeling on edge

ADHD

  • Concentration challenges
  • Restlessness or difficulty achieving relaxation
  • Sleep difficulties
  • Distractibility
  • Trouble staying organized
  • Being forgetful
  • Impulsivity (interrupting, difficulty waiting your turn, taking actions without fully considering consequences) 

If you noticed some similarities, you are absolutely right! The main symptoms that appear in both anxiety and ADHD are:

So if we can identify one of the other symptoms, and it’s not on the other list, we’ve figured it out, right? It would be incredible if it were that simple, but unfortunately piecing apart these differences can be a challenging and complicated process. Let’s discuss the reasons why. 

Diagnostic Assessment Challenges 

Because there are no definitive tests to diagnose mental health conditions, we must rely on a combination of self-report assessments and clinician assessments, all of which come with their own challenges. 

For example, a common symptom assessed in a mental health intake is focusing. Someone may report yes, they have trouble focusing, but without further investigation, we have no way of knowing the mechanism of why they have trouble focusing. Is there mind racing with anxious thoughts, or are they having trouble applying sustained attention to something? 

Without accurately understanding the underlying mental health condition behind the concentration issues, a mental health professional could end up providing completely ineffective care. Someone with anxiety impacting concentration likely needs coping tools, relaxation strategies, and help to process the fears that are consuming their thoughts. A person with ADHD likely needs strategies and supports to work with their concentration challenges and find behavioral strategies that work for them. 

What If I Live With Both?

It is certainly possible for someone to meet the criteria for both ADHD and anxiety. For some people, the symptoms are linked in some way, but for others, they exist in almost entirely different arenas. 

Some people experience diagnoses many years apart, which can make the diagnostic process a bit simpler. If someone already knows they have ADHD, new or worsening anxiety might be easier to tease out as a response to a stressor or event. If someone has been diagnosed with anxiety but has been experiencing increasing symptoms of ADHD, it could help cue the mental health professional to look into what early symptoms led to an anxiety diagnosis.

The difficulty is knowing whether the first diagnosis is accurate, or if the second might encompass those symptoms entirely. It can take quite a bit of investigating to know!

While most clinicians don’t assign functioning labels like “severe” or “mild” to mental health diagnoses like this, it’s also important to note that for some people, there is a diagnosis that seems to cause them immense difficulty, while another is significantly less impactful. It’s still worthy of treatment and support, but it can change how symptoms look. 

How Can I Tell the Difference?

As we discussed earlier, assessing mental health diagnoses can be complex and challenging. In most cases, seeing a trained mental health professional is an important step to understanding the difference. 

However, if you’re not trained in diagnostics, are trying to sort things out on your own, or have received these diagnoses and want to know how to differentiate between the symptoms and feelings on the day-to-day, there are a few questions you can ask yourself to help understand this. 

  • When did this start? Has it always been an issue since childhood, or did it begin at some point in my life? 

For most people with ADHD, symptoms have been present in some capacity since childhood. There may have been an event or developmental phase when symptoms were more apparent (going to college or becoming a parent are common), but with some investigating, a pattern of symptoms can be identified even if it wasn’t at the time. Things like having a messy backpack, teachers commenting “bright, but doesn’t apply themselves”, or behavioral issues can be a clue. 

On the other hand, if symptoms started in response to a major stressor, anxiety might be the correct label. Keep in mind, again, that ADHD symptoms can be present for many years and seem to “show up” after a stressor because of a phenomenon called masking, where people with ADHD 

  • What seems to help this feeling? Managing stress or finding behavioral supports?

Thought it can be a frustrating process of trial and error, some people find the best way to pinpoint these symptoms is by noticing them, and experimenting with different coping strategies. 

Try out strategies targeted for either ADHD or anxiety, and take note of how you respond to each. With time, you’ll learn what strategies work for you, and how to know when to employ each oen. 

  • What’s happening in my body? What sensations can I pinpoint?

While it seems basic, understanding what’s happening for you is a vital step. With both anxiety and ADHD, a hallmark characteristic is simply moving too quickly through things. 

Slow down, and try to learn the cues your brain and body are sending out. 

  • Can I tie this to anything else going on in my life? 

Mental health symptoms can have a way of feeling like they come out of nowhere. Sometimes that’s true, but in many cases if we are checking in with ourselves regularly, we might notice patterns when symptoms feel more challenging. 

Sleep changes, environmental stressors, work or home stress, traumatic experiences, and so many more experiences can increase symptoms of anxiety or ADHD. Try to pinpoint as much as you can, and give yourself support where you’re able. 

Maybe it’s time to slow down at work or ask for help managing household tasks. Even if it’s temporary, easing up on yourself in one area can give you the space to explore what led to the challenges. 

When ADHD Leads to Anxiety 

To further complicate this diagnostic picture, there are some cases where a person has ADHD, and the ongoing challenges and complications of those symptoms actually develop into an anxiety disorder. This is especially common in people who were diagnosed with ADHD later in life, and therefore likely went without proper support. 

To illustrate this, let’s take an example of a person who experiences distractibility or easily forgetting things as a symptom of ADHD. For this example, let’s say they are a young professional who works in a position that handles sensitive information that requires strong attention to detail. 

They know they are likely to make errors because they become distracted or forgetful; maybe it’s happened before and they were reprimanded for the mistake. In order to not experience that again, they may start to become hyper-focused on not making a mistake- checking and rechecking, worrying about whether they made a mistake and will get called to the bosses’ office the next morning, or lose their job. The stress and anxiety of hoping they never make a mistake might even lead to…you guessed it…making more mistakes! 

If this anxiety is ongoing and impacting their daily life, they’ll likely meet the criteria for an anxiety disorder as well. It’s a challenging combination (and a bit like a game of “chicken or the egg” in some cases), but once you can understand the mechanism behind a symptom, the treatment becomes much more clear and effective.  

Gender bias in diagnosing

We discussed how diagnostics can be challenging, often relating to the inherent ambiguity of symptoms and diagnostic labels. Another major factor in why anxiety and ADHD can be misdiagnosed comes from a gender bias in both reporting and diagnosing. 

There’s no difference in gender when it comes to the diagnostic criteria in the DSM. But we know now that many mental health conditions can look different based on gender expression. Specifically, we’ll focus on people who are assigned female at birth (AFAB). 

Many people, (even some mental health professionals!) are under the impression that ADHD always looks like obvious impulsivity, “bouncing off the walls”, poor academic performance, and behavioral issues. There are so many cases (especially in AFAB people) where this simply isn’t true. In fact, they can even look like the polar opposite of this on the surface, often withdrawn, anxious, and perfectly following the rules. 

It begs the question, why? Why is there such a variance in presentation based on sex or gender? There is some debate among professionals and researchers, but most agree on one major point reason: masking and social conditioning.

We briefly mentioned this earlier, but masking refers to when a neurodivergent person (in this case, someone with ADHD) attempts to cover up, or “mask” their symptoms and differences in how their brain functions in order to fit in or be more accepted by their neurotypical peers. Some people mask for so long and from such an early age that they may struggle to even know they are doing it at first. 

Similarly, social conditioning around gender expression plays a role here. In broad stereotypes, our society expects young girls to be soft-spoken, gentle, rule-followers, and by contrast expect young boys to be confident, “rough and tumble”, expectation breakers. Rarely are people directly told that this is the expectation for them, but over time most people notice and try to fall in line with this. 

With this in mind, let’s explore an example of two young children who both have undiagnosed ADHD, one boy, and one girl. They have similar symptoms of impulsivity, difficulty concentrating, forgetfulness, etc. When they reach school age, those symptoms might become more apparent as they are expected to maintain certain structures and rules, but they’ll likely be met with very different responses from adults and even peers. 

Let’s say, for instance, that each student was struggling to control their impulsivity and blurted something out in class. The boy might be met with laughter from his peers and a correction from the teacher, but also with a touch of acceptance like “that’s just how it’ll be”.  The girl, on the other hand, might receive ostracizing looks and a harsh reprimand from the teacher because the behavior is so different from her same age, neurotypical peers. 

These moments might seem small, but these nuances in societal responses are what developing minds use to learn about themselves and their environment. 

Fast forward to when these two students are teenagers, and let’s say they are still both undiagnosed. The boy may have continued to show these behaviors and symptoms, because there wasn’t much social cost to doing so. The girl, on the other hand, may have figured out a way to mask that symptom because the cost of social rejection was worse than closing herself off. 

Fast forward to when these two are adults and present in a mental health clinic for the first time. When asked about their childhood and if they were impulsive, the boy might answer a resounding “yes!” because his report cards and parent-teacher conferences always mentioned it. The girls’ report cards called her a pleasure to have in class, and she never impulsively blurted out, so she may emphatically say no. Until these are discussed in more detail by someone who knows these nuances and the power of masking, the girl may be incorrectly diagnosed with anxiety, depression, or another mental health condition. 

The Takeaway

Anxiety and ADHD are both conditions that can cause major disruptions in your life. If you’re wondering about how to tell these two apart, it’s a great idea to see a mental health professional who can help you work through all the differences and explore how to understand and best treat your symptoms. 

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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