Anxiety And ADHD: What’s the Link?
ADHD and anxiety disorders commonly occur together. The National Comorbidity Survey Replication found that 47% of all adults with ADHD have at least one anxiety disorder. A recent study found that adults with ADHD are two to four times more likely to also be diagnosed with Generalized Anxiety Disorder.
Since many symptoms of anxiety and ADHD overlap, it helps to identify both conditions to get the treatment you need. Keep reading to learn how to identify the signs of an anxiety disorder and discover more about the connection between ADHD and anxiety.
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What is anxiety?
Everyone experiences anxiety in their daily lives. In small doses, anxiety can help us move positively toward our goals. However, when anxiety becomes excessive and has a significantly negative impact on our lives, it may indicate the presence of an anxiety disorder. If your stress response is a knob, you can think of anxiety disorders as a knob that won’t turn down how it’s supposed to!
Types of anxiety disorders
There are six major types of anxiety disorders that each have unique features and qualities. It is possible to have more than one anxiety disorder.
Generalized Anxiety Disorder: Characterized by a continued state of excessive worry and tension, even without any actual major stressors.
Obsessive-Compulsive Disorder (OCD): Characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviours (compulsions). These repetitive behaviours are often performed as rituals to help reduce or alleviate obsessive thoughts. Some common themes of obsessive thoughts include germs, safety, and symmetry. Some common repetitive behaviours might include excessive hand-washing, behaviours believed to ward off danger, or spending amounts of excessive time putting things in a particular order.
Panic Disorder: Characterized by unexpected and repeated bouts of intense fear accompanied by physical symptoms such as shortness of breath, dizziness, heart palpitations, chest pain and even the sensation that one might die.
Post-Traumatic Stress Disorder (PTSD): A disorder that develops in response to trauma and includes a variety of symptoms such as increased startle response, hypervigilance, trouble sleeping, and restlessness.
Social Anxiety Disorder: Feeling overwhelmed or excessively self-conscious in everyday social situations. Social anxiety disorders may be limited to specific scenarios, such as speaking in public with the main concern of being judged or rejected.
Agoraphobia: Feeling excessively fearful or anxious about being in public spaces or leaving home. The main fear of agoraphobia is losing control or having an anxiety attack while in public.
Signs you may have an anxiety disorder
The major difference between experiencing a healthy amount of anxiety and an anxiety disorder is its impact on your overall functioning. When you live with an anxiety disorder, the amount of anxiety you experience is excessive, often out of the blue, and can be very difficult to control. Here are some common symptoms that are associated with anxiety disorders:
Excessive worry or rumination
Restlessness and feeling on edge
Muscle tension and difficulty unwinding
Trouble falling asleep or staying asleep
Difficulty controlling your anxious thoughts even when you know they’re excessive
Avoiding people, places, or situations because it causes too much stress or worry
Mental and physical fatigue
Physical symptoms such as grinding your teeth, picking at skin or hair, gastrointestinal issues, or rapid heartbeats
Feeling fearful without an obvious cause
Headaches and muscle aches
What are the overlapping symptoms between ADHD and anxiety?
There are many overlapping symptoms between anxiety and ADHD, which can make diagnosis complicated in some cases. Some of the most commonly experienced overlapping symptoms include:
A frequent feeling of being distracted, especially by your thoughts: In ADHD, these distractions often feel random, whereas being distracted by anxious thoughts often revolves around fears or worries.
Restlessness: Both ADHD and anxiety are associated with physical and emotional restlessness, which can look like fidgeting, hand wringing, moving around, and feeling on edge. With an anxiety disorder, these responses arise when a person feels nervous. With ADHD, restlessness often pops up when a person is understimulated or bored.
Trouble relaxing: Feeling unable to calm down or relax is a shared complaint in people with anxiety disorders and ADHD. With anxiety disorders, this wound-up feeling is often associated with anxious thoughts and worries. With ADHD, difficulty unwinding tends to feel like a general unsettledness and can be related to feeling understimulated or not getting enough energy out that day.
Obsessive thinking: Anxiety can lead to an endless thought loop over a particular idea, past event, or future worry. These thoughts are often distressing and can feel very difficult to stop. People with ADHD may also become fixated on topics or situations, but the theme is often generic and not associated with stress. For instance, people with ADHD may obsessively think about a new hobby or fixate on a particular favourite meal or a new song. These fixations may or may not cause distress in the person’s life.
Determining whether your symptoms are due to anxiety or ADHD may not always be straightforward because both conditions may be impacting you. Getting a proper ADHD diagnosis from a medical professional can help you better understand the symptoms you might be experiencing.
Caffeine genes and anxiety – Could this finding explain why so many people with ADHD develop anxiety disorders?
It is well known that genes are involved in the development of mental health disorders. A 2022 research study on caffeine-related genes took blood samples from 240 children and 406 adults with ADHD to help understand if gene sets related to caffeine response also influence the onset of anxiety disorders in ADHD. They found that a set of 19 genes involved in how we respond to caffeine played a role in the development of anxiety disorders among people with ADHD.
Overall, it suggests some common genetic components to both disorders and how we get our caffeine buzz might offer meaningful information to the genetic puzzle.
Does ADHD cause anxiety?
There are several qualities of ADHD which can contribute quite a bit to anxiety. For instance, a person with ADHD may speak impulsively in social situations and have deep regrets over the interaction, leading to rumination and stress. These stressful foot-in-mouth moments can become anxiety triggers. Let’s take a closer look at the qualities of ADHD that may increase your anxiety levels and even contribute to an anxiety disorder.
Hyperactivity and impulsivity
The executive dysfunction in brain areas associated with ADHD may increase anxiety levels due to engaging in impulsive or reward-seeking behaviours that may not benefit overall health. For instance, engaging in reckless activities, binge eating or drinking, and ignoring responsibilities to focus on a hobby or hyperfocus can elevate anxiety levels.
Impulsivity may also drive behaviours that have unfortunate consequences that elevate anxiety levels. These consequences can range from wasting a few dollars on an impromptu shopping spree to jeopardizing your health and safety.
One of the most challenging aspects of overcoming impulsivity and hyperactivity in ADHD is learning to be kind and forgive yourself when you make mistakes. Learning how to show yourself compassion can be very helpful for reducing anxiety when dealing with the negative consequences of your actions.
Time management
ADHD is associated with a concept known as time blindness, where time feels abstract and can be difficult to track. When you combine time blindness with distractibility and difficulty engaging in perceived boring activities, it’s common for people living with ADHD to experience consistent problems with time management. As a result, creeping deadlines, missed appointments, and feeling frozen by indecision (due to a lengthy to-do list) are all common contributors to anxiety when living with ADHD.
Social skills and relationships
It is common for people with ADHD to have conflict in their interpersonal relationships that can heighten anxiety. Factors such as difficulty waiting your turn, speaking over people, and missing social cues can all lead to challenging interactions. Even though your intentions are good, blurting out brutally honest observations is one of the most common reasons for social challenges in adult ADHD. The consequences of social challenges can limit your support system and lead to anxiety-inducing interpersonal conflict. People with ADHD are also especially sensitive to rejection due to rejection sensitivity dysphoria.
What is Rejection Sensitivity Dysphoria?
An estimated 99% of people with ADHD have Rejection Sensitivity Dysphoria (RSD). RSD refers to a heightened sensitivity to rejection that can lead to extremely difficult feelings. People with RSD may feel easily embarrassed or judged, hold themselves to unrealistic standards, and feel like a failure for not meeting certain expectations. RSD feelings are extremely intense but do not tend to last very long. This dysphoria negatively impacts all kinds of relationships due to how you might behave when you feel that you are being rejected or judged.
RSD may occur due to a combination of difficulties regulating emotions and a history of negative feedback from the world around you. People with ADHD are especially susceptible to receiving negative feedback throughout their lives since they are trying to navigate life with an instruction manual that wasn’t written for their brains.
Learning more about RSD and talking to your loved ones about how it impacts your life is an excellent way to try and reduce its impact on your relationships. RSD can heighten anxiety, especially social anxiety, so building a more positive inner dialogue and seeking support from those around you can be vital for improving how you feel.
Emotional dysregulation
People with ADHD often experience emotions more intensely than their neurotypical peers. In ADHD, there is a weakened connection between the emotional center of your brain (amygdala) and the “let’s take a breath and assess this emotion” center (prefrontal cortex). This break in connection leads to reactions that may seem overblown, struggling to calm down when upset, or being insensitive or unaware of other people’s feelings. Emotional dysregulation can majorly impact your anxiety levels and contribute to developing an anxiety disorder over time.
Treating ADHD and anxiety
There are many different types of treatments available for anxiety and ADHD. You may need to try several things to find what works for you.
Therapy
Therapy is one of the most effective treatments for building long-lasting strategies to help you cope with the symptoms of Anxiety and ADHD. Therapy is not a temporary fix for the problems anxiety causes. You will work with your therapist to learn effective coping mechanisms and techniques to help you learn how to better control your anxiety and manage negative thoughts.
Therapies such as Cognitive Behavioural Therapy (CBT), exposure therapy, and Acceptance and Commitment Therapy (ACT) are commonly used with anxiety and ADHD. Your therapist will help you identify the triggers and responses holding you back and teach you how to deal with challenges such as emotional dysregulation and rejection sensitivity.
Medication
Once diagnosed with an anxiety disorder, your doctor may prescribe medication to help reduce your symptoms. Commonly prescribed medications include antidepressants or anti-anxiety medications. Your medication may be taken on an as-needed basis or daily. Medicine for anxiety can generally be used in combination with ADHD medications. Treating both disorders is sometimes necessary to help the person feel more in control and respond better to other interventions such as talk therapy and lifestyle changes.
Lifestyle
There are numerous lifestyle changes you can make to help lower your overall anxiety and reduce the impact of your ADHD symptoms on anxiety. Some of the most effective lifestyle changes include increasing exercise (even a short daily walk can majorly impact your stress levels), reducing screen time before bed and keeping a regular sleep schedule, and getting your daily intake of nutrients and good fats.
In addition to the standard recommendations like good sleep hygiene, exercise and diet, you can try some of the following habits to help ease your anxiety when you have ADHD.
Journal it out: Journaling is an excellent way to help you identify triggers, process your emotions, and work through some of your problems. Try setting aside 5-20 minutes daily and writing whatever comes to your mind. You can also write about your daily experiences as if they were happening to a character in a story– it’s a fun way to learn more about yourself.
Break up your work: When trying to get something done, try to move away from perfection and focus on breaking down your big task into smaller tasks. It may feel underwhelming, but it’s a great way to get the ball rolling and help you move into that sweet spot of productivity. You’ll also feel less frozen by indecision which reduces overall anxiety.
Learn to let go: Our thoughts can often lead to instant emotional reactions, but we can train ourselves to create space between thoughts and feelings. Learn to examine your thoughts logically and let them pass without judgment. You have over 6,000 thoughts daily, so even if the thought feels important, it will pass, just like the other 5,999 did. When you find yourself responding emotionally to a thought, try taking a deep breath, picture that thought as though it exists on a snowflake, and let that thought float away into the ground and melt away.
Get scientific: Take an honest inventory of the things in your life that trigger your anxiety and use a solution-based approach to brainstorm ways that you can reduce their effects on your mind and body. For instance, if your volunteer position adds too much stress, you may need to reduce your hours or let it go for a while. As someone with ADHD, you may find that boredom is a big trigger, and you simply need more accessible, rewarding hobbies around the house. Observe your life as if it were a clinical study and test some practical solutions for reducing your daily anxiety levels.
Learning how to decompress can be very hard with ADHD. You may prefer to focus on relaxing activities rather than quiet time. This week try scheduling some self-care decompression, such as a warm bath, nature walk, or sunset picnic with your favourite snack. Pick an hour that works for you and schedule the date with yourself now!
Get help for anxiety & ADHD
Navigating mental health resources as an adult with ADHD can feel overwhelming. It is extremely common to have your ADHD symptoms dismissed, overlooked and disregarded when experiencing significant life challenges that put your health and well-being at risk. Here at Frida, we understand what it’s like to feel unheard and misunderstood as you seek to find your best path forward through the challenges you face. We also understand that mental health issues are unique to you, and every person is different.
Getting a proper diagnosis is an important first step in finding the right treatment and lifestyle changes for you. If you think you may have ADHD and anxiety, try taking Frida’s ADHD self-assessment tool today and get connected with a clinical expert who can provide you with a full evaluation and treatment plan. You’ll also receive ongoing care because your needs are dynamic, and change takes time.
Living with ADHD and anxiety can feel overwhelming. There are multiple treatment avenues that can help you take back control of your life and reduce the negative impact of anxiety on your day-to-day functioning.
