Hidden ADHD common in women seeking treatment for depression and anxiety

A recent study reveals that nearly one in five women seeking treatment for anxiety or depression also have attention deficit hyperactivity disorder, with nearly half of those cases having never been previously diagnosed. The research highlights how overlapping symptoms can obscure the underlying attention condition in adult women. These findings were published in The International Journal of Psychiatry in Medicine.

Attention deficit hyperactivity disorder, commonly known as ADHD, is a neurodevelopmental condition involving inattention, hyperactivity, and impulsivity. During childhood development, hyperactive traits often fade, while inattentive traits tend to persist. Medical professionals historically diagnosed the condition much more frequently in males, and in clinical settings, the ratio of diagnosed males to females is roughly ten to one.

Population surveys show a much narrower gap, suggesting the condition often goes unrecognized in female populations. Women frequently display more subtle, internalizing symptoms like emotional sensitivity or internal restlessness. These internal struggles are easily mistaken for mood or anxiety disorders. Because conditions like major depressive disorder and generalized anxiety disorder share traits with ADHD, such as difficulty concentrating, the underlying attention disorder is frequently missed.

An additional feature commonly reported by people with ADHD is hyperfocus. This phenomenon involves episodes of intense, prolonged concentration on specific tasks, often to the exclusion of everything else going on around the person. Though not an official diagnostic criterion, hyperfocus is well-documented and can substantially affect daily functioning.

Psychiatrists Hazal Yavuzlar Civan and Tonguc Demir Berkol from the Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery in Istanbul, Turkey, conducted the research. They wanted to understand how ADHD manifests in women already seeking help for mood problems. They also examined hyperfocus to see if it could help clinicians distinguish these conditions.

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The researchers recruited 170 female patients at outpatient psychiatric clinics. The participants first completed the Beck Depression Inventory and the Beck Anxiety Inventory, which are standard questionnaires that measure the severity of depressive and anxious symptoms. Women scoring above the threshold for clinical depression or anxiety then took additional surveys.

These follow-up surveys included the Wender Utah Rating Scale to measure childhood ADHD traits, a separate screening tool for adult ADHD symptoms, and the Hyperfocus Scale. Following the questionnaires, a trained psychiatrist conducted a structured clinical interview with each participant. The final diagnoses were based on standard psychiatric guidelines.

The clinical interviews revealed that 33 of the 170 women met the criteria for ADHD. Within this group, 15 patients had no prior ADHD diagnosis. ADHD was especially prevalent among women experiencing social anxiety disorder and a condition called double depression. Double depression occurs when a patient experiences a severe depressive episode on top of a chronic, long-term baseline of low mood.

The women with ADHD reported distinct life experiences compared to the participants who only had mood or anxiety disorders. They had more disciplinary issues in school, more frequent job changes, and a higher rate of family members with ADHD. The rates of past suicide attempts did not differ in a statistically significant way between the two groups, but the women with ADHD reported higher levels of current suicidal thoughts and feelings of failure.

When looking at specific depressive symptoms, the two groups diverged. The group without ADHD reported more concerns about physical health and changes in sleeping habits. The authors suggest this health-related worry reflects a somatic focus, which is a heightened awareness of bodily sensations commonly seen in anxiety and depression.

Conversely, individuals with ADHD often experience impaired interoception, meaning they have a harder time recognizing internal physical states. This altered awareness might reduce how often they notice or report physical symptoms like poor sleep.

ADHD was highly prevalent among women experiencing social anxiety disorder. The researchers suggest social anxiety in these patients may be driven by ADHD-related executive dysfunction, which impairs the brain’s ability to plan, organize, and interpret social cues. Difficulties in self-regulation often lead to repeated interpersonal failures, which can eventually create lasting feelings of shame and a fear of social evaluation.

The researchers also identified distinct patterns regarding symptom overlap. In the group without ADHD, higher attention deficit scores correlated with worse depression. Higher hyperactivity scores correlated with worse anxiety. Hyperfocus scores also rose alongside general ADHD-like symptoms in these women.

The women diagnosed with ADHD did not show these same statistical correlations. While their overall hyperfocus scores were substantially higher than the group without ADHD, the severity of their hyperfocus did not track directly with the severity of their mood or anxiety symptoms. The findings suggest hyperfocus may serve different roles depending on the diagnosis, acting as a coping mechanism in ADHD but manifesting as a maladaptive trait in mood disorders.

The study details how similar symptoms stem from different root causes. Both ADHD and anxiety can involve restlessness, distractibility, and tension. In anxiety, inattention usually stems from excessive worry, with mental energy consumed by ruminating or anticipating threats, and this type of distractibility often improves in relaxed environments.

In contrast, inattention related to ADHD is consistent across different settings and typically appears early in life. It is usually associated with poor task initiation, organizational difficulties, and mind-wandering that is completely unrelated to specific fears. The authors note that thorough developmental histories are required to distinguish primary ADHD from secondary attention problems caused by mood disorders.

The research relied on a cross-sectional design, meaning the assessments occurred at a single point in time. The methodology cannot determine the sequence of symptom onset. It remains unclear whether ADHD symptoms preceded the depressive and anxious symptoms, or vice versa.

The sample focused entirely on women seeking outpatient psychiatric care. The prevalence rates and symptom patterns might look different in men, people not seeking psychiatric help, or individuals treated in inpatient hospital settings. The group of women diagnosed with ADHD was also much smaller than the group without the condition, which limits the statistical power of certain comparisons.

Future research should follow patients over extended periods to track how these overlapping conditions develop over a lifespan. Incorporating biological markers or tracking symptoms in broader populations could further clarify how hyperfocus operates across different mental health diagnoses.

The study, “ADHD Comorbidity in Women With Depression and Anxiety: Prevalence, Clinical Features and Hyperfocus Dynamics,” was authored by Hazal Yavuzlar Civan and Tonguc Demir Berkol.