Therapist Take Thursday: The Overlap Between ADHD & Anxiety Disorder Symptoms

Sarah Close, a licensed professional counselor (LPC) in Oregon, is joining BetterHelp this Therapist Take Thursday to explore the overlap between attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders and share ways to find support. Anxiety and ADHD can have various similar symptoms, which can sometimes make diagnosis more tricky. In addition, a high number of people with ADHD also have an anxiety disorder. Below, we’ll explore these connections in more detail as well as advice and insights from Close regarding mental health and wellness. 

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What is attention-deficit/hyperactivity disorder (ADHD)?

Attention-deficit/hyperactive disorder is a neurodevelopmental condition impacting the brain and nervous system. This lifelong form of neurodivergence is often first noticeable in early childhood, usually before age six. According to the Centers for Disease Control and Prevention (CDC), 6% of all US adults have an adult ADHD diagnosis (15.5 million people). 

There are three main presentations or subtypes of ADHD: the primarily inattentive type (ADHD-PI), the primarily hyperactive/impulsive type (ADHD-HI), and the combined type. ADHD-PI used to be referred to as ADD, but that term is no longer used. Symptoms of ADHD depend on the presentation an individual has but can include things like: 

• Inattentiveness 
• Impulsive behaviors and dopamine-seeking 
• Difficulty with short-term working memory
• Misplacing items frequently
• Difficulty waiting in line or waiting one’s turn to speak
• Interrupting others during conversation 
• Difficulty staying seated for long periods
• Difficulty focusing on tasks
• Difficulty following instructions
• Hyper-focusing on passionate interests but having no interest in activities one doesn’t enjoy
• Difficulty with organization and cleanliness 
• Losing one’s train of thought in the middle of a conversation 
• Difficulty paying attention when listening to someone else speak 
• Difficulty completing projects once started (potentially abandoning a project midway through or procrastinating until the last minute) 

For ADHD to be diagnosed, symptoms must not be due to another developmental condition or mental illness, persist for over six months, not be due to a medical illness, and occur in childhood before age 12, even if a diagnosis is not made then.  

What are anxiety disorders? 

Anxiety disorders are a type of mental health condition in which a person experiences persistent worry, fear, and related symptoms that impact daily life. the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists many different types of anxiety disorders a person could be diagnosed with, including: 

• Panic disorder
• Generalized anxiety disorder (GAD)
• Specific phobias
• Social anxiety disorder
• Separation anxiety disorder
• Selective mutism
• Agoraphobia
• Substance or medication-induced anxiety disorder
• Anxiety disorder due to another medical condition
• Other specified anxiety disorder

Anxiety disorders tend to cause symptoms like distressing thoughts, anxious feelings, specific fears, worry, and/or a sense of impending doom. Some people experience anxiety attacks or panic attacks, which can cause severe physical symptoms and distress, often accompanied by crying, hyperventilation, and even fear of death. Physical symptoms can include shakiness, sweaty palms, headaches, gastrointestinal issues, and other distressing sensations. 

Some anxiety disorders, like agoraphobia, specific phobias, and social anxiety, only arise in specific situations. For example, a person with agoraphobia may only experience panic attacks when in public or thinking about leaving home. These types of specific anxiety are often effectively treated using a modality like exposure and response prevention therapy (ERP), also known as exposure therapy. 

Research on the comorbidity of ADHD and an anxiety disorder

Therapist Sarah Cope, LPC, talks about how ADHD and anxiety are often comorbid in her Therapist Take Thursday video. She shares: “While ADHD may be increasing in awareness, something less known is how often this diagnosis co-occurs with anxiety disorders. In fact, up to 50% of people with ADHD also have an anxiety disorder.” This statistic translates to millions of people with the condition, so some may wonder about the cause behind this comorbidity. 

Causes of ADHD and anxiety disorder comorbidity 

There are typically multiple factors that contribute to whether a person may develop a mental health condition like an anxiety disorder. One factor experts suspect may be at play in those with ADHD in particular is rejection sensitivity dysphoria (RSD).People with ADHD are more likely to experience this symptom, which can cause anxiety when they fail or are rejected or judged by others. 

In addition, many adults with ADHD—especially women, LGBTQ+ individuals, and people of color—are less likely to receive an ADHD diagnosis. Going undiagnosed for many years can lead to anxiety and negative self-talk, which may contribute to the development of an anxiety disorder in some.

How ADHD and anxiety symptoms can overlap 

Some symptoms of anxiety and ADHD are the same or similar, which may lead to misdiagnosis or a provider overlooking the fact that a person may be living with both. In addition, ADHD symptoms can worsen anxiety symptoms and vice versa. Below are some of these commonly overlapping symptoms: 

• Racing thoughts and worry loops 
• Restlessness and physical tension 
• Difficulty concentrating and distraction due to worry 
• Avoidance of tasks due to fear or ADHD symptoms 
• Getting easily distracted due to overwhelm or ADHD symptoms 

Therapist Take Thursday: advice on coping with anxiety and ADHD 

To address anxiety and ADHD, it can be important to work with a licensed provider—especially because both conditions are complex and can have overlapping symptoms with other mental health challenges. In addition, ADHD has been trending in recent years, and some people may think they have ADHD because of its popularity online and misinformation spread in videos. (Some research suggests that over 50% of all videos about ADHD online spread misinformation). 

Early intervention and treatment are often considered important. Seeking help as soon as you notice symptoms can ensure you get screened and potentially receive a diagnosis, if applicable. That way, you can begin receiving treatment to address symptoms as soon as possible.

Other treatment and support options

When seeking treatment for ADHD and anxiety, the following lifestyle changes and treatment modalities are often recommended. Consult with your doctor, therapist, or psychiatrist for specific recommendations for your unique situation.

Therapeutic modalities

Therapy is typically the number-one treatment recommended for both anxiety and ADHD. There are several therapeutic modalities that may reduce symptom severity. Cognitive behavioral therapy (CBT) is generally considered the gold standard of psychotherapy, but other modalities can also be effective for comorbid disorders, such as: 

• Dialectical behavior therapy (DBT) 
• Exposure therapy
• Trauma-informed CBT 
• Mindfulness-based therapy 
• Internal family systems (IFS) 
• Animal-assisted therapy 
• Occupational therapy 

Self-care for your overall mental health 

Self-care generally refers to lifestyle changes you can make at home to reduce anxiety and stress. Self-care may help people with ADHD and anxiety better manage their symptoms instead of making anxiety worse. Below are some self-care practices to consider for comorbid ADHD and anxiety: 

• Eating nutritious meals and talking to a nutritionist about the eating habits that might be best for you
• Exercising each day 
• Trying meditation or mindfulness practices 
• Spending regular time with loved ones 
• Finding a new hobby or reconnecting with old hobbies, such as making jewelry, learning a language, cooking, etc. 
• Making or listening to music 
• Hiking 
• Spending regular time in nature 
• Talking to your doctor about vitamins or supplements that may be helpful for you 
• Practicing regular hygiene and physical self-care habits 

Anxiety and ADHD medication

Both ADHD and anxiety are sometimes managed with the help of medication as well—especially when symptoms are severe. Although anxiety or ADHD medication might not be the right choice for everyone, it can often be a helpful short-term support option for those who struggle to practice self-care or attend therapy because their symptoms are so severe. Remember to not start, change, or stop any medication without consulting a doctor. 

The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action without consulting a qualified medical professional.

Support groups for an anxiety disorder or ADHD symptoms 

Support groups offer a way to connect with others experiencing similar symptoms, which can be validating. If you frequently feel alone in your experience, a support group may help you feel more connected. In addition, you may learn tips that have worked for others and may work for you, too. Support groups can be online or in your area. 

Accommodations for symptoms of attention-deficit hyperactivity disorder and anxiety disorders 

For many people with ADHD, daily life is more distressing because the world isn’t made for people with unique brains. Navigating a neurotypical society can be distressing for someone who doesn’t understand or connect with the “traditional” methods of completing tasks. To help reduce this anxiety, you may be able to accommodate yourself in some ways to make life less stressful, potentially reducing anxiety. In addition, you can ask for professional accommodations in school or at work, which may make your job or studies easier. 

Address co-occurring anxiety and ADHD in therapy

Connect with a licensed counselor

Finding mental health support for ADHD and anxiety disorder symptoms 

In some cases, seeking in-person support for ADHD and anxiety is difficult—especially for those who struggle to leave home or forget appointments easily. In such cases, online therapy through a platform like BetterHelp can be a more convenient way to receive care. You can engage in online therapy sessions via phone, video, and/or live chat from anywhere you have an internet connection and a smart device. In addition, a BetterHelp subscription allows you to participate weekly online support groups for no extra cost, including those for neurodivergent adults. 

Studies indicate that online therapy can often be effective for reducing anxiety. In one study, for example, researchers suggest that online therapy may even be more effective than face-to-face interventions for anxiety, depression, a mood disorder, and stress in some cases, all of which commonly comorbid with ADHD. In addition, the study shares clinical implications such as online interventions typically being more cost-effective than in-person sessions and leading to improved quality of life for the participants. 

Takeaway 

As reiterated by Sarah Close in this week’s Therapist Take Thursday, anxiety and ADHD are often comorbid and have overlapping symptoms. Children, young adults, and older adults getting evaluated for comorbid anxiety and ADHD can be important in the process of receiving the proper support. In addition, talking to a therapist or professional in clinical neurosciences online or in your area may help you cope better with your symptoms and reduce stress levels.