Why are women misdiagnosed with Anxiety or Depression instead of being diagnosed with ADHD?

Women have been left out of clinical testing of ADHD until recently. Clinicians look at the presenting symptoms instead of looking at the holistic set of symptoms associated with ADHD, this includes presenting symptoms of anxiety and depressive but includes OCD, and PMDD.

Many women are misdiagnosed with anxiety or depression when they actually have ADHD due to a combination of gender biases, differing symptom presentations, and overlapping symptoms. Here's an overview of the contributing factors:

1. Gender Bias in Diagnosis

Historically, ADHD has been stereotyped as a condition primarily affecting hyperactive young boys. This misconception leads clinicians to overlook ADHD in women, especially when symptoms don't align with the hyperactive-impulsive subtype. Consequently, women presenting with inattentiveness or emotional dysregulation are often misdiagnosed with mood disorders instead. Women are often diagnosed with Bipolar Disorder, without taking the totality of ADHD symptomology into account.

2. Internalized and Masked Symptoms

Women with ADHD often exhibit less overt hyperactivity and more internalized symptoms, such as:

• Chronic disorganization

• Forgetfulness

• Emotional sensitivity

• Mental restlessness

These manifestations are frequently mistaken for anxiety or depression. Additionally, societal expectations may pressure women to mask their struggles, leading to compensatory behaviours like perfectionism or over-preparation, which can further obscure the underlying ADHD.

3. Overlap with Mood Disorders

ADHD shares several symptoms with anxiety and depression, including:

• Difficulty concentrating

• Restlessness

• Sleep disturbances

• Low self-esteem

• Time blindness - looks like procrastination

• Disordered eating - inconsistent eating patterns

• Eating disorders - Anorexia, Bulimia, ARFID

This symptom overlap can result in clinicians attributing these signs to mood disorders without considering ADHD as a potential underlying cause. Studies indicate that women with ADHD are more likely than men to receive prior diagnoses of depression or anxiety, suggesting a pattern of misdiagnosis. 

4. Hormonal Influences

Fluctuations in estrogen levels throughout a woman's life—during menstrual cycles, pregnancy, and menopause—can exacerbate ADHD symptoms. These hormonal changes may lead to increased emotional instability or cognitive challenges, which are often misattributed to mood disorders, anxiety or depression rather than recognized as manifestations of ADHD. Eating issues can exasperate these issues.

This hormonal factor is one of the biggest factors in leaving women out of clinical research, as they need to include women within similar hormonal cycles, which becomes expensive for clinical trials, maybe vetting 10,000 females to get 1000.

5. Societal Expectations and Stigma

Societal norms often expect women to be organized, attentive, and emotionally regulated. When women struggle in these areas due to undiagnosed ADHD, they may internalize feelings of failure or inadequacy. This internalization can lead to the development of secondary conditions like anxiety or depression, further complicating the diagnostic process. 

Dr. Hallowell* in has stated that generally, males tend to be more hyperactive and females tend to be hyperfocus. This isn't entirely true, I have had females jump around my office like it's a climbing frame, and males sit and focus on a task set in front of them. But in the end we are all distracted. Especially when it's something we don't want to do.

6. Lack of Awareness Among Healthcare Providers

Many healthcare professionals lack training in recognizing ADHD presentations in women. This knowledge gap contributes to the underdiagnosis and misdiagnosis of ADHD in female patients, as their symptoms may not align with the traditional, male-centric diagnostic criteria. 

The advantage of being a female with ADHD, I can see my female clients that maybe misdiagnosed. I see the totality of symptoms in the women I have treated, and I have lived the symptoms myself. Seeing a Doctor that focuses on ADHD with Autism can help identify where they are and what their real diagnosis is, which makes their treatment more effective.

Moving Forward

To address these challenges, it's crucial for clinicians to:

• Receive training on the diverse presentations of ADHD across genders.

• Consider ADHD as a potential diagnosis when women present with chronic anxiety, depression, or executive functioning issues.

• Utilize comprehensive assessment tools that account for gender differences in symptom expression.

• Be an advocate for your own healthcare, if you feel you aren't getting the right treatment or it's just not working for you, there has to be another opinion to consider. You know your body, and using your gut feeling to dig deeper may be required to get the help you really need.
  

For women experiencing persistent challenges with focus, organization, or emotional regulation, seeking an evaluation from a professional experienced in adult ADHD can be a pivotal step toward accurate diagnosis and effective treatment.

*Dr Hallowell "Driven to Distraction"