Generalized Anxiety Disorder Symptoms and ADHD in Women

What is Generalized Anxiety Disorder?

Generalized Anxiety Disorder (GAD) is a prevalent mental health condition frequently co-occurring with ADHD, especially in women. When you look at the symptoms, it's easy to see why, as an unsupported ADHD woman, you would have Generalized Anxiety Disorder! In fact, women with ADHD are 4x as likely to have GAD (Fuller-Thomson, Carrique, & MacNeil, 2022). 

Why is it important to talk about the connection of Anxiety and ADHD Women? 

Anxiety often makes it hard to spot ADHD in women, which is a problem because many women already struggle to get the right diagnosis.

Doctors need to learn more about how ADHD shows up in women and use better ways to find it. Right now, many doctors mistake ADHD symptoms in women for just being anxious.

Women with ADHD are also good at hiding their struggles. The medical world hasn't yet caught up with finding ways to notice when women are coping well, and its something that they need to learn to see. 

A lot of this issue comes from the way we diagnose ADHD, which has mostly been based on studies of men and boys. This means we miss out on seeing how ADHD can look different in women, and as a result, a lot of women don't get the diagnosis they need.

There's also a wrong belief among some doctors that if a woman is doing well in school or work, she can't have ADHD. This isn't true. This belief can leave some women without the right diagnosis for a very long time, sometimes until they hit a rough patch, like the hormonal changes during perimenopause, which can make their ADHD symptoms a lot worse.

Most of these issues are due to  Medical Bias.  This needs to change!

Generalized Anxiety Disorder Symptoms

GAD presents various symptoms

Difficulty Concentrating: Those with GAD often struggle to focus because of their worry.

Avoidance Behaviors: Avoiding situations or objects that provoke worry is a typical coping strategy.

Pessimistic Worldview: Individuals with GAD often interpret situations with heightened fear and mistrust.

Autonomic Arousal: A core symptom of GAD, marked by feeling hypervigilant, hyperactive, or overly alert.

Muscle Tension: Continuous worry and agitation hinder relaxation, causing muscle tension.

Sleeplessness: Insomnia is frequent in GAD, leading to mood swings and irritability.

Constant Worry: Those with GAD perpetually dwell on and fret about the future.

Diagnostic Criteria for Generalized Anxiety Disorder

The two primary diagnostic manuals, DSM-V and ICD-11, present different criteria for GAD, complicating its study and understanding.

DSM-V Criteria:

• Excessive anxiety or worry.
• It is challenging to control the worry.
• More days than not for at least six months.
• At least three out of six symptoms: restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
• Anxiety or worry that isn't better explained by another mental disorder.

What is ADHD?

The diagnosis of ADHD is based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These criteria include symptoms of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. Symptoms must be present for at least 6 months to a degree that is inconsistent with the individual's developmental level and impacts directly on social and academic/occupational activities. Note that the presentation can vary, and an individual might primarily show symptoms of inattention, hyperactivity-impulsivity, or both.

Inattention

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; keeps materials and belongings in disorder; messy, disorganized work; has poor time management; fails to meet deadlines).

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

Hyperactivity and Impulsivity

Often fidgets with or taps hands or feet, or squirms in seat.

Often leaves seat in situations when remaining seated is expected.

Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

Often unable to play or engage in leisure activities quietly.

Is often "on the go" acting as if "driven by a motor" (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

Often talks excessively.

Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).

Often has difficulty waiting his or her turn (e.g., while waiting in line).

Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Additional Criteria

Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

Several symptoms are present in two or more settings (e.g., at home, school or work; with friends or relatives; in other activities).

There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, Personality Disorder).

This checklist is a simplified version of the diagnostic criteria. A professional diagnosis requires a comprehensive evaluation by a qualified healthcare provider, such as a psychologist or psychiatrist.

 

Let's see how Anxiety and ADHD look the Same!

There are significant negative consequences of missed or delayed diagnosis of ADHD in women and girls, including academic, social, and emotional impacts

 The symptoms of these two conditions often overlap, making it difficult to distinguish between them. WOMEN Also often have both. Let's look at the signs that both GAD and ADHD have in common.  

1. Excessive worry and restlessness: Individuals with GAD often experience persistent and excessive worry about various aspects of their lives, such as work, health, finances, and relationships.

Similarly, individuals with ADHD may frequently feel restless, finding it hard to relax or sit still.

2. Difficulty concentrating and staying focused: Both GAD and ADHD can impair an individual's ability to concentrate and maintain focus. In GAD, the constant worrying and intrusive thoughts can make it challenging to concentrate on tasks. In ADHD, this struggle with concentration and attention is a core feature of the disorder.

3. Racing thoughts and difficulty controlling thoughts: Those with GAD often experience a stream of racing thoughts, making it difficult to prioritize or control them. Similarly, individuals with ADHD may have a constant flood of thoughts, leading to difficulties in organizing and managing them effectively.

4. Physical symptoms: Physical symptoms can manifest in both GAD and ADHD. Due to persistent anxiety, individuals with GAD may experience muscle tension, headaches, stomachaches, and fatigue. ADHD can cause restlessness, fidgeting, and feeling on edge, leading to physical symptoms like muscle tension and restlessness.

5. Sleep disturbances: Both GAD and ADHD can disrupt sleep patterns. Individuals with GAD often struggle with falling asleep or staying asleep due to excessive worrying and racing thoughts. Similarly, individuals with ADHD may experience difficulty winding down at night and may have trouble falling asleep.

6. Irritability and mood swings: Both GAD and ADHD can affect an individual's mood and emotional well-being. Those with GAD may constantly feel on edge, irritable, and easily agitated. Similarly, individuals with ADHD may experience mood swings, and difficulty regulating emotions.

7. Impulsivity and reckless behavior: impulsive decision-making, and engaging in risky behavior are core symptoms of adhd, not gad.

8. Challenges in daily functioning: Both GAD and ADHD can significantly impact an individual's daily life and functioning. Both conditions have common difficulties with organization, time management, and completing tasks. Additionally, individuals may struggle with maintaining relationships, meeting work deadlines, and overall productivity.

ADHD and GAD travel together. The critical thing to note is that it is likely, especially if you are a woman, that you will have GAD if you have ADHD. Many women are diagnosed only with GAD and never with adhd. This is where accurate assessment tools and diagnostic tools for adhd become so important. We are lagging in our ability to diagnose ADHD accurately.

Treatment for Generalized Anxiety Disorder (GAD) and Attention Deficit Hyperactivity Disorder (ADHD): 

Treatment typically begins with addressing ADHD.

 

Many women diagnosed with anxiety, whose ADHD remains unidentified, often report considerable anxiety relief once their ADHD is supported. 

This is because unsupported ADHD symptoms can induce anxiety. Living in a world where one feels inferior, perpetually exposed, and always lagging can provoke anxiety.

 

Therapists need to be cautious when dealing with coexisting anxiety. Traditional anxiety treatments like exposure therapy may be too overwhelming and backfire during therapy. There is a real demand for psychology to investigate therapy that works for adhd people who have coexisting anxiety. We don't currently have a lot of reliable and researched techniques that we can say help. 

Why?

In my experience, while  Cognitive Behavioral Therapy is a standard treatment for GAD in the neurotypical population, it has to be used carefully with ADHD people. 

Instead of exclusively relying on CBT, it's more effective to explore environmental accommodations first and strategies that teach neurodivergent affirming ideas. Often, anxiety in neurodivergent individuals stems from unrealistic and harmful expectations. Removing these can often magically help alleviate symptoms! Traditional CBT fails to consider this. 

Note: In some cases, if anxiety is extreme, a doctor may prescribe anxiety medication in conjunction with your adhd medication. That's just fine!

 

Medication for adhd and generalized anxiety disorder

Medication is a standard treatment option for both ADHD and Generalized Anxiety Disorder (GAD). However, it's important to note that a qualified healthcare professional should prescribe and monitor medication.

For ADHD, stimulant medications such as methylphenidate (Ritalin) or amphetamines (Adderall) are often prescribed. These medications can help improve focus, attention, and impulse control. They can also help reduce hyperactivity and impulsivity. Non-stimulant medications like atomoxetine (Strattera) may also be prescribed, especially for individuals who cannot tolerate stimulant medications.

When it comes to treating GAD, selective serotonin reuptake inhibitors (SSRIs) are commonly used. These medications, such as sertraline (Zoloft) or escitalopram (Lexapro), can help reduce anxiety symptoms by increasing serotonin levels in the brain. Other medications, such as benzodiazepines, may be prescribed for short-term relief of severe anxiety symptoms. However, these medications can be habit-forming and are typically used on a short-term basis.

It's important to remember that medication is not a one-size-fits-all solution. Different individuals may respond differently to different medications, and finding the proper medication and dosage may require some trial and error. Working closely with a healthcare professional to monitor potential side effects and adjust as needed is essential.

Strategies for Managing Generalized Anxiety Disorder and ADHD

Currently, there is a great need to research effective strategies for treating both adhd and GAD when they occur. In my practice, these are some of the strategies I use:

Embrace neurodivergent-affirming concepts: Recover from the trauma that has led you to feel unworthy and damaged.

Learn to Advocate for Yourself: Understand and recognize your unique needs and strengths. Standing up for yourself reduces stress and helps others understand and support your journey with ADHD.

Practice Setting Boundaries: Setting boundaries is crucial, whether it's setting aside time for yourself or limiting interruptions during specific tasks. This helps maintain focus and ensure your needs are met in personal and professional environments.

Self-Accommodate: Ask yourself, "What can make things easier on my executive functioning?" This might mean using tools like alarms, calendars, or task lists or creating a designated workspace free from distractions. Tailoring your environment to your needs can significantly boost your productivity and mental well-being.

Understand Your Sensory Preferences and Triggers: Women with ADHD often have sensory sensitivities. Recognizing what calms you, as well as what overstimulates or irritates you, can help in creating a balanced environment. This might mean using noise-canceling headphones, soft clothing, or dimmable lights.

Practice Self-Care: Taking time to rest, engage in hobbies, and care for your physical and mental well-being is essential. This could include activities like meditation, journaling, exercise, or even simply spending time in nature. Ask yourself "what do my mind and body need to feel cared for? "

How can loved ones support women with Generalized Anxiety Disorder and ADHD?

Loved ones can be crucial in supporting women living with ADHD and GAD. Here are some ways they can help:

1. Educate Yourself: Take the time to learn about both ADHD and GAD. Understanding the challenges and symptoms associated with these disorders can help you provide the necessary support and empathy.
2. Be Patient and Understanding: Living with both ADHD and GAD can be overwhelming at times. Be patient with your loved one and try to understand that their struggles may not always be visible or accessible. Show empathy and offer a listening ear when they need to talk.
3. Offer Practical Help: Offer to assist with tasks or chores that may be particularly challenging for someone with ADHD and GAD. This could include organizing their schedule, helping with time management, or offering assistance with daily responsibilities.
4. Create a Supportive Environment: Foster an environment that is calm, organized, and free of unnecessary distractions. This can help your loved one stay focused and reduce anxiety triggers.
5. Encourage Treatment: Encourage your loved one to seek professional help and stick to their treatment plan. Offer to accompany them to appointments or help with any necessary research or paperwork.

Several related posts  might benefit women dealing with ADHD and Generalized Anxiety Disorder:

Breathing and generalized anxiety disorder

Menopause and generalized anxiety disorder

How gad exacerbates adhd

Stress and gad

How adhd fuels gad

References

Crocq MA. The history of generalized anxiety disorder as a diagnostic category. Dialogues Clin Neuroscience 2017;19(2):107-116. doi:10.31887/DCNS.2017.19.2/macrocq

Fuller-Thomson, E., Carrique, L., & MacNeil, A. (2022). Generalized anxiety disorder among adults with attention deficit hyperactivity disorder. Journal of Affective Disorders, 299, 707-714. https://doi.org/10.1016/j.jad.2021.10.020

References

Crocq MA. The history of generalized anxiety disorder as a diagnostic category. Dialogues Clin Neuroscience 2017;19(2):107-116. doi:10.31887/DCNS.2017.19.2/macrocq