ADHD and Anxiety: Symptoms, Connections & Coping Mechanisms
ADHD and anxiety are closely connected. Anxiety disorder is ADHD’s most common comorbidity — in no small part because the ADHD experience makes for a life characterized by stress and worry. This is especially true in the time of COVID, when new coping mechanisms are required.
Adults with attention deficit hyperactivity disorder (ADHD or ADD) lead anxious lives. The nature of ADHD often makes day-to-day life stressful, creating situations and environments fraught with uncertainty – anxiety’s primary fuel.
That is why ADHD cannot be discussed without bringing up anxiety, whether that means pesky, troublesome bouts of worry that present only in specific contexts (like meeting work deadlines or making difficult back-to-school decisions), or full-fledged anxiety disorder. Either way, the link between the two is direct, so much so that anxiety is the most common comorbid diagnosis with adult ADHD.
This ADHD-anxiety link is magnified today by an almost universal and unprecedented stressor: the pandemic. A giant, unfamiliar cloud of uncertainty hovers indefinitely over us, raining down feelings of discomfort and anxiety that make this relationship impossible (and unhealthy) to ignore.
Is Anxiety a Symptom of ADHD?
Although anxiety alone is not included in the diagnostic criterion for ADHD, the link between the two conditions is strong. Individuals with ADHD are more likely to have an anxiety disorder than are individuals without the condition, with rates approaching 50 percent.1
Anxiety refers to our mental and physiological response to a perceived risk or threat. Anxiety disorders, which range from social anxiety disorder to panic attacks to post-traumatic stress disorder (PTSD) and more, are characterized by constant feelings of worry and fear that interfere with daily life.
Some symptoms — like fidgeting and trouble concentrating — are hallmarks of both ADHD and anxiety. As a result, clinicians must rule out anxiety and other mental disorders when diagnosing ADHD, and vice versa.
Does ADHD Make Anxiety Worse?
Individuals diagnosed with ADHD and anxiety disorders tend to have more severe anxiety symptoms than do those without ADHD.2 But even adults with ADHD who do not meet the diagnostic criteria for anxiety may experience occasional and situational anxiety in their daily lives – precisely because of ADHD, which may cause time blindness, poor working memory, and exaggerated emotions, among other anxiety-producing symptoms.
In one study on adults with ADHD, researchers noted that problems stemming from ADHD — such as tardiness, procrastination, and the prospect of social stigma — all led participants to experience anxiety at many points in their lives, “and once they were anxious, their ADHD symptoms worsened.”3
Other ADHD Symptoms That Exacerbate Anxiety
Inherent uncertainty about how an event or a task will play out is at the core of anxiety. Understanding “consistent inconsistency,” a common element of life with ADHD, is key to understanding the persistent anxiety of living with ADHD. “Consistent inconsistency” describes the distrust and uncertainty in yourself that builds up after years of experiencing ADHD symptoms such as inattention, overwhelm, memory lapses, and more. “Consistent inconsistency” is knowing, for example, that a task needs to be accomplished, but doubting the ability to get it done.
ADHD as a Performance Problem
Individuals with ADHD know what they need to do, but they have problems with implementation – a tension that begets anxiety. This is a big part of what makes ADHD maddening, particularly in adulthood. Barriers to implementation include the following:
- Self-regulatory efficacy: “I know I can do this, but I’m not sure if I can resist distraction or focus.”
- Incautious optimism: Otherwise known as distorted positive thoughts. “I work best at the last minute.”
- Front-end perfectionism: “I have to be in the mood/have enough energy to do something.” These unlikely standards are by far the most common distorted automatic thought within adults with ADHD.
- Emotional dysregulation: While not included in the DSM-5, emotional intensity is a central feature of ADHD. Part of managing anxiety is being able to change and control our emotional states so that we can readily engage in a task. Failing to manage discomfort effectively can lead to avoidance and procrastination, which exacerbates and is exacerbated by anxiety.
How Do You Treat Both ADHD and Anxiety?
Both ADHD and anxiety are treated through medication and/or psychosocial therapy. Often, treatment that focuses on one condition actually improves symptoms in both, though that depends on the individual. Still, clinicians always attempt to treat the most severe condition first.
Stimulant medications used to treat ADHD generally do not worsen anxiety symptoms, and non-stimulants are considered second-line pharmacological treatments for comorbid ADHD and anxiety. A combination of medicine and therapy, however, has been found to be most beneficial for individuals with ADHD and anxiety.4
General feelings of anxiety can also be quelled through healthy coping mechanisms.
ADHD and Anxiety During the Pandemic
With ADHD minds experiencing so much overwhelm and so many new stressors – like working remotely from home, assuming the role of teacher, navigating disorienting routines, and treating health problems – it’s important, more than ever, to develop skills to effectively manage anxiety and achieve resiliency.
Regulate Emotions, Behaviors & the Mindset
To effectively manage your anxiety, begin by using your feelings and behaviors as information. Anxiety or an otherwise troubling feeling can signal the question, “What’s this discomfort telling me?” Good follow-up questions include:
- What am I feeling?
- What is the problem?
- What was the trigger?
- Is the problem really a problem? If so, how can it be managed?
- What’s the best, worst, and most likely outcome of the issue?
Pursue this disentanglement exercise through writing. Making notes on your phone or computer is fine, but there is something more therapeutic and engaging about using pen and paper to write out stressors and worries. Either way, moving the issue out of your head and seeing it take shape as text can help you clearly see what’s in your control, and what’s not. The exercise is also one of exposure – coming face-to-face with the problem.
Here’s the exercise in action: Suppose you find yourself self-medicating through alcohol or binge eating during quarantine. How can you manage these urges?
- Ask: “What am I feeling? What is the benefit of this behavior? What am I getting out of it?” These behaviors are typically associated with reducing anxiety, numbing oneself to stress, or feeling in control. Labeling the feeling (anxiousness, overwhelmed, out of control) is also a form of acknowledging the situation, in turn an action that calms us.
- Identify the triggers or problems that gave rise to the bingeing or self-medicating behavior. This varies according to the individual, but common ones include boredom, loneliness, worries about meeting obligations, unrest or tension at home, work-related stress, and even the news cycle.
- Think hard about these triggers and problems. Are the listed problems truly problems? Maybe you gave yourself an unrealistic deadline to meet the obligation you’re stressing over. What are the best- and worst-case scenarios, and what’s most likely to happen? Thinking through these can help us dwell in the probabilities rather than the possibilities – the problem may not be a problem after all.
- That said, self-medicating on alcohol and bingeing are problems that need addressing. One way to handle both is through stimulus control – removing temptations in the household – and looking for replacement behaviors, like swapping in healthy foods or replacing alcohol with another liquid or stimulus, like tea or listening to calming music. Of course, if these or any other issues feel completely out of control, it may be best to get in touch with a licensed mental health clinician.
Other Coping Mechanisms for ADHD and Anxiety Today
- Structure unstructured time. There’s no way around it: Creating routine is a must, especially one that’s highly visible. That could be an appointment planner, a calendar on the wall, or a digital planner kept open on a tablet. Think of planners as time machines that allow us to look hours, days, and weeks into the future, priming us for what we plan to do. Breaks must be worked into any schedule, including making room for…
- Exercise and movement. We underestimate the loss of “stealth” movement during the course of the traditional workday (walking down hallways, to the parking lot or train station, etc.). As basic as it sounds, movement helps. This is especially true when cooped up and working from home. Movement can be its own form of meditation, allowing us to remove ourselves from work or home and reset.
- Maintain healthy habits. Many individuals, ADHD or not, are experiencing chronic stress and general feelings of overwhelm with no one particular stressor. Better exercise, sleep, and diet — like limiting physical anxiety triggers like caffeine and alcohol — are effective at reducing overall stress.
- Specify tasks. Avoid vaguely defining activities, and instead fill your calendar with task- or time-based items. Reviewing a report for work can be a 15-minute of 15-page task, and checking emails can be a 5-emails or 5-minute activity. Clearly laying out tasks helps combat front-end perfectionism and becomes an easy way to engage in a task for which you are not “in the mood.” Discomfort fades soon after engagement.
- Organize physical spaces. Define where work, leisure, sleep, study, and other activities will be done around the home to help with behavioral priming and habit formation. Combat “sight pollution” by resetting and preparing your spaces for the next day, which also helps with transitions.
- Stay on ADHD medication and continue to attend psychotherapy sessions if applicable. Medications help reduce ADHD symptoms and improve coping and functioning, helping adults with ADHD feel more efficacious and, overall, less anxious. Same goes for psychotherapy, now widely available remotely.
- Lower the bar on expectations. We can’t expect the same performance in this pandemic world as before. That’s a recipe for entrapment. Instead, we can reframe tasks into do-able terms and take on a sufficiency mindset. Being good enough is better than expecting to be perfect, and this mentality alone can get you unstuck and to a less anxious state. Now’s probably not the time to embark in radically new endeavors, but it can be for new opportunities, like attending to deferred projects around the house.
- Decatastrophize. Maintaining perspective and practicing gratitude is needed to get through all of this, even if loss, in any way, has touched the household. One way to modify thoughts is to disengage with the inflexible “should” mindset –– as in things “should” only work out one way and are no good if they don’t. We can also “defuse” by accepting some negative thoughts for what they are – just thoughts.
The content for this webinar was derived from the ADDitude Expert Webinar “Coping with Anxiety and Adult ADHD in the Pandemic World” by J. Russell Ramsay, which was broadcast live on June 25, 2020.
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1Kessler, R. C., Adler, L., Barkley, R., Biederman, J., et.al. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American Journal of Psychiatry. 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716
2 Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3
4 Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 4(2), 389–403. https://doi.org/10.2147/ndt.s6985