Study: Women with Undiagnosed ADHD Suffer Poor Self-Esteem, Mental Health
Living with undiagnosed ADHD in childhood profoundly impacts self-esteem, mental health, well-being, and relationships; a diagnosis improves self-acceptance, according to new research on women.
May 30, 2023
Growing up with undiagnosed ADHD negatively impacts women’s self-esteem, mental health, well-being, and relationships, while diagnosis and treatment for ADHD increase feelings of self-acceptance and self-worth, according to new research published in the Journal of Attention Disorders.1
Women with undiagnosed ADHD are most likely to experience impairment in the areas of social-emotional well-being, relationships, and life control, according to the research — the first of its kind to examine how under-diagnosis impacts the mental, emotional, and physical health of women.
Studies have consistently shown that females are underdiagnosed with ADHD in childhood2, 3,4; to better understand adult women’s experiences living with undiagnosed ADHD and receiving a late diagnosis, researchers conducted a systematic review of three databases that revealed the following themes.
Theme 1: Social-Emotional Well-Being Impairment
Undiagnosed ADHD can profoundly impact self-esteem and self-worth. Findings indicated that girls with undiagnosed ADHD often endured childhood misunderstanding, self-blame, and rejection.
“Low self-esteem might result from difficulties endured growing up with an undiagnosed disorder that neither they nor those around them understood,” researchers wrote. “With no external cause to attribute functional impairments to, the women in these studies often felt something was wrong with them.”
The researchers noted that many women in these studies felt “different” and alienated in childhood and expressed difficulties relating to their peers. “Women with ADHD had problems picking up on social cues, felt awkward and out of place socially, and struggled with unintentionally saying things considered hurtful or inappropriate,” they wrote. “These women experienced peer rejection, bullying, and difficulty making friends.”
Social difficulties persisted into adulthood for many of these women. “Social anxiety and feeling unable to relate to other women were common experiences suggesting that difficulty in social relationships in adulthood may be a result of peer rejection in childhood,” researchers wrote.
In addition, women with undiagnosed ADHD may have experienced shame and frustration when comparing themselves to their peers. They may have felt that they did not meet society’s expectations, resulting in self-loathing, poor self-esteem, and increased anxiety.
Women also experienced anger issues, poor emotion regulation, and a fear of losing self-control. Some women developed maladaptive behaviors to cope. “Women in these studies engaged in less task-oriented coping and more emotion-oriented coping and often turned to recreational drugs, alcohol, nicotine, and sex to self-medicate for symptoms of undiagnosed ADHD,” researchers wrote.
The researchers’ findings echo ADDitude’s own survey results regarding life transitions for women with ADHD. Of the 1,975 women with ADHD who responded to ADDitude’s survey, 14% said their ADHD symptoms had a life-altering impact at nine or younger, and 35% said their ADHD symptoms were life-altering between the ages of 10-19.
Survey respondents marked adolescence with the following:
- Procrastination and time-management problems: 78%
- Feelings of sadness or depression: 70%
- Rejection sensitive dysphoria: 63%
- Feelings of overwhelm 62%
- Worry or anxiety: 58%
“Things were very confusing for me in middle school, high school, and college before I was diagnosed with ADHD,” one respondent said. “I would test into advanced academic courses but do poorly in them. I was confused. Am I smart or not smart?”
One respondent recalled not knowing how to act “normal” in social situations. Another described herself as “a moody, socially avoidant teenager who always felt rejected.”
Another respondent shared that she was “always the oddball, always on the outside, never knowing how to behave and be accepted.”
“My social anxiety increased [during puberty], and the gap between me and other kids became more apparent,” a respondent said. “Getting close to people was difficult since I seemed to have more emotions and intensity than others.”
Theme 2: Difficult Relationships
Undiagnosed ADHD may affect women’s ability to form and sustain close and meaningful relationships.
“Women in these studies had difficulty with emotionally close relationships, intimacy, and the ability to share emotions with others without losing their own identity,” researchers wrote.
Women with ADHD also reported worse relationships with teachers, peers, and siblings; more abusive homes; more drug and alcohol abuse by their parents; and they perceived relationships more negatively than did women without ADHD.
These findings support those found in ADDitude’s survey, wherein 42% of respondents reported having relationship problems.
“I found myself in abusive relationships, unable to reach my potential or find satisfaction in my work. I’m learning now how my ADHD affected the trajectory of my life and finding myself in these situations,” one reader said.
“I believe the forgetfulness of ADHD and my tendency towards rumination and self-doubt kept me with my abuser longer, as it contributed to second-guessing myself, shame, self-blame, and not trusting what I saw or valuing how I felt,” another survey respondent said.
Said another: “I have nearly quit my job several times. I terminated a relationship that did not really have any issues. I contemplated self-harm. I felt like running away from everything.”
Theme 3: Lack of Control
Results from the review indicated that women with undiagnosed ADHD may feel little control over their lives (academically and in relationships with teachers, peers, parents, and siblings). These women viewed negative events as uncontrollable.
“They often attributed successes to external causes (i.e., luck, powerful others, etc.) and failures to internal flaws (i.e., lack of intelligence, laziness, etc.),” researchers wrote.
Theme 4: Self-Acceptance After Diagnosis
Researchers reported that an ADHD diagnosis and subsequent treatment positively impacted the women’s self-esteem and enabled them to begin to view themselves less critically. With diagnosis and treatment for ADHD, the women could make more sense of their lives and fully accept themselves.
“Many women in these studies experienced a sense of relief after diagnosis and felt that a professional diagnosis served as an external validation of their struggles,” researchers wrote.
Many women reported that it was only after diagnosis that they could feel more in control of their symptoms. “Knowing that they had ADHD may have allowed them to view difficult situations from a different perspective; results suggested they now felt they had more control and viewed situations as more changeable,” researchers wrote. They replaced their shame, anxiety, and depression with feelings of pride as they began to view their “disorder” as strength.
Women also described a change in their behavior after receiving their ADHD, reflected in their relationships with their children, romantic partners, and themselves.
Researchers found that 38% of the women regretted not being diagnosed and treated earlier. “These women felt that an earlier diagnosis would have benefited them growing up,” researchers wrote.
Many ADDitude survey respondents shared these sentiments.
“Most major life events like marriage and parenthood were over before I even suspected I was neurodivergent,” said a respondent diagnosed with ADHD at 65. “It was a relief to finally have a name for how I knew I was different, but I’m left with so many regrets that fall under the heading ‘If I had only known.’”
Another survey respondent shared, “I have struggled my whole life to get ahead, get organized, and be financially stable. While it’s a relief to get a diagnosis, I’m also experiencing a lot of grief. Life could have been different had I gotten this diagnosis and the correct support earlier.”
Diagnosing Women with ADHD: Next Steps
While this review provided summative insight into the experiences of women diagnosed with ADHD as adults, the researchers cautioned that it is impossible to draw definitive conclusions, and more studies are needed.
“Based on these findings, it is apparent that undiagnosed ADHD in childhood can have lasting negative consequences into adulthood,” they wrote. “Missed or late diagnosis can be damaging for a woman’s self-esteem, mental health, and overall well-being, while accurate and timely diagnosis can profoundly change the lives of women and girls with ADHD, allowing them to stop blaming themselves and begin to lead more fulfilling and satisfying lives. Women and girls are too often suffering in silence, being left out of the ADHD narrative; it is imperative that these women are not forgotten.”
View Article Sources
1Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders. 27(7), 645–657. https://doi.org/10.1177/10870547231161533
2 Mowlem, F. D., Rosenqvist, M. A., Martin J., Lichtenstein, P., Asherson, P., Larsson, H. (2018). Sex Differences in Predicting ADHD Clinical Diagnosis and Pharmacological Treatment. European Child & Adolescent Psychiatry. 28, 481–489. https://doi.org/10.1007/s00787-018-1211-3
3 Quinn, P., Wigal, S. (2004). Perceptions of Girls and ADHD: Results from a National Survey. Medscape General Medicine, 6(2), 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395774/#__ffn_sectitle
4 Waite, R. (2010). Women with ADHD: It Is An Explanation, Not the Excuse Du Jour. Perspectives in Psychiatric Care. 46(3), 182–196. https://doi.org/10.1111/j.1744-6163.2010.00254
