ADHD in women
posted 15th August 2023
ADHD in women is commonly comorbid with other psychiatric conditions. Women with undiagnosed ADHD are more likely to have comorbid psychiatric disorders such as depression, anxiety, suicidal ideation, and post-traumatic stress disorder (PTSD). Women with ADHD are also more likely to suffer with chronic pain and sleep disorders.
Girls and women with ADHD present with more 'internalizing' (depression and anxiety), than 'externalizing' (disruptive behaviour or overt aggression) symptoms. Females with ADHD are more likely to be diagnosed with a mood disorder prior to their diagnosis of ADHD. This may be due to mood disorders occurring more often as independent events in women with ADHD, the development of a mood disorder secondary to the impairment and distress caused by a delayed ADHD diagnosis, women are more likely to seek medical help for their low mood compared with men, and the clinician is more likely to interpret the presenting symptoms of a woman as a mood disorder rather than a manifestation of ADHD. Women with ADHD may present with impairing emotional symptoms (temper, mood instability and emotional over-reactivity)Importantly, these symptoms are qualitatively different to a mood disorder. As these are often not recognized as being intrinsic to ADHD, some patients may be misdiagnosed, for example with a personality disorder or bipolar disorder. A probable explanation for a delayed diagnosis in women is that females are often good at compensating for their difficulties. Women commonly deal with the fear and potential emotional distress of 'messing up again' by becoming 'people pleasers. They closely attend to the needs of others and often forget their own needs They aim to be beyond criticism, relentlessly working extra hours in the drive for perfectionism, often driven by harsh self-criticism. Many women also present after the diagnosis has been made in their children As they are completing diagnostic questionnaires and interviews for their children's diagnosis, they realise that they have had many of the same symptoms throughout their own lives. Alternatively, women present after having read an article about ADHD at identifying with the clinical features For the woman who presents in adulthood, there is usually a lifetime of underachievement relative to ability, adverse outcomes, low self-esteem, and the shame of being 'less than' when compared with their peers. High intelligence, academic achievement, or apparent high functioning within one domain (e.g., at work) does not exclude a diagnosis of ADHD. The influence of female hormones on ADHD symptoms is important and many women with ADHD are affected by changes in hormone levels both within the menstrual cycle (with a seemingly high frequency of significant premenstrual dysphoria syndrome) and in the perimenopause period, with an apparent worsening of both the core and associated features of ADHD. It is therefore worth enquiring about the relationship of symptom severity to the menstrual cycle or to the onset of menopausal symptoms and, if present, enquiring whether the woman has any medical contraindications to the use of hormonal contraceptives or hormone replacement therapy (HRT).Some patients may have read about the concept of 'rejection sensitive dysphoria (RSD)' and feel distressed by these features. Rejection Sensitive Dysphoria (RSD) is described as the exquisite sensitivity to teasing, rejection, criticism, or their own perception that they have fallen short, real, or imaginary.