ADHD Symptoms in Adult Women
7 Unique Ways Symptoms of ADHD Manifest in Women
Attention Deficit Hyperactivity Disorder (ADHD) is widely undiagnosed, misdiagnosed and dismissed in women. There are many factors that contribute to inadequate treatment for women with ADHD; and as a female therapist living with ADHD, I can confidently say…none of them are okay. Women deserve better. There’s so many reasons why ADHD is missed in the clinical picture for women; I can probably do an entire blog on this topic (and hey maybe I will). Factors include: symptoms types, inadequate research, internalized symptoms, provider bias, lack or training, stigma, stereotypes, societal expectations, gender roles, camouflaging and fluctuations in hormones. Although the symptoms for ADHD are diagnostically the same between men and women, the presentation and ways in which they manifest differ. So lets dive in.
Inattention
Women often struggle with predominantly inattention symptoms of ADHD, and they can be subtle; daydreaming, zoning out, not paying attention and procrastinating to name a few. Inattention symptoms of ADHD are often missed by educators, physicians, therapists and parents. It’s much easier to catch ADHD in the boy who is climbing the bookshelves, than the girl in the back looking out the window and twirling her hair. Inattention symptoms unfairly get labeled as some sort of negative character flaw such as being lazy, flaky or spacey. These stigmatizing labels are harmful to self-esteem, self-confidence and further perpetuate stigma. To complicate it even more, women learn societal expectations early on and become expert camouflagers, hiding and repressing their ADHD symptoms, which we now know leads to further mood issues such as depression and anxiety.
Internalized Hyperactivity
Women may be more likely to experience internalized hyperactivity that manifests as racing thoughts, internal restlessness, body tension, anxiety, picking, difficulty relaxing, mental exhaustion and fatigue. As a young girl, I was very talkative and thus frequently moved around the classroom for for disrupting my peers. Every parent-teacher conference was the same…”she talks to much”. As an adult, the chatter has largely been trapped inside. Reasons for this? Societal expectations, camouflaging, stereotypes and stigma contributing to internalized symptoms. Internalized symptoms might also include mood symptoms; and all of this contributes to the difficulty of early detection of ADHD in women.
Hypersensitivity
Women with ADHD tend to experience more central nervous system hypersensitivities compared to men with ADHD. These hypersensitivities may include sensory processing issues, chronic overwhelm, over-stimulation (fight/flight) and sensory overload. Examples might include: uncomfortable clothing materials, scratchy tags, loud music, loud chewing (misophonia), bright or un=natural lights (think fluorescent lighting), crowded spaces and strong smells like perfumes. Theses sensitivities might contribute to somatic complaints, headaches, migraines, stomach aches, nausea, dizziness, sleep disorders and Inflammatory conditions. Women with ADHD get unfairly labeled as being to “sensitive”. Hypersensitivities can make women feel overwhelmed by the world they are living in.
Perfectionism
Perfectionism is a common experience for women with ADHD. Perfectionism might stem from several places including: overcompensation, rigid or concrete thinking styles, fear of criticism, rejection sensitive dysphoria (we will come back to this one later), low self-esteem, gender roles, societal expectations and more. Perfectionism is unhealthy, maladaptive and leads women to extreme exhaustion, defensiveness, unrealistic expectations, negative comparisons of themselves and unattainable personal standards. Sounds tiring right?!
Comorbidity
ADHD rarely travels alone and women with ADHD appear to be more susceptible to comorbid conditions than their male counterparts. What is comorbidity anyways? Comorbidity refers to the co-existence of multiple mental health or physical conditions occurring at the same time. Women are susceptible to co-occurring conditions that include: depression, anxiety, addiction, migraines, sleep disorders and more. The presence of these other conditions can make for a complex diagnostic picture and is in part why ADHD might fly below the radar unseen for many years. Meanwhile women are struggling with the consequences of a missed diagnosis.
Emotional Dysregulation
You know what I’m talking about…nuclear meltdowns, outbursts, fits of rage, tantrums and tears. Emotional regulation is an executive function and a core symptom of ADHD. Hormonal fluctuations and low estrogen across the lifespan complicates the ADHD picture. Symptoms like irritability, mood swings and difficulty concentrating are sometimes attributed to PMDD or other mental health disorders when really…all signs point to ADHD.
Rejection Sensitive Dysphoria
Your are not going to find Rejection Sensitive Dysphoria (RSD) in the diagnostic criteria of the DSM-5, but this symptom has gained a lot of traction over the last several years and deserves to be recognized here. RSD is an intense response to both real or perceived rejection, criticism or failure. Symptoms of RSD include intense feelings of shame, guilt, fear, low self-esteem and difficulty regulating emotions. RSD can result in hours of distress, spiraling, ruminating. RSD causes functional impairment in day-to-day activities, relationships, work environments and sometimes leads to further isolation or avoidance and perpetuates comorbid conditions (see above).
