Unveiling the Hidden World of ADHD in Women: Symptoms, Diagnosis, and Struggles
March 16, 2023 - Reading time: 9 minutes
Author: Adeel Sarwar, PhD, Clinical Psychologist Specialized in ADHD
In my career as a clinical psychologist with over 15 years of experience treating patients with ADHD, I've seen many instances where women have been misdiagnosed or left without a diagnosis because of the distinctive ways that ADHD manifests in females..In order to shed light on the frequently ignored world of ADHD in women, I will share some observations and experiences from my professional life in this blog post. We will explore the symptoms, diagnosis challenges, hidden struggles, and ways to support women living with this misunderstood condition.
Understanding the Symptoms and Manifestation of ADHD in Females
Through my clinical practice, I have observed some key differences in how ADHD presents in women compared to men:
- Inattentiveness: Many female clients have reported difficulties with organization, forgetfulness, and maintaining focus on tasks - symptoms they often overlook as personality flaws rather than ADHD.
- Hyperactivity and Impulsivity: While external hyperactivity may be less obvious in women, I have frequently observed excessive talking, internal restlessness, and impulsive decision-making among my female clients.
- Emotional Dysregulation: Intense emotions, mood swings, sensitivities to criticism, and difficulties managing anger or frustration are exceedingly common complaints from women with ADHD.
- Executive Dysfunction: Significant challenges with planning, organizing, prioritizing, initiating tasks, and time management have been prevalent among my female clients over the years.
The Challenges of Diagnosing ADHD in Women
Over the years, I've witnessed several key challenges in accurately diagnosing ADHD in women:
- Societal Expectations and Gender Bias: Women frequently internalize their symptoms as personal flaws rather than ADHD, keeping their profound struggles hidden. After all, societal norms expect women to be organized, emotionally stable multitaskers. Per CDC data, girls manifest overt hyperactivity up to 75% less than boys, contributing to under-diagnosis. In one case study, a woman only received an accurate ADHD diagnosis at age 45, after her child's severe ADHD prompted her evaluation.
- High Comorbidity and Symptom Overlap with Other Conditions: As a clinician, I've seen multiple complex cases of women getting misdiagnosed with generalized anxiety, chronic depression, PTSD, borderline personality disorder or bipolar disorder for years before their ADHD discovery. Up to 70% of women with ADHD tend to have at least one comorbid condition like these leading to symptom overlap and inaccurate diagnoses.
- The Impact of Hormonal Fluctuations: Research indicates estrogen and progesterone can significantly influence ADHD presentation. Changes during puberty, before/during menses, pregnancy, and perimenopause exacerbate symptoms in women with ADHD. I've had patients with minimal childhood symptoms experience paralyzing ADHD symptom spikes along their hormonal rollercoasters, delaying their ADHD identification by decades.
- The Camouflaging Effect: Many women unconsciously camouflage their symptoms through overcompensation, elaborate planning, strict routines, or self-medication. While seemingly functioning fine outwardly, this masking effect leads to inner distress. However, its skillful nature often backfires during clinical assessments causing missed or delayed ADHD diagnoses.
The interplay between female biology, societal conditioning, and skillful camouflaging allows women's ADHD to remain hidden behind far more socially acceptable diagnoses. Knowledge, compassion, and careful evaluation are key to accurate identification and support for the millions of women battling ADHD silently.
The Hidden Struggles of Women with ADHD
In my clinical practice over the past decade, I have encountered numerous women with profound struggles at school, jobs, relationships and simply basic functioning due to undiagnosed or undertreated ADHD. Sarah's case (name and details changed for confidentiality) highlights a classic example faced by many women invisibly battling this condition daily.
Sarah, an articulate 32-year old marketing analyst came to me distressed over an unsettlingly similar pattern permeating every sphere of her life - tumultuous relationships marred by impulsive decisions, friendships prematurely ended due to miscommunications, prolific job changes due to restlessness and boredom.
While extremely bright and verbally facile, Sarah endured chronic self-doubt and guilt over her repeated "failures." Despite strong yearnings for stability and connection, she remained unable to sustain healthy relationships or even regular social outings due to frequently double-booking dates/appointments. She endured paralysis trying to organize complex projects at work too. Her strained personal and professional landscape seeded a depressive spiral.
Through psychoeducation and diagnostic assessments, Sarah uncovered that her inexplicable lifelong struggles were attributable to undiagnosed ADHD. The revelation brought immense relief along with grief over years spent berating herself for symptoms she never realized indicated a neurobiological disorder. With evidence-based treatment, Sarah began to view herself through a gentler, more empowered lens. Over time, she consciously nurtured supportive relationships and carved strategies to harness her innate talents rather than suppress them indefinitely.
Sarah's journey demonstrates how easily women can carry the shameful burdens imposed by their ADHD symptoms without ever receiving accurate diagnosis and care. It is my sincere hope that heightened awareness and compassion can lead to positive change for the millions still suffering silently.
Balancing Busy Roles While Battling Stigma
Like many busy women managing life with undiagnosed ADHD, Sarah faced profound challenges balancing her multifaceted roles while simultaneously coping with self-doubt and stigma.
As a dedicated mother of two young children, Sarah relentlessly strove to keep up with endless housework, kid schedules and activities amidst a demanding full-time job. However, ADHD-related disorganization, forgetfulness and overwhelm often left her dropping balls across domains. She desperately yearned for personal time yet spent every evening frantically catching up just to start the next day utterly exhausted.
Additionally, Sarah agonized over real and perceived judgments from those unaware of her silent struggles. Her supervisor frequently reprimanded her for forgetfulness and branded her as irresponsible without realizing Sarah's ADHD symptoms. Unable to recognize her own ADHD before diagnosis, Sarah internalized intense self-blame and shame despite investing enormous efforts to function. "I must be lazy, stupid and completely incompetent," Sarah thought, if she could not even accomplish basic tasks that seemed effortless for others.
It was only after her diagnosis, when Sarah found an understanding therapist and an empowering women's ADHD support group, that she began looking through a lens of self-compassion rather than self-judgment. By acknowledging her neurobiological challenges and unique strengths, she paved the road to harness her abilities while also seeking necessary accommodations and nurturing her wellbeing. Her outlook shifted from shame to empowerment, no longer carrying the burden alone.
Supporting Women with ADHD
Based on my experiences, I believe there are several ways we can support women with ADHD:
- Encourage Seeking Help: Identifying ADHD early leads to better outcomes. Yet women often suffer in silence, unaware their struggles may be ADHD-related. We must encourage women to seek help if ADHD is suspected without fear of judgment.
- Bridge the Gender Research Gap: We need increased research focused specifically on ADHD presentation and needs among adult women. Bridging this gender research gap can uncover more accurate diagnostics and tailored treatments.
- Foster Connected Sisterhoods: Women with ADHD often feel isolated and alone. Building supportive communities to share stories and advice creates connected, empowering sisterhoods critical for thriving with ADHD.
- Speak Up and Speak Out: Raising awareness and advocating for the unique needs of women with ADHD chips away at stigma. The more we educate and speak out, the more we pave the path for positive change.
My experiences show me the quiet struggles faced by women with ADHD daily. By continuing to support one another, raise awareness, and advocate for change, we can transform lives. The future is bright for the exceptional women warriors battling ADHD each day. Together, we can help them shine.
ADHD in Women: Next Steps
Self-Test: ADHD Symptoms in Women
Find: ADHD Specialists or Clinics Near You
Dr. Adeel Sarwar, PhD, is a mental health professional specialising in a broad spectrum of psychological conditions such as depression, anxiety, ADHD, eating disorders, and obsessive-compulsive disorder (OCD). Armed with years of experience and extensive training in evidence-based therapeutic practices, Dr. Sarwar is deeply committed to delivering empathetic and highly effective treatment.