ADHD is already a fickle beast. But what if…fickler (that a word?)
Indeed, here we thought ADHD doesn’t discriminate, but apparently, it does.
Or, more precisely, ADHD manifests itself differently in women than men. And there are many reasons for this, some rooted in nature while others in society being kind of cringe at times.
But today, we will dive deep to unravel the mystery of ADHD in women.
Today, you will learn the following:
- Common misconceptions about ADHD
- ADHD symptoms in adult women
- Societal and biological factors that cause them
- How modern screening is still biased against women with ADHD
- The ways to seek help, the right way
All right, with me?
Let’s dig in.
[Misconceptions]A Refreshing Primer on Misconceptions about ADHD
First, let’s wrap our minds around what ADHD is. Yeah, I understand that many of you reading this have a semblance of an idea, but it never hurts to refresh our memory.
Plus! It will be extra important in the context of our current conversation and help us pick at the mystery of why ADHD in women is so often underlooked.
Okay. So, ADHD is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Sounds pretty straightforward, right? But here's where things get tricky. There are a lot of misconceptions about ADHD.
Misconception 1: ADHD is Solely a Childhood Disorder
Many people think that it’s just a childhood disorder or that it’s about being hyperactive. Essentially, there’s this thought that ADHD is something “you grow out of.”
Yet, ADHD is much more complex than that, and it can manifest itself differently. While symptoms do start in childhood, they can continue way past that. Many adults with ADHD were never diagnosed as children because their symptoms were overlooked or misinterpreted2.
So, you have an already overlooked disorder that is even more overlooked in adults because symptoms tend to change with time. That “hyperactivity” commonly touted as a major symptom? It might look a lot more like restlessness or having difficulty relaxing in adults.
Misconception 2: ADHD Equals Inattention
The second misconception worth addressing is the “inability to pay attention.” Well, anyone with ADHD would tell you that it’s not a lack of attention but the inability to pay attention to things that aren’t interesting or mundane. Long story short, it’s more about dopamine and how ADHDers need more dopamine faster to feel as excited as their neurotypical friends1.
Instead of being “just pay attention, LMAO,” it becomes about executive dysfunction that leads to a lack of impulse control, inability to manage time and plan, and the emotional dysregulation that follows with realizing that you can’t just do “normal things.”
Because it’s rarely registered as a true symptom of ADHD, however, it leads to misconceptions about what the person is.
The Impact of Misconceptions
And that’s the issue here - misconceptions about ADHD turn symptoms into character flaws. In the eyes of society, there is no “adult with ADHD.” There is just “an adult that sucks at adulting.” 🤷
And this is REALLY important when we are talking about ADHD in women. Because unfortunately, women still get the short end of the stick whenever the talk about mental disorders comes up.
[Shared symptoms]ADHD Symptoms that Women Share With Men
Men are from Mars, and women are from Venus, but ADHD didn’t get the memo. While we will focus primarily on the symptoms unique to women, it’s worth noting that the dividing line isn’t straight and solid. So, there are going to be certain symptoms that overlap across the entirety of the adult demographic.
1. Scattered Focus
People with ADHD, regardless of gender, may find it challenging to maintain a focus lock on a given task. This lack of sustained attention can result in a haphazard approach to tasks or constant distractions, making daily life feel unstructured and overwhelming.
2. Hasty Decision Making
Another shared symptom is impulsivity, which often manifests as hasty decision-making. People with ADHD might act or respond without considering the full spectrum of consequences. That leads to interrupted conversations, struggles with patience, and actions taken on a whim.
3. Difficulty With Task Management
Men and women with ADHD might struggle with organizing tasks or managing time effectively, making it challenging to meet deadlines or manage multiple responsibilities concurrently, which can contribute to feelings of stress and overwhelm.
4. Emotional Volatility
Characterized by quick mood changes or an inability to control emotions, volatility is a common experience for many people with ADHD. It manifests in getting excessively upset over minor issues, experiencing intense emotions more frequently, or having difficulty calming down after getting excited or upset.
[Symptoms in women]Symptoms of ADHD in Women
As we delve into these symptoms, let's keep our mantra at the forefront: ADHD is a shape-shifter, transforming and presenting differently in each individual. Similarities and overlaps exist, but the absence of any discussed symptoms doesn't equate to an absence of ADHD. Remember, only a mental health professional holds the key to a definitive diagnosis.
With that established, let's dissect the symptoms of ADHD that predominantly surface in women and attempt to understand why. More often than not, women express their ADHD through internalization and inattention, whereas hyperactivity tends to take a backseat.
5. Internal Restlessness
Instead of an obvious display of hyperactivity, women with ADHD often wrestle with a sense of restlessness that seems to bubble constantly under the surface. Imagine, if you will, a piano wire stretched taut, trembling under the tension and threatening to snap at any moment, yet it never does. This internal restlessness may be less apparent to outsiders but is just as impactful, creating an inner world of constant agitation.
Women with ADHD may also find their senses on high alert. This hypersensitivity can emerge in various ways: an aversion to certain clothing textures, a heightened reaction to specific smells or sounds, or even an intense discomfort under bright lights.
7. Relationship Troubles
The complexities of ADHD can cause ripple effects in relationships. Executive dysfunction makes maintaining relationships challenging for all with ADHD, but for women, there's an additional layer: heightened rejection sensitivity. That refers to an intense emotional reaction to perceived or real rejection. As a result, relationships can become a source of distress, leading some women with ADHD to avoid forming bonds, be they platonic or romantic.
8. Gender-atypical behaviors
Among women with ADHD, one might observe behaviors more commonly associated with men, such as exhibiting controlling tendencies, demonstrating aggressiveness, or possessing a short temper. These aren't the typical ADHD symptoms you'd find on a quick internet search, but they're part of the reality for many women living with the condition.
While these symptoms are more prevalent in women, all individuals with ADHD can experience more general symptoms, such as:
We've painted quite a different picture of ADHD, haven't we? It might not align with the usual image that pops into your head when you think of ADHD.
Many women with ADHD remain oblivious to their condition simply because these symptoms seem so... unconventional. They aren't necessarily bouncing off the walls or underperforming at school or work. They're just moving to their rhythm, often struggling to pinpoint why life feels disproportionately challenging compared to their peers.
[Expectations on women]How Expectations on Women Influence ADHD Symptoms
The world has made real strides in breaking gender norms and heteronormativity. Today more people than ever who don’t map 100% to either man or woman can feel comfortable in their skins.
But. You don’t topple something as fundamental as gender roles in a day or even a decade.
So, what does #society expect of women? As it turns out, a lot.
I will oversimplify it; otherwise, this will become a 20 pages-long sociological thesis. Still, society expects women to manage and control a lot of things.
DISCLAIMER: Neither I nor anyone at NUMO sincerely believes these things, so please, don’t bombard us with hate mail. 🥺 We’re just exploring the expectations that already exist here.
Expectation 1: A woman has to be pretty
A woman has to be pretty. She needs to care about her makeup, haircut, and stylish clothing. But her appearance must also thread the fine line between “boring” and “risque”; otherwise, she’ll get bombarded with labels.
Expectation 2: A woman needs to have a perfect body
It’s as if policing externalities wasn’t enough. Women’s bodies are also scrutinized. Too heavy? Too thin? Girl, it’s to judgment city to you 💅If your appearances don’t conform to a mercurial idea of “perfect woman form,” it’s to the cringe pits with you.
Expectation 3: A woman needs to control her emotions and relationships
Women can't escape certain expectations, whether it’s a professional or personal relationship. So they have to be timid and caring. They must be passionate and bubbly but also be in control of their emotions, lest they want the labels of being “too emotional” or “drama queens.”
Try wrapping your head around this cognitive dissonance.
Oh, and if a woman is trying to be assertive in her career? Well, duh, she’s just acting like a man.
Expectation 4: A woman needs to maintain the household
Oh, and if a woman ever enters a committed relationship…hoo, boy.
So the funny little thing called capitalism happened, making it difficult for many to survive on a single income. A husband and wife in a “traditional family” must work.
But all these funny things like preparing dinner, cleaning the house, G-d forbid caring for kids? Gee, that’s women's thing. Men can’t do that. 😀
So, whether voluntarily or not, these responsibilities, too, fall on women’s shoulders.
What do we have in conclusion?
Managing, managing, managing…that’s a lot of managing things and keeping them in order.
Do you know what ADHDers are bad at? That’s right! Managing things! And especially managing them in specific, rigid ways enforced by others.
So, you get this funky cocktail of a person that has executive dysfunction and a myriad of rules and norms that require, without exaggeration, a pretty high level of functioning.
And THERE’S MORE (oh, no).
Recall that these women might not even know that they have ADHD. And anyone who assumes they’re completely normal incorrectly deduces that they just suck at living, so they “just have to be better.”
And this “better” comes out as masking behaviors. Women with ADHD try to sweep these problems under the rug, hoping to power through them. Instead, they feel shame and self-doubt from an inability to conform5.
Just because you put a heavier lid on a pot of boiling water doesn’t mean it stops boiling. It will end up with a bigger but delayed explosion.
[Why it's misdiagnosed]Why is ADHD in Women So Often Misdiagnosed?
Okay, let’s assume that by luck or any other virtue, a woman decides to learn if she has ADHD. So all she needs to do is go to any specialist in the field to get her diagnosis, right?
Even getting the right diagnosis can be challenging for women with ADHD. Issues here obviously include the gender expectations mentioned above, but they go even deeper than that.
So, let’s look at each one.
Gender bias in assessments and screenings
So, what caused a belief that ADHD is but a hyperactivity disorder? Far from being a mere rumor, this belief stems from earlier conceptualizations of ADHD, which some professionals continue to uphold.
The Quiet Symptoms in Women
As previously noted, women often present more subtle, masked symptoms of ADHD. Consequently, they are less likely to earn a referral to an ADHD specialist, leading to underdiagnosis.
A Testing Bias
When women do get a referral, they face another hurdle. The standard ADHD rating scales (those diagnostic tests and quizzes that measure your ADHD symptoms) are frequently skewed towards the more visible, hyperactive symptoms often associated with male presentations of the disorder.
The Consequences of Misdiagnosis
So, imagine a woman with ADHD who seeks help, pays her dues, and invests her time, only to be turned away because she doesn't fit the "hyperactive" mold. Unfortunately, this is more than just a hypothetical situation.
The Dilemma of Masking
Women with ADHD often mask their symptoms out of fear of being labeled, inadvertently obstructing an accurate diagnosis. Honesty is essential for an accurate diagnosis, but what happens if the individual isn't even aware that they're masking their symptoms?
Consider a scenario where a woman only discusses the symptoms that break through her mask. That could easily lead to a misdiagnosis, as these "breakthrough" symptoms often resemble anxiety-related disorders, leaving the underlying ADHD undetected.
Role of Estrogen in Diagnosing ADHD in Women
At the root of our existence, hormones reign supreme. Thanks to biology's uncaring impartiality, women are particularly prone to hormonal mood fluctuations.
Short-term and Long-term Hormonal Changes
We must consider two categories of hormonal fluctuations: the monthly changes in estrogen levels during the menstrual cycle and the broader hormonal shifts experienced from puberty to menopause.
The world of hormones is an intricate web, with many interactions still shrouded in mystery. Consequently, the course of ADHD symptoms isn't linear as they tend to fluctuate with time6.
Daily Variances and Misconceptions
Daily, women with ADHD might experience amplified or diminished symptoms. Because of this variability, it's easy to overlook these symptoms as unrelated to any long-term mental disorder — a dismissal often from the women themselves.
Hormonal Surges and ADHD Misunderstanding
Consider more substantial hormonal shifts, such as the estrogen surge accompanying puberty. A young girl with ADHD suddenly grapples with anxiety, emotional volatility, and chaotic thoughts. It's easy to dismiss these symptoms as "just hormones" and let it slide.
Why ADHD is Considered Stable: A Bias in Science
So, where does the misconception that ADHD is a stable disorder come from? It stems from the scientific tendency to use symptoms prevalent in males as a baseline for ADHD diagnosis. Post-puberty, men's hormones settle into a more stable rhythm — a contrast to the fluctuating hormonal landscape of women. Consequently, ADHD's reputation as a steady condition persists.
[Comorbidities]Trouble loves company: ADHD comorbidities in women
Are you feeling overwhelmed? You're not alone. But bear with me because we have more ground to cover.
Imagine a bout of flu left untreated. It might escalate to more severe conditions such as pneumonia. Mental health disorders are no different. Let them simmer, and you'll soon be acquainted with comorbidity.
The Unfortunate Reality of Comorbidity
It's not unusual for those with ADHD to develop other disorders due to struggling to manage executive dysfunction and the overwhelming feelings of burnout. If ADHD is left unchecked, it could be just a matter of time before other mental health issues like:
- personality disorders,
- burnout appear7.
The Additional Plights of Women with ADHD
The picture grows even bleaker for women. Frequently, they find themselves in a constant battle between concealing their symptoms and receiving inadequate support. When they contact professionals, they may be turned away or treated for an unrelated or symptomatic issue. This approach can exacerbate feelings of inadequacy and shame, causing further damage to their mental well-being.
The Domino Effect
Such unaddressed issues create a domino effect. The sensation of life spiraling out of control can deepen the severity of existing conditions and invite new ones. So, while the world may see a woman successfully masking her ADHD symptoms, on the inside, it could be a storm of co-occurring mental health disorders.
[Strategies]How women with ADHD can get the help they need
But fret not, dear reader!
It’s not like there’s no way to help. Quite to the contrary. Of course, it can be more difficult than traditional cases, but it's more than doable with the right attitude and methods.
So, here’s what we would recommend.
- Finding the right clinician: when you’re out and about shopping for an ADHD expert, inquire what their expertise is in treating women with ADHD. A professional that’s right for you will understand not only the nuances of the women’s symptoms but preferably would also understand the interplay between ADHD medication and women’s fluctuating hormones.
- Psychotherapy: by the time you start seeking help, some misconceptions and masking might be inseparable from “You,” so it can be difficult to recognize your behavior as abnormal. Finding a therapist to help you reframe these experiences and make you realize that these shouldn’t be problems you must carry at all times can be a great kickstart for your betterment journey.
- Education about your condition: this includes educating not only yourself but your family and loved ones as well. They, like you, might be completely oblivious to you having ADHD, so learning what it is and how it impacts your life can help you nurture a supportive and caring environment.
- Seek community support: I would never have learned that I have ADHD if not for my acquaintance that did have it diagnosed. By learning that our quirks and behaviors were eerily similar, I decided to seek a diagnosis. That is why it’s so important to find support groups of individuals that go through the same thing you are. We sometimes might learn more about ourselves through sharing stories than we would have otherwise.
We also have an app that can help exactly with that 👀
And speaking of communities! That’s what we’ve been trying to build here at Numo - a definite stop for all your ADHD needs.
Our founder, Julia, lived with undiagnosed ADHD for 28 years until she finally found her needed help. So, if anyone understands the plight of women with ADHD, that’s her. So, what do we have in store? All the baubles that our ADHD brains need on top of great community features!
- ADHD planner boosted by gamification - ADHD planner is what many of us need to reign in dysfunctioning. We strived to make it as simple as possible while also creating some extra motivation to fill out and complete your tasks. 🎮
- Pink/white/brown noise generator is another great boon that can help us relax or focus when overwhelmed. 〰️
- Squads and tribes are the backbones of our community, where we get to connect, ask questions, and share stories of losses and victories. It’s a great place to find inspiration or maybe learn about things that “don’t feel like ADHD symptoms but actually are” ⛺
- Learning materials and stuff - we are also constantly sharing useful materials and bits and bobs of knowledge about developing coping skills and strategies to keep that ADHD at bay.
So, whether you’re in it just for tools or our community efforts, then come along. We’re cool, I promise 😉
[Summing Up]Summing It All Up
So-o-o. What have we learned today?
- There are many misconceptions about ADHD, including how symptoms manifest, which makes diagnosis and treatment difficult.
- These misconceptions are amplified for women as their symptoms of ADHD are more subdued and are not like those commonly found in men.
- Diagnosing ADHD in women gets even more complicated by societal pressures put on women as well as hormonal fluctuations that make it easy to misdiagnose ADHD as fluctuations of hormones or anxiety.
- Many practitioners still use outdated practices and standards, such as evaluation criteria created with men’s symptoms in mind.
- Finding help for women with ADHD requires more nuanced research; you need to find a specialist with experience treating women and seek community support to identify less common and reported symptoms.
ADHD in women is still a niche with many misconceptions and misunderstandings, but it doesn’t have to be this way.
By spreading knowledge about these unique circumstances, we hope to empower people to find the help they need. 😌
And, if you want to read more stories about women's experiences straight from the source, then we have plenty of those in our app. 😉
Whatever your choice is going to be, we hope that you find the help you need.
See you around! 👋
3 Frontiers. Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children
4 Materia Socio Medica. ADHD Symptoms in Females of Childhood, Adolescent, Reproductive, and Menopause Period
7 Global Pediatric Care. Comorbidities Associated With Attention-Deficit/Hyperactivity Disorder in Children and Adolescents at a Tertiary Care Setting
8 European Psychiatry. Atypical sensory profiles as core features of adult ADHD, irrespective of autistic symptoms