ADHD Comorbidity Research in Women Needed: Anxiety, Depression, Autism, More – ADDitude magazine

by | Anxiety

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What We Know

Women with ADHD suffer from serious comorbid conditions with more frequency and severity than do men with ADHD or the neurotypical population.

A staggering 93% percent of women with ADHD report at least one related diagnosis, according to a 2023 ADDitude survey. The most common comorbidities among women were:

  • Anxiety (73%)
  • Depression (63%)
  • PTSD or c-PTSD (23%)
  • Migraines (22%)
  • Sleep disorder (18%)
  • Eating disorder (15%)
  • PMDD or severe PMS (15%)
  • Obsessive compulsive disorder (11%)
  • Sensory processing disorder (10%)
  • Learning disorders (9%)
  • Autism spectrum disorder (8%)
  • Substance use disorder (7%)

A separate ADDitude survey of 1,148 women with ADHD found that 57% of those who had given birth suffered from postpartum depression (PPD) with at least two-thirds reporting symptoms of mood swings, crying spells, and feelings of worthlessness, shame, guilt, or inadequacy.

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These self-reported comorbidity rates are higher than those found in most other studies. But even those scientific research reports contain shocking findings:

  • 59% of women diagnosed with ADHD have an additional psychiatric disorder compared to only 5% of the women without ADHD1
  • Women with ADHD are five times more likely to experience anxiety than are women without ADHD2
  • Women with ADHD face 2.5 times higher risk for major depression than do their neurotypical counterparts3
  • Among women with ADHD, depression has an earlier age of onset, lasts longer, presents with more severe symptoms, a higher rate of suicidality, and a greater likelihood of requiring psychiatric hospitalization compared to women without ADHD4
  • Up to 46% of women with ADHD experience PMDD5
  • 25% of people with ADHD who give birth will suffer from postpartum anxiety — compared to approximately 10% of women without ADHD. In addition, 17% of women with ADHD who give birth will experience PPD — at least a 24% increase over the general population6
  • Girls with combined type ADHD are three to four times more likely to attempt suicide than are their neurotypical peers, and they are more than twice as likely to engage in self-harm7

“Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD in females can be profound,” says Stephen Hinshaw, Ph.D., director of the Berkeley Girls and ADHD Longitudinal Study (BGALS) — the only longitudinal study on females with ADHD conducted to date.

What We Don’t Know

Why are women with ADHD at greater risk for developing comorbid conditions and why do these conditions appear to take a greater toll on this group? What factors — neurological, biological, social, emotional, and others — possibly put women with ADHD at such relatively high risk for comorbid conditions? These questions remain unanswered due to an absence of research.

A 2023 study found that sleep disorders impact a higher percentage of women with ADHD than men with ADHD,8 and it implored researchers to investigate the root causes of this gender-specific discrepancy. This pattern is repeated in other conditions as well. We know women with ADHD are more likely than men to suffer from mood disorders, anxiety, eating disorders, borderline personality disorder, and countless other co-existing conditions, but we don’t understand why — or how to best help them — because there is simply no research to guide clinicians.

Longitudinal and double-blind studies are needed to probe questions like the following:

  • Why do nearly three-quarters of women with ADHD report living with anxiety and more than half with depression? Why are these comorbidity rates so much higher than those seen in men with ADHD?
  • Are comorbid conditions more often co-occurring or secondary to ADHD in women?
  • Do years spent undiagnosed and untreated for ADHD cause such emotional turmoil and low self-esteem that secondary anxiety commonly develops? Is secondary depression similarly a common byproduct of a missed ADHD diagnosis? What about eating disorders? Sleep disorders? Substance use disorder?
  • Do clinicians commonly dismiss or misinterpret signs of ADHD in women and misdiagnose them with internalizing disorders, and vice versa?
  • Is there a biological, neurological, or genetic connection between ADHD and these comorbid conditions that cause them to co-exist so commonly in women?
  • Does having a single ADHD comorbidity increase the likelihood that a woman will have others?
  • Does acute sensitivity to hormonal fluctuations put women with ADHD at higher risk for PMS, PMDD, and PPD? What about migraines?
  • How can we better screen girls and young women with ADHD for the comorbid conditions we know they experience most frequently and those associated with the worst long-term outcomes?
  • Why isn’t it standard practice for clinicians to perform ADHD evaluations on the girls and young women who have been referred to them for internalized symptoms of emotional dysregulation, anxiety, and low mood?
  • Does early, effective treatment for ADHD reduce the likelihood that women will experience symptoms of comorbid conditions as they age?

“At age 12, I was diagnosed with general anxiety disorder, major depression, and OCD,” wrote one ADDitude reader. “When I got my ADHD diagnosis at age 23 and went on medication, almost all my problems with depression and anxiety disappeared. I realized that my untreated ADHD was a likely factor in every other problem I’d faced. Addressing the root cause nearly fixed all the other issues.”

Why It Matters

Clinicians who do not understand the overlap of ADHD and other conditions in women cannot begin to accurately piece apart and diagnose those symptoms or prescribe effective treatments. Until research exists on complex ADHD and its comorbidities, women will continue to suffer inaccurate or incomplete diagnoses with adverse effects touching every aspect of life.

As covered in Part One of this We Demand Attention package, ADHD is missed more than it is diagnosed in girls and young women. Their internalized symptoms are either misinterpreted as signs of another condition, like anxiety or a mood disorder, or they receive only a partial diagnosis. Typically, inappropriate and ineffective treatment follows, which only increases the likelihood for additional or more severe mental health problems.

“ADHD does not happen in a vacuum,” notes Nelson M. Handal, M.D., founder of the Dothan Behavioral Medicine Clinic. “Its effects are far more impairing when the condition goes undiagnosed, untreated, or improperly treated.”

“Many women seeking treatment for mood and emotional problems may have unrecognized ADHD,” states the 2023 research paper “Miss. Diagnosis: A Systematic Review of ADHD in Adult Women.” “Higher rates of comorbidities such as depression and eating disorders in females with ADHD may make diagnosis more difficult. As well, physicians may have more difficulty separating ADHD from its comorbidities, potentially clouding ADHD symptoms and leading to delayed diagnosis in females.”9

In an ADDitude survey of 703 readers, 59% said that research on comorbidities like depression and anxiety in girls and women with ADHD would positively impact their lives. Greater study, they argue, would help ensure that more women receive an accurate diagnosis early in life — the effects of which cannot be overstated.

“I was diagnosed with depression first, but I couldn’t stick to treatment because nothing worked. When I finally got my ADHD diagnosis, it was life-saving,” wrote one ADDitude reader. “Maybe I wouldn’t have developed depression if I didn’t have untreated ADHD for decades.”

“I was recently diagnosed with ADHD after years of struggling with anxiety and depression. It turns out that ADHD (with a side of PTSD) has been the underlying problem all along — 38 years in the making,” wrote another survey respondent.

“I initially had generalized anxiety disorder and depression in high school,” wrote an ADDitude reader. “I was shy of 30 when I finally received my ADHD diagnosis. It finally made sense. My anxiety symptoms were ADHD symptoms. I overthink and overreact, not because I am afraid but because I am wired differently. My ADHD diagnosis is a life-changer.”

In addition, it is critical to understand how ADHD affects females with chronic illnesses that require reliable daily medication, timely medical appointments, and consistent self-care.

What ADDitude Readers Tell Us

While research on ADHD comorbidities is needed across the board, ADDitude readers are desperate for studies on autism, trauma, sensory sensitivities, and other comorbid conditions with strong ties to ADHD but very little study to date. Readers also urge greater research into hormonal influences on ADHD and comorbid conditions.

“I would like to see research into AuDHD (autism and ADHD) in girls and women — primarily as it affects racialized minorities/POC!” wrote one ADDitude reader in Canada. “I’m Black and, as a POC, and I struggled for years in higher ed and workplaces due to this absence of medical research supporting our existence as research subjects… With dedicated investment and deep investigation, I’m confident that public and private awareness will organically follow.”

“I have ADHD, anxiety, depression, and PTSD. My symptoms can shift daily or pile on top of each other,” said an ADDitude reader with multiple diagnoses. “Sometimes my ADHD symptoms get challenged. This triggers my PTSD, which then increases my anxiety and causes depression. They all feed off each other, and it never ends.”

“I would like to see more autism research, but also generally anything that might help undo/uncover all the countless misdiagnoses that have been assigned to women/AFAB,” wrote an ADDitude reader in Utah. “With a child, I’m all for investing in the accuracy of future diagnoses, but as a late-diagnosed AuDHD person, I don’t want anybody to be left behind.”

“I’d like to see research on how women’s hormonal changes impact behavior, mental health, physical health, and other aspects of well-being throughout their lifespan,” wrote an ADDitude reader in North Carolina. “This would be critical to understanding how ADHD, autism, depression, and many other conditions affect women and girls differently than men.”

“I’d like to see the treatment options for those with eating disorders and ADHD better understood, particularly when sensory issues and food allergies are present from birth,” wrote an ADDitude reader in California.

What ADHD Experts Say

Experts agree that women with ADHD face a disproportionately large risk for comorbid conditions with adverse outcomes, and that clinicians could do much more to identify and treat these women at a young age.

“Women with ADHD are more likely to have comorbid conditions such as depression, anxiety, and eating disorders,” said Dawn Brown, M.D. “Recognizing and addressing the potential for these concurrent conditions is essential for comprehensive treatment and improved outcomes.”

“Girls and women with untreated or undertreated ADHD — or those who have been misdiagnosed with other conditions — have been put at higher risk for an array of negative outcomes including higher rates of depression and anxiety, intimate partner victimization, and risky sexual behaviors resulting in teen and unplanned pregnancies,” said Julia Schechter, Ph.D. “These girls and women with untreated ADHD are at double the risk for engaging in self-harm and significantly more likely to attempt suicide.”

Next Steps

Related Reading

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

  1. Sex Difference in ADHD
  2. The Health Consequences of Delayed ADHD Diagnoses on Women
  3. How Hormonal Changes Impact ADHD Symptoms in Women
  4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
  5. The Elevated Risk for PMDD and PPD Among Women with ADHD
  6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
  7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
  8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
  9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
  10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

View Article Sources

1 Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

2 MGH Center for Women’s Mental Health (2023, October). “ADHD as a Risk Factor for Postpartum Depression and Anxiety.” https://womensmentalhealth.org/posts/adhd-as-a-risk-factor-for-pmad/

3 Biederman, J., Ball, S. W., Monuteaux, M. C., Mick, E., Spencer, T. J., McCREARY, M., Cote, M., & Faraone, S. V. (2008). New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child and Adolescent Psychiatry, 47(4), 426–434. https://doi.org/10.1097/CHI.0b013e31816429d3

4 Biederman, J., Ball, S. W., Monuteaux, M. C., Mick, E., Spencer, T. J., McCREARY, M., Cote, M., & Faraone, S. V. (2008). New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child and Adolescent Psychiatry, 47(4), 426–434. https://doi.org/10.1097/CHI.0b013e31816429d3

5 Obaydi, H., & Puri, B. K. (2008). Prevalence of Premenstrual Syndrome in Autism: A Prospective Observer-Rated Study. The Journal of International Medical Research, 36(2), 268–272. https://doi.org/10.1177/147323000803600208

6 Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, L., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. J Affect Disord, 325:817-823. https://doi.org/10.1016/j.jad.2023.01.069

7 Hinshaw, S.P., Owens, E.B., Zalecki, C., Huggins, S.P., Montenegro-Nevado, A.J., Schrodek, E., Swanson, E.N. (2012). Prospective Follow-Up of Girls with Attention-Deficit/Hyperactivity Disorder into Early Adulthood: Continuing Impairment Includes Elevated Risk for Suicide Attempts and Self-Injury. J Consult Clin Psychol, 80(6):1041-1051. https://doi.org/10.1037/a0029451

8 Ahlberg, R., Garcia-Argibay, M., Taylor. M., Lichtenstein, P., D’Onofrio, B.M., Butwicka, A., Hill, C., Cortese, S., Larsson, H., Du Rietz, E. (2023) Prevalence of Sleep Disorder Diagnoses and Sleep Medication Prescriptions in Individuals with ADHD Across the Lifespan: A Swedish Nationwide Register-Based Study. BMJ Ment Health. (1):e300809. https://doi.org/10.1136/bmjment-2023-300809

9 Attoe, D.E., Climie, E.A. (2023) Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. J Atten Disord. (7):645-657. https://doi.org/10.1177/10870547231161533

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