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The Link Between ADHD and Anxiety: Why So Many Patients Have Both

The Link Between ADHD and Anxiety

Many people have been diagnosed with ADHD and in addition to that also suffer from constant worry, racing thoughts or even a sense of impending doom. Here at Pima Behavioral Health, we treat many patients with ADHD that also suffer from Anxiety. We have found that their Anxiety can actually be caused by their ADHD not being under control. We also have many patients with ADHD who have developed so much anxiety over the years that their ADHD is masked by their Anxiety. In this article, we will explore the link between ADHD and Anxiety in more detail and what this link can mean for you.

How Common Is the Overlap?

In adults, 25-50% of those with ADHD are also diagnosed with an anxiety disorder at some point in their life. For children with ADHD, a similar number also develop an anxiety disorder. These two disorders are not coincidental and are, in many ways, the result of similar deficits in brain systems that govern attention and the processing of emotions.

Why ADHD and Anxiety Often Travel Together

Shared brain circuitry

ADHD and anxiety, as we stated earlier, affect and are caused by the same parts of the brain, specifically areas in the prefrontal cortex and the amygdala, respectively. Therefore, it is only logical that these two afflictions impact each other. The brain with prefrontal cortex under stress (due to ADHD) will not have the resources to handle the normal amygdala based threats that occur in everyone’s lives, and therefore will cause more anxiety in people with ADHD then in people without the disorder.

Secondary Anxiety

This Type of Anxiety is Caused by ADHD Symptoms. People with ADHD experience a lot of stress and may even develop what is called secondary anxiety. They often have a lot of worry about things that could potentially happen, including problems at work, in school, or in social situations. Because of this, many people with ADHD are considered to have an anxiety disorder as well as ADHD.

Anxiety as camouflage

While anxiety is a very common comorbidity in adults with ADHD, some people with an inattentive-type of ADHD can appear to be more anxious or “needy” than others. These individuals can be especially difficult to diagnose as they suffer from years of uninspected ADHD while resorting to anxious behavior that seems to further underscore their need for assistance and structure.

Genetic and familial links

There is substantial evidence that ADHD and anxiety disorders are influenced by a number of genes that contribute to the development of both conditions. Additionally, individuals with a family history of either ADHD or anxiety are at increased risk of developing the other condition.

Why Getting the Diagnosis Right Matters

There are several reasons that treating the anxiety and the ADHD separately can be difficult and often lead to limited results. There are several reasons for this.

Stimulant medications can, in anxious patients, lead to an increased feeling of anxiety; when the patient is very anxious, this can be severe enough to lead to him/her being hesitant to take the prescribed ADHD medication. SSRIs and other anxiety medications can be used to treat the anxiety in an individual with ADHD, however they have little effect on the symptoms of attention, hyperactivity, impulsivity, etc. that are seen in individuals with ADHD. Therefore, although the anxiety may be under control, the individual with ADHD may still be functioning poorly in terms of their attention, etc.

Many ADHD treatment approaches (such as those that use cognitive behavioral therapy (CBT) or medication) will also work for someone with co-occurring anxiety. Because of this, there is often  reason for someone with both ADHD and anxiety to see two different providers.

An accurate diagnosis of ADHD can be difficult to come by if the clinician conducting the evaluation doesn’t have a good understanding of the symptoms of ADHD as well as the other psychiatric disorders that can be present at the same time. The psychiatric evaluation is typically a very thorough assessment that looks at the time of onset of all of the symptoms, family history, and the pattern of symptoms that are present in different situations. This type of evaluation is typically best conducted by a specialist such as a Psychiatric Nurse Practitioner.

Treatment Approaches That Address Both

A Treatment Approach for ADHD and Anxiety: Effective treatment approaches and strategies can be individualized for each person with both ADHD and an Anxiety Disorder.

1. Careful medication selection and titration, sometimes combining a non-stimulant or lower-dose stimulant with an anxiety-focused medication, closely monitored for side effects.

2. Cognitive behavioral therapy (CBT), which treats both anxious thought patterns and the deficits in the individual with ADHD, such as problems with the organization of time, and other related problems that he or she encounters in daily activities.

3. Establish routines and environmental supports. There is nothing more unpredictable than a day of ADHD. One of the biggest sources of anxiety for individuals with ADHD is not knowing what is going to happen from one day to the next. By establishing routines and supports, the anxiety that is created by not knowing what is going to happen can be alleviated.

4. Psychoeducation to explain to patients and their families how ADHD and anxiety are connected in order to better recognize triggers and to prevent relapse of symptoms.

When to Seek an Evaluation

If a patient has been experiencing symptoms of chronic worry but also difficulties with focus, disorganization, and impulse control, an evaluation for ADHD would be in order. Conversely, if a person with ADHD is experiencing symptoms of persistent anxiety that are not being alleviated by treatment, then an evaluation for an anxiety disorder would also be in order.

Get Support at Pima Behavioral Health!

At Pima Behavioral Health we are committed to making sure our clients get the best psychiatric evaluation and the most individualized treatment plan to meet their needs. So, if you are dealing with both ADHD and anxiety, or are not sure which is going on, we would like to help you figure it out. So, schedule an evaluation today by calling 520-355-1122.

We can help you get the clarity you need and start you on the road to becoming more focused and calm.