Is It Anxiety, ADHD, or Both?

How to Understand What’s Really Going On

Most women do not come into therapy asking, “Is this ADHD?”

More often, they arrive feeling frustrated and confused. They assume something is wrong with them. They believe it must be anxiety, or maybe they believe they should just be able to manage life better than this.

Then a friend receives an ADHD diagnosis. A sibling is evaluated or diagnosed. A doctor casually mentions it. And suddenly a question appears that was never considered before.

What if this is ADHD?

At first, the emotional tone is rarely relief. It is usually frustration. Why wasn’t this seen sooner? Why can’t I get past this? Why does this feel harder for me than for other people?

Most women initially assume their symptoms are anxiety. But over time, they begin to notice that their experiences do not quite match their friends’ anxiety. That is often where the confusion begins.

Why Anxiety and ADHD Can Look So Similar

Anxiety and ADHD share many real overlapping symptoms.

Difficulty focusing, procrastination, overwhelm, racing thoughts, trouble starting tasks, missing deadlines. All of these can occur in anxiety and in ADHD.

People rarely say, “I cannot focus.” It is usually more nuanced.

They say they cannot respond to texts because they are too locked im at work. They say they stay up all night to finish something that could have been done earlier. They say they do their best work under pressure but do not understand why they wait. They say they hold it together at work but cannot manage their home.

From the outside, it can look like inconsistency. From the inside, it feels like exhaustion.

I do not begin by trying to definitively separate anxiety from ADHD in a single session. That level of clarity often requires time and sometimes formal assessment. Instead, we look at patterns and responses. How does the brain function when anxiety decreases? What happens when structure is introduced? Does executive functioning improve, or do the difficulties remain?

I also remind women that their brain is not broken. Some brains require different kinds of support. Just as someone might need medication for blood pressure or diabetes, some people need medication or tools for attention and regulation. Removing shame is often the first and most important step.

When Anxiety Is the Primary Driver

When anxiety is primary, treating it changes something meaningful.

The nervous system calms and the mind slows down. Tasks that once felt impossible become manageable. Focus improves when the brain is no longer operating under constant threat.

In anxiety-driven executive dysfunction, once anxiety decreases, follow-through often improves.

With ADHD, the picture looks different. Anxiety may lessen, but the difficulty breaking tasks into smaller steps remains. Time management is still inconsistent. Prioritizing feels confusing. Compensating behaviors such as elaborate lists or overworking continue even after anxiety improves.

It can feel like a chicken-and-egg problem. Are you anxious because you struggle to complete tasks? Or are you struggling to complete tasks because anxiety overwhelms your thinking?

Often the answer becomes clearer through observation over time rather than a quick conclusion.

When ADHD Is Primary but Labeled as Anxiety

There are certain patterns that make me look more closely at ADHD.

When someone can no longer hold it together across multiple areas of life. When work demands increase, children are added to the picture, or responsibilities multiply and the old systems stop working. When anxiety treatment helps somewhat, but something still does not shift.

Many women believe that relying on anxiety helps them stay organized. Anxiety keeps them alert, but usually it keeps them over-prepared. The idea of reducing anxiety can feel frightening because it feels like the only thing holding everything together. But it is important to remember that anxiety is not keeping everything together, you are keeping everything together, and in fact your anxiety is only making it harder to keep everything together.

Emotional regulation is another important clue when thinking about ADHD. Emotion dysregulation is not often discussed in adult ADHD it is more frequently discussed in children, but emotional dysregulation remains part of the picture. It can show up in relationships in impulsivity or arguments that feel outsized to your partner or even yourself. Partners may describe someone as distracted, absent, lazy, or not caring. Over time, those messages create shame. And that shame leads women to not seek help, and just turn these feelings inward and identify with them as part of who they are. Not understanding it is part of ADHD.

Interestingly, many women who truly meet criteria for ADHD are hesitant to claim it. They do not want the label. They do not want to believe it is anything but themselves who are to blame for why things are so challenging. That reluctance can sometimes tell us more than certainty.

When It Is Both Anxiety and ADHD

Often the answer is not either-or.

ADHD and anxiety commonly coexist. ADHD can create anxiety through repeated experiences of missed deadlines, forgotten commitments, and relationship strain. Anxiety can worsen ADHD symptoms by overwhelming working memory and narrowing attention.

In my practice, I often address anxiety first. It is generally easier to approach and more socially accepted. We see what changes. If executive functioning challenges persist, we explore ADHD more directly.

Treatment is collaborative. I frequently recommend coordinating care with a psychiatrist so we can evaluate medication thoughtfully while continuing therapy. The process is rarely immediate. It unfolds gradually and carefully.

Looking at Patterns Over Time

More important than any single symptom is the pattern across your life.

What were you called growing up? Forgetful? Messy? Head in the clouds? Not living up to your potential?

Did you consistently lose things? Procrastinate? Struggle to organize? Or did these issues appear after a traumatic event or prolonged stress?

Many intelligent women compensate well until the demands exceed their coping strategies. This may happen in high school, college, graduate training, motherhood, or a demanding career.

The key question is not whether you meet a checklist. It is how your experience has unfolded over time.

The Risk of Oversimplifying ADHD

Online conversations about adult ADHD have helped many women feel understood. They have also simplified a complex condition.

Executive dysfunction can result from anxiety, depression, trauma, sleep deprivation, burnout, or simply having too much responsibility. It is not always ADHD.

At the same time, sometimes people are right. When we step back and examine years of consistent patterns, ADHD becomes clearer.

The goal is not to dismiss curiosity. The goal is to approach it carefully and responsibly.

If You Are Still Not Sure

You do not need certainty before seeking support.

Sometimes we begin with behavioral strategies. Sometimes we focus on mood or anxiety. Sometimes we refer to psychiatry for evaluation. Often we do these things together, adjusting as we learn more.

It is okay to know. It is also okay to not know.

If this question has been on your mind, you may also find it helpful to read my article on ADHD in women and why it is often missed. And if you would like to talk through your own experience, I offer free consultations so we can explore what may be going on and what kind of support would feel most helpful.

You do not have to sort this out alone.