A new study finds that almost one in five women seeking treatment for anxiety or depression also meet criteria for ADHD, with nearly half of these cases previously undiagnosed. The research, published in The International Journal of Psychiatry in Medicine, highlights how overlapping symptoms can mask an underlying attention condition in adult women.
ADHD, a neurodevelopmental condition characterised by inattention, hyperactivity and impulsivity, has historically been diagnosed far more often in males. In clinical settings, the male-to-female ratio sits around ten to one, though population surveys suggest the gap is narrower in real-world settings.
Women often present with subtler, internalising symptoms such as emotional sensitivity or internal restlessness. These patterns can be mistaken for mood or anxiety disorders, meaning the underlying attention problems are frequently missed when conditions like major depressive disorder or generalized anxiety disorder overlap with ADHD traits.
An additional feature commonly reported by people with ADHD is hyperfocus — episodes of intense, prolonged concentration on specific tasks that can shut out other stimuli. Although not an official diagnostic criterion, hyperfocus is well-documented and can significantly affect daily functioning.
The research was conducted by Hazal Yavuzlar Civan and Tonguc Demir Berkol from the Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery in Istanbul, Turkey. They sought to understand how ADHD manifests in women already seeking help for mood problems and to explore whether hyperfocus could help clinicians distinguish these conditions.
The researchers recruited 170 female patients at outpatient psychiatric clinics. Participants first completed the Beck Depression Inventory and the Beck Anxiety Inventory, standard measures of depressive and anxious symptom severity. Women scoring above the clinical threshold then undertook additional surveys.
Follow-up surveys included the Wender Utah Rating Scale to measure childhood ADHD traits, a separate screening tool for adult ADHD symptoms, and the Hyperfocus Scale. After completing the questionnaires, a trained psychiatrist conducted a structured clinical interview with each participant, with final diagnoses based on standard psychiatric guidelines.
Findings and implications
The clinical interviews revealed that 33 of the 170 women met the criteria for ADHD, and among them, 15 had no prior ADHD diagnosis. ADHD was particularly prevalent among women experiencing social anxiety disorder and a condition known as double depression, where a severe depressive episode sits atop a chronic low mood.
The women with ADHD reported distinct life experiences compared with those who had mood or anxiety disorders alone. They faced more disciplinary issues in school, changed jobs more frequently, and had a higher incidence of family members with ADHD. Past suicide attempts did not differ significantly between groups, but those with ADHD reported higher levels of current suicidal thoughts and feelings of failure.
In terms of depressive symptoms, the non-ADHD group showed more concerns about physical health and changes in sleeping patterns. The authors suggest this health-focused worry reflects a somatic orientation more typical of anxiety and depression.
Conversely, individuals with ADHD often display impaired interoception, making it harder to recognise internal physical states. This altered awareness may mean they notice and report physical symptoms such as poor sleep less readily.
ADHD proved highly prevalent among women with social anxiety disorder. The researchers propose that social anxiety in these patients may be driven by ADHD-related executive dysfunction, which impairs planning, organisation and interpretation of social cues. Difficulties in self-regulation can lead to repeated interpersonal failures, fostering lasting shame and fear of social evaluation.
The researchers identified distinct patterns regarding symptom overlap. In the non-ADHD group, higher attention deficit scores correlated with worse depression, while higher hyperactivity scores correlated with worse anxiety. Hyperfocus scores also rose alongside general ADHD-like symptoms in these women.
Women diagnosed with ADHD did not show these same statistical correlations. While their overall hyperfocus scores were substantially higher than the non-ADHD group, the severity of their hyperfocus did not track directly with mood or anxiety severity. The authors suggest hyperfocus may function as a coping mechanism in ADHD but as a maladaptive trait in mood disorders.
The study emphasises that similar symptoms can stem from different root causes. Both ADHD and anxiety can involve restlessness, distractibility and tension, but in anxiety, inattention typically stems from excessive worry and tends to improve in relaxed settings. ADHD-related inattention, by contrast, tends to be persistent across settings and life, with early onset and associated with initiation and organisational difficulties.
Because of the cross-sectional design, the researchers cannot determine the sequence of symptom onset. It remains unclear whether ADHD symptoms preceded depressive and anxious symptoms or vice versa.
The sample consisted solely of women seeking outpatient psychiatric care, so findings may differ for men, those not seeking treatment, or individuals treated in inpatient settings. The group diagnosed with ADHD was smaller, which limits the statistical power of certain comparisons.
Future research should follow patients over longer periods to map how these overlapping conditions evolve. The authors suggest incorporating biological markers or examining broader populations to clarify how hyperfocus operates across different mental health diagnoses.
The study is titled “ADHD Comorbidity in Women With Depression and Anxiety: Prevalence, Clinical Features and Hyperfocus Dynamics” and was authored by Hazal Yavuzlar Civan and Tonguc Demir Berkol.
