Anxiety or ADHD – Which Disorder Do I Have?

For many patients and doctors, these can two disorders can be the hardest to distinguish from one another. After all, both can affect concentration, make people distractible and forgetful, and result in impulsive or rash decisions that can sometimes have bad consequences. Anxiety and ADHD also make many people feel uncomfortably energized or “keyed up.” Unfortunately, the Internet—where many turn to for answers—has not proven very helpful for the public.   Most sites just tend to reproduce lists from the DSM-5®, the manual that mental health professionals such as psychiatrists, psychologists and therapists refer to for diagnosing disorders.   This can be similarly confusing for many to digest. In addition, there are several subtypes of ADHD, as well as many different anxiety disorders. As a result, many patients often find themselves overwhelmed with the labels themselves, or convinced that they meet the criteria for the diagnosis. This sometimes even creates more anxiety! It also seems that once the label has been given, it seems to stick. The potentially unsafe consequence is that, if you actually have anxiety, and you are prescribed stimulants for ADHD (such as Adderall® or Ritalin®), it can make anxiety symptoms worse. Ideally, the best way to discern the two diagnoses is a carefully taken history from the patient. Some brief patient questionnaires can be helpful (such as the Becks Anxiety Inventory® or the Adult ADHD Self Report scale®). The gold standard is psychological testing to help accurately pinpoint specific symptoms. However, because it can take time to administer and score, testing is usually done after a tentative diagnosis has been made and treatment has already been started. In my own approach to this, I usually try to look for anxiety first.   Anxiety is more common and is usually much more uncomfortable for the patient. If anxiety is properly treated, it can also help clear the air diagnostically.  When a patient is less worried, anxious or tense, they can simply concentrate a lot better. Then, I will ask the patient: “What’s still there?” It is also usually safer to start anti anxiety medications first as, unlike stimulants for ADHD, they do not potentially worsen anxiety or complicate the picture. Other pointers include the fact that ADHD is sometimes more noticeable to others than the patient such as employers, teachers and family. Conversely, anxiety is always more troublesome for the patient. Both can, of course, affect school grades, work performance, and relationships. The most common cause of distractibility and inattention that we see in clinical practice is usually worrying, also known as ruminations.  This is when a person finds himself so consumed in analyzing a seemingly unsolvable issue that their thinking circulates back to the same topic over and over again. As a result they can lose sight of the task at hand. Treatment itself can also be informative. This is where the patient’s response to medication can either help confirm or cast doubt on the diagnosis made. For example, most patients will usually tell you when the ADHD medications, which can be quite short acting in duration, wear off and how they notice their disorganized and haphazard decision-making returning by the end of the day. For many, anxiety does not just mean poor concentration. It can manifest in very disabling ways such as physical symptoms (elevated heartbeat, chest pain, shortness of breath), muscle tension or even panic attacks (sudden onset intense anxiety). ADHD is never usually that intrusive or uncomfortable. In addition, many patients with anxiety will complain of co-existing depressive symptoms that can affect interest in things or concentration. This again is less common with ADHD. Nothing will ever substitute a candid conversation with your clinician about your symptoms. This will hopefully uncover patterns, causes, and consequences. The good news is that both disorders are actually quite treatable once the appropriate medications, therapy, and lifestyle changes are made.