Almost one in five women seeking help for anxiety or depression may have attention deficit hyperactivity disorder (ADHD) - a condition in which a person has difficulty concentrating, is impulsive and/or overly active. In almost half of such cases, this diagnosis had not been made before. This is reported in a study published in The International Journal of Psychiatry in Medicine.
The authors - psychiatrists Hazal Yavuzlar Civan and Tonguc Demir Berkol from Istanbul's Bakirkoy Professor Dr. Mazhar Osman Hospital - examined 170 women who came to outpatient psychiatric clinics. First, the participants completed Beck questionnaires to assess the severity of depression and anxiety. Those whose scores exceeded the clinical threshold underwent additional tests: the Wender Utah Rating Scale (about childhood ADHD traits), an adult ADHD screening and a hyperfocus scale. Then each woman was interviewed by a trained psychiatrist using a structured interview, and the final diagnosis was made according to standard psychiatric guidelines.
It turned out that 33 of the 170 women had ADHD, and 15 of them had not been diagnosed with it before. ADHD was especially common in patients with social anxiety disorder and so-called double depression - when a severe depressive episode is superimposed on long-term low mood.
Women with ADHD more often had disciplinary problems at school, more often changed jobs and more often reported relatives with ADHD. The number of past suicide attempts did not differ statistically significantly between the two groups, but current suicidal thoughts and feelings of failure were more pronounced in participants with ADHD.
Depression symptoms also differed. Women without ADHD complained more about health problems and changes in sleep. The authors suggest that such focus on bodily sensations is characteristic of anxiety and depression. In ADHD, by contrast, interoception - the ability to recognize internal signals from the body - is often impaired, so physical symptoms, including poor sleep, may be noticed less often.
The researchers also studied hyperfocus - episodes of excessively prolonged concentration on a task to the detriment of everything else. This is not an official diagnostic criterion, but it affects daily life. In women without ADHD, higher attention-deficit scores correlated (were statistically associated, which in itself does not prove causation) with more severe depression, and hyperactivity scores with more severe anxiety. In women with ADHD there were no such associations, although the overall level of hyperfocus was higher. The authors suggest that hyperfocus may play different roles: it may be a coping strategy in ADHD and a maladaptive trait in mood disorders.
The scientists recall that both ADHD and anxiety can manifest as restlessness and distractibility. But in anxiety, inattention is usually caused by excessive worry and weakens in a calm environment, whereas in ADHD it is persistent across different situations and often noticeable from an early age. To distinguish primary ADHD from secondary attention problems against the background of mood disorders, a detailed developmental history is needed.
The study has limitations. It is a cross-section - all measurements were made at a single point in time, so it is impossible to determine what appeared first. The sample included only women seeking outpatient psychiatric care; the picture may be different in men, people outside treatment or inpatient patients. The ADHD group was significantly smaller, which reduces the statistical power of some comparisons. The authors call for long-term observations and consideration of biological markers.