ADHD is often missed when it co-exists with depression or anxiety, and vice versa. Here’s what to look for — and how to ensure you get a thorough and accurate diagnosis.
Studies find that 80 percent of people with ADHD will have at least one other psychiatric disorder in their lifetime. The two most common are depression and an anxiety disorder, like obsessive-compulsive disorder (OCD) or generalized anxiety disorder (GAD).
ADHD without a comorbid disorder is the exception rather than the rule. Having ADHD is challenging enough, but the other disorders that accompany ADHD profoundly affect a person’s daily life. A patient of mine, Antonio, knows this well. Although his ADHD was diagnosed when he was in fifth grade, his anxiety disorder was not caught until his last year of college.
“Everyone assumed that my anxiety behaviors were just the hyperactivity part of my ADHD,” he says. Years of his life were spent suffering from paralyzing anxiety that resulted in his missing classes, being housebound for days, and not being able to work.
When ADHD and another disorder co-occur, there will likely be one of the following scenarios:
1. The ADHD has been diagnosed, but the comorbid disorder has not been. Doctors sometimes mistakenly chalk up depressive and anxiety symptoms to the ADHD diagnosis, as in Antonio’s case. The comorbid disorder can be independent of the ADHD (primary) or a direct result of ADHD symptoms (secondary).
Corey was never an anxious person before he went to college. But, without the structure of high school and his parents’ support, he felt lost. His ADHD and executive functioning deficits stymied him. He had severe anxiety about taking tests and writing papers, which led to poor sleep. His sleeplessness caused him to feel “on edge” all the time. He met the criteria for having an anxiety disorder and needed treatment, even though it was secondary to his ADHD.
A secondary diagnosis does not make anxiety less challenging to live with. There is a parallel to substance abuse. Most people who abuse drugs or alcohol are depressed or anxious, yet the addiction is a separate entity that must be dealt with, in addition to its underlying causes.
2. The depression or anxiety has been identified and diagnosed, but the ADHD has not been. Doctors see ADHD symptoms as part of the comorbid disorder. Janice had a severe binge-eating disorder, and her doctor assumed that her impulsivity and lack of concentration were due to that disorder. Her previous therapist questioned whether she really wanted to get better because she was late for many of her appointments.
3. ADHD and the comorbid disorder are both diagnosed and treated — the ideal scenario. A patient’s doctor focuses on depression or anxiety’s effect on ADHD and vice versa. The ADHD affects the comorbid disorder and, in turn, is affected by depression or anxiety, whether or not the comorbid disorder results from ADHD. When someone struggles with two conditions, the symptoms of each disorder are more intense.
To avoid the plight of Antonio, Corey, and Janice, it is important that your doctor get the diagnosis right. Here is a checklist of symptoms you and she should be looking for, questions your doctor should be asking you, and some tools she should be using to assess you.
Taken from additudemag