The woman with ADHD, that great unknown
Every time I write about being a woman with attention deficit hyperactivity disorder (ADHD), I always mention how difficult it is to be a woman, and I emphasize that being a woman with ADHD is even more so. So I'm not going to resist the urge to do this, for several reasons: first, because I have ADHD and impulsivity can be a powerful factor, and second, because it's true. Being a woman with ADHD is a dangerous combination , since the implications for us are much more serious and are less researched and diagnosed than in men.
The most obvious evidence is that, historically, the prevalence in childhood has been one girl for every three boys, although in adulthood these figures are equal, demonstrating a clear delay in diagnosis for girls and adolescents . In fact, the average age for diagnosis in males is 7 years, compared to 38 for females (INECAP). Many are unaware of their condition until adulthood, and it is then that they seek help, feeling overwhelmed or finding answers to their problems through their children's diagnosis , because they identify similar patterns and behaviors between them. So, yes, being a woman with ADHD is truly complex. But why is this?
I've been diagnosed with ADHD as an adult, now what?
The difficulties in diagnosing ADHD in women
This late diagnosis is not only a matter of lack of awareness, but is directly related to the different ways symptoms manifest in men and women . ADHD in girls often goes unnoticed because they are more likely than boys to have the inattentive subtype, compared to the hyperactive subtype in boys, which is more disruptive, more bothersome, and raises red flags indicating that something is wrong.
Being a woman and having ADHD is a dangerous combination, as the implications for us are much more serious and are less researched and diagnosed than in men.
On the other hand, women develop compensatory strategies , which translates into a lower probability of academic failure and behavioral problems, and greater ease in obtaining and maintaining a good job or managing their home and family effectively. It may seem simple, but the truth is that this apparent success in managing the symptoms comes at a very high price, as it requires a superhuman effort to go unnoticed and try to fit in.
On the other hand, when women decide to see a doctor, comorbidities associated with ADHD are often given more weight than the disorder itself. Women have higher rates of depression, anxiety, mood disorders, and cognitive difficulties. With so many options, any combination of these comorbid problems creates a truly complex diagnostic picture.
It's important to remember that the endocrine system significantly influences the onset and intensity of symptoms. The fluctuations in estrogen secretion we experience during our menstrual cycle play a major role in altering dopamine production. This affects the nature and intensity of symptoms, leading to increased irritability and impulsivity . A girl going through puberty experiences a significant increase in levels of sex hormones such as estrogen and progesterone, which leads to a worsening of symptoms , especially impulsivity and inattention. This is often simplistically attributed to puberty without understanding that ADHD plays a significant role in this situation. The same occurs during menopause , a period in which symptoms multiply, although in this case, due to the opposite: a drop in estrogen levels.
Anna
Gender bias
And, on the other hand, there is a clear problem of roles and gender since our society places more demanding expectations on women at the school, professional or personal level than on men, and many fail to meet these demands, since they have an undiagnosed condition.
To all this, we must add the gender bias , which favors men, since their diagnosis carries disproportionate weight compared to women's. Until relatively recently, it was assumed that ADHD was a disorder only present in men. This was due to the way cases were assessed, as it failed to take into account that the symptoms manifested differently in women.
Our society places more demanding expectations on women at the school, professional or personal level than on men, and many fail to meet these demands because they have an undiagnosed condition.
Gender bias has historically led to male research subjects being favored over female subjects in many medical and mental disorders, and even to women being excluded from clinical trials . Therefore, this bias contributes to misdiagnosis and a lack of focus on the female manifestations of ADHD compared to an overemphasis on male symptoms.
How does ADHD manifest in adult women?
This different presentation of symptoms has implications for women's daily lives. These are some of the most disruptive:
- Difficulty with time management and organization.
- Frequent forgetfulness.
- Concentration problems.
- Low self-esteem.
- Increased emotional sensitivity, stress, anxiety, and depression.
- Chronic fatigue.
- High levels of perfectionism, self-demand, and procrastination.
- Problems in social and interpersonal relationships.
Daily life with ADHD
Consequences of the lack of diagnosis
The absence of a diagnosis or a misdiagnosis has serious consequences. Women with undiagnosed ADHD are more likely to experience physical, emotional, and other problems in various areas of life, such as:
- Depression, anxiety, or personality disorders.
- Emotional instability.
- Low self-esteem.
- Insomnia.
- Frustration.
- Experiencing a divorce.
- Forming single-parent families.
- Having little education.
- Being underemployed or unemployed.
- Obesity and fibromyalgia.
- Constant stress due to difficulty in managing the demands of daily life.
- Shorter life expectancy due to accidents or suicidal thoughts.
The diagnosis is the turning point. Putting a name to what has been with us throughout our lives implies, in turn, a multidisciplinary treatment that requires a combination of medication, psychoeducation, and family and social support. Medication can help regulate neurotransmitters, but it is also essential to provide the tools for the daily management of symptoms.
The diagnosis provides answers that help us with the acceptance of our condition, with self-knowledge, and with the possibility of developing the positive aspects of our ADHD.
Fortunately, diagnoses are increasing among adult women and have arguably doubled since 2020 (Lynch, 2024). This doesn't mean that ADHD is trendy or overdiagnosed, but rather that medicine is gradually taking our reality into account . Nevertheless, it remains essential to dismantle prejudices, improve training for healthcare professionals , and understand gender differences to achieve a more inclusive and understanding future for us.
Ultimately, early diagnosis of ADHD is the initial step for women to reverse their life process, as it offers a neurobiological explanation of why things are so difficult for us and provides us with strategies to take ownership of our neurodivergence.
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