ADHD and Anxiety in Adults: How to Tell Them Apart—and What to Do When You Have Both
Friday, March 28, 2025. This is for my new client, at my public health clinic, Nicholas, my first session on Fridays.
If ADHD and anxiety were characters in a sitcom, ADHD would be the lovable chaos agent with a million ideas and zero follow-through, while anxiety would be the neurotic roommate constantly cleaning up after them and muttering about deadlines.
Together? They’re exhausting—but also oddly relatable.
For adults—especially in romantic relationships—the co-occurrence of ADHD and anxiety isn’t just common; it’s a clinical headache.
They amplify each other in unpredictable ways.
ADHD forgets to pay the bill. Anxiety lies awake all night obsessing about identity theft. ADHD gets distracted mid-sentence. Anxiety spirals into self-doubt and rumination.
Yikes! Let’s jump in!
The Mental Health Power Couple No One Asked For
This post will explore the science behind adult ADHD and anxiety, how they fuel each other in daily life and relationships, and what couples, families, and therapists can do to untangle this cognitive chaos.
Along the way, we’ll introduce specific concepts—like “executive dysfunction,” “emotional dysregulation,” and “time blindness”—and give you practical tools grounded in research, with a side of compassionate humor.
The ADHD-Anxiety Overlap: One Brain, Two Operating Systems
Shared Symptoms, Different Roots
Let’s get all diagnostic for a moment.
ADHD (Attention-Deficit/Hyperactivity Disorder) is a neurodevelopmental disorder rooted in executive function deficits—things like working memory, impulse control, and sustained attention.
Generalized anxiety disorder (GAD), by contrast, stems from overactivation of the brain’s threat detection system, especially the amygdala.
Yet they often present similarly: restlessness, distractibility, trouble sleeping, racing thoughts, chronic procrastination.
This shared symptom profile leads many adults to be misdiagnosed or underdiagnosed—especially women and people of color, whose ADHD may present as perfectionism or people-pleasing rather than hyperactivity (Quinn & Madhoo, 2014).
Which Came First: The Dopamine Deficit or the Existential Dread?
ADHD often precedes anxiety, but chronic failure, social judgment, and school/work struggles can trigger an anxiety disorder.
This is sometimes referred to as secondary anxiety, a downstream effect of living with a brain that doesn’t sync with neurotypical expectations (Torgersen et al., 2006).
But it also goes the other way.
Chronic anxiety can mask ADHD by fueling hypervigilance, compulsive checking, and perfectionistic compensations—especially in high-functioning adults.
Many finally receive an ADHD diagnosis in adulthood after decades of managing anxiety with spreadsheets, coffee, and shame.
What Happens When ADHD and Anxiety Show Up Together
Time Blindness + Catastrophic Thinking = Disaster Planning on a Loop
Let’s say you have a report due Friday.
Your ADHD brain says: “I’ll start it Thursday night when the pressure is real.”
Your anxious brain says: “If we don’t start now, we’ll be homeless by June.”
Your body says: “Let’s take a nap.”
Welcome to the paradox: ADHD avoids, while anxiety anticipates. ADHD says “Later.” Anxiety says “Now.” The result is chronic inner conflict, guilt, and burnout—a phenomenon so common it has its own subreddits.
Emotional Dysregulation: When Small Problems Feel Life-Threatening
Both ADHD and anxiety come with a hidden symptom: emotional dysregulation.
This means, for some folks, a minor annoyance—like a forgotten password or a partner's comment—can trigger a meltdown or a shutdown.
Relationships suffer, not because of lack of love, but because of nervous systems in constant overdrive.
One partner may see the other as "overreacting" or "not trying hard enough," when, in fact, they're experiencing a neurological traffic jam of cortisol, adrenaline, and unmet dopamine needs.
ADHD and Anxiety in Relationships: The Attachment Dance of Doom
Real-Life Case Study (Names Changed to Protect the Guilty)
Lena (anxious-preoccupied attachment, spreadsheets, runs early)
Rob (ADHD, avoidant attachment, snacks at midnight, allergic to plans)
Lena feels like she’s always reminding, managing, and preparing. Rob feels micromanaged, judged, and perpetually “in trouble.”
Lena thinks: “If I don’t do it, it won’t get done.” Rob thinks: “If I try and fail again, she’ll be disappointed.”
Both are right. Both are hurting.
This dynamic is a classic manifestation of the ADHD-anxiety polarity in romantic relationships: one partner over-functions while the other under-functions—not because of character flaws, but because of mismatched coping mechanisms.
Executive Dysfunction Isn't Laziness. It’s a Circuit Breaker.
Let’s clear something up for anyone who loves (or is) a person with untreated ADHD: forgetting isn’t careless.
Missing deadlines isn’t disrespectful.
It’s executive dysfunction, and it’s as real as a broken leg.
You wouldn’t shame a friend for not running a marathon with a sprained ankle. ADHD brains have neurological limits that can’t be powered through with positive affirmations alone.
Understanding whether your freeze response is coming from ADHD or anxiety changes how you treat it.
ADHD responds well to external structure and dopamine-enhancing rewards. Anxiety responds well to soothing safety cues, mindfulness, and slow exposure to fear.
You can’t treat anxiety by yelling “focus!” at your ADHD, and you can’t treat ADHD by telling your anxious brain to “just calm down.”
What Actually Helps? ADHD and Anxiety Coping Strategies for Adults
Use the Body to Calm the Brain
When the mind is spinning, start with the nervous system. Try:
Cold water on the face (vagus nerve hack)
30 seconds of intense cardio
Grounding through texture, scent, or pressure
Create Rituals for Emotional Regulation
Neurodiverse couples often benefit from scheduled “transition rituals” like:
Five-minute check-ins after work
Morning planning sessions with coffee
Digital intimacy rituals to stay connected asynchronously
These routines serve as anchors in time, reducing chaos and reducing both overwhelm and anticipatory dread.
Name the Combo and Claim It
One of the most powerful interventions?
Language.
Call it: "My ADHD-anxiety spiral is flaring up."
This reduces self-blame and invites shared problem-solving. Some couples even name the combo something ridiculous—“Captain Crunchbrain”—to help disarm shame and restore playfulness.
Medication May Help—But It’s Not a Magic Pill
Stimulants like Adderall or Vyvanse can boost focus, but they may also ramp up anxiety. Anti-anxiety meds may calm nerves but worsen motivation.
The gold standard? A carefully managed, personalized treatment plan that addresses both sides. And most critically, a good therapist trained deeply in neurodivergence.
Final Thoughts: The Art of Holding Complexity
Living with ADHD and anxiety isn’t a character flaw—it’s a neurobiological condition compounded by a cultural mismatch.
Modern society rewards hyper-efficiency, linear productivity, and emotional containment.
I think of ADHD and anxiety as protest songs against that system—loud, messy, but full of truth.
For my couples, families, and individual clients, the path forward isn’t perfection.
It’s noticing. It’s naming.
And for couples grappling with this combo, it’s designing a life—together—with intention that embraces both of your neurodiverse rhythms and nervous system truths.
You’re not broken.
Your brain just has more tabs open than the average neuronormative browser.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., ... & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723.
Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3).
Torgersen, T., Gjervan, B., Rasmussen, K. (2006). ADHD in adults: A study of clinical features and co-morbidity. Nordic Journal of Psychiatry, 60(1), 38–43.
Tuckman, A. (2012). More Attention, Less Deficit: Success Strategies for Adults with ADHD. Specialty Press.
Maté, G. (2003). When the Body Says No: Exploring the Stress-Disease Connection. Knopf Canada.