The ramifications of abuse are dire and, in some cases, life-threatening: half of female homicide victims are killed by current or former partners.² The consequences of psychological abuse — the most frequent kind of IPV and often a precursor to physical violence — are no less critical. Research shows that psychological abuse is an even stronger predictor of post-traumatic stress disorder and depression than is physical abuse.³

Though intimate partner violence is startlingly common and harmful, many avenues can lead victims to help and health care providers are instrumental in connecting patients to these paths. Though traditional IPV screening is an effective intervention, it’s not the only one. For some providers, distributing safety cards may be a better fit.

The size of business cards, these safety cards contain information about the red flags and health consequences of IPV. They share contact information for hotlines as well as guidance for safely seeking help, and they let people know they’re not alone.

“It takes 30 to 45 seconds to share the card, and it can change someone’s life,” says Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. “We hear from women with lived experience of violence: ‘Why didn’t anyone ever give me something like this? It could have made all the difference to me.’”

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Obstacles to IPV Screening

With traditional IPV screening, a provider uses a survey like the HITS (Hurt, Insult, Threaten, Scream) to detect if a patient is experiencing violence. This can be transformative.

“If you trust your provider, it can be a very empowering experience to connect with someone who can listen, make you feel less alone, talk to you about making decisions,” Sullivan says.

But several significant obstacles stand in the way of effective screening for IPV. Survivors may be hesitant to disclose their experiences of violence, fearful of retaliation by their partners, or of being reported to police and potentially losing custody of their children. They may worry they’ll be judged, blamed, or shamed. These concerns may be particularly salient for women with ADHD who receive near-constant criticism, correction, and judgement.

[Watch: “How to Avoid Toxic Relationships and Find Your Ideal Match”]

These obstacles contribute to relatively low rates of disclosure in IPV screenings; less than a quarter of women who have experienced IPV report disclosing this to a health care provider.⁴

The efficacy of screenings also relies on a meaningful response from the provider. Many providers don’t feel comfortable addressing such a sensitive and personal revelation because they’ve not received training in IPV.

“We shouldn’t expect people to develop expertise in responding,” Sullivan explains. “But we want the provider to feel comfortable enough so that they’re not being judgmental, so they can let the person know they’re heard, and connect them to someone who does have expertise.”

If a survivor reveals abuse on a survey and her disclosure is never addressed, or if it’s met with judgement, Sullivan explains, it can discourage her from revealing the abuse to others in the future.

Safety Cards: A Universal Approach

The part of IPV screening that helps survivors most, research has found, is the engagement with support services that happens after disclosure.⁵ This is where safety cards come in.

IPV safety cards, which are distinct from screening methods, bypass surveys altogether and take a direct path to offering help.

The method is simple: Providers order safety cards like these for free and hand them out to every female patient they see (without their partner present). The cards come in 10 languages and contain information about the red flags and health consequences of IPV. They also connect patients to support and resource hotlines

For providers looking for guidance on how to distribute the cards, Sullivan suggests the following language:

“We’ve started talking with all of our patients about relationship health and abuse in relationships, in case it’s ever an issue for them or for their friends and family. This card talks about healthy and safe relationships, ones that aren’t — and how relationships affect your health.”

Safety cards offer myriad benefits, including:

• Getting help to the people who need it, no questions asked. Offering resources to everyone, a universal education model, ensures that the women who need help will get access to it – regardless of whether they disclose abuse.
• Empowering women to help others. Many of the patients who receive cards may not be experiencing IPV, but they may know people who are. Safety cards enable these individuals to recognize abuse in the lives of loved ones, and empower them to offer helpful resources. Research found that people who received universal education were twice as likely as those who did not to share the number for an IPV hotline to someone in need.⁶
• De-stigmatizing conversations about IPV. Broaching the topic of intimate partner violence to all patients helps to break the taboo which often keeps women silent about their experience.
• Planting a seed for future action. It’s important for providers to distribute safety cards at every visit because it may take more than one interaction for patients to recognize abuse in their own lives, or to prepare themselves to consider next steps.  “Often, the cards plant a seed for future action. You give it to patients every time they come in so that it’s routine and becomes comfortable,” Sullivan says. “They come to understand that their relationships affect their health.”

While disclosures aren’t necessary in this IPV intervention, they may happen. When responding, providers should use non-judgmental, validating language, and avoid directing patients to take specific action. “It should never be a provider, trained or not, telling people what they should do,” Sullivan explains. “Though it’s likely well-intentioned, this prescriptive approach mimics the dynamics of abuse and disempowerment.”

Instead, follow the patient’s lead. “Let people know the supports available to them and listen to them,” suggests Sullivan. “You might ask: ‘Have you thought about what you want to do? Do you want help thinking about what makes sense? Would you like to call a helpline from this office?’”

What survivors of abuse need from providers, Sullivan explains, is autonomy, empathy, and information about their options for getting help.

To Order Free Safety Cards

• Visit Futures Without Violence.

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help

• National Domestic Violence Hotline, Call 800-799-7233 or text START to 8878
• Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 2252
• National Sexual Assault Helpline, Call 1-800-656-HOPE

Abusive Relationships and IPV Screening: Next Steps

• Read: “What Are the Signs of a Controlling Relationship?”
• Quiz: “Is My Relationship Toxic?” A Quiz for Adults with ADHD
• Read: How to Respond to Gaslighting — In Your Relationship and In Yourself

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

²Jack SP, Petrosky E, Lyons BH, et al. Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015. MMWR Surveill Summ 2018;67(No. SS-11):1–32.

³Mechanic MB, Weaver TL, Resick PA. Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse. Violence Against Women. 2008 Jun;14(6):634-54. doi: 10.1177/1077801208319283. PMID: 18535306; PMCID: PMC2967430.

⁴Black MC, Basile KC, Breiding MJ, et al. The national intimate partner and sexual violence survey: 2010 summary report. Atlanta, GA Natl Cent Inj Prev Control Centers Dis Control Prev. 2011;19:39-40.

⁵US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Grossman DC, Kemper AR, Kubik M, Kurth A, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018 Oct 23;320(16):1678-1687. doi: 10.1001/jama.2018.14741. PMID: 30357305.

⁶Miller E, Tancredi DJ, Decker MR, et al. A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial. Contraception. 2016;94(1):58-67. doi:10.1016/j.contraception.2016.02.009

ADHD symptoms are impacted by changes in sex hormone levels in females across the lifespan, finds a new systematic review published in the Journal of Attention Disorders.¹ The review included 11 studies that investigated puberty, pregnancy, postpartum, and the menstrual cycle and tracked changes in symptomology and in the efficacy of ADHD medication during these times.

“There is an ADHD experience that is unique to females,” the study’s authors concluded. “Recognizing potential influences of sex hormones on ADHD symptoms in females may have key implications to clinical management and treatment of ADHD.”

The study included several key findings.

Sex Hormones and ADHD During Menstrual Cycle

The research reviewed four studies that explored the fluctuation of ADHD symptoms during the menstrual cycle. The following associations were identified:

• Early luteal phase: increased impulsivity and hyperactivity²
• Mid-luteal phase: increased emotional dysregulation, executive dysfunction, inattention³
• Late luteal phase: increased inattention and executive dysfunction, and mental health symptoms such as depression, irritability and anxiety⁴

Linking these symptom trends to increase and decrease of specific female hormones, the authors wrote: “Inattention symptoms may be related to decreasing estrogen and moderated by progesterone, whereas hyperactive/impulsivity symptoms may similarly be driven by reducing estrogen levels, though without effect of progesterone.” ⁵

These significant shifts in symptom severity were vividly described by Chloe, an ADDitude reader, in an article titled “Menstrual Cycle Phases and ADHD.” “The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual,” she wrote. “My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.”

The review found that increasing stimulant dosage premenstrually resulted in improvement of ADHD and mood symptoms, including emotional dysregulation. This point was echoed in the lived experience of many ADDitide readers, who reported that their typical medication dosage seems less effective in the luteal phase of their cycle. Norma, a reader from Wisconsin wrote: “The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.”

Sex Hormones and ADHD in Pregnancy and Postpartum

The review included one study investigating ADHD in pregnancy.⁶ Three groups of pregnant women were included: those who discontinued ADHD medication, those who continued, and those who took medication as needed.

The study found hyperactivity symptoms were significantly lower and both mood and family functioning were better among the women who continued medication compared to those who discontinued. Other ADHD symptoms did not differ between the groups, leading researchers to theorize that, for some, the high estrogen of pregnancy may ameliorate certain ADHD symptoms. Because just one study was reviewed, and its sample size was small, the authors stressed that more research is required to contextualize the results.

Allison Baker, M.D., lead author for the study included in the review, wrote about her findings in an article for ADDitude, “Treating for Two:” “Women who discontinued stimulant treatment during pregnancy were more likely to experience conflict within their family, rate parenting as more difficult, and report feeling more isolated. Those who discontinued stimulants but did not stop taking their antidepressant medication, experienced a clinically significant increase in depression.”

While the study did not investigate an association between ADHD and postpartum depression, other studies have found that 17% of women with ADHD experience PPD compared to 3.3% of women without ADHD. and 25% experience postpartum anxiety disorders, compared to 4.61% of women without ADHD.⁷

“New mothers with ADHD face distinct postpartum challenges that are as ubiquitous as they are unstudied,” wrote Baker in “Postpartum Care for Mothers with ADHD.” “The months following the birth of a baby are uniquely difficult, and women with ADHD do not usually receive the medical support and treatments they need during this time.

Future Research on Hormones and ADHD

Understanding the role that sex hormones play on ADHD symptoms in women has far-reaching implications for diagnosing the condition and treating it. The review’s authors put forth the following interventions as possible ways to improve ADHD symptoms exacerbated by female hormones:

• premenstrual adjustment of stimulant dose ⁸
• use of hormonal therapies to stabilize estrogen and progesterone levels during menopause⁹ for those who struggle with PMDD ¹⁰

The main limitation of the review, authors acknowledged, is the small number of studies included, many of which include small sample sizes. “To advance our understanding of ADHD in females, research that seeks to understand the mechanisms underlying how sex hormones may influence ADHD symptoms is essential,” they wrote, calling for a multi-disciplinary approach that combines assessments of hormone levels with neurocognitive, brain imaging, genetic, or neurophysiological investigations.

This call for research was echoed in the ADDitude magazine article “Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research,” written by five leading experts on ADHD in women, including Michelle M. Martel, Ph.D., a lead author of several of the studies included in the review. “We know that hormones collide with ADHD to cause heightened mood dysregulation, memory problems, and impulsivity each month,” the authors explained. “But we don’t yet see the big picture of how symptoms manifest during different reproductive stages because research is scant and leaves more questions than answers.”

Sources

¹Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547251332319

²Roberts B., Eisenlohr-Moul T., Martel M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

³Bürger I., Erlandsson K., Borneskog C. (2024). Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences. Sexual & Reproductive Healthcare, 40, Article 100975. https://doi.org/10.1016/j.srhc.2024.100975

⁴de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

⁵Eng A. G., Nirjar U., Elkins A. R., Sizemore Y. J., Monticello K. N., Petersen M. K., Miller S. A., Barone J., Eisenlohr-Moul T. A., Martel M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158, Article 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

⁶Baker, A. S., Wales, R., Noe, O., Gaccione, P., Freeman, M. P., & Cohen, L. S. (2020). The Course of ADHD during Pregnancy. Journal of Attention Disorders, 26(2), 143-148. https://doi.org/10.1177/1087054720975864

⁷Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

⁸de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

⁹Herson M., Kulkarni J. (2022). Hormonal agents for the treatment of depression associated with the menopause. Drugs & Aging, 39(8), 607–618. https://doi.org/10.1007/s40266-022-00962-x

¹⁰Appleton S. M. (2018). Premenstrual syndrome: Evidence-based evaluation and treatment. Clinical Obstetrics and Gynecology, 61(1), 52–61. https://doi.org/10.1097/GRF.0000000000000339

First, I would encourage you not to be defensive during your visit. Clinicians have to follow a process to give you a diagnosis. This may seem like a waste of time, but a full differential diagnosis requires more than just asking neurodivergent-related questions. You may be asked questions that you feel are irrelevant, but that are important nonetheless.

There might be something you can learn, and something that you can teach the clinician. I have thanked patients for correcting me about certain things and I think that those interactions have been transformative for them too. I know I’ve learned from them.

[Take the Autism in Women Self-Test]

Having said that, it is important for all of us to feel respected, and that includes respect from your clinician. If you feel your provider is cynical or not listening to you, or they’re not acting in a collaborative way, then you can say thank you and move on.

Q: “What are the common misdiagnoses given to girls and women with ADHD and autism?”

Autistic girls and women with ADHD are often diagnosed with borderline personality disorder. This is a difficult differential diagnosis because it entails so much — dichotomous thinking, emotional reactivity, and fears of rejection and abandonment.

They also get misdiagnosed with bipolar disorder and, more commonly, with obsessive-compulsive disorder (OCD). This is because many neurodivergent individuals like repetitiveness, or like to systematize things, and have trouble interrupting a sequence, but that doesn’t necessarily mean they have OCD. It’s also not uncommon to have co-occurring conditions.

Q: “Are autistic girls with ADHD more likely to experience emotional dysregulation than their neurotypical peers?”

Emotional dysregulation is not part of the diagnostic criteria for ADHD or autism, but it is very much a part of the lived experience for both conditions — and it can be very impairing. Rejection sensitivity (the tendency to intensely react to real or perceived rejection), along with spiraling emotions or thoughts, impairs a person’s functioning and ability to interact and listen.

[Get This Free Download: Your Autism Evaluation Checklist]

According to society’s gender roles, girls and women are not supposed to get upset or display anger. When faced with rejection, we may hold it in and mask — only to eventually explode. So being unable to understand our emotions and know when we need to breathe, or step away, is important.

AuDHD Diagnosis: Next Steps

• Take These Self-Tests:
  • ADHD in Women
  • Autism in Women
• Learn: How to Get Evaluated for Autism as an Adult
• Read: Autism and ADHD in Adults
• Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”
• Read: “What to Expect After Your AuDHD Diagnosis”
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: “A Living Contradiction” — The AuDHD Experience
• Free eBook: The Truth About Autism in Adults
  

Karen Saporito, Ph.D., is a licensed clinical psychologist who has been in private practice for more than 20 years.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

In research examining eating disorder symptoms among women aged 45 to 61, body dissatisfaction was cited as a key risk factor.¹ I have seen this firsthand. In 2024, more than 21% of calls to the National Alliance for Eating Disorders, a support and advocacy organization I founded in 2000, were from individuals (primarily women) age 40 and older.

Eating disorders are serious, brain-based mental illnesses with a strong genetic link.² They have the second-highest mortality rate among all psychiatric disorders.³ Yet many middle-aged and older women may not even recognize that they’re struggling with eating disorders due to misconceptions about these conditions and who they affect.

[Self-Test: Do I Have an Eating Disorder?]

An adult might have an eating disorder if they:

• experience extreme weight loss or dramatic weight fluctuations
• refuse to eat certain foods or skip meals
• exercise excessively
• show signs of purging

Calorie restriction, or bingeing and purging, can have a particularly adverse effect on an older body, possibly leading to poor health outcomes. When eating disorders go untreated, they can lead to bone loss, heart problems, and, in people who force themselves to vomit, lung conditions. And research shows that 11% of women with ADHD, compared to 1% of women without it, have a history of bulimia nervosa, a common eating disorder that involves gorging followed by vomiting or laxative use.
Other eating disorders common in older adults include:

• anorexia nervosa (extreme food restriction)
• binge eating (consuming large amounts of food beyond the point of feeling full)

Eating Disorder Triggers

For some women, the battle with eating disorders began in childhood. For others, body image struggles may be triggered by later-in-life events. These include:

• Perimenopause and menopause. The transition to menopause is now recognized as a high-risk time for eating disorders to develop or redevelop, in part because women are seeking ways to “control” their changing bodies amid significant estrogen shifts.⁴
• Aging and unrealistic ideals. The anxiety and stress of aging in a society that values youthfulness provides fertile ground for increased symptoms of disordered eating and dysfunctional attitudes, beliefs, and behaviors around food and physical appearance.
• Transitions. Divorce, an empty nest, widowhood, and other life events may lead to or reactivate disordered eating.

[Watch: “Eating Disorders Comorbid with ADHD — ARFID, Anorexia, and Others”]

“Too Old” for an Eating Disorder

Eating disorders are considered diseases of the young, and, consequently, they often go unrecognized in older women. Many clinicians believe their mature patients are “too old” to have such conditions.

If you suspect that you or a loved one may have an eating disorder, talk with a doctor trained in this area. The National Alliance for Eating Disorders offers guidance, resources, and referrals for treatment and care. It provides free, therapist-led virtual support groups for women at midlife and older to connect with others who are experiencing or recovering from eating disorders.

Do I Have an Eating Disorder: Next Steps

• Free Download: Types of Eating Disorders Associated with ADHD
• Read: We Demand Attention! A Call for Greater Research on Women with ADHD
• Read: ADHD and Eating Disorders: Research, Diagnosis & Treatment Guidelines
• Watch: “Eating with ADHD: Improving Your Relationship with Food”

Johanna Kandel is the founder and CEO of the National Alliance for Eating Disorders and the author of Life Beyond Your Eating Disorder: Reclaim Yourself, Regain Your Health, Recover for Good. (#CommissionsEarned)

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Kilpela, L.S., Hooper, S.C., Straud, C.L., Marshall, V.B., Verzijl, C.L., Stewart, T.M., Loera, T.T., Becker, C.B. (2023) The longitudinal associations of body dissatisfaction with health and wellness behaviors in midlife and older women. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph20247143

²Berrettini W. (2004). The genetics of eating disorders. Psychiatry (Edgmont), Nov;1(3):18–25. PMID: 21191522; PMCID: PMC3010958

³van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current opinion in psychiatry. https://doi.org/10.1097/YCO.0000000000000641

⁴Khalil, J., Boutros, S., Kheir, N., Kassem, M., Salameh, P. et al. (2022). Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women. BMC Women’s Health. https://doi.org/10.1186/s12905-022-01738-6

No, it’s not cancer. In fact, the number of worldwide deaths from all types of cancer combined is equivalent to half the number of fatalities caused by heart disease in women.

More than 60 million women in the United States have heart disease — and for the large majority, serious cardiac problems begin in perimenopause when estrogen, which protects the heart, decreases dramatically.

While the risk for cardiovascular disease increases in all women during perimenopause, women with ADHD may face an even greater risk than their non-ADHD peers. Research has revealed that the prevalence of heart disease is higher among adults with ADHD of both genders compared to adults without ADHD: 38% vs 23%.¹

While research investigating the prevalence of heart disease among women with ADHD, specifically, remains incomplete, it is reasonable to hypothesize that rates are high because this population faces myriad heart disease risk factors including chronic stress, anxiety, depression, substance use disorders, sleep disorders, obesity, and diabetes.

To test this hypothesis, I partnered with the HeartLife Cardiology Clinic in the Netherlands. Included in the study were 300 women, the majority of whom were of perimenopausal age, as this is commonly the age at which women seek treatment for cardiac complaints.²

[Read: Let’s Talk About Perimenopause and ADHD]

We found that 35% of these patients met criteria for lifetime ADHD symptoms: a rate that is nearly 10 times that found among women in general. We also found that the women with ADHD symptoms experienced cardiac complaints two years earlier than their non-ADHD peers, suggesting that their cardiac problems may be relatively more severe.

This exploratory study indicated to us that further research is needed. To that end, my colleagues and I have launched the Women with ADHD Health Study, which has enrolled more than 3,000 female participants from across the world and is investigating the relationship between female hormones and cardiovascular issues, among other physical conditions. The ongoing research survey is accepting responses until the end of June 2025, and all women with ADHD or who identify as having ADHD symptoms are invited to participate.

Today, research shows that just 44% of women in the U.S. correctly identify heart disease as the greatest threat to their health.³ This lack of awareness is due, in part, to the fact that women often experience significantly different symptoms of cardiovascular disease than men. If patients, and their doctors, aren’t educated about how heart disease presents in women, potentially deadly health repercussions may result.

[Download: Free Guide to Hormones & ADHD in Women]

So, while we wait for research to be completed, we seek to equip at-risk women with the information necessary to protect their hearts from harm.

The Big Impact of Small Vessel Disease

When people think of heart disease, what usually comes to mind is coronary artery disease (CAD). In this disorder, plaques build up in the larger coronary arteries, causing a narrowing that may lead to an obstruction and possible heart attack. CAD is associated with risk factors such as high cholesterol, high blood pressure, obesity, diabetes, smoking, and lack of exercise.

Seldom discussed is another type of coronary heart disease that predominantly affects women, called coronary microvascular disease (CMD). Unlike CAD, which affects the heart’s large arteries and reduces blood flow due to obstruction, CMD also affects the heart’s smallest blood vessels, and reduces blood flow due to spasms.

Symptoms of CAD tend to occur after physical effort, whereas signs of CMD are more erratic in nature. Symptoms frequently occur during rest, even during sleep. They are also more commonly associated with chronic stress, depression, and anxiety.

Heart Attacks in Women Look Different

We are all familiar with the “classic” symptoms of a heart attack; sudden pain in the chest, often after physical effort, sometimes accompanied by pain in the left arm and jaw. These symptoms are real and serious, for women as well as men — but they are not the only signs of a heart attack.

For many women, signs of a heart attack include:

• tightness in the chest, the feeling of being in a harness or too-tight bra
• shortness of breath
• pain in the back
• indigestion
• nausea or vomiting

Though these symptoms are sometimes called “atypical,” the truth is that they are only atypical for men. They are quite common, and often under-recognized, in women.

Microvascular disease is much more difficult to diagnose than is CAD. Because it involves the heart’s smallest vessels, it’s not visible via routine angiography. Unlike blockages in the arteries that are fixed and persistent, the spasms associated with CMD come and go. It can be diagnosed through a provocative acetylcholine challenge test, however this is an invasive and uncomfortable procedure that is not often used.

Women with cardiac complaints frequently report going to the emergency room, where an angiogram is performed and finds no evidence of blockage in the arteries. These women are often misdiagnosed with anxiety, and told the problem is not in their heart, but in their head. They’re sent home, their cardiovascular disease unrecognized and untreated.

Female-Specific Risk Factors for Heart Disease

In addition to heart disease risk factors that impact both men and women (high cholesterol, hypertension, smoking, obesity), there are several heart disease risk factors specific and exclusive to women. These include:

• gestational diabetes
• a history of preeclampsia
• endometriosis
• polycystic ovarian syndrome
• autoimmune disorders
• oral contraceptive use
• premature menopause

Menopause most commonly occurs when a woman is in her early 50s. When it occurs before the age of 40, it’s considered premature menopause, which is a risk factor for cardiovascular disease. This is because the early drop in estrogen exposes the heart to more harm over a longer period.

Women with ADHD may experience premature menopause at relatively higher rates, according to a recent study in Nature Genetics.⁴ While the reasons for early menopause remain largely unclear, we do know that smoking can be a contributing factor. Surgeries that impact the ovaries can also result in early menopause.

Tailoring Treatment to ADHD Patients

When treating patients with cardiac problems, doctors often start with lifestyle changes. This can prove especially challenging for patients with ADHD. Unless their ADHD, sleep problems, and mood disorder are treated first, they will likely be too exhausted, forgetful, or disorganized to make changes to their lifestyle. For this reason, I advise addressing ADHD and other symptoms first to lay the groundwork for successful changes to diet, exercise, and other habits. Blood pressure and heart rate should be monitored during ADHD treatment, as stimulants may increase both.

I also urge perimenopausal women to address hormonal complaints that may be at play and to consider the protective effect of estrogen on heart function.

Heart Disease in Women: Next Steps

• Read: Falling Estrogen, Soaring ADHD: Menopause Care for Neurodivergent Women
• Read: Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research
• Learn: Menopause, Hormones & ADHD – What We Know, What Research is Needed

The content for this article was derived, in part, from a plenary address at the 2025 Annual Conference of the American Professional Society for ADHD and Related Disorders (APSARD) delivered by prof. J.J. Sandra Kooij, M.D., Ph.D., titled, “Gender & Endocrine Issues in ADHD.” J.J. Sandra Kooij is a professor on Adult ADHD at Amsterdam UMC/VUMc, the Netherlands.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Li L, Chang Z, Sun J, Garcia-Argibay M, Du Rietz E, Dobrosavljevic M, Brikell I, Jernberg T, Solmi M, Cortese S, Larsson H. Attention-deficit/hyperactivity disorder as a risk factor for cardiovascular diseases: a nationwide population-based cohort study. World Psychiatry. 2022 Oct;21(3):452-459. doi: 10.1002/wps.21020. PMID: 36073682; PMCID: PMC9453905.

²Ter Beek LS, Böhmer MN, Wittekoek ME, Kooij JJS. Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Arch Womens Ment Health. 2023 Dec;26(6):851-855. doi: 10.1007/s00737-023-01356-7. Epub 2023 Aug 18. PMID: 37594562; PMCID: PMC10632230.

³Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, Newby LK, Poudel R, Reynolds HR, Rexrode KM, Sims M, Mosca LJ; American Heart Association. Ten-Year Differences in Women’s Awareness Related to Coronary Heart Disease: Results of the 2019 American Heart Association National Survey: A Special Report From the American Heart Association. Circulation. 2021 Feb 16;143(7):e239-e248.

⁴Demontis, D., Walters, R.K., Martin, J. et al. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet 51, 63–75 (2019).

The night Rollins left her husband, he knew what she was planning. “He had his hand on the gun in his holster and he threatened me,” says Rollins. “I remember trying to be strong and saying to my daughter, ‘What is happening now should never happen.’”

Rollins is focused now on trying to heal and cut herself some slack. Getting an ADHD diagnosis in adulthood has been an illuminating part of her journey. “It explains everything,” she says. “How self-critical I was, never feeling good enough, always feeling like, ‘Why can’t I just get it right?’ I think, in hindsight, I wouldn’t have chosen who I chose to marry if I’d known I had ADHD.”

IPV and ADHD

IPV can include physical, sexual, and/or psychological abuse executed by a current or former partner. It does not discriminate, and can affect people of any gender, race, socioeconomic status, or level of education, explains psychologist Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. Women, however, are far more likely to be victims. Intimate partner violence is more common among women than breast cancer, diabetes, or depression.

Among women with ADHD, rates of IPV are even higher. Recent research from Berkeley Girls with ADHD Longitudinal Study (BGALS) found that women aged 17-24 who had received a childhood diagnosis of ADHD were five times more likely than their neurotypical peers to experience physical IPV. Greater ADHD symptom severity in childhood was associated with increased risk for IPV. ¹

[Read: Why Adults with ADHD Are Particularly Vulnerable to Gaslighting]

“It’s underappreciated how difficult ADHD can be for girls and women because the consequences are more internal,” says Stephen Hinshaw, Ph.D., lead researcher of BGALS and professor of psychology at the University of California, Berkeley. “Girls with ADHD are smart, but they can’t get it together. As they age, the tendency is depression, very low self-image, unplanned pregnancy, intimate partner violence, and non-suicidal self-injury.”

Risks, however, are not predetermined outcomes, and information is empowering. Below, learn what intimate partner violence looks like, how its impacts are felt, and what help is available.

The Truth About IPV

What IPV Looks Like

• Psychological: threatening, intimidating, humiliating, criticizing, insulting, belittling, blaming, invading privacy, extreme jealousy/possessiveness, dismissing feelings
• Physical: hitting, pushing, slapping, punching, restraining, choking, dragging
• Sexual: coercing victim to have sexual acts or watch pornography, drugging victim
• Technological: tracking location, demanding check-ins, excessive texting, monitoring communications
• Financial: withholding access to bank accounts and credit cards, ruining the victim’s credit, taking the victim’s paycheck

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Psychological Abuse Is Rampant—and Overlooked

“Media depictions focus on physical and sometimes sexual abuse, showing a woman fearing for her life on a daily basis,” Sullivan says. “By promoting only that stereotype, we do a disservice to women who experience IPV differently, because they think, ‘Well, that’s not me. I’ve never had a bruise or a broken bone.’”

While patterns and specifics of abusive behavior vary widely, psychological abuse is pervasive. Explains Sullivan: “You almost never see physical and sexual abuse alone, without psychological abuse.” Sullivan and her research team collected data from victims of IPV for 90 days and found that psychological violence occurred on 27% of days — 13 times more often than physical, psychological, and sexual violence together. ²

It’s critical to identify psychological abuse because it often appears first, and can lead to physical and sexual abuse, not to mention dire health consequences on its own.

IPV Has Far-Reaching Impact

The health implications of IPV are often severe:

• 51% of female homicide victims were killed by intimate partners ³
• 80% of IPV survivors display trauma symptoms
• 30% of survivors meet criteria for post-traumatic stress disorder (PTSD)

Survivors are at an increased risk for:

• diabetes: +51%
• total mortality: +44%
• cardiovascular disease: +31% ⁴

IPV is also associated with an increased risk for substance use disorders, depression, anxiety, suicidality, traumatic brain injuries, working memory declines later in life ⁵, and issues of the gastrointestinal, reproductive, and musculoskeletal systems.⁶

And, to be clear, psychological abuse can be as serious and detrimental as physical abuse — even more so, in some cases. “Psychological abuse erodes self-worth and self-efficacy, that feeling of, ‘I’ve got this,’” says Sullivan. “It can be a stronger predictor of PTSD and depression than physical abuse.” ⁷

Healing from Abuse

“Twenty years ago, the mentality was, How do we get her to leave? The approach now is survivor-centered: What does she want to have happen?” explains Sullivan. “Not every person wants the abusive relationship to end; some just want the violence to stop. Providers need to ask, ‘Have you thought about what you want to do?’ This gives the person voice, something that’s often taken away from them.”

Evidence-based therapeutic interventions should be present-centered with a focus on empowerment, Sullivan says. These include Cognitive Behavior Therapy (CBT), STAIR (Skills Training in Affective and Interpersonal Regulation), Interpersonal Psychotherapy (IPT), HOPE (Helping to Overcome PTSD through Empowerment).

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help:

• National Domestic Violence Hotline, Call 800-799-7233 or text START to 88788
• Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 22522
• National Sexual Assault Helpline, Call 1-800-656-HOPE

*Name has been changed to protect the person’s privacy

Intimate Partner Violence and ADHD: Next Steps

• Read: “We Demand Attention on Self-Harm, Intimate Partner Violence, and Substance Abuse Among Women with ADHD
• Self Test: Is My Relationship Toxic? A Quiz for Adults with ADHD
• Q and A: “What Are the Signs of a Controlling Relationship?”
• Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”

Nicole C. Kear is Consumer Health Editor at ADDitude magazone.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

²Sullivan TP, McPartland T, Armeli S, Jaquier V, Tennen H. Is It the Exception or the Rule? Daily Co-occurrence of Physical, Sexual and Psychological Partner Violence In a 90-Day Study of Substance-Using, Community Women. Psychol Violence. 2012 Apr 1;2(2):10.1037/a0027106. doi: 10.1037/a0027106. PMID: 24349863; PMCID: PMC3859524.

³Jack SP, Petrosky E, Lyons BH, et al. Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015. MMWR Surveill Summ 2018;67(No. SS-11):1–32.

⁴Chandan JS, Thomas T, Bradbury-Jones C, Taylor J, Bandyopadhyay S, Nirantharakumar K. Risk of Cardiometabolic Disease and All-Cause Mortality in Female Survivors of Domestic Abuse. J Am Heart Assoc. 2020;9:e014580. doi: 10.1161/JAHA.119.014580.

⁵Baker JS, Greendale GA, Hood MM, Karlamangla AS, Harlow SD. Self-reported history of physical intimate partner violence and longitudinal cognitive performance in midlife women. Womens Health (Lond). 2024 Jan-Dec;20:17455057241309782. doi: 10.1177/17455057241309782. PMID: 39707890; PMCID: PMC11663271.

⁶Stubbs, A., & Szoeke, C. (2022). The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. Trauma, Violence, & Abuse, 23(4), 1157-1172. https://doi.org/10.1177/1524838020985541

⁷Mechanic MB, Weaver TL, Resick PA. Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse. Violence Against Women. 2008 Jun;14(6):634-54. doi: 10.1177/1077801208319283. PMID: 18535306; PMCID: PMC2967430.

During my psychiatry residency from 1987 to 1991, I only treated one adult with ADHD, a young man who was having difficulty in his medical school classes. After completing my child and adolescent psychiatry fellowship, however, I joined the United States Air Force, where I saw many enlisted members who had untreated ADHD and could not pass testing to get promoted to the next rank. Clearly, ADHD in adults was real.

ADHD in Women Gains Attention

Still, adult ADHD did not land on the national radar until 2006, when Ronald Kessler, Ph.D., and his colleagues published data from a study in the International Journal of Methods in Psychiatric Research that estimated a prevalence of 4.4 percent in adults. Of those, 38.4 percent were women. ¹

[Self-Test: Could You (or Your Daughter) Have ADHD?]

According to that study, only one in 10 adults had been treated for ADHD in the last 12 months. Over the next decade, clinical trials were conducted with amphetamine, methylphenidate, and atomoxetine. More than 40 percent of trial participants were women; clinical studies on ADHD began to show that females were just as impaired as males, and they responded just as well to medication.², ³, ⁴

Despite all of this, there was no clinical emphasis on evaluating ADHD in women even a decade ago. Often, I would diagnose mothers with ADHD after diagnosing their children. These patients’ symptoms were typically missed in childhood because they did not include outward hyperactivity. As young adults, many had been misdiagnosed and treated for anxiety and depression. These conditions often did not improve with treatment because ADHD symptoms were not addressed.

In 2020, after experts convened to evaluate data on ADHD in females across the lifespan, Susan Young, Ph.D., and her colleagues published an expert consensus statement “providing guidance for the identification and treatment” of ADHD in girls and women. It cited, in part, a lack of understanding or recognition among clinicians regarding gender differences in ADHD symptom presentation and functioning.⁵

ADHD Research on Women Falls Short

Today, ADHD diagnoses in women continue to increase — and with good reason. Of the roughly 15.5 million adults with an ADHD diagnosis, 44.2 percent are women, according to recent data by the Centers for Disease Control and Prevention (CDC). Yet, of the 1,737 studies involving ADHD listed on ClinicalTrials.gov, only four were evaluating females only. The research has been slow to catch up.

As a result, there is still much we don’t know about ADHD in women. In recent years, the largest increases in stimulant prescriptions were for women of childbearing age. ⁶

[Free Download: Women, Hormones, and ADHD]

Research is needed to guide better treatment of this cohort, as well as midlife and older women with ADHD. The opportunity to unlock meaningful improvements to patients’ lives is real — and really overdue.

ADHD Research Studying Gender Differences: Next Steps

• Free Download: The Facts About Major Depressive Disorder in Women
• Read: We Demand Attention! A Call for Greater Research on Women with ADHD
• Read: Hormonal Changes in Women with ADHD & 4 Gaping Holes in Research
• Read: How ADHD Gender Bias Is Slowly, Steadily Harming Females
• Watch: Girls and Women with ADHD – Gender Differences and Stigma

Ann Childress, M.D., is a past-president of the American Professional Society of ADHD and Related Disorders ( APSARD) and was the first woman elected to lead the organization.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Kessler, R.C., Merikangas, K.R. (2005) The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res. 13(2):60-8. https://doi.org/10.1002/mpr.166
² Rasmussen, K., Levander, S. (2009). Untreated ADHD in adults: are there sex differences in symptoms, comorbidity, and impairment? J Atten Disord. https://doi.org/10.1177/1087054708314621
³ Mowlem, F. D., Rosenqvist, M. A., Martin J., Lichtenstein, P., Asherson, P., Larsson, H. (2018). Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. European Child & Adolescent. Psychiatry. https://doi.org/10.1007/s00787-018-1211-3
⁴ Platania, N.M., Starreveld, D.E.J., Wynchank, D., Beekman, A.T.F., and Kooij, S. (2025). Bias by gender: exploring gender-based differences in the endorsement of ADHD symptoms and impairment among adult patients. Front. Glob. Women’s Health. 6:1549028. https://doi.org/10.3389/fgwh.2025.1549028
⁵ Young, S., Adamo, N., Ásgeirsdóttir, B.B., Branney, P., et al. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. https://doi.org/10.1186/s12888-020-02707-9
⁶ Danielson, M.L., Bohm, M.K., Newsome, K., et al. (2023).Trends in stimulant prescription fills among commercially insured children and adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep. https://doi.org/10.15585/mmwr.mm7213a1

Despite earning the nickname “Busy” as a child because she rarely stopped moving, she had long dismissed her ADHD symptoms as personal weaknesses. Today the Dawson’s Creek, Freaks and Geeks, Cougar Town, and Girls5eva star reflects on life before and after her ADHD diagnosis at age 39.

Q: How has being diagnosed with ADHD as an adult made a difference in your life?
A late diagnosis allows you to look back at all the times when people in your life or career attributed certain ADHD traits – lack of organization or time management – to your not being able to get it together. I spent a great deal of my life not fully understanding why “easy” things were so difficult for me.

[How is ADHD Diagnosed? Your Free Guide]

The diagnosis has changed the way I view my past self. I’m so grateful that I know now. So many feelings of low self-worth have dissipated. With an earlier diagnosis and treatment plan, I probably would not have had the same kinds of struggles that I had in my 20s and 30s.

Q: Juggling motherhood and a career can feel like a precarious balancing act for just about any woman, let alone one with weak executive function skills. How did you manage when you were undiagnosed and untreated?
When I was a young mother and had small kids and was working full time on a network television show, I couldn’t keep appointments straight. I’d find myself double-booked or unable to make it at the last second. You really feel like you’ve let down your kid when you miss gymnastics class by an hour.

[Read: ADHD Symptoms in Women Aren’t ‘Hidden;’ They Are Misinterpreted]

I spent a great deal of my kids’ early lives being very weighed down by my own feelings of inadequacy. I felt I was failing them and myself. I thought that I couldn’t keep these things straight because of my lack of concentration, because I wasn’t trying hard enough, because I was tired, because all these other moms have it figured out and I don’t. I was very hard on myself.

Q: Some people with ADHD struggle with working memory. In your acting career, was it especially difficult to learn a new script and remember your lines?
If it’s something I’m interested in, I have no issue remembering that information. I recall my math teachers saying to me, “You can remember all those lines for the school play; why can’t you remember your times table?” I do think that has to do with my ADHD. I’m actually great at memorizing lines. I have a real gift for it.

Being an actor was something I was interested in, and so my ADHD let me focus on it. Even with time blindness, I was never late for a call time. This career that I loved so much and wanted to do – that took over and it was my only focus.

Q: Do you have any advice to help people with ADHD live better?
Make sure you’re able to get the treatment that works for you. You shouldn’t feel shame or stigma. There’s real power in owning it, even at work, even with people you love.

Adult Women with ADHD: Next Steps

• Free Women’s Health Month Calendar: 31 Days to Demand Attention!
• Read: Hormonal Changes in Women with ADHD — 4 Gaping Holes in Research
• Watch: Roundtable on ADHD in Women
• Read: “You Are Way Too Hard On Yourself…”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.
Carole Fleck is Editor-in-Chief at ADDitude magazine.

Research suggests that women with ADHD are more likely than their neurotypical peers to engage in sexual exploration at a younger age and to have multiple sexual partners. Their behavior is often an attempt to find validation or soothe the emotional chaos that ADHD can create. For some, it’s a way to fill the void created by low self-esteem or a lack of meaningful connections.

Here’s what that looks like for the women with ADHD who have trouble setting boundaries, misjudge risk, and suffer poor self-esteem: In seeking connection, they find themselves in risky encounters without considering the potential consequences. They tolerate disrespect or unsafe situations to avoid rejection.

Risky Sex and Women with ADHD

Many teen girls and women with ADHD are unprepared to handle the consequences of risky behavior, whether it’s dealing with a sexually transmitted disease or an unintended pregnancy.

Understanding how ADHD affects decision-making, through education and self-awareness, can empower women to take a step back before acting. That can mean practicing how to assert your needs and say “no” under pressure to build confidence in relationships, and using checklists to plan safe dates, manage contraception, and schedule health check-ups.

[Read: How ADHD Impacts Sex and Marriage]

Dealing with Low Self Esteem

From a young age, females with ADHD endure criticism for being impulsive, disorganized, and/or emotionally labile. These experiences can create a narrative of self-doubt, where they internalize the idea that they are the problem. This mindset doesn’t disappear in adulthood and often affects their relationships.

When things go wrong in sexual relationships, due to a lack of intimacy, mismatched desires, or conflicts with a partner, many women with ADHD blame themselves. Self-blame can have a profound impact on self-esteem and emotional wellbeing. It can lead to feelings of shame, guilt, and worthlessness that make it harder to address the real issues in a relationship. Instead of expressing her needs and desires, a woman may withdraw in fear of rejection or criticism.

If you have experienced any of this, here’s how to shift your internal narrative:

[Watch: Are ADHD Symptoms, Medications Affecting Your Love Life?]

Making Healthy Choices

Emotional Hypersensitivity

Women with ADHD are deeply affected by any criticism, real or perceived. If a partner declines intimacy, you interpret it as a rejection because of your low self-worth.

• Do this: Recognize external factors. Work stress, family pressures, or physical health issues can all influence intimacy. Relationship struggles are rarely the fault of only one person.

Difficulty Communicating Needs

Expressing desires or frustrations can be challenging, especially for women who fear being misunderstood. When conversations about sex go awry, it’s easy to assume you’ve done something wrong.

• Do this: Communicate openly. Tell your partner how ADHD affects your emotions. Together, explore ways to navigate challenges without placing blame.

Negative Self Talk

Many women with ADHD have an inner critic who harps on their perceived flaws. This voice can be particularly harsh around the vulnerable topic of sex.

• Do this: Letting go of self-blame begins with embracing your authentic self and recognizing that you deserve relationships in which you feel valued and supported.

Build Intimacy and Healthy Relationships

Breaking the cycle of self-blame is an essential first step toward a fulfilling sexual relationship. Next comes the work of building and maintaining healthy intimacy. ADHD can sometimes create barriers, but you can strengthen your bond by:

• Planning regular moments together when you intentionally block the distractions that steal your attention.
• Focusing on what brings you joy. Physical affection, emotional vulnerability, and shared activities all contribute to a sense of closeness. If medication or stress dampens your libido, get advice about alternatives or supplements that can support sexual health.
• Learning to say “no” to situations that don’t feel right. This empowers you to protect your wellbeing and foster healthy relationships.

You deserve a relationship in which you feel loved, respected, and understood – not despite your ADHD, but because you are uniquely you.

Risky Sex, Hypersexuality and ADHD: Next Steps

• Watch: “ADHD and Sex: Building Focus and Attention for Intimacy”
• eBook: Women with ADHD
• Watch: Living with ADHD – It’s Different for Women 

Susan Young, Ph.D. is a clinical psychologist in London.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

When I became a mom, I realized that people with ADHD do not tolerate lack of sleep and changes in routine. My impaired executive functioning — poor time management, procrastination, emotional dysregulation — made motherhood acutely difficult. Societal expectations (i.e., women should have the perfect house and perfect kids and bake endless cookies) sparked feelings of isolation.

3 Ways to Cope with ADHD

Here are some approaches I’ve learned over the years that can help mothers with ADHD today.

[Get This Free Guide: ADHD Diagnosis for Women]

1. Ask for help. Seeking backup is not a reflection of poor parenting or a sign of weakness. Dump any unhealthy, unrealistic expectations for yourself.
2. Reframe negativity. You’re not hyperactive; you’re energetic. You’re not disorganized; you’re spontaneous. If someone calls you moody, explain that sensitive people make for empathetic friends
3. Practice self-care. Put yourself first. Get up before your kids to enjoy a quiet workout or breakfast. Do what makes you feel grounded before you take on the day’s responsibilities.

Reframing Negative Thoughts: Next Steps

• Free Download: Get a Grip on Tough Emotions
• Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”
• Read: Putting a Stop to Negative Thoughts
• Read: “We Demand Attention on the Health Consequences of Delayed ADHD Diagnoses on Women”

Terry Matlen, LMSW, ACSW,  is a psychotherapist, consultant, and author. She has 25 years of experience helping women with ADHD.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Join ADDitude in sharing the following information during Women’s Health Month in May. And check back daily for updates. Click on any image below to read more.

We Demand Attention on Self-Harm, Intimate Partner Violence, and Substance Abuse Among Women with ADHD

“The extraordinarily high risk for self-harm incurred by girls with ADHD requires a shift in clinical perspective.” – Stephen Hinshaw, Ph.D.

We Demand Attention on Understanding Why Comorbid Conditions Like Anxiety and Depression Uniquely Impact Women with ADHD

Women with ADHD are five times more likely to experience anxiety than are women without ADHD. Read more

We Demand Attention on the Benefits and Risks of Hormonal Contraception and Hormone Replacement Therapy for Women with ADHD

“Females with ADHD are usually excluded from studies on contraceptive effectiveness and tolerability.” – Lotta Borg Skoglund, M.D., Ph.D.

We Demand Attention on How Medication Adjustments During the Monthly Menstrual Cycle and Menopause Could Improve Treatment Outcomes for Women

36% of women say adjusting ADHD medication to their menstrual cycle could significantly impact their lives. Read more

We Demand Attention on the Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing

99% of women with ADHD report at least one comorbid condition. Read more

We Demand Attention on the Elevated Risk for PMDD and PPD Among Women with ADHD

Women with ADHD appear more sensitive to the hormonal fluctuations of the menstrual cycle, and we do not know why. Read more

We Demand Attention on How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa

ADHD has the greatest impact on women’s lives during perimenopause and menopause. Read more

We Demand Attention on How Hormonal Changes Impact ADHD Symptoms in Women

“The relationship between hormones and cognition is an important issue in women’s health… but the literature is so sparse.”
– Jeanette Wasserstein, Ph.D.

We Demand Attention on the Mental and Physical Health Consequences of Late-Life Diagnoses on Women

Living with undiagnosed ADHD in childhood profoundly impacts self-esteem, mental health, wellbeing, and relationships. Read more

Sex Differences in ADHD

“Women with ADHD receive more negative feedback regarding the exact same symptoms that men exhibit, and that affects us.” — an ADDitude reader

We Demand Attention!

The symptom criteria in the DSM-5 exclude many key characteristics specific to the expression of ADHD in women. Read more

Funny Girl

“Believe in the way your mind works.” – Rachel Feinstein, comedian

“Taking Up Space”

“Tune into your voice and communicate your story — that’s when you’re going to create something nobody’s ever seen before.” – Hayley Wall, illustrator

“They Called Me the ‘Bright Underachiever.'”

“I cannot forgive the cruelty, sexism, and failure to recognize the fact that I didn’t want to do poorly.” – Maria Reppas

“I Love the Way My Brain Works.”

“It’s like I’m listening to a radio with very poor reception, catching three words and pretending I know what’s going on.” – Rebecca Makkai, bestselling author

Turning Regret Into Reset After an ADHD Diagnosis

“After decades of shame, apologizing, and fearing criticism, a diagnosis gives you explicit permission to forgive yourself.” — Ellen Littman, Ph.D.

“Women with ADHD Prefer Silence Over Disclosure. This Needs to Change.”

“Many women develop the core belief that ‘there’s something wrong with me.’ And this doesn’t change overnight.” — Sarah Greenberg, M.Ed.

ADHD and Feelings of Low Self-Worth

“I spent a great deal of my kids’ early lives being very weighed down by my own feelings of inadequacy.” — Busy Philipps, actor

ADHD Reduces Life Expectancy by 7 to 9 Years

Women with ADHD die 8.6 years younger than women without ADHD. It is a serious condition with serious consequences, especially for the undiagnosed and untreated. Read more

Intimate Partner Violence Among Women with ADHD

Women with ADHD face higher rates of intimate partner violence, which can manifest as physical, psychological, and/or sexual abuse. Read more

The ADHD Effect on Sex and Self-Worth

“When things go wrong in sexual relationships, many women with ADHD blame themselves.” – Susan Young, Ph.D.

10 Steps to Unmasking and Thriving with ADHD

“Women take care of their children at their own expense.” – Kathleen Nadeau, Ph.D.

“I Felt So Misunderstood.”

“Like other girls with ADHD, I mistook my difficulties for character flaws.” – Terry Matlen

The Key to Postpartum Depression Recovery

“Postpartum depression is significantly more common among women with ADHD.” – Jayne Singer, Ph.D.

The Impossible Burden of Motherhood

In an ADDitude survey, Moms with ADHD reported more stress than their male or non-ADHD counterparts in 12 out of 14 parenting domains. Read more…

ADHD and the PMDD Roller Coaster

“Premenstrual dysphoric disorder plagues nearly half of all women with ADHD.” – Dara Abraham, D.O.

“You Are Way Too Hard on Yourself…”

“It’s not great to work in hard mode constantly. There’s no prize for that.” – Diane Miller, Psy.D., M.Ed.

Falling Estrogen, Soaring ADHD

“The transition to menopause is, arguably, the most consequential stage of life for women with ADHD.” – Jeanette Wasserstein, Ph.D.

Let’s Talk About Perimenopause and ADHD

“Estrogen regulates the effects of neurotransmitters implicated in ADHD.” – Lotta Borg Skoglund, M.D., Ph.D.

Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research

“Perimenopause and menopause are thought to intensify ADHD symptoms, but they are largely overlooked in research.” – Michelle Martel, Ph.D.

“Women Need Better, More Accurate Diagnostic Tools for ADHD”

“Most diagnostic tools have been developed by men and screen for symptoms seen in boys with ADHD.” – Kathleen Nadeau, Ph.D.

Grown-ups write a weekly meal schedule on a Sunday and do careful calculations before drilling holes. They make sandwiches the night before and remember to take them to work.

Grown-ups quell their transient urges in the pursuit of long-term goals. They commit, they save, they resist, and they toil. They get where they were planning to go.

Tedium does not torment the regular grown-up. If a boring job needs doing, they simply get on and do it. They are not hijacked by the urgent need to be anywhere else but the present.

Grown-ups don’t pull their phone-charger cable out while chatting and distractedly plug it into their mouth. They hardly ever go to bed with their keys left hanging on the outside of the door, and I very much doubt that they have 14,000 unread emails. Grown-ups absolutely do not tell someone they’ve just met that their underwear is stuck up their bum.

So, nope. Not much grown-uppery going on around here.

Even motherhood has failed to rebirth me as a convincing adult, if I’m honest. I love with abandon, but I do not have the skill set of an executive PA, despite what my children’s school might assume.

I’m the parent with the kid in full uniform on wear-whatever-you-want day and no cash for the cash-only book fair. I’m the mum at the bounce party who demos an illegal maneuver and then watches as a 6-year-old copies and knocks out his tooth.

[Read: Diaries of “Adulting” (or Not) with ADHD]

I Don’t Feel Like an Adult: The Fallout from Falling Short

Like lots of people acutely aware of their flaws, I’ve learned to jump in and laugh at myself before others can take a shot. But I still feel small when I fail to measure up to societal norms, no matter how many jokes I churn out at my own expense.

I am also reduced to jelly by the ice-cold dead eye of those proudly logical humans repulsed by malfunctions of common sense. I see their disdain as a sign of deep self-loathing, but I nonetheless crumble at their condemnation of me and the faults I may well never fix.

My lack of adulting acumen has cost me. Failure to plan, persist, and apply what I learn from experience has thwarted my ambition and harmed my self-trust. It limits my capacity to meet my potential and avoid repeating mistakes. It hurts.

Why Can’t I “Adult?” It Was ADHD All Along

I cannot describe how I felt when I read about the symptoms of inattentive-type ADHD in women. I ticked almost all of the boxes and made sense to myself for the first time ever. A single condition explained what I had always viewed with quiet shame as manifestations of immaturity, weak character and sloth.

I waited 30 months for an assessment and then sobbed the whole way through it. When my diagnosis came, it felt like a big “welcome home” by people who finally got me. You are not alone! Come on in! Sorry about the mess. It was truly the biggest relief of my life.

[Take This Self-Test: ADHD Symptoms in Women]

Now I’m busy learning how my traits and behaviors conspire to keep me feeling like a child.

Of course I have trouble resisting temptation. My brain yearns for dopamine to bolster its fragile supply. And I leave things to the last minute not out of preference or bravado but because concentration evades me until a deadline is so close I can smell it.

There’s a reason too why I struggle to stay on-task when a job is neither urgent nor appealing. My filter for blocking out irrelevant stimuli has the authority of wilted spinach. Distracting noises and thoughts roll in freely while I’m trying to focus and the effort it takes to ignore them leaves me feeling drained and frustrated.

I am not devoid of reason (though I never really thought I was). My prefrontal cortex is clear-thinking and analytical. But when my lizard brain floods with emotion, the rational part of me doesn’t carry sufficient clout to talk it out of a spiral.

It’s empowering to have language and insights about ADHD to help me understand and convey to others what I’ve always known but lacked the words or concepts to explain.

Learning How to Be an Adult

My ADHD diagnosis hasn’t magicked me into a grown-up. But it has made me feel happier and more in control of my choices. I’ve grieved for lost dreams and stopped beating myself up all day long. Decades of self-castigation, it turns out, yield little positive change.

And ADHD is not all bad, let’s be honest. My neurodivergent strengths and leanings make life a lot more fun. They predispose me to creativity, which brings me joy and flow. It can feel like the meaning of life itself when ideas spill forth with apparently mystical ease. I’m entertained by my daydreaming too, which helps me spot links and patterns that don’t always jump out at others. I’m flexible and adaptable and I come alive under pressure. I’m pretty sure ADHD makes me more tolerant as well. Being aware of my own annoying quirks makes it natural for me to cut others some slack over theirs.

I’m not sure I’d swap any one of these traits for an immaculate car or the ability to tell you what I’m having for dinner next Tuesday.

Will I ever feel like a grown-up? Never completely, I hope. I’m pleased my diagnosis has helped me find ways to manage. But I plan to grow more than just upwards. I intend to grow outwards, inwards, and in any direction that my passion and curiosity take me. That is the most authentic, and surely therefore the most grown-up thing I can do.

“I Don’t Feel Like an Adult:” Next Steps

• Sign Up: Essential Support for Women with ADHD
• Read: The Adult in the Room — I’m Not It!
• Read: 42 Raw Confessions from Women with ADHD
• Read: “I Learned I Couldn’t Trust Myself, Then I Found I Had Undiagnosed ADHD.”

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