Mental health problems associated with ADHD
ADHD can present with symptoms of other mental health disorders and these are more likely to be diagnosed by GPs and health care professionals. The underlying problem of ADHD is often missed and yet this may be fuelling more commonly diagnosed problems such as anxiety, depression and sleep problems.
Many people cope for years with undiagnosed ADHD and this comes at significant cost. Perhaps they have not been as successful as they feel they should be able to be and this affects self esteem. Perhaps they have been successful but at huge personal cost in terms of the time and effort that this has needed which seems excessive compared to others.
Because of the stress and impact of ADHD it can lead to symptoms of other mental illnesses and may be missed or misdiagnosed as another mental health problem.
ADHD is associated with the co-occurrence of other mental health disorders. About 75% of adults with ADHD will have at least one other mental health. Having three or more psychiatric disorders is associated with a ten-fold increase in the chance of having ADHD. Depression or anxiety may have been diagnosed but with no thought given to the possibility that ADHD may also be present.
Mood swings may be misdiagnosed
Mood instability and emotional over-reactivity is common in ADHD in adulthood – often with periods of great distress that can result in suicidal thoughts albeit transient. If this is not appreciated, a wrong diagnosis of a disorder such as depression, cyclothymia, bipolar disorder or emotionally unstable / borderline personality disorder can be made.
Internal restlessness is often associated with mental restlessness and over thinking and may be interpreted as a symptom of anxiety.
Women with ADHD often have low self-esteem and feel demoralised by their relative underachievement and other impairments. It is important to differentiate between despondency due to repeated failure and depression which can also co-occur and may warrant treatment in its own right. There is evidence however that ADHD treatment can reduce symptoms of depression by 40% and suicidal ideas by 11%.
ADHD can also prevent sleep onset and cause insomnia. When waking in the night it can also be harder to get back to sleep as mental restlessness occurs and the return of busy thoughts make it harder to get back to sleep. This can reduce the quality and quantity of sleep significant and contribute to daytime fatigue. Excessive daytime fatigue can worsen ADHD symptoms, reduce further the ability to function and increase the risk of road traffic accidents. The prevalence of sleep problems in patients with ADHD increases with age, with a notable increase in around the time of puberty.
Circadian rhythm sleep disturbances (CRSD)
CRSDs are problems relating to the timing of when a person sleeps and is awake. Over 70% of patients with ADHD have evidence of a CRSD. Many patients have a delayed sleep pattern, regularly going to sleep and waking late. Many patients with ADHD like being up late at night. They are “night owls” and feel at their most productive in the evening when the rest of the household is quiet. Many people describe not being able to “switch off” at night-time to go to sleep, either at the start of sleep or if they wake in the night and then try to return to sleep. Patients commonly report it taking one to two hours to fall asleep. They report an over-active mind and can’t switch off. In the morning, patients often cannot wake despite the use of multiple alarms and multiple “prods” by family members. They can be extremely irritable and cross with any calls from family who try and wake them (despite having asked the previous day to ensure that they are woken up in good time). Often the patient does not feel fully awake until noon.
Substance misuse is common in individuals with ADHD. Many patients use alcohol or cannabis to reduce the unpleasant internal hyperarousal and to facilitate sleep.
The association between ADHD and the development of PTSD following a traumatic experience suggests that patients with ADHD may be particularly vulnerable to developing PTSD after a traumatic experience.
Post-traumatic stress disorder (PTSD)
The binge eating disorders and bulimia, are more common in patients with ADHD. Obesity in both children and adults is also associated with ADHD.
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Rejection Sensitive Dysphoria (RSD)
RSD is a form of emotional over-reactivity and is described as the exquisite sensitivity to teasing, rejection or criticism.
Physical health problems
Physical health problems associated with ADHD including obesity, epilepsy and migraine