The Emotional Problem Hiding Behind “Anxiety”: Why Women with ADHD Get Missed and What to Do About It

If a feeling of rejection, or imposter syndrome wrecks you, or if small comments spiral into days of shame, and you’ve been told it’s “just anxiety”, read this.

Before we start, I’m running a free masterclass on 31st of October called The Hidden ADHD Symptom Wrecking Your Life. In one hour I’ll show you practical 5-step method to catching your triggers early, quietening the noise in your head, and feeling steady when emotional turbulence hits. If any of this sounds like you, save your seat by clicking here..

What we’re actually talking about

People with ADHD don’t just misplace keys or lose focus. There’s a whole emotional side to having ADHD, that nobody wants to talk about, especially during your assessment. If you get rapid, intense feelings, and have trouble calming down afterwards, there’s a name for it, deficient emotional self-regulation (DESR) or simply “emotional dysregulation.”

Russell Barkley, world renowned ADHD expert, and others have argued that these emotional problems are a core part of ADHD for many people, not just an add-on.

Clinically, this shows up as: losing control in the heat of the moment, struggling to soothe yourself, replaying things in your head for hours, and finding it hard to choose responses that actually help in the long run. These are not moral failings, they’re brain wiring and emotional regulation issues.

Why women get missed, and why it looks like anxiety

Most ADHD research and diagnostic ideas were built on the image of a noisy, hyperactive boy. That picture still shapes how clinicians think, but it doesn’t match the way ADHD frequently looks in women. Women more often present with inattentive symptoms, internalised hyperactivity, emotional lability and fatigue, and they’re therefore more likely to be labelled as anxious or depressed first. That’s why women are commonly under-diagnosed or misdiagnosed.

So when a woman says she feels anxious or low, the clinical route often goes straight to anxiety treatment, which can help, but misses the ADHD driver underneath, which is the root cause.

The result: the emotional storms keep coming, and the person is left feeling they’re not getting better despite therapy or medication for “anxiety.”

Rejection Sensitive Dysphoria (RSD): the blow that feels like being punched

One common and brutal expression of emotional dysregulation is RSD, which is experienced as intense pain or panic triggered by perceived rejection or criticism. People with RSD often scan for rejection, read subtle cues as hostile, or react in ways that later shame them. Clinicians are increasingly recognising RSD as tightly linked to ADHD and to real disruption in attention and emotion.

When RSD is active you don’t just feel upset,  your attention narrows, your body floods with emotion, and you might take actions (cutting people off, lashing out, withdrawing) that create consequences you didn’t intend. That’s what makes it so dangerous long-term: the feelings drive behaviour that reinforces shame and isolation.

How anxiety and ADHD overlap, and why that matters

Research shows women with ADHD have higher rates of anxiety and mood disorders, sometimes because years of undiagnosed ADHD lead to chronic stress, low self-esteem, and secondary mood problems. In practice, that means a clinician sees anxiety symptoms and treats them, but the attention/executive/emotional regulatory issues of ADHD remain unaddressed. Recognising ADHD as the underlying cause changes the treatment plan and the likely outcomes.

Put bluntly: treating anxiety without considering ADHD is often incomplete care. It’s like putting on a band aid , when the wound needs a good cleaning out and stitching up.

Why trauma and life stress make emotional dysregulation worse

ADHD increases risk of negative experiences (academic failure, peer rejection, impulsive choices) that raise the likelihood of trauma. If someone with ADHD later develops PTSD or complex trauma, their DESR gets worse, trauma and ADHD interact in ways that deepen emotional volatility. That’s why trauma-informed approaches are often necessary.

What actually helps, practical and evidence-informed

There’s no single magic bullet. Good outcomes tend to come from a blend:

• Accurate assessment (spotting ADHD in women instead of labelling everything as anxiety). Accurate diagnosis raises the odds of getting targeted help. During assessment, having a clear understanding of emotional dysregulation, RSD and anxiety, and where exactly it’s showing up in the persons life. Most ADHD assessments miss this part.

• Medication where appropriate, meds can reduce emotional reactivity for many people, but they can also blur emotions for some, making therapy more difficult or causing rebound as they wear off; careful management is key if this is a path you choose to follow. Meds really aren’t for everyone, and again can be viewed as a band aid fix.

• Psychological work tuned to ADHD, CBT/ACT and mindfulness approaches adapted for ADHD help with noticing thoughts, building distance from them, and taking value-led actions rather than reacting. This is what we specialise in at COREADHD. Our core ethos is to get to the heart of where the ADHD is affecting our clients most, and helping them retrain their brain for a long term truly empowering solution.

• Practical regulation skills , grounding, breathing, brief behavioural scripts for how to respond in the moment, and small pre-planned “next steps” you can actually do when the wave hits.

• Environmental fixes and pacing, protecting downtime, reducing decision overload, restructuring tasks so your executive system isn’t constantly failing.

• Trauma-informed therapy when needed,  because trauma changes how the nervous system reacts.

• Community and shame-work,  the more isolated someone is, the worse DESR gets. Connection reduces the intensity of shame.

A short practical ACT-informed tool you can use today

(Quick: try this when you feel the sting of rejection or feeling social anxiety)

1. Notice, name what you’re feeling (“I’m noticing shame/heat in my chest”).

2. Breathe , slow exhale (4 in / 6 out) for two cycles to calm the nervous system.

3. Label the thought,  “I’m having the thought that they dislike me.” Say it out loud or in your head to create distance., or say whatever thought you’re having. Name it.

4. One tiny value-led step, choose a five-minute action that reflects who you want to be (a short text that honours connection, a walk, making a cup of tea). Small choices break the spiral.

This isn’t therapy in one minute,  but it’s a reliable “first-aid” that creates space between feeling and action.

If you recognise this  you’re not imagining it

Emotional dysregulation and RSD are common in ADHD, especially in women who were overlooked by childhood stereotypes. Being told “it’s just anxiety” or “you’re too sensitive” is a real harm because it prevents targeted help.

If this hits home, you’ll get a lot from joining the masterclass on 31 October: The Hidden ADHD Symptom Wrecking Your Life. I’ll teach a practical 5-step method to spot triggers earlier, reduce the noise in your head, and respond with steadiness rather than react with panic or shame. Save your seat.

Final note. It’s never too late

Even if you’ve been told you’re anxious, over-sensitive, or that nothing will change, that’s not the end of the story. Accurate assessment, the right mix of therapy and practical skills, and a community that understands ADHD can shift everything. People diagnosed later in life do find relief and better outcomes when treatment targets both attention and emotional regulation.

If you want the 5-step method in depth and a live chance to practise it, join me on 31 October. I’ll keep it practical, evidence-based and cut the waffle. Save your place (link in bio).

References (key sources cited in this post)

• Barkley, R. (argument that emotional dysregulation is core to ADHD). Summary and discussion. adhdevidence.org

• Shaw P., et al., Emotional dysregulation and ADHD — review of prevalence and impact. PMC

• Expert consensus: Females with ADHD — diagnostic and treatment recommendations. PMC

• Cleveland Clinic overview of Rejection Sensitive Dysphoria and ADHD link. Cleveland Clinic

• APA overview: Managing emotion dysregulation in ADHD and treatment options. American Psychological Association