The reason, at least in part, is one you’ve heard countless times before: gender bias.
Since boys are “socialized generally to be more physically active and rowdier than girls,” their ADHD symptoms are noticed more quickly, says says Sabrina Gratia, D.O., a psychiatrist specializing in children and adolescents. Girls with ADHD still struggle with the characteristic inattentiveness and constant distraction, but are typically less hyperactive—they often fly under the radar. “A female student who daydreams, doodles in her book and takes a longer time to complete her assignment does not raise as many flags as a student who is loud, throws, and runs out of the classroom,” Gratia explains.
The pressure placed on women to do well and not make trouble doesn’t help. Without an ADHD diagnosis girls can go years—even their whole lives—compensating for the condition rather than getting treatment. Just like I did.
There’s just one little problem with the “just work harder” strategy: there are consequences to ignoring your ADHD.
I learned this in a dozen different ways over the years. Because my hands always needed to be in action, I fidgeted constantly, with disturbing results: bitten nails, pulled eyebrows, torn-apart lips. I picked at every little blemish leaving acne scars in their wake. Because I struggled so much with being present, I even had difficulty focusing during sex, and often felt like I was missing out on a deeper, more in-tuned feeling. I grew angry that I couldn’t seem to rein in my behaviors, and that disappointment was compounded by shame. I felt like I wasn’t “normal,” lacking the self-control and peace that so many other people seemed to have.
That’s a dangerous way of thinking, says Gratia. Over time, those thoughts can lead to an even more challenging mix of depression and anxiety on top of the ADHD. Almost a decade after I’d decided to ignore my diagnosis, I found myself feeling worse than I ever had. I’d always felt on edge and antsy, but entering a relationship when I was 23—and having someone actually witness just how often I cracked my joints or compulsively picked at my face, and point it out to me with concern—finally made me see just how much my behaviors were spiraling out of control. So I spoke to a therapist, who attributed the tics to anxiety—not ADHD.
This is a common situation for women with ADHD, says Sanam Hafeez, Ph.D., a licensed psychologist. “Mental health professionals, physicians, and educators may not see or may attribute ADHD symptoms in girls and women to other conditions,” she says. They’re often overlapping conditions but anxiety is often the more obvious diagnosis for women. In my case, I had both anxiety and ADHD, but the latter condition never came up in conversation.
I started taking Zoloft for the anxiety; it helped but, it didn’t address my fidgeting or the feeling that I was constantly in overdrive. So I switched to Prozac, but instead of toning down my behaviors, it just made them worse. After a few scary weeks of cracking my knuckles every few seconds and picking my skin until it bled, I stopped the Prozac and moved to Cymbalta, eager for a change. Yet even though that medication was supposed to address OCD symptoms (aka my body-focused tics), that just made me feel lethargic and disconnected. So after awhile, I stopped that one, too.
I was frustrated. Would it really be so bad if I never found the right fit? After all, I thought, channeling my 16-year-old self, wasn’t I happy and successful, with a career in which people who could think fast and multi-task thrived? It would’ve been nice to slow down, yes, but I could manage. I always had.
I might’ve stayed like that—convincing myself that the abnormal was normal, making excuses for my behavior, finding even more ways to compensate—if I hadn’t mentioned, in an appointment with a new psychiatrist, that I’d once been diagnosed with ADHD. “Really?” he asked, immediately intrigued. “Well, that makes a lot of sense.”