January 9, 2026

ADHD or Anxiety? Why Adults Are So Often Misdiagnosed

ADHD and anxiety look similar in adults—but misdiagnosis delays effective treatment and worsens outcomes.

Created By:
Emma Macmanus, BS
Emma Macmanus, BS
Emma Macmanus is a research assistant who supports clinical and research projects with a warm, thoughtful focus on child and adolescent mental health.
Created Date:
January 9, 2026
Reviewed By:
Ryan Sultan, MD
Ryan Sultan, MD
Dr. Ryan Sultan is an internationally recognized Columbia, Cornell, and Emory trained and double Board-Certified Psychiatrist. He treats patients of all ages and specializes in Anxiety, Ketamine, Depression, ADHD.
Reviewed By:
Ryan Sultan, MD
Ryan Sultan, MD
Dr. Ryan Sultan is an internationally recognized Columbia, Cornell, and Emory trained and double Board-Certified Psychiatrist. He treats patients of all ages and specializes in Anxiety, Ketamine, Depression, ADHD.
Reviewed On Date:
January 8, 2026
Estimated Read Time
3
minutes.

Key Takeaways

  • ADHD and anxiety overlap but require different treatments
  • ADHD is neurodevelopmental; anxiety is threat-based
  • Misdiagnosis leads to ineffective care and burnout
  • Comprehensive evaluation is essential
  • Correct diagnosis unlocks effective treatment
  • Misdiagnosed ADHD vs Anxiety in Adults: Why the Difference Matters More Than You Think

    Why Adult ADHD and Anxiety Are So Often Confused

    Adults seeking mental health care frequently receive an anxiety diagnosis when ADHD is the primary condition—or vice versa. Both conditions involve restlessness, overwhelm, difficulty concentrating, and emotional reactivity.

    However, treating the wrong condition can worsen symptoms, delay recovery, and increase frustration.

    Many adults spend years in anxiety treatment before discovering that untreated ADHD is driving their distress.

    How ADHD Can Look Like Anxiety

    Adult ADHD often presents without childhood hyperactivity stereotypes. Instead, it may appear as:

    • Constant mental noise
    • Racing thoughts tied to task overload
    • Difficulty prioritizing or initiating tasks
    • Chronic overwhelm and burnout
    • Emotional reactivity under pressure
    • Fear of forgetting or falling behind

    These experiences are often mistaken for generalized anxiety, leading individuals to seek care through standard anxiety treatment without lasting improvement.

    How Anxiety Can Look Like ADHD

    Conversely, anxiety can impair attention and executive functioning:

    • Worry hijacks working memory
    • Threat monitoring disrupts focus
    • Avoidance mimics procrastination
    • Mental fatigue reduces concentration

    When anxiety is primary, stimulant treatment alone may exacerbate symptoms, underscoring the importance of accurate diagnosis.

    Key Differences Between ADHD and Anxiety

    Onset and Development

    ADHD is neurodevelopmental and typically present since childhood, even if unrecognized. Anxiety disorders may emerge later, often in response to stress, trauma, or life transitions.

    Attention Patterns

    In ADHD, attention fluctuates based on interest and stimulation. In anxiety, attention is consistently pulled toward perceived threats.

    Response to Structure

    ADHD often improves with external structure and novelty. Anxiety may worsen with pressure or evaluation.

    Emotional Drivers

    ADHD-related distress stems from overload and executive dysfunction. Anxiety is driven by fear, uncertainty, and threat anticipation.

    Conditions That Complicate the Picture

    Depression

    Both ADHD and anxiety increase risk for depression, particularly when untreated. Individuals often seek integrative depression care after years of misdiagnosis.

    OCD

    Obsessive-compulsive disorder can masquerade as ADHD through intrusive thoughts and mental rituals that disrupt focus. Targeted OCD treatment is essential when this pattern is present.

    Trauma

    Trauma-related hypervigilance can impair attention and mimic ADHD symptoms. Trauma-focused approaches such as EMDR therapy help clarify whether attention issues are fear-based or neurodevelopmental.

    Eating Disorders and Substance Use

    Misdiagnosed ADHD or anxiety may drive maladaptive coping strategies involving food or substances, highlighting the value of early intervention through eating disorder treatment or integrated care for addiction and substance use.

    Why Misdiagnosis Has Real Consequences

    When ADHD is treated as anxiety:

    • Therapy may feel insightful but ineffective
    • Anxiety medications may dull symptoms without improving function
    • Shame and self-blame increase

    When anxiety is treated as ADHD:

    • Stimulants may worsen worry or panic
    • Emotional regulation remains impaired
    • Avoidance patterns persist

    Accurate diagnosis changes everything.

    Evidence-Based Treatment Approaches

    Comprehensive Evaluation

    Accurate differentiation requires developmental history, symptom trajectory, functional impact, and response to prior treatments. Specialized assessment through adult ADHD psychiatry is often decisive.

    Psychotherapy

    Cognitive Behavioral Therapy addresses anxiety-driven thinking patterns, while Dialectical Behavior Therapy supports emotion regulation across both conditions.

    Medication

    Medication strategies differ significantly:

    • ADHD may require stimulants or non-stimulants
    • Anxiety may respond to antidepressants
    • Complex cases sometimes involve carefully monitored antipsychotic medication

    Medication should always follow accurate diagnosis.

    Advanced and Integrative Options

    For treatment-resistant symptoms or overlapping conditions, ketamine-assisted therapy may support cognitive flexibility and symptom relief when integrated with ongoing care.

    When Misdiagnosis Masks Serious Mental Illness

    In rare cases, attention difficulties and anxiety may precede mood instability or psychotic symptoms. Early evaluation through specialized psychosis services or comprehensive schizophrenia care can be protective.

    About Integrative Psych

    Integrative Psych specializes in nuanced adult psychiatric diagnosis, particularly where ADHD, anxiety, trauma, and mood disorders overlap. Our clinicians—featured on our experts page—integrate psychotherapy, medication management, and advanced interventions to deliver precise, individualized care.

    If you’ve tried anxiety treatment without improvement—or suspect ADHD has been missed—a confidential consultation can help clarify the next steps.

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