We need to go deeper in uncovering the reasons behind depression, anxiety and eating disorders in women.
Did you know 4 million women who have ADHD are not diagnosed? It has only been in the past decade that the mainstream media and medical community have considered women having ADHD.
Why is this?
According to Dr. Ellen R. Littman, author of Understanding Girls with ADHD, early studies back in the 1970’s only focused on boys and men.
“These studies were based on really hyperactive young white boys who were taken to clinics,” Dr. Littman said. “The diagnostic criteria were developed based on those studies. As a result, those criteria over-represent the symptoms you see in young boys, making it difficult for girls to be diagnosed unless they behave like hyperactive boys.”
ADHD, previously referred to as a childhood disorder, typically presents itself in boys as ‘Dennis the Menace’ hyperactive behavior. In girls, it’s often more subtle.
When girls are diagnosed, it is not until age 12; diagnosis for boys can occur as early as age seven. Girl’s symptoms intensify as estrogen increases during puberty, and for boys during puberty the symptoms lessen. And, the manual of the American Psychiatric Association, (APA) the DSM-IV, identifies males as primarily having ADHD.
In a recent podcast interview with ADDitude magazine, Michelle Novotni, Ph.D. stated these reasons the diagnosis in women gets missed:
The symptoms are different. There is an inattentive type of ADHD where a women’s brain is hyperactive. She may be sitting entirely still while her brain jumps from one idea to the next. She may talk a lot or interrupt. Similarly, “antsy” movements may be more subtle, such as a fidgeting foot or hand.
Women may worry or feel guilt and anxiety over leaving the stove on, or misplacing their keys, especially if it has happened in the past.
Women are often better socialized and not always disruptive. Actually, many women are expected to act like a superwoman and flawlessly play mom, wife and career woman. That’s enough pressure for a woman who does not have ADHD.
Girls and women are held to lower expectations in our society. If they can’t understand the details of a math problem, this may be brushed off with an explanation such as “Girls aren’t usually good at math anyway.”
Girls might struggle with homework assignments, fail to detect social cues, seem withdrawn, act “ditzy”, daydream, talk non-stop, interrupt or speak out of turn, be messy or disorganized, and can be overly emotional, sensitive or depressed.
“They’ve been anxious or depressed for years,” Littman said. “It’s this sense of not being able to hold everything together.”
“We need to go deeper and ask women why they are depressed, anxious, or have an eating disorder,” Novotni said. Sometimes the reason for these symptoms stems from being unable to control ADHD. An eating disorder could be a result of impulsivity, for example.
According to Dr. John C. Fleming a psychologist who treats eating disorders, and Lance Levy, M. B. in ADHD and Disordered Eating, “As we took a fresh look at our clients, we found that roughly one-third of the people we were seeing showed compelling evidence of ADHD. We found this to be true for people with binge eating disorder, bulimia and for the severely obese.”
Not all individuals with eating disorders have ADHD but as Annie’s story demonstrates the sub-population of people with eating disorders that is later diagnosed with it.
A successful career woman, wife and mother of two children, at 32 years old Annie found it hard to lose weight. Despite a normal metabolism, her body mass index was 47, too high for her 5 foot tall frame.
During Annie’s interview (while tapping her foot uncontrollably and rapidly firing off answers), she described how she did well in school on subjects she enjoyed and poorly in subjects she didn’t care for. Her career advancement today was due to challenges that invoked her adrenalin. Every deadline was made through projects started at the 11th hour. She had trouble sleeping, was clinically depressed, and ate one extra meal daily.
Further assessment revealed Annie had ADHD, but had never been diagnosed.
ADHD carries a high risk of internalizing and self-destructive behaviors, such as suicide and self-injury, especially those with ADHD – combined symptoms. According to The Journal of Consulting and Clinical Psychology, young women diagnosed with ADHD are 3 to 4 times more likely to commit suicide and 2 to 3 times more likely to engage in self-destructive behaviors.
ADHD makes life harder, so why wouldn’t it make a woman depressed?
According to Ari Tuckman, a clinical psychologist and author of More Attention, Less Deficit: Successful Strategies for Adults with ADHD, “This is especially true because ADHD difficulties persist—it’s not like going through a bad break-up, where things get better with time.”
Are girls / women less likely to be referred for mental health services for ADHD?
Women with ADHD
A study in 2009 done by the University of Queensland addressed the fact that girls are less likely to be referred for mental health services for ADHD.
In the study, 96 parents of children with ADHD symptoms and 140 elementary school teachers read vignettes about children with ADHD. Half of the vignettes featured boy’s names and half of the vignettes had girl’s names. Parents and teachers were less likely to recommend services for the girls with ADHD in the vignettes, but not because girls were less disruptive that the boys. The main reason services were not sought was because parent and students believed that learning assistance is less effective for girls than boys with ADHD.
There is progress. The greatest increase in use during the five-year study period was among adults, with the largest gains seen in women ages 26 to 34, climbing 85%. Medications like Alderall and Ritalin and Concerta are easily accessible once a woman is diagnosed.
(A protocol for alternative / multimodal approach, (biofeedback, behavioral therapy, exercise, etc.) and non-medical treatments currently where (please fill this in or delete!) There are benefits to medications, provided patients remember to take the prescribed doses. )
By becoming aware of the symptoms, more women with ADHD can be accurately diagnosed. Treatment can begin before disorganization and chaos become habitual.
Resource: Quiz to learn if you have ADHD