Trigger warning: This post contains topics surrounding self-harm, eating disorders, and mental illness. Please take precaution and refer to the following resources if you believe you may be suffering and needing recovery assistance:
Eating Disorder Hotline: https://www.therecoveryvillage.com/mental-health/eating-disorders/related/eating-disorder-hotlines/
Self-Harm Hotline: https://www.crisistextline.org/topics/self-harm/#what-is-self-harm-1
Substance Abuse and Mental Health Services Administration (Treatment referral & more): https://www.samhsa.gov/find-help/national-helpline
The issues pertaining to women with ADHD go so far into the topics of historical inconsistencies, lack of research, and sexism within the health care system that I could write about it for hours and days and weeks and I still would be unable to provide you with all of the information (along with all of the reasons there is a lack of information) on this subject. However, my goal here is only to shine light upon a disorder and the side effects of the much too common misdiagnosis that has impacted my life so profoundly and is leaving so many women to suffer alone in the dark.
ADHD In Women
ADHD is often misconstrued as a fidgety little boy who loses his homework and interrupts class. This misconception of the disorder has led to the higher diagnosis rate among males when compared to females.
While males with ADHD often fall into the hyperactivity subtype, females with ADHD are more likely to showcase inattentive behaviors. This inattention is likely to be dismissed for laziness in school or job settings.
Stephen Hinshaw, a psychologist at the University of California, Berkeley, and a leading researcher on ADHD in girls, states:
“You get referred [to a specialist] if you’re noticeable, if you’re disrupting others. More boys than girls have aggression problems, have impulsivity problems. So girls with inattentive problems are not thought to have ADHD.” "Instead," he says, "educators and others assume the problem is anxiety or troubles at home."
With these preconceived ideas about the disorder and how it manifests through behavior, women are more likely to be diagnosed with depression, anxiety disorder, borderline personality disorder, and bipolar disorder. I found this to be true through my own depression-misdiagnosis as a 7th grader. I was placed on anti-depressants which only made things in my head more unclear and made me feel even more disconnected from my body and from reality. I began to adopt an "I don't care" attitude because it was easier than constantly defending the fact that I really was trying. In fact, I was trying my absolute hardest and I could never live up to any standard or expectation simply because the lack of neurotransmitter reception in my brain would never even give me the chance to. I felt as though the feeling of hope itself was an extravagant and unattainable state of mind to wish for.
ADHD symptoms in females are often hidden, difficult to be detected in youth as the lack of emotional intelligence makes it tough for young girls to understand or describe their feelings or struggles. They grow up knowing that they're different than others, without ever being able to pinpoint why or in what exact ways. Common symptoms of ADHD in women include:
- low self-esteem
- perfectionistic behavior
- substance dependance
- chronic relationship problems
- chronic anxiety
- sensory hypersensitivities
- eating dysregulation
- intense premenstrual symptoms
- frequent irritability
- emotional dysregulation
- internalizing symptoms
- episodes of rage or tears
a. binge eating
b. unnecessary spending
- picking behaviors
- feelings of imposter syndrome
- constantly paying for mistakes such as parking tickets, new glasses after losing the others, etc.
- feelings that life is out of their control
- feeling overwhelmed in stores, busy offices, at parties
ADDitude magazine describes the potential outcomes for undiagnosed women:
"As women’s responsibilities increase, their psychological distress increases as well, but low self-esteem rarely allows their needs to come first. Distracted from their own self-care, women with ADHD postpone checkups and procedures, and function with serious sleep deficits. Inconsistent eating patterns, shaped by inattention and impulsivity, can result in complications. Chronically stressed, they may depend on prescription medications to manage anxiety, mood disorders, sleep, or pain, or they may self-medicate with alcohol or drugs.
As women mature, they learn to appear less symptomatic, yet their suffering continues as their well-guarded secret. They may distance themselves from friends, and hide their despair from partners. Believing in their unworthiness, they may endure relationships involving emotional and physical abuse. Such hopelessness, combined with impulsivity, contributes to significantly more self-harm compared to men. Even more concerning is their much greater likelihood of suicidal thoughts and attempts. Recent population studies suggest that women with ADHD are more likely to die earlier of unnatural causes, especially due to accidents."
The graphic below simply depicts what factors can contribute to ADHD development:
Source: childmind.org; S. Hinshaw / AR Clinical Psychology 2018
ADHD + Self-Harm
So... if you're wondering whether or not my ADHD has sent me into a hyper-focus spiral, throwing me off track throughout the research and you're thinking "uh, where does self-harm play a part in all of this?" the answer is... almost.
When illnesses or diseases go undiagnosed or are misdiagnosed, the lack of adequate treatment can lead to comorbidity. Comorbidity is defined as the presence of more than one distinct condition in an individual. The additional condition(s) exist alongside the primary condition and often come to fruition as a result of improper treatment and/or management of the primary condition. Girls with ADHD are 2x more likely to experience depression than girls without the disorder. Mixing depression and its symptoms of hopelessness, apathy, discontent, and guilt with feelings of low-self esteem, inability to control thoughts and/or emotions, and impulsivity brought on by ADHD is the ideal combination for damaging and addictive self-harming behaviors to establish themselves as coping mechanisms in an individual's life.
Physiological Effects of Self-Harm
Stated in a literature review of deliberate self-harm,
"Although it seems counterintuitive, the self-harm action itself seems to result in immediate release and relief, and there is biological evidence that self-harmers experience a physiological stress reduction after an episode that may last as long as 24 hr (Crowe & Bunclarck, 2000)."
During a study of a deliberate self-harmer (correlating diagnosis not disclosed), researchers examined the subject's base cortisol level, which was rather low. When faced with stressors, her (study subject) cortisol levels were raised, which led her to performing one of multiple self-harming behaviors. After completing the self-harm act, her cortisol level returned to it's base.
This provides us with the knowledge that deliberate self-harm becomes a physiologically effective coping mechanism, regardless of it's effects on mental and physical wellbeing. This is what makes it easy to habituate or even become addicted to the act of harming oneself.
Furthermore, ADHD makes it difficult for the brain to generate "happy" chemicals like serotonin and dopamine. Dopamine is released by the body among other feel-good chemicals immediately after an injury, in attempt to prevent feelings of panic and distress from infiltrating the protective adrenaline and endorphins. This would make it incredibly easy to find false feelings of calmness and happiness in a time of misery, leading to a dangerous and difficult-to-break cycle.
Eating Disorders In Women With ADHD
Additionally, eating disorders are overt avenues of self-harm that are often acquired by women with ADHD in two separate ways: deliberately and non-deliberately.
Just as ADHD symptoms vary on a spectrum, eating disorders do as well. While obesity and binge eating have been linked to ADHD and it's impulsive tendencies, many girls and women are found to develop anorexia nervosa and bulimia nervosa as a form of control. Sufferers find a sense of power that their ADHD symptoms prevent them from regularly possessing emotionally, socially, and mentally.
The Heartbreak of a Late Diagnosis
Between the complicated mess of ADHD studies in the social work field, psychology & psychiatry, and neurology, I'm struggling to go back in time to pull out painful experiences throughout my adolescence of misdiagnosis.
To be honest, I'm pissed.
I'm pissed that I have to spend time mourning the person I could have become if I would have received the proper treatment earlier, rather than at age nineteen. I'm pissed that due in part to the outdated misconceptions about ADHD held by medical professionals, I'll have to look at my wedding photos and try to ignore the self-harm scars that will line my arm and shoulders.
Its extremely difficult to look at all of the potential possibilities I may have missed out on and not be filled with anger.
Although I know the anger leads me down a road to nowhere, the frustrations remain present as I move forward on my healing journey. The most unsettling aspect of this process is that it has taken me three years since my diagnosis to even begin to come to peace with my misunderstood upbringing and the set backs that came with it. I have only now, as a twenty-two year old, begun to forgive my teenage self.
I want to give the past versions of myself grace, and I pray that other women experiencing similar struggles are able to give themselves the same.
I'd like to see changes within ADHD testing and referrals to specialists. I hope more research and studies are conducted around the comorbidity that the majority of women with ADHD attain and the different treatment options available for coexisting conditions and illnesses. We need more correlative studies on the most and least effective therapies and medications used to treat ADHD (and comorbidities) in women, along with information on how, if at all, birth control affects their symptoms. If contraceptives are found to have adverse effects on the emotional, mental, and biological wellbeing of women suffering from these already debilitating disorders, physicians need to be mandatorily, verbally disclosing whether or not the patients' medication efficiency will be affected along with hormone therapy options/recommendations.
If you feel as though you may need to be tested for ADHD, I urge you to contact your physician, a therapist, a psychiatrist, or other mental health service in your area and advocate for yourself to the fullest extent. With the rise of stimulant abuse, many mental health providers are being advised against prescribing proper ADHD medication or are hesitant to do so in fear of putting it in the hands of someone using it for the wrong reasons.
I hope this small review of the ADHD & self-harm phenomenon brought you insight on the issues that way too many women struggle with in silence. I also wanted to use this topic to expose some of the discrepancies in the world of medical diagnosis, and more specifically, mental illness diagnosis. Advocacy and alliance are the driving forces promoting more research and resources for those fighting to live their most exceptional lives beyond their disorders.
Oh and by the way... I'm a week away from being one year clean of self-harm. Cheers to many more!