Highly Successful While Living With ADHD and Anxiety

Even when the surface seems calm, ADHD can impact well-being, stress, and anxiety.

Reviewed by Margaret Foley

Key points

• Many people struggle with ADHD even though they are successful on the surface.
• Undertreated ADHD can cause a sense of overwhelm or require working too hard to keep up, even when succeeding.
• It's not uncommon for those with persistent anxiety to have unrecognized ADHD, including issues managing time.

Stephanie Moulton Sarkis, Ph.D. is a psychotherapist specializing in anxiety, gaslighting, narcissistic abuse, and ADHD. She is the author of eight books and three workbooks, including Healing From Toxic Relationships: 10 Essential Steps to Recover from Gaslighting, Narcissism, and Emotional Abuse and Gaslighting: Recognize Manipulative and Emotionally Abusive People—and Break Free. Dr. Sarkis is a National Certified Counselor, Licensed Mental Health Counselor, American Mental Health Counselors Association Diplomate (Clinical Mental Health Specialist in Child and Adolescent Counseling), and a Florida Supreme Court Certified Family and Circuit Mediator. She has been in private practice for over 20 years. Dr. Sarkis is a senior contributor to Forbes Online and Psychology Today. She hosts the "Talking Brains" podcast and is based in Tampa, Florida. You can visit her website at www.stephaniesarkis.com.

I recently spoke with Dr. Sarkis about the connections between ADHD, stress, and anxiety, with a focus on the struggles of highly successful people who struggle with the effects of ADHD.

Mark Bertin: Stephanie, I wanted to ask you today about the connection between the inattentive type of ADHD, stress, and anxiety. I saw a statistic recently that up to 75 percent of women with persistent anxiety also have ADHD. I'm not sure where that exact number came from, but what do you think?

Stephanie Moulton Sarkis: We do know that in studies of women with ADHD, the rate of comorbidity with anxiety disorders is clinically significant. This means that it is pretty likely that anxiety will be present with ADHD. This finding applies to all subtypes of ADHD—inattentive, hyperactive/impulsive, and combined.

There can be primary anxiety, for example, when you inherit (and express) the genes for anxiety and ADHD. There is also secondary anxiety, where you can develop anxiety due to the chronic stressors of ADHD. These stressors, as seen in studies, include being underemployed, having difficulty reaching your potential, having unfulfilling relationships, more challenges in parenting, and having a higher amount of debt than non-ADHD peers. Fortunately, there are treatments available for both ADHD and anxiety.

MB: You can be highly successful on the outside and struggling on the inside. What's that experience like for people?

SMS: There's the metaphor of a duck who seems calm on the water's surface but is paddling frantically underneath. People with ADHD can "mask" to a certain extent, but it is challenging to keep it up, and it can cause exhaustion and burnout.

In addition, many people with ADHD feel like they are imposters and that, eventually, someone will find out that they aren't that great. People with ADHD, especially those who are untreated, have to work five times as hard to get only half the amount of work done as their peers. It is isolating and demoralizing.

We also need to look at how "highly successful" is defined. If it is defined as having a clean desk and getting all projects completed on time, that can be a challenge. There is so much emphasis put on this definition of "highly successful" that it can lead to people with ADHD developing perfectionistic tendencies. These tendencies can be a form of overcompensation for difficulties related to ADHD. However, if we define "highly successful" more as being kind and compassionate toward ourselves and others, many people with ADHD are highly successful.

MB: Executive function relates to our ability to tell time. So that means there may be struggles keeping up with stuff, managing projects, or just being always late, which can all be part of ADHD. It seems like people can live their whole lives without making that connection, and blame themselves instead.

SMS: In addition to this, many people with ADHD were told that they weren't "good enough," that they were choosing to be "lazy," or heard a host of other comments related to a person with ADHD having "poor morals." Because of all of that, people with ADHD can have self-esteem issues from an early age. It is natural for them to blame themselves, as others have blamed them.

There's a difference between not wanting to do something and not being able to do something. For people with ADHD, executive function impairment can make it extremely difficult to complete tasks, estimate time (time blindness), regulate emotions, and inhibit behavior. In addition, executive function impairment means that it can be difficult for people with ADHD to regulate motivation. They may find they have difficulties beginning a task, or they can experience hyperfocus. Luckily, there are treatments available for ADHD.

MB: So what can people do about it then? How do they get evaluated, and what treatments work if they get diagnosed?

SMS: If people feel like they are not able to reach their potential, have a family history of ADHD, or their quality of life is being affected, it is recommended that they seek an evaluation from a mental health professional (MHP). It is important that the MHP you go to specializes in ADHD, particularly adult ADHD.

Based on decades of research, the most effective treatment for ADHD is stimulant medication. Non-stimulant medication is also available. Cognitive-behavioral therapy has also been found to be effective, although not as effective as stimulant medication. Other non-medication treatments that are somewhat effective, according to research, include regular exercise, mindfulness practice, receiving accommodations at school and work, and omega 3-6-9 supplements. Coaching is also available, but keep in mind that mental health issues may be addressed only by a licensed mental health professional. And always consult with a medical professional before beginning any supplement.

MB: Let’s talk, before we end, about that treatment approach. I find that medication is best for specific symptoms, like attention and impulsivity. But time management, organization, and even emotion often require more of a coaching or therapy approach. And then, anxiety often gets better when ADHD is managed well—but not always. Any closing thoughts on framing intervention that way?

SMS: Combined interventions tend to be more effective, depending on the issue. For example, studies have found that therapy and antidepressant medication work better together for the treatment of depression.

For people with ADHD, executive function impairments may lead to not getting as much benefit from therapy or coaching without taking stimulant medication. Executive function impairment can cause difficulties with skills like following multistep directions, learning from consequences, working memory performance, and mood regulation. For someone with anxiety secondary to ADHD, symptoms sometimes improve with ADHD treatment. That’s why ADHD care requires individualized decision-making and long-term support for most people.

To find a therapist, please visit the Psychology Today Therapy Directory.