Tangled: Exploring the Overlapping Symptoms of ADHD and Trauma

Against a bright yellow background, a small pile of earbud headphones, in different colors, is tangled up together.
Credit: Shutterstock/Elena Khairullina

CONTENT NOTE: discussion of domestic/child abuse

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Hypervigilance, trouble focusing, dissociating, trouble maintaining relationships. These are only some of the common symptoms that overlap between ADHD and the effects of trauma. As someone diagnosed with both ADHD and PTSD, much of my work has been untangling, trying to understand the roots of my symptoms. I’ve been in therapy for five years and I am currently a graduate student studying to be a marriage and family therapist. As I begin to see similar patterns in my clients, I notice that I’m asking the same question I’ve been asking myself: “What is ADHD and what is trauma?”

 

Understanding which symptoms are present when examining the dual ADHD/PTSD diagnosis can be confusing and complicated. What makes this web even more difficult to untangle is trauma that takes place in childhood, while the brain is still developing. It can cause cognitive changes that resemble ADHD, but it may not necessarily be so.

 

And sometimes ADHD itself can exacerbate trauma. Rejection sensitivity disorder is often a comorbid disorder for people with ADHD. It’s defined as “an extreme emotional sensitivity and pain that comes from being rejected/criticized by important people in their lives.” People with ADHD tend to be bullied at school, feel left out by peers, and are often shamed and admonished by adults for their behavior. 

 

ADHD symptoms can show up differently for each individual, but many adults with ADHD don’t even know that they have the disorder; this was my personal experience. This can come from societal expectations of what ADHD “should” look like, and the common misconception that ADHD is only seen in young, hyperactive boys.

 

I was a “gifted” student in early elementary school. My academic struggle didn’t begin until I reached middle school, where I began a more rigorous course load. My teachers said that I was “spacey” and “distracted,” but they told me that I just needed to work harder. So I did. I overworked myself into perfectionism. I did what I had to do to get by.

 

I’ve always struggled with executive function and time management, but I wasn’t diagnosed with ADHD until I was 19 years old. As I began to educate myself about ADHD and sought out the help of a therapist, I felt a mixture of emotions. There was a lot of anger toward my parents and teachers for not seeing my struggle. I was hurt and ashamed that my loved ones dismissed my concerns. I felt grief for the person that I could have been had I been given support and resources earlier. And under all of that inner turmoil, I felt truly hopeful for the first time. For the first time in my life, I understood that there was nothing “wrong” with me. Finally, there were resources available to help.

 

I developed PTSD from growing up in an unstable home that never felt safe. My father was emotionally and psychologically abusive towards my mother; his hostility frightened me to my core. As a young child, I remember wondering when the day would come that he would begin physically abusing her. I never witnessed him become physically violent with another person, but he would throw things and punch the walls. I anticipated that one day it would escalate to physical violence.

 

I have always been an anxious person; witnessing this abuse only increased that anxiety. It’s so confusing to see the adults around you in such obvious distress, but not understand why. I think my anxiety stemmed from trying to anticipate my father’s moods, and trying to avoid being hurt myself. 

 

The PTSD diagnosis came about a year after the ADHD diagnosis. When I first began therapy, my primary concerns were controlling my ADHD symptoms and processing the late diagnosis. My therapist began asking about my childhood. We began to see the patterns of domestic violence and the connection between the volatility and my anxiety. What I didn’t understand at first was that domestic violence is not just physical abuse. That’s only one facet of what it can look like. It can also look like shaming, misdirected anger, degrading, and yelling—emotional, psychological, and verbal abuse. 

 

It’s difficult to treat either condition if it is not clear what the person is experiencing. In my experience, beginning to take stimulant medication was a game-changer. I was blown away by how well the medication worked and how much it benefited me. It was a similar experience to putting on glasses and seeing clearly for the first time. It was incredible. Suddenly, I was able to sit down and focus on assignments. I’d always struggled to remain still while driving and now I no longer experience those jitters. However, taking the medication did not lessen my anxiety or the impact of trauma.

 

A common experience of both ADHD and trauma is extremely low self-esteem. DBT therapy is a powerful tool that allowed me to unlearn some of those beliefs about myself. Because I didn’t understand why I was struggling so much growing up, I thought that something was inherently “wrong” with me. My therapist and I began exploring where I learned that, and when it showed up in my life. This is not an easy task; I still have moments of negative self-talk to this day. I try my best to have patience and grace with myself in those moments.

 

As a clinician working with clients with similar backgrounds to me, it is becoming clear that my experience is not unique. There is a lack of education around neurodiversity—how brains can vary between individuals. Having gone through the process of diagnosis as an adult, there will always be a part of me that wonders who I’d be today if I’d received support earlier. This is why sharing my experience, and the profound impact that my ADHD diagnosis had on my life and my mental health, is so important to me. 

 

So, is it ADHD or trauma? Does it even matter? It’s complicated. I’ve found that, for me, what helped me pull out some of the strings in this tangled web of symptoms was medication. Once my ADHD symptoms were more manageable, I was able to get in touch with my childhood and how it affected me. I don’t know that I will ever fully untangle this web—and maybe that’s okay. The strings have become so interwoven that it can be difficult to know where one ends and the other begins.

 

What I do know is that being kind and patient with myself as I pull on the strings has helped the most in my healing journey. I know now that nothing is wrong with me and I deserve support and resources as much as anyone else. As a therapist, I use my experiences to connect with my clients. It helps me stay open minded and present so I don’t miss the signs that the adults in my life missed. If I can make an impact in just one client’s life, allowing them to begin the untangling of their own web, then it will all have been worth it.

 

 

Lydia N. (she/her) is a second-year graduate student studying to be a Marriage and Family Therapist. She is currently participating in her clinical internship, where she is focused on working with LGBTQ+ individuals and couples as well as those with ADHD. In her spare time, you can most likely find Lydia at the dog park with her wife and two pups.

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