ADHD vs Anxiety: How to Tell the Difference — and Why So Many Adults Are Misdiagnosed
ADHD & Anxiety
ADHD vs Anxiety: How to Tell the Difference — and Why So Many Adults Are Misdiagnosed
More than 1 in 3 adults with a common mental health condition such as anxiety or depression also screen positive for ADHD — five times the rate of adults without one, according to NHS England's latest national survey (2023/4).
Racing thoughts at 2am. A mind that won't switch off. Restlessness you can't quite explain. For years, "anxious" might have been the only word that fit — because it's the label a GP reaches for first, and the one everyone else understands. But what if the racing thoughts aren't worry at all? What if it's ADHD?
What's the difference between ADHD and anxiety?
Anxiety is the mind and body's alarm system — a response to perceived threat, fuelled by worry about what might happen next. ADHD is a neurodevelopmental difference in how the brain manages attention, regulation and impulse control, present since childhood even when it isn't recognised, or named, until years later.
On the surface, they can look almost identical. A racing mind, restlessness, poor concentration, disrupted sleep, procrastination — either can produce all of it. The difference is usually what's underneath.
Anxiety
Driven by worry and threat-perception. The mind races because it's scanning for danger — usually one specific fear, or a looping "what if." Once the worry lifts, the restlessness tends to settle too.
ADHD
Driven by regulation, not fear. The mind moves fast because it's understimulated, not threatened. Thoughts jump between several unrelated things rather than circling one concern — and the restlessness is often there even when nothing is "wrong."
Why the two get confused so often
The symptom overlap is real, not imagined:
- Restlessness and an inability to switch off
- A racing or overactive mind
- Trouble concentrating on one thing
- Disrupted or delayed sleep
- Procrastination followed by last-minute panic
- Irritability and a low tolerance for overwhelm
Living with unrecognised ADHD is also, quite reasonably, anxiety-inducing. Years of missed deadlines, forgotten plans, and the quiet exhaustion of masking to keep up with everyone else can produce genuine anxiety as a consequence — and that secondary anxiety is often the only thing that ends up being treated.
It might genuinely be both
For a great many people, this isn't an either/or question. ADHD and anxiety are among the most commonly co-occurring conditions in adults, and NHS data confirms the two are strongly linked at a population level. Anxiety can develop because of ADHD, sit alongside it, or exist entirely independently. Reaching a clearer picture matters — but it starts with someone actually asking the question, rather than assuming the first label that fits is the whole story.
Why women are especially likely to be misdiagnosed
ADHD in women is still significantly underdiagnosed, and when it does surface, it's often mistaken for anxiety or low self-esteem rather than recognised for what it is. The presentation tends to be more internalised — less visible hyperactivity, more racing thoughts, more masking, more quietly assuming that everyone else finds life this hard too.
NHS screening data now shows women are slightly more likely than men to score positive for ADHD on standard adult assessments, yet many still aren't diagnosed until well into adulthood — often after a first, or second, diagnosis of anxiety along the way.
A few honest questions
None of this replaces a proper assessment, but it can help clarify what you're dealing with:
Has this always been part of you, even in childhood — or did it start after a specific event or period of stress?
Does the restlessness ease once a worry resolves, or is it there even when nothing is wrong?
Is your mind circling one fear, or jumping between many unrelated things?
Do you struggle to start tasks you're not even worried about?
How therapy can help
You don't need a formal diagnosis to start making sense of this. Neuroaffirming ADHD therapy creates space to explore what's actually going on for you — not to fit you into a checklist, but to understand the patterns underneath: the shame, the masking, the years of assuming you were just "too much" or "not doing enough."
If exam pressure or academic overwhelm is where this shows up most for you, our page on therapy for students explores that overlap further.
And if anxiety, low mood, or something harder to name feels like the bigger picture right now, individual therapy offers a space to untangle it, at your own pace, with no pressure to have the right label before you begin.
Key takeaways
- Anxiety and ADHD can look alike but are driven by different things — threat-perception versus regulation.
- More than 1 in 3 UK adults with anxiety or depression also screen positive for ADHD (NHS England, 2023/4).
- Unrecognised ADHD frequently causes secondary anxiety, which can mask the underlying picture.
- Women are especially likely to be misdiagnosed, often presenting with more internalised symptoms.
- You don't need a formal diagnosis to start therapy and begin understanding what's really going on.
Frequently asked questions
Can ADHD be mistaken for anxiety?
Yes, very commonly. Restlessness, racing thoughts and poor concentration appear in both, and ADHD-related anxiety built up over years of struggling can end up being the only thing diagnosed.
Do I need a diagnosis before starting ADHD therapy?
No. Whether you have a formal diagnosis, are waiting for an assessment, or simply recognise the patterns, there's space to explore it in therapy.
Is ADHD-related restlessness different from generalised anxiety?
Often, yes. ADHD-related restlessness tends to be constant and untethered to a specific worry, while generalised anxiety usually centres on identifiable fears.
Not sure which one this is for you?
That uncertainty is worth taking seriously, not powering through. Book a free 20-minute intro call and we can start untangling it together.
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