Inattentive ADHD and Anxiety: Understanding the Connection

The foundational connection: Our brain, ADHD, and the impact on anxiety.

The Intertwined Realities of Inattentive ADHD and Anxiety

Do you struggle to focus or pay attention in conversations? Do you often drift away into your head and get caught up in various different thought processes – constantly falling into spirals in your own mind?

Living with inattentive ADHD often means navigating a world that isn’t quite set up for how your brain works. For instance, you might feel three statements behind in group conversations, always trying to keep up pace with the chat. When you realize it’s too late to comment on a previous statement, anxiety can quickly set in, sending you into a mental spiral. You start worrying how others will perceive you, whether you fit in, and whether anyone can tell that you are totally in your head. Does this sound familiar?  

This is one example of what happens when you experience anxiety with ADHD. Research indicates anxiety frequently accompanies ADHD, with some studies suggesting that between 15% and 50% of adults with ADHD will also experience an anxiety disorder at some point in their life (CDC, n.d.; ADD.org, n.d.). These anxious feelings aren’t always separate. They often arise directly from ADHD challenges, what experts sometimes term “secondary anxiety.” In this article, we will explore some of the ways that ADHD symptoms can contribute to the development of feelings of anxiety.

Masking, Motivation, and the Anxious Overdrive

One of the ways this complex relationship can manifest is through “masking” – the conscious or unconscious effort to hide ADHD traits to fit in, or camouflage, in social situations (ADD.org, n.d.). We often learn to mask because it previously helped prevent or avoid negative judgments from others. And here’s where anxiety can play a surprising, yet unhelpful, role.

• Anxiety can Facilitate Masking:

  If you have inattentive ADHD (or any type), you might find that anxiety inadvertently helps you mask some of your symptoms. Perhaps you fear doing the “wrong” thing in social settings, worry about forgetting important details at work, or are concerned about appearing “different.” These fears fuel a state of heightened alertness or hypervigilance, pushing you to meticulously plan, over-prepare, or constantly monitor your behaviour, facial expressions, thoughts, and feelings.
  
  This isn’t a conscious choice. Instead, it’s a learned coping mechanism often shaped by past negative experiences. These might include neglectful or absent caregivers, being belittled or judged, or experiencing insecure attachment relationships throughout childhood. Overall, anxious feelings act as your internal warning system, preemptively trying to protect you from feeling like you’re “failing,” “not good enough,” or from being socially excluded.

• Anxiety used as “Motivation”:

  Have you ever gotten things done only because you were filled with anxiety? For individuals with ADHD, especially those with executive function challenges like task initiation and time management, anxiety can become a powerful, although maladaptive, motivator. The internal alarm bells of anxiety might be the only thing that kicks your system into gear. This isn’t true emotional regulation in a healthy sense; it’s more like anxiety hijacking the driver’s seat. It forces actions that “protect” you from future uncomfortable feelings of shame, guilt, and potential perceived “failures.”

  • Punctuality Trade-Offs:

    A classic example is being extremely early for appointments. Someone with ADHD might struggle with “time blindness.” This intense anxiety about being late – fearing consequences or letting someone down – can lead to overcompensation. For instance, you find yourself pacing your living room 20 minutes before you need to leave, your mind racing, all to ensure you’re not late. This behaviour, sometimes called “waiting mode,” makes it difficult to start or engage in a task when something is planned later in the day (like work, an appointment, or school). 

Recognizing the signs of mental fatigue is key when managing both inattentive ADHD and anxiety.

Hypervigilance and Following the Leader

Anxiety activates the sympathetic nervous system – our “fight/flight” response – leading to a state of physiological hyperarousal. This includes hypervigilance: constantly scanning your environment for potential “threats” to your physical, emotional, and social well-being. 

But does this anxiety-fueled hypervigilance actually help with inattentiveness? Research and expert opinion suggest it’s a double-edged sword:

• Distracting Awareness:

  While you might “check your environment” more, this awareness is often scattered and tinged with worry. Dr. Roberto Olivardia, a clinical psychologist and expert in ADHD, notes that anxiety can be particularly distracting for people with ADHD, preventing them from being grounded and mindful (HealthWell Foundation, n.d.). So, while you’re scanning and hyperalert, your internal focus will still be fragmented. You might notice anxiety-provoking thoughts/worries or uncomfortable physical sensations, leading you to feel more tense, agitated, and reactive.

• Struggling to Lead:

  If your internal compass feels unreliable due to inattention and your environment is perceived through an anxious, hypervigilant lens, you might overly rely on external cues or others’ actions to know what to do in situations or how to act. You wait for explicit instructions (“Okay, let’s leave now!”) or passively “go with the flow.” Initiating or navigating scenarios based on your own internal state feels too chaotic. This isn’t true “following” by choice. Instead it’s a consequence of internal overwhelm and an anxious attempt to stay on track by mirroring those around you. This mirroring and imitating of others often results in (and intertwines with) “people pleasing” tendencies, as you regularly prioritize others’ needs over your own.  

The Freeze Response: When ADHD Impulses Meet the Brakes of Anxiety

The internal world of someone with ADHD and anxiety can often feel like a battleground. The ADHD part of you, which likely just feels like you, experiences feelings, thoughts, and impulses. Yet, at the same time, the anxious part awakens in protective mode due to previous negative experiences like judgement, shaming, or other threats to yourself. This causes you to self-doubt, criticize yourself, and/or stay silent. Here are some examples of how this internal battleground may specifically impact you:

• Decision Paralysis:

  Do you often feel “frozen” or struggle immensely with making decisions? This is a common experience and is sometimes called “ADHD paralysis” or “choice paralysis.” Overwhelm from too many options, fear of making the wrong choice (often amplified by past negative experiences), or general sensory overload can trigger an anxiety response. This can eventually lead to shutting down (hypoarousal).

• Impulse vs. Inhibition:

  There might be an ADHD-driven impulse to do something, to act, to explore. But then, anxiety – perhaps born from a desire to fit in, follow rules, or avoid negative outcomes – slams on the brakes. This internal conflict between the “go” of ADHD and the “stop” of anxiety can leave you stuck, unable to move forward. Research suggests anxiety can indeed inhibit impulsivity, though often at the cost of increased inattention or internal distress (Meza et al., 2024). 

Hyperfocus and Social Anxiety

The unique way ADHD can impact attention, like the ability to hyperfocus, can also inadvertently fuel social anxiety.

• The Downside of Deep Focus:

  When intensely absorbed in something (a task, a game, a conversation), you might lose track of time, social cues, or the needs of others around you. Difficulty transitioning out of this hyperfocused state can also lead to agitation if interrupted. These moments, while unintentional, can lead to misunderstandings, frustration from others, and negative social feedback.

• Social Faux Pas:

  Repeated experiences of unintentionally upsetting others or missing social expectations can understandably lead to anxiety around social situations. You develop a heightened concern about others’ needs and perceptions. That anxious part of you will naturally begin to think more frequently about what others are thinking.

• Self-Silencing and Anxious Monitoring:

  To cope with this social anxiety, you might begin to “self-silence” – holding back your thoughts and impulses. You might also find yourself constantly, anxiously monitoring others for their reactions and intentions, trying to prevent negative outcomes. This hypervigilance isn’t about genuine connection but about threat detection. It often involves neglecting your own needs and authentic way of being.
  
  This often leads to a self-fulfilling cycle. You try to avoid conflict and threats while in a state of threat-detection. Therefore, you are more likely to react agitated/abruptly to others, which can then unintentionally result in receiving negative perceptions from others. Rejection Sensitive Dysphoria (RSD), an intense emotional pain in response to perceived rejection or criticism, can further amplify these patterns.

The journey towards healing often begins with quiet reflection, seeking solace, and discovering new ways to support ourselves amidst the complexities of ADHD and anxiety.

The Long-Term Cost: When Anxiety Becomes the Default

When anxiety acts as a primary coping mechanism or motivator, it offers short-term “solutions” but comes with significant long-term costs. Remember, experiencing this anxiety is not a conscious choice. It’s your body and nervous system’s way of trying to protect you from what it deems as threats to your wellbeing (often social survival).

Here are some ways regular feelings of anxiety can become more harmful than helpful. I hope this facilitates your self-awareness and understanding, helping you make conscious changes to these, until now, unconscious processes.

• Anxious Fog and Confusion:

  When anxiety seems the only way you “function” to get through the day – to meet deadlines, to be on time, to manage social interactions – it becomes incredibly difficult to discern if the anxiety in a specific situation (like going to work) is truly about that situation. Or, is it the familiar buzz of your nervous system’s self-regulatory mechanism built to help you get to that situation (work) on time? Anxiety that facilitates the managing of ADHD symptoms can start to look and feel a lot like generalized anxiety.

• The Path to Burnout and Depression:

  Living in a constant state of anxiety-driven motivation is exhausting. As experts note, this constant adrenaline kick is not a sustainable or effective way to live. Life can become less enjoyable, more stressful, and feel increasingly bleak. You might feel always “on,” operating primarily to meet others’ expectations or avoid failure, rather than from genuine desire or interest.
  
  This chronic stress, feelings of inadequacy, and constant effort of masking and managing pave the way for burnout and increase the risk of developing depression. Research shows a significant overlap between ADHD, anxiety, and depression, with the challenges of living with ADHD often contributing to mood disorders over time (CDC, n.d.).

Moving Towards Healthier Coping

Understanding these complex interactions between inattentive ADHD and anxiety is the first step. Remember, your feelings of anxiety, from this anxious part of you, originally developed out of a need to protect you from social, emotional, and physical harm (whether perceived and/or real) – it’s just your evolutionarily derived mind, body, and nervous system doing what it does best, surviving. 

While these patterns can feel deeply ingrained, they are not unchangeable. Recognizing that anxiety might be serving as an unhelpful coping strategy, currently, can open the door to seeking healthier, more sustainable ways to manage ADHD symptoms, emotional well-being, and connecting more deeply and authentically with others. 

If this article resonated with your own experience and you are curious about starting to learn other strategies of managing anxiety, feel free to check out more about my counselling practice to see if a free consultation is something you are interested in.

This blog post is intended for informational purposes only and does not constitute medical advice. If you have concerns about ADHD, anxiety, or your mental health, please consult with a qualified healthcare professional.

References:

1. Centers for Disease Control and Prevention. (n.d.). Data and Statistics on ADHD | Attention-Deficit / Hyperactivity. Retrieved June 4, 2025, from https://www.cdc.gov/adhd/data/index.html
2. Kooij, J. J. S., Middelkoop, G. H., & Sprengers, J. (2010). Adult attention deficit hyperactivity disorder in an anxiety disorders psychiatric outpatient department. Journal of Clinical Psychiatry, 71(5), 589-593. https://pubmed.ncbi.nlm.nih.gov/20406249/
3. ADD.org. (n.d.). ADHD Masking: Does Hiding Your Symptoms Help or Harm? Retrieved June 4, 2025, from https://add.org/adhd-masking/
4. Dorey, A. (n.d.). Hypoarousal and Hyperarousal: How to Tell Which State You’re In. Neurodivergent Insights. Retrieved June 4, 2025, from https://neurodivergentinsights.com/hypoarousal-hyperarousal/
5. Meza, K. K., Biederman, J., Spencer, T. J., et al. (2024). The interaction of ADHD traits and trait anxiety on inhibitory control performance. Frontiers in Psychiatry, 15, 11871067. https://pmc.ncbi.nlm.nih.gov/articles/PMC11871067/
6. HealthWell Foundation. (n.d.). ADHD & Anxiety: Two Common Coexisting Disorders. Retrieved June 4, 2025, from https://www.healthwellfoundation.org/realworldhealthcare/adhd-anxiety-two-common-coexisting-disorders/