The World Health Organization, WHO, points out in the ADHD screening test it developed, “The symptoms of this disorder are often misidentified as stress.” Nigg formulates: “…adversity can cause a child to look just like he has ADHD.” and says nothing else than that stress can generate very confusable symptoms to ADHD. Individual studies also address the relationship between stress and ADHD symptoms.
We believe that almost all ADHD symptoms are “normal” stress symptoms. This does not mean that ADHD and stress are the same thing. Chronic uncontrollable stress, i.e. severe (and often psychological) stress that is perceived as threatening or frightening, can - completely independently of ADHD - trigger almost identical symptoms as can be caused by ADHD. Cognitive impairment can be caused by psychological as well as physical stress.
Conversely, however, not all stress symptoms are also ADHD symptoms - although the degree of correspondence is quite impressive. In this article, we only present ADHD symptoms that are also stress symptoms.
The fact that ADHD symptoms can also be caused by other causes than ADHD is already being balanced by differential diagnostics during the ADHD history. ⇒ Differential diagnostics in ADHD
We have added the manifestation of the corresponding ADHD symptoms in italics.
In each case, the references refer to the symptom as a stress symptom.
At ⇒ Symptoms of ADHD For each ADHD symptom, we have also integrated the source references from the stress literature that prove that the respective symptom is also known to be a stress symptom.
The initially somewhat surprising fact that all ADHD symptoms are also stress symptoms becomes apparent when one understands the utility of stress symptoms. At ⇒ Stress benefits-the survival-enhancing purpose of stress symptoms We explain the term stress benefit and describe the stress benefit of the particular stress/ADHD symptom.
We explain that ADHD thus mediates its symptoms by causing a disruption of the stress response systems in which they chronically overreact, so that affected individuals suffer from symptoms of significant stress even in the absence of an external stressor, in our article ⇒ ADHD as a chronicized stress regulation disorder. To avoid misunderstanding, this does not mean that ADHD would be a consequence of still ongoing chronic stress and would end with elimination of the stressor. This is the essential difference between ADHD and chronic stress: stress goes with the stressor, ADHD stays.
1. Cognitive symptoms¶
1.1. Attention problems¶
Attention problems as stress symptoms.
- Almost any mental disorder will cause attention problems, for example:
- Psychosis
- Tourette
- Mania
- Panic disorders
- Obsessive Compulsive Disorder
Specific to ADHD is the (attentional) impairment to perform a preconceived future directed action. ADHD sufferers are distracted by unimportant stimuli from the environment, but selective attention is hardly impaired.
In our view, however, task switching problems are common in ADHD and are a consequence of impaired controllability of attentional orienting.
The norepinephrine and dopamine levels, which are elevated during acute stress, impair the functionality of the PFC above a certain level. While slightly elevated norepinephrine levels increase the ability to think, very high norepinephrine levels decrease this ability and behavioral control is transferred from the PFC to the posterior cortex.
Stress directly influences
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Arousal
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Vigilance
- focused attention.
1.2. Concentration problems¶
Concentration problems as stress symptoms.
For the alteration of the functions of the PFC due to the very elevated level of noradrenaline during stress, see under 1.1. Attention problems.
Identical for ADHD.
1.3. Forgetfulness¶
Forgetfulness or memory problems as a symptom of stress:
- Implicit memory impaired
- Declarative memory impaired
- Working memory impaired
- For the alteration of the functions of the PFC due to the very elevated level of norepinephrine during stress, see under 1.1. Attention problems
All of the above symptoms also occur in ADHD, but not in all sufferers.
1.4. Blocks to thinking¶
Thought blocks are a symptom of stress.
For the alteration of the functions of the PFC by very elevated levels of norepinephrine during stress, see under 1.1. Attention Problems. The shutdown of the PFC by very high levels of norepinephrine and dopamine during severe stress blocks
- The ability to think analytically
- Decision-making processes
Thought blocks are a typical ADHD symptom.
1.5. Brooding; thoughts focus on the stressor¶
Rumination is a symptom of stress.
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for ADHD: circling of thoughts
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in ADHD: Compulsion as a frequent comorbidity
1.6. Deteriorated self-awareness until inability to recover¶
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Low emotional self-control, spontaneity of feelings or avoidance of feelings (coolness, emotional dysregulation) is a symptom of stress.
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with ADHD: not being able to enjoy
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in ADHD and procrastination: aversion to mindfulness / reduced mindfulness
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See also: Alexithymia under feelings
1.7. Delay Aversion / Delay Aversion¶
Delay aversion is a stress symptom. It is understood as an impulsivity reaction. It correlates with impulsivity under stress, in women at the same time with increasing heart rate.
Stress-reducing measures simultaneously reduce delay aversion.
Expressions:
Occurs identically in ADHD.
Although not included in the ICD 10 / DSM IV symptom lists, delay aversion is one of the core symptoms of ADHD.
1.8. Delay Discounting / Devaluation of later reward¶
Delay Discounting is a stress symptom. This is also called Discounting of Delayed Rewards, Temporal Discounting or Reward Prediction Error (RPE).
Rewards that are immediate are preferred to the same degree as by people without stress.
Rewards that are distant in time are considered less attractive than by people without stress.
Delay Discounting has several forms of expression:
1.8.1. Procrastination¶
1.8.2. Addictive tendencies¶
1.8.3. Clutter¶
1.8.4. Self-regulatory ability impaired¶
Self-regulatory ability is an even greater predictor of career success than intelligence.
1.9. Decision problems¶
Decision-making problems are well-known symptoms of stress.
for ADHD identical
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ADHD-HI: impulsive, non-thought-out, spontaneous decisions
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ADHD-I: Difficulty making decisions
2. Behavior¶
2.1. Increased locomotor activity (urge to move, restlessness to move)¶
Hyperactivity is a symptom of stress.
Increased locomotor activity is a direct effect of the stress hormone CRH.
In ADHD-HI this symptom is called hyperactivity (occurs mainly in children).
2.2. Unrest¶
(Inner) restlessness and restlessness are symptoms of stress.
Inner restlessness is a typical symptom of the approaching end state of burnout.
In ADHD-HI: inner drive, always having to do something (primarily adults)
2.3. Aggression¶
Aggression is a symptom of stress.
In ADHD-HI (with hyperactivity), aggression often occurs as a comorbidity.
2.4. Listlessness¶
Listlessness is a symptom of stress
Listlessness is a typical symptom of the approaching end state of burnout.
In ADHD: dysphoria with inactivity
2.5. Social withdrawal¶
Social withdrawal is known as a typical symptom of severe stress.
A reduction in social contacts during stress is attributed to the fact that
- No positive or even negative response is expected (avoidance or aggression, see the article on Rejection Sensitivity)
- The need for security and control is too great (too much closeness, ambivalence, closeness-distance pendulum)
Increased withdrawal behavior is a direct effect of the stress hormone CRH.
An increasing restriction of social contacts is a typical symptom of burnout.
In ADHD, social withdrawal is common and goes as far as social phobia.
2.6. Performance impaired¶
When stress is severe, performance is impaired.
Obstruction of effort, due to lack of satisfaction from success or lack of expectation of success (listlessness, shutting down, denial) are symptoms of stress.
Slight exhaustibility, lack of energy and daytime fatigue are typical symptoms of the approaching end state of burnout.
Occurs identically in ADHD.
2.7. Drug / nicotine / alcohol abuse (addiction)¶
Medication / nicotine / alcohol abuse (addiction) is a symptom of stress
Smoking correlates with stress.
For ADHD:
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significantly increased rate of smokers
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frequent comorbidity addiction
2.8. More risky decisions¶
Riskier decisions are a symptom of stress.
Occurs identically in ADHD-HI (with hyperactivity):
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Risk affinity
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spontaneous, rash decisions
2.9. Impulsivity¶
Impulsivity is a symptom of stress.
Occurs identically in ADHD-HI (with hyperactivity).
2.10. Sexual problems / loss of libido (not an ADHD symptom)¶
Sexual problems / loss of libido are a symptom of stress
Libido suppression is a direct effect of the stress hormone CRH.
Sexual problems or listlessness are not typical ADHD symptoms, but they do occur in ADHD.
In ADHD, disturbed sexuality tends to be mentioned as a common comorbidity. Sexuality is further mentioned as an addictive object and a means of tension relief in ADHD. One study found less sexual satisfaction, more sexual desire, more sexual dysfunction, and riskier sexual behavior in ADHD sufferers.
The number of sexual partners in ADHD is typically increased, and first sex occurs earlier on average than in unaffected individuals. A decrease in libido is sometimes cited in conjunction with medication for ADHD or depression.
3. Emotional symptoms¶
3.1. Mood swings (often sad / depressed)¶
Mood swings are a symptom of stress.
Frequent sadness is known as a stress symptom.
Being frequently depressed / depression are also stress symptoms.
Despair is a direct effect of the stress hormone CRH. In contrast, noise or movies rarely trigger cortisolergic stress.
In ADHD: dysphoria with inactivity as the main symptom; in addition, true depression often occurs as a comorbidity.
3.2. Self-esteem issues¶
Self-esteem problems are typical symptoms of severe stress.
- Low self-worth
- Self-hate
- Suicidal tendency
- Guilt and shame
This is equally true of listlessness, which could be considered the equivalent of dysphoria when inactive and feeling depressed.
In particular, a perceived uncontrollable threat to self-esteem leads to cortisol release.
Feelings of inferiority and failure are typical symptoms of the final state of burnout.
In ADHD: emotional dysregulation is a typical symptom.
3.3. Irritability¶
Frequent irritability is a symptom of stress. Irritability is a typical symptom of the approaching end state of burnout.
In ADHD and extraverted personality (ADHD-HI, ADHD-C): often
3.4. Anger / Rage¶
Anger / rage are well-known symptoms of stress.
In ADHD and extraverted stress phenotypes (ADHD-HI, ADHD-C): often
3.5. Listlessness/motivation problems¶
Listlessness/motivation problems are common symptoms of stress. Listlessness is presented here as the emotional side of listlessness.
For listlessness see above under 2.4.
Motivation and drive problems are common in ADHD.
3.6. Feeling of being overwhelmed¶
Feeling overwhelmed is a symptom of stress.
This is also common in ADHD.
3.7. Fear/anxiety¶
Increased anxiety is a symptom of stress.
Increased anxiety, increased fear conditioning, and increased caution in unfamiliar environments, open field, elevated plus maze, and conflict are direct effects of the stress hormone CRH.
Anxiety is often elevated in ADHD, especially ADHD-I. Anxiety disorders are a common comorbidity of ADHD and can develop from untreated ADHD.
3.8. Increased sensitivity¶
Increased sensitivity is a symptom of stress.
ADHD always includes (at least partial) high sensitivity.
3.8.1. Frightfulness¶
Increased startle responses are a direct effect of the stress hormone CRH.
3.8.2. Increased alertness / attention¶
Increased alertness and attention is a direct effect of the stress hormone CRH.
3.8.3. Increased acoustic perception¶
Increased auditory perception is a direct effect of the stress hormone CRH.
3.8.4. Sensory overload¶
Overstimulation is a symptom of stress.
Heightened sensitivity can also be referred to as high sensitivity.
In ADHD: stimulus filter too wide open.
3.9. Alexithymia (reduced perception of feelings)¶
- Reduced perception of own feelings
- Low emotional self-control, spontaneity of feelings or avoidance of feelings (coolness, emotional dysregulation)
- Emotional flattening (with persistent sickliness) is a typical symptom of the end state of burnout.
In contrast to many other symptoms mentioned here, alexithymia does not seem to be a directly neurophysiologically mediated symptom, but rather a frequent consequence of or associated with an insecure-avoidant attachment style.
Emotional poverty / inner emptiness / alexithymia is a possible symptom in ADHD.
3.10. Frustration Intolerance¶
Frustration intolerance is a typical symptom of the end state of burnout.
Frustration intolerance is a typical ADHD symptom.
3.11. Easier to get sick¶
Increased sickliness is a typical symptom of the end state of burnout.
Increased sickliness is a very common ADHD symptom. We call it Rejection Sensitivity there.
4. Physical symptoms¶
Somatic complaints could be the only type of stress that occurs significantly less in ADHD sufferers than in non-affected persons. This circumstance would be most astonishing and not plausible without more detailed research and explanation. As is well known, this does not apply to sleep disorders. However, our own research also indicates - to our own astonishment - that somatic stress symptoms are significantly underrepresented in adult ADHD sufferers. Exceptions exist only in sleep disturbances (very clearly) and exhaustion states and muscle tension (still clearly). All other somatic stress symptoms, however, are (still significantly) lower than in non-affected persons.
4.1. Sleep disorders¶
Sleep disorders are a symptom of stress.
Increased wakefulness and decreased deep sleep is a direct effect of the stress hormone CRH.
Frequent nightmares are also mentioned as a symptom of stress.
Sleep disturbances are very common in ADHD.
4.2. Muscle twitching¶
Muscle twitching is a symptom of stress.
In ADHD: often similar muscle twitching to a mild form of restless legs when falling asleep
4.3. Increased muscle tension¶
Increased muscle tension is a symptom of stress.
Increased muscle tone can lead, for example, to back pain and even vertebral blockages.
In combat, increased muscle tone protects against injury.
4.4. Increased sensitivity to pain¶
Increased sensitivity to pain is a symptom of stress.
4.5. Exhaustion states¶
Exhaustion is a symptom of stress.
4.6. Cardiovascular complaints¶
Cardiovascular complaints are a symptom of stress.
ADHD-HI and ADHD-C (less ADHD-I) often correlate with elevated blood pressure and susceptibility to heart problems.
4.7. Loss of appetite / ravenous hunger¶
Eating disorders are a symptom of stress.
Loss of appetite is a direct effect of the stress hormone CRH.
Obesity is at least twice as common in ADHD as in non-affected individuals. Eating disorders are up to 8 times more common in ADHD sufferers than in non-affected individuals. More on this in the article ⇒ ADHD, obesity, and eating disorders.
4.8. Headache¶
Headaches are a well-known symptom of stress.
4.9. Abdominal pain¶
Abdominal pain is a common symptom of stress, especially in children.
Nausea is also known as a symptom of stress.
4.10. Frequent colds¶
Frequent colds are a symptom of stress.
An increased susceptibility to infections is a typical symptom of the approaching end state of burnout.
Stress hormones (adrenaline, CRH, ACTH) are able to artificially boost the immune system for a certain time. For the Homo sapiens species, it was simply conducive to survival in situations of hardship, where survival had to be fought for at great expense, when not exactly simple (preventable) diseases occurred. The stress hormones adrenaline and CRH therefore cause a (temporary) pro-inflammatory increase in the activity of the immune system.
However, on the one hand, this increase is energy-sapping and, on the other hand, during the first stress pause, the body now takes the necessary regeneration and starts actively fighting disease - e.g. through fever and other mechanisms with which the body protects itself against pathogens.
This is the reason why many people get sick during the first week of vacation - when the stress subsides.
In addition to its stress symptom-mediating effects, cortisol also has the task of terminating the stress response (by inhibiting the hormones secreted at the beginning of the stress chain and thus limiting its own release over time). Cortisol simultaneously reduces the pro-inflammatory effects of adrenaline and CRH and instead promotes other immune responses directed primarily against bacteria and parasites. Depending on the direction in which the stress systems are out of balance, excessive inflammation (e.g. of the intestinal mucosa in morbus crohn’s or of the skin in neurodermatitis) or excessive immune reactions against external pathogens (e.g. allergies) can occur.
4.11. Increasing respiratory rate¶
Panting is a symptom of stress.
Increased breathing rate is not known to be an ADHD symptom.
