ADHD symptoms are stress symptoms
The World Health Organization, WHO, points out in the ADHD screening test it developed, “The symptoms of this disorder are often misidentified as stress.”1 Nigg formulates: “…adversity can cause a child to look just like he has ADHD.”2 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.3
We believe that almost all ADHD symptoms are “normal” stress symptoms. This does not mean that ADHD and stress are the same. 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 those that can be caused by ADHD. Cognitive impairments can be caused by psychological as well as physical stress.4
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 checked by differential diagnostics during the ADHD history. ⇒ Differential diagnostics for 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 benefits of stress symptoms. At ⇒ Stress benefits - the survival-promoting purpose of stress symptoms We explain the concept of stress benefits and describe the stress benefits of each stress/ADHD symptom.
We explain that ADHD thus mediates its symptoms by causing a disturbance 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 chronified stress regulation disorder. To avoid misunderstandings: this does not mean that ADHD would be a consequence of still ongoing chronic stress and would end with an elimination of the stressor. This is precisely the essential difference between ADHD and chronic stress: stress goes with the stressor, ADHD stays.
1. Cognitive symptoms
- 1.1. Attention problems
- 1.2. Concentration problems
- 1.3. Forgetfulness
- 1.4. Blocks to thinking
- 1.5. Brooding; thoughts focus on the stressor
- 1.6. Deteriorated self-awareness until inability to recover
- 1.7. Delay Aversion / Delay Aversion
- 1.8. Delay Discounting / Devaluation of later reward
- 1.9. Decision problems
- 2.1. Increased locomotor activity (urge to move, restlessness to move)
- 2.2. Unrest
- 2.3. Aggression
- 2.4. Listlessness
- 2.5. Social withdrawal
- 2.6. Performance impaired
- 2.7. Drug / nicotine / alcohol abuse (addiction)
- 2.8. More risky decisions
- 2.9. Impulsivity
- 2.10. Sexual problems / loss of libido (not an ADHD symptom)
3. Emotional symptoms
- 3.1. Mood swings (often sad / depressed)
- 3.2. Self-esteem issues
- 3.3. Irritability
- 3.4. Anger / Rage
- 3.5. Listlessness/motivation problems
- 3.6. Feeling of being overwhelmed
- 3.7. Fear/anxiety
- 3.8. Increased sensitivity
- 3.9. Alexithymia (reduced perception of feelings)
- 3.10. Frustration Intolerance
- 3.11. Easier to get sick
- 4. Physical symptoms
1. Cognitive symptoms
1.1. Attention problems
- Almost any mental disorder will cause attention problems,9 for example
- 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 affected.10
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.4 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.11
Stress directly influences12
- focused attention.
1.2. Concentration problems
For the alteration of the functions of the PFC due to the very elevated norepinephrine level during stress, see under 1.1. Attention problems.
Identical for ADHD.
- Implicit memory impaired17
- Declarative memory impaired17
- Working memory impaired17
- 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.18
1.4. Blocks to thinking
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.8
- with ADHD: mind circles
- in ADHD: Compulsion as a frequent comorbidity
1.6. Deteriorated self-awareness until inability to recover
Low emotional self-control, spontaneity of feelings or avoidance of feelings (coolness, emotional dysregulation) is a symptom of stress.19
with ADHD: not being able to enjoy
in ADHD and procrastination: aversion to mindfulness / reduced mindfulness
See also: Alexithymia under feelings
1.7. Delay Aversion / Delay Aversion
Stress-reducing measures simultaneously reduce delay aversion.22
- Can not wait
Occurs identically in ADHD.
Although not included in the ICD 10 / DSM IV symptom lists, delay aversion is one of the core ADHD symptoms.
1.8. Delay Discounting / Devaluation of later reward
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 various forms of expression:
1.8.2. Addictive tendencies
1.8.4. Self-regulatory ability impaired
Self-regulatory ability is an even greater predictor of career success than intelligence.
1.9. Decision problems
identical for ADHD
- ADHD-HI: impulsive, non-thought-out, spontaneous decisions
- ADHD-I: Difficulty making decisions
2.1. Increased locomotor activity (urge to move, restlessness to move)
In ADHD-HI this symptom is called hyperactivity (occurs mainly in children).
Inner restlessness is a typical symptom of the approaching end state of burnout.31
In ADHD-HI: inner drive, always having to do something (primarily adults)
In ADHD-HI (with hyperactivity), aggression often occurs as a comorbidity.
Listlessness is a typical symptom of the approaching end state of burnout.31
In ADHD: dysphoria with inactivity
2.5. Social withdrawal
- 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)
In ADHD, social withdrawal is common and goes as far as social phobia.
2.6. Performance impaired
When stress is severe, performance is impaired.61415
Obstruction of effort, due to lack of satisfaction from success or lack of expectation of success (listlessness, shutting down, denial) are symptoms of stress.19
Slight exhaustibility, lack of energy and daytime fatigue are typical symptoms of the approaching end state of burnout.31
Occurs identically in ADHD.
2.7. Drug / nicotine / alcohol abuse (addiction)
- significantly increased rate of smokers
- frequent comorbidity addiction
2.8. More risky decisions
Riskier decisions are a symptom of stress.34
Occurs identically in ADHD-HI (with hyperactivity):
- Risk affinity
- spontaneous, rash decisions
Impulsivity is a symptom of stress.22
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 stress568
Libido suppression is a direct effect of the stress hormone CRH.2930
Sexual problems or listlessness are not typical ADHD symptoms, but do occur in ADHD.
In ADHD, disturbed sexuality tends to be mentioned as a common comorbidity.35 Sexuality is further mentioned as an addictive object and a means of tension relief in ADHD.36 One study found less sexual satisfaction, more sexual desire, more sexual dysfunction, and riskier sexual behavior in ADHD sufferers.37
The number of sexual partners in ADHD is typically increased, and first sex occurs earlier on average than in non-affected individuals. A decrease in libido is sometimes cited in conjunction with medication in ADHD38 or depression.
3. Emotional symptoms
3.1. Mood swings (often sad / depressed)
Mood swings are a symptom of stress.15
Frequent sadness is known as a stress symptom.8
Being frequently depressed / depression are also stress symptoms.1656515
Despair is a direct effect of the stress hormone CRH.3930 In contrast, noise or movies rarely trigger cortisolergic stress.
In ADHD: dysphoria with inactivity as the main symptom; in addition, genuine depression often occurs as a comorbidity.
3.2. Self-esteem issues
- Low self-worth
- Suicidal tendency
- Guilt and shame
This is equally true of listlessness,56 which could be considered the equivalent of dysphoria when inactive and feeling depressed.406
In particular, a perceived uncontrollable threat to self-esteem leads to cortisol release.4142
Feelings of inferiority and failure are typical symptoms of the final state of burnout.31
In ADHD: emotional dysregulation is a typical symptom.
In ADHD and extraverted personality (ADHD-HI, ADHD-C): often
3.4. Anger / Rage
Anger / rage are well-known symptoms of stress.6
In ADHD and extraverted stress phenotypes (ADHD-HI, ADHD-C): often
3.5. Listlessness/motivation problems
Motivation and drive problems are common in ADHD.
3.6. Feeling of being overwhelmed
This also occurs frequently in ADHD.
Increased anxiety is a symptom of stress.62815
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.4330
Anxiety is often elevated in ADHD, especially in ADHD-I. Anxiety disorders are a common comorbidity of ADHD and can develop from untreated ADHD.
3.8. Increased sensitivity
ADHD always includes (at least partial) high sensitivity.
3.8.2. Increased alertness / attention
3.8.3. Increased acoustic perception
3.8.4. Sensory overload
Overstimulation is a symptom of stress.44
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 feelings45
- Low emotional self-control, spontaneity of feelings or avoidance of feelings (coolness, emotional dysregulation)19
- Emotional flattening (with persistent sickliness) is a typical symptom of the end state of burnout.31
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.31
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.31
Increased sickliness is a very common ADHD symptom. We refer to it there as Rejection Sensitivity.
4. Physical symptoms
Somatic complaints could be the only type of stress that occurs significantly less in ADHD sufferers than in non-affected persons.46 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.4730682815
Increased wakefulness and decreased deep sleep is a direct effect of the stress hormone CRH.2930
Frequent nightmares are also mentioned as a symptom of stress.828
Sleep disorders are very common in ADHD.
4.2. Muscle twitching
In ADHD: often similar muscle twitching as a mild form of restless legs when falling asleep
4.3. Increased muscle tension
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.15
4.5. Exhaustion states
Exhaustion is a symptom of stress.6
4.6. Cardiovascular complaints
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
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 nonaffected individuals. More on this in the article ⇒ ADHD, obesity and eating disorders.
4.9. Abdominal pain
4.10. Frequent colds
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, it leads to the body now taking the necessary regeneration and actively combating illness - 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 secretion 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
Increased respiratory rate is not known to be an ADHD symptom.
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