ADHD & Social Anxiety: Connections & How to Cope

Can You Have Both ADHD & Social Anxiety?

It is common for a person with ADHD to experience another mental health disorder including social anxiety disorder. In fact, one in three individuals with ADHD will also experience social anxiety.¹ While ADHD and social anxiety are two very different conditions, there is much overlap between symptoms and their impact on a person’s life. For example, a person with either or a comorbid condition likely experiences an intense fear of rejection, leading to social isolation or avoidance. Thus, it is quite common for comorbid ADHD and social anxiety to occur.¹

Connections Between ADHD & Social Anxiety

As mentioned, certain symptoms of ADHD and social anxiety are very similar in nature. These symptoms can cause problems for one’s self-esteem, in their relationships, and in their professional life. However, while living with comorbid ADHD and social anxiety can be daunting, there are ways to address and treat them.²

Connections between ADHD and social anxiety include:

1. Low Self-Esteem

Low self-esteem often includes feelings of self-doubt, inadequacy, and a lack of self-confidence. A person may feel unworthy or undeserving. For those with ADHD and social anxiety, low self-esteem is common as they may feel anxious about how they are being perceived by others in social settings. They may believe that others are judging them for their behaviors or actions.

For instance, distractibility is a well-associated symptom of ADHD, which can make completing tasks challenging for those diagnosed. Because of this, a person may feel that they will be perceived negatively by others for not following through on projects. In turn, this can lead to self-criticism and negative self-talk.

2. Difficulty Completing Tasks

A person with ADHD and social anxiety may struggle with completing tasks because they fear how their work will be perceived by others. This fear of being judged can result in emotional overwhelm, only making it more difficult to carry through. Furthermore, they typically will not ask for help to avoid being looked down upon.

3. Difficulties Socializing

While it may seem obvious to assume a person with social anxiety will have difficulty socializing, this trait may not be typically associated with ADHD. However, those with ADHD often set high expectations for themselves. When socializing, they may overthink how they talk to and engage with others because they worry about not acting how they “should” in a certain situation. Therefore, this fear can result in challenges communicating, furthering one’s anxiety about interacting with others.

4. Avoidance & Isolation

Avoidance behavior and isolation is a common occurrence for those with ADHD and social anxiety. Doing so offers them a way to cope with their intense fears of judgment and criticism. However, this causes more insecurities and issues in the long run. The avoidance feeds the social anxiety, leading to a harmful cycle of self-isolation.

5. Inattentiveness

While inattentiveness may be more prevalent in ADHD, it can also affect those with social anxiety. Being diagnosed with comorbid ADHD and social anxiety can lead to distractibility when it comes to interacting with others. This may be due to the constant flow of thoughts about how to respond, act, and behave “correctly” in social settings. This then may appear as disinterest in a conversation. Unfortunately, this can frustrate others as they feel ignored or overlooked.

Why Do ADHD & Social Anxiety Occur Together?

There are many contributing factors to the development of social anxiety and ADHD. While genetics play a role for both conditions, external factors can intensify or exacerbate any possible predispositions.³

Possible causes of comorbid social anxiety and ADHD include:

• Previous trauma: A person is more likely to have difficulty engaging with others if they have experienced trauma, such as childhood trauma or sexual trauma. This may lead to fears about people in general, resulting in anxiety.
• Genetic factors: Those with other family members with a history of either condition may be more likely to experience ADHD and social anxiety.
• Environment: This may include how a person was raised, where they grew up, and other aspects of their life. Certain circumstances may lead to increased symptoms of either condition.
• Social roles: Depending on the responsibilities a person has, they may feel the need to fit a certain role or fill expectations placed on them. This can make them anxious as they fear the perception of others based on their performance.

Can ADHD & Social Anxiety Be Misdiagnosed?

For any mental health condition, receiving the appropriate treatment is essential. In order to receive this, a person must first be given a diagnosis. In some cases, it is possible for a misdiagnosis to be provided, as symptoms of various conditions can mimic or resemble one another. This may be the case for a person with ADHD, social anxiety, or both. Further, many people who spend time around a person with ADHD think of them as being very outgoing because they are hyperactive, but this behavior is not the same as being comfortable interacting socially with others.

Another cause for misdiagnosis may include ADHD masking, as a person may either purposefully or inadvertently hide their symptoms from themselves and others. This only makes receiving an accurate diagnosis more difficult. Because of this, it’s important to honestly share any and all of the symptoms you are experiencing with your doctor so you can better understand what is causing them.

How Are ADHD & Social Anxiety Treated?

ADHD and social anxiety are often treated with therapy and medication. When considering treatment, be sure to explore all of your options to ensure you find what works best for you. No treatment method is one size fits all, so understanding what you are looking for can be helpful. Additionally, it may be beneficial to find a neurodiverse affirming therapist who you feel safe with and validated by.⁴

Therapy

Therapy is beneficial for exploring how a person’s symptoms impact them and their lives. Additionally, if someone is interested in including family members in their treatment, they can opt to do so and receive extra support when needed.

Therapy options for social anxiety and ADHD include:

• Cognitive behavioral therapy (CBT): CBT for ADHD and social anxiety allows a person to identify unhealthy thought patterns and reframe them in order to decrease anxiety.
• Group therapy: Group therapy is beneficial for both conditions as it offers a way for individuals to feel validated and supported by others who are experiencing similar symptoms.
• Somatic therapy: Somatic therapy encourages an individual to pay attention to how their emotions affect their body. This can help them recognize when they are feeling anxious and make efforts to cope with it.
• Dialectical behavioral therapy (DBT): DBT teaches an individual how their thoughts, patterns, and emotions relate to an action and how to address these feelings as they arise.
• Acceptance and commitment therapy (ACT): ACT incorporates elements of mindfulness which help an individual stay centered and grounded when feeling overwhelmed.

Medication

It is important to know which medications for ADHD and medications for anxiety may be appropriate during treatment. The proper prescription can decrease unwanted symptoms and help a person better navigate their day to day. However, it is also important to understand possible side effects and risks of any medication you are considering. Your doctor will help you determine the best option for your treatment.

Medication options for social anxiety and ADHD may include:

• SSRIs*: Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that increase a person’s serotonin levels, resulting in decreased anxiety.
• SNRIs*: Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase levels of both serotonin and norepinephrine, thus decreasing feelings of sadness and improving one’s overall mood.
• Stimulants**: Stimulants increase dopamine levels in the brain, resulting in increased motivation.
• Benzodiazepines***: These medications help alleviate anxiety and stress levels by increasing the effects of the neurotransmitter GABA.
• Tricyclic antidepressants: Tricyclic antidepressants work similarly to SNRIs, but may result in less side effects.

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

**This medication has a black box warning, the most serious kind of warning from the FDA for a risk of medication misuse or abuse.

***This medication has black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence and risk of serious side effects, including death, when combined with an opioid.

How to Cope With ADHD & Social Anxiety

While navigating ADHD and social anxiety may be challenging, there are healthy coping mechanisms a person can adopt to do so. Finding the methods that work best for you may take time, but can help you decrease symptoms and live a healthier life.

Here are some tips for coping with ADHD and social anxiety:

• Practice mindfulness: Mindfulness for anxiety helps a person remain grounded in the present moment instead of focusing on the future. Mindfulness can help ease negative thoughts as they arise.
• Try journaling: When journaling, a person is able to rid their mind of unhealthy and negative thoughts, rather than ruminating on them.
• Socialize: While this may sound a bit scary, it is important to socialize in order to gain new experiences and opportunities for growth.
• Exercise: Exercising releases endorphins that can help a person feel less uneasy and anxious.
• Find a support system: When a person becomes overwhelmed, knowing they have the support of others can help them feel relaxed and secure.
• Reframe your thoughts: By reframing negative thoughts, a person can recognize that these thoughts are not true and make conscious efforts to change them.

Final Thoughts

If you struggle with ADHD and social anxiety, a therapist can help you determine a treatment plan that best suits your individual needs. Remember that there is no shame in seeking help–support may be the key to feeling rejuvenated and happy in your own skin.