About a year ago, I was diagnosed with complex PTSD, and during discussions with my therapist, the possibility of having ADHD also came up. Many behaviours typical of ADHD apply to me, leading us to explore this further.
My therapist explained that ADHD and CPTSD share many overlapping symptoms. This spurred me to investigate which specific symptoms are common to both conditions.
Understanding this overlap is crucial because both ADHD and CPTSD are relatively new areas of scientific research. There is a concern that this novelty might lead to frequent misdiagnoses. For example, women with ADHD are often diagnosed and treated for anxiety and depression without considering ADHD, which can cause these symptoms.
Additionally, I’m interested in whether the treatments for these shared symptoms are identical for both disorders. If they differ (and I suspect they will), accurate diagnosis becomes even more critical to ensure appropriate treatment.
Attention Deficit Hyperactivity Disorder (ADHD)
There’s been much discussion on social media about ADHD and how it manifests in behaviour, emotions, and thoughts. While there are similarities between ADHD and CPTSD, significant differences exist in the ‘why’ and ‘how.’
From a clinical perspective, what is ADHD?
Generally, ADHD in children results in pronounced impairments and long-term adverse effects on academic performance, vocational success, and social-emotional development, profoundly impacting individuals, families, schools, and society (National Institutes of Health, 19981).
My research for this blog post focuses on ADHD in women and girls. ADHD symptoms tend to manifest differently in girls compared to boys, with girls more often displaying signs of inattentive ADHD rather than the hyperactivity commonly seen in boys. Historically, ADHD research has focused primarily on young, hyperactive boys, leading to a lack of awareness and understanding of how the condition appears in girls. As a result, diagnosing ADHD in girls is a relatively recent development. The symptoms in girls are typically subtler and less disruptive, contributing to delays and challenges in recognising and diagnosing the condition in females.
Though my focus is on girls and women, these subtler signs of ADHD can also be experienced by males. It’s important for males to understand these signs in themselves and in the girls and women around them who may have the condition.
The Weaknesses of ADHD Research
On top of the fact that most of the research has focused primarily on young, hyperactive boys, much of the clinical ADHD research has also been undertaken with individuals who have already been diagnosed with ADHD (those who have been referred). As diagnosis often remains restricted to those showing up on the higher spectrum of the condition, studies tend to be biased towards those on the higher spectrum, missing data from those with daily impairment who may not be considered impaired enough for diagnosis. This can create differences in data between referred and non-referred individuals.
General Findings in Research Between Boys and Girls with ADHD
Studies are mixed on how ADHD manifests in girls versus boys, but there is a growing consensus that girls are more likely to be inattentive without being hyperactive or impulsive, compared with boys2.
Inattention in Girls
Inattention3 in girls with ADHD typically involves significant difficulty in sustaining attention on tasks that lack high stimulation or frequent rewards. This can manifest as:
- High distractibility
- Problems with organisation
Cognitive and Social Impairments
Girls with ADHD, particularly those with the inattentive subtype, may experience:
- Greater cognitive and attentional impairment3
- Higher rates of peer rejection3
- Greater intellectual impairment6
- Lower levels of hyperactivity6
- Lower rates of other externalising behaviours6
- Verbal impulsivity and hyperactivity9
- Faster conversational and school-work pace9
- Greater boredom9
- More frequent troublemaking9
- Difficulty waiting9
- Increased moodiness, anger, and stubbornness9
Emotional and Behavioural Challenges in Adult Women
Adult women with ADHD often face additional challenges compared to non-ADHD peers, including:
- Higher prevalence of depression, anxiety, and conduct disorder3
- Cognitive impairments3
- Academic problems3
These issues underscore the importance of early identification and treatment for ADHD in females to mitigate the heavy social and personal impacts. There is also growing evidence18 that boys’ and girls’ brains develop and mature at different rates, suggesting that the trajectory of early brain development in ADHD may also be sex-specific.
Complex Post Traumatic Stress Disorder (CPTSD)
Research on CPTSD and its differences between genders is limited. Some studies on PTSD indicate that females are more likely to develop post-traumatic stress symptoms19, but this pattern doesn’t necessarily apply to CPTSD. One study found that unlike PTSD, CPTSD does not show significant differences based on sex and age20. Therefore, the current research does not support distinct gender differences in the manifestation of CPTSD symptoms. Consequently, the information provided here is generalised across all genders.
CPTSD goes beyond the symptoms of PTSD, often associated with experiences such as long-term domestic abuse, childhood neglect or abuse, being a prisoner of war, or being part of a cult. Unlike PTSD, which can develop due to a single traumatic event, CPTSD arises from chronic or long-term exposure to traumatic situations. This extended exposure can deeply affect a person’s personality and sense of self, leading to complex symptoms that are more difficult to treat than those of PTSD.
Key Symptoms of Complex PTSD
Diagnosis of PTSD21 requires the presence of symptoms from at least two of three specific domains: re-experiencing (uncontrollable memories of the trauma), avoidance (inability to be exposed to reminders of the trauma), and sense of threat (feelings of heightened threat, hypervigilance).
For a CPTSD diagnosis, additional symptoms across three more domains must be present:
- A negative self-concept (characterised by low self-esteem, guilt, and shame)
- Disturbances in relationships (difficulty in forming and maintaining close relationships)
- Affective dysregulation (including self-harm, dissociation, emotional numbness, anger, and anhedonia)
If you have been diagnosed with CPTSD, or the symptoms above resonate with you, I found this study22 quite insightful, as it highlights relatable thoughts and feelings. Participants sometimes felt their very self was not strong enough, weak, or just odd compared to others. Many were unaware of their symptoms23, and they struggled with regulating themselves and coping with their condition.
The results elaborate the struggle of those trying to suppress and control the unknown and latent dangerous feelings they were experiencing.
Participants also reported a high frequency of symptoms, e.g. every day since their childhood… dissociation had a high impact and intensity in their daily life, while their feeling of worthlessness was described as latent and an almost omnipresent symptom, which eventually was identified as part of their very self…
… it was highly important to them was being able to learn to trust again.
… they feared their relatives’ reactions… having feelings of shame and guilt.
(Stadtmann, et al., 2018)
To sum this up, based on the research, key symptoms of complex PTSD include:
- Persistent sadness, suicidal thoughts, or feelings of worthlessness
- Ongoing sense of hopelessness and despair
- Emotional regulation difficulties, such as persistent sadness, explosive anger, or covert anger
- Feelings of detachment from others, isolation, or difficulty in maintaining relationships
- A persistent sense of threat, leading to a heightened state of alertness
- Distorted perceptions of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with a relationship to the perpetrator
- Changes in self-perception, such as feeling different from others, feeling shame or guilt, or feeling utterly helpless
- Loss of systems of meanings, such as losing beliefs, values, or previously sustaining faith
I’ve also created a couple of videos that explain complex PTSD and common symptoms associated with the condition.
Similarities of Symptoms in Girls and Women with ADHD and Individuals with Complex PTSD
We should now have a reasonable understanding of the common symptoms of both conditions and how they manifest. Let’s explore the similarities between these two conditions based on research, anecdotal evidence from social media, and my own experience.
Although, from a research perspective, ADHD and CPTSD may seem very different, the way they manifest in individuals can be strikingly similar. This similarity in manifestation often leads to overlapping symptoms that complicate the process of accurate diagnosis and treatment.
Emotional Dysregulation
Both ADHD and CPTSD sufferers frequently experience intense emotional responses and difficulty regulating these emotions. This can manifest as mood swings, irritability, and an inability to manage stress effectively.
Attention and Concentration Issues
Individuals with ADHD struggle with maintaining focus, staying organised, and completing tasks. Similarly, those with CPTSD often have trouble concentrating, especially when dissociating or experiencing daily threat triggers. This shared symptom can lead to misdiagnosis, as inattentiveness is a hallmark of both conditions.
Hypervigilance
Hypervigilance is a common symptom in CPTSD, where individuals are constantly on high alert for potential threats. Interestingly, people with ADHD also exhibit hypervigilance, often interpreted as restlessness or difficulty settling down.
Impulsivity
Impulsivity is another shared symptom. For ADHD sufferers, this might mean acting without thinking, interrupting others, or taking unnecessary risks. In CPTSD, impulsivity can manifest as self-destructive behaviours, such as substance abuse or risky decision-making, often as a means to cope with overwhelming emotions.
Sleep Disturbances
Both ADHD and CPTSD can severely impact sleep. Individuals may experience insomnia, restless sleep, or frequent nightmares, contributing to daytime fatigue and difficulty functioning. In cases of PTSD, research shows that the locus coeruleus (a noradrenergic nucleus in the brainstem that delivers norepinephrine (also called noradrenaline) throughout the brain as part of the complex circuitry that initiates the body’s stress response) is not shutting down, causing hyperarousal24 25.
I’ve also put my own list together below showing similarities between the two conditions based on my research, anecdotal evidence being played across social media platforms, and my own personal experience. I would love you guys to add to the list and fill in the blanks and unknown’s to gain a better understanding! Feel free to comment on this post.
| ADHD (in girls and women) | Symptom/Manifestation | CPTSD (generalised across genders) |
| Yes | Inattention | Yes |
| Yes | Verbal impulsiveness/inappropriate talkativeness/faster talking | Yes |
| Yes | Faster completion of school work | Unknown |
| Yes | Easily bored (when not offered something of interest) | Yes |
| Yes | Difficulty in waiting their turn | Unknown |
| Yes | Moodiness, anger, and stubborness | Yes |
| Yes | Depressive symptoms | Yes |
| Yes | Negative effects on self-esteem | Yes |
| Yes | Difficulty in focusing | Yes |
| Yes | Forgetfulness | Yes |
| Yes | Poor coordination | For me, yes |
| Yes | Anxiety | Yes |
| Yes | Failure to complete tasks | Yes |
| Yes | Racing thoughts | Yes |
| Yes | Masking (hiding symptoms and internalising) | Yes |
| Yes | Difficulty getting on with parents and making friends | Yes |
| Yes | Cognitive and attention impairment | Yes |
| Unknown | Dissociation | Yes |
| Unknown | Few memories of childhood | Yes |
| Yes, but possibly for a different reason | Hypervigilance | Yes |
| Unknown | Can read the energy of a room, fully on guard | Yes |
| Unknown | Avoidant-attachment | Yes |
| Unknown | Codependency | Yes |
| Yes | Promiscuity | Yes |
| Yes | Feelings of being left out, loneliness, lack of belonging | Yes |
| Yes | Low self-worth / worrying about people think of them | Yes |
| Yes | Rejection Sensitivity (RS) | Yes |
| Unknown | Rejection Sensitivity Dysphoria (RSD) (RS plus one more component: People with RSD describe feeling an intense — if not overwhelming — level of emotional pain). | Yes |
| Due to social pressure to fit in | People pleasing | Due to seeking acceptance and love |
| Unknown | Flashbacks and triggers | Yes |
| Unknown (I imagine yes due to ‘masking’) | Repressing ones needs and feelings | Yes |
| Possibly, due to social pressure to fit in | Perfectionism | Yes |
| Yes | Shame | Yes |
| Yes | Poor time management | Yes |
| Yes | Poor organisation | Yes |
| Yes | Scattered thoughts | Yes |
| Yes | Prone to overwhelm | Yes |
| Yes | Procrastination | Yes |
| Unknown | At home with conflict, attracted to working to be loved or chosen | Yes |
| Unknown | Difficulting in relationships: skin uncomfortable with touch, racing heart with fear of betrayal, intense sensations to run or ghost, high reactivity | Yes |
| Unknown | Lack of trust – overly independent, can’t rely on anyone | Yes |
| Most likely | Fear of being a burden to others, so become overly considerate or won’t ask for help | Yes |
| Yes, fear of being seen as lazy | Feeling guilty for resting – ashamed of resting, a need to be useful and productive all the time | Yes |
| Yes | Constantly stressing about the future – never feeling good enough and feelings of never amounting to own potential | Yes |
| Unknown | Prolonged elevated level of performance (over longer lengths of time, such as years, rather than in a prolonged hyper-focused state) | Yes |
| Yes | Suppression of symptoms / not being aware of symptoms until they are pointed out | Yes |
| Yes | Exhaustion and physical discomfort | Yes |
| Yes | Insomnia or poor sleep routine | Yes |
The Importance of Accurate Diagnosis
Understanding the overlap between ADHD and CPTSD is crucial for accurate diagnosis and treatment. Misdiagnosis can lead to inappropriate treatment plans that fail to address the root causes of a person’s symptoms. For instance, treating someone solely for anxiety or depression without considering the potential underlying ADHD or CPTSD can result in suboptimal outcomes.
Treatment Approaches
While there are shared symptoms, the treatment approaches for ADHD and CPTSD can differ significantly:
- ADHD Treatment: Typically involves a combination of medication (such as stimulants) and behavioural therapy to improve focus, organisation, and impulse control.
- CPTSD Treatment: Often focuses on trauma-informed care, including therapies like EMDR (Eye Movement Desensitisation and Reprocessing), CBT (Cognitive Behavioural Therapy), and sometimes medication to manage symptoms of anxiety or depression.
Accurate diagnosis ensures that individuals receive tailored treatments that address the full spectrum of their symptoms, improving overall outcomes.
Personal Perspective
From my personal experience and the stories shared across social media, it is evident that living with either ADHD or CPTSD (or both) presents unique challenges. Understanding and recognising the similarities in how these conditions manifest can foster greater empathy and better support for those affected.
In conclusion, while ADHD and CPTSD may differ in their root causes and clinical definitions, their manifestations in daily life can be remarkably similar. Recognising these overlaps can help in achieving more accurate diagnoses and more effective, individualised treatment plans.
Final Thought
When my therapist first revealed that I was suffering with complex PTSD, the first video I watched about the condition described it so profoundly. She says (timestamp: 8:55), “People can have these symptoms and experience extreme distress; however, they may still be “high functioning.” They have to work twice, three, or four times as hard. Think about running a marathon: a person with CPTSD is running that marathon with an 80-pound rucksack and army boots, while the other person is running in shorts and sneakers.“
This illustrates the burden carried by people with trauma, but even people living with undiagnosed ADHD, or other similar mental health challenges like Borderline Personality Disorder (BPD), anxiety, or depression, as they strive to live their lives like everyone else. When I saw the BBC Children in Need 2024 advert, ‘The Heaviest Backpack’ on TV recently, I had to inwardly applaud the creators. They get it.
I share this because hundreds of thousands of people suffering from the mentioned conditions are being ignored, largely due to a lack of understanding and consideration in this area. Research needs to be conducted, support systems must be developed, and society must recognise these conditions. We need to start recognising the behaviours of those who are suffering and normalise talking about it. We cannot continue to let people suffer their entire lives without understanding how their brains work, the roots of their emotional triggers, why they behave in ways they are ashamed of, and what they can do about it.
Just knowing is a powerful step towards living better lives.
My next blog post will delve deeper into the brains of individuals with ADHD and CPTSD, highlighting similarities in deficits within brain areas and neurotransmitters. I will explore how these deficits lead to issues with cognition, hormones, and emotional regulation compared to those without either condition.
References
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- Staller, J., Faraone, S.V. Attention-Deficit Hyperactivity Disorder in Girls. CNS Drugs 20, 107–123 (2006). https://doi.org/10.2165/00023210-200620020-00003 https://link.springer.com/article/10.2165/00023210-200620020-00003 ↩︎
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- The participants did not recognise their symptoms as such and were unaware of their diagnosis for many years. ↩︎
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