On ADHD, Misdiagnosis, and What Was Actually Happening
At some point, someone told you it was anxiety.
Or depression. Maybe stress. Perhaps a sensitivity you needed to learn to manage. Or a personality trait — perfectionism, overthinking, emotional intensity — that was getting in your way. Something real, something yours, something causing you genuine difficulty — but in the explanation you received, framed fundamentally as a problem with how you responded to the world rather than a mismatch between your neurology and the world you responded to.
The explanation wasn’t entirely wrong. Anxiety was real. Depression, where present, was real too. So was the sensitivity. But these were responses to something nobody was naming — symptoms of a source the available frameworks mostly failed to identify in women. So practitioners treated the symptom, sometimes successfully and sometimes not, while the source ran on unaddressed. And you continued to wonder, privately, why the treatment helped some things and not others, why the anxiety came back, why you worked so hard to manage yourself and the management kept not quite sticking.
The anxiety was real. It was also downstream of something else entirely. Treating it without naming the source is like treating the smoke without addressing the fire.
Why the System Missed Women
The history of ADHD diagnosis is a history of male presentation.
Researchers identified and characterised the condition primarily through studies of boys — specifically, hyperactive boys whose difficulties showed up immediately, visibly, and disruptively in classroom settings. The diagnostic criteria that emerged from that research reflected what ADHD looked like in that population. Overt hyperactivity. Obvious impulsivity. Difficulty that was external, visible, and disruptive to others.
Girls with ADHD, as a general pattern, present differently. The hyperactivity is more likely to show up internally — a racing mind rather than a restless body. Impulsivity tends to surface verbally or emotionally rather than through physical disruption. By the time she reaches a professional setting, she has usually already learned to manage, mask, and compensate for the difficulty. The presentation reads quieter, more internal, more easily attributed to anxiety, emotional sensitivity, or simply being a particular kind of girl.
The same pattern holds for autism. Clinicians have historically recognised the autistic presentation in women and girls far less often, because it differs — sometimes significantly — from the presentation that shaped the diagnostic criteria. Autistic women tend to mask more comprehensively, to develop social scripts and compensatory strategies that let them pass as neurotypical in many contexts, to present social difficulties in ways that don’t match what clinicians’ training teaches them to look for.
The result, across decades, was systematic underdiagnosis. Practitioners instead diagnosed women who met the criteria for ADHD or autism — or both — with anxiety disorders, depressive disorders, borderline personality disorder, or bipolar disorder. Conditions real in the sense that the symptoms were real, but that addressed the presenting layer rather than the structural one.
What the Misdiagnosis Actually Cost
A wrong diagnosis is not a neutral experience. It has consequences that compound over time.
The most immediate consequence is treatment that addresses the symptom without the source. Anxiety management techniques are useful and can make real differences to quality of life. But for a woman whose masking, compensating, and unsupported neurodivergent nervous system generate most of her anxiety, anxiety management is partial at best. It reduces the presenting symptom while the generator continues running.
The second consequence is the message the misdiagnosis carries about the nature of the problem. A diagnosis of anxiety or depression locates the difficulty in how you respond to the world. It is, implicitly, about something you do or don’t do, something about your reactions, something you need to manage differently. That framing settles in over years and becomes part of how you understand yourself. You are the person who responds badly, who can’t manage her emotions, who apparently needs to work harder on her thinking patterns.
The third consequence is the specific damage that comes from decades spent in treatment with practitioners working from the wrong explanation. Not because they were incompetent or unkind — most of them were neither — but because the framework they applied never accounted for you. And because you, being who you are, found yourself in those sessions doing what you do everywhere else: reading the practitioner, editing your presentation, giving them the version of your experience that fit their framework. That meant you never challenged the framework, no one in the room ever questioned the misdiagnosis, and the years accumulated.
The wrong diagnosis does not just miss the correct explanation. It actively teaches you to understand yourself incorrectly. That is the damage that takes the longest to undo.
The Conditions That Get Called Something Else
For women still working out whether the explanation they received actually fits — or whose late diagnosis is recent, and who are rereading their history — naming some of the specific ways undiagnosed ADHD and autism showed up in women who received different labels can help.
Anxiety that never fully resolves despite treatment, that returns reliably when demands increase, that transitions, deadlines, sustained social performance, or high sensory load particularly activate — this is often anxiety a neurodivergent nervous system generates rather than anxiety as a primary condition.
Depression that presents as flatness and withdrawal rather than persistent sadness, that periods of significant demand or social exhaustion trigger, that lifts when external pressures reduce, that returns when masking demands increase — this pattern is frequently burnout in someone who has run on empty for too long rather than a primary depressive disorder.
Emotional dysregulation that clinicians labelled as sensitivity, moodiness, or, in more clinical settings, as borderline features — the intense emotional responses, the difficulty returning to baseline, the feelings that seem larger than the situation warrants — this is a recognised feature of ADHD that for a long time people attributed to personality rather than neurology.
None of this means that anxiety, depression, and other mental health conditions are not real or do not occur independently in neurodivergent women. They do — and they’re also more common in this population, partly because of years spent operating without the correct explanation and the specific stress that produces. The point isn’t that one diagnosis excludes the other — it’s that treating the secondary condition without identifying the primary one leaves the care incomplete.
What Changes When the Correct Explanation Arrives
When women who once heard it was anxiety finally receive the correct explanation — ADHD, autism, or both — several things tend to happen in fairly consistent sequence.
The relief is significant and specific. Not just the general relief of having an explanation, but the particular relief of understanding the difficulty was never a character flaw. The anxiety was real, but downstream. The depression was real, too, though her circumstances — now navigable differently thanks to the correct explanation — largely produced it. And the responses people labelled oversensitivity or emotional dysregulation turn out to be features of a specific neurological profile, not evidence of a personality needing correction.
Then comes the reread. The history looks different through the correct lens. The things you once attributed to anxiety were often masking demands. What you called depression was often burnout. And what looked like personality was often neurology. The reread is not comfortable — it involves sitting with the years that went differently because the correct explanation wasn’t available — but it is clarifying. And clarity, even when it arrives late, changes what is possible going forward.
I was one of the women who heard it was anxiety. Depression, too. Stress, at other times. And, at various points, various other things that were adjacent to accurate without quite being accurate. The correct explanation arrived late, and the reread that followed was significant. What I understand now that I didn’t understand then is that the difficulty was never primarily with how I responded to the world. It was with the mismatch between my neurology and the environments I was in, the frameworks people assessed me against, and the explanations people offered me for my own experience.
That understanding changes things. Not instantly, not completely, but genuinely and in ways that hold.
If you are somewhere in this territory — sitting with a diagnosis that never quite fitted, or a recent correct explanation that is rewriting a long history — the Practice page explains how the coaching works. When you’re ready to talk, get in touch.
