When a person with ADHD complains of severe anxiety, I recommend that the clinician not immediately accept the patient’s label for her emotional experience. A clinician should say, “Tell me more about your baseless, apprehensive fear,” which is the definition of anxiety. More times than not, a person with ADHD hyperarousal will give a quizzical look and respond, “I never said I was afraid.” If the patient can drop the label long enough to describe what the feeling is like, a clinician will likely hear, “I am always tense; I can’t relax enough to sit and watch a movie or TV program. I always feel like I have to go do something.” The patients are describing the inner experience of hyperactivity when it is not being expressed physically.
At the same time, people with ADHD also have fears that are based on real events in their lives. People with ADHD nervous systems are consistently inconsistent. The person is never sure that her abilities and intellect will show up when they are needed. Not being able to measure up at the job or at school, or in social circles is humiliating. It is understandable that people with ADHD live with persistent fear. These fears are real, so they do not indicate an anxiety disorder.
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