ADHD is, technically speaking, a set of symptoms. But the experience of living with ADHD is about much more than that.
It’s about not just the symptoms themselves, but the cumulative effect of those symptoms over time. People with ADHD have to constantly deal with the frustrations, failures, and missed opportunities that come with ADHD symptoms, and that process tends to leave a mark on people’s self-image.
For ADHDers, living with ADHD becomes about not just coping with ADHD symptoms themselves, but also with the psychological toll those symptoms bring.
For that reason, lower self-esteem is common among people with ADHD. You might’ve heard that before, and if you have ADHD, you may well be able to recognize that pattern in your own life. What I’d like to do in this post is highlight some research that has been done on the topic of ADHD and self-esteem, and some facts that have emerged from that research that can help in coping with ADHD.
1. ADHD damages self-esteem
We should start by establishing that there’s solid evidence people with ADHD tend to have lower self-esteem.
In 2014, a review of studies on the topic of self-esteem in adults with ADHD found that, on the whole, ADHD in adults was linked to lower self-esteem. The review didn’t dive into the question of why that would be the case, but the authors did note that ADHDers “often grow up with negative messages surrounding their abilities and may experience adverse outcomes throughout their lives.”
Two years later, another systematic review of studies on self-esteem in ADHD turned up the finding that people with untreated ADHD consistently averaged lower self-esteem across different studies.
That pattern appears to hold up across ADHDers of all ages, with one study finding that adults over the age of 65 with ADHD report low self-esteem as affecting their lives. In other words, issues with self-esteem are yet another aspect of ADHD that people do not necessarily just grow out of!
2. Treating ADHD helps improve self-esteem
I’ve started with the bad news – that living with ADHD tends to bring lower self-esteem. The good news is that diagnosis and treatment appears to make a real difference.
For example, the two systematic reviews I mentioned above didn’t just find that people with ADHD tend to have lower self-esteem. They found that treating ADHD is associated with a reduction in this self-esteem deficit. Even better, that finding appears to hold whether the treatment in question is medication, psychotherapy or some combination of the two!
That’s a good reminder that trying a broad range of ADHD treatments can pay off. On one hand, treatments like meds or intentional coping strategies that help manage the effects ADHD symptoms can give a direct confidence boost.
But treatments that don’t directly target ADHD symptoms can also be invaluable. In particular, it’s always a good idea to make therapy a part of ADHD treatment because it’s a way to address the more general psychological baggage, including lower self-esteem, that tends to come along with ADHD!
3. Anxiety can be a link between ADHD and self-esteem
People with ADHD frequently have other mental health conditions, and anxiety is one of the most common companions to ADHD.
Interestingly, a study published in 2017 suggests that anxiety might be involved in the relationship between ADHD and self-esteem. The study found that among children with ADHD, those with high levels of anxiety and combined subtype ADHD were the most prone to making negative statements about themselves and their perceived personal failures.
Although that study focused on children with ADHD, it’s not totally implausible that a similar pattern might show up in adults. In any case, the findings are a good reminder of the need to take into account ADHD as well as comorbid conditions when untangling issues related to self-image!
4. Low self-esteem doesn’t mean ADHDers are aware of their symptoms
Here’s something that seems like a paradox at first glance: even though people with untreated ADHD tend to have lower self-esteem, there’s a branch of research suggesting that they also tend to underestimate how impairing their symptoms are.
For the sake of example, take a 2017 study showing that teenagers with ADHD tend to lack self-awareness of their executive functioning deficits and a 2015 study showing that adults with ADHD tend to underestimate their symptoms relative to people who know them well.
In fact, it’s not really a contradiction to say that ADHDers have low self-esteem but also don’t know how severe their symptoms are.
Think about it this way: what people with ADHD are aware of is the effect of their symptoms. They are aware of the goals the fail to meet, the negative feedback they get from others, and the things they “should” be able to do but for some reason can’t.
Not being aware that those are all consequences of ADHD symptoms will tend to hurt self-esteem because if people don’t realize how specific symptoms are playing a role, they’re more likely to chalk their experiences up to some kind of character flaw, or something mysterious that’s inherently wrong with them.
And indeed, the 2015 study I mentioned above found that in underestimating their symptoms, people with ADHD “seemed to be unaware of the causal relation between ADHD symptoms and their impairments.”
5. Self-esteem deficits in ADHD have real effects in daily life
Why is self-esteem such an important topic in ADHD? Because self-esteem has wide-ranging implications for the outcomes that ADHDers experience.
It turns out, for instance, that self-esteem seems to partly explain difficulties that young adults with ADHD have in adjusting to college. Among adults with ADHD, feelings of distress related to lower self-esteem are linked to lower social functioning and satisfaction.
Happily, the same study that highlighted a connection between self-esteem and social outcomes also found that one year of therapy significant reduced ADHDers’ feelings of distress related to “self-esteem deficits.”
That point circles back to the main takeaway. It’s very true that self-esteem is an area where ADHD can take a toll, and the hit on self-esteem can reverberate throughout ADHDers’ lives. But the flip side is that by seeking out treatment from mental health professionals, by developing awareness into how ADHD symptoms effect one’s life, and by engaging in therapy, this is also an area where it’s possible to see a rewarding and liberating sense of progress!