Gender Bias In Adhd Diagnosis
Attention-deficit/hyperactivity disorder (ADHD) is one of the most commonly diagnosed neurodevelopmental conditions worldwide. Yet, despite decades of research, ADHD continues to be defined, investigated, and diagnosed predominantly through a male perspective.
In 2026, within the mental health community, it is now widely recognized that women are more likely to experience predominantly inattentive ADHD, a presentation characterized not by overt hyperactivity but by internal restlessness, chronic distractibility, difficulties with organization, emotional instability, and a persistent sense of failure (ADHD in women, gender bias in diagnosis) (Quinn & Madhoo, 2014; Young et al., 2020).
When it comes to diagnosis, however, women are estimated to be two to three times less likely to receive an ADHD diagnosis than men, particularly in childhood (Willcutt, 2012). Research shows that ADHD in women is frequently underdiagnosed, and symptoms are often misread as personality flaws, anxiety, or a lack of effort (Biederman et al., 2007).
Instead of presenting itself in the image of a noisy, disruptive little boy bouncing off classroom walls, ADHD in young girls often slips quietly into the background, disguising itself as constant daydreaming, inattentiveness, organization problems followed by low self-worth, and chronic self-doubt (Quinn & Madhoo, 2014; Hinshaw et al., 2022).
Gendered expectations push little girls into internalizing their symptoms rather than expressing them through external, disruptive behaviors like their male counterparts (Hinshaw et al., 2022). When these girls are not diagnosed in childhood, they often grow up in environments in which they are constantly criticized and, over time, develop deep insecurities by interpreting their symptoms as fundamental personality flaws.
Cultural Ideals And The Pursuit Of Control
In the golden age of fillers, beauty influencers, and Ozempic, when women’s sense of adequacy is under constant attack, young women with undiagnosed ADHD become particularly easy targets for the beauty and diet industries.
Their low self-worth collides with a culture obsessed with physical restriction and unattainable beauty ideals. For many of these women, who have spent their lives feeling “not enough,” physical appearance begins to feel like the last remaining fixable aspect of their perceived faulty existence.
Control over food, over body, and over desirability begins to compensate for what they never had growing up: control over their authentic selves. Hence, the body becomes a constant work in progress, and undiagnosed ADHD quietly lays the groundwork for eating disorders long before it is ever recognized as such (ADHD and eating disorders).
Why Eating Disorders Often Mask Adhd In Women
Women with undiagnosed ADHD show significantly higher rates of eating disorders, particularly binge eating disorder and bulimia nervosa, both marked by cycles of severe food restriction followed by periods of binge eating (Nazar et al., 2016; Reinblatt et al., 2015).
Nevertheless, ADHD and eating disorders are often treated in isolation, and eating disorder symptoms frequently mask underlying ADHD. For many women, disordered eating is rarely about appearance or appetite; instead, it functions as a means of nervous system regulation and emotional relief.
Research suggests that ADHD and eating disorders share overlapping neurobiological and psychological mechanisms. These shared vulnerabilities help explain why eating disorders are significantly more prevalent among women with ADHD than in the general population (Nazar et al., 2016).
The Neurobiological Intersection
At the neurobiological level, ADHD and eating disorders involve shared brain systems related to impulse control, emotional regulation, and reward processing. In ADHD, these systems often function differently, making it more difficult to manage stress, regulate impulses, and tolerate emotional discomfort.
Additionally, ADHD is associated with chronic understimulation of the brain, leading individuals to actively seek external sources of stimulation or reward (Volkow et al., 2009). Dopamine, a neurotransmitter involved in motivation and pleasure, plays a central role in this process.
Foods high in sugar and fat can temporarily increase dopamine activity, offering short-term relief or stimulation (Volkow et al., 2009). For individuals with ADHD, eating can therefore become an accessible coping mechanism during periods of emotional overwhelm or mental understimulation (dopamine regulation) (Reinblatt et al., 2015; Nazar et al., 2016).
For women—who are disproportionately targeted by diet culture and thinness ideals—these attempts to self-soothe through food often become entangled with efforts to meet societal beauty standards. Over time, these regulatory behaviors may evolve into deeply dysfunctional relationships with food, weight, and appearance.
Making Invisible Strings Visible
Taken together, the low self-worth shaped by missed or delayed ADHD diagnoses, the pressures of diet culture, and ADHD-related difficulties with food regulation illuminate the significant relationship between ADHD and eating disorders among women.
This does not imply that every woman with ADHD develops an eating disorder, nor that every woman with an eating disorder has underlying ADHD. However, the prevalence of comorbidity between these conditions is clinically meaningful, and recognizing this connection has the potential to play a central role in treatment planning and long-term recovery.
Considering that ADHD and eating disorders are among the most frequently diagnosed mental health conditions worldwide, making this invisible link visible—especially for women whose struggles have long been misinterpreted as personal failures—carries critical importance.
References
Biederman, J., Mick, E., Faraone, S. V., Braaten, E., Doyle, A., Spencer, T., Wilens, T. E., Frazier, E., & Johnson, M. A. (2007). Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. American Journal of Psychiatry, 159(1), 36–42. https://doi.org/10.1176/appi.ajp.159.1.36
Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2022). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology, 90(4), 300–312. https://doi.org/10.1037/ccp0000713
Nazar, B. P., Bernardes, C., Peachey, G., Sergeant, J., Mattos, P., & Treasure, J. (2016). The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. International Journal of Eating Disorders, 49(12), 1045–1057. https://doi.org/10.1002/eat.22643
Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3), Article PCC.13r01596. https://doi.org/10.4088/PCC.13r01596
Reinblatt, S. P., Leung, B. M., & Thaler, L. (2015). Eating disorders and attention-deficit/hyperactivity disorder: A review of the literature. Current Psychiatry Reports, 17(3), Article 10. https://doi.org/10.1007/s11920-015-0552-6
Volkow, N. D., Wang, G. J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., Fowler, J. S., Zhu, W., Logan, J., Ma, Y., Pradhan, K., Wong, C., & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: Clinical implications. JAMA, 302(10), 1084–1091. https://doi.org/10.1001/jama.2009.1308
Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490–499. https://doi.org/10.1007/s13311-012-0135-8
Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Sedgwick, J. A., Skirrow, C., Tierney, K., & Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry, 20, Article 404. https://doi.org/10.1186/s12888-020-02707-9