Is it CPTSD or ADHD?

Understanding the Complex Relationship Between ADHD and CPTSD.

Attention Deficit Hyperactivity Disorder (ADHD) and Complex Post-Traumatic Stress Disorder (CPTSD) are two distinct mental health, emotional and physiological conditions that can present with overlapping symptoms, leading to confusion and misdiagnosis.

Over the past 24 years (and as I approach my 25th year!) of my professional clinical and academic work in mental health, trauma, neuroscience and emotional wellbeing I have been witness to many a misinterpretation, misdiagnosis and miscommunication (not least in recent years to the tiktofication of these subjects!) of ADHD and CPTSD in particular. It has become hugely more important to me in my valued integrative therapy relationships, with clients of all ages, to educate, demystify and bring clarity to what, at times, has become an oversimplification of these complex systems. In the US alone, it is estimated that up to 1 million children are misdiagnosed with ADHD a year, due in part to children not feeling able to disclose the trauma/abuse they are experiencing, so the behaviours and symptoms are categorised within an ADHD diagnosis. Certainly as I reflect back on my 24 years, I have equally seen this misdiagnosis and only as I studied the impact of developmental childhood trauma, complex trauma and the neuroscience of their impact have I been able to help individuals truly understand what is happening for them and support them to adapt or ‘rewire’ this impact.

Though ADHD has been aggressively studied, few researchers have explored the overlap between its symptoms and the effects of chronic stress or experiencing trauma like maltreatment, abuse and violence.

In this article, I’m delving into the differences and co-morbidity (co-existence) of ADHD and CPTSD, exploring the neurological underpinnings, symptoms, and the importance of seeking professional diagnosis and expert support.

ADHD and/or CPTSD: What’s the Difference?

At it’s simplest level ADHD is an innate neurodevelopmental presentation characterised by persistent symptoms of difficulties in attention, hyperactivity, and impulsivity. Whilst most commonly diagnosed in childhood, it persists into adulthood. CPTSD is a complex condition that arises in response to prolonged and severe traumatic events, leading to disturbances in emotional regulation, self-concept, and interpersonal relationships.

What does ADHD ‘look’ like?:

• Inattention: Having problems staying on task, paying attention, or being organised, which are not due to lack of comprehension.
• Hyperactivity: Being extremely restless or constantly moving, including in situations when it is not appropriate; excessively fidgeting or tapping; or talking too much.
• Impulsivity: Acting without thinking, interrupting others, or having difficulty with self-control. Impulsivity can also involve a desire for immediate rewards or an inability to delay gratification or consider long-term consequences.

Inattention

People with symptoms of inattention may often:

• • Overlook or miss details and make seemingly careless mistakes.
  • Have difficulty sustaining attention during play, work, tasks or conversations.
  • Not seem to listen when spoken to directly
  • Find it hard to follow through on instructions or finish work or chores.
  • Start tasks but lose focus and get easily sidetracked
  • Have difficulty organising tasks and activities, doing tasks in order, keeping track of materials and belongings, managing time, and meeting deadlines
  • Avoid tasks that require sustained attention.
  • Be easily distracted by unrelated thoughts or stimuli
  • Be forgetful in daily activities

Hyperactivity-impulsivity

People with symptoms of hyperactivity and impulsivity may often:

• • • Fidget and squirm while seated
    • Leave their seats in situations when staying seated is expected.
    • Feel frequently restless
    • Be unable to play or engage in hobbies quietly
    • Be constantly in motion or act as if driven by a motor
    • Talk excessively or interrupt others
    • Answer questions before they are fully asked, finish other people’s sentences, or speak when it is not their turn in a conversation
    • Have difficulty waiting, for example, in conversations.

For a person to receive an ADHD diagnosis, the symptoms of inattention and/or hyperactivity and impulsivity must:

• Be chronic or long-lasting
• Impair functioning
• Cause them to fall behind the typical development for their age

ADHD symptoms must begin in childhood (before age 12).

Please note that this is an overview of ADHD and you can explore more specifically on the National Institute for Mental Health page HERE

What does CPTSD ‘look’ like?

Complex Post-Traumatic Stress Disorder (CPTSD) is a condition that can develop in individuals who have experienced prolonged traumatic events, such as ongoing abuse, neglect, or captivity. The presentation of CPTSD is characterised by a range of symptoms that are typically more severe and pervasive than those seen in traditional PTSD.

Here are some of the key signs and symptoms of CPTSD:

• Emotional Dysregulation: Individuals with CPTSD often struggle with regulating their emotions. They may experience intense mood swings, have difficulty managing anger or shame, and may feel overwhelmed by their emotional responses to triggers.
• Dissociation: Dissociation is a common coping mechanism for individuals with CPTSD. They may feel disconnected from their thoughts, feelings, or surroundings, and may experience episodes of depersonalisation or derealisation.
• Interpersonal Difficulties: People with CPTSD may have challenges forming and maintaining healthy relationships. They may struggle with trust, intimacy, and communication, and may exhibit patterns of either avoiding or seeking out close connections.
• Negative Self-Concept: CPTSD can lead to a distorted and negative self-image. Individuals may struggle with feelings of worthlessness, shame, and self-blame, and may have difficulty recognising their own strengths and accomplishments.
• Hyper-vigilance: Due to their history of trauma, individuals with CPTSD often experience hyper-vigilance, a state of heightened alertness and sensitivity to potential threats. This can manifest as difficulty relaxing, problems with sleep, and a persistent feeling of being on edge.
• Difficulty with Emotional Attachment:  CPTSD can impact an individual’s ability to form secure attachments with others. They may struggle with intimacy, trust, and vulnerability, and may have a fear of abandonment or rejection.
• Difficulty with Emotional Regulation: Individuals with CPTSD may have difficulty regulating their emotions. They may experience intense emotional reactions to triggers, have difficulty expressing their emotions, and may resort to unhealthy coping mechanisms such as substance abuse or self-harm.
• Somatisation: CPTSD can manifest in physical symptoms & somatic complaints that have no clear medical cause. These physical symptoms may be a manifestation of the psychological distress and implicit sensory experience of trauma.

It is important to note that the symptoms of CPTSD can vary from person to person and may change over time. A comprehensive assessment by a trauma trained and attuned mental health professional is crucial for accurate diagnosis and appropriate therapeutic support. You can explore more about CPTSD HERE

Why CPTSD Can Resemble ADHD?

CPTSD and ADHD can share certain overlapping features and symptoms, leading to potential diagnostic confusion or misinterpretation.

1. Attention Difficulties: Both CPTSD and ADHD can manifest with attention-related challenges. In CPTSD, individuals may struggle with concentration and focus due to hypervigilance, intrusive thoughts, and emotional dysregulation. Similarly, ADHD is characterised by symptoms such as inattention, distractibility, and impulsivity, which can also impact an individual’s ability to stay focused on tasks.

2. Impulsivity: Impulsivity is a common feature of both conditions. Individuals with CPTSD may exhibit impulsive behaviours as a coping mechanism to deal with overwhelming emotions or distressing implicit and explicit memories. This impulsivity can be similar to the impulsive behaviors seen in individuals with ADHD, where actions are often taken without forethought or consideration of consequences.

3. Emotional Dysregulation: This is a core feature of CPTSD, where individuals may experience intense emotional responses, mood swings, and difficulty managing their feelings. This can sometimes be mistaken for the emotional reactivity observed in individuals with ADHD, who may struggle with emotional impulsivity and have difficulty modulating their reactions to stimuli.

4. Hyper-arousal: Both CPTSD and ADHD can involve heightened states of arousal. Individuals with CPTSD may experience persistent hypervigilance, exaggerated startle responses, and a constant sense of danger due to their past traumatic experiences. Similarly, individuals with ADHD may exhibit hyperactivity and restlessness, leading to a state of heightened arousal that can resemble the hyperarousal seen in CPTSD.

5. Executive Functioning Deficits:  difficulties with planning, organisation, and time management, are common in both CPTSD and ADHD. These deficits can impact various aspects of daily functioning, including work and relationships, and can contribute to the overlapping symptomatology between the two conditions.

6. Sleep Disturbances: such as insomnia, nightmares, or disrupted sleep patterns, can be present in both CPTSD and ADHD. Sleep problems are commonly reported by individuals with CPTSD due to intrusive memories and heightened arousal, while individuals with ADHD may also struggle with sleep due to racing thoughts and difficulty winding down.

7. Hypervigilance: or a state of heightened alertness and scanning the environment for potential threats, is another shared feature between CPTSD and ADHD. Individuals with CPTSD may be hypervigilant as a result of past trauma experiences, while individuals with ADHD may also exhibit hypervigilance as a response to sensory stimuli and difficulties with attention.

It is important to consider these overlapping features and similarities when evaluating individuals who present with symptoms that could be indicative of either CPTSD or ADHD. 

The complex interplay of attention difficulties, impulsivity, emotional dysregulation, hyperarousal, and executive functioning deficits in both CPTSD and ADHD can result in overlapping clinical presentations, making it challenging to differentiate between the two conditions without a comprehensive assessment by a qualified trauma attuned mental health professional.

Let’s know Geek Out with some of the neuroscientific perspectives!

Neuroscientific Perspectives on ADHD and CPTSD. 

Neuroscience plays a crucial role in understanding the underlying mechanisms that differentiate ADHD and CPTSD, as well as the areas of overlap between these two conditions. Let’s delve into some of the intricate neurobiological aspects of ADHD and CPTSD, shedding light on the similarities and differences at the brain level.

ADHD Neurobiology:

ADHD is primarily characterised by deficits in executive functioning, attention regulation, and impulse control. Neuroimaging studies have pointed towards alterations in the structure and function of several key brain regions in individuals with ADHD.

• Prefrontal Cortex (PFC): The PFC is responsible for executive functions such as decision-making, working memory, and cognitive control. Structural and functional abnormalities in the PFC have been consistently observed in individuals with ADHD, contributing to difficulties in inhibitory control and attention regulation.
• Basal Ganglia: The basal ganglia, particularly the caudate nucleus and putamen, play a crucial role in motor control and cognitive functions. Studies have shown aberrant activity in the basal ganglia circuits in individuals with ADHD, linking to hyperactivity and impulsivity symptoms.
• Dopaminergic System: Dysregulation of the dopamine neurotransmission pathway has been implicated in ADHD. Dopamine plays a key role in reward processing, motivation, and attention. Alterations in dopamine receptor availability and function have been associated with ADHD symptomatology.

CPTSD Neurobiology:

The neurobiological underpinnings of CPTSD are complex and involve alterations in brain regions implicated in stress response and emotional processing, including:

• Amygdala: The amygdala, known for its crucial role in emotional processing and fear response, shows hyperactivation in individuals with CPTSD. This heightened reactivity of the amygdala contributes to increased emotional arousal and hypervigilance in response to trauma-related cues.
• Hippocampus: The hippocampus, involved in memory consolidation and contextual processing, exhibits structural changes in individuals with CPTSD. Reduced hippocampal volume has been linked to deficits in memory encoding and retrieval, as well as the fragmentation of traumatic implicit and explicit memories.
• Hypothalamic-Pituitary-Adrenal (HPA) Axis: Chronic stress and trauma can dysregulate the HPA axis, leading to abnormalities in cortisol secretion and stress response. Disruptions in the HPA axis have been associated with symptoms of hyperarousal and emotional dysregulation in CPTSD.

Overlapping Neurobiological Mechanisms:

While ADHD and CPTSD are distinct clinical entities, there are certain neurobiological overlaps that may help explain both their co-occurrence in some individuals and the misdiagnosis of one instead of the other in individuals.

The neuroscience behind the similarities and differences between CPTSD and ADHD involves intricate interactions within the brain that contribute to the manifestation of symptoms in both conditions.

Brain Structure and Function

• Prefrontal Cortex: Both CPTSD and ADHD can exhibit abnormalities in the prefrontal cortex, a region responsible for executive functions such as decision-making, impulse control, and emotional regulation. In ADHD, structural and functional deficits in this area may lead to difficulties in attention, planning, and self-regulation. In CPTSD, chronic stress and trauma can impact prefrontal cortex functioning, affecting emotional processing and cognitive control
• Amygdala and Hippocampus: The amygdala and hippocampus play key roles in emotional processing, memory formation, and fear responses. In individuals with CPTSD, these regions may exhibit alterations due to sustained exposure to trauma, leading to heightened emotional reactivity and difficulty in processing traumatic memories. In ADHD, dysregulation in the amygdala and hippocampus can contribute to emotional dysregulation and difficulties in forming and recalling memorie

Neurotransmitter Systems:

• Dopamine: Dysregulation of the dopaminergic system is implicated in both CPTSD and ADHD. In ADHD, decreased dopamine levels or impaired dopamine receptor functioning are associated with challenges in attention, motivation, and reward processing. In CPTSD, alterations in dopamine signaling due to chronic stress and trauma can impact arousal, motivation, and the processing of emotional stimuli.
• Noradrenaline: Dysfunction in the noradrenergic system is linked to symptoms of hyperarousal and hypervigilance in both CPTSD and ADHD. Heightened noradrenaline release under stress can contribute to persistent anxiety and difficulties in focusing attention in individuals with ADHD. Similarly, individuals with CPTSD may exhibit dysregulation in noradrenaline signaling, leading to enhanced vigilance, exaggerated startle responses, and sleep disturbances.

Neural Networks:

•    Default Mode Network (DMN): Altered connectivity within the DMN, a network involved in self-referential thinking and mind-wandering, is observed in both CPTSD and ADHD. Dysfunctions in the DMN may underlie symptoms of rumination, dissociation, and impaired attention regulation in individuals with CPTSD, as well as difficulties in sustaining attention and maintaining task-relevant focus in individuals with ADHD.

Neuroplasticity and Stress Response:

• Hypothalamic-Pituitary-Adrenal (HPA) Axis: Chronic exposure to stress and trauma in CPTSD can dysregulate the HPA axis, resulting in an altered stress response characterised by heightened cortisol levels and impaired feedback mechanisms. Similarly, individuals with ADHD may exhibit HPA axis dysregulation associated with difficulties in stress coping and emotional regulation.

While there are distinct neurobiological underpinnings that differentiate CPTSD from ADHD, shared neurobiological pathways involving brain structures, neurotransmitter systems, neural networks, and stress responses contribute to the overlapping clinical presentations observed in these two conditions. However, in spite of all the neurobiology there is no brain scan or DNA test that can give a definitive diagnosis of ADHD & there is also no convincing evidence that trauma or chronic stress lead to the development of ADHD.

A mental health professional and therapist with comprehensive understanding of the neuroscience behind CPTSD and ADHD can deepen insights into their similarities and differences, informing accurate diagnosis, diagnostic education for the individual and guiding personalised therapeutic support.

The big question that you may have is also …….can you have both ADHD and CPTSD?

The simple answer to this is yes and the more complex answer is in the individual assessment and evaluation of all the detail laid out above, the understanding of the unique history (without needing to relive the trauma narrative) of an individual from womb to birth and beyond, and how the current ‘present’ is for that individual. It is always essential to consider the interplay of neural mechanisms and symptoms, alongside history and presentation across the ages with a reminder that elements of both ADHD and CPTSD can have their origins in other difficulties just like the origin of chest pain in one person can be different to another. This is why every person needs to be considered as unique and there should not be a blanket cookie cutter approach to either diagnosis or the therapeutic support received.

I know from many of the people I have worked with over the years that all anyone seeks to understand is who they are, why there are patterns of emotions, behaviours, impulses and sensations that impact on their daily life and how to move with these as opposed to having them dictate their lives.

In conclusion, distinguishing between CPTSD and ADHD can be a complex and challenging task due to the overlapping symptoms and shared characteristics between these two conditions. The neuroscience behind CPTSD and ADHD reveals both similar and distinct patterns in brain function, shedding light on the complexity of these mental health presentations. Understanding the nuanced differences and co-morbidities between CPTSD and ADHD is essential for accurate diagnosis and effective strategies tailored to individual needs. By recognising the overlapping features, comprehensive support that addresses the unique challenges faced by individuals who may be navigating both CPTSD and ADHD simultaneously is crucial.

Meet Helen Ferguson

Thank you for taking the time to read this, I know it was a lot to get through and true to my usual form I could have written for much longer!! I am passionate about my craft and supporting as many people as I can by providing clarity in the midst of confusion and chaos. I’ve been working in the mental health and emotional wellbeing field for 24 years now with children and adults of all ages specialising in childhood/developmental, complex and sexual trauma. As an Integrative Psychotherapist with significant academic research and training in trauma and with a number of therapy models under my belt, I go beyond the traditional ‘talking therapy’ and integrate somatic, polyvagal, internal family systems, attachment therapy, compassionate inquiry, EMDR and, nutrition and medicine for mental health & emotional wellbeing, to provide a bespoke therapeutic approach to each unique individual.

Feel free to get in touch in the comments and you can explore some of my at home self healing tools to either begin your healing journey or add some incredible value to where you already are. Just click HERE