Do ADHD and anxiety often occur together?

Yes. Research shows that 25–50% of adults with ADHD also experience an anxiety disorder. This overlap can make symptoms more severe and complicate treatment.

What is the ADHD boom and bust cycle?

The boom and bust cycle describes periods of high energy and productivity (boom) followed by burnout or crash (bust). Awareness of this pattern helps reduce the severity of crashes.

How does perfectionism affect ADHD and anxiety?

Perfectionism can drain energy and feed procrastination. While it may give short-term relief, it often increases anxiety, delays tasks, and worsens ADHD challenges like time blindness.

ADHD and Anxiety: Why the Usual Advice Doesn’t Always Work

Q: What is the ADHD anxiety cycle?

In ADHD, anxiety can fuel a cycle where energy is channelled into worry and anxious behaviours. This often leads to exhaustion and low mood, similar to a bust phase.

Q: How can you cope with ADHD and anxiety together?

Coping strategies include staying within your zone of tolerance, managing energy levels, noticing boom phases before they lead to bust, and reflecting on patterns without judgement. Therapy can also help identify and address underlying drivers like perfectionism.

Matthew Hallam
Sep 9
4 min read

Anxiety and ADHD often go hand in hand. Research shows that 25–50% of adults with ADHD also experience an anxiety disorder (Koyuncu et al., 2022). But the way these conditions overlap is unique, and the strategies that work for neurotypical people don’t always translate.

For example, expanding your comfort zone is a go-to approach in treating anxiety. The idea is simple: do the thing that scares you, prove to yourself it’s safe, and your anxiety reduces.

But if you’re living with ADHD, this approach can backfire. Instead of recovery, it can push you into burnout. That’s because the real key to managing anxiety when you also have ADHD is regulation—learning how to stay within your zone of tolerance.

What is the boom and bust cycle in ADHD?

A useful way to think about ADHD is through the boom and bust cycle (see Beheshti et al., 2020).

When you’re in a boom state, you’ve got energy, you’re motivated, and you’re riding the wave while it’s here. So, you do more. The problem is, doing more also means you’re burning through more energy. Eventually, that leads to the bust—burnout, exhaustion, or a complete crash. These cycles can be dramatic and they can last a long time.

If you can build awareness of when you’re booming, you can actively manage how much you do. That way, you can reduce the impact of the bust phase. Instead of needing a week to recover, you might only need a day.

What is the ADHD anxiety cycle?

Anxiety plays out in a similar way. The difference is that in the boom phase, all that energy isn’t being channelled into productivity—it’s being channelled into anxious thinking and anxious behaviours.

This can look like endless worrying, over-checking, or rehearsing every possible scenario in your head. And then comes the bust—often a low mood or depressive state, when your system is completely drained.

Managing anxiety, especially alongside ADHD, is about flattening these waves. It isn’t about doing more. It’s actually about doing less—slowing things down, staying within your window of tolerance, and learning to regulate rather than push.

How does perfectionism drive anxiety in ADHD?

One of the hidden drivers of anxiety in ADHD is perfectionism. It can show up in the small stuff:

Needing your hair just right before leaving the house.
Rewriting an email ten times before hitting send.
Buttering your toast edge to edge because “at least that’s perfect.”

These behaviours can feel good in the moment—they give a sense of control. And in a world that often feels chaotic, that little moment of “perfect” can feel like a win.

But perfectionism is also a massive energy drain. It doesn’t address the bigger picture: the deadlines you keep pushing back because you “don’t have time” to do it properly, the assignments you avoid because “if I can’t do it perfectly, what’s the point?”

Perfectionism feeds procrastination. Time blindness means “next week” suddenly becomes “tomorrow” in what feels like two days. Anxiety and stress ramp up, which only makes ADHD executive function challenges worse. Research shows that difficulties with emotion regulation in ADHD are directly linked to higher anxiety, depression, and functional impairment (Shaw et al., 2014; Beheshti et al., 2020).

And in that dysregulated state? Your brain isn’t going to focus. Of course it isn’t—it thinks you’re in survival mode. And when your brain is in survival mode, it doesn’t care about emails or essays—it cares about getting through the threat in front of you.

Why do ADHD and anxiety often lead to procrastination?

Here’s the kicker: the runaway snowball didn’t start because you’re “disorganised,” or “lazy,” or “bad at your job.” It started when you decided perfection was the measure of success or self-worth.

Perfectionism might give you short-term relief, but long-term it creates the very conditions that feed anxiety, procrastination, and self-criticism. And when you’re caught in that loop, it’s easy to blame yourself instead of seeing the underlying patterns.

How can you cope with ADHD and anxiety together?

The overlap between ADHD and anxiety is complex. Reviews show that when ADHD coexists with anxiety, the illness burden is heavier and treatment outcomes are often poorer (Frontiers in Psychiatry, 2025). Traditional “face your fear” approaches can lead straight into the boom-and-bust cycle.

Instead, the focus has to be on:

Regulation – staying within your zone of tolerance.
Awareness – recognising when you’re booming before it tips into bust.
Reflection – noticing the perfectionism, the avoidance, and the self-talk without judgement.

Therapy can help you unpack what’s really driving the anxiety. Often it’s not the task itself—it’s the deeper patterns like perfectionism or negative self-belief. By working through those, you can learn how to manage your energy, flatten the waves, and stop the cycle before it spirals.

Key takeaway

ADHD and anxiety don’t just add up—they interact in ways that make recovery more about regulation than exposure. It’s not about pushing harder. It’s about learning to do less, with awareness, so you can find balance that lasts.

References

Beheshti, A., Chavanon, M.-L., & Christiansen, H. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: A meta-analysis. BMC Psychiatry, 20, Article 120. https://doi.org/10.1186/s12888-020-2442-7
Frontiers in Psychiatry. (2025). Adult ADHD and comorbid anxiety and depressive disorders: A review. Frontiers in Psychiatry, 16, Article 1597559. https://doi.org/10.3389/fpsyt.2025.1597559
Koyuncu, A., Ayan, T., Guliyev, E. I., Erbilgin, S., & Deveci, E. (2022). ADHD and anxiety disorder comorbidity in children and adults: Diagnostic and therapeutic challenges. Current Psychiatry Reports, 24(10), 129–140. https://doi.org/10.1007/s11920-022-01324-5
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966

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Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not a substitute for professional psychological or medical advice. The content is intended to support general wellbeing and personal growth, but it may not address specific individual needs. If you have mental health concerns or require personalised support, please consult a qualified healthcare provider. Equal Psychology, Equal Breathwork, Reflective Pathways and its authors are not liable for any actions taken based on this information.

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