ADHD or PTSD? How misdiagnoses happen

When the nervous system is stuck in permanent alert mode

Many people report symptoms such as inner restlessness, concentration difficulties, forgetfulness, or impulsivity – typical signs that are quickly associated with ADHD (Attention Deficit / Hyperactivity Disorder). Yet a neurobiological disorder is not always the underlying cause. Very often, the same symptoms are produced by a chronically overstimulated nervous system that has been thrown out of balance by long-term stress or trauma (PTSD: Post-Traumatic Stress Disorder).

In practice, this frequently leads to an ADHD misdiagnosis, even though the root cause is something entirely different: a nervous system that has never had the chance to settle.

PTSD and ADHD – why the symptoms overlap

A traumatised nervous system essentially lives in a constant “survival mode”. Fight, flight, or freeze are no longer short-term reactions, but a permanent state. This can lead to a wide range of symptoms:

• Concentration problems and forgetfulness – because the brain is scanning for danger instead of working in a focused way

• Inner restlessness and driven behaviour – similar to hyperactivity in ADHD

• Impulsive reactions – as the prefrontal cortex has reduced regulatory control under stress

• Emotional overreactions – because the nervous system responds with heightened sensitivity to even minor stimuli

All of these are also classic diagnostic criteria for ADHD – and this is precisely why the risk of confusing trauma-related symptoms with ADHD is so high.

Experts warn against misdiagnosis

The fact that the symptoms of a chronically overstimulated nervous system in adulthood can easily be mistaken for ADHD is well documented in scientific research. Specialist literature indicates that adults with traumatic backgrounds or complex PTSD are frequently misdiagnosed with ADHD. The overlap is substantial: inner restlessness, concentration difficulties, sleep disturbances, impulsivity, or hypervigilance can occur in both ADHD and trauma-related disorders. The crucial difference lies in the underlying cause. ADHD is a neurobiological developmental disorder, whereas trauma-related symptoms stem from a nervous system locked in a chronic state of alarm. International review studies (see references) therefore emphasise that diagnosing ADHD in adulthood is particularly complex and always carries a significant risk of misdiagnosis.

ADHD or trauma? How to recognise the differences

A clear distinction is not always easy. However, there are indicators that can help:

• Course and triggers: ADHD is a neurobiological developmental condition that is usually evident from childhood. Trauma-related symptoms often emerge after distressing events or prolonged stress.

• Physical reactions: Trauma often manifests physically as well – sleep problems, chronic tension, digestive issues.

• Fluctuations: With trauma, symptoms are often context-dependent and may decrease noticeably in safe environments. With ADHD, they tend to remain relatively constant.

Only an experienced professional can make an accurate assessment through comprehensive diagnostics. This is exactly why a person’s life history must be taken into account, not just their symptoms.

Why the correct diagnosis is so crucial

An ADHD misdiagnosis can have serious consequences. Those who are actually dealing with a traumatised nervous system do not primarily need medication for ADHD, but trauma-informed and nervous-system-oriented therapeutic approaches. These include:

• Trauma therapy

• Nervous system regulation through breathing exercises, mindfulness, and body-based work

• Stabilisation techniques to increase a sense of safety in everyday life

• Psychoeducation, helping people understand that their symptoms are normal responses to overload

Incorrect treatment, on the other hand, can deepen self-doubt, especially when medication offers little or only short-term relief.

Conclusion: more attention to the nervous system

Not every concentration problem automatically means ADHD. And not every form of restlessness is a neurological deficit. Often, it is the result of a nervous system that has been overwhelmed by trauma or chronic stress.

The question, therefore, should not only be: “Do I have ADHD?”but also: “Could my symptoms be a sign that my nervous system has been stuck in survival mode for years?”

Adopting this perspective opens up an entirely different path to healing – not through stimulants alone, but through regulation, self-care, and the processing of deeper wounds.

References

Johnson, J., et al. (2021). Misdiagnosis and missed diagnosis of adult attention–deficit/hyperactivity disorder. BJPsych Advances. Cambridge University Press.

National Academies of Sciences, Engineering, and Medicine (2023). Impact of Misdiagnosis, Bias, and Stigma. In: Identifying and Supporting Children with ADHD: A Resource for Clinicians. NCBI Bookshelf.

ADD.org. (2022). Is ADHD Overdiagnosed in Adults? Attention Deficit Disorder Association.

PTSD UK. (2022). Can PTSD be mistaken for ADHD? PTSD UK – Nonprofit Organisation.

La Concierge Psychologist. (2023). The Difference Between ADHD and PTSD-Related Executive Dysfunction.

Dobrosavljevic, M., et al. (2022). Miss. Diagnosis: A Systematic Review of ADHD in Adults. Frontiers in Psychiatry, 13:879435.