Risky Sexual Behavior (RSB) and female adolescent adhders
TL;DR
The second post in Tommy Underhill’s miniseries covers Cycle 2, risky sexual behavior, in female adolescent ADHDers. It argues that impulsivity, social-cue difficulties, rejection sensitivity, and ADHD Baseline Trauma can push some girls to use self-sexualization for peer acceptance and self-worth. The post lists long-term risks, including shame, coercion, unprotected sex, and reinforced low self-worth, and says adults often misread these girls as manipulative rather than vulnerable.
This post is the second of four in a miniseries addressing how some female aADHDers use sex to improve social standing.
Sexual vulnerability in female adolescent ADHDers (aADHDers) develop through three interlinked cycles that begin early in life with ADHD Baseline Trauma (Underhill, 2025). The Risky Sexual Behavior cycle often begins as the ADHDer enters adolescence and social environments increase in scope and complexity. Interactions and relationships gain additional importance in social standing, and many female aADHDers are prone to make entry into social groups in any way possible, including the utilization of risky sexual behavior. The resultant shame and reduced sexual and relationship esteem then extend into and throughout adult life.
Figure 1: the three interlinked cycles of female aADHD sexuality.
Cycle 2: Risky Sexual Behavior
ADHDers often face misunderstandings due to impulsivity, difficulty with social and physical boundaries, and challenges in reading social cues. This often leads to chronic social rejection, peer relationship difficulties, and emotion regulation challenges, which cyclically exacerbates social isolation. In this context, sexual behavior may be used strategically to gain attention, acceptance, or power within peer groups. Unfortunately, these traits increase vulnerability to being sexualized by peers, adults, and social systems that misinterpret ADHD social behaviors through a hypersexualized lens. ADHD often exacerbates peer rejection, and aADHDers, especially those with prominent hyperactive-impulsive presentations, are more likely to experience fewer close friendships, peer alienation, bullying, and negative reputations among classmates, even when sexuality is not involved.
Self-sexualization in female aADHDers is socially- and clinically-significant but often misunderstood. These young women may intentionally present themselves in adultified and sexualized ways—often conforming to societal ideals of attractiveness or sexiness through dress, behavior, or social media—for peer or social validation, attention, or acceptance, and to gain or improve a sense of self-worth (Liss et al., 2011). In aADHD females, this may manifest as dressing provocatively to gain attention or favor, flirting, and employing sexually-suggestive posts and content on social media. They often view sexual appeal as a primary source of value and identity, and may pursue and prioritize dating older males for the increased social cachet these relationships provide. While self-sexualization is not unique to ADHD, the emotional and neurological traits of ADHD (e.g., ADHD Baseline Trauma, rejection sensitivity, impulsivity, poor self-esteem) make some adolescent females more vulnerable to adopting sexualized identities or behaviors to meet social demands.
ADHD presents with a number of consistent traits that contribute to self-sexualization. Rejection sensitivity and social vulnerability can lead to struggles with peer rejection, social awkwardness, and emotional dysregulation. According to Quinn and Madhoo (2014), female aADHDers often experience a strong need for external validation, confront difficulty forming stable peer relationships, and express feelings of being “different” or not good enough. While ADHD Baseline Trauma provides a significant foundation and feedback loop for these externalized endorsements (Underhill, 2025), these social factors can push females to self-sexualize as a way to gain quick social acceptance, feel a sense of belonging, and soothe the discomfort of ADHD Baseline Trauma.
The impulsive and novelty-seeking behaviors associated with ADHD increase the likelihood of adolescent females engaging in attention-seeking behaviors, including sexual activities (Halkett & Hinshaw, 2021; Becker et al., 2012). These behaviors can make it harder for these adolescents to anticipate consequences or reflect on how sexual self-presentation may affect their self-image or safety, both now and in the future. This misunderstanding of the permanence of consequences extends into the social media world, and it’s often too late when ADHD adolescents often learn that what’s posted to the internet tends to have a significant permanence (Georgianna et al., 2010).
Membership in the group feels good until the reality of an aADHDer’s social abilities and RSD become apparent to the group. Remaining in the group necessitates additional risky sexual behavior or results in the expulsion of the adolescent from the group. Self-sexualization presents long-term risks and consequences. Adolescent females who use sex to gain social standing may experience early or unprotected sexual activity, increased risk of sexually transmitted infections (STIs), unplanned pregnancy, coercion, feelings of shame, regret, or confusion about consent, reinforced low self-worth and relational trauma with the effects lasting throughout adulthood. Sexual behavior in this context is often performative—lacking emotional or relational authenticity—which can cause deeper emotional harm over time.
Tommy will be presenting this research at the 2026 International Symposium on Sex Therapy in Budapest, Hungary.
Sources
Becker, S. P., Luebbe, A. M., & Langberg, J. M. (2012). Co-occurring mental health problems and peer functioning among youth with ADHD. Journal of Psychopathology and Behavioral Assessment, 34(4), 362-374. doi:10.1007/s10862-012-9299-8
Georgianna, C., Underhill, T., & Celland, C. (2010). Hyperstimulation: Teens, Pornography and Online Addictions. Creative Continuum.
Halkett, A., & Hinshaw, S. (2021). Initial engagement in oral sex and sexual intercourse among adolescent girls with and without childhood attention-deficit/hyperactivity disorder. Archives of Sexual Behavior, 50, 181-190. doi:10.1007/s10508-020-01733-8
Liss, M., Erchull, M. J., & Ramsey, L. R. (2011). Empowering or oppressing? Development and exploration of the Enjoyment of Sexualization Scale. Personality and Social Psychology Bulletin, 37(1), 55-68. doi:10.1177/0146167210386119
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), PCC.13r01596. doi:10.4088/PCC.13r01596
Underhill, T. (2025). ADHD Baseline Trauma in Romantic Relationships. International Journal of Psychosexual Therapists, 1(1). doi:10.64207/x41fc649
