Female adolescent adhders and life-long poor sexual esteem

This post is the third 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 3: Poor Sexual Esteem

Female aADHDers may experience challenges in assessing the intentions of sexual partners which sometimes leads to regrets or victimization, including reputational attacks. Despite their desire for romantic relationships, these aADHDers face complications due to past experiences, low self-esteem, interpersonal conflicts (Wallin et al., 2024), and the continuing experiences with RSD and ADHD Baseline Trauma (Underhill, 2025).

In a study of early adolescents of both sexes, over half of young ADHDers experienced at least one form of victimization behavior on at least a weekly basis. Notably, the study revealed a higher prevalence of relational victimization (51%) compared to reputational victimization (17%) and physical victimization (14%) (Becker et al., 2017). Risks and consequences of adolescent sexualization and self-sexualization in both sexes include an increased risk of sexual exploitation or coercion, negative self-image, body dissatisfaction and dysmorphia, and internalized objectification (seeing oneself primarily as a sexual object). They often experience shame, regret, or emotional confusion following sexual encounters, and are more prone to potential re-traumatization, especially if a trauma history outside of ADHD Baseline Trauma is present.

Society continues to negatively view female sexual promiscuity and their active sexuality. Sexual shame is deeply rooted in many clients due to religious trauma, abuse, gender-based oppression, or cultural messaging (Wilhoite, 2025). When therapists avoid sex-related topics, especially with ADHD clients, they unintentionally collude with this shame, reinforcing the client’s fear that their sexual thoughts, behaviors, or identities are unacceptable. As Buehler (2017) writes, “Clients come to therapy already silenced. We do them a disservice when we participate in that silence.”

Tommy will be presenting this research at the 2026 International Symposium on Sex Therapy in Budapest, Hungary.

Sources

Becker, S. P., Mehari, K. R., Langberg, J. M., & Evans, S. W. (2017). Rates of peer victimization in young adolescents with ADHD and associations with internalizing symptoms and self-esteem. European child & adolescent psychiatry, 26(2), 201-214. doi:10.1007/s00787-016-0881-y

Buehler, S. (2017). What every mental health professional needs to know about sex (2nd ed.). Springer Publishing Company.

Underhill, T. (2025). ADHD Baseline Trauma in Romantic Relationships. International Journal of Psychosexual Therapists, 1(1). doi:10.64207/x41fc649

Wallin, K., Alehagen, S., Hanberger, L., Lundell, I. W., & Hultsjö, S. (2024). Sexual and reproductive health in young women with ADHD from the view of health care professionals. BMC women’s health, 24(1), 389. doi:10.1186/s12905-024-03230-9

Wilhoite, C. M. (2025). The Role of Body Image and Sexual Shame in Women’s Sexual Dysfunction. In C. Jacobson (Ed.), Unifying the Field of Psychosexual Therapy: An International Dialogue on Theories and Practices, Vol 1. Cambridge Scholar’s Press.