How Does ADHD Shame Differ from Guilt?

PostedOctober 30, 2025

UpdatedNovember 5, 2025

ByMy Patient Advice

Author: Harriet Winslow, BSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Shame and guilt are both powerful emotions but differ significantly in their experience, especially for those with ADHD. While both can affect self-esteem and emotional regulation, shame tends to be more pervasive and tied to identity, whereas guilt focuses more on specific actions. This blog will explore how these emotions manifest differently in individuals with ADHD.

The Nature of Shame and Guilt in ADHD

Shame and guilt are distinct emotional experiences, with different behavioural and cognitive effects. According to a 2024 study by Zaccari et al., shame is a self-directed emotion tied to feelings of being defective or exposed, while guilt is a response to specific behaviours and encourages reparative actions. Individuals with ADHD often experience stronger shame, especially when errors lead to social criticism. This is largely due to impaired emotional regulation, as those with ADHD struggle with self-soothing after perceived failure (Frontiers in Psychiatry, 2024).

A 2023 review by Bodalski et al. found that emotional dysregulation exacerbates shame more than guilt in ADHD. Children and adults with ADHD are more likely to internalise shame, blaming themselves for behaviours that are beyond their control, leading to self-criticism and avoidance. This contrasts with guilt, which tends to prompt corrective actions and self-reflection rather than self-blame (Journal of Attention Disorders, 2023).

Neurobiological Differences in Shame and Guilt Responses

The neurobiological mechanisms behind shame and guilt in ADHD differ, with shame being linked to disrupted circuits in the amygdala and prefrontal cortex. A 2024 study by Liu et al. revealed that abnormal connectivity between these areas impedes emotional regulation, leading to an overwhelming sense of self-devaluation. This is in contrast to guilt, which engages more adaptive circuits in the ventromedial prefrontal cortex, helping with error correction and social repair (Acta Psychologica, 2024).

Gender differences also influence the experience of shame in ADHD. A 2025 study by Holden & Kobayashi-Wood found that women are more likely to experience internalised shame, hiding their ADHD symptoms to avoid perceived inadequacy. On the other hand, adolescent males often express shame through irritability or oppositional behaviour, which may complicate diagnosis and treatment (Frontiers in Global Women’s Health, 2025).

Clinical Implications for ADHD Treatment

Addressing shame in ADHD requires a tailored approach. The NICE guidelines and RCPsych recommend focusing on psychoeducation, compassion-focused therapy, and CBT techniques to reframe self-blame and improve self-worth. Clinicians are encouraged to differentiate between guilt and shame, as this distinction is vital in providing appropriate interventions to enhance emotional regulation and support overall mental health (NICE NG87, 2023).

Conclusion

In conclusion, shame and guilt have distinct roles in the emotional landscape of individuals with ADHD. Shame tends to be more global and identity-based, while guilt focuses on specific behaviours. Understanding these differences is key in improving the diagnosis and treatment of ADHD, particularly through interventions that address the emotional and cognitive aspects of shame.

Harriet Winslow, BSc

Author

Harriet Winslow is a clinical psychologist with a Bachelor’s in Clinical Psychology and extensive experience in behaviour therapy and developmental disorders. She has worked with children and adolescents with ADHD, autism spectrum disorder (ASD), learning disabilities, and behavioural challenges, providing individual and group therapy using evidence-based approaches such as CBT and DBT. Dr. Winslow has developed and implemented personalised treatment plans, conducted formal and informal assessments, and delivered crisis intervention for clients in need of urgent mental health care. Her expertise spans assessment, treatment planning, and behavioural intervention for both neurodevelopmental and mental health conditions.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.