ADHD & OCD: Understanding the Connection

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a developmental condition that can influence one’s ability to remain attentive, control their impulsivity, and stay overly active. Without appropriate diagnosis, mental health treatment, or medication intervention, people with ADHD may have difficulty staying organized and completing tasks. This difficulty can cause problems in academic, professional, or social environments.

ADHD is one of the most commonly diagnosed behavioral health disorders. Approximately 9% of all children and adolescents are diagnosed with ADHD.¹ In most cases, ADHD will be diagnosed with a comorbid mental health condition, such as anxiety or other mood disorders. Almost 75% of children and adolescents diagnosed with ADHD will have at least one comorbidity.² Additionally, ADHD is commonly divided into three distinct categories: inattentive type, hyperactive-impulsive type, and combined type.

What Is OCD?

Obsessive compulsive disorder (OCD) is a chronic disorder that causes a person to experience intrusive thoughts (obsessions) and compulsions, or repetitive behaviors that are designed to alleviate the anxiety from the obsessions. People diagnosed with OCD will often feel intense anxiety due to how their thoughts and behaviors will often have a significant impact on their daily life.

OCD can be diagnosed from early childhood on into adulthood, but it is commonly diagnosed in late teen-early adult years. Research has shown that there is a genetic component to developing OCD. A close relative being diagnosed with the disorder more than doubles one’s chances of being diagnosed with it as well; however, environmental factors like extreme stress also play a part.⁴ Common symptoms of OCD include repetitive behaviors, ruminating thoughts, and anxiety.³

Similarities Between OCD and ADHD

Although ADHD and OCD are different disorders, there are several similarities between the two diagnoses. Both disorders may affect the diagnosed individual’s day-to-day life by disrupting neurotypical behaviors. Both disorders may influence the way diagnosed individuals act in academic, professional, or social environments, and how they are perceived by others.

Here are several similarities between ADHD and OCD:

Brain Abnormalities in the Frontostriatal Area

Research regarding ADHD and OCD has indicated that both disorders may involve abnormal activity in the same part of the brain. Both disorders are associated with abnormalities in the frontostriatal system of the brain, which is responsible for higher order, motor, cognitive, and behavioral functions.⁵ Impairments of the frontostriatal system can affect executive function and quality of life.

Difficulty Paying Attention

ADHD and OCD can interfere with maintaining attention to a specific person or task. While ADHD may influence how easily one is distracted by external sources, OCD will introduce obsessive thoughts and compulsive behaviors that steals the focus.

High Risk of Depression, Anxiety & Anger

Those diagnosed with ADHD and OCD are likely to deal with comorbidities of depression, anxiety, and poor anger management. Frustration with oneself, or the diagnosis, is expected. Without proper intervention, quality of life will suffer, leading to depression or anxiety.

Professional Development Challenges

Both ADHD and OCD have the potential to hinder academic or professional development and success. Much of academic or professional development requires focus, organization, and attentiveness, all of which are impacted by a diagnosis of ADHD, OCD, or both. Developing and maintaining academic or professional success without appropriate coping skills can be a struggle.

Social Relationships Struggles

Those close to people diagnosed with ADHD and/or OCD may have to deal with certain behaviors, such as disorganization, difficulty focusing, or obsessing over other things. It may appear that the relationship is not a priority as these other feelings and behaviors take precedence.

Sleep Disruption

Both disorders can throw mental energy expenditure off balance. Sometimes, a diagnosed individual will deal with focus issues and rumination at inopportune times, disrupting one’s ability to sleep. 70% of individuals diagnosed with OCD have some form of sleep disorder.⁶ Those diagnosed with ADHD have been known to also have difficulty sleeping due to restlessness, disrupted circadian rhythms, and insomnia.

Gastrointestinal Issues

People with ADHD are more likely to be diagnosed with gastrointestinal issues, such as dyspepsia, chronic constipation, and irritable bowel syndrome (IBS), than in the general population.⁷ People with ADHD are also more often than those in the general population to seek primary care visits for gastrointestinal symptoms and experience more recurrence of gastrointestinal symptoms.⁷

People with OCD are at a higher risk of IBS than those without OCD.⁸ They also tend to experience more severe depressive symptoms with comorbid OCD and IBS.⁸

Both Potentially Worsened or Caused by Trauma

There are clear links in the research between experiences of childhood trauma and diagnoses of both ADHD and OCD. Trauma sometimes serves as the trigger for symptoms to occur, and other times trauma can worsen symptoms in those who already have been diagnosed with ADHD or OCD. In one study of individuals with diagnosed OCD, childhood trauma was associated with more severe anxiety, higher levels of impulsive behaviors, higher prevalence of ADHD, and lower levels of education.⁹

Differences Between ADHD and OCD

While ADHD and OCD may share similarities, they are distinct disorders that have drastically different effects on a diagnosed individual’s neurological functioning. ADHD will affect external functioning, while OCD will disrupt internal functioning. Impulsiveness can compound these difficulties.

Differences between ADHD and OCD include:

The Basic Nature of the Disorders Are Different

People with ADHD and OCD manage distress in different ways. Those with OCD are highly motivated by avoiding the anxiety caused by obsessions. Individuals with ADHD are highly motivated by seeking the pleasure of sensory stimulation, which is often marked with impulsive behaviors. This sometimes leads to people with OCD seeking less stimulation and those with ADHD seeking more stimulation from their environments.

Different Effects on Brain Activity

While research has indicated that both ADHD and OCD affect the frontostriatal area of the brain, the ways in which the frontostriatal area is affected are different: Individuals with ADHD show decreased activity, while those with OCD show increased activity.⁵

Internal Vs. External Symptoms

Symptoms of ADHD are often external. ADHD can manifest as inhibited social functioning and hyperactivity. The problems stemming from ADHD are often due to the individual’s reaction to external stimuli. This is a major factor in an ADHD diagnosis. The symptoms of OCD are often internal. OCD manifests as obsessions, ruminations, and intrusive thoughts. Compulsions, while often external, function as vessels for an individual to try to control their internal struggles and obsessions.

Impulsivity & Risk Tolerance Differences

OCD and ADHD impulsivity affect people in varying ways. People with ADHD have been shown to engage in more risk-taking or impulsive behaviors for potential benefit.¹⁰ Individuals with OCD have been shown to be less likely to engage in risk-taking or impulsive behavior for potential gain, generally engaging in risk-taking or impulsive behaviors when faced with the possibility of loss.¹¹

Presence of Rituals

A common indicator of OCD is “rituals,” or repetitive maladaptive behaviors that impact one’s day-to-day life by being time-consuming, frustrating, or disruptive in other ways. The need to complete rituals is not a diagnostic criterion of ADHD.³ In fact, an ADHD diagnosis often indicates difficulty staying on task, which would preclude a ritual.

How Can I Tell If I Have OCD Vs. ADHD?

The best way to tell if you have OCD vs ADHD is to seek a professional’s opinion and clinical assessment. However, exploring some of these questions can help you have the information needed to explain to a professional when, how, and to what degree you experience symptoms. In general, obsessions and compulsions are hallmark features of OCD, while impulsivity and inattention are hallmark features of ADHD.

Here are some questions to ask yourself if you’re unsure whether you’re dealing with ADHD or OCD:

Do You Have Intrusive Thoughts?

Intrusive thoughts are ideas, images, or urges that are part of an OCD diagnosis, that are unwanted and often contain taboo material. The thoughts tend to have certain themes, which usually center on what is most important to you as a person. When the thoughts happen, they cause intense distress and urges to perform certain mental or physical behaviors to make them stop.

Potential intrusive thoughts could include:

• What if my family member gets hurt in a freak accident today?
• How would I know I was really happy in my marriage?
• What if I didn’t clean the counter enough after the raw chicken touched it, and now someone gets sick because of me?
• What if I pass by that stranger on the subway and say something rude to them?
• What if I drive my car off this road on purpose?
• What if I pushed that person down the stairs?

Do You Perform Compulsions?

Compulsions in OCD are mental or behavioral acts performed to neutralize the anxiety caused by obsessions. When compulsions are mental, they can be harder to see because they occur within a person’s mind, such as mentally reviewing past situations. When compulsions are behavioral, sometimes they turn into certain repetitive rituals or routines for the person with OCD.

Common compulsions include:

• Mentally reviewing past or future situations to prove or disprove the content of obsessions
• Ruminating on past situations to prove or disprove the content of obsessions
• Comparing the current situation to past situations to prove or disprove the content of obsessions
• Checking that locks are locked, plugs are unplugged, or stoves are turned off in a repetitive manner or for a certain number of times
• Ordering or arranging the environment until it feels “right”
• Repeating a specific phrase a certain number of times
• Counting to certain numbers to avoid something “bad” happening
• Magical thinking related to certain numbers or phrases
• Arranging household items in a certain way until it feels “right”

Are You Impulsive?

Impulsivity has to do with acting before thinking through the pros and cons of a situation. People with ADHD can interrupt others, intrude on others, have emotional outbursts, or engage in reckless or self-destructive behaviors. Impulsivity is a hallmark feature of someone who struggles with ADHD symptoms, and it often affects their personal and professional relationships.

Do Stimulants Make Your Intrusive Thoughts Worse?

For someone with OCD and not ADHD, stimulants can make intrusive thoughts worse. This is because stimulants are highly effective for the biological makeup of someone with ADHD, helping to soothe the part of their brain that craves stimulation. For someone with OCD, a stimulant could worsen coexisting anxiety and increase or exacerbate the nature of obsessive thoughts.

Can You Have ADHD and OCD Together?

It is possible to be diagnosed with both ADHD and OCD, but the prevalence of dual diagnoses is a debate among researchers. Certain research indicates that 11.8% of individuals diagnosed with OCD have a comorbidity of ADHD.¹² Other research indicates that rates of dual diagnosis may be inflated due to misdiagnosis of the two disorders for one another.¹³

Does ADHD Make OCD Worse?

When diagnosed with both ADHD and OCD, the two diagnoses may worsen one another. Symptoms from one disorder may influence symptoms of the other. As symptoms of one disorder appear to lessen, symptoms of the other disorder may dominate. This pivot between behaviors of ADHD and the compulsions of OCD can be exhausting.

How ADHD Can Present When You Have OCD

When you have a dual diagnosis of both ADHD and OCD, you may have certain symptoms or subtypes under the OCD umbrella. For example, you may be more likely to present with Pure O as a subtype of OCD. Pure O OCD is characterized by obsessions followed by mental compulsions, such as mentally reviewing events, which can be more difficult to recognize than a physical compulsion. You may also be diagnosed with Tourette Syndrome, which is a nervous system disorder characterized by verbal or behavioral impulsive movements, known as tics.

Body-Focused Repetitive Behaviors in People with ADHD and OCD

Body-focused repetitive behaviors are recurrent self-grooming behaviors which cause distress and bodily damage. These behaviors can occur in both people with ADHD and those with OCD. These behaviors are often focused on one body part, such as hair-pulling, cheek-biting, nail-chewing, or skin-picking. The person often feels unable to stop or control the repetitive behaviors, which can result in feelings of shame and embarrassment.

OCD & Executive Function

Experts believe that people with OCD have problems with executive functioning. Specifically, issues with cognitive flexibility, focusing attention without distractions from tasks, and working memory, are executive functions which are impaired in individuals with OCD.¹⁴ This might show up as someone having trouble switching between tasks, focusing on a task, or multi-tasking at home or work.

Diagnosis Process for ADHD and OCD

Currently, no laboratory or brain imaging tests can be used to diagnose ADHD or OCD. Both disorders are diagnosed through behavioral observation and psychological assessment. During the observational period, a mental health professional may consider how some symptoms commingle.

Why ADHD Can Be Misdiagnosed as OCD

ADHD can be misdiagnosed as OCD when intrusive thoughts present as a symptom. Since intrusive thoughts are a hallmark feature of OCD, sometimes ADHD can be misdiagnosed when intrusive thoughts are present. Intrusive thoughts in OCD will always come with compulsions and are often centered on themes of obsessions. However, ADHD-induced intrusive thoughts are often caused by difficulties in regulating attention and experiences of overflowing thoughts that can be random and unconnected.

Why OCD Can Be Misdiagnosed as ADHD

OCD can be misdiagnosed as ADHD when issues with obsessions and compulsions are causing trouble in completion of tasks at work or school. Since time blindness in ADHD leads to an inability to focus and a hard time starting and completing tasks, OCD is sometimes misdiagnosed as ADHD in these cases. A person with OCD may actually be engaging in compulsions that are taking up their time and leading to issues with time management.

Treatment for ADHD

ADHD treatment can help with coping with symptoms that impact daily functioning. A combination of medication intervention and psychotherapy will often yield the greatest results. A primary care physician (PCP), a psychiatrist, or a licensed mental health provider may render treatment.

Treatment options for ADHD include:

• Cognitive behavioral therapy (CBT): CBT for ADHD can be a framework for evaluating how the rapid thinking (cognitions) in ADHD may result in maladaptive behaviors.
• Medication: ADHD medications are not a permanent cure for ADHD; however, medications may help with day-to-day function by improving concentration, lessening impulsivity, and providing a calmer state of mind.¹⁵
• Psychoeducation: Psychoeducation for the individual or the family is a useful tool for improving social dynamics within the home. Those with ADHD will learn more about their condition and how it affects themselves and others. Family members will learn about the condition and how to react best and help.¹⁵
• Social Skills Training: Social skills training uses role-playing to give people with ADHD an opportunity to practice the skills learned during psychotherapy. This can help with behaviors and reactions in social situations.¹⁵
• Parent Training and Education Programs: For parents of children with ADHD, training and education programs will teach how to reinforce the behavioral skills taught during psychotherapy.¹⁵

Treatment for OCD

Treatment for OCD can help diminish rumination, intrusive thoughts, compulsions, and other symptoms of OCD. OCD is typically treated with psychotherapy; however, in certain instances, medication may also be an option. OCD is a chronic disorder and may continue to cause discomfort during or after treatment.

Treatment options for OCD include:

• Exposure response prevention (ERP): ERP for OCD involves exposing individuals to thoughts, images, objects, or situations that make them uncomfortable and cause obsessions. The objective is to have the diagnosed individual practice making a conscious choice to resist the resulting compulsive behavior.¹⁶
• Cognitive behavioral therapy (CBT): CBT for OCD will provide a framework for evaluating how particular obsessions result in specific compulsions. Individuals can readjust their reactions to obsessions or ruminating thoughts and learn strategies to cope with intrusive thoughts and rumination.
• Medication: Medications for OCD that can be used to assist with symptoms of OCD include serotonin reuptake inhibitors (SSRIs) and clomipramine.⁷
• Psychoeducation: Psychoeducation may help individuals and families to cope with negative emotions regarding their diagnosis. Learning about common challenges, coping mechanisms, and support options may be addressed.

Can OCD and ADHD Be Treated Together?

Similarly to those diagnosed with either ADHD or OCD, cognitive behavioral therapy (CBT), medication intervention, and psychoeducation are the key strategies for understanding, coping with, and overcoming challenges associated with both disorders. A trial of stimulant medication may be attempted. Stimulants are sometimes prescribed for individuals with ADHD; however, stimulant use may worsen symptoms of OCD.⁸

Getting Help for ADHD and OCD

Seeking professional support is an advisable option for those diagnosed with ADHD, OCD, or both. One may use an online therapist directory to find a practitioner specializing in treating either or both disorders. When talk therapy practices do not yield positive results on their own, one may consider finding a psychiatrist who can evaluate whether there is a need for medication. Many online resources also exist for both conditions, such as NOCD or ADHD Online.