When we see a person who’s fidgety, impulsive, can’t concentrate on their tasks, and is prone to procrastination, it’s easy to assume that they have ADHD automatically. 

But we’re better than that!

We know that lots of other mental health conditions can disguise themselves as ADHD, like three raccoons in a trench coat. 🦝 🦝 🦝

The usual suspects are anxiety, depression, or bipolar disorder. But sometimes, even the disorders that are inherently different from ADHD can be mistaken for it. Yes, OCD, we’re looking at you.

[ADHD and OCD connection] What is going on with ADHD and OCD? 

We also are wondering about that! How can these two conditions that are so unlike each other be mixed up? Before diving into the unexpected similarities between ADHD and OCD, let’s make it clear what OCD is at all (We hope you’re all ADHD experts by now, but you can refresh your memories by getting back to our ADHD 101).

Obsessive-compulsive disorder (OCD) is a mental health condition where a person experiences either uncontrollable thoughts - obsessions or engages in repetitive behaviors - compulsions, or both. Like with ADHD, OCD is a disorder that interferes with the different aspects of a person’s life. Folks with OCD can often feel trapped or afraid of losing control. They are also reluctant to look for help because they feel ashamed of their condition.

OCD usually shows up between late childhood and young adulthood. But unlike many other mental health conditions of the sort that become less intense with age, OCD can get worse as time passes. Stress or traumatic events can provoke the symptoms, too (1). So, it’s important to diagnose and start treating OCD from early on so the symptoms don’t get too challenging to manage. 

What exactly causes OCD is unknown, but some factors can spark this condition. You’re more likely to develop OCD if some of your first-degree relatives have it if you experienced some sort of childhood trauma, or if you showed the symptoms of anxiety or depression as a kid. Weirdly enough, women can develop OCD during their pregnancy or after giving birth - they may start having urges to check if their baby is breathing or thoughts that somebody may hurt them. 

OCD Symptoms

Let’s get back to the symptoms of OCD. What exactly are these obsessions and compulsions? How do you spot them? 

Obsessions are usually unique to people and are related to their lived experiences, but some obsessions are more common. Among some of the more widespread obsessions:

• Fear of germs, infections, or disease;
• Wish to keep everything in perfect order;
• Fear of losing, missing, or misplacing things;
• Unwanted thoughts about religion or sex;
• Aggressive thoughts about oneself or other people;
• Fear of causing someone harm.

Compulsions, on the other hand, are repetitive behaviors that are often caused by these obsessions. To name a few:

• Excessively cleaning things or washing hands;
• Сounting, repeating phrases, either out loud or in the mind, constantly praying;
• Constantly checking feelings or bodily sensations;
• Checking that doors are locked, appliances are shut off, alarms are on, and taps are closed;
• Rearranging and ordering things in a particular way.

Of course, not all intrusive thoughts are obsessions, and not all rituals or habits are compulsions. You don’t have OCD if you’re just used to rechecking your appliances before going out or if you like to keep things in order. But if you can’t control these repeating thoughts and behaviors even if you know perfectly well that you don’t need them, if they complicate your daily life and don’t bring you any pleasure or satisfaction, only short-lived relief, if you’re feeling that they take up a lot of your time (more than an hour per day), then you might need to get checked for OCD.

[ADHD and OCD similarities] So, where are the similarities between OCD and ADHD?

Looking through the list of OCD symptoms, you can barely see the overlap between it and ADHD. Folks with ADHD are fidgety, restless, distracted, and disorganized; they daydream a lot and tend to forget about things - which is the opposite of people with OCD. They are generally calmer, more focused, and more attentive. If OCD and ADHD are so unlike, why do people continue to mix these two conditions up? 

The two disorders have a similar neurobiological nature - problems in the brain's frontal lobe cause both. But even in this, they are distinct - ADHD is caused by under-activity in the frontal lobe - there’s a lack of dopamine and norepinephrine, and OCD is due to overactivity - there’s too much serotonin (2).

But we, regular people, don’t have the ability to casually spot the brain activity of a new person we meet. We just observe their behavior and try to understand why they act in one way or another. This is where the confusion between the two conditions happens - when the observer misunderstands the motivations behind a person's behavior. 

The deal is - some ADHD coping skills can look like OCD. 

Let’s get to some examples. 🤓

People with ADHD may spend a lot of time rearranging things and cleaning, but that’s because the clutter can often overwhelm and distress them. So they are just trying this way to prevent this by seemingly obsessively organizing their spaces. Some folks with ADHD can also do this because of their tendency to procrastinate. But it’s not obsessive-compulsive behavior, though it may look like it when we don’t know what is happening in the person’s head. 

[ADHD and OCD comorbidity] ADHD and OCD comorbidity: can someone have both conditions?

Yeah, about that. 

There’s a study that shows that 11.8% of those with OCD also have ADHD (3). It’s not that surprising as comorbidity is familiar with mental health conditions - folks with one type of mental disorder often develop others across their lifespan.

But it’s important to note that when somebody experiences ADHD and OCD symptoms from a young age, it’s more likely that their OCD is more intense and persistent, and it is much more challenging to treat. 

And, of course, people who have both ADHD and OCD symptoms can struggle with getting a diagnosis - it’s so much harder for doctors to identify these conditions when they are comorbid accurately.

ADHD vs. OCD treatment: are medications for OCD and ADHD the same?

We all very well know that you can’t treat ADHD with a single pill. ADHD treatment is complex and typically involves not only medication but also therapy, education, skills training, and sometimes even additional coaching. 

What about OCD? Is it usually treated similarly?

Actually, yes. Two of the main methods of treating OCD are used for treating ADHD as well.

Hello, good old CBT! 

While being quite a common therapy for ADHD, it is also considered to be one of the most effective treatments for OCD (4). As we know, CBT is a form of psychotherapy that helps people recognize faulty or unhelpful ways of thinking and behaviors reevaluate and change them for healthier ones. 

When talking about using CBT for treating OCD, the specific aspect of it is often brought up - exposure and response prevention (ERP). Sorry for casually throwing in another abbreviation again - we just can’t keep it from happening.

Exposure and response prevention

So, back to ERP. It is a therapy that exposes people to situations designed to provoke their obsessions but does that in a safe, controlled environment (5). 

ERP isn’t made to eradicate intrusive thoughts and behaviors completely. Neither is it focused on teaching a person to avoid distressing situations. It provides a person with effective coping mechanisms to resist the compulsion when facing a triggering situation in real life.

It may seem frustrating for a person with OCD to purposefully expose themselves to the things that trigger their compulsive behaviors. They may have tried it themselves, but these experiments possibly made them even more anxious. ERP is different because the person’s exposure to triggers is gradual and controlled by a therapist, who guides you through the process, teaching them to confront the trigger, understand the feelings they provoke, and resist the urges. 

It is still not simple and pretty uncomfortable, but if you commit to this process, you can learn to manage your responses and deal with everyday triggers. By stopping the compulsive behaviors, you will teach your brain not to panic when it’s unwarranted. 

For a long time, it was considered that OCD is untreatable with medications. Still, in recent decades, many studies have explored the efficiency of different psychotherapeutic medications on the condition (6).

Like with some symptoms of ADHD, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and clomipramine, are established as quite effective in treating OCD. These medications help regulate serotonin levels in the brain, which can reduce obsessive thoughts and compulsive behaviors. If these medications are ineffective, the doctors prescribe other psychiatric medications - among them more common are antipsychotics or benzodiazepines.

As for some “lighter” methods of treating OCD, you can also see some familiar faces here - relaxation techniques such as mindfulness meditation, deep breathing, and yoga. They can reduce anxiety and improve the coping skills of a person with OCD. And of course, physical exercise, a good night's sleep, and a balanced diet are here as well, as they support overall mental health and can help greatly reduce stress.

[Schlussfolgerung] Schlussfolgerung

Though in some aspects, OCD and ADHD may seem like polar opposites, they can visibly manifest themselves in similar ways, making it difficult for doctors to diagnose and treat them accurately. It becomes even more complicated when a person has both - which is not rare at all. So, if you’ve caught yourself having some ADHD or OCD symptoms - hurry to your doctor. Or you can start by trying out our fun little ADHD test. But then - to the doctor, seriously! 

Quellen

¹ NIMH. Obsessive-Compulsive Disorder - National Institute of Mental Health

² Current Treatment Options in Psychiatry. Misdiagnosis of ADHD in Individuals Diagnosed With Obsessive-Compulsive Disorder: Guidelines for Practitioners

³ PMC. Co-Morbid Obsessive–Compulsive Disorder and Attention Deficit Hyperactivity Disorder: Neurobiological Commonalities and Treatment Implications

⁴ FOCUS. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update

⁵ Practice Guideline for the Treatment of Patients With Obsessive-Compulsive Disorder

⁶ PMC. Drug treatment of obsessive-compulsive disorder

‍