OCD & ADHD: Similarities and Differences Explained

Obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are two common psychiatric disorders.

A person with little knowledge of these disorders could confuse the symptoms associated with attention and concentration, believing one disorder to be the other.

However, the two conditions are wildly different.

Someone with OCD turns their attention to the internal. Following their anxiety trigger, they turn their attention inward and question their relationship with themselves and their sense of self-concept.

ADHD, on the other hand, affects how sufferers relate to and behave toward their environment. Their attention is given to the external.

There is a high comorbidity of OCD and ADHD – especially of ADHD in pediatric OCD. But, while these two conditions often coincide, they are very different.

Here we will discuss the ins and outs of OCD and ADHD, together and separately.

Content

What is OCD?

OCD is categorized as repetitive, intrusive, and disturbing obsessions (thoughts, images, urges, feelings, and sensations) which provoke highly uncomfortable levels of anxiety and uncertainty followed by repetitive ritualistic behaviors known as physical or mental compulsions.

According to ICD – 10 (World Health Organization 1996), OCD can be divided into ‘predominately obsessional thoughts’, ‘predominantly compulsive acts’, or a combination of both ‘obsessions and compulsions’.

Within OCD are various OCD subtypes.

These might include:

Harm OCD
Pedophilia OCD
Relationship OCD
Religious OCD
Checking OCD (both a symptom and a subtype)
Sexual Orientation OCD
Just Right OCD
Hoarding OCD

The obsessions and compulsions of each individual vary greatly depending on the OCD subtype.

What is important to note is that the content of OCD can change. This sometimes leaves the sufferer wondering if they have a ‘new’ type of OCD, or ‘another’ type of OCD, or that they’ve relapsed in some way.

However, content switching is very common in OCD.

The brain struggles to manage the uncertainty and doubt that arises with the disturbing intrusive thoughts that arise. And OCD thrives in this uncertainty. The more we ruminate on trying to solve for this uncertainty, the stronger the OCD hold becomes.

It is because of this that OCD can flit between subtypes and that it is not uncommon for a sufferer to experience more than one subtype across their OCD experience.

Ultimately, the content is not important.

What is important is how we engage and respond to the obsessions as they arise.

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What is ADHD?

Attention-deficit hyperactivity disorder (ADHD) is categorized as a behavior disorder.

In modern-day language, someone with ADHD may also be called ‘neurodiverse’.

Neurodiversity is the term coined for those whose brain functions a little differently from a typical brain and who view the world around them through a different lens.

Someone with ADHD would struggle with inattention, impulse control, and hyperactivity. Typically, someone with ADHD may appear as someone who is scatty, fidgety, and lacks the ability to focus.

However, like most disorders, ADHD is a spectrum and you can have this condition without hyperactivity. It is because of this that many go undiagnosed with ADHD (or in this case, ADD) because the ‘obvious’ behavior that we associate with this disorder isn’t always present.

It is considered a disorder of executive function that involves the mental processes we use to plan, focus our attention, remember, and manage multiple tasks.

When you struggle with these executive functions, day-to-day tasks that most take for granted can feel very difficult.

Similarly to OCD, ADHD is considered a serious mental health condition.

The lack of focus, impulsive behavior, and what can appear as socially awkward behavior can have a negative impact on relationships, work, or school performance, and can lead to low self-esteem and self-confidence.

Is OCD common with ADHD?

Over 35 studies have shown that, on average, 21% of children and 8.5% of adults with OCD also have ADHD.

While the overlap isn’t as high as other comorbidities such as OCD and depression, or OCD and body dysphoric disorder (BDD), it is arguably high enough to confirm that it isn’t uncommon for someone with OCD to also live with ADHD.

What is most interesting about when these two disorders co-exist, is that they live on opposite ends of the behavioral spectrum.

Certain disorders live on a compulsive-impulsive scale.

On this scale, OCD lives at one end (compulsive) and ADHD lives on the other end (impulsivity). There are significant differences between impulsive and compulsive behaviors.

Impulsive behavior is when someone acts on instinct and often without thought. You’ve done the action before realizing you’ve even done it and without any thoughts of potential consequences.

Compulsive behavior is engaging in repetitive behavior following a strong urge. In the case of OCD, it is done to relieve feelings of uncertainty and anxiety following obsessions. Although these compulsive behaviors can also be done without awareness, they can also be performed knowing that they will alleviate distress levels.

This is why it can be quite fascinating to have these two disorders coincide with one another.

It suggests that a person can be both impulsive and considered, a risk taker and risk-averse.

Symptoms of ADHD

Someone with ADHD may exhibit the following symptoms:

Impulsive behavior
Fidgeting & irritability
Restlessness
Interrupting conversations
Acting without considering the consequences
Unable to maintain eye contact
Unable to concentrate on tasks for extended periods of time
Difficulty making plans and sticking to them
Poor time management

Symptoms of OCD

Someone with OCD may exhibit the following symptoms:

Disturbing unwanted thoughts
Excessive avoidance of people, places, or things
Excessive checking (the hobs, the doors, locks)
Excessive reassurance-seeking
Excessive rumination and mental review
Excessive cleaning
Excessive hand washing
Excessive counting
Needing to arrange things in a certain way
Needing things symmetrical
Excessive worry about the safety of you or someone you love

Differences between OCD and ADHD

OCD	ADHD
Risk Averse	Risk Taker
Compulsive behavior	Impulsive behavior
Persistent and distressing intrusive thoughts	Racing thoughts/hyperfocus
Need for certainty	Needs novelty and new experience
Focus is internal	Focus is external

Similarities between OCD and ADHD

These two disorders may be very distinct but there are certain features found in both:

Sleep issues – difficulty going to sleep or staying asleep
High levels of stress and anxiety
Low self-esteem – embarrassment or shame for the behaviors they engage in
Low self-worth – comparing themselves with others who do not have these disorders
Low self-confidence – feeling judged by others for their behavior
Impact on working memory function
High levels of comorbidity
Genetic and hereditary influences
Difficulties with executive functions

Diagnosis of OCD vs ADHD

ADHD in and of itself is an incredibly difficult disorder to diagnose. Thankfully, due to the increase in awareness of neurodiversity, more people are receiving a solid diagnosis than ever before.

However OCD can often be missed in ADHD patients, and visa versa.

A specific environment or structure needed to help someone with ADHD to function more effectively could be mistaken for an OCD compulsion. For example, someone may be seen frantically organizing their home or their workspace and this could be because of the impulsivity of ADHD or the symptom of symmetry/just right OCD.

Likewise, someone may have a hard time concentrating and this could be a symptom of ADHD or it could be a symptom of OCD as the repetitive intrusive thoughts can make it difficult to focus and concentrate.

The symptom may look the same but the underlying cause is different.

In both disorders, certain presentations can be confused and so it is very important that if you suspect yourself of having one or the other (or both) you speak with a qualified professional who can diagnose you correctly.

IOCDF recommends that clinicians examine two major diagnostic factors to aid an accurate diagnosis…

Note the presence or absence of risk-taking and impulsivity
Note the ability to perform accurate and repetitive rituals directed by a specific set of complex rules.

Treatment for OCD

The most effective treatment for OCD is cognitive behavioral therapy (CBT) with exposure response prevention (ERP).

The reason these two modalities are incredibly successful in the treatment of OCD is that it guides the sufferer through a process of changing their relationship and response to those obsessions.

Someone with OCD will experience extreme discomfort and distress when those obsessions arise and typically fight to try and ‘figure them out’ or solve for them. CBT asks us to give our intrusive thoughts less value and weight.

The sufferer learns that thoughts are not facts and that they are not their thoughts.

The process helps to separate their thoughts from their self-concept so they can begin to allow them without questioning the reason for their appearance.

ERP is the process of exposing oneself to the scenario or situation which would typically trigger the obsessions.

The goal here is to learn to manage the anxiety and uncertainty that arise following those obsessions without the need to do compulsions.

You are effectively teaching your brain that you can in fact handle this anxiety and uncertainty, and the more you do this the more your brain learns that those intrusive thoughts and obsessions are not important (or a source of danger) and don’t require your attention.

Treatment for ADHD

When most people think of treatment for ADHD, they immediately jump to medication.

Medication can be a very helpful tool for treating ADHD, however, it is important to note that it is not a ‘cure’ for ADHD and works best alongside other treatment plans.

Alongside medication, behavioral therapy and CBT are incredibly effective at helping to manage ADHD. This is why the simultaneous treatment of OCD and ADHD can coincide easily, as CBT is a helpful tool for both.

With this particular disorder, we can work to strengthen those executive functions such as poor planning, time management, and attention and focus regulation to make day-to-day life easier and more manageable for a neurodiverse mind.

Medication does not agree with everyone. So please consult a medical professional who can assist you with a proper diagnosis and recommend the best course of action.

Can I fully recover from OCD and ADHD?

A full OCD recovery is entirely possible!

For those with OCD, simply living everyday life can seem like an impossible task. There are so many things that non-sufferers take for granted. So, if you are living with OCD, give yourself credit for being brave and strong every day that you manage to get out of bed in the morning.

The good news is that CBT with ERP therapy has been proven to yield incredible results.

Following a tailored treatment plan, OCD sufferers are able to resist the urge to do compulsions and go on to live a life according to their values. Their quality of life vastly improves, and while the timeframe may be different for everyone, a full recovery from OCD is entirely possible for you with the right support.

Our team of specialists can work with you 1:1 to construct and follow a bespoke treatment plan under the guidance of OCD expert, Kimberley Quinlan, LMFT. If you are based in California, you are welcome to get in touch with our team HERE for an initial discussion about how we can support you toward a life free from OCD.

In ADHD, a full recovery might look like this:

A decrease in anxiety levels
An increase in executive function performance
An increase in self-confidence
Management of ADHD symptoms

With the right support, you can learn to fully embrace your neurodiverse brain and make it work for you, rather than against you.

Having ADHD does not have to limit your experiences or success in life. There are many wonderful qualities that come with having what is sometimes called, a ‘spicy’ brain.

Our highly qualified team of OCD specialists are skilled at implementing CBT and ERP.

If you have co-existing ADHD, our team can support you if OCD is the primary condition. If your ADHD is of big concern and interfering with treatment, we will refer you to an ADHD specialist to ensure you have access to the best care.

If you are living with OCD and are needing support to manage your obsessions and compulsions but do not currently have access to private therapy, you can check out ERP SCHOOL.

ERP SCHOOL gives you the exact tools that you can apply to your specific obsessions and compulsions so you can stop letting intrusive thoughts control your life and resist the urge to do compulsions.
As mentioned above, a full recovery is possible for you!

This self-paced program was created by top OCD specialist, Kimberley Quinlan, LMFT.

Kimberley has extensive experience and expertise in helping sufferers take control of their OCD symptoms and find freedom from the anxiety and distress caused by this disorder.

If you have been wanting to begin your OCD recovery journey but do not have access to private therapy, ERP SCHOOL has everything you could need to take your life back from OCD.

Sign up for the program HERE.

(Please note: this program is designed for OCD recovery only and does not address ADHD)