OCD and ADHD: Can I Have Both?

One minute you’re obsessed with getting those magazines arranged just so. The next, you can’t remember where you left your backpack and everything in it. Oh wait, now you’re late for work!

Sometimes you think it’s just the OCD. But other times, it feels like you’re scattered all over the place. Could it be OCD and ADHD?

The short answer is yes! You can have more than one diagnosis when you have OCD. In fact, a number of other mental health issues often co-occur with OCD. 

It’s a common misconception that you can’t have both OCD and ADHD due to their seemingly contradictory symptoms. 

OCD is characterized by a hyperfocus on one’s obsession(s) and rigid, meticulous compulsions and rituals. ADHD, on the other hand, is characterized by impulsiveness, distractibility, and shortened attention span. In other words, controlled vs. chaotic.

But that misconception isn’t exactly accurate. While they are quite different disorders, OCD and ADHD can and do co-occur. Understanding how they intersect can help you to better manage your symptoms and treat each optimally. 

Understanding OCD and ADHD

Obsessive Compulsive Disorder (OCD) is a mental health disorder characterized by the presence of intrusive thoughts, images, or urges, known as obsessions, which cause significant anxiety or distress. To alleviate this distress, individuals engage in repetitive behaviors or mental acts, known as compulsions. These symptoms can be severe, consuming a significant portion of a person’s time and attention, and causing marked emotional distress and impaired functioning. 

Attention Deficit Hyperactivity Disorder (ADHD), on the other hand, is categorized in the DSM 5 as a neurodevelopmental disorder. It is characterized by inattention, hyperactivity, and impulsivity. People with ADHD may struggle to focus, become easily distracted, or have difficulty organizing tasks, often feeling scattered or overwhelmed by daily routines.

Though these two disorders might seem to be polar opposites, research shows that co-occurrence is not uncommon. While estimates vary, studies suggest that about 30% of people with ADHD also have symptoms of OCD, and up to 20% of people with OCD have symptoms of ADHD. This combination can make for a complex experience and treatment challenge. 

Why Do OCD and ADHD Co-Occur?

While the exact cause of this overlap isn’t fully understood, several factors contribute to the likelihood of having both:

Genetics 

Both OCD and ADHD have genetic components, and some studies suggest that certain genetic factors may predispose individuals to both conditions. Family history of either disorder increases the likelihood of having one or both.

Brain Structure and Function

Research indicates that people with OCD and ADHD may have differences in brain structure and activity in areas of the brain associated with focus, impulse control, and decision-making, including the prefrontal cortex. Both conditions may involve irregularities in dopamine production, which affects attention and reward systems.

Behavioral Response to Symptoms

Comorbid OCD and ADHD can enhance the symptoms of each other, though the presence of OCD may actually reduce hyperactivity in some people with ADHD. Sometimes, the symptoms of one disorder can trigger behaviors or stress responses that mimic the other. For example, someone with ADHD might develop obsessive behaviors as a coping mechanism for dealing with forgetfulness or impulsivity.

When OCD and ADHD Interact

The combination of OCD and ADHD can present unique and sometimes conflicting challenges. 

Obsessions vs Impulsivity

When you have both OCD and ADHD, obsessive thoughts can feel overwhelming, while the impulsivity from ADHD can drive compulsive behaviors. For instance, someone might obsessively worry about contamination, leading them to impulsively wash their hands repeatedly. ADHD’s impulsivity may worsen compulsive behaviors, making it difficult to stop once they start.

Hyperfocus vs Distraction

While often misunderstood, ADHD doesn’t always look like distraction or inattentiveness. It does have a component of hyperfocus. However, that hyperfocus is on topics of interest and there is difficulty sustaining attention on less interesting things. With OCD, the focus is squarely on the compulsions or obsessive thoughts, making it harder to disengage from them. For instance, they may spend excessive time arranging their belongings "just right" and feel distressed if interrupted, even though ADHD makes maintaining focus on other tasks challenging. This can make getting things like work tasks or homework or chores done difficult. 

Perfection vs Disorganization 

Organization is a common challenge for people with ADHD. For people with OCD, especially those with perfectionistic tendencies, they may spend inordinate amounts of time organizing or structuring things in a way that “feels just right”. For people with both ADHD, they may experience periods of messy disorganization due to their ADHD, and periods of hyper-organization driven by their OCD. Again, it can make getting things done in a timely and consistent manner difficult. Family, friends, bosses, teachers and others may not understand the seemingly inconsistent behavior. 

Time Management

Managing one’s time is a common struggle with both OCD and ADHD. OCD compulsions and rituals can take up substantial amounts of time. People with ADHD often report losing track of time. When ADHD and OCD combine, this time issue can lead to significant difficulty staying on track. To be sure, their intention to complete a task is good. But the inability to manage their time and getting sidetracked creates even more stress. Missed appointments and deadlines, incomplete work, missed family events, and more can leave them feeling frustrated and create conflict within their personal and professional relationships. Keeping a daily routine, so important to one’s ability to function well, is challenging. 

Social Interactions and Relationships

Not surprisingly, these struggles can wreak havoc on social activities and relationships. People with OCD may worry intensely about what others think. ADHD, with its impulsive or inattentive behaviors, can lead to some socially awkward situations. For both scenarios, this creates the stress of feeling overly self-conscious and anxious in social settings, and sometimes it even leads to the decision to simply opt out and avoid the social stress altogether, further isolating them from the social connection so important to support. 

What Can Help

While living with both OCD and ADHD can be difficult, there are things you can do to help manage your symptoms and help you navigate the challenges.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a widely accepted treatment for both OCD and ADHD, but the specific techniques vary. 

For OCD, Exposure and Response Prevention (ERP), a specialized form of CBT, is the gold-standard for treatment. ERP involves gradually exposing the person to their obsessive fears without allowing them to engage in compulsions. Over time, this helps reduce the anxiety associated with the obsessions.

For ADHD, CBT strategies are often used to help improve focus, time management, and impulsivity. There is also good evidence that CBTs emphasis on cognitive restructuring helps with reducing negativity and improving self-esteem. However, it’s important to remember that ADHD is a neurodevelopmental disorder and psychotherapy can only help to a degree. Research suggests that, for some, neurofeedback may offer an additional option for ADHD symptom management. 

Medication

For many people, medication can be an effective tool for managing both ADHD and OCD symptoms. 

Selective serotonin reuptake inhibitors (SSRIs) are often prescribed for OCD. They help balance serotonin levels, alleviating symptoms of anxiety and obsessive thoughts. SSRIs may help with ADHDs attentional symptoms too. Stimulant medications like methylphenidate (Ritalin) and amphetamines (Adderall), commonly prescribed for ADHD, can sometimes worsen OCD symptoms, so doctors may recommend alternative medications or lower doses. 

Establish A Routine

Creating a structured daily routine can provide a sense of stability and control. Routines can help with organization and focus, reducing anxiety and impulsivity. Visual aids like calendars, checklists or visual cues/reminders can help reinforce the structure.  Building flexibility into the routine is also crucial, as overly rigid routines can exacerbate OCD symptoms.

Practice Mindfulness

Mindfulness and relaxation practices can help to reduce anxiety and improve focus and awareness, reduce emotional reactivity, improve cognitive flexibility, and more. Some easy strategies include deep breathing, progressive muscle relaxation, or meditation. Some people find that practices like yoga or tai chi helpful. There are many ways to practice mindfulness. Find the ways that work best for you. 

Break It Down

For those with both OCD and ADHD, some tasks can feel too big to even approach. Breaking tasks down into smaller, more manageable steps can make large tasks feel more approachable and doable. Whether it’s dividing a task into steps or using a timer to limit the time spent on a task, this approach can help prevent time from slipping away and keep you on track. 

Build a Support Network

Whether it’s friends, family or a support group, having a support system helps. Support networks provide a space to share experiences and learn coping strategies. Whether in person or online, support groups for  OCD and ADHD can offer advice, encouragement, and understanding.

The Takeaway

Living with both OCD and ADHD can be frustrating, but with the right strategies, support, and treatment, you can find balance between managing your symptoms and enjoying life in the ways you want to. While there may be challenges along the way, having a plan is the best way to keep moving forward. If you find yourself struggling to find that plan, reaching out to a mental health provider who specializes in these disorders can help you find the path that is right for you. 

References

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