Obsessive-compulsive disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are two distinct mental health conditions, yet they share overlapping traits that can sometimes make diagnosis and treatment complex. While ADHD is characterized by inattention, impulsivity, and hyperactivity, OCD involves intrusive thoughts and compulsive behaviors aimed at reducing anxiety. Despite their differences, research suggests that the two conditions can co-occur, and in some cases, their symptoms can even mimic one another. Understanding the link between OCD and ADHD is crucial for developing effective strategies to manage both conditions.
OCD and ADHD: Similarities and Differences
At first glance, OCD and ADHD might seem like complete opposites. ADHD is often associated with impulsivity and difficulty maintaining focus, while OCD involves excessive control, perfectionism, and repetitive behaviors. However, both conditions can impact executive functioning—the brain’s ability to plan, organize, and regulate thoughts and behaviors.
- Impulsivity vs. Overcontrol: Individuals with ADHD may struggle with impulsivity, acting without thinking, while those with OCD tend to overanalyze and hesitate due to obsessive doubts. In both cases, impulses and compulsions can feel (and be) beyond the person’s control, meaning that both issues can result in being plagued by something unwanted. Where OCD seeks to exert control over compulsions through rituals and certain behaviors, ADHD does not.
- Attention Difficulties: ADHD can cause difficulties in sustaining and/or regulating attention, whereas OCD-related obsessions can consume so much mental energy that a person struggles to focus on other tasks.
- Co-Occurrence: Some individuals have both ADHD and OCD, making it difficult to differentiate whether a behavior stems from distractibility (ADHD) or compulsivity (OCD). Studies suggest that having ADHD can increase the risk of developing OCD symptoms and vice versa. ADHD or OCD diagnosis can be delayed while trying to determine which is which.
3 Ways to Manage OCD and ADHD
- Cognitive-Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP):
CBT, particularly ERP, is the gold standard for treating OCD. It helps individuals confront their obsessive fears without engaging in compulsions. For those with both ADHD and OCD, therapy can also include skills training to improve focus, emotional regulation, and impulsivity management.
Those who attend our practice for OCD therapy in Woodland Hills learn and implement the process of CBT to help them identify how their patterns and behaviors are impacting their lives. CBT is a process of considering what is being thought, what is assumed, what stories we are telling ourselves, and then looking at the behaviors that support that narrative. Through replacing those habits with behaviors more in line with goals and ideals, you can adjust the patterns that surround you. This treatment model won’t eliminate OCD, but it will help you to set and choose behavioral responses to your OCD that are more helpful. In in-person or online OCD therapy, you can also utilize CBT to address the way you feel about your OCD, the way you talk about yourself, and the ways you’d like that to change for the better.
A lot of the shame and guilt that surrounds both OCD and ADHD is alleviated by Cognitive Behavioral Therapy. The truth is that everyone has weaknesses, everyone struggles with things about themselves. Some of these things are true, and addressing them can increase happiness and self-confidence. Some of these things used to be true, and have been overcome, but the trauma and/or pain of that time still lingers – bidding farewell to the old story about yourself can take time and effort, but it can be done. And some of the things we tell ourselves about who and what we are simply aren’t true at all. Learning how to identify when we aren’t telling ourselves a true story can help us avoid dealing with unwarranted distress and focus on what is real and tangible, both the weaknesses we want to work on and the strengths we want to celebrate.
When it comes to OCD, there is usually a trigger that is being avoided or reacted to when compulsive behaviors come into play. Some folks ritualize their days in an attempt to prevent the trigger from occurring. Others have patterns they replicate in order to re-stabilize after encountering a trigger. Managing these triggers in real time becomes an invaluable skill when you are dealing with OCD.
ERP therapy allows you to confront triggers in one of two ways: through imagined exposures or through actual exposures. You may begin with imagining certain scenarios, getting used to picturing them, hearing certain words, and imagining the consequences. As applied to some fears, imagining may be the extent of the exposure, as it would be dangerous to experience one in real life. In other cases, you might progress to real-life trigger exposures, such as visiting certain locations or participating in certain activities. However you confront them, exposures are meant to be intentional. The goal is to feel safe and secure enough to take them on and to be patient over the time it takes to habituate to each trigger. Habituation occurs when you are exposed to something so much that you become used to it, and it no longer triggers you the way it used to.
Along with these exposures, you may practice ritual prevention. If you find yourself ritualizing in order to “prevent” certain mishaps, you will be aware that that pattern is disruptive and ineffective in your daily life. Being able to resist rituals, either those performed as a talisman or those utilized after an exposure, is a skill that takes time. Confronting triggers without ritualizing is part of exposure and response prevention therapy; you will learn other ways to cope with the distressing and intrusive thoughts you are dealing with.
- Medication Management:
While there is no medication that you can take to eliminate OCD, there are ways to utilize medication to alleviate symptoms. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for OCD, while stimulant and non-stimulant medications can help manage ADHD symptoms. However, treating both conditions with medication requires careful balancing, as some ADHD medications can exacerbate OCD symptoms. On the other hand, OCD symptoms that are triggered by inattentiveness can be alleviated by stimulants in some cases. Consulting a psychiatrist experienced in treating both conditions is essential; I know this first-hand as an OCD counselor in Woodland Hills.
When you are utilizing medication as treatment for your OCD and ADHD, you will likely be prescribed a medication that addresses whichever disorder is the most prevalent or causing the most disruption for you to begin with. You will more than likely begin taking it at a low dose and gradually increase it. This slow and steady methodology can lead to an extended wait for the benefits to kick in. At this time, it is important to continue with CBT and other lifestyle habits. The medication needed to treat the second disorder will, like the first medication, be introduced gradually, so that you can experience any impact and report back to your healthcare professional(s). This is why it is important to have a professional managing your medications, and why it’s important to feel safe and confident sharing with them how the medication is impacting you.
As with all medications, it is important to take them as prescribed. You may choose to utilize daily pill containers, to set alarms to remind you when to take them, as well as any other related behaviors (such as avoiding certain food or drink for a certain amount of time or making sure you’ve eaten within a certain amount of time or any other habits that you notice impact how you absorb and react to your medication). Many people who take medications cease taking them if they don’t like the side effects. It’s important to talk to your doctor about side effects and see if there is a solution, rather than deciding on your own to cease medication. When going off medication, the dosage is reduced gradually, much like how starting a medication is a process of gradual increases. This is the safest way to care for your body and its reactions to the chemical reactions of the medication.
SSRIs are commonly the most effective OCD medication, but they are not the only option. Some of those who don’t experience success with SSRIs try TCAs (Tricyclic Antidepressants). An adequate time period of testing is typically between three to four months, so expect to invest time in each medication you try and spend time in honest reflection about how each is impacting you.
- Structure, Routine, and Mindfulness:
Creating a structured routine helps those with ADHD stay organized while also reducing uncertainty and anxiety for those with OCD. Mindfulness techniques, such as meditation and deep breathing, can help manage intrusive thoughts and impulsivity, allowing for greater emotional balance and focus.
In our Woodland Hills OCD therapy sessions, we hear a lot from folks who have ADHD and say that it prevents them from having structure and routine. We also hear from some people who have OCD and are afraid to tap into their thoughts because their thoughts can sometimes be distressing. What is important is to create the structure, routine, and mindfulness practice that works for you. Talk to your mental health care provider about what you experience, what outcomes you want, and what you notice as far as changes when you make adjustments.
Structure and routine can help to make things more predictable, which can help keep your nervous system more regulated overall. The more regulated you are for more of the time, the easier it is to return to that place when you’re disrupted, because that becomes your body’s natural state. It can also help you to let go of anxiety about forgetting or being surprised by something that upsets your nervous system.
Utilize a planner to help you map out your schedule and obligations. Find one that provides all the space you need for the things you need to keep track of. Put it somewhere you will see every day. Buy different-colored pens to represent different obligations. Use stickers to highlight important events (or just to decorate because you enjoy using them). Do whatever it takes to make a planner work for you. Allocate time for rest, time for relaxation, and time between activities. Give yourself deadlines by breaking goals down into small steps that you can accomplish over time.
For both ADHD and OCD, having a regular sleep schedule (sleeping and waking at the same times every day), consistent meal schedule, set time to work, and set time to relax is helpful. These things provide consistency and framework for those who have ADHD; you’re not going to hyperfocus on something and skip lunch, and you’ll do well having a set window for work with a known endpoint. They remove a lot of unknowns and question marks for those with OCD, thereby minimizing the anxiety that can be created by triggers. There are some tactics that work for both ADHD and OCD. For example, if you have a project to do some work on and set yourself a timer for fifty minutes, your ADHD will appreciate the urgency created in knowing that you have a limited time to finish, and your OCD will appreciate knowing that there will be an alarm that signals the end of this time to prevent you from missing the next thing.
Because there is no way to control your environment and create a 100% predictable routine, it is important to have self-care in place to help you handle surprises and triggers. Mindfulness is a practice that can help bring you back to your body and the present moment when something upsetting occurs. If you pause to connect with your breathing and focus on what is happening in real time, you can intervene before you go down a path of worrying about the future, ruminating about the past, and catastrophizing about both.
Through mindfulness, you are able to develop the skill of noticing what is happening without judgment. When an unpleasant thought arises, mindfulness doesn’t repress it or seek a way to distract. It sees the thought for what it is and accepts that the thought has occurred. Without the judgment and shame attached, that thought loses its power over you, and you are able to move forward more easily.
Addressing the interaction of OCD and ADHD is paramount when it comes to managing both disorders. Because symptoms can both mimic and exacerbate one another, it is always wise to keep careful track of incidents and occurrences that lead to the worsening of OCD and/or ADHD symptoms. One disorder is likely more intrusive than the other for you, but that doesn’t mean that you should put the other on the back burner. Take steps to find the care you need in order to go through the process of understanding and managing your OCD and ADHD. Take care to rewrite the narratives you’ve told yourself about your worthiness and your value – you are not a sum of the compulsions you’ve fought or the appointments you’ve missed. Practice self-care and invest in the support you deserve so that you can treat yourself with compassion and grace.
OCD Treatment in Woodland Hills
OCD goes beyond just hand-washing or repeatedly checking locked doors. It can manifest in relationships, while driving, or even during the postpartum period. To break free from the OCD cycle and make meaningful changes in your life, working with our OCD specialist can help. We offer in-person treatment in Woodland Hills or virtual sessions, using evidence-based approaches like ERP, CBT, ACT, and mindfulness techniques.
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