OCD and ADHD

girl with paper

One of my most controversial posts, written almost two-and-a-half years ago, talks about the connection, or lack thereof, between obsessive-compulsive disorder and attention deficit (hyperactivity) disorder. To me, these disorders have always seemed to be the complete opposite of each other. When my son Dan’s OCD was severe, both his therapist and psychiatrist felt he might also be dealing with ADHD. The reason?  He was disorganized, had trouble focusing in class, and frequently misplaced things. I suggested these symptoms were all by-products of Dan having to deal with severe OCD. I was given a patronizing look from both of them, implying I should stop being in denial over my son’s newly acquired disorder. Dan was then prescribed Vyvanse with disastrous consequences.

I just came across this article, which discusses a recent study conducted at Harvard Medical School. Researchers examined the possible connection between OCD and ADHD. Dr. Amitai Abramovitch of the department of psychiatry says,

“We believe that there is a growing convergence of evidence that may, at least in some cases, challenge the diagnostic validity of OCD and ADHD comorbidity.”

The article goes on to say:

Making a clear distinction between the two disorders is crucial because stimulant medication given to treat ADHD is known to exacerbate OCD symptoms and has even been reported to induce full-blown OCD, the researchers noted in the second of two papers they have written on the topic (J. Obsessive Compuls. Relat. Disord. 2013;2:53-61).

And finally:

The authors conclude that “clinicians ought to pay careful consideration to OCD symptoms in the diagnostic process of individuals suspected of having ADHD, and be mindful that [obsessive-compulsive] symptomatology has the possibility to manifest through ADHD-like symptoms,” the investigators said.

I highly recommend reading the article, which supports everything I discuss in this PsychCentral article. To me, this validation of my beliefs once again brings to light one of the most important lessons I learned during my son’s journey through severe OCD. The thoughts, feelings, and opinions of  parents (and other loved ones) should always be considered and taken seriously when dealing with OCD, or any health issue for that matter. Because nobody knows or cares about our children as much as we do.

 

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14 Responses to OCD and ADHD

  1. Angie says:

    “The thoughts, feelings, and opinions of  parents (and other loved ones) should always be considered and taken seriously when dealing with OCD, or any health issue for that matter. Because nobody knows or cares about our children as much as we do.”.

    I could not agree more! And would also like to add that this love and concern for our children does not end at age 18, so neither should our rights to be included in their care (especially since the parents are paying the doctors).

  2. This is a very interesting and helpful post, Janet. I have wondered in the past if I had ADHD, but I’ve done no research on it. So I didn’t even know about the controversy over possible comorbidity. Sometimes I have a difficult time focusing, misplace things, and am just generally absentminded. But I agree that those same symptoms can be indicative of the effects of OCD. If I’m thinking about whether or not I turned off the light in the bathroom, I’m not paying close attention to what the person talking to me is saying. And I’ve got so many more examples like that–my mind is caught up in OCD activities, not on what’s going on before me. I wonder if I was a child today and displayed the symptoms I had when I was a child in school (in 7th grade especially–delaying my schoolwork, reading assignments slowly, etc.) if I wouldn’t be diagnosed with ADHD BECAUSE I would be too afraid to speak up about the obsessions I was having and the compulsions driven by those obsessions.

    • Thanks for your thoughtful comment, Tina. I think you bring up an excellent point. How many children are diagnosed with ADHD because they are too afraid to speak up about their (possible) OCD symptoms? This is definitely something diagnosticians should be aware of so they can ask appropriate questions……..

  3. The Hook says:

    I’ll check it out as soon as I can.
    Thanks again for enlightening me.

  4. Buzz says:

    Of course if you compare people with ADHD only to people with OCD only, they’re going to have different results. And everyone already knows that ADHD can mimic SEVERAL anxiety disorders, and vice versa, and that *mono-diagnosis* ADHD and *mono-diagnosis* OCD have some opposing neurological correlates.

    Why not finally do the obvious, and study the brains they’re actually making suggestions about, i.e. those who meet diagnostic criteria for both conditions? If someone would think to study them DIRECTLY instead of extrapolating from the results of two DIFFERENT sets of patients, we could find out if their brains have all the hallmarks of one, the other, some of both, OR something else altogether. In fact, if any researchers are reading, have a free hypothesis on me: maybe underactive regions of the brain in ADHD are only under-active in specific circuits, and those same regions are over-active in OCD again, only in specific, different circuits. Brain imaging is a blunt measurement tool, and with the current data, claiming that they can’t possibly co-exist is like saying ADHD can’t be caused by a insufficient dopamine availability because it doesn’t share all the symptoms of Parkinson’s Disease.

    Luckily, there are at least *heredity* studies that have bothered to include people who actually have the dual diagnosis they’re interested in, instead of deliberately excluding them. There is at least one more I can remember reading about, but the only one I can find right now is that below. Both conclude there is probably a “unique familial subtype” for the comorbidity.

    http://www.ncbi.nlm.nih.gov/pubmed/17241617

    I have both OCD and ADHD (inattentive subtype, which despite the ignorant quote from the article, is just as much ADHD as the hyperactive/combined subtypes he describes, and often involves being OVER-inhibited and anxious, as OCD patients are). The OCD is episodic, and tellingly, when it periodically sods off back to whichever hell dimension it came from, the ADD does not follow. When I “forget” to obsess during a bad spell, even in those carefree minutes, my attention is as dysregulated as ever. Think of my mind as the manic little bee musically depicted in “Flight of the Bumblebee”. Now imagine that at certain times of year it finds itself careering into fly paper everyday.

    I take methylphenidate most days, and it makes me LESS likely to get stuck on the compulsive answer-seeking that characterises my OCD these days. When I’ve taken methylphenidate, provided I can get started on something important before it kicks in, the mind doesn’t wander to the questions that fill me with dread as much, and when it DOES, the reaction the thoughts is different. It makes me so much more objective and productive, and temporarily less emotional in certain ways, that when the OCD isn’t in a more severe phase, the thoughts just make me impatient because they seem like wastes of time. I’m not the only person on ADD medication who says it has a positive effect on their OCD, either. In fact when I sought medication for OCD, because it was making me suicidal, at first I kept being told I should try taking MORE of my methylphenidate, so well-established is it that people with ADD become less anxiously obsessive when they take them.

    It makes all the sense in the world that executive function-enhancing drugs would help some people’s OCD, when you know that on average, a certain type of problem with attentional control and prioritising and remembering the priority/dismissal given to thoughts/activities, is a risk factor for OCD, for perhaps obvious reasons. It’s probably not a contributing factor to every sufferer’s OCD, but enough of them to make a difference to the group average.

    • Hi Buzz, Thank you for your insights and the link to that study. I think you bring up some great points and I hope research continues on both of these disorders, together and separately. I appreciate your sharing.

  5. matt says:

    I’m intrigued if anyone can enlighten me, I’m a pure-o variant OCD sufferer and believe I suffer with some sort of ADHD primarily because I suffer from attention deficit and Hyperfocus.

    Is there under any circumstances a scenario where OCD would cause Hyperfocus? I don’t use Hyperfocus for avoidance I simply become completely absorbed in the subject/topic I’m studying at that present moment.

    I suffer from social anxiety too which makes things completely incomprehensible to me: OCD, Social anxiety and ADHD surely can’t all co-exist!?!

    • Hi Matt, Thanks for commenting. I am not a therapist and would never attempt to diagnose you, but I can share our family’s experiences. Dan also would hyperfocus at times, especially with his schoolwork, often getting absorbed in the small details instead of the “big picture.” When his OCD was severe, he also had social anxiety, and isolated himself from his friends. If you undergo successful therapy for your OCD, you will see whether your other issues improve. That’s certainly the route we would take if faced with that situation again. Wishing you all the best.

  6. Katy Rollins says:

    Just to add to what Buzz posted – there are people with ADHD who exhibit behavior that looks like OCD. It sometimes looks like trying to make things perfect…to make up for difficulty with organization. It sometimes looks like “checking” things over and over to make sure they haven’t been overlooked. Classic overcompensation. Just putting that out there.

    I am a person with an ADHD and anxiety disorder diagnosis…and, like Buzz, my anxiety is generally lessened by taking stimulant medication. I currently take Vyvanse but have also tried others. In the past, I have had many episodes that look like OCD, especially when I was younger (obsessive worrying, handwashing, other little rituals, unrealistic perfectionism). Did I have OCD? Maybe. Some of these lines are little fuzzy at this point in history, of course. All I know for sure is that ADHD makes sense as a diagnosis for me, because the treatment helps me to feel better – and positively impacts my anxiety issues.

    • Hi Katy, Thanks for sharing. I think you hit the nail on the head with your last sentence: “ADHD makes sense as a diagnosis for me, because the treatment helps me to feel better – and positively impacts my anxiety issues.”
      It’s hard to argue with success and I wouldn’t want to :)! I’m glad you found what works for you and wish you all the best!

  7. Alexis says:

    When I was 17, I was finally diagnosed with OCD and generalized anxiety (which had been going on all of my life). I had many obsessions about the world ending, fears that I would kill myself (even though I was not suicidal), being worried about all of the unknowns in the world, fears that when I hit a bump while driving that I hit a child, and various checking worries. I always compulsively checked locks for minutes straight and I still compulsively ask for reassurance.

    Just recently, at the age of 20, I was diagnosed with depression and ADHD. I’d been having an extremely rough semester in a top ranked STEM field where depression, anxiety, and horrible focus plagued daily life. I graduated as the valedictorian in my high school and made the honor roll every semester in college prior.

    So the first question is, how can someone with OCD have ADHD? Well I certainly am not the standard model for ADHD. I clearly showed DSM recognized obsession and compulsions. Similarly, I experience nearly every inattentive and hyperactive symptom of ADHD as recognized by the DSM.

    For example, I often fail to pay attention to details and make careless mistakes, but I am also meticulous in my work. I am a perfectionist and always have been. Ever since I started school, I had to have every assignment perfect, and I took all the time needed to make it perfect. I perfect things that are important to me. But I’ve always made careless mistakes while doing chores and things that I didn’t care for. I also have to constantly set up reminders for small tasks.

    In the classroom, I was always a model student. I obsessed over being perfect, so instead of being disruptive in class, I fidget constantly by thumping my leg or twirling a pencil. When I got home, I was excessively talkative and hyperactive.

    Even though I needed to have my work perfect, I’ve always had a difficult time learning in class. In lectures I get distracted by flickering lights and realize later that I’ve missed a bunch of information. Or I’ll try my best to listen, but I feel as if there’s a fog blocking the information from getting to me. So, I spend a lot of time outside of class learning. I do whatever I can to learn the material I need, but it takes me much longer than my fellow students to do it all. I have a very particular way of learning and it doesn’t include lectures and textbooks.

    Throughout the years, it seems to me that my OCD and ADHD have masked each other. I’ve noticed that when my overall anxieties and OCD is under control, I’ve had a MORE difficult time studying. It’s common for people with ADHD to work BEST under anxiety because your body is in fight or flight mode and releases dopamine. ADHD is often thought of as being caused by a lack of dopamine. Maybe there is a connection.

    I used to only be on an SSRI and now I am on an SNRI and a stimulant. I’ve noticed that my anxiety has reduced dramatically. I have the ability to actually sort through my thoughts and am more successful at redirecting my thoughts to reduce my anxiety. The first time I took the stimulant, it had felt as if I had put glasses on for the first time. My overall quality of life has dramatically increased and everyday tasks have gotten easier.

    While ADHD and OCD are sometimes seen as complete opposites, my experience has shown me that they can be comorbid. Clearly, the dual diagnosis for your son was incorrect and only had a negative impact on his life. However, having the dual diagnosis has made a positive impact on my life.

    • Hi Alexis, Thank you so much for sharing your story. You sound as if you have a lot of insight into your OCD and ADHD which is great. I’m so glad you have found what works for you and that things are going much better for you. You have been through a lot! I wish you all the best and hope to hear from you again,

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