ADHD and OCD
Recent studies estimate that approximately 30 percent of patients with OCD (Obsessive Compulsive Disorder) also have ADHD. Unlike ADHD, which is characterized by problems with attention, executive functioning and emotional dysregulation, OCD is characterized by persistent thoughts, impulses, or images that cause distress and anxiety as well as repetitive physical behaviors and / or mental acts. These are constant for sufferers and can significantly interfere with their in their lives.
With OCD, the person feels compelled to engage in the compulsive behavior to undo, neutralize or cope with the obsession. However, the compulsive behavior may have nothing to do with the actual obsession.
ADHD and OCD share a genetic connection. Brain scans show that ADHD and OCD both produce atypical activity in the same neural pathway in the brain—the frontostriatal area. This circuit is involved with a number of important cognitive and behavioral abilities such as:
- attention-shifting
- flexibility
- habits
- goal-directed behaviors
When an individual has both ADHD and OCD, it is common that one disorder is diagnosed while the other goes undiagnosed due to the similarities in som of the symptoms they share. Having both disorders is associated with more severe symptoms of both than having either alone.
How OCD and ADHD Interact
Having both disorders is associated with more severe symptoms of each than having either alone.
The two disorders can feed off each other. For example, a student could be in class and getting bored and distractible (ADHD) and then find themselves gravitating to an OCD ritual (like saying words silently in the middle of a class).
The symptoms of one disorder may dominate, but then, once those decrease, the other disorder takes over. For instance, someone may be working on impulsive spending (ADHD), and when they find themselves successfully managing the impulsivity, they lapse into more compulsive thinking (OCD).
The challenge for clinicians or therapists working with the sufferer is being able to distinguish which diagnosis is essentially in control and tailoring interventions to that diagnosis. Managing the two conditions takes an understanding of each condition and how they present when active at the same time.
Treating Both Conditions Together
There are several recommended modalaities of treatments for co-occurring ADHD and OCD.
- ERP Therapy – Exposure plus response prevention (ERP) includes confronting the thought, image, object, or situation that makes an individuals with OCD anxious. ERP will also include confronting an exaggerated symptom of OCD. The goal is to habituate the sufferer to the cause of their anxiety.
- Medication – Medication is highly effective for treating OCD. The most common class of effective medications are antidepressants known as selective serotonin reuptake inhibitors (SSRIs). They can help by boosting serotonin levels in the brain. However, while OCD medications do not make ADHD symptoms worse, stimulant medication used to treat ADHD can sometimes make OCD worse. Patients with ADHD and OCD sometimes find that stimulants enable them to focus more on their obsessions.
- Psychotherapy – Psychotherapy can also be helpful in discussing issues related to OCD, such as shame and self-esteem issues. Couples or family therapy is also recommended, as OCD impacts loved ones as well.
Living with OCD and ADHD together can be challenging. But there are effective treatments to manage both so you can enjoy a better quality of life.
References
- https://www.psychologytoday.com/us/blog/child-development-central/202201/living-both-adhd-and-ocd
- https://www.additudemag.com/ocd-and-adhd-are-the-polar-opposites-that-are-not/
- https://www.healthline.com/health/mental-health/adhd-and-ocd
- https://impulsetherapy.com/ocd-and-adhd-the-relationship-between-them/