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What’s the Difference Between OCD and ADHD?

Mar 20, 2024 | ADHD, OCD

As we become increasingly aware as a society, understanding our mental health is more important than ever. Due to the overlap of symptoms, for many, OCD and ADHD can appear to be the same condition, and distinguishing between the two can be difficult for those unfamiliar with how these conditions arise, the cause of their symptoms, and how to address them.

While symptoms overlap, OCD is marked by unwanted repetitive thoughts and/or behaviors, whereas ADHD is characterized by inattention, or impulsivity/hyperactivity. Recognizing the differences in symptoms and their causes is crucial for effective management and improving quality of life.

The focus of this article is to demystify OCD and ADHD by exploring their unique symptoms, causes, and how they affect daily life. In doing so, this article serves as a guide to identify distinct paths to treatment and to help individuals start their journey to wellness and self-empowerment.

Understanding OCD

Obsessive-Compulsive Disorder is a mental health condition that involves unwanted thoughts (obsessions) that cause an individual’s distress, followed by repetitive behaviors or mental acts (compulsions) that an individual feels the need to perform in response to, or avoidance of, the obsession.

These obsessions and compulsions can significantly interfere with daily activities and cause considerable anxiety for those involved. For example, a person might fear germs to the extent that they ritually and persistently wash their hands or clean their surroundings.

While everyone has individual manifestations of OCD, the obsessions for those with OCD can consume hours of one’s day, impairing their ability to work, study, or interact in social settings.

OCD Causes and Risk Factors

Similar to many mental health conditions, there is no one cause for OCD, and it arises from an interaction of genetic, neurological, behavioral, cognitive, and environmental factors. In other words, its causes are complex and not necessarily pre-determined.

Genetically, OCD tends to run in families. Individuals with first-degree relatives who have OCD are at a higher risk of developing the condition, indicating some genetic predisposition. Neurology, or brain chemistry, also plays a role, with neurotransmitter imbalances such as serotonin worsening symptoms.

However, one of the most significant components is environmental factors, such as stressful life events or trauma, which can trigger or worsen OCD symptoms. Childhood trauma, in particular, has been linked to the onset of OCD in some individuals.

OCD DSM-5 Symptoms

The symptoms of OCD, particularly compulsive behaviors, primarily serve as a coping strategy to manage anxiety stemming from obsessive thoughts. Individuals with OCD typically engage in these compulsions to manage the discomfort caused by their obsessions.

For example, someone who feels that they are in constant danger or threat of harm may obsess over this and repeatedly check that all their doors are locked to help alleviate their stressful thoughts.

The action doesn’t dispel the stress but does help manage it or provide a sense of control. OCD symptoms can also arise in response to rule making. For example, a person with OCD may think that compulsive counting can prevent something bad from happening.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the presence of obsessions, compulsions, or both is essential for an OCD diagnosis. Here’s a summary of the criteria:

Obsessions are defined as recurring and persistent thoughts that are intrusive and that, in most individuals, cause heightened anxiety or distress. Individuals attempt to ignore or suppress these thoughts with another thought or action.

Compulsions are repetitive physical or mental behaviors that individuals are driven to perform in response to their obsession or according to a rigidly followed rule. These behaviors are meant to reduce stress or prevent a perceived event from happening. These can include:

- - Counting
  - Hand washing
  - Checking
  - Repeating words silently

The obsessions or compulsions are time-consuming or create an inability to function in social, work, or educational settings.

The symptoms are not attributable to another mental illness or due to medication or drugs.

For more information, please check out this informative article:
What is Rumination in OCD?

Recognizing ADHD

ADHD is a neurodevelopmental disorder that features consistent inattention and/or hyperactivity that limits or interferes with functioning and development. Neurodevelopmental refers to the fact that ADHD affects brain development across life stages.

Inattention refers to difficulty holding attention in educational tasks, chores, or play activities. Individuals will often seem not to listen when spoken to directly and may struggle to follow directions and finish necessary tasks.

Where inattention is primarily mental, hyperactivity typically manifests as physical responses to the environment. These responses can include fidgeting, being loud during leisure activities, talking excessively, or blurting out answers in classroom settings.

ADHD Causes and Risk Factors

Similarly to OCD, ADHD is influenced by a combination of genetic, environmental, and neurological factors. Unique to ADHD is that it begins early in childhood and affects children more severely than adults..

Here are the primary causes and risk factors associated with ADHD:

Genetics: ADHD tends to run in families. Research indicates that siblings and parents of those with ADHD are more likely to have the condition themselves, indicating a hereditary influence.

Brain Chemistry: Differences in neurology, or brain structure and function, have been observed in ADHD. Neuroimaging studies have shown variations in the size of the pre-frontal cortex of those with ADHD, notably in the right hemisphere, an area associated with attention and control.

Environmental Factors: Exposure to certain environmental factors during pregnancy, such as alcohol or nicotine, and other factors, such as low birthrate or premature birth, can increase the risk of developing ADHD.

- Research indicates that external environmental factors, such as diet, media attention, or parenting styles, do not cause ADHD, although some conditions can worsen symptoms.

ADHD DSM-5 Symptoms

The hallmark symptoms of ADHD are inattention and/or impulsivity-hyperactivity. However, the DSM-5 provides specific criteria for diagnosing ADHD and its severity as well as determining if another issue is present.

According to the DSM-5, these symptoms must:

Be developmentally significant (i.e., not appropriate for one’s current age).
Be present for at least six months.
Have been present before the individual was 12.
Be present in such a way that impairs daily functioning or quality of life.
Be present in multiple environments.
Not be part of another mental health condition or medication.

Individuals under 17 must have at least six symptoms of inattention, at least six symptoms of impulsivity, or a combination of both symptom types. The threshold is five symptoms for individuals over 17. An individual can be diagnosed with one of three types of ADHD:

Combined Presentation: A mix of inattentive and hyperactive-impulsive symptoms.

Predominantly Inattentive Presentation: Individuals show symptoms of:

Failing to sustain attention on schoolwork and essential tasks.

- - Not being interested in play activities.
  - Not listening when spoken to, or not making eye contact.
  - Not finishing or following instructions on school or work tasks.
  - Having difficulty sustaining mental effort.
  - Being forgetful in daily activities.

Predominantly Hyperactive-Impulsive Presentation: Individuals show symptoms of:

- Fidgeting or squirming when seated.
- Running around or climbing in inappropriate locations.
- Having difficulty playing quietly.
- Talking too much for the social context.
- Having difficulty waiting.

Key Differences Between OCD and ADHD

Due to their diverse symptoms, ADHD and OCD can overlap and appear to be similar, especially to those unfamiliar with either condition. Both conditions affect quality of life and daily functioning to a distressful degree, while avoidance of some activities and rumination on others can appear to be the same process on the surface.

For both conditions, the following symptoms may appear to be the same condition:

Issues Focusing: While ADHD is characterized by inattention, individuals with OCD might also appear distracted, not because they cannot pay attention but because they are consumed by obsessions or intrusive thoughts.

Repetitive Behaviors: Compulsions in OCD can appear to be the hyperactivity or repetitive actions seen in ADHD.

Performance: Both ADHD and OCD can lead to poor performance in academic or occupational settings, albeit for different reasons.

Avoidance: The procrastination or avoidance seen in ADHD due to difficulty starting tasks can be confused with avoidance behaviors in OCD, where an individual avoids situations that trigger them.

However, it becomes clear that the cycle of obsessions and compulsions in OCD is very different in scope from inattentive and hyperactive elements of ADHD. Where symptoms of OCD are meant to establish a sense of control and autonomy, ADHD symptoms reflect challenges in regulating attention, impulse control, and activity levels.

Another way to view this is that despite the symptoms, OCD is an internal disorder, where individuals become introspective and withdraw due to external stressors. ADHD is external, where individuals react or relate outwardly to their environment.

Below are the ways in which OCD and ADHD differ among symptoms, causes, and their impact on quality of life.

Symptoms Between Conditions

OCD symptoms stem from a profound need for certainty and safety, driving the cycle of obsessions and compulsions. Obsessions, such as intrusive thoughts, are unwanted and cause distress, driving the need for compulsive acts.

Compulsive acts neutralize the fear obsessions create. Compulsive acts can themselves intensify rather than reduce the obsessive thoughts. This cycle is not merely a habit but a legitimate attempt to regain control and alleviate the intense discomfort caused by obsessions.

On the other hand, ADHD symptoms arise from inherent difficulties in managing attention, impulses, and energy levels. The inattention seen in ADHD is a fundamental challenge in maintaining focus and organizing thoughts. Hyperactivity reflects an issue with the brain’s ability to self-regulate and is usually spontaneous rather than ritual.

For more information, please check out this informative article:

When are Attentional Problems not ADHD?

Causes Between Conditions

The origins of OCD and ADHD are complex and involve many factors, most notably genetics, environment, and neurology. However, the degree to which these factors influence onset is considerably unique.

In OCD, genetic predispositions create a vulnerability, which, when combined with specific environmental triggers, can activate the disorder.

Conversely, ADHD is deeply rooted in genetic and neurodevelopmental factors, with environmental influence playing a supporting role. The genetic link suggests a hereditary pattern, while prenatal and early-life experiences (through birth complications or drug exposure) can worsen symptoms.

The Impact on Relationships, Work, and Education

OCD compulsions, although aimed at reducing anxiety, can become time-consuming rituals that significantly disrupt daily life, relationships, and work. The issue isn’t simply managing stress; it involves an exhaustive battle for a sense of safety and normalcy, often leading to isolation.

In ADHD, the difficulty with focus or impulsivity doesn’t just affect academic or work performance; it touches every aspect of life, from maintaining relationships to self-esteem. The frustration and low self-esteem stem from a continuous struggle to meet societal expectations and feeling misunderstood or incapable despite their unique and inherent strengths.

Is it Possible to Have ADHD and OCD Simultaneously?

ADHD and OCD are two of the most common mental health disorders in the U.S., especially among children. Because of their relative occurrence, it is not uncommon for individuals to be diagnosed with ADHD and OCD comorbidity (simultaneously diagnosis).

According to a study published in the Frontiers in Psychiatry Journal, the prevalence of OCD-ADHD comorbidity is about 12% for adults and over 25% for children with OCD, or 1 in 8 adults and 1 in 4 children with OCD.

However, other studies have noted the inconsistency in testing methods and how diagnoses were made, positing that the above rates may be somewhat high, as ADHD can be misdiagnosed as OCD and vice versa.

There is also an almost double rate of comorbidity in children as adults. This prevalence can partly be explained by children showing more apparent symptoms than adults of the same condition(s).

Nevertheless, while it’s possible to have ADHD and OCD concurrently, the diagnosis must be made with a complete understanding of an individual’s condition, symptoms, and background to adequately assess an individual’s progress in their current journey to mental wellness.

For more information, please check out this informative video:

How do I know if I have ADHD? What if I also have symptoms of anxiety and/or depression?

The Importance of Tailored Therapy for Managing Mental Health

Given the complexities and overlapping symptoms of ADHD and OCD, especially in children who may show more pronounced behaviors, the importance of obtaining a professional diagnosis is crucial. Mental health professionals, through comprehensive evaluations and the most updated criteria, can discern the nuances between conditions.

A professional diagnosis is the first step for tailored treatment plans, whether you’re managing OCD, ADHD, or both. Further, due to the spectrum of ways each condition manifests, a personalized approach ensures you get the best help you need for your specific situation.

Treatment Options

Both OCD and ADHD require distinct approaches that address the root causes of these disorders while personalizing the therapy for an individual’s unique context and life experience. While both are different in approach, the aim of treatment and counseling is always to improve daily functioning and quality of life for those affected.

In both cases, behavioral therapy, particularly cognitive-behavioral therapy (CBT), can be a highly effective option. CBT, in the broadest sense, involves challenging negative thought patterns and replacing them with new, more constructive patterns.

However, CBT is not a standard or fixed type of treatment, and in every case, it is specifically tailored to the individual’s current mental health landscape while focusing on changing current thought patterns in a productive and empowering way.

Treatment Options for OCD

For OCD, treatment focuses on managing the cycle of obsessions and compulsions through behavioral therapy, particularly exposure and response therapy. Some medications, such as SSRIs, may be prescribed to help manage anxiety.

Overall, some of the best treatment options for OCD include:

Exposure and Response Therapy (ERP): ERP involves exposing an individual to the source of their anxiety and then helping them learn not to perform their usual compulsion in response. Over time, this reduces the anxiety of the obsession by normalizing the trigger.

Mindfulness-based CBT: A subset of CBT, mindfulness-based CBT involves becoming comfortable with and accepting intrusive or unwanted thoughts and learning to deal with obsessions in a healthy way. It is not as direct as ERP but challenges the same thought processes that are at the root of OCD.

Short-Term Psychodynamic Therapy (STPP): STPP is a novel approach to psychodynamic therapy that uses psychoanalysis to get to the heart of an individual’s obsessions and compulsions. It focuses on distressing thoughts or feelings that interfere with daily functioning and addressing those thoughts constructively.

Treatment Options for ADHD

ADHD treatment emphasizes improving attention, reducing impulsivity, and enhancing executive functioning. This treatment typically involves a combination of medication and behavioral therapies designed to develop organizational skills and challenge negative thought patterns.

Some of the best treatment options for ADHD include:

Cognitive Behavioral Therapy: CBT for ADHD involves strategies to help manage troubling or inappropriate behaviors and thought patterns. Techniques often involve behavior modification, positive reinforcement, and social skills training.

Medication: Medications may be prescribed to help manage the symptoms of ADHD in the context of therapy, where individuals learn strategies to relearn or modify their current behaviors. These medications help improve attention and focus while reducing hyperactivity.

Family Therapy: Since ADHD often affects family dynamics, family therapy can be beneficial to establish expectations and set up strategies to support a loved one with ADHD. These strategies help improve communication and reduce stress within a household.

Lifestyle Modification: While not a replacement for medical treatments, regular physical exercise, a healthy diet, adequate sleep, and mindfulness practices can all help manage symptoms.

Begin Your Journey to a Better You With Start My Wellness

As we explore the unique challenges and treatment options for OCD and ADHD, the following becomes apparent and crucial:

Understanding OCD and ADHD is essential for correct diagnosis and treatment.
A tailored therapeutic approach is necessary to address the specific disorder, additional subtypes of that disorder, and the individual’s current mental landscape.
Individuals can receive an appropriate diagnosis and treatment with qualified, compassionate, and experienced mental health professionals.

At Start My Wellness, we are committed to supporting you through every step of your journey, offering personalized treatment options and expert care tailored to your needs. Whether you’re dealing with OCD, ADHD, or both, our team of experienced therapists is here to help you navigate the path to better mental health and a more fulfilling life.

Embrace your journey with Start My Wellness. Call us at 248-514-4955 or meet our therapists to begin your path to empowerment and better mental health.

Sources

Author: Anton Babushkin, PhD

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