On the surface, ADHD and OCD are seemingly impossible bedfellows. “Messy,” “hyperactive,” and “scatterbrained” are just a few common synonyms for the former, while the latter is frequently associated with being exceedingly clean, uptight, and meticulous. (While some of these assumptions about these disorders are accurate for some people, they cannot be generalized or applied to everyone.)
Yet, that’s precisely the combination I have. Research shows that up to 30% of people with ADHD also have OCD.
In my reality, ADHD and OCD are codependent frenemies that sometimes help balance each other, even as they egg on one another.
My OCD diagnosis came first, and it never quite felt like the whole picture. I had trouble focusing, which is a common struggle in OCD that stems from difficulty managing compulsive symptoms. Still, it didn’t explain the day-to-day distractibility I experienced. It also didn’t explain my childhood issues with school or my impulsivity. When my psychiatrist added the ADHD diagnosis, it all suddenly made sense.
OCD and ADHD both think they are helpful. ADHD knows you need more dopamine, but it fails to differentiate between healthy and unhealthy sources. OCD wants to relieve anxiety; it just tends to do so in maladaptive ways.
Converse to its stereotype, ADHD also brings hyperfocus – a curious combination with OCD, as “obsessive” is right in the name. For ADHD brains, obsessions are a way to get the stimulation your brain thinks it needs. For OCD, obsessions are a catalyst for the compulsion part of the disorder. The two frequently exacerbate each other for me; this was especially true before I understood that I have both.
The interplay might go something like this: I have an obsessive thought that creates anxiety. So I perform a compulsive action or thought to make it better. Making it better gives relief, and relief makes dopamine. Therefore, the compulsion not only relieves the anxiety temporarily but also activates my brain. Trying to avoid a compulsion, on the other hand, produces a hefty dose of adrenaline while dopamine and serotonin perform an endless dance in my brain.
OCD exploits the poor impulse control of ADHD. It is so much easier to “give in” to a compulsion for that quick relief.
As a kid, ADHD contributed to feelings of shame. I felt like I was lazy and could not do anything right. I felt like a failure and understood that I was not “living up to my potential.” OCD feeds on shame; its what-ifs led me farther into this spiral. What if my obsessions and intrusive thoughts meant that I was a terrible person? And what if, as a horrible person, I was truly lazy?
While “I have OCD” is accurate, it doesn’t mean that the disorder rules everything that I think about and do. For instance, I am not neat and orderly, and germs don’t bother me beyond what feels rational. Those aren’t my particular flavors of OCD. So while it’s true that OCD and ADHD have functional and physiological differences, there is room in my brain for both.
OCD tends to resemble a game of whack-a-mole, with new worries and obsessions popping up just as others begin to feel manageable. ADHD means I can always find new ideas to turn into intrusive thoughts.
Uncertainty fuels OCD, and ADHD produces a lot of uncertainty. For example, it’s challenging to reassure yourself that you locked the car when you have forgotten to do so many times before.
However, I suspect ADHD works to keep OCD in check in some ways. For example, people with comorbid ADHD and OCD are more likely to experience mainly thought-based compulsions, which I find less disruptive than any physical compulsions I experience. Sometimes, the distractability of ADHD smooths the roughest edges of my OCD.
I also think ADHD makes OCD therapy more successful for me. Having a breakthrough, figuring something out, and relieving shame all bring the jolt of dopamine my brain craves. So, in some ways, their coexistence led me to more effective treatment.
It would be great if neurodivergence and symptoms of mental conditions could fit nicely into individual columns. If only we could say, “this compulsion clangs around in the OCD bucket,” “that quirk lines the bottom of the ADHD basket,” and “that neurosis fits in the wider anxiety container.” But it’s rarely that easy. While OCD and ADHD are opposites in some ways, they are also too intertwined to tease apart.
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