OCD vs. ADHD: How They Compare

Attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are both conditions that can make it difficult for people to pay attention, hindering the ability to function at school or work.

ADHD and OCD affect similar parts of the brain: Both conditions may cause a person to take a long time to get things done, or they may cause difficulty in relationships with others. However, there are also key differences between the two conditions. For example, people with ADHD tend to be impulsive, while people with OCD are more likely to avoid risk-taking behavior. ADHD is also much more common, especially in children. 

In some people, symptoms of OCD can overlap with the symptoms of ADHD. Here’s what you should know about ADHD, OCD, and whether the conditions can occur together. 

Symptoms of OCD vs. ADHD

People with OCD and ADHD may share some of the same challenges. For example, difficulty paying attention is a key symptom of ADHD, but a person with OCD may also have trouble paying attention when they become distracted by obsessive thoughts and compulsions.

Impulsive behavior is another key symptom of ADHD; people with OCD also behave impulsively when they engage in the repetitive behaviors that are a hallmark symptom of their condition. However, the reasons for this behavior are very different than the reasons why people with ADHD behave impulsively.

OCD Symptoms

• Obsessions, or unwanted thoughts and urges that cause distress. Examples include fear of germs, fear of leaving something unlocked, unwanted thoughts about sex, etc.
• Compulsions, or repetitive behaviors that you do to help ease your obsessive thoughts. This could include repeatedly checking things, excessive handwashing, arranging things in a precise way, etc.

ADHD Symptoms

• Trouble staying focused can cause a person with ADHD to have difficulty paying attention, poor attention to detail, and problems keeping track of important items.
• Impulsivity can cause risk-taking behavior, trouble staying in one place, blurting or talking too much.

Attention Deficit Hyperactivity Disorder

ADHD is a neurodevelopmental disorder that, by some estimates, affects about 11% of school-age children and about 4% of adults. The symptoms of ADHD can present in different ways, depending sometimes on a person’s sex or age.

The symptoms usually fall into these three categories:

• Inattention: Trouble staying focused and organized
• Hyperactivity: Talking or moving constantly
• Impulsivity: Trouble with self-control

These can present as common symptoms, including: 

• Forgetfulness and disorganization
• Trouble focusing or completing a task
• Avoiding tasks that are tedious or challenging
• Fidgeting or restlessness
• Trouble getting along with others 

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a chronic mental health illness in which intrusive, recurring thoughts (obsessions) and behaviors (compulsions) are repeated over and over again, to the point that they interfere with a person’s functioning.

OCD occurs in 2.3% of people. Although it’s most often diagnosed in adulthood, research indicates that OCD can occur in a small percentage of children as well.

OCD revolves around two primary categories of symptoms:

• Obsessions manifest as repeated thoughts, urges, or mental images that are involuntary, disturbing, and anxiety-inducing. 
• Compulsions are repetitive behaviors that are done in response to or in hopes of controlling an obsession.

These core symptoms can manifest in common symptoms of OCD, including:

• Fear of contamination resulting in frequent washing
• A need for order and an inability to move on until items are perfectly ordered
• Aggressive thoughts toward self or others

OCD and ADHD Similarities

At first glance, OCD and ADHD appear to be very different. However, they have several commonalities, which can make it difficult to get a proper diagnosis. 

Affected Regions of the Brain

People with OCD and patients with ADHD both experience abnormalities in the brain's frontostriatal circuits, the neural pathways that connect the frontal lobes of the brain with the ganglia.

A 2020 study found that ADHD was associated with a reduced brain volume in these areas. A 2017 study found that people with OCD had functionally abnormal connections in the frontostriatal circuits compared to healthy individuals.

Potential for Interfering With School and Work

ADHD and OCD both make it difficult for people to complete a task. People with ADHD might not have the ability to focus on a task until completion, while people with OCD have their focus continually interrupted by obsessive thoughts and compulsions.

Because of these difficulties regulating attention, people with OCD and ADHD often struggle to reach their full potential at school and work. This is not due to their cognitive abilities, but due to the symptoms of their disorder.

Relationships With Others

ADHD and OCD both can complicate relationships with others. Symptoms of ADHD, including lack of impulse control and insistent talking, can make friendships difficult for kids and adults. For people with OCD, the time that is dedicated to certain obsessions and compulsions can make relationships difficult, particularly if the obsessions they are experiencing are violent or sexual. 

Development of Other Disorders

People with ADHD or OCD are at an increased risk for developing other disorders or health conditions, including:

• Depression: A significant percentage of people with ADHD will experience symptoms of depression during their lifetime. People with OCD are also at increased risk of depression, especially right after OCD symptoms begin.
• Sleep disorders: Between 25% and 50% of people with ADHD are estimated to also have sleep problems. It is quite frequent for people with OCD to also have insomnia.
• Gastrointestinal (GI) disorders: People with ADHD are more likely to have gastrointestinal disorders. People with OCD are at higher risk for irritable bowel syndrome (IBS, disorder of the large intestine) and often experience more severe symptoms than those without OCD.

Risk factors

OCD and ADHD share risk factors, including:

• Genetics: Both conditions tend to run in families.
• Stress: Feeling under stress can make the conditions of both disorders worse.
• Trauma: Experiencing trauma, especially in childhood, raises the risk for both conditions and can make symptoms worse.

OCD and ADHD Differences

Although OCD and ADHD can have some similar effects on a person’s life, they are very different disorders. One distinguishing difference between OCD and ADHD is risk tolerance. People with OCD tend to avoid risk and strive to be in control, whereas people with ADHD tend to be impulsive. 

These opposite effects are seen in the brains of people with OCD and ADHD. People with OCD have more activity in the affected frontostriatal area, whereas people with ADHD have less.

OCD is generally considered an internalizing disorder, which means that the symptoms cause internal stress. ADHD is often considered an externalizing disorder, which means that the symptoms impact how a person interacts with their environment. 

Finally, about 40% of kids with ADHD will outgrow the condition by the time they reach adulthood, whereas people with OCD will often have to manage the condition throughout their lives.

Treating OCD vs. ADHD

Both OCD and ADHD are chronic conditions that can be treated with behavioral and medical interventions. The conditions are treated differently so it's important to see your healthcare provider to ensure you get an accurate diagnosis.

Treatment for ADHD typically includes behavioral modifications based on symptoms, therapy, and prescription medications. For children with ADHD, behavioral therapy may include classroom interventions, education for parents and teachers, and developing strategies for staying organized and completing tasks. Medications may be stimulant or non-stimulant, though stimulant drugs are used more often because they tend to be more effective.

For people with OCD, cognitive behavioral therapy (CBT) can be an effective way to help a person understand their behavior and develop strategies for coping with obsessive thoughts and compulsions. People with OCD may also be prescribed antidepressants or other medication to help alleviate symptoms.

Outlook for OCD vs. ADHD

Some children with ADHD may outgrow their symptoms over time, but for many people, ADHD is a lifelong condition. Similarly, a child with OCD may outgrow their symptoms, however, OCD can also be a lifelong condition. 

Fortunately, both ADHD and OCD are manageable conditions. With the right treatment and support, most people with these conditions can go on to lead normal, productive lives.

Can OCD and ADHD Co-Occur?

A person can have OCD and ADHD at the same time. One study found that around 12% of those with OCD also have ADHD. The incidence is even higher in children with OCD; around 25.5% of pediatric OCD patients also have ADHD.

However, because some people with OCD have symptoms—like inattention—that might be misdiagnosed as ADHD, a 2017 study recommended that healthcare providers treat OCD first, then address symptoms of ADHD in individuals who present with symptoms of both conditions.

Someone with both ADHD and OCD will likely need treatment for both conditions. However, having one condition can complicate treating the other. For example, people with OCD often live by rigid routines, which can be hard for people with ADHD to maintain. Additionally, stimulants can sometimes make symptoms of OCD worse. This includes amphetamines, a class of medications that are often used to treat ADHD.

If you suspect that you or a loved one is dealing with both ADHD and OCD, talk with a trusted healthcare professional who is experienced in treating co-occurring mental health disorders. Research in this area is constantly changing, as are treatment recommendations. Your healthcare provider will help develop a plan that is specific to you.

Summary

ADHD and OCD are two different conditions that can present with some similarities. Both may trigger an inability to focus or sit still or trouble getting along with others. However, there are key differences, including how each condition affects brain activity and how their symptoms and behaviors present. It's important to see a healthcare provider for an accurate diagnosis.