OCD vs ADHD: which is it?

OCD and ADHD are both misunderstood conditions, and many people don’t get the right diagnosis until adulthood. Sometimes, they’re confused for each other, which complicates diagnosis and treatment. It’s critical to know the similarities and differences between OCD vs ADHD so you can understand what you’re going through and get effective treatment.

Here, we provide a guide to the similarities and differences between OCD and ADHD, effective treatments for both, and how to tell the difference.

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OCD vs ADHD at a glance

OCD symptoms vs ADHD symptoms in adults: similarities

OCD is sometimes misdiagnosed as ADHD (and, less frequently, vice versa). They’re both serious neuropsychiatric conditions and share some similar symptoms that may be confused with each other.

Here are some examples of similar symptoms of OCD vs ADHD with different causes.

Both ADHD and OCD can cause anxiety

Both people with ADHD and OCD present with anxiety. Both of these conditions are difficult to live with, and a significant portion of people who have OCD and/or ADHD are also diagnosed with an anxiety disorder. 

People with OCD experience anxiety because of their obsessions, which fill them with intense fear or dread that their thoughts are (or will come) true. For example, they might become anxious that their family will be harmed because they didn’t count something the right number of times. 

People with ADHD often have anxiety because of the way their condition affects their daily lives. They might be behind on daily tasks like paying bills or have conflicts in their relationships. 

Learn more about OCD vs anxiety and ADHD vs anxiety.

People with ADHD and OCD can be easily distracted

Sometimes, OCD is misdiagnosed as ADHD because people with OCD can appear to be distracted. One of the key ADHD symptoms, particularly the inattentive type, is a lack of focus and being easily distracted. So when people with OCD have a hard time staying focused, the 2 conditions look similar. (Read more about the types of ADHD.)

But an individual with ADHD has a hard time with focus because of the way their condition affects their brain. Although people with OCD can have trouble with focus, it’s not a symptom of the condition. Usually, it’s because they’re going over obsessions in their mind or mentally performing compulsions.

Both ADHD and OCD can lead to executive functioning deficits

Both ADHD and OCD can lead to deficits in executive functioning —  a set of complex brain functions, including reasoning, problem-solving, intrinsic motivation, emotion regulation, and more. Both people with OCD and people with ADHD struggle with executive function deficits, which means they struggle with these types of tasks. OCD and ADHD affect the same area of the brain (the frontostriatal system), which may partly explain why people with either condition have a hard time.

For example, both people with OCD and those with ADHD may struggle with managing their emotions on their own. They can both have difficulties getting motivated for tasks. For people with ADHD, it can be due to ADHD paralysis. For people with OCD, it can be because they’re stuck performing compulsions. 

OCD vs ADHD in adults: differences

OCD and ADHD share some broad traits. But in actuality, they’re very different mental health conditions with unique sets of symptoms. It’s important to understand the differences between OCD and ADHD to get a proper diagnosis and proper ADHD treatment or OCD treatment.

Here are some of the major differences between OCD vs ADHD.

Obsessions vs intrusive thoughts

People with OCD or ADHD can experience intrusive thoughts. But OCD obsessions are a unique symptom that only affects people with OCD. Obsessions are unwanted, extremely upsetting thoughts that haunt the person with OCD. They tend to revolve around topics that the person finds most disgusting or taboo. 

For example, someone with OCD might have obsessions like, “What if I lost my mind and murdered my entire family?” or “What if I’m actually a pedophile without knowing it?” These thoughts are so upsetting that the person with OCD needs to perform compulsions.

Research shows that people with ADHD also have intrusive thoughts and more than “healthy” people. ADHD intrusive thoughts aren’t the same as OCD obsessions and are often linked with distractibility and excessive mind-wandering. For people with ADHD, their intrusive thoughts aren’t as obsessive. They can be about any topic and don’t tend to revolve around specific themes. They also don’t cause the same level of anxiety and dread that they do for people with OCD.

Compulsions vs fidgeting

People with ADHD or OCD can appear restless or fidgety. But the root causes behind this behavior is different for ADHD and OCD. 

People with ADHD, especially the hyperactive-impulsive type, fidget because of their restless energy. They may have a hard time staying still especially during boring or monotonous tasks, like work meetings. They fidget, for example, by tapping on surfaces or constantly rearranging things, to expend energy.

When someone with OCD is fidgeting, they may be performing a compulsion. Common OCD compulsions can include tapping a certain number of times, counting items, or rearranging things until they feel “just right.” While it may look like they’re restless, there’s much more going on underneath the surface.

Impulsivity vs risk avoidance

A major way OCD and ADHD differ is that people with ADHD struggle with impulsivity, while those with OCD experience the opposite — they’re risk-averse. 

Impulsivity is a core symptom of ADHD, especially the hyperactive-impulsive type. People with ADHD are more likely to struggle with controlling their impulses, which often causes them to engage in risk-taking behaviors like reckless driving or overspending. People with OCD are often so fearful that they’re unwilling to take any risks at all, even small ones.

Note that some experts have pointed out the similarities between ADHD impulsivity and OCD compulsions. Although they’re not the same thing, both represent an inability to stop doing a behavior you don’t want to do.

Internalizing vs externalizing

In mental health, experts often think about conditions and symptoms as internalizing or externalizing. Internalizing conditions are ones that cause the person to experience emotional distress and carry out behaviors directed toward themselves. For example, depression can cause someone to experience self-loathing and low mood. Anxiety can cause internal racing thoughts.

On the other hand, externalizing conditions are those that are primarily defined by behaviors directed outwardly. 

ADHD is considered an externalizing disorder because it causes externalized behaviors like impulsivity, hyperactivity, and restlessness. OCD is an internalizing disorder. It causes internal anguish and anxiety. And sometimes OCD compulsions aren’t visible to others.

OCD vs ADHD: neurological similarities and differences

Studies have found that neurobiologically, OCD and ADHD share some similarities but also have key differences in how they affect the brain. 

Both conditions involve the cortico-striato-thalamo-cortical (CSTC) circuit, a network responsible for managing behavior and decision-making. The CSTC circuit functions differently in people with each disorder. In OCD, it tends to be overactive. In ADHD, it’s linked to underactivity.

The chemical messengers in the brain, or neurotransmitters, also play distinct roles in each disorder. ADHD is linked to issues with dopamine, a neurotransmitter crucial for attention and motivation. OCD is more closely tied to serotonin, which helps regulate mood and anxiety. These differences are backed up by genetic studies.

The differences within the CSTC circuit and neurotransmitters explain why treatments for OCD and ADHD are so different. ADHD treatment often includes medications that target dopamine. OCD treatment often focuses on boosting serotonin (sometimes in combination with dopamine-based treatment for specific symptoms). 

Can you have OCD and ADHD at the same time?

Research shows that 12% of people with OCD are also diagnosed with ADHD. And studies have found that when someone lives with both ADHD and OCD, their symptoms are more likely to be more severe and disabling. 

If you live with both OCD and ADHD, it’s possible for the symptoms of one condition to mask the other. For example, you may have displayed externalizing ADHD symptoms from an early age, which led teachers to refer you for an ADHD diagnosis. You could have internally dealt with OCD obsessions and compulsions, but since your treatment team was so focused on managing ADHD symptoms, the signs of OCD stayed hidden until adulthood.

Diagnosing OCD vs ADHD

Whether you have OCD, ADHD, or both, a correct diagnosis is the first step toward effective treatment.

Mental health professionals use the Diagnostic Statistical Manual (DSM-V-TR) to help diagnose all psychiatric disorders, including OCD and ADHD. They might ask you questions about your experiences or observe your symptoms in session and compare your symptoms with the diagnostic criteria listed in the DSM-V-TR. In some cases, they also interview other people in your life, like your partner or family members.

There are specific diagnostic tools for each condition too. For OCD, your provider may ask you to fill out the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which is a clinical questionnaire that measures what types of OCD symptoms you experience as well as their severity. For ADHD, they may use the World Health Organization’s Adult ADHD Self-Report Scale (ASRS).

No clinical questionnaire conclusively determines whether you have OCD or ADHD. Your provider will likely use these tools in combination with other diagnostic methods, like observing your symptoms.

Treating ADHD vs OCD

ADHD treatment and OCD treatment are different, largely because of the different ways the 2 conditions affect the brain. Both can be treated with medication, therapy, or ideally, a combination of both.

The first-line treatment for ADHD is stimulant medication, including Ritalin or Adderall. But stimulants may not be the best choice for everyone, especially if you live with high blood pressure or have had an addiction to stimulant drugs. Fortunately, there are also effective non-stimulant ADHD medications available, including Strattera. (Read more about stimulants vs non-stimulants for ADHD.)

Therapy, including cognitive-behavioral therapy (CBT) and behavior coaching or training, can also be helpful for you if you have ADHD. These therapies can teach you important life skills like time management and regulating emotions. Therapy can also address feelings of depression and low self-esteem that can come with ADHD.

For OCD, the first-choice treatment is a specific type of cognitive behavioral therapy for OCD called exposure and response prevention (ERP) or simply exposure therapy. ERP challenges you to intentionally trigger obsessions while resisting the urge to perform compulsions. This gets you out of the OCD loop and lessens the power that obsessions have over you.

Medication is also used to treat OCD. Specifically, a class of antidepressant medication called selective serotonin reuptake inhibitors (SSRIs), like Zoloft, Prozac, Lexapro, and others, can help balance the parts of the brain that are affected by OCD. Other types of medications are also effective, such as Anafranil. 

Treating co-occurring ADHD and OCD

If you live with both ADHD and OCD, it’s important to get a diagnosis and treatment for both. If you address 1 condition and leave the other untreated, you can get stuck in a cycle of worsening symptoms.

Unfortunately, treatment when you have both ADHD and OCD can be complex. This is partly because stimulant medications for ADHD can sometimes make anxiety worse. So if you already live with OCD-related anxiety, a stimulant may make you feel worse.

Some treatments can work for both. For example, while SSRIs aren’t used to treat ADHD directly, it can help reduce symptoms of depression that can be associated with ADHD. In addition, there are many treatment options for ADHD that don’t impact OCD symptoms. (Read more about the connection between ADHD and depression.)

If you have both ADHD and OCD, your healthcare provider can work with you to figure out a treatment plan and prioritize treatment goals in a way that makes the most sense for your unique situation. 

Key takeaways

• ADHD and OCD are distinct conditions with unique sets of symptoms. However, they share some traits, which can sometimes lead to one being misdiagnosed for the other.
• Some similarities between ADHD and OCD include that they both lead to executive function deficits, they can both cause fidgeting behaviors, they both lead to intrusive thoughts, and they both cause anxiety and lack of focus.
• Some differences between ADHD and OCD include key differences in symptoms (like the presence of obsessions and compulsions in OCD but not in ADHD), internalizing vs externalizing symptoms, and that people with ADHD tend to be more impulsive.
• Both OCD and ADHD can be treated effectively. Treating co-occurring OCD and ADHD can be more complex, but it’s possible with the support of a qualified health provider.

Get help with ADHD and/or OCD

Navigating life with ADHD and/or OCD can be confusing and lonely. You don’t need to go through it alone. On Klarity, find an ADHD provider or an OCD provider to work with you to create a treatment plan for one or both conditions.