ADHD vs. OCD: What's the Difference?

Key Differences

The primary difference between OCD vs ADHD is that someone with OCD typically lives with repetitive obsessive thoughts (obsessions) that they try to stop by engaging in ritualistic compulsive behaviors (compulsions). People with ADHD typically experience disruptive behavior such as hyperactivity, disorganization, and an inability to stay on topic or task.

Symptoms

Do I have OCD or ADHD? The core symptoms of OCD and ADHD are marked.

ADHD

According to the National Institute of Mental Health (NIMH), ADHD is an externalizing condition, meaning it affects how people relate to their environments outwardly. It can present with impulsivity, hyperactivity, and/or inattention. You may experience any of these traits, or a combination of some or all of them.

Some examples of ADHD inattention behaviors include:

• Seeming to not listen when others are speaking
• Being careless and lacking attention to detail
• Poor time management skills
• Inability to complete tasks
• Poor organizational skills
• Frequently losing things
• Losing focus easily
• Being forgetful

People with ADHD may also display impulsivity and hyperactivity symptoms including:

• Fidgeting
• Having difficulty waiting to speak during conversations
• Making excessive noises
• Lacking patience
• Having a tough time waiting for the proper time to act during group activities

OCD

In comparison, OCD is an internalizing condition, which means people who live with it respond to their anxiety by turning inside themselves. OCD symptoms include unwanted repetitive thoughts and corresponding repeated behaviors. The actions are performed in hopes of stopping their unwanted thoughts. However, some people with OCD have only repetitive thoughts (obsessions) or redundant behaviors (compulsion).

Some examples of the obsessive symptoms that are typical of OCD include:

• Fearing causing harm to yourself or others
• Fearing contamination, infection, or disease
• Fearing that you’ll misplace or lose something
• Being excessively concerned about order and exactness
• Having unwanted repetitive thoughts about sex or religion
• Having repetitive thoughts of violence towards oneself or others

Some examples of compulsive behaviors that people with OCD might respond to anxiety with include:

• Repetitively arranging things in a very specific way
• Cleaning your environment or yourself excessively
• Routinely and compulsively counting
• Verbally or mentally repeating numbers or phrases
• Repetitive body scanning
• Repetitively checking that doors are locked, appliances are shut off, alarms are on, etc.

Causes

ADHD vs OCD causes might seem similar, but scientists aren’t currently sure of the exact origin of either of these mental health conditions. In both cases, there appears to be some type of genetic predisposition.

Norepinephrine, dopamine, and serotonin are all neurotransmitters, which are chemical messengers that send and receive information. According to the International OCD Foundation (IOCDF), OCD and ADHD are both likely caused by inefficiencies in the frontal lobe of the brain. However, ADHD is believed to be the result of too little norepinephrine and dopamine, while OCD is believed to result from having too much serotonin.

According to the National Health Service (NHS), specific areas of the brain have shown up smaller or larger than normal on brain scans. It’s also been noted that people living with ADHD might have brains with imbalanced levels of neurotransmitters.

Treatment

ADHD and OCD treatment typically involve a combination of prescription medication and psychotherapy (also commonly referred to as talk therapy).

Medications

Medication used to treat ADHD:

• Long-acting stimulants (both methylphenidate and amphetamine)
• Short-acting or immediate-release stimulants (both methylphenidate and amphetamine)
• Non-stimulants
• Antidepressants

Common OCD medications:

• SSRIs
• Tricyclic antidepressants (TCAs)
• Benzodiazepines

Since prescription medications are associated with possible adverse side effects and may have low success rates, sometimes people are reluctant to use them — or to allow their children to take them. Fortunately, routine sessions with a therapist are proven beneficial in helping people with a variety of mental health conditions— including OCD or ADHD — experience decreased symptom frequency and intensity.

Therapy

Cognitive behavioral therapy (CBT) is another first-line treatment for both OCD and ADHD. This type of psychotherapy teaches you how to stay better connected with your thoughts and feelings. It focuses on learning how to avoid negative behaviors you might have used in the past for coping with many symptoms of your disorder.

• CBT for OCD: CBT can help people with OCD anticipate and recognize developing thoughts so they can intentionally avoid engaging in negative behaviors.
• CBT for ADHD: In the same manner, but with a different result, CBT can help people with ADHD learn how to slow down, witness their thoughts, choose their words, exercise patience, be a good listener, and generally fit better into social situations.

Mindfulness-based CBT is particularly useful for people with OCD, ADHD, bipolar disorder, major depressive disorder, generalized anxiety disorder, and other similar mental health conditions. All these disorders can benefit from closer attention to thoughts and better decisions about behaviors.

Doctors of young children with either (or both) of these mental health conditions might recommend that caregivers undergo behavior management training, which allows them to parent a child with ADHD and work with their children’s essential skill sets more effectively.

During school, ADHD or OCD in children requires special accommodations, including group interventions that focus on proper interactions with others.

Why the Two Are Commonly Misdiagnosed

It can sometimes be challenging to spot the difference between OCD and ADHD. There are similarities and overlaps that must be considered and ruled out to accurately diagnose either condition. Of course, there are some people who have both ADHD and OCD, making the diagnosis more challenging still.

ADHD and OCD can be confused in particular with children who actually have OCD, but present with symptoms of ADHD. For example, OCD can cause an intense need for checking and rechecking, arranging supplies, and ordering things. This behavior might result in them appearing to be distracted, unable to focus, and perhaps even hyper. The reality, though, is they might just be acting on their urge to place things in order.

Alternatively, someone with ADHD might develop coping skills that are remarkably OCD-like. ADHD can cause executive functioning problems with planning, organizing, prioritizing, reasoning, and following through on tasks to completion. This can cause extreme anxiety, which can even become debilitating for some people. Learning to use organization as a coping tool might look like OCD behavior.

How to Tell if You Have ADHD or OCD

Do I have OCD or ADHD? Determining the answer to this question requires a diagnosis from a mental health professional. If you feel that you have either, or both, of these mental health conditions, don’t be discouraged.

The process of identifying whether you’re dealing with Obsessive Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), or possibly a comorbid ADHD and OCD condition involves multiple steps to ensure an accurate evaluation.

1. Initial consultation with a mental health professional

The first step is to consult with a licensed healthcare provider, such as a psychiatrist or your doctor. They will begin by discussing your mental health history, symptoms, and concerns. Be prepared to describe specific behaviors or feelings, such as obsessive thoughts, compulsive behavior, inattention, or impulsivity. Accurately reporting your symptoms is crucial for a proper diagnosis.

2. Assessment of symptoms

The healthcare provider will assess your symptoms based on the specific criteria for each condition. 

• For OCD, this may include identifying obsessions (persistent, unwanted thoughts) and compulsions (repetitive behavior aimed at reducing anxiety). 
• For ADHD, they will look for signs of inattention, hyperactivity, and impulsive behavior. The differences in brain activity and how individuals respond to stimuli are key indicators in distinguishing OCD vs ADHD.

3. Ruling out other conditions

It’s essential to rule out other potential causes of your symptoms, as OCD symptoms and ADHD symptoms can sometimes overlap with each other and other conditions. For example, someone with OCD may exhibit repetitive behavior or compulsive actions, which might seem like the disorganization or hyperactivity typically seen in someone with ADHD. 

A clinician will carefully assess for any signs of comorbid OCD or other conditions that can further complicate the diagnosis.

4. Structured diagnostic tools

Many professionals use structured questionnaires or diagnostic tools to evaluate executive functioning deficits or compulsive behavior. These tools help differentiate whether you’re experiencing OCD behavior or if your symptoms align more with ADHD.

5. Behavioral observations and interviews

Behavioral observation over time is another key component. The professional might interview your family or friends to gain insights into your behavior in different settings. Understanding how you react in various situations will help in differentiating between OCD obsessions and ADHD impulsivity. These insights can guide decisions about OCD treatment vs. ADHD treatment.

6. Exploring treatment options

Once the proper diagnosis is made, your healthcare provider will develop a treatment plan. Both OCD and ADHD can be treated with a combination of cognitive behavioral therapy (CBT) and medications, but the approach will differ based on your condition. 

• For OCD, CBT might focus on recognizing and reducing compulsive behaviors and controlling obsessive thoughts. 
• For ADHD, CBT can help improve executive function and decision-making.

7. Comorbid diagnosis considerations 

In some cases, individuals may receive a dual diagnosis if both conditions are present. Comorbid ADHD and OCD can be challenging, as each disorder can amplify the other. 

For example, the inattention associated with ADHD can exacerbate OCD symptoms, such as fixating on unfinished tasks or obsessions. A dual diagnosis requires a tailored approach to both ADHD treatment and OCD treatment, which might include different types of behavioral therapy.

Receiving a proper diagnosis for OCD vs. ADHD is the first step in managing your symptoms effectively and finding a treatment option that works best for you. ADHD and OCD are both very common conditions, but they’re treatable. Being dedicated to routinely using therapy and adhering to your medical treatment plan, you can learn to manage your symptoms and live a happier, healthier life.

Finding Help for ADHD or OCD

Understanding the differences between ADHD and OCD is integral to learning to manage the symptoms you may be experiencing. Educate yourself about both conditions and be open to using various methods that can effectively help you manage the symptoms that you live with.

If you believe you have either comorbid ADHD or OCD, and your symptoms are interfering with your quality of life, reach out to your family doctor. They will likely recommend you to a mental health professional for an official diagnosis.

A combined OCD or ADHD treatment plan of medication, therapy, and holistic techniques can be highly effective. Many people see results much faster than they think they will. Medication can help you cope with your symptoms while you’re learning more holistic methods and working on other coping strategies in therapy. As your mindfulness and coping skills develop, you may even find that you need a lower dosage of medication to live a contented life.