Obsessive Compulsive Disorder

The Odd Couple, Indeed: OCD and ADHD in Contrast

Jack Nicholson in “As Good As It Gets” or Leonardo DiCaprio in “The Aviator” — for many people, these extreme examples epitomize OCD. But the reality is that Obsessive-Compulsive Disorder is seldom so easy to recognize. Here are key distinctions from ADHD.

A depiction of the possible symptoms of OCD.
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What Is OCD?

Obsessive-compulsive disorder (OCD) is a neurological and behavioral condition. Symptoms of OCD include recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). While OCD is sometimes misdiagnosed as ADHD due to symptom overlap, it is possible to have both disorders. In fact, as many as 50-80 percent of people with ADHD also have related, comorbid conditions (such as OCD).

A woman holds her head, wishing she could stop her OCD symptoms.
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Common Obsessions

Obsessions can take the form of repetitive words, thoughts, fears, worries, memories, or pictures. Some common obsessions include fear of dirt, germs, or becoming ill/dying; fear of losing control and causing harm to oneself or others; perverse or forbidden sexual thoughts; and the extreme need for order, symmetry, or “perfection.” An individual with OCD may view her obsessions as being extreme or unnecessary, yet still feel like she cannot control or stop them.

Obsessive handwashing can be a sign of OCD.
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Common Compulsions

People with OCD often take part in compulsive rituals in an attempt to calm their obsessive thoughts. Common compulsions include excessively cleaning, bathing, or washing hands; refusing to shake hands or touch door knobs; repeatedly touching, counting, or rearranging objects; excessively checking alarms, locked doors, or unplugged fixtures; hoarding; and perfectionism. Although doing these rituals provides only temporary relief, not doing them can dramatically increase anxiety.

One sharp pencil among unsharpened pencils.
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OCD Is Not…

The occasional worry about getting sick or the desire to keep things clean and orderly does not indicate an obsession — everyone has these thoughts from time to time. Additionally, not all repetitive behaviors, rituals, or routines point to compulsions — in fact, a daily routine can be quite beneficial for those with ADHD. It’s only OCD when repetitive thoughts or behaviors interfere with day-to-day life.

There could be many people in the crowd with OCD since it affects more than 2 million people in the US.
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Who Is Affected?

It is estimated that OCD affects more than 2 million people in the United States. Although OCD can be found in individuals of any age, according to the International OCD Foundation, OCD most commonly presents itself in individuals between ages 8-12 years old and between late teens and early adulthood.

The causes of OCD are brain-based but not confirmed.
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Causes of OCD

While the exact causes of OCD are largely unknown, it is believed that obsessive-compulsive behavior results from a deficiency of a neurotransmitter, serotonin, in specific areas of the brain. New research suggests that the more severe forms of the condition, in which obsessive thoughts “lock” and cannot be relieved, involve more than a neurotransmitter shortfall. There may also be a genetic component to OCD.

A boy struggles with homework, which appears to be an ADHD issue but may actually be OCD.
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Diagnostic Difficulties

OCD is easily confused with ADHD due to overlapping behavioral symptoms. For example, a child who has trouble completing schoolwork may seem inattentive; however, the problem may actually stem from a fear of making a mistake that is so intense that he is unable to move on to the next task. Determining the root of behavior problems is the key to a proper diagnosis.

A woman talks to her therapist about treating her combination of ADHD and OCD.
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OCD Treatment

If you believe that you or your child may have ADHD and OCD, it is recommended that you see a professional who specializes in treating patients with more than one disorder. OCD is typically treated with a combination of therapy and a non-stimulant medication, such as an SSRI, which increases serotonin levels in the brain.

ADHD medication can sometimes make OCD worse.
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OCD and Stimulant Medication

For reasons that are not known, stimulant medications, often used to treat ADHD, may exacerbate an existing case of OCD. Often, the first clue that someone has ADHD and OCD — or may have OCD rather than ADHD — is a significant increase in OCD behaviors after taking a stimulant medication. Once symptoms of OCD are under control, a stimulant can often be reintroduced without causing a flare-up of the OCD behaviors.

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