Understanting comorbidity: When People with OCD Also Have ADHD

By Andrea Lacayo, Psy.D.

While attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) may seem like opposite conditions - one characterized by impulsivity and distractibility, the other by a need for control and focus on small details - they are both points along the impulsive- compulsive spectrum of disorders and often co-occur.  

Research indicates that comorbidity between ADHD and OCD is not uncommon, with studies reporting rates of ADHD in those with OCD ranging from 5% to 52%. People with both conditions tend to experience an earlier onset of OCD symptoms, greater symptom severity, and more persistent difficulties compared to those with OCD alone.

Differentiating ADHD and OCD can be difficult. Anxiety can make people with OCD appear distractible. People with ADHD may be quite perfectionistic and compulsive in certain situations. Psychological assessment is often needed to confirm an ADHD diagnosis in those with OCD.  

If a person with OCD has ADHD, this is important to factor into the treatment approach, including exposure and response prevention (ERP) and medications. Individuals with OCD who also have ADHD often need extra structure, coaching, and accountability to stay engaged in ERP tasks. 

When ADHD co-occurs with OCD, clinicians may need to build greater flexibility into session timing and ensure self-directed ERP tasks are scheduled clearly and consistently. 

If someone with OCD has ADHD, consulting with an experienced medical provider to assess if they might benefit from ADHD medication is also an important consideration.  

Subscribe to NBI Exposure for more articles on clinical practice and evidence-based treatment.