Obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are two distinct conditions. ADHD doesn’t cause OCD, and OCD doesn’t cause ADHD. However, the two conditions can coexist, and when they do, this can create some additional challenges. In particular, I’ve noticed in my clinical practice that ADHD can sometimes make OCD-related rumination and intrusive thoughts especially difficult to manage.
Can ADHD make OCD worse?
One of the main features of ADHD is difficulty regulating attention. Some people with ADHD also describe having a particularly busy mind, with thoughts moving rapidly from one subject to another. When OCD is also present, this can sometimes feel as though the ADHD is turbo-charging the OCD. For example, someone might experience an intrusive doubt, begin catastrophising about what it could mean, and quickly find themselves caught up in a series of increasingly worrying hypothetical questions. The speed at which thoughts arise, along with difficulty directing attention away from them, can make it particularly challenging to disengage from rumination. There may also be a heightened sense of urgency, as though the question must be resolved immediately before the person can move on.
Of course, not everybody with ADHD experiences this, and we shouldn’t assume that all difficulties with concentration or repetitive thinking are caused by ADHD. OCD itself can be extremely distracting, particularly when someone is spending considerable time engaging in mental compulsions.
Does treating ADHD help OCD?
This is where things become particularly interesting. In my experience, some people with both conditions find that managing their ADHD makes it easier to tackle their OCD. This can be particularly noticeable when someone experiences extensive rumination or finds it difficult to disengage from intrusive thoughts. Improving attention regulation and reducing some of the difficulties associated with ADHD may make it easier to put CBT and exposure and response prevention (ERP) strategies into practice.
For some people, medication can be an effective part of managing their ADHD. When attention and other ADHD symptoms become more manageable, they may find it easier to engage in psychological therapy and resist compulsive rumination. Of course, treating ADHD doesn’t automatically treat OCD, and research into the interaction between these conditions is still developing. Nevertheless, recognising and appropriately treating coexisting ADHD can be an important part of helping someone make progress with their OCD.
What if I think I might have ADHD?
If you’re experiencing difficulties with attention, impulsivity, organisation or restlessness, particularly if these have been present since childhood and affect different areas of your life, it may be worth discussing the possibility of ADHD with your GP. Your GP can consider whether a referral for a specialist ADHD assessment would be appropriate. In England, some people may also be able to access an NHS-funded ADHD assessment through the Right to Choose pathway, which lets you choose from eligible assessment providers.
The bottom line
OCD and ADHD are different conditions, but they can coexist and sometimes interact in ways that make everyday life and psychological treatment more challenging. Recognising and appropriately managing both conditions can be an important part of helping someone make progress. And in some cases, addressing previously unrecognised ADHD may make overcoming OCD feel considerably more manageable.