OCD Related Conditions How OCD and ADHD Similarities Can Cause Misdiagnosis By LuAnn Pierce, LCSW LuAnn Pierce, LCSW Facebook Twitter LuAnn Pierce, LCSW, is a licensed clinical social worker who has worked in the field of mental health and human services for over 25 years. Learn about our editorial process Updated on October 26, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Akeem Marsh, MD Medically reviewed by Akeem Marsh, MD LinkedIn Twitter Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities. Learn about our Medical Review Board Print SEBASTIAN KAULITZKI / Getty Images OCD is believed to affect 1 in 100 adults and 1 in 200 children, according to the International OCD Foundation (IOCDF). The Anxiety and Depression Association of America (ADAA) reports the median age of onset is 19, with one-fourth of cases present by age 14. One-third of adults with OCD had the disorder as a child. ADHD is estimated to affect between 5-9% of the population, whereas OCD affects about 1-2%. It is pretty common knowledge that OCD coexists with several other disorders, including other anxiety disorders and Major Depressive Disorder (MDD). Many also recognize there are crossover symptoms of OCD-like behavior and several other disorders. Autism Spectrum Disorders and ADHD are among those. Some research also suggests that there is an overlap of ADHD and OCD among people who engage in hoarding behaviors. Causes OCD and ADHD are strange bedfellows. Both are caused by problems in the frontal lobe, but ADHD is caused by under-activity (not enough dopamine and norepinephrine) in the brain, and OCD is due to overactivity (too much serotonin). Although the different types of ADHD present very differently, all types are believed to be caused by low levels of dopamine and norepinephrine in the brain. The person with the hyperactive type of ADHD that is fidgety, restless, impulsive, and careless would appear to be the opposite of a person with OCD, generally more cautious, focused, and attentive. People with the inattentive type of ADHD are often distracted, disorganized, day-dreamy, and forgetful. Again, not your stereotypical OCD traits. Those who have the combined type of ADHD (about 70%) have symptoms of both. Misdiagnosis These two disorders often get confused when a child (or adult in a work setting) with OCD has trouble in school. After all, ADHD, which causes problems with executive functioning (organization, planning, reasoning, prioritizing, executing projects, following through with work, etc.), wreaks havoc in the classroom. A child with OCD who spends a lot of time ordering, arranging, or checking their books, supplies, and handwriting may appear to be having problems with executive functions when in fact, they are simply trying to get or keep things on the desk in the proper place. Understanding what motivates the child’s (or adult’s) behavior is key to a proper diagnosis. ADHD can result in OCD-like coping skills. A child or adult who has trouble getting organized or who are easily distracted may spend an inordinate amount of time arranging, ordering, and cleaning things. Sometimes that is procrastination, a typical ADHD trait, but it may be an ADHD coping-skill. Many people with ADHD become over-stimulated by the clutter and disorganization in their environment. This often results in anxiety, or simply shutting down. As a result, they may learn strategies to prevent clutter and disorganization that look like OCD behaviors, ie. arranging, ordering, checking. With regard to proper diagnosis, it is important to remember that ADHD is present across all domains; OCD is generally very specific with regard to obsessive thoughts and compulsive behaviors. It is also worth noting that not all people with OCD have the type related to fear of germs and cleaning. In fact, most do not have spotless homes or lockers. Although ADHD was once believed to affect only children, the research has finally caught up with reality; in 2013 the DSM-5 moved ADHD from the category of "Disorders Usually Diagnosed in Infancy Childhood, or Adolescence" to that of "Neurodevelopmental Disorder," recognizing that many continue to have symptoms into adulthood. It was once believed to largely disappear after puberty. Treatment About 30% of people with ADHD have co-occurring anxiety disorders, including OCD. Those who have problems with low dopamine and/or norepinephrine and high levels of serotonin may indeed have both OCD and ADHD. In these cases, it is extremely important to treat both disorders. However, doing so requires skill and patience. Research also suggests that co-occurring OCD and ADHD is associated with an earlier onset of OCD symptoms. While the treatment for OCD with SSRI is not usually contraindicated in ADHD (some estimate up to 50% of people with ADHD also have depression), stimulant medications used to treat ADHD can exacerbate OCD symptoms with very serious outcomes. Prescribers often treat the symptoms that are causing the most problems first. For those with both disorders, there are non-stimulant medications for ADHD that may have less impact on OCD symptoms. Treatment for both OCD and ADHD should include medication management, therapy, and self-help. 10 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. International OCD Foundation. Who Gets OCD? Brem S, Grünblatt E, Drechsler R, Riederer P, Walitza S. The neurobiological link between OCD and ADHD. Atten Defic Hyperact Disord. 2014;6(3):175-202. doi:10.1007/s12402-014-0146-x Park JM, Samuels JF, Grados MA, et al. ADHD and executive functioning deficits in OCD youths who hoard. Journal of Psychiatric Research. 2016;82:141-148. doi:10.1016/j.jpsychires.2016.07.024 Salvi V, Migliarese G, Venturi V, et al. ADHD in adults: clinical subtypes and associated characteristics. Riv Psichiatr. 2019;54(2):84-89. doi:10.1708/3142.31249 Abramovitch, A. Misdiagnosis of ADHD in Individuals Diagnosed With Obsessive-Compulsive Disorder: Guidelines for Practitioners. Curr Treat Options Psych 3, 225–234 (2016). doi:10.1007/s40501-016-0084-7 Mahone EM, Denckla MB. Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective. J Int Neuropsychol Soc. 2017;23(9-10):916-929. doi:10.1017/S1355617717000807 Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). Coexisting Conditions. Mersin Kilic S, Dondu A, Memis CO, Ozdemiroglu F, Sevincok L. The clinical characteristics of adhd and obsessive-compulsive disorder comorbidity. J Atten Disord. 2020;24(12):1757-1763. doi:10.1177/1087054716669226 Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17(1):302. doi:10.1186/s12888-017-1463-3 Abramovitch A, Dar R, Mittelman A, Wilhelm S. Comorbidity Between Attention Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder Across the Lifespan: A Systematic and Critical Review. Harv Rev Psychiatry. 2015;23(4):245-62. doi:10.1097/HRP.0000000000000050 By LuAnn Pierce, LCSW LuAnn Pierce, LCSW, is a licensed clinical social worker who has worked in the field of mental health and human services for over 25 years. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for OCD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.