ADHD vs. OCD: How to Tell the Difference and Why It Matters for Treatment

The good news? There are ways to avoid this scenario from happening to you or a loved one.

In this blog, we’ll break down the key distinctions between each mental health condition, as well as a powerful diagnostic tool that helps ensure greater accuracy. With the right diagnosis, you (or a loved one) can get the right treatment and move toward lasting relief and a better quality of life.

WHY OCD AND ADHD MISDIAGNOSIS IS MORE COMMON THAN YOU THINK

Experts have noted that ADHD and OCD symptoms associated with attention and concentration can appear remarkably similar despite each disorder having different brain activity dysfunction. This overlap in symptoms is particularly common among children and adolescents.

Related: 11 Things Not to Do If You Have ADHD

Unless a clinician is highly trained to spot nuanced differences between the two disorders and/or uses imaging to examine activity patterns in the brain, misdiagnosis can and does occur. Indeed, in one study, evidence suggested that OCD may be misdiagnosed as ADHD. This is because OCD-related attentional impairment looks like ADHD symptoms.

OCD is well-known to be misdiagnosed in general, particularly with family physicians. For certain types of OCD, misdiagnosis is shown to be as high as 52%, according to research.  Childhood ADHD misdiagnosis also happens as documented in research.

WHAT IS ADHD? UNDERSTANDING THE CORE SYMPTOMS

ADHD is a neurological disorder rooted in prefrontal cortex dysfunction and linked to lower levels of dopamine and norepinephrine. It is characterized by significant problems with attention and disorganization, and frequently with impulsivity and hyperactivity as well.

Often these issues lead to behavioral problems, which may create challenges in school or at work. They may also interfere with social development and interactions.

ADHD is the most common neurodevelopmental disorder in childhood—and it can continue into adulthood. Roughly 7 million (11.4%) U.S. children aged 3–17 years have ever been diagnosed with ADHD, based on a 2022 national survey. Survey data from 2023 from the Centers for Disease Control and Prevention (CDC) estimates 15.5 million adults have had an ADHD diagnosis.

The core symptoms of ADHD include:

• Trouble focusing and concentrating
• Impulsivity (such as exhibiting inappropriate behavior without thinking or blurting out thoughts before thinking them through)
• Short attention span for routine tasks (such as homework or chores)
• Easily distracted
• Procrastination
• Disorganization
• Lack of follow-through

Symptoms can range from mild to severe. Note that hyperactivity is not one of the hallmark ADHD symptoms.

The brain SPECT imaging work at Amen Clinics has revealed  seven types of ADHD, which share the core symptoms plus the following:

• Classic ADHD: Restlessness, impulsive, fidgeting, talking excessively, and often, hyperactivity
• Inattentive ADD: Trouble maintaining focus, making careless mistakes, appearing unmotivated or preoccupied, being sluggish, not hyperactive
• Overfocused ADD: Over worrying, holding grudges, obsessive, may or may not be hyperactive
• Temporal Lobe ADD: Irritability, dark thoughts, periods of spacey or confused, feelings of fear or panic, may or may not be hyperactive
• Limbic ADD: Moodiness, hopelessness, chronically negative, loss of interest in things, may or may not be hyperactive
• Ring of Fire ADD: Overly sensitive, oppositional, has cycles of moodiness, may or may not be hyperactive
• Anxious ADD: Often feels nervous, stressed out, conflict avoidant, predicts the worst, may or may not be hyperactive

ADHD symptoms are known to overlap with a number of other mental health conditions, including:

• OCD
• Oppositional defiant disorder (ODD)
• Anxiety disorders
• Autism spectrum disorder (ASD)
• Major depressive disorder
• Bipolar disorder

WHAT IS OCD? UNDERSTANDING OBSESSIONS AND COMPULSIONS

Obsessive-compulsive disorder is a serious and often debilitating mental health condition rooted in brain overactivity, primarily in the frontal lobes. It is associated with:

• Reduced serotonin levels
• Obsessions—intrusive thoughts, urges, or mental images
• Compulsions—repetitive behaviors

Left untreated, persistent obsessions and compulsive rituals can take over an OCD individual’s life and lead to significant problems with personal, interpersonal, professional, academic, and social functioning.

The lifetime prevalence of OCD among U.S. adults is estimated to be about 2.3%, reports the CDC.  That is 1 in 40 adults. In children and teens, it is estimated to be 1 in 100, according to the International OCD Foundation.

Related: What You Need to Know About OCD According to a Psychiatrist

OCD Symptoms: Obsessive Thoughts

Obsessive thoughts typically involve unwelcome, repetitive ideas, urges, or mental images that may feel disturbing, irrational, or even offensive. These thoughts often spark intense feelings of anxiety, fear, or revulsion.

Individuals with OCD will often try to suppress or resist their obsessions, but the more they attempt to control them, the stronger they can become.

Obsessive thoughts are often focused on one of these areas:

• Germs or contamination
• Forbidden sexuality
• Harm or violence
• Losing control
• Religion
• A need for symmetry or perfectionism

OCD Symptoms: Compulsive Behaviors

Compulsions are behaviors that are performed repeatedly, even though they do not bring any reward or pleasure. The disorder’s compulsions serve to neutralize the distress caused by the obsessions.

Inside, a person with compulsions feels compelled, almost like they have to perform the compulsive behavior according to certain rules and often in a specific, rigid manner. They can be complicated, time-consuming rituals.

Some of the most frequent compulsive behaviors seen in OCD include:

• Repeated handwashing or excessive focus on personal hygiene
• Over-the-top cleaning rituals, such as scrubbing household items that aren’t dirty
• Saying or mentally repeating certain words, names, or prayers over and over
• Checking things multiple times—like ensuring a door is locked or the stove is off
• Counting actions or objects, often driven by a need to stop on a “safe” or “right” number
• Touching objects in a specific order or pattern

Interestingly, most people with OCD either know or have a feeling that their obsessional thoughts are not true or realistic, but they still have trouble disengaging from the obsessive thoughts or stopping the compulsive behaviors.

WHY ADHD AND OCD ARE OFTEN CONFUSED

While distinct disorders, there’s an ADHD-OCD overlap of symptoms, which leads to confusion and misdiagnosis.

The most common symptoms they share are the following:

• Perfectionism
• Impulsivity
• Distractibility
• Repetitive Behaviors
• Anxiety

Here’s how these five symptoms can cause both ADHD and OCD diagnosis confusion:

1. Perfectionism

Perfectionism is the most common cognitive distortion adults with ADHD report. It typically manifests as procrastination and/or a negative self-image.

Having ADHD often makes a child the recipient of criticism and punishment because memory and attention issues make completing schoolwork and chores very difficult and hyperactive behavior can cause disruption.

Additionally, the disorganization that goes with impaired executive function may also cause ADHD people to be perfectionistic. They’re basically trying to overcome their shortcomings, as if a little more discipline or trying harder would solve their challenges.

But OCD individuals struggle with perfectionism too. With OCD, perfectionism manifests in fixing and checking behaviors to ensure things look, feel, and sound correct, symmetrical, organized, and balanced.

For example, OCD children or adults might compulsively check a written communication to ensure it is perfect or repeatedly rearrange objects on their desk or in their closet.

2. Impulsivity

In addition to having poor impulse control because of executive dysfunction, ADHD individuals may additionally display impulsivity as a result of perfectionism. They set very high standards typically and when they are not met, they can make impulsive decisions out of frustration. It creates a negative feedback loop.

Imaging research on OCD individuals shows that they have dysfunctional reward processes thought to be important in addictive disorders and impulse control. Impulsivity is linked to more severe OCD.

3. Distractibility

The low dopamine and epinephrine in the frontal lobes of an ADHD brain translates to difficulty paying attention for longer periods of time and being easily distracted. Those who struggle with ADHD can overcompensate for their inclination to be disorganized, distracted and inattentive by adopting OCD-like coping skills. Such compulsive tendencies indicate OCD traits in ADHD patients, which can be misleading.

Conversely, when OCD mimics ADHD in school and social settings, a clear diagnosis is difficult. Like ADHD, OCD can cause inattention but for a different reason. Preoccupied by an obsession or a compulsion, an OCD person may not be able to keep their focus on what’s going on around themself. 

For example, a student who seems inattentive and antsy during class may actually have OCD and not ADHD since distraction from repetitive thoughts and fidgeting from compulsive behaviors can both appear to be ADHD symptoms. Because teachers usually equate attention problems and hyperactivity with ADHD, many OCD patients are being misdiagnosed.

4. Repetitive Behaviors

ADHD with compulsive behaviors and sensory seeking, like fidgeting or touching objects for stimulation, can look superficially similar to OCD compulsions.

5. Anxiety

ADHD individuals may experience heightened stress and anxiety from the inherent challenges of the disorder, such as disorganization and impulsivity.

For example, a person with ADHD may regularly struggle with managing their time, which may lead to anxiety about keeping up with deadlines and maintaining job performance. Of course, anxiety is a hallmark symptom of OCD, stemming from distressing obsessions.

Other Similarities

Additionally, both conditions may trigger irritability and depression and are associated with sleep and gastrointestinal health issues.

Press Play to Learn If Having ADHD and OCD Is Possible

In this video, Dr. Daniel Amen shares whether or not people can have both ADHD and OCD at the same time while offering advice on what medicine or supplements will help balance the brain.

Click below to tune in:

Video: Is It Possible To Have ADHD & OCD?