OCD…and ADHD: An Advocate’s Treatment Experience

By Maya Tadross

After years of progressing well through exposure and response prevention (ERP) therapy, I found myself at a standstill, unable to tackle certain symptoms attributed to OCD and anxiety. Restlessness, fidgeting, distraction, and slow processing persisted for me, despite my having achieved a major decrease in my obsessing and anxious thinking. I never expected my subsequent ADHD diagnosis to be the missing link in my OCD recovery.

I recently learned that about 30% of people with OCD meet the diagnostic criteria for a comorbid ADHD diagnosis (ADDitude Magazine.)

When both OCD and ADHD are present, research indicates that treating only one of them results in poorer treatment outcomes (Advokat & Scheithauer, 2013.) Further, a study by Farrell et al. (2020) found that children and adolescents with both disorders experience higher rates of comorbidity with other disorders, executive dysfunction, and functional impairment than children/adolescents with OCD, without ADHD.

Fortunately, there are effective treatment interventions for both disorders. 70% of individuals with OCD will benefit from ERP and/or SSRI medication [International OCD Foundation (IOCDF.)] Additionally, higher levels of care (i.e., intensive outpatient, partial hospitalization, or residential) exist for individuals who did not benefit from outpatient treatment (IOCDF.) Acceptance and commitment therapy (ACT) has also shown promise in treating OCD (IOCDF.) Similarly, 70% of adults and 70-80% of children/adolescents with ADHD will see symptom improvement from stimulant medication (Advokat & Scheithauer, 2013). Other helpful treatments for ADHD include behavioral interventions for children and psychotherapy for adults (Advokat & Scheithauer, 2013.)

When both disorders are properly addressed, the treatments for one can positively impact the treatments of the other. Stimulant medication for ADHD can improve attention, learning, and the retention of cognitive-behavioral skills, thereby helping decrease comorbid obsessive-compulsive symptoms (Advokat & Scheithauer, 2013.) Conversely, ERP and SSRI medication for the treatment of OCD can improve attentional symptoms associated with ADHD (Advokat & Scheithauer, 2013.) A knowledgeable psychiatrist can prescribe and manage both SSRI and stimulant medication, and a properly trained clinician (therapist or psychologist) can guide you through ERP.

I admit that upon my own ADHD diagnosis, I was hesitant to begin stimulant medication. I had heard that such medications may actually make me more anxious, although I later learned that this claim is largely anecdotal (Advokat & Scheithauer, 2013.)

To my pleasant surprise, however, stimulant medication allowed my previously jumbled thoughts to unravel and follow a more efficient, linear path. This allowed me to better prioritize my thoughts, which has been extremely helpful in managing my OCD. Also, the decrease in my restlessness, fidgeting, etc. proved to me that those were indeed symptoms of ADHD, not OCD or anxiety.

In addition to medication, psychoeducation on ADHD has been an extremely helpful factor in learning to manage my symptoms. Specifically, I have learned that my brain often works differently than what society considers “typical,” and that is okay. I no longer force myself to do things in the manner that seems to work for the majority of people, as this often results in more distress and decreased confidence. Instead, I am constantly considering new and modified ways of doing things to find what works best for me.

I credit my ability to complete formal ERP and enter OCD “remission” to my ADHD diagnosis and treatment. Admittedly, I do still experience occasional obsessive-compulsive symptoms and am actively learning to better manage my ADHD behaviorally. If you live with both OCD and ADHD too, you are not alone. Although both disorders present a bit differently across individuals, the similarities in our experiences can draw us together for support. Your challenges are valid, and they make you neither “strange” nor “lazy.” Getting diagnosed with both these disorders is half the battle, as they provide both an explanation and potential interventions for your struggles.

Read Maya's original blog on her diagnoses: OCD…and ADHD?