Obsessive-compulsive disorder (OCD) and attention deficit-hyperactivity disorder (ADHD) are two well-known conditions that can significantly alter normal mental function in affected individuals. While the two conditions are distinct, they can produce symptoms that strongly resemble each other in a variety of ways. For this reason, doctors sometimes mistake OCD for ADHD—or vice versa—when making their initial patient assessments, according to the results of a study published in the Journal of Neuropsychology in late 2012. Unless corrected, such a mistaken diagnosis can lead to serious problems and the worsening of OCD or ADHD symptoms.
OCD belongs to a larger group of mental health conditions known collectively as anxiety disorders. People with the disorder classically become fixated on certain ideas, thoughts, feelings or sensations, then engage in specific compulsive behaviors that are consciously or unconsciously intended to relieve anxious states of mind brought about by obsessive fixations. In some cases, affected individuals only develop obsessive symptoms of OCD; in other cases, affected individuals only develop compulsive symptoms of the disorder. Whether obsessive and compulsive symptoms appear together or separately, they can vary considerably in their intensity. People with the worst forms of the disorder can develop highly debilitating problems, especially when they’re unable to complete compulsive rituals they rely on to ease OCD’s anxiety-related effects. ADHD is a collective term for a spectrum of childhood conditions that center on varying degrees of hyperactive behavior, impulsive behavior and/or an inability to focus, pay attention and participate appropriately in various types of activities. Some people with the disorder have predominating symptoms of hyperactivity or impulsivity, while others have predominating symptoms of inattention. In addition, some people with the disorder have roughly equal problems in both of these areas. Up to 50 percent of all children diagnosed with ADHD continue to show signs of their condition in adulthood. The effects of the disorder can potentially cause serious disruptions in a broad range of everyday school-related, social, personal, or work-related interactions.
Similarities in Appearance
Adults with OCD and ADHD frequently display highly similar symptoms in a controlled setting such as a doctor’s office, the authors of the study published in the Journal of Neuropsychology report. They made this conclusion after examining men with both of these disorders through direct neuropsychological testing and the use of detailed symptom questionnaires. Specific problems found in both groups of patients include an impaired ability to exercise normal memory function, abnormally slow reaction times during reflex testing, an impaired ability to focus or pay attention, and an impaired ability to regulate impulsive behaviors. Because of these similarities, doctors assessing new patients for OCD or ADHD may sometimes misidentify the source of a given symptom, and therefore end up misdiagnosing the underlying condition associated with that condition.
Outside of a doctor’s office or other controlled settings, the differences between OCD and ADHD in adults are typically much more apparent, the authors of the study in the Journal of Neuropsychology explain. For instance, while people with either disorder may appear to have similar problems with impulse control in a doctor’s office, people with ADHD generally have much greater difficulty controlling their impulses than people with OCD during the course of their everyday routines. In addition, the underlying motivations for certain behaviors commonly vary greatly between people with OCD and people with ADHD. For example, while a person with ADHD may grow distracted as a result of restlessness or an inability to pay attention, a person with OCD may seem similarly or identically distracted while engaging in obsessive thinking or specific compulsive rituals.
Potential Consequences of Misidentification
Common treatments for obsessive-compulsive disorder include a form of psychotherapy called cognitive behavioral therapy and antidepressant medications such as sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox) and paroxetine (Paxil). Common treatments for ADHD include various forms of counseling and behavioral therapy; stimulant medications such as dextroamphetamine-amphetamine (Adderall), methylphenidate (Ritalin), and lisdexamfetamine (Vyvanse); and other medications such as clonidine (Catapres), buproprion (Wellbutrin), and atomoxetine (Strattera). When mistakenly prescribed to a person with OCD, stimulant medications used in the treatment of ADHD can significantly worsen OCD-related behaviors and degrade that person’s overall well-being, the authors of the study in the Journal of Neuropsychology report. While treatments for OCD may not produce such dramatic problems in people with ADHD, they can still significantly diminish the chances for effective control or resolution of ADHD-related symptoms.