Could Obsessive-Compulsive Disorder Start as Attention Deficit Disorder?

Obsessive Compulsive Disorder (OCD) and Attention Deficit/Hyperactivity Disorder (ADHD) are very different conditions, according to the Diagnostic and Statistical Manual—the “bible” of psychiatric diagnoses published by the American Psychiatric Association. Yet, my clinical experience tells me they may be linked.

OCD is characterized by unwanted and intrusive thoughts and behaviors. A patient might complain that she “can’t stop thinking” about germs and, therefore, feels compelled to wash her hands dozens of times a day. It is as though the mind or brain is doing senseless laps around a track the person very much wants to stop running.

ADHD is characterized in part by distractibility, forgetfulness and trouble organizing. A patient might complain she “can’t focus” and never seems to finish a task. It is as if the mind cannot stay on course and complete even one lap around the track the person very much wants to run.

Different medicines (in addition to various forms of therapy) are used to treat OCD and ADHD. Obsessions and compulsions seem to yield to medications like Prozac or Effexor that boost serotonin and norepinephrine in the brain. ADHD seems to improve more with stimulants, like Ritalin or Adderall.

But for several of my patients, their obsessions and compulsions seem to have developed as a counterproductive way of “dealing with” preexisting and severe attention deficit problems. Since they couldn’t select what to pay attention to, and since that meant their focus shifted painfully from one thing to another to another, their brains seem to have dropped anchor into rigid, repetitive thought and behaviors (obsessions and compulsions)—so that they began to think or do the same thing again and again and again, in order to stop the very distressing sense of drifting aimlessly.

It is as though having begun life as sailboats without rudders, unable to chart a course, they have wandered into whirlpools. They have no more control of their thoughts or behaviors, but they are certainly much more predictable.

For OCD patients like these, whose symptoms seem rooted in ADHD, I have found that stimulant medications can indeed be helpful.

This certainly isn’t a strategy for every patient with OCD. Using Ritalin or Adderall for obsessions and compulsion isn’t common practice, but it may be an option to relieve suffering in very severe cases.