Torn Between Chaos and Control: When OCD and ADHD Coexist

Imagine a brain that won’t stop looping distressing thoughts... and also struggles to stay focused long enough to finish a simple task. It might sound contradictory, but for people living with both Obsessive-Compulsive Disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD), this is daily life.

While these two conditions seem like opposites—one marked by rigidity and control, the other by impulsivity and inattention—they often show up together. And when they do, the experience can be deeply confusing, especially when treatment is only targeting one part of the picture.

OCD vs. ADHD: Opposites… or Overlapping?

Let’s start with the basics.

• OCD is an anxiety disorder driven by intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) meant to reduce distress or prevent feared outcomes.

• ADHD is a neurodevelopmental disorder that affects executive functioning—things like focus, planning, working memory, and emotional regulation.

Here’s the twist: Both conditions involve difficulties with regulation. They just show up in very different ways.

• In OCD, the brain gets stuck—looping thoughts, rituals, and fears.

• In ADHD, the brain skips around—jumping from one thing to the next without finishing.

For someone living with both, it can feel like being mentally trapped and mentally chaotic at the same time. This internal push-pull is exhausting—and can leave people wondering what’s wrong with them when nothing seems to fit.

Signs You Might Be Dealing with Both

Because OCD and ADHD can mask or mimic each other, they’re often missed in assessments—or misdiagnosed altogether. Here are some common signs that both may be at play:

• Difficulty following through on compulsions due to inattention or forgetfulness

• Feeling torn between obsessively needing to “get it right” and impulsively rushing through tasks

• Trouble sticking with ERP (Exposure and Response Prevention) or therapy homework because of ADHD-related avoidance or disorganization

• Rumination over “mistakes,” real or imagined—especially when executive functioning issues lead to actual consequences

When OCD Becomes a Coping Strategy for ADHD

For many people, OCD rituals start to feel like a way to manage their ADHD—especially if they’ve spent years being criticized for forgetfulness, lateness, or “careless” mistakes. Compulsions can offer a (false) sense of control in a brain that often feels out of control.

This can lead to a fear that treating OCD will make things worse.

“If I stop checking everything five times, I will make a mistake.”
“If I don’t obsessively plan, I’ll forget something important.”
“My OCD is the only thing keeping me functional.”

In these cases, OCD becomes a compensatory strategy—one that’s anxiety-driven and unsustainable, but also deeply tied to a fear of ADHD-related failure. That fear is real, and it deserves attention in treatment.

Treating OCD and ADHD Together

When both conditions are present, therapy needs to be flexible, compassionate, and strategic.

• ADHD treatment (like structure, medication, or behavior strategies) can help—but sometimes fuels compulsions if not monitored.

• OCD treatment (like ERP or ICBT) is essential—but may need to be adapted for brains that struggle with follow-through, focus, or internal motivation.

As a therapist who specializes in both OCD and ADHD, here are a few strategies I use in my work:

• Incorporating visual reminders, timers, and external cues for exposure tasks

• Breaking therapy goals into small, achievable steps

• Helping clients differentiate between OCD-related guilt and ADHD-related forgetfulness

• Validating the distress while untangling what’s driven by anxiety vs. executive dysfunction

• Supporting clients through the fear of losing their coping mechanisms as OCD treatment begins

This is where self-compassion becomes just as important as any skill or tool.

You’re Not “Too Much.” You’re Not Alone.

OCD and ADHD can make the world feel like a maze with no map. You might feel like you’re always behind, constantly second-guessing, or trying to do things “right” without knowing what that even means anymore.

But you’re not broken. You’re navigating a brain that processes the world differently—and it’s possible to build skills, find relief, and move forward without having to choose between chaos and control.

Looking for an OCD and ADHD-Affirming Therapist?

I specialize in working with people who live at the intersection of OCD and ADHD. Whether you're struggling with compulsions, attention challenges, or both, therapy can help you build clarity, flexibility, and self-compassion.

Navigating the Landscape of OCD: Understanding Its Diverse Manifestations

Obsessive-Compulsive Disorder (OCD) is a multifaceted condition that manifests in various ways, often presenting unique challenges to those affected. Let's explore some of the lesser-known subtypes of OCD, shedding light on their intricacies and offering insights into effective coping strategies.

Relationship OCD (ROCD)

Ah, the rollercoaster of love, where every "I love you" comes with a side of doubt and analysis paralysis. For those with ROCD, navigating the romantic landscape can feel like tiptoeing through a minefield of uncertainty. From constantly wondering if your partner is smart or funny enough to analyzing how much you enjoyed each kiss, the fear of uncertainty can cast a shadow over any romantic relationship. 

People struggling with ROCD may constantly question the authenticity of their feelings, analyze every interaction for hidden meanings, or seek reassurance from their partner excessively. This relentless scrutiny can strain even the strongest of relationships as the individual grapples with doubts and insecurities. 

Coping Tip: Having a negative thought about a partner doesn’t mean you have to act on the thought to resolve or avoid feelings of uncertainty. Work on gradually confronting and tolerating feelings of discomfort to make the negative thoughts of self-doubt, insecurity or uncertainty less relevant.

Violent/Harm Obsessions

Ever catch yourself imagining tripping an unsuspecting stranger or pushing a colleague down the stairs? Welcome to the wild and wacky world of violent/harm obsessions, where intrusive thoughts run wild like unruly toddlers at a playground. Despite their terrifying nature, these thoughts are harmless, and surprise: everyone has them!

Intrusive thoughts of violence or harm can be distressing for individuals with OCD, triggering intense feelings of guilt, shame, and fear. Despite knowing these thoughts are irrational, they struggle to shake the relentless onslaught of disturbing imagery or impulses. This subtype often leads to avoidance behaviors and social isolation as individuals strive to protect themselves and others from perceived harm. 

Coping Tip: Practice radical acceptance of your thoughts. Remember, thoughts are just thoughts, and they don't define who you are. Work on develop coping strategies and embracing the absurdity of intrusive thoughts with a healthy dose of humor.

“Just Right” OCD

Imagine a world where everything must feel "just right" to alleviate anxiety. Individuals with Just Right OCD experience intense discomfort when things feel off-balance or incomplete. They may engage in repetitive actions, such as adjusting objects or repeating behaviors until they achieve a sense of perfection. This quest for equilibrium can consume significant time and energy, often interfering with daily functioning.

Coping Tip: Cognitive-behavioral therapy (CBT) techniques, such as exposure and response prevention (ERP), can help individuals gradually confront and tolerate feelings of discomfort associated with imperfection.

Urge to Confess

Ever had the urge to confess that you accidentally used your roommate's toothbrush once? Yeah, that's the urge to confess in action. For individuals with this subtype, the line between harmless secret and impending moral crisis blurs into a messy tangle of guilt and anxiety. 

The urge to confess is a common manifestation of OCD, characterized by an overwhelming compulsion to divulge thoughts, feelings, or actions deemed unacceptable or morally wrong. Individuals may feel compelled to confess even minor transgressions, fearing the consequences of withholding information. This perpetual need for absolution can lead to strained relationships and heightened anxiety. 

Coping Tip: Practice discernment when it comes to confession. Not every thought or action requires a public airing. Challenge yourself to sit with discomfort and trust that not every secret is a ticking time bomb waiting to explode. Work with a therapist to help challenge the urge to confess and develop healthier coping mechanisms.

Understanding these subtypes is crucial for providing effective support and treatment for individuals with OCD. If you or someone you know is struggling with OCD, don't hesitate to reach out for help. As an OCD psychologist, I'm here to provide compassionate guidance and support on your journey towards healing and recovery.