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.
