Part 3: OCD/ADHD Diagnosed Together- Why Women Are Hit Hardest: Masking, Misdiagnosis, and the Invisible Load of Responsibility

Sarah Jurrens
Apr 10
3 min read

A Series Understanding the ADHD & OCD Comorbidity

We were not taught to recognize ADHD in girls or OCD in women — and the cost of that invisibility is enormous.

The Hidden Epidemic Now Being Exposed

Women with ADHD and OCD often grow up believing they are:

too sensitive
too emotional
too messy
too perfectionistic

Not because their symptoms are mild — but because their symptoms are misunderstood.

Research shows that up to 30% of people with OCD also meet criteria for ADHD, and women are disproportionately misdiagnosed or diagnosed decades later.

Clients' and authors' observations from their own experiences:

“I’ve known I had OCD since I was young, but didn’t know about the ADHD until my 40s.”

“It took a long time to understand the interplay of ADHD and OC.”

Why ADHD Is Missed in Girls and Women

ADHD research historically focused on hyperactive boys, not internalized, masked, or inattentive presentations common in girls.

Girls learn early to:

sit still
be polite
be helpful
be quiet
be “good”

So instead of being disruptive, they become:

anxious
perfectionistic
people‑pleasing
overwhelmed
exhausted

Their ADHD hides behind:

straight‑A masking
overachieving
caretaking
emotional sensitivity
“high functioning” anxiety

And because OCD can also look like perfectionism, rigidity, or anxiety, clinicians often diagnose only the OCD, missing the ADHD entirely.

Why OCD Is Missed or Misunderstood in Women

OCD in women often presents as:

contamination fears
relationship obsessions
harm‑avoidance
moral scrupulosity
hyper‑responsibility
intrusive thoughts about caregiving or safety

These are easily dismissed as:

general anxiety
being a worrier
being a "neat freak”
being too sensitive
being dramatic

But they are not personality quirks — they are symptoms.

And when ADHD is also present, the OCD becomes harder to recognize because the person is constantly fighting internal chaos.

The Perfect Storm: ADHD + OCD in Women

When both disorders coexist, women often experience:

1. Chronic masking

They hide symptoms so well that even they don’t realize something is wrong.

2. Internalized shame

They blame themselves for not being able to “just get it together.”

3. Emotional exhaustion

They live in a constant tug‑of‑war between chaos and control.

4. Misdiagnosis or partial diagnosis

They are told they have:

anxiety
depression
trauma
“perfectionism”
personality issues

…while the ADHD and OCD remain unaddressed.

5. Delayed diagnosis

Many women aren’t diagnosed with ADHD until their 30s, 40s, or 50s — often after burnout, a crisis, or a child’s diagnosis prompts self‑reflection.

💔 The Emotional Cost of Being Missed for Decades

A client captured this with heartbreaking clarity:

“I am sometimes shocked I am still alive after dealing with both for so long with very limited support or understanding.”

This is the part clinicians rarely see:

the years of self‑blame
the relationships that are strained by misunderstood reactions
the fear of being “too much”
the exhaustion of holding everything together
the grief of realizing how different life could have been with support

Women with ADHD + OCD often grow up believing they are:

dramatic
messy
irrational
overreactive
difficult
broken

When in reality, they were undiagnosed.

The Grief and Relief of Late Diagnosis

Late‑diagnosed women often describe a mix of:

relief (“I’m not crazy.”)
grief (“Why didn’t anyone see this?”)
anger (“I suffered for nothing.”)
clarity (“Everything makes sense now.”)
hope (“Maybe things can get better.”)

🌟 Coming Next: Part 4 — What Clinicians Need to Know

Next, we’ll shift into a clinician‑focused section:

why this dual diagnosis is counterintuitive
how misinterpretation fuels shame
what signs clinicians should look for
how to support clients without retraumatizing them
.