PART 4: What Clinicians Need to Know- The Counterintuitive Nature of ADHD + OCD

A Series Understanding the ADHD & OCD Comorbidity

by Sarah Jurrens, LPC, LMHC, ADHD-CCSP, CCTP

Why traditional assessment misses the interplay — and how to avoid retraumatizing clients.

Research consistently shows that ADHD and OCD share overlapping symptoms and high comorbidity, yet clinicians frequently diagnose only one disorder. This is often due to symptom presentation that appears contradictory on the surface — impulsivity vs. rigidity, disorganization vs. perfectionism — but is actually part of a single, intertwined neurobiological system.

When clinicians assume these disorders cannot coexist, clients lose access to accurate treatment and often internalize the belief that they are “difficult,” “noncompliant,” or “treatment‑resistant.”

Why the Interplay Is Counterintuitive

ADHD involves executive dysfunction, emotional dysregulation, and difficulty sustaining attention. OCD involves intrusive thoughts, compulsions, and hyper‑control. When both are present, symptoms can mask or mimic one another, leading to diagnostic errors.

For example:

• ADHD‑driven checking may look like OCD compulsions.

• OCD perfectionism may hide ADHD disorganization.

• ADHD impulsivity may worsen compulsive behaviors.

• OCD rigidity may be misread as “discipline,” masking ADHD symptoms.

⚠️ Misinterpretation Creates Shame and Clinical Harm

Clients have described this with painful honesty:

“If you haven’t experienced it, you'd better really do your research if you want to treat it.”

“People can mock you or get defensive because they think you're overreacting.”

When clinicians misinterpret freeze responses, compulsions, or emotional overwhelm as:

• resistance

• manipulation

• avoidance

• personality issues…it retraumatizes clients and reinforces shame.

  
  

  This is especially harmful because people with ADHD + OCD already experience higher functional impairment and emotional distress than those with either disorder alone.

  
  

  Assessment Must Be Intentional and Nuanced

  
  

  Clinicians should screen for both disorders when clients present with:

  • chronic overwhelm

  • inconsistent functioning

  • intrusive thoughts + impulsivity

  • perfectionism + disorganization

  • emotional dysregulations, shutdowns, or freeze responses

  Guidelines for complex ADHD emphasize the importance of evaluating coexisting psychiatric conditions to avoid incomplete or inaccurate diagnosis.

  
  

  💡 Treatment Must Address Both Disorders Together

  
  

  Treating only one disorder leads to poorer outcomes. Research shows:

  
  

  • ADHD treatment improves attention and helps clients retain CBT/ERP skills.

  • OCD treatment (ERP + SSRIs) can reduce attentional symptoms.

  • Combined treatment yields the best functional outcomes.

    
    

  Clinicians must avoid assuming stimulants worsen OCD — this belief is largely anecdotal and not supported by evidence.

  
  

   References for Part 4

  • Olivardia, R. (2025). OCD and ADHD: Comorbid Symptoms and Treatment. ADDitude.

  • Bertin, M. (2022). Living With Both ADHD and OCD. Psychology Today.

  • Tadross, M. (2024). OCD…and ADHD: An Advocate’s Treatment Experience. International OCD Foundation.

  • Society for Developmental & Behavioral Pediatrics. (2024). Clinical Practice Guideline for Complex ADHD.