A Sketch of the Relationship Between ADHD and OCD
The purpose of this essay is to provide a fictional conceptualization of the relationship between Attention-Deficit/Hyperactivity Disorder and Obsessive Compulsive Disorders. Understanding ADHD as a product of neurodevelopment, the assumption made below is that ADHD precedes and thus influences the development of OCD symptoms. The rate of ADHD and OCD comorbidity stands at near 30%, and even with this significance, there is little information available providing a conceptualization of this relationship. The narrative below is fictional and includes no identifying or personal information from real people. The information included is a coherent compilation of themes gathered through my work with dual-diagnosed ADHD and OCD individuals in the private practice setting.
Written by Trevor Holak, MA, LAC
Jacob was born in the Spring of 1996 into a neat lived-in home where even the refrigerator magnets had an unwavering order to them. As he and his brothers grew, Jacob seemed to stand out against the norm set by the two older boys. Some time after the family welcomed their fourth and final boy, it was quickly noted that Jacob had taken the longest of them to read. There was never a missed opportunity to bring awareness to mountains of laundry exiled to the desk chair in Jacob’s bedroom. Anytime either of his parents asked him to put down the Gameboy and clean his room more than once, the household was made aware of the transgression. And then there was Jacob’s reliable tendency to forget to replace the lid on the milk after pouring himself a glass, morning or evening did not matter.
Jacob would hear about himself from every willing source, pouring forth a flow of labels. “You are LAZY”, his father would proclaim liberally. “You are just DIFFERENT from your brothers” was a common attempt to console his tears after punishments. His brothers too, sharing their opinions with grins sharpening their convictions that Jacob was “BAD” at this or that. Naturally, Jacob began to identify with the labels so confidently and consistently affixed to him by those closest to his heart. Though, as his dissonance built, Jacob felt he needed to prove these accusations wrong.
And so he did. Every Tuesday Jacob would do his laundry, making sure to separate darks and lights, vibrants from earth-tones. Keys had hooks, utensils had drawers, dishes had washing and drying and a specific spot on a specific shelf of the dish cabinet. Jacob focused efforts on clutter and arranged nice neat piles of old papers and magazines, of bills and junk mail. Eventually, Jacob developed a meticulous attention for the sequence of events and a rigid preference for the order of dressing himself. First underwear, then socks (left then right), deodorant next, followed by one spray of cologne, his undershirt, pants, belt, shirt, and shoes. Still, dissonance loomed, forever threatening, as it was not the case that Jacob was “PERFECT”. There were lapses in attention, like the time he forgot he set the toaster and took a shower, alarmed by the smoke detector’s cry and the smell of burnt betrayal. There was also that night during the summer he first moved out when he must have clicked “unlock” instead of “lock” on his car key fob and woke the next morning to find his car burglarized for phone chargers, parking quarters, and chewing gum.
Self-doubt was an old friend by now, accommodations had been made but Jacob wondered whether he could really “TRUST” himself. A mold creeping from the damp corners out along the walls of his mind, rotting and corrupting his self-image and worldview. Laying in bed, questioning if the front door is locked and the refrigerator closed fully and not left cracked open after getting a handful of blueberries two-hours ago. Questioning if the chance encounter and conversation with an old coworker made her think that he was weird and off-putting because she seemed in a rush after a minute or two. Finally, Jacob dashed to the front door to unlock and relock it to satisfaction. Then to the refrigerator where he opened and closed and opened and closed until the door felt certainly sealed. And texting his old co-worker on a number he could not guarantee was even still hers “I am sorry if I made you uncomfortable earlier”. Satiated for the moment, worries briefly quelled, Jacob found his cure. A way to make sure his worries did not come true.
As this vignette highlights, ADHD and OCD can overlap in ways that are easy to miss—where distraction, overthinking, or low self-esteem may be part of a more complex pattern. Trevor specializes in ADHD and OCD and offers comprehensive assessments to help bring clarity and direction to treatment. If this resonates, feel free to reach out to learn more.
