Similarities, and differences between OCD, ADHD and Autism
(Part 3 of a 3 part series on the similarities and differences between OCD, Autism and/or ADHD)
Language: There is a sordid history of the DSM. I may use direct language from the DSM, this is for educational purposes. The language in the DSM, including the use of the word disorder (D in acronym) is harmful. When this language is used, it is either because I am quoting the DSM, or because there is unfortunately a lack of different terminology out there (i.e. leaving the “d” in OCD or the “D” in ADHD). Because I leave this, does not mean that I agree with the wording.
Educational Purposes: The information presented here is for educational purposes, and not meant to diagnose, treat or cure medical conditions or challenges, including neurodivergence (including mental health challenges), or physical health.
Welcome to the final installment in our OCD series from our newest therapist, Alex McLaughlin! Alex is working with clients ranging from early childhood to adults in Minnesota, both virtually and in person in Edina! They currently have openings and would love to chat to see if they are a good fit for you!
Last week, Alex deep dived into Autism and OCD so before we move onto Autism and ADHD, don’t miss out on that one and the first part here!
Now, let’s continue our exploration with Alex!
ADHD
ADHD is a neurodevelopmental disability that stands for attention deficit hyperactivity disorder. There are three types of ADHD a person can be diagnosed with; predominantly inattentive presentation, predominantly hyperactive/impulsive presentation or combined presentation (inattentive and hyperactive/impulsive).
You’re here, so I’m assuming, again, that you’ve got some knowledge, or are expanding your awareness about ADHD now. If you’d like to expand your knowledge more - feel free to read these links, if you’ve got a base level understanding, you can skip these next two links, or not - it’s up to you! First is this blog post about ADHD. second you can find some additional blog posts about ADHD that we've posted.(1)
We’ll look more at how ADHD may look like OCD, then look at all three together.
Similarities, differences, and co-occurrences
So now that you’ve, hopefully, got a basic understanding of OCD, ADHD and Autism. Let’s explore where OCD may differ, be similar and overlap between ADHD and/or Autism.
As you may be able to tell by now from the sources, and footnotes, I appreciate the work of Dr. Megan Anna Neff, she has a blog post about this very topic. Let’s give oodles of gratitude to Dr. Megan Anna Neff and all the work they do educating folks. I reference it for this part of the post, and also encourage you to check it out. The beautiful visual comes from her blog post!
(2)
(If you read the OCD & Autism blog post, you may choose to skip this paragraph, it’s a repeat). That said, let’s discuss the term comorbidity / co-occurrence, this is used in the mental health, and likely physical health field, to describe when a person has one or more condition. For example, an Autistic person may also have PTSD. There are comorbidities / co-occurrences that are common; such as Autism & ADHD; Autism & PTSD. And you guessed it, Autism and OCD; and ADHD and OCD.
Co-occurrences
According to Brem, 2014, up to 30% of individual with OCD are also ADHDers.
Among ADHDers, 17% to 25% show signs of OCD (Masi, et. al, 2010).
One in five children with OCD also had ADHD (Abramovitch and Mittelman; 2013).
Now let’s look at the overlaps and differences between ADHD and OCD.
ADHD and OCD (3)
Similarities:
Impacts on working memory
Challenges with attention and focus
Compulsive checking
Intrusive thoughts
Sensory differences
How these similarities may differ
Working memory impacted:
With ADHD, this is due to a this being a symptom of ADHD
With OCD, this could be due to a variety of reasons; some of them possibly be the amount of mental activity that a person with OCD may be engaged in as a result of managing their OCD symptoms impacts their working memory.
Attention and focus difficulties
With ADHD, this will exist with or without intrusive thoughts and managing compulsions (including mental compulsions).
With OCD, this will be a result of managing intrusive thoughts and compulsion (including mental compulsions).
Compulsive checking:
With ADHD, this may be due to forgetting whether or not you performed an action.
With OCD, this is due to doubting whether or not you did when, if you relied on your sense data, you would be able to conclude that you did. For example, “I touched the lock on my car key, and I heard the car beep when it locked, but what if I am just imagining that I did that. What if I really didn’t lock it, even though I felt the sensation and heard with my ears?”
If an ADHDer tends to forget things, it is possible that they may develop OCD as a way to “mask” or compensate for ways their ADHD impacts their life.
We’ve explored what OCD is, the similarities and differences between OCD & Autism, and OCD & ADHD; let’s now look at all three (weee)!
ADHD, Autism and OCD (4)
Similarities
Insomnia
Skin-picking and hair pulling
Intrusive thoughts
High rate of: depression, anxiety, eating disorder, self-harm and substance abuse
Executive functioning difficulties
Sensory differences
GI issues
Differences: I’m not going to cover the differences that were already covered.
Skin picking and hair pulling:
ADHD and Autism: this is usually done as a way to stim and self-regulate
While body-focused-repetitive-behaviors (BFRBs) (5) such as trichotillomania (the fancy, diagnostic term for hair pulling) or excoriation (the fancy, diagnostic term for skin picking) are not necessarily OCD compulsions, BFRBs co-occur with OCD (6), and BFRBs often feel compulsive.
Closing Thoughts
There are a number of other challenges that co-occur with OCD, if you’re interested, you can learn more here. Interestingly, in my research, I also found that 90% of individuals with OCD met the criteria for at least one other psychiatric condition. (7)
If you have, or think you may have OCD, along with ADHD and/or Autism, it’s important to work with a provider who is neurodiversity affirming, informed and who is trained in treating OCD by using ERP, I-CBT or ACT.
The risk of working with a provider who is not, they may ask you to do exposures for things that are upsetting to your nervous system, which could lead to sensory overload, sensory meltdowns, and burnout. For example, if you experience distress in social situations, and socializing with folks you need to mask around, doing an exposure around socializing is not going to have the opposite effect (granted, if a person’s social needs are not being met, then exploring exposures that are affirming, and that may reduce the chances of burnout / sensory overload may be worthwhile).
Are you working with a provider who treats OCD already? Consider educating them on the overlaps and differences (i.e. send them this blog post and/or the resources linked in the footnotes), advocate for yourself when you feel that they’re encouraging you to do an exposure that may actually be harmful for you due to your Autism and/or ADHD. If you feel that you want to find a better fit, see below….
Do you live on Wahpekute land (colonized as MN) (8), and have, or suspect you might have OCD, ADHD or are Autistic ? Alex is an AuDHD therapist with lived experience of OCD, who is trained in treating OCD and committed to providing ND-affirming therapy, reach out to schedule a free consultation. Live on either Wahpekute land, or Chumash land (colonized as Los Angeles, CA), and wanting an assessment to understand what might be going on (Autism, ADHD and/or OCD, among other things), then reach out to see about scheduling an assessment!
Live on Chumash land and wanting referrals for an ND-affirming therapist who treats OCD, we may be able to help!
We live and work on the unseated territories of the Wahpekute and Chumash land, we pay respects to their elders past and present. We encourage folks to explore the ancestral lands they live and work on, and to learn about the Native communities that live there, the treaties that have been broken. If folks feel called, we encourage them to consider taking actions to support (9) Native communities, reparations, and land back movements.
Footnotes:
Want a hack to find a blog post about ADHD, which you may or may not already know. On a PC, simultaneously click “ctrl” and “f” key and type “ADHD into the search bar that appears. On a mac, simultaneously click “command and “f” key and type in ADHD. Magic, right!?
This graphic comes from here
Obsessive–compulsive disorder (reported here).
Support starts with educating yourself about history, and being willing to sit with uncomfortable truths. It can then include things like: learning about cultural appropriation, and commit to not engaging in and perpetuating cultural appropriation; committing to calling people in to conversations; educating others, honoring Native folks on holidays such as Indigenous People’s Day, considering the implications of celebrating holidays such as Thanksgiving, or the Fourth of July; making land acknowledgements, having conversations with people about what you learn; financial support; uplifting and amplifying Native voices and stories; understanding and supporting Land Back efforts; researching and supporting Native causes, including supporting and advocating Native-led for legislation changes. Some options for financial support of Native communities on Wahpekute land are here, here, here, here, here or here; Chumash land here; National.
