Get to Know OCD

Episode Summary: Understanding ADHD and OCD — How to Treat and Navigate Both

Host: Dr. Patrick McGrath, NOCD Chief Clinical Officer
Date: October 19, 2025

Episode Overview

This episode explores the nuanced relationship between Obsessive Compulsive Disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD). Dr. Patrick McGrath breaks down how these two often misunderstood and co-occurring conditions overlap, differ, and what these distinctions mean for effective treatment. The conversation is layered with clinical insight, practical examples, and encouragement for those navigating both diagnoses, with a special focus on evidence-based therapies and the importance of correct assessment.

Key Discussion Points & Insights

1. Prevalence & Assessment Challenges

• Prevalence Data ([00:22]):
  • About 1 in 5 children with OCD also have co-occurring ADHD.
  • Only 1 in 12 adults with OCD have ADHD, though this gap may reflect underdiagnosis in adults rather than true prevalence differences.
  • “We're still kind of behind on assessing ADHD in adults, so maybe we'll catch up one day.” (Dr. McGrath, [00:32])
• Improvement in Assessment Tools:
  • The importance of refining assessments to better tease apart ADHD and OCD features is highlighted.
  • Both under- and over-diagnosis concerns remain, particularly in children.

2. Defining Characteristics of ADHD

• Core Symptoms ([01:10]):
  • Inattention, hyperactivity, impulsivity; can make day-to-day functioning difficult.
  • Common symptoms: trouble focusing, excessive movement, restlessness, acting without forethought.
  • ADHD is often diagnosed in childhood but may persist into adulthood or go undiagnosed until later in life.

Quote:
“Being my age, ADHD did not exist as a diagnosis. Not saying it didn’t exist, but at least as a diagnosis when I was a kid.” (Dr. McGrath, [01:59])

• Impact on Life:
  • Affects work, school, and relationships; adults might seek diagnosis after prolonged challenges.

3. Overlap and Distinctions Between OCD and ADHD

• Shared Challenges ([03:00]):
  • Both disorders can be misunderstood and misdiagnosed.
  • Commonalities include: racing thoughts, feeling mentally stuck, challenges in daily functioning.
• Key Differences:
  • OCD: Driven by intrusive, distressing thoughts (obsessions) and ritualistic (often compulsive) behaviors to reduce anxiety.
  • ADHD: Primarily characterized by inattention, poor impulse control, and hyperactivity.
  • Both may have executive functioning difficulties—poor planning and focus—but underlying drivers differ.

4. Consequences & Manifestations in Daily Life

• Procrastination Comparison ([05:35]):
  • In OCD, procrastination may come from perfectionism or the need to do things "just right."
  • In ADHD, it often stems from difficulty initiating tasks, time management issues, and a need for stimulation.
  • Both may experience anxiety and shame related to productivity struggles, but their origins and patterns differ.

Quote:
“Procrastination is common in ADHD…trouble initiating tasks, setting a deadline that's realistic, and even breaking down a large project into smaller steps…” (Dr. McGrath, [06:17])

• Perfectionism and Shame:
  • OCD may infuse treatment itself with perfectionism, sabotaging progress.
  • ADHD may generate guilt from not meeting personal goals, despite sincere effort.

5. Treatment Approaches

• OCD Treatment ([08:12]):
  • Primary: Exposure and Response Prevention (ERP) – a form of cognitive behavioral therapy (CBT).
  • Medications: Selective Serotonin Reuptake Inhibitors (SSRIs).
• ADHD Treatment:
  • Behavioral interventions via CBT; stimulant medications (a different class from SSRIs).
• Complications in Co-Management ([09:45]):
  • Sometimes, OCD can sabotage its own treatment (“If you don’t do treatment for me perfectly, it’s not going to work.”)
  • Therapists must guard against perfectionistic traps during ERP.

6. Practical Strategies for Navigating Both OCD & ADHD

• Behavioral Supports ([11:05]):
  • For ADHD: slow down thinking, choose words deliberately, practice listening and patience, foster better social interactions.
  • For both: add structure, build “reward systems” for following through, support with reminders and scheduled sessions.
• Role of Medication ([12:35]):
  • Medication effects can vary:
    • Some patients report OCD symptoms worsening with ADHD stimulants.
    • Others find ADHD medication helps calm overall mental distress, decreasing OCD symptoms.
  • “Always talk to your medication provider about any risks of combining medication.” (Dr. McGrath, [13:20])

7. NOCD’s Approach & Support Services

• Specialized Support ([15:10]):
  • Flexible session pacing, reminders, structured plans, and in-app support for blended symptom management.
  • Ongoing training for clinicians in ADHD.
  • Case consultations to enhance care for those with dual diagnoses.

Quote:
“We’re excited to do more in the area of ADHD...to make sure that people with the combined OCD and ADHD also get the best treatment, that gold standard of care that’s available to them.” (Dr. McGrath, [16:10])

• Encouragement for Listeners:
  • Seek specialized, integrated care for both conditions.
  • “You don’t have to live the life that OCD wants you to live. You can live the life that you want to live.” (Dr. McGrath, [17:22])

Notable Quotes & Memorable Moments

• On Assessment Gaps
  “Maybe we’re overdoing it a little bit in the area of children and adolescents, but I think as our assessments continue to improve and we recognize where does OCD stop and ADHD begin, we’ll be able to really see some differences.” ([00:43])

• On Procrastination’s Roots
  “Maybe someone with OCD puts off doing something until the very end, due to their perfectionistic nature...procrastination is common in ADHD…because of their difficulties to even get themselves started on doing something.” ([05:48])

• On Medication Variability
  “Even someone in the NOCD community once said they found that their OCD went away almost when they went on ADHD meds...it had a positive effect on their OCD as well.” ([13:00])

Important Timestamps

• [00:22] – Prevalence and challenges in OCD/ADHD diagnosis
• [01:10] – Core ADHD characteristics
• [03:00] – Symptom overlap and distinctions
• [05:35] – Procrastination and executive function in both
• [08:12] – OCD/ADHD treatment modalities
• [11:05] – Practical therapy strategies
• [12:35] – Role of medication and provider guidance
• [15:10] – NOCD’s supportive practices and promise of further integration
• [17:22] – Final words of encouragement and empowerment

Takeaways

• ADHD and OCD frequently co-exist, often complicating both diagnosis and treatment.
• Individualized, specialized therapy and medication tailored for both are crucial for meaningful improvement.
• The best outcomes come through integrated care—leveraging behavioral, cognitive, and pharmacological approaches, plus robust personal support.
• Empowerment, ongoing education, and expert guidance are central to managing both—and living a life authored by the individual, not their diagnosis.