Now that I've been on meds for about 1 1/2 years, certain OCD traits are starting to show: for example, having to have everything in my room in its exact place or I can't find it, having chairs pushed in under the table, only keeping clothes I wear on a regular basis (I get too overwhelmed and shut down if there's too many choices), having my books back in their proper spot (I'm a librarian and that sends me over the edge), and having things saved “willy-nilly” on my computer (including having anything saved to the desktop),
My therapist and I have discussed this in detail, and she wants me to discuss it with my Psychiatrist. So, my questions are:
1. is it common to find “hidden” OCD traits once ADHD is diagnosed?
2. What meds are typically given for OCD?
3. Are the modifications that can be done to help with the OCD (to make it less of a hindrance) without meds?
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NotAChevy
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I don't have much to respond to, since I don't have a diagnosis of OCD.* I do know that OCD is a common comorbidity with ADHD, but I don't know how common.
Certain points that you mention are a likely overlap with ADHD, like:
• needing things to be put away in certain places so that they can be found
• only keeping clothes that you wear on a regular basis (although I think the opposite is true for impulsive ADHDers, who might be prone to acquiring excess clothes that they don't need)
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I will be interested to learn anything that others have to share in this conversation.
*(I've mentioned this before, but I suspect that I have a particular form of OCD known as "scrupulosity", e.g. I cannot tell a lie, and other "moralistic" compulsions. ~ My other OCD-like behaviors seem to be directly related to my ADHD, like always checking for my wallet, keys and phone before I leave the house.)
1) It is definitely possible to find "hidden" traits of one disorder when treating another. It's also possible that the treatment itself can cause symptoms... such as how ADHD stimulants can cause it increase the severity of anxiety symptoms in some people (but decrease anxiety in other people).
2) I have found mentions on different websites that OCD is often treatable with certain antidepressants (but not all antidepressants). This site for the International OCD Foundation lists some of them:
3) There are non-medication therapies for OCD. I know that in some ways it's treated similarly to anxiety, but OCD is definitely distinct from general anxiety.
ADHD parenting coach and podcaster Brenden Mahan (ADHD Essentials) is very familiar with OCD, because one of his twin boys has a more severe presentation of it. I just heard him talking about it on a podcast (perhaps not his, but the Father's Day episode of the Men's ADHD Support Group podcast, which I was listening to last night and this morning).
• If you're on Facebook, Brendan can be reached via his ADHD Essentials private group or the Men's ADHD Support Group private group. His website also lists other contact info. I think he would be a great person to contact for questions about ADHD and OCD.
Like I've mentioned, I think that I have a type of OCD. It's pretty mild now, but used to have much more of an impact on my behavior.
It became less of a problem around the time that I had gotten diagnosed and treated for anxiety and ADHD. It let up sometime in early 2021.
After looking at that list of medications, I noticed that the anxiety medication that I was for a few months (Sept 2020-Jan 2021) was on that list.
Could it be that just taking an SSRI for a few months could rewire my brain enough to partially relieve OCD symptoms that I'd had since at least my teens?
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Scrupulosity is a form of OCD which is described by Wikipedia as "pathological guilt and anxiety about moral issues."
Since I grew up as a Roman Catholic congregant, I had always chalked it up as "Catholic guilt". (Yes, that's really what some people call moral conviction among Catholics. I've heard the term the most from ex-catholics.)
While I choose to live my life by a certain set of morals, I had felt powerless before, obsessing over how well I was or wasn't following my convictions, and feeling compelled to follow certain behaviors. I felt robotic.
• One very obvious behavior was that I was incapable of ever cussing or telling a lie. (I could refrain from telling something private or embarrassing, but if I gave an answer about anything, it had to be as absolutely truthful as I could tell it... not even over or under exaggerating. It also made telling jokes hard to do.)
I knew that I was finally relieved of much of those compulsions when my wife (at the time) revealed that she was having an affair...and when I was alone, I could cuss as easily as the guys I went to high school could.
(I still choose not to cuss, ordinarily, but I realize how cathartic it can be when I'm hurt or upset.)
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So, that's my realization since first responding to this post.
If I'm right about my experience, it was my treatment with an SSRI (Lexapro/escitalopram) for anxiety that seemed to help me with undiagnosed OCD.
My daughter has DX of OCD/anxiety/depression and exhibits ADHD traits but it's difficult to find a practitioner who can manage all of this in her area or even accurately figure out if there is a misdiagnosis because of the overlap of symptoms between OCD and ADHD. Her antidepressant appears to help the OCD but exacerbates the ADHD and affects memory. Its a struggle...There needs to be more research !!
I certainly agree, there needs to be more research!
Also, it needs to be better understood that comorbidities are very common. So, differential diagnosis needs to be considered more often.
Practitioners do tend to specialize in just a few conditions. (The ones who claim they can treat everything often can't treat each as effectively.) I think that a good care model would be to have a team of caregivers ... doctor, therapist (for talk therapy), and specialists (for OCD, ADHD, ASD, etc).
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Just last week, I listened to an episode of the Focus Forward podcast (episode 47)in which the guest was an expert on OCD. He talked about how OCD and ADHD can often be comorbidities with each other.
• Here's a link to the podcast episode on the website. I found it via Spotify , after hearing about Focus Forward on another podcast (though I don't recall which one...I listen to several, at least three others about ADHD). beyondbooksmart.com/podcast...
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I've definitely got ADHD and anxiety, and I've had depression. I haven't been diagnosed with OCD, and since I got treatment for anxiety and ADHD, my OCD-like compulsions have dropped to have a very minimal affect on me.
Before, I had daily issues with feeling certain compulsions. For instance, I was incapable of swearing, and had a compulsion to only tell the truth; I couldn't have told a lie to save my own life. I recently realized that I've stopped number counting, which used to be a regular habit of mine that I didn't realize had gone away (probably around the same time that the other compulsions went away). I do still find myself tapping surfaces like I used to, but probably half as much as before.
Now, I doubt that I could get an OCD diagnosis if I tried. Even before, I probably would have been labeled as "subclinical" because my traits didn't seem to be debilitating, just bothersome.
So, in my case, treating ADHD and anxiety has benefited my former OCD-like issues.
I was only on an SSRI temporarily, the same one twice. I've seen Lexapro (escitalopram) listed as one of several SSRI medications and other medications which have been found to help with OCD.
Perhaps since I was on atomoxetine for most of the time after I had escitalopram in the first place, it's helped to keep the compulsions at bay. Atomoxetine is primarily an SNRI (selective norepinephrine reuptake inhibitor), but it has also been discovered to act as a mild SSRI.
• This month, I switched to bupropion (aka Wellbutrin), a selective norepinephrine and dopamine reuptake inhibitor (NDRI). I don't know if it also had SSRI properties, but while it seems to be working about as well as atomoxetine for the last two weeks, today I feel a little more anxious than I've been. (But some days, I just get anxious.)
STEM Dad...Your posts are also so informative!! My daughter is on Lexapro and has been for some time. Her husband is convinced its helped the depression and OCD but enhanced the ADHD traits. Memory is certainly compromised but her daughter is 5 with ADHD/anxiety ad SPD--so she is quite busy trying to manage her life.
Ive tried to educate myself on all of the potential medications & symptoms to help her. I find that there are huge gaps in care and the psychiatrist and counselor function in different worlds with little communication about the patients real needs and comorbitidies.
Since your granddaughter has ADHD, and your daughter has ADHD traits, then your daughter ought to be assessed for ADHD.
I know I've heard that if a child has ADHD, then there's at least a 30% chance that at least one of their parents also has ADHD.
(The reverse is that if a parent has ADHD, then there's over a 70% chance that each of their children had ADHD.)
I think that I got both statistics from talks my Dr. Russell Barkley, an expert in ADHD. He's an emeritus professor of psychology who was also a clinical neuropsychologist. There are several videos of him giving presentations about ADHD on YouTube, and he now hosts his own YouTube channel. (And he tells dad-jokes... and I think his delivery is actually worse than mine! 😂)
For more information on ADHD, I would actually recommend starting with the documentary "ADD & Loving It?!" and the TEDx Talk by YouTuber Jessica McCabe titled "Failing at Normal: An ADHD Success Story".
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Also, you mentioned that your granddaughter has SPD. (I presume that's Sensory Processing Disorder.)
I know that it can come on it's own, and having ADHD can make it more likely for a person to have it, but I've heard that it's even more common to occur with ASD (Autism Spectrum Disorder). Both ADHD and ASD tend to be under-diagnosed in girls, so you might need to be aware of the possibility of ASD in your granddaughter.
• These connections are correlations, not causations. It's just that these conditions can more frequently occur together.
But, more is being learned all the time. I think it's possible that SPD could show up completely on its own.
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Note: Historically, autism and ADHD had been presumed to be linked to intelligence and learning disabilities. Now, it's understood that a person could have one or both of these conditions, yet have no learning or cognitive impairment whatsoever. (Indeed, they can even be more intelligent or gifted than peers their age, and thus referred to as "twice exceptional", or "2e".)
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I have never been diagnosed with SPD, but my ears were extremely sensitive to noise when I was under 12 years old. So, I probably could have been diagnosed with it back then...but that was in the 1980s, when a lot less was known about all these conditions.
Now, I self-identify as an HSP (Highly Sensitive Person, a person with higher than average physical &/or emotional sensitivity; this typically doesn't rise to the level of SPD).
Interestingly enough-Ive not been diagnosed but since you mention the 70% heredity link-it explains the family tree.. In my work life-while I was productive as a nurse educator provided I worked alone so I could multitask and be everywhere at once -I'm pretty sure I'm classic ADHD and quite surprised I was as successful-I think most people just let me go my own way as long as I produced work . There is also ADHD and ASD on my son in law's side of the family so there are no surprises with this gene pool.
My grand-daughter wears head phones much of the time -and is also very sensitive-just like her Mom. She does have a 504 but the public schools system has been a challenge. My little grand-daughter is the only ADHD kid in her kindergarten class-which statistically just means the others haven't been diagnosed yet. Also, the teachers in this state are not required to have any specific education related to ADHD.
Thank you for the links. Ive got quite a few resources already under my belt as well as a library of too many books. I like the ADDitude webinars and magazine as well. Im afraid there are so many sources it's hard to really digest it all and of course I want to. I usually research information related to what particular challenges the girls are having and that makes it more pertinent for them. School avoidance has been a new one for my granddaughter and my daughter struggles with organizing tasks.
Ultimately we are all doing well considering. Thank you again for your posts!!
”only keeping clothes that you wear on a regular basis (although I think the opposite is true for impulsive ADHDers, who might be prone to acquiring excess clothes that they don't need)” made me giggle because you would think that is true except in my situation I’m extremely impulsive and leads to bad spending habits. I will impulsively buy new clothes and about every couple weeks I have a mental break where I donate bags of clothes due to being overwhelmed and then going back to my same 5 comfort outfits, then the cycle repeats lol
About 75% of people with ADHD have hyperactive-impulsive traits.
(Also, about 75% have inattentive traits...so with the overlap, about 50% have the Combined presentation.)
Impulsive shopping is fairly common with ADHD. (Men who do impulsive shopping might be less drawn to clothes, and more drawn to tools, video games, other tech, sports stuff or car stuff.)
Impulsive shopping can definitely give a big dopamine hit.
(A lot of people also get a dopamine hit from making charitable donations.)
I do have ADHD but I don't have OCD. However, I do know that it is common for some with ADHD to have some OCD traits. Some believe that it has to do with some ADHD brains tendency to over focus on things rather than under focus, which is what is generally associated with ADHD. We sometimes over focus on things that we find engaging, interesting, and important (like things being where they're supposed to be).
My question to you is, are these OCD traits dysfunctional? That is, are they making your life more difficult?
I haven’t been formally diagnosed but my therapist wants me to talk to my Psychiatrist about it. She says she sees more and more OCD traits the longer I’ve been on ADHD meds.
I have ocd. As a kid I started out the messy, overwelmed by my toys and having to put them back and didnt know where to start person.... where as I got older I was the opposite but I feel overwelmed when things aren't where they should go.. almost to like what I call Mr. Monk syndrome. But, not quite that bad. It was natural for me. No meds just something within me changed fairly early on. I think it was a way of subconsciously fixing the things we do have control over.
are you officially diagnosed? I think I may have it, but I just got diagnosed borderline personality disorder on top of my diagnoses of ADHD, cptsd and anxiety.
Like yourself, I too have the OCD and ADHD. My ADHD diagnosis was just the other month, but my OCD diagnosis was back in about 2009 and it was a really bad experience for me, as the psychiatrist and psychologist fixated on germ phobia (apparently washing my hands once after going to the toilet, or using public transport, was too much!) more than my obsessive thoughts and hoarding. They put me on antidepressants that took me from being not a depressive to majorly depressive and aggressive (which I wasn't before then). My Doctor and the psychologist and psychiatrist found it amusing that I began acting way out of character. I did things like collect knives, read heavily in to articles about murder, become the most miserable son of a gun I'd ever been. I also picked fights with random people, had major anger issues and began asking out random women in work. I was completely out of control and the people who knew me could see it too.
I've only now found out that the antidepressants exacerbated my then undiagnosed ADHD, to fever pitch. What was so frustrating is the medical professionals wouldn't listen to me and instead contradicted me by saying the side effects I was experiencing were not known side effects of the meds - but everyone is different and I know myself better than they do. I could feel myself losing my grip on reality.
Unless I took antidepressants, they wouldn't help me, so I've just been left floundering for nearly 15 years. My OCD continues and my hoarding continues, because they just don't know how to help me and because I refuse the antidepressants, as they were so dangerous for me, they refuse assistance.
I'll be interested to hear how you get on - fingers crossed it's much better than my own experience.
If I am untreated I present with more OCD traits. I don’t have a diagnosis of OCD but need things to be organized, tidy, and neat. If things are not in order and organized and structured I can experience impulses to get things in order. I have been this way my whole life. Most of my life ADHD was not treated so short and long term goal setting, planning ahead, lists, and neatness and tidiness compensated for the difficulties. Keep a journal on what you notice and take it to your doctor. It may help to discuss changing medicine or dosage based on what you discover. ADHD is unique to each person and how these OCD traits affect you are personal experiences that your doctor may have not seen before.
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