By the end of his freshman year in college, my son Dan’s obsessive-compulsive disorder (OCD) was so severe that he could not even eat. He would sit in one particular chair for hours, doing absolutely nothing, and he was not able to enter most of the buildings on campus. Because he desperately wanted to be well enough to return to school in the fall, Dan spent his summer at a world-renowned residential treatment program for OCD.
Fast-forward a few months and Dan has returned to college. Though he understands his OCD now, and has improved greatly thanks to Exposure Response Prevention Therapy, he is still battling the disorder. He is also taking three different medications. His program of study is intense, and his anxiety levels are high. He is having a hard time keeping track of his cell phone and glasses, and is quite disorganized. His room is a mess. He tells his therapist that he often has trouble focusing in class.
Given this information, Dan’s therapist and psychiatrist now think he may have attention deficit hyperactivity disorder (ADHD) in addition to OCD. I don’t know a lot about ADHD, but I do know that it doesn’t just appear. Throughout his schooling, before OCD made its appearance, Dan had been a teacher’s dream: obedient, attentive and engaged. He excelled academically and never once were there any issues of concern. In fact, we often marveled at how he could read, or stay focused on anything, for hours at a time. It seemed obvious to me that Dan’s disorganization and inability to focus were a byproduct of having to deal with OCD.
It is known that OCD sufferers are at risk of having one or more co-morbid conditions (meaning two or more disorders that co-exist together). According to one study, some of the more common co-existing conditions with OCD include major depression, social phobias, additional anxiety disorders, and Tourette syndrome.
There are also those who believe that OCD and ADHD often occur together. This site on ADHD states, “It is not uncommon for someone to have both ADHD and OCD.” I find this statement baffling, as the basic symptoms of ADHD (listed below), in my opinion, seem to be in direct contrast to those of OCD:
- Inattention: Having a short attention span and easily distracted. (Most people with OCD would love to be able to not pay attention to their thoughts.)
- Impulsivity: Causes a person to do dangerous or unwise things without thinking about the consequences. (Those with OCD do the exact opposite. They play it safe and obsess about the consequences.)
- Hyperactivity: Inappropriate or excessive activity. (Those with OCD often go out of their way to do what they feel is appropriate. Also, in Dan’s case, he often had very low energy as he was “wiped out” from struggling with his OCD.)
The fact that the symptoms of OCD and ADHD appear to be opposite should not really come as a surprise. Research has shown that both OCD and ADHD involve problems with the prefrontal cortex region of the brain. However, while OCD is associated with overactivity in this region, those with ADHD present with reduced activity in this area of the brain. So how can these disorders coexist?
In Dan’s case, there was no question in my mind that he did not have ADHD. But the psychiatrist and Dan wanted to try a stimulant, and because Dan was over 18, the decision was his.
Though Vyvanse definitely gave Dan more energy, he showed no improvement at all in his “ADHD-like” symptoms. As his new psychiatrist would later tell us, this should have been an immediate red flag. If Dan had indeed had ADHD, the medication should have helped.
My son should never have been prescribed this drug, and taking it was disastrous. We certainly didn’t know this at the time, but there is evidence to suggest that stimulants such as Vyvanse can not only exacerbate symptoms of OCD, they can precipitate the disorder as well.
Fast-forward again two and a half years and Dan is now a senior in college. He has been medication-free for over two years and his OCD, in his own words, is practically non-existent. His program of study is still intense but he is doing well academically. He is still somewhat disorganized and on occasion has been known to lose things.
So can someone truly suffer from OCD and ADHD at the same time? I’m not an expert, and I can only speak from my own experience. I will say that I know that things are not always what they seem, and if you or someone you care about have been diagnosed with both of these disorders, I recommend that you do your homework. Read, research, ask questions, and make sure the diagnosis makes sense to you. While the experts may know OCD and ADHD, you know yourself or your loved one better than anyone. Your thoughts, feelings, and insights should be considered. In the end, it really doesn’t matter so much what labels are assigned to all of our symptoms, as long as the treatment program in place is working.