OCD with Autism, ADHD or Depression
Repetitive behaviour, inattention and low mood each mimic OCD, coexist with it, and change how it is treated
Roughly one in five people with OCD is first given another diagnosis. Depression is the commonest, the low mood that follows years of obsessions is easy to see, while the obsessions themselves are never asked about. Autism and ADHD are the others: in my clinical experience around one in six people presenting with OCD has autistic traits, and one in eight has ADHD. Each can be mistaken for OCD, each can coexist with it, and each changes what treatment will work. Untangling them is the part of my assessment that most often alters the plan.
- Autism and OCD
- Autistic repetitive behaviours and routines are soothing and wanted; compulsions are distressing and unwanted. But the two live side by side more often than chance, and telling them apart in one person requires care, as does adapting exposure therapy, which works for autistic people with OCD but needs a different pace, more concrete structure, and attention to sensory sensitivities. I assess for autism where it has not been considered, and I treat the OCD in a way that respects the autism rather than fighting it.
- ADHD and OCD
- Ritual and inattention can look superficially similar, and the two conditions have different underlying mechanisms. Untreated ADHD undermines exposure therapy, which demands sustained attention and follow-through, and stimulant medication can occasionally worsen tics or obsessional symptoms. The order in which the two are treated, and the choice of medication, has to be planned rather than improvised.
- Depression and OCD
- Most people with long-standing OCD are also depressed, and severe depression blunts the response to exposure therapy. Serotonergic medication treats both, but at OCD doses; where depression is dominant, I may treat it first so that the psychological work for OCD can succeed. Suicidal thinking in OCD is real and often attributed to the depression alone. I ask about it directly, and about the obsessions that drive it.
- What I do
- A full neuropsychiatric assessment that screens for all three; a diagnosis you can trust; and a sequenced plan (which condition to treat first, with what, and how the exposure-based work is adapted), agreed with you and, with your consent, shared with your GP and any therapist already involved.
To arrange an assessment
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