THE BLOG
07/01/2011 08:20 am ET | Updated Aug 31, 2011

Is It ADHD, OCD or Both?

Many people ask me what the difference is between attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Both ADHD and OCD seem to be highly heritable: if you have it, it's likely that at least one of your parents also has it. When you have ADHD, one of the issues is that your brain has a low level of a chemical called dopamine. When you have OCD, one of the issues is that your brain has too much of a chemical called serotonin. Sometimes people have both ADHD and OCD. This means that you have the inattention and/or hyperactivity of ADHD, along with the compulsions and/or obsessions of OCD.

Sometimes people with ADHD tend to have what look like compulsive tendencies. This is because we've learned to overcompensate for difficulties that we've experienced with distraction, disorganization and inattention. For example, when I shut the trunk of my car, I look to make sure my keys are in my hand. I also check that the stove is turned off after I've been using it and about to leave the house. I don't do those things because I have a compulsion; I have tendency to misplace my keys, so I want to make sure that I know that they're with me and in my hand before I shut the trunk of the car, and I check the oven because I've left it on before when I was at home. So there are some things that people with ADHD do to compensate for having problems with attention, focusing and forgetfulness.

In regards to organization, I need to have a really clean workspace in order to work effectively. I went from having a large desk to a small desk just to eliminate the space I would use to stack papers. Moreover, it's much easier to keep a small desk clean. I'm not alone; a lot of people with ADHD need to have things really clean and organized in order to focus. The issue is that we can't always keep it clean. To combat this, I spend 15 minutes each night just picking up as much stuff in the house as I can. That seems to keep things pretty organized and prevents clutter from building up. I also hired an assistant to come to my house a few hours a week. She helps keep me organized by going through papers with me, and she shows me new ways to stay organized that I can actually stick to. I've noticed even more now that when I go somewhere and there is a lot of clutter, my brain hits overload. I feel overwhelmed and have to step back for a few minutes to give my brain a rest. Having those experiences reminds me that having a nice, clean workspace where everything's organized helps me focus and have a greater feeling of well-being. And that gives me even more incentive to keep things organized.

Stimulant medication for ADHD also helps me stay organized. It also helps me stay focused in environments that are not as organized. It helps me filter out distractions, such as being surrounded by piles of papers or being in a chaotic environment. Being organized is not something that came naturally to me; I had to learn how to do it. And I still need help in order to maintain organization.

When you have OCD, you may have compulsions and/or obsessions. When you have compulsions, that means that you have a certain ritual or have to do things a certain way. You may also have something called "magical thinking" where you feel that you have to do something "just so" or else something bad will happen. Compulsions are like a scratch you just have to itch. Not being able to follow through with your ritual causes you great distress. You continue to focus on that ritual during the day, you can't stop thinking about it, and you just don't "feel right" until you can do the ritual again. You never really get relief from that feeling of anxiety.

When you have OCD, you may also have obsessions -- images, thoughts or ideas in your head that won't go away. The more you try to get rid of these thoughts, the more they show up. The content of these obsessive thoughts can be nonsensical, scary or both. You may have an uncontrollable urge to repeat a word or phrase over and over in your head. Disturbing images may pop into your head, images that you just feel like you don't have control over.

As you can see, when you have OCD symptoms, it's different from just overcompensating for being disorganized, which is the case with ADHD. When you have ADHD, forgetting to check your oven before you leave the house may bother you a little, but you usually can talk yourself down from it and get on with your day. With OCD, however, not doing a checking ritual causes you great distress, to the point where you can have difficulties functioning for the rest of the day. So again, when you have ADHD, you may check things and have a need for a clean workspace, but it's because you are compensating for your tendency to be forgetful and disorganized.

If you feel like you may be experiencing symptoms of ADHD, OCD or both, talk to your doctor. Be honest with him or her about what symptoms you are experiencing. Remember, have hope -- there is treatment available for both ADHD and OCD.