Magazine article Clinical Psychiatry News

Obsessive-Compulsive Symptoms Can Manifest through ADHD

Magazine article Clinical Psychiatry News

Obsessive-Compulsive Symptoms Can Manifest through ADHD

Article excerpt

FROM THE JOURNAL OF OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

In adult patients with obsessive-compulsive disorder who are thought to have comorbid attention-deficit/hyperactivity disorder, the symptoms of inattention, forgetfulness, and impaired executive function might actually be an epiphenomenon of OCD rather than a manifestation of ADHD, a study has shown.

OCD patients' "continuous and excessive attempts to control behavior and thoughts" may cause a flooding of the executive system, interfering with attention, memory, and other executive processes, said Amitai Abramovitch, Ph.D., of the department of psychiatry Harvard Medical School, Boston, and his associates.

"We believe that there is a growing convergence of evidence that may, at least in some cases, challenge the diagnostic validity of OCD and ADHD comorbidity." Making a clear distinction between the two disorders is crucial because stimulant medication given to treat ADHD is known to exacerbate OCD symptoms and has even been reported to induce full-blown OCD, they noted. 11

Dr. Abramovitch and his colleagues began with the observation that OCD and ADHD have very different, even directly opposite, clinical presentations. ADHD is characterized primarily by impulsivity, risk taking, and novelty-seeking behavior. "In contrast, the behavioral manifestations of OCD seem to lie on the opposite end of an impulsive-compulsive spectrum," typified by inhibited temperament, avoidance of novel stimuli, increased risk avoidance, and lower than normal impulsivity.

To test their hypothesis that OCD and ADHD are so fundamentally different that they're unlikely to coexist in the same person, the researchers assessed 30 men with OCD, 30 men with ADHD, and 30 healthy control subjects who had no history of psychiatric, neurologic, developmental, or learning abnormalities.

The three groups were well matched for age (mean, approximately 30 years) and level of education (mean, approximately 13 years). …

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