OCD and ODD: Understanding the Key Differences

Do you know someone who “flips out” if the dishes in the dishwasher are not in the “correct” order? What about someone who experiences extreme anxiety if their school work or work tasks are not completed or performed “perfectly?” Perhaps, you have a co-worker who is “anal” about every document being labeled, categorized, and placed neatly in a filing cabinet or desk.

Do any of these scenarios sound familiar?

Is that person you or someone you love? If so, this individual (even if it is you) may have OCD or obsessive-compulsive disorder. There are many different types of OCD, but the key components in all of them are that they all involve stress, anxiety, obsessions, and compulsions. Understand, however, that some people may only experience obsessions, or compulsions, however, most experience both obsessions and compulsions.

Approximately 2% of adults (2-3 million) in the US struggle with OCD. And, approximately 500,000 children and teens in the US struggle with OCD.

Now ask yourself, do you know a young child or teen who exhibits behavioral problems, namely frequent temper tantrums, “meltdowns,” or mood swings so much that it is negatively affecting their life in some way? Is this individual irritable and easily agitated even when the trigger is small and insignificant? Can this person be stubborn to a fault, often “bucking against” rules or authority figures?”

Do any of these scenarios sound familiar?

If the answer to any of these questions is “yes,” then this child or teen may be suffering from ODD. People with ODD or oppositional defiant disorder are often described as “moody,” “stubborn” or “defiant,” and easily irritated by things that would not normally agitate most people. Unbeknownst to many, ODD is one of the #1 causes of mental health services referrals in the US and likely around the world.

Approximately 7% of children and teens in the US struggle with ODD.

ODD tends to be more prevalent in males than females, and it has a lifetime prevalence of approximately 10%

And, guess what? Approximately 12% of children with obsessive-compulsive disorder (OCD) also simultaneously struggle with oppositional defiant disorder (ODD). Thus, OCD and ODD can be a comorbid condition. Additionally, people with OCD and ODD comorbidity can also have other mood and behavioral conditions, such as OCD, ODD, and ADHD (attention-deficit hyperactivity disorder), OCD, ODD, and ASD (autism spectrum disorder), OCD, ODD, and anxiety, or OCD, ODD, and depression.

If you believe that you or someone you know is grappling with OCD and ODD, you have come to the right place because in this article you will learn what OCD and ODD are, how they are connected, and how they are typically treated when they occur independently or simultaneously. You will also learn the key differences between these two mental health conditions, you can make an informed decision about your health and well-being.

What is OCD?

According to the American Psychiatric Association (APA) and published in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), obsessive-compulsive disorder (OCD) involves obsessions and compulsions.

More specifically, people with OCD experience non-stop, unwanted, and upsetting or intrusive thoughts, fears, visions, emotions, and/or urges (obsessions). These intrusive thoughts and emotions are stressful and anxiety-provoking creating an OCD cycle of stress and anxiety – obsessions – compulsions – stress and anxiety – and so on. To stop or reduce their obsessions, people with this condition tend to perform rituals or routines (compulsions). For instance, an OCD sufferer who is afraid of “catching a virus,” like COVID-19, may wash or sanitize their hands until they crack and bleed (a compulsion).

A compulsion, on the other hand, is a repetitive “act,” designed to ease the stress and anxiety triggering the obsession. Examples of compulsions include repetitive handwashing, counting, organizing, repeating mantras or phrases, cleaning, checking, etc. These rituals or routines are designed to reduce or alleviate emotional distress (i.e., excessive fears, worries, anxiety, stress, etc.).

Non-stop obsessions and compulsions take a lot of effort and time, which adds to an OCD sufferer’s stress and angst. This condition not only affects the person’s self-esteem and self-confidence but also their ability to excel at work or school, build and maintain healthy relationships, and complete household, child-rearing, and personal tasks.

Understand that people with OCD are unable to control their thoughts, feelings, and behaviors. Additionally, OCD sufferers tend to spend an hour or more on their obsessions and/or compulsions, which prevents them from being productive and negatively affects their quality of life. There are different types of OCD each with specific characterizations. And, while there is no “official” cure for OCD, it can be effectively managed with psychotherapy, medication, natural remedies, and self-help tools, like Impulse Therapy, an online OCD recovery treatment plan.

Who is Most At Risk For OCD?

OCD usually occurs during a person’s teen or young adult years, however, it can present during childhood. OCD symptoms typically begin slowly and then wax and wane throughout a person’s life. Understand, however, that OCD is very common, accounting for millions of people worldwide. The cause of OCD varies from person to person, however, there are some known risk factors.

Children or teens who are or who have had these experiences have an elevated risk of developing OCD:

• Parents who have an anxiety disorder like OCD
• Parents or close relatives that have a mood disorder like depression
• A highly stressful or traumatic experience
• The presence of other mental health conditions like ODD, ADHD, Autism spectrum disorder (ASD), or tic disorder
• Substance abuse 
• Addiction

How is OCD Treated?

OCD treatment varies from person to person, however, it is normally treated with psychotherapy (i.e., cognitive-behavioral therapy (CBT) and/or exposure-response and prevention (ERP) therapy), medication (i.e., SSRI antidepressants), self-help tools (i.e., mindfulness meditation, hypnosis, and OCD forums and podcasts), and natural remedies (i.e., probiotics, vitamins, CBD, marijuana, and crystals therapy). 

The first line of treatment is psychotherapy, however, if that is ineffective, medication is typically added to the treatment program. When outpatient psychotherapy and medication supplementation are ineffective (i.e., treatment-resistant OCD), inpatient or residential OCD treatment may be required.

What is ODD?

Oppositional defiant disorder (ODD) is a behavioral condition that is disruptive in nature. It is similar to attention-deficit hyperactivity disorder (ADHD) and conduct disorder. When a person has ODD, they are repeatedly uncooperative, uncompliant, resistant, stubborn, defiant, and/or hostile towards people in authority (i.e., parents, grandparents, teachers, law enforcement, coaches, elders, bosses, etc.).

These individuals have a hard time controlling their temper, mood, and behavior, which is why they are often described as being hostile, moody, irritable, disruptive, easily agitated, angry, and disobedient. ODD symptoms typically fall into one of three categories – anger and irritability, argumentative and defiant behavior, and vindictiveness. ODD can interfere with or prevent a person from completing their daily tasks or accomplishing their goals. ODD can also interfere with romantic, family, and work relationships, friendships, dating, and social activities.

ODD usually presents around the age of 8. Researchers suggest that approximately 6% of school-age children and teens have ODD. According to experts, it is common for toddlers (children who are 2-3 years old) and pre-teens to be uncooperative, defiant, stubborn, and even hostile towards people of authority like their parents and/or teachers from time to time. Children and teens in these age groups may show disobedience by talking back to their parents, breaking household or school rules, arguing with their teachers, etc.

A child or teen may have ODD if the hostility, stubbornness, and disobedience last more than 6 months, and are more excessive than what is commonly exhibited in a particular age group. In fact, some experts suggest that ODD can be detected in some children as young as 2-3 years old. But, while ODD is more common in children and teens, it can also affect adults. 

Most children and teens who have ODD also have at least one other mental health condition, such as:

• Attention-Deficit Hyperactivity/Disorder (ADHD)
• An Anxiety Disorder (i.e., Obsessive-Compulsive Disorder (OCD))
• Learning Challenges
• A Mood Disorder (i.e., Depression)
• An Impulse-Control Disorder

Who is Most At Risk for ODD?

Although the cause of ODD varies from person to person, there are some known risk factors.

Children or teens who are or who have had these experiences have an elevated risk of developing ODD:

• A history of child abuse or neglect
• A parent or caregiver who has a mood disorder
• A parent or caregiver who has an addiction or engages in substance abuse or alcohol abuse
• Exposure to violence
• A lack of adult supervision
• Inconsistent parenting
• Dysfunctional family dynamics
• Familial instability (i.e., divorce, relocation, changing schools, new additions to the family, the loss of a loved one)
• Family debt
• A family history of ODD, ADHD, or behavioral problems

Note: Approximately 30% of children and teens with ODD will eventually develop conduct disorder, a more serious version of ODD, involving extreme anger and excessive aggression. And, approximately 40% of children and teens will eventually develop ADHD, or vice versa. 

If left untreated, ODD behaviors can continue into adulthood, causing relationship, academic, personal, social, and professional issues. Studies also suggest that children and teens with ODD have an elevated risk (90%) of developing mood or anxiety conditions like OCD or depression or engaging in substance abuse at some point in their lives. So, while ODD symptoms diminish with time for some children and teens, for others, these symptoms follow them into adulthood.

How is ODD Treated?

ODD treatment is based on a variety of factors, such as the person’s age, the severity of their ODD symptoms, the person’s ability to tolerate and engage in certain treatments (i.e., psychotherapy, natural remedies, or medication), and whether or not the person has other mental health conditions, such as ADHD, depression, or OCD.

When a child or teen is being treated for ODD, their families, teachers, coaches, and other authority figures in the person’s life may be involved in the ODD treatment. The most common ODD treatment involves parent-management training (PMT), psychotherapy (cognitive-behavioral therapy (CBT), CBT-based anger management, and family-focused therapy), school-based interventions, and/or medications (i.e., SSRI antidepressants or ADHD medications).

What Are Some Key Differences Between OCD and ODD Causes?

While there are some similarities between OCD and ODD when it comes to possible causes, there are also some key differences.

Possible causes of OCD include brain structure (i.e., orbitofrontal cortex (OFC), basal ganglia, and anterior cingulate cortex (ACC)) abnormalities. According to researchers, hyperactivity in these brain regions can lead to OCD symptoms (i.e., obsessions, compulsions, and learning deficits. Studies also suggest that trauma is a potential cause of OCD. More specifically, researchers have found that compulsions are linked to traumatic experiences like emotional and sexual abuse, neglect, or violence. Lastly, children who have had a streptococcal infection have an increased risk of developing pediatric autoimmune neuropsychiatric disorder (PANDAS), an infection-related form of OCD.

Conversely, the potential cause of ODD is personality traits or temperament. According to a previous study, toddlers who have a combative personality or difficult temperament have an increased risk of developing ODD later in life. Moreover, researchers suggest that parenting styles and practices, for example, authoritarian parenting, along with parental mood fluctuations (parental emotional dysregulation), can elevate a child’s risk of developing ODD. Lastly, social/environmental factors, such as poverty, exposure to toxins, dysfunctional family dynamics, poor nutrition, and disruptive or violent family environments appear to play a role in the development and progression of ODD.

What Are Some Key Differences Between OCD and ODD Symptoms?

While some symptoms overlap between OCD and ODD, there are also some key differences.

OCD symptoms typically involve intrusive, continuous and unwanted intrusive thoughts, fears, urges, emotions, and/or visions (obsessions), and/or repetitive rituals or routines (compulsions). Symptoms may also include inattention or a lack of focus, self-isolation, depression, and/or low self-esteem and self-confidence. While ODD symptoms typically involve an an inability to maintain a job due to one’s anger issues, hostility, and stubbornness, anti-social personality trait, irresponsibility, substance abuse or addiction, conduct disorder, self-harm, and suicidal ideation.

The main differences between OCD and ODD symptoms are that OCD symptoms involve obsessions and compulsions, while ODD symptoms do not. OCD symptoms are repetitive and involuntary while ODD sufferers have some control over their behaviors. OCD symptoms can be solely mental, while ODD are primarily physical. Although OCD sufferers can be stubborn or hostile, these behaviors stem from stress, anxiety, or fear, while ODD sufferers can be stubborn or hostile due to past trauma or a disregard of authority figures.

Note: Both OCD and ODD can involve anger and resentment. However, when anger is present in OCD, it usually has to do with anger at having unwanted, intrusive, and upsetting thoughts, visions, emotions, fears, and/or urges (obsessions) or engaging in ritualistic behaviors (compulsions). While anger and resentment in ODD has to do with defiance or a feeling of disregard of authority. In other words, ODD sufferers do not like being told what to do, following rules, being told “no,” etc.

What Are Some Key Differences Between OCD and ODD Diagnosis?

While there are some similarities in how OCD and ODD are diagnosed, there are also some key differences.

OCD and ODD are not the same disorder, and they are not listed under the same category in the DSM-5. For instance, observation, self-reports, a physical exam, psychological evaluations, and diagnostic tests are needed to diagnose OCD.

On the flipside, ODD is typically diagnosed in childhood by assessing the following factors: the person’s overall health, the frequency of behaviors, the severity of the behaviors, emotions and behaviors in various settings and with various people, family dynamics, coping strategies that have worked and those that have not worked, family issues caused by the behaviors, and other mental health condition, learning challenges, or problems with communication.

With ODD, parents, teachers, coaches, and other adults in the child’s life are usually the first to notice behavioral problems. ODD typically presents during early childhood or teen years, while OCD typically arises during the teen years or early adulthood.

What Are Some Key Differences Between OCD and ODD Treatments?

While there are some similarities in how OCD and ODD are treated (i.e., cognitive-behavioral therapy), there are also some key differences.

OCD is normally treated with CBT, ERP therapy, and sometimes acceptance and commitment therapy (ACT), along with other psychotherapies. When OCD therapy alone is ineffective, then medications, like SSRI antidepressants are prescribed to reduce OCD symptoms. If these antidepressants are ineffective or if the antidepressants present too many serious side effects, then antipsychotics are usually prescribed to “calm” the mind and ease the non-stop obsession and compulsions.

Another treatment that is often used to treat people with treatment-resistant OCD is transcranial magnetic stimulation (TMS). TMS is a safe and effective deep brain stimulation procedure that transmits electrical impulses to the brain through the scalp.

Conversely, ODD is normally treated using psychosocial therapies like parent-child interaction therapy. This therapy involves teaching parents how to interact (i.e., talk with, discipline, etc.) with their ODD children to elicit positive behavioral changes in them). It may also involve family therapy, which involves changing family dynamics in an effort to change ODD behaviors in the affected. Similar to OCD treatment, CBT is often used to treat ODD, however, the purpose for using it is different in the two disorders.

For instance, CBT is used in OCD to reduce or eliminate the unwanted, intrusive, and repetitive thoughts and behaviors (i.e., obsessions and compulsions), while CBT in ODD is used to reduce aggression, disobedience, defiance, hostility, and anger. It also helps people, especially children and teens learn how to problem-solve in a healthy way.

Lastly, multidimensional therapy is a common ODD treatment that not only focuses on the ODD sufferer but also takes into account family dynamics, relationships, social skills and interactions, and the environment for a more holistic approach. When these therapies are ineffective, antipsychotics are normally prescribed.

Note: If ODD persists despite interventions, medical practitioners prescribe an antipsychotic like risperidone, an atypical antipsychotic. Risperidone is sometimes used in ODD treatment to reduce or eliminate anger, aggression, and hostility. When there is a ODD and ADHD comorbidity, ADHD medications like methylphenidate (i.e., Ritalin).

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