It doesn't primarily manifest as anxiety, more of an intrusive thought (obsession). E.g. until you have washed your hands, you are actively aware of a feeling t

It doesn't primarily manifest as anxiety, more of an intrusive thought (obsession). E.g. until you have washed your hands, you are actively aware of a feeling they are unclean and need to be washed. This can amount to distractability and irritability, which is remedied by the compulsive act (washing hands). Combined with the highly co-morbid condition of ADHD, the intrusive thoughts can impair ability to manage attention.