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Episode 92. Understanding ADHD and OCD with Dr. Roberto Olivardia, Part I

What is Obsessive Compulsive Disorder (OCD)? Is OCD common with ADHD? What are the types of OCD? Roughly 80% of people with ADHD will be diagnosed with a psychiatric disorder, a comorbidity, at some point in their lifetime. This episode is the first of 2 parts with an expert on both ADHD and OCD, Dr. Roberto Olivardia. Before we go deep and discuss the relationship between OCD and ADHD, let’s first know more about OCD and the interplay of symptoms between both. Part 2 will follow next week.

Dr. Olivardia is a Clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School as well as a Clinical Associate at McLean Hospital. He also treats patients through his private practice in Lexington, MA where he uses evidence-based psychodynamic and cognitive behavioral treatment to treat a variety of disorders. He is the co-author of “The Adonis Complex,” a book that explores the various manifestations of body image problems in men and he currently serves on the Professional Advisory Boards for Children and Adults With ADHD (CHADD), The Attention Deficit Disorder Association (ADDA), and serves on the Scientific Advisory Board for ADDitude.

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Lindsay Guentzel (00:01):

You’re listening to Refocused. On today’s show, we’re exploring another one of the comorbidities tied to ADHD. This time, looking at obsessive compulsive disorder with clinical psychologist and ADHD advocate, Dr. Roberto Olivardia.

(00:38):

Roughly 80% of people with ADHD will be diagnosed with a comorbidity at some point in their lifetime. This includes psychiatric disorders like depression and anxiety, both rising to the top of the list as the most common. On today’s show, we’re looking at another psychiatric disorder that can pop up in the life of a neurodiverse person.

(01:03):

Today, we’re talking about obsessive compulsive disorder and its connection to ADHD. There are some OCD studies that show a higher prevalence of a dual diagnosis between OCD and ADHD, that an estimated 30% of patients with OCD also have attention deficit hyperactivity disorder. The problem is, when people have both OCD and ADHD, it’s pretty common that one of the disorders has been officially diagnosed, while the other one tends to fly under the radar. That complicates things, because having both disorders means it’s likely symptoms will be more severe than if a person were to just have one of the disorders.

(01:52):

Joining us today is Dr. Roberto Olivardia, an expert on both OCD and ADHD. Dr. Olivardia is a clinical instructor of psychology at Harvard Medical School, as well as a clinical associate at McLean Hospital, and he also treats patients through his private practice in Lexington, Massachusetts, where he uses evidence-based psychodynamic and cognitive behavioral treatment to work with people who have OCD, ADHD, executive functioning issues, eating disorders and body dysmorphic disorders.

(02:30):

He is also the co-author of The Adonis Complex, a book that explores the various manifestations of body image problems in men. He currently serves on the professional advisory boards for Children and Adults with ADHD through CHADD, ADDA, the Attention Deficit Disorder Association, and he serves on the scientific advisory board for Attitude Magazine.

(02:54):

Dr. Olivardia has also been a guest on Refocused, before all the way back on episode three, the Science Behind an ADHD Podcast: How Do ADHD Brains Learn? We are so excited to have him back here on Refocused. With that, let’s get into part one of understanding ADHD and OCD with Dr. Roberto Olivardia.

(03:27):

To get started, I want to ask you to explain obsessive compulsive disorder, but I want you to explain it twice. I’m hoping that you can start by giving us the technical version of the explanation, and then I’m wondering if you would put on your provider hat and explain it like you would if I were a patient coming to you, and it was something that we needed to talk about moving forward.

Roberto Olivardia (03:49):

They may be a bit one and the same in that, when describing to patients what OCD is, is we have these collection of symptoms that, one are what we call obsessions, which are these intrusive, repetitive thoughts that create a lot of anxiety for someone, can make someone feel really uncomfortable, but are just nagging, that someone just can’t push away, and often have some level of threat associated with it.

(04:21):

An obsessive thought could be, for example, someone close to you is going to get cancer. After touching a doorknob, you’re going to get an incommunicable disease. You’re going to Hell if you do something. Here are these thoughts that just keep coming to somebody, and you could just have obsessions and be diagnosed with OCD. Often though, OCD is coupled with what we call compulsions, and compulsions are behaviors that are in a sense, designed to neutralize the obsessive thought, to basically … That is the way of almost “coping” with the thought.

(05:01):

Now, sometimes the compulsion could be very related to the obsession. In contamination issues, for example, if I touch something and I think I have germs on my hands, the compulsion may be to wash my hands, but sometimes, compulsions could have nothing to do with the obsession. If I have an obsession that my best friend is going to get cancer, the compulsion could be to count things in sevens, for whatever reason. The compulsion could be to blink my eyes 40 times. The compulsion could be to not step on a crack on a sidewalk. The compulsion could be if I bump into something with my left side of my body, I have to then move and bump into my right side of my body.

(05:42):

Now, you can also just have compulsions, and also be diagnosed with OCD. That’s common, where sometimes people have these compulsive behaviors, and they almost don’t know why they’re doing it. It’s not that they have an obsessive thought to it, but the compulsions, typically with OCD, you’ll see this combination, although there is a type of OCD we can talk about called just right OCD, where often, you don’t have as many of those compulsive behaviors, but the compulsive behaviors are meant to neutralize the thought.

(06:10):

Someone does the compulsive behavior and temporarily, they feel better. It’s almost like, “Oh, okay, that thought has now lost power.” Now of course, what we know about OCD, you give it an inch, it will take a mile, it will take 10 miles very quickly. The more that that pattern happens, the more those intrusive thoughts start to happen, which then only increase more compulsive behavior. Then, OCD could be the kind of thing that really starts to take up a lot of territory.

(06:40):

It’s very interfering. It could be tormenting at times. It’s often used as this verb in popular culture, “I’m so OCD,” which is not appropriate, because OCD is a very difficult clinical disorder that people deal with. We’re not talking about, oh, I like to have my desk very neat. We’re talking about people who could spend perhaps hours organizing something, because it has to be perfect, or it has to be perfectly symmetrical.

(07:12):

Sometimes again, it could just be compulsive, and sometimes it’s connected to these very intrusive thoughts. There are many different manifestations of OCD. We have, the contamination fears are the ones that you’ll typically see in Hollywood movies, but it could be intrusive, violent, or sexual thoughts. People who might be convinced, for example, that they’re a pedophile when they’re not at all. It could be somebody who fears that they’re going to go to Hell by doing the slightest thing that could potentially be offensive. Then, they obsess about everything they’ve done or said in that day, in hopes that they didn’t say anything offensive that will lead them to Hell. It could be symmetry issues, perfectionism, again, this just right feeling. It could come in many different forms.

Lindsay Guentzel (07:58):

Now, before we get too far into our conversation, it is important to note that there are two primary categories for symptoms when we’re talking about OCD. Can you explain that to us?

Roberto Olivardia (08:08):

Yeah. With obsessions, this is more of a cognitive phenomenon in terms of, these are thoughts that people will have, and they just are intrusive. They just come out of the blue. They’re not wanted. They’re often thoughts that people try to push away. The way that our thoughts work is, the more we try to push something away, the more it’s going to hit us. If I just told you, don’t think of an elephant, your mind automatically is going to think of an elephant.

(08:39):

Maybe you’ll think of an elephant with a line through it to try not to think of one, but now you’re thinking of it. Then, the compulsions are, again, those behaviors that are often meant to neutralize those obsessive thoughts. Those are the two main symptoms that you’ll see with OCD.

Lindsay Guentzel (08:56):

You’ve just talked about the two different categories for symptoms of OCD, but then I understand there are different types of OCD, and you mentioned a few of them when we got started. Are there any types of OCD that tend to surprise people? Because as you mentioned, there is this idea of what OCD is, and a lot of that is perpetuated by stereotypes in the media.

Roberto Olivardia (09:19):

Yeah, there are a lot of types. One of the ones I mentioned before is something that’s called pedophilia OCD, which if somebody, especially if a clinician, for example, is not an expert in OCD or doesn’t understand OCD, and they have a client that comes to them and says, I fear that I molested my niece, for example, that could send a lot of alarm bells, as it should, if somebody thinks that a patient of theirs is committing harm to a child.

(09:50):

With this type of OCD, these are individuals who absolutely are not doing that, but they have intrusive thoughts that … For example, I had a patient years ago who when he would hug his son, he would think, am I hugging him because I love him, or because I want to be sexual with him? Am I getting an erection? Am I playing horsey with him because I want to and I’m getting aroused by this? Then, the more he would think about it, the more he would think, I must be, because why am I thinking about it so much unless I am?

(10:24):

We start to almost reason from our thoughts. With OCD, that’s a very slippery slope. Sometimes, patients don’t even know that there is that kind of OCD, for example. When they describe it and then they describe their symptoms, and I tell them about this, there’s this sense of both relief, and then the way OCD works is often that reassurance only takes you a small way. Then, they think, that would be nice if I had that, but I don’t think I have that. I think I really am that, for example.

(10:55):

That could be one. There’s another kind called scrupulosity, for example, which is almost like this hyper morality OCD. For people, whether it’s the fear of going to Hell or even just this fear of retribution or punishment, if they’ve done something wrong. Now, when they talk about doing something wrong, it could be something that objectively, that you and I would be like, that’s something we all do. We all cut someone off in traffic every now and then. Maybe if we’re at the supermarket and they didn’t charge us for that mandarin orange, we’re like, whatever, 50 cents, I didn’t get charged. To someone with OCD, they might see that as this very big sin, that somehow there’s going to be retribution now to them.

(11:43):

There are a lot of types that people … And then there’s this, what we call just right OCD, which a lot of times, patients will be like, “I don’t know if it’s OCD because I’m not doing any compulsions, and I’m not washing my hands or ordering things. I just have these thoughts that just go over and over and over and over again in my head.”

(12:02):

Sometimes, and it turns out that there technically can be a compulsion, it’s just a mental compulsion. For example, a just right thought could be, I had a patient recently who, every time he would make a decision, he would have to almost doubt … He felt that he had to doubt the decision, argue against the decision, and then get to a place where he’s like, okay, well maybe that was the right decision, but it would be immoral if I rested on my laurels and believe that this decision was right. I have to find every reason that it’s wrong, to the point where he was never making a decision, he was just paralyzed.

(12:46):

It all comes from a place of morality, where he’s wanted to make the most moral decision. In a way, the way that OCD is set up is that, the most moral people are the people that really labor on their decisions.

(13:03):

OCD, one of the … This isn’t a DSM criteria, but I always like to describe to people, the phenomenon, the sensibility around it. With OCD, what makes it so difficult is it disguises itself as a value. We all have values. I have a value for being a healthy person. I really want to live to be 100, at least. I have OCD traits, and it’s not surprising that one of the ways that it will come out is around health. If I send something off in my body, it definitely sends alarm bells up more than I know it would for somebody else.

(13:46):

Part of it is, well, I value my health, so I should be upset, and I should be concerned if something feels off. Yes, I should be. But, with OCD, it gets very … It goes from zero to 100. I know for example, now, I never google anything, I will call my doctor because in the past, I have googled things and get my head into a really bad space, because I’m then convinced that I have the worst-case scenario.

(14:15):

To be a moral person is a great value, but OCD hops on that value and it twists it, to convince you that the OCD is … That satisfying the OCD is satisfying the value. A lot of the work is helping people separate, no, being an adult that is good to children and is safe with children is a great thing. That’s a good value, but this thing with this OCD is not serving that value.

(14:48):

In fact, with that patient of mine years ago, he wasn’t the dad that he wanted to be, because his OCD got so bad, he felt he shouldn’t touch his son, hug his son, kiss his son, change his diaper, and for months before he sought treatment, he refused to even sleep in the same room, eventually the same house. It got so bad. His wife was like, “What are you talking about? You’re a loving individual.” His OCD convinced him that if he got close, that he would do something bad.

(15:22):

That’s the thing is that … He was the most loving father, and now he’s in a very good place, and being the father that he wants to be.

Lindsay Guentzel (15:30):

That’s a wonderful example of something that is incredibly traumatic and very serious, but can have a positive outcome when one, you know what you’re working with, and two, you’re working with somebody who knows how to treat it.

(15:44):

You implied a little bit as to what intrusive thoughts are, and I think most of us can read between the lines in the examples that you use to see what those are. I’m wondering if you wouldn’t mind explaining exactly what intrusive thoughts are?

Roberto Olivardia (15:58):

Yeah. An intrusive thought is something that almost seems like it’s just coming out of the blue. It’s not even something that patients will regard that they feel that they’re actively generating themselves, almost as if you’re driving on the highway and then suddenly, this bird just flies, and you swerve a little bit. People are almost like taken by it in some ways.

(16:25):

It’s not psychosis, because it’s not like they’re hearing a voice, for example, but it’s as if the thought though is coming from this other place, they’ll often report, and it’s intrusive in the way that it grips their attention, and it’s highly charged. There’s nothing casual about an intrusive thought. It’s, your mother’s going to get breast cancer if you do this or think this way, or just, your mother’s going to get breast cancer. It could be something that just almost takes someone by surprise.

(16:58):

Then, because it has that charge to it, it sets off from a neurological perspective, that amygdala, which is the part of our brain that is that fight or flight threat assessment. It activates that part of the brain. Now, human nature, when the amygdala is activated, we are designed to pay attention to that. We’re designed for our survival to, if we hear a grumbling in the bushes, that might be a tiger, we should be heightened and scared a little bit, for our survival, and seek out the evidence. Then, we find out, oh, that’s not a tiger, that’s a little kitty cat. Then, we’re soothed and we’re calmed down.

(17:41):

With OCD, this intrusive thought doesn’t almost … It’s so charged that it almost doesn’t respond to the same evidence, because OCD is also something that predicates itself on possibility, rather than probability. If I’m working with someone who, let’s say, has obsessive thoughts about driving, that they’re going to … And this was something that I experienced when I was in my early 20s when I started driving, I would have intrusive thoughts of, oh my gosh, I could drive my car into another lane and I could instantly hit another car and I can kill a family of four in a second.

(18:25):

For those who know me, one of my core values is, I want to be a positive force in the world. I want to elevate people. I want to make people happy and healthy. Here’s this intrusive thought that is not only not that, but it’s killing people. It’s causing destruction, it’s causing harm. Not surprising that that’s how it would come out, and it was very, very difficult. It would just come out of the blue. I would just start driving, and it could be, when you swerve a little bit on the lane, when you’re moving, going down the road, and then suddenly the thought would hit me, and it would be so charged and I can visualize it.

(19:04):

Then, I’m thinking, am I going into the other lane? Do I want that to happen? Then, if I did, that would make me an awful person. That would be terrible. Then, you start going … When I have patients, for example, who might have a certain, let’s say, an intrusive thought around someone getting cancer, I can’t tell them that won’t happen. I can guarantee that if someone’s going to get cancer, it’s not because they thought about it. Thoughts don’t create cancer, but can someone close to you get cancer? They could. It’s a possibility.

(19:39):

With the evidence that we see, it’s not a high probability, but OCD grips people in possibility. If you’re telling me there’s a .0000001% chance that I might go to Hell if I don’t pray 50 times after having an impure thought, then I’m going to do it, is how OCD works. It’s very difficult to hear when people are like, “Oh, just don’t think about it,” or, “Oh, that’s ridiculous,” or, “You’re not capable of doing that.” It doesn’t really work for someone.

Lindsay Guentzel (20:14):

It’s like when you said, don’t think about an elephant, and then I immediately think of an elephant, and then if you came to me 10 minutes later, and you were like, “Stop thinking about the elephant, why are you still thinking about the elephant?” You’re like, “There’s this thing called hyperfocus and it is in my brain now, and it is not going anywhere.”

Roberto Olivardia (20:32):

Exactly.

Lindsay Guentzel (20:34):

Let’s talk a little bit about the symptoms of OCD, how it shows up in a person’s life. Keeping in mind that public perception, what are some of the symptoms that people tend to know about when they come to you?

Roberto Olivardia (20:47):

A lot of times when we think about representations of OCD in film and TV shows, certainly the one that’s the most common are contamination concerns, the germaphobes and that sort of OCD. I think that’s very clear for a lot of people. The ones that are lesser known are the intrusive thoughts, and particularly because it’s very …

(21:12):

First, it’s very shameful for people who have intrusive violent and sexual thoughts. When I’m talking about those thoughts, an intrusive violent thought might be somebody who has … And sometimes it’s a thought and sometimes it’s an image. For a patient, I might have a patient that came in and he’s like, “I have an anger problem,” is what his presenting issue was. Okay, let’s talk about that. He said, “I get these flashes of imagery of stabbing my mother in the neck.”

(21:42):

Okay, let’s talk about that. Have you ever been violent? “Oh, no. I would never be. I hate violence. I don’t even like confrontation.” Okay, do you and your mom have a very difficult relationship? “Oh, no. I love my mom dearly. We’re very, very close. We’re very connected.” Okay, so I’m not … Do you get mad at her? “No, not at all.”

(22:02):

Then, as we’re talking, it becomes clear, this isn’t an anger management problem. He’s having these intrusive imagery of stabbing a person who he loves dearly, again, values the relationship with his mom. They were super close, wonderful mom, of just this imagery of just stabbing her with the steak knife. He got to a point where he could not eat meals next to her, because he was afraid, I’m going to get my fork and stab you in the neck. I’m going to get my knife, stab you in the neck.

(22:32):

Then, he couldn’t use pencils, pens, and then eventually he couldn’t see his mother at all. This is before COVID, and this is what OCD does, is that, avoidance is a very characteristic symptom as well. You have, in addition to the compulsion, sometimes it gets all out avoidance. Then, he thought, I can’t even be near her.

(22:53):

Then, as we assessed it, and when I explained to him, because again, when we think about … Sometimes even in Buddhist thought, you hear, you are your thoughts in some ways, and culturally we think, if again, you don’t understand OCD and you have a patient saying, I have this imagery of stabbing my mom in the neck, of course, I assess it, but if you don’t understand OCD, and then when I explained to him, oh no, this is a type of OCD, it’s intrusive, violent thoughts, and he said, “Oh my gosh.”

(23:21):

First, he thought that I was saying that just to reassure him, and he was like, “No, I really am a terrible, evil person, but you’re trying to make me feel like I’m not,” because again, OCD is so rigid in that way. I had books and I had YouTube videos to show him, and he wanted to believe it, but he goes, “I think for me, it’s different. I think I’m capable of doing that.”

(23:49):

Those thoughts in particular are ones that are rarely discussed, and where there’s the most shame around. There’s a type of OCD, I remember years ago, working with someone who believed that a family member of hers was an imposter, and it was not psychosis, there is a form of OCD where you have an obsessive thought that somebody close to you is not who … That it’s an imposter that literally has assumed that role. She was like, “This person is infiltrating our family.”

(24:22):

I had another person years ago who had a type of OCD where, if she sat or stood in the same spot as a particular member of her family, then she would inhabit all of those qualities of that person in the family whom she did not have a good relationship with. She had to find out, when she came home from school, she would ask her mom, “I need to know every place that so-and-so sat and stood in this house, so that I don’t sit …” It was almost a 20 to 48-hour period.

(24:56):

Now, as you can imagine, this is so difficult for a family to deal with. For the individual, it’s tormenting, but for a family, this is a disorder that doesn’t just affect the individual. I think with families, they often think that they’re helping by accommodating it. We call it an accommodation syndrome where it’s all good intentions, but it’s not going to be helpful to then say, “Oh, these are all the places that this person sat,” and those sorts of things.

(25:23):

It can come in a lot of different ways that don’t always get represented in popular culture.

Lindsay Guentzel (25:31):

The examples you used feel like ones that are incredibly extreme, to the point where that is what is bringing them to you, and you’re able to say, “Hey, there’s something here we can actually explore, and there’s ways to treat it.”

(25:44):

I’m wondering about some of the symptoms that even someone like myself might be managing or masking on a day-to-day basis, that I might not even know could be connected to OCD.

Roberto Olivardia (25:57):

Yeah. There are certainly traits that people might have in these things. Most symptoms exist on a spectrum. Sometimes, it’s that just right feeling, and anytime, especially when ADHD is in the picture, it could be sometimes, these OCD traits can almost be overcompensation for some ADHD symptoms. Sometimes, they’re habits or rituals that are overcompensations for executive functioning issues, but sometimes, they’re not.

(26:25):

Sometimes, they could be these nagging thoughts, but that people have better ways of coping with, or better able to disconnect from in ways. Sometimes, I work with many people where they’re not coming to me for OCD, they’re coming to me for something else, but we’ll talk about rituals that they have, but they’re not really looking to treat them, because they’re not that impairing or interfering, even though I might think that they take up a lot more time than it probably should.

(26:56):

There are a lot of people that live with rituals and intrusive thoughts, and things like that, that just might not hit a certain level enough that cause that much, or they just have strategies of dealing with them.

Lindsay Guentzel (27:13):

For someone who’s being treated for both ADHD and OCD, from your experience, do they come in knowing that they’d like to talk to you about OCD, or does it tend to be something that you observe from your time working with them?

Roberto Olivardia (27:27):

Typically, I would say in probably 90% of the time, people come in with one of those diagnoses made, and the other one not identified. I’ve seen it both ways. I’ve worked with lots of people who come in, they have ADHD, and then in the course of working together, and in my intake, I usually ask about symptoms of everything else, depression, bipolar, substance abuse, eating disorders.

(27:53):

Sometimes, it gets … I can identify it pretty quickly, but other times, even in the course of the work, I say, it seems to me that there’s something more here than ADHD, or some of the attention issues that we assume are just ADHD might be more OCD related. Then, it turns out they also have a diagnosis of OCD. I’ve also seen the other, where many people come in with OCD, and one example that very much comes to mind 20 years ago, working with this young man who had very severe OCD, and he would be 45 minutes late to a 50-minute session.

(28:33):

He was late all the time, and sweating coming to sessions, and just so shameful that he was late. It was clear he was invested in treatment, but he was late all the time, and we would explore it. Now, it’s not unusual for some OCD patients to sometimes run late, because they’re ritualizing. They might be stuck in their house, especially if their OCD involves stuff around their house, or checking stoves or things like that.

(29:03):

That wasn’t it. When we explored it, and I said, “Okay, we have five minutes, let’s explore this.” He described, he said, “I have every intention,” we have the appointment at 9:00 a.m., he lives maybe 20 minutes away. He said, “I am ready to leave my house at 8:00 a.m.. I’m way early, but I can’t find my keys, because I don’t know where I put them the night before, and my house is a total mess.

(29:27):

“Then, as I’m leaving the house, I realized, oh, I didn’t send that email to my boss, so let me quickly send that email to my boss now, since it’s on my mind.” Then, he’ll go out and then he’ll start driving and realize that his car tank is almost out of gas, and then he has to go to the gas station, and then he left the gas station, but left his credit card at the gas station. This is literally what happened, and then got the wrong address and would …

(29:55):

It would be all of this executive functioning stuff. Then, lo and behold, when we did a clinical evaluation, he had classic ADHD, but what pains me when I think about him, and I actually have kept in touch with him, and he’s doing great now, but he said to me, “Please don’t fire me.”

(30:15):

I’ve never fired a patient, but I said, “What do you mean?” He said, “I’ve had three therapists who have fired me because they assumed,” because he said, this is the biggest … This is such a problem, always late, always late for sessions. They assumed I wasn’t motivated for treatment, I was treatment resistant. I said, “I’m absolutely not going to fire you. In fact, this is the work. This is the work we’re going to do, is getting you here on time. There’s no shame in this. This is what ADHD is.”

(30:45):

Lindsay, that’s what we worked on for, it was maybe seven weeks, we were working on getting a system down for him to be on time. After seven, I remember the seventh week, he was only 20 minutes late, as opposed to 45, and we celebrated that. We were like, wow, we have now a good half hour, 35 minutes, and we can get some stuff done. Then eventually, he was on time, and we started then really immersively working on the OCD.

(31:14):

I work with a lot of comorbidity with ADHD for lots of different things. If ADHD is not managed or treated, it will undermine the treatment of any comorbid disorder. Yeah, very rarely do I have people who come in diagnosed accurately with both. There’s usually one, and whatever is diagnosed, a lot of times, the symptoms of the other get subsumed under that, where they’re like, “Oh, he has OCD, that’s why we assumed he had attention problems. We didn’t even imagine that he also had ADHD,” or the opposite like, “Oh, we assumed it was just the ADHD that was distracting him,” but no one thought, “Oh, no, intrusive thoughts is very different than, oh, I’m bored, let me think about something.”

Lindsay Guentzel (32:02):

There’s no doubt a lot going through your brain right now. Mine too. I want to dive further into something Dr. Olivardia touched on in today’s episode. He mentioned how people with OCD use compulsions to deal with intrusive thoughts, and he spoke briefly about habits and rituals, and how the latter can be used to overcompensate for some of the executive functioning issues us ADHDers often struggle with.

(32:33):

I wanted to learn a little more about it, and so I sent Dr. Olivardia an email. Here’s his reply. “A ritual in and of itself is a repeated behavior or set of behaviors you engage in for a goal in mind. Many people with ADHD have rituals they have for getting ready in the morning, getting things done, et cetera. It’s fine if it’s moving someone forward and achieving the actual goal. If your ritual is get up, brush teeth, shave, shower, dress, breakfast, feed dog, go to work, you are going through the same pattern of behaviors because it helps us remember what we need to do, and moves us through the morning.

(33:16):

“It crosses into an OCD ritual when it either gets us stuck and not moving forward, as in brushing your teeth five times before moving on to the next task, or is under the illusion that we need to perform the ritual when we do not, like needing to count to seven or pray repeatedly before leaving the house, for fear that something bad would happen.”

(33:40):

Again, some more incredible insight from Dr. Olivardia there that I hope helps you clarify the difference a little better, because knowing that difference between the two is a big deal, because then we have an idea if maybe we want to seek out help for something that’s going on. We’re all in this game to grow a little, right? Which we’ll have another opportunity to do next week for part two of our conversation with Dr. Olivardia.

(34:07):

We’ll talk more about why OCD and ADHD often get mixed up, and we’ll look at how these two brains compare and contrast to one another. Plus, we’ll learn more about treatments for OCD and how ADHD can affect that process. Way more for us to learn about next week. In the meantime, the Refocused team has compiled an awesome list of resources for you to learn more about ADHD and OCD. You can find that in the show notes right now.

(34:38):

Thank you so much for joining us today, and we’ll see you back here very soon.

(34:44):

Refocused is a collaboration between me, Lindsay Guentzel, and ADHD Online, a telemedicine mental healthcare company that provides affordable and accessible ADHD assessments and treatment plans. To learn how they can help you on your journey, head to ADHDonline.com.

(35:06):

A huge thanks to my managing editor, Sarah Platanitis, who is instrumental in building these conversations for you guys. She is the yin to my ADHD brain yang, and I’m so lucky to have her on the team.

(35:21):

Our coordinating producer, Phil Rodemann, does everything in his power to keep me on track. It is a monster task, and I am so happy he came out of retirement to give podcast life a go.

(35:34):

Al Chaplin is our go-to for all things social media, and I love what they’ve been creating for us. Make sure to give it a like and a follow @RefocusedPod over on Instagram.

(35:47):

Lauren Terry is our fearless associate producer who tackles everything I give her with tenacity and a great sense of humor, and I absolutely have to give a shout-out and a huge thank you to Jake Beaver for his help in editing this episode.

(36:03):

Refocused couldn’t happen without my partners-turned-friends at ADHD Online. High fives to the ones that I bug the most. Keith Boswell, Claudia Gotti, Melanie Mile, Susanne Spruitt, and Tricia Merchanduni. Our show art was created by Sissy Yee of Berlin Grey, and our music was created by Louis Inglis, a singer-songwriter from Perth, Australia, who was diagnosed with ADHD in 2020 at the age of 39.

(36:32):

Finally, a big thanks to Mason Nelly over at Dexia in Grand Rapids, Michigan for all of his help in getting our videos ready to share with you guys. Links to all of the partners we work with are available in the show notes.

(36:47):

To connect with the show or with me, you can find us online at Refocused Pod, as well as, @LindsayGuentzel, and you can email the show directly, [email protected]. That’s [email protected].

(37:05):

Take care of yourselves please, and in an effort to reduce the unbelievable amount of stress we all carry around with us unnecessarily, be a little kinder to yourselves this week.

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