Episode 93. Understanding ADHD and OCD with Dr. Roberto Olivardia, Part II

This week we continue our conversation with Dr. Roberto Olivardia and talk about how & why ADHD and OCD can get mixed up. What are the biggest connections between the two? What is the difference between external and internal distractibility and what that means for a person who could have both? Don’t miss out on this episode because it is full of useful information.

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 (00:00):

You’re listening to Refocused, a podcast all about ADHD in episode 93, part two of Understanding ADHD and OCD with Dr. Roberto Olivardia. Get started right now. My name is Lindsay Guentzel, and every week on Refocused we dive into the incredibly complex world of ADHD, exploring the topics most important to our community by interviewing medical providers, mental health professionals, and ADHD experts.


We also just talk to other Neurodiverse folks who share what it’s like living in a world not built for them and of course, all of that brings up lots of tips, tricks and workarounds that we can mix and match to fit in our own lives and needs. Whether you’ve been navigating ADHD your entire life, or you’re just starting your journey, there’s something for everyone on Refocused and I promise that while we take this very seriously, we also have a lot of fun because life is way better with a little laughter in it. So sit back, relax, or do whatever you need to do to get into your listening mode because the latest episode of Refocused, gets started right now.


Welcome back to our two-part discussion on ADHD and OCD. If you haven’t listened to our last episode just yet, feel free to give this one a pause and head over to part one, to take a listen and get a solid overview on OCD, its symptoms and its types. Something that has surprised me as I started learning more about OCD was just how similar it can be to ADHD. They are so similar in fact that Roberto even refers to them as cousins. Now, as a mental health advocate, I like to think I’m up on things, but our conversation has made me realize I didn’t fully comprehend the complexity of OCD.


I only knew a very small sliver, most of which came from representations I had seen in television and in movies, but just like other mental health diagnoses, even with OCD, there’s a pretty vast spectrum to the playlist, and we often only hear the best hits, which leaves a lot to still be discovered and that can play a significant role in holding people back from getting the help they need. People can have narrow ideas about mental health and what we see, hear, and read can impact how we deal with our own mental health and unfortunately, it can perpetuate stigmas that can cause a whole myriad of emotions like shame and fear.


The thing is, successful treatment of OCD means getting symptoms to a level where they are manageable and no longer interfering or causing impairment in someone’s life and that requires maintenance for both OCD and ADHD as well as mindfulness with symptoms that goes beyond just taking medication. And it is important to note that the consequences can be dire if both of the disorders are left untreated, so today we are going to dig in again, welcoming back Dr. Roberto Olivardia for more on OCD and ADHD. We’ll talk about why the two disorders often get mixed up, how the two brains are similar, as well as different and we’ll learn more about treatments for OCD and how ADHD can affect that process.


This is a perfect time to talk about why ADHD and OCD can get mixed up as you just mentioned. So we know that there are symptoms that crossover, but we also know that they share risk factors including genetics, stress and trauma, which is great because it just adds to the complexity of that lovely gray area of ADHD and all of its comorbidities. So I’m curious what you see when you’re working with people on what stands out as to the biggest connections between the two for why they do get mixed up?

Dr. Roberto Olivardia (04:43):

What’s so interesting about it is when looking at why do we see it often together that we know, as you mentioned, about 30% of people with OCD and research have been shown to have ADHD. We don’t know how many percent of people with ADHD have OCD and when we look at neurological research and genetics and things like that, that the thing that stands out the most of why we might see this comorbidity is that people with ADHD tend to marry and mate with people with OCD and then you have children and the genetics are going to be, maybe one has pure ADHD, one has pure OCD, and one is going to have a little of both. And when I have said that in talks, anytime I say that and there’s couples in the audience, they look at their partner.


If I’m at an ADHD conference or an OCD conference, because I’ve spoken at this in both communities, they giggle and laugh and it makes sense because it’s understandable why someone with ADHD would be attracted to someone, and it’s not like, “Oh, I’m attracted to obsessive compulsive disorder,” but some of the personality traits that can come along with someone with OCD that is not pathological, someone who is very orderly, that dots their I’S and crosses their T’s, that is very logical and sort of practical in that way. And we can also see why someone with those traits could be attracted to someone with ADHD, someone who’s more spontaneous, who can maybe go with the flow, who maybe doesn’t always have to be perfect and is okay in a sense with themselves.


So there’s an attraction there. However, if it’s not understood that those two things are happening, it can also be a recipe for divorce if a relationship isn’t understanding both of those things can play a role in it, but that’s actually one of the major reasons that has been shown as to why we see this comorbidity as just these genes sprinkling down. Now, one of the other things too is in thinking about OCD, OCD is I think of it also as an attention disorder, if you think about it.


I mean with ADHD, we know it’s an attention dysregulation. We have a hard time paying attention to things that are boring and uninteresting. We have a super easy time when it’s something that we find stimulating with OCD, it’s also an attention dysregulation. The person with OCD is thinking too much though about something that is regarded as a threat related thought. They cannot unstick themselves. They cannot unglue themselves from that threat related thought and think about these other things. So there’s almost this rigidity of thought, but almost they’re held hostage by it though, they don’t want to be thinking of it except in service of the OCD where they might say, “Well, no, I should be thinking of this because not thinking of this makes me a bad person. If I don’t pay attention to the fact that I’m a violent person,” or something. So in that level, there are studies that have looked neuro-scientifically that wonder whether this comorbidity is also something about in terms of our attentional regulation system, is it just that it’s almost like fluctuating from one end of the spectrum to another?


And we see that with ADHD as well that we glue ourselves to certain thoughts, and we know with emotional dysregulation for people with ADHD who might have, let’s say, rejection sensitivity, they can hone in on those kinds of things. It’s interesting, because we often think of it as opposite like ADHD and OCD, I don’t think of them as so opposite. I really think of them as kind of in this, almost like cousins in a way, but there isn’t a significant amount of research actually that has looked at a lot of the etiology behind it, but the thing so far that seems to come through is this meeting and genes and how they sprinkled through.

Lindsay Guentzel (08:48):

I was not thinking about my family and I was not going to text my sister after this was done, I promise. I’m wondering if we know anything, anything specific about a person who has ADHD and OCD and their brain, what does that brain tend to look like or behave?

Dr. Roberto Olivardia (09:04):

So what’s interesting is in studies that have looked at people with ADHD as compared to people with ADHD and OCD, interestingly one of the things that comes through is OCD actually has a mitigating or protective factor towards impulsivity. So in some regards, people with ADHD and OCD in certain respects like with risk of substance abuse, risk of impulsive behaviors, people with ADHD and OCD score lower in than people with just ADHD. So there’s almost a strange protective factor of having OCD because typically with OCD, it’s more inhibitory. People with OCD are often, or I think of ADHD as for myself, I think of it as an orientation. I am oriented to the world by what is going to stimulate me and someone with pure OCD, they’re oriented to the world by what is threatening that I need to move away from, what is threatening in this environment, I’m going to move.


So an OCD person almost is not pleasure driven by nature because there’s so much more about avoiding the harm, avoiding avoiding, avoiding. The ADHD person, pure ADHD person is, I don’t care. I mean, I certainly could remember when I was a kid, I didn’t care if it was dangerous, if it was stimulating and interesting, let’s go with it. I used to say, “It’ll be a story.” Now when both of them are in there, this is where it can be so nuanced and it can be so different for different people depending on how their ADHD works and how their OCD works and how specific it is. So if I think personally, for example, where health is a very important thing for me and something that I can definitely get obsessive about, I in some ways have embraced that because it has prevented me from crossing lines that I know if I didn’t have that trait would’ve brought me to not so great places.


I do have a very addictive personality, but I did not experiment with drugs because I worry too much about… I mean, I remember in high school, I’m a huge music lover and I had a lot of friends and a lot of them took very difficult paths in their life, but one of them I remember was doing acid. We were listening to The Cure, who I love. I’m going to see them in Atlanta in a couple of weeks, can’t wait and he said, ‘Oh my gosh, you can taste Simon Gallup,” the bass player, “Simon Gallup’s notes, I can taste them,” and I thought, oh my gosh, that must be so amazing and the thing that prevented me from not doing it was one thinking, well, I love music so much, and if I do this and it heightens the experience, then I’m never going to want to not do it.


I mean, if you’re telling me I can optimize it, then I’m always going to want it that way, which that’s not good and two is anything that could do that is probably not going to be good for your brain, but I can tell you I was very curious, but I know that that sort of held me back. I would never not wear a seatbelt. I remember in driver’s ed when they would talk about seat belts and how a lot of people don’t wear seat belts, and I thought, that is insane to me. How would you not, that’s so preventable, but that’s because health is such a thing. So for me, in that realm now, it doesn’t mean that there are other things that my ADHD might play itself out. So it really depends, because we know we could take 20 people with ADHD in a room and there are going to be things that we all a hundred percent relate to.


And then there are things that are vastly different based on all these intersectional variables, our gender, our race, how old we were, where did we grow up, our parental support, what school did we go to and OCD is very similar, I mean, in that way. There’s such variation as to how even different people experience it. So then when you put the two together, my job, a lot of the time at the beginning when I’m working with someone is to understand their individual experience with each condition and then when it’s all combined, how does it present to them, because I can tell you I’m an expert in ADHD and in OCD, but I always tell people, I’m not an expert on your presentation of ADHD and OCD, I need your story. I need you to tell me what that is

Lindsay Guentzel (13:37):

Going off of the idea that ADHD and OCD are cousins, distractibility shows up in both disorders, but it shows up differently and I’m wondering if you can explain a little bit about the difference between the external and the internal distractibility and what that means for a person who would have both?

Dr. Roberto Olivardia (13:54):

Great question. So this is the example I often think about and what’s fascinating is patients of mine, and this is true even for young kids that I work with that have ADHD and OCD most of the time, they’re very good at actually identifying and distinguishing the difference when you ask them. I always say, “Is ADHD driving the bus or is OCD driving the bus?” And they know, most of the time they know. So the example I think about is, let’s say you have a kid in class and he is totally distracted, not paying attention to what the teacher is saying in ADHD land, it’s the kid that’s trying to pay attention, but he’s bored and it’s like wah, wah, wah, the teacher. And so he’s disconnected from it because there’s not enough glue in that situation to keep him grounded in it.


So then he’s wandering and he’s searching for something stimulating to think about, and then he thinks, oh, maybe he’s thinking of the video game that he’s going to play when he’s at home and now he’s thinking of all the moves that he does in this video game and he’s sort of lost in this thought, but it’s what we call Egosyntonic. He likes it. It’s not distressing to him. He’s engaging with it as a way of coping with the fact that he can’t glue himself to sort of the present moment and he doesn’t really want to go back into the present moment because it’s boring, it’s not stimulating.


Now, scenario B, you can have, let’s say an individual who they are connected to the class, they might be engaged in it, they’re not bored by it, they’re totally, and then let’s say it’s a biology class, and they are learning about Aids, and then suddenly they have this intrusive thought, “Do I have aids? I was coughing yesterday, if that’s a symptom of Aids, do I have aids?” And now suddenly, again, threat, it is now they’re derailed away from listening to the teacher and then they’re thinking in their mind, “Okay, what are all the symptoms? Do I satisfy those symptoms? Oh my gosh. Well, if blood… Did I touch anything that had blood? Wait a minute, that thing last week looked like blood. Well, maybe it was paint, but I don’t know, maybe it wasn’t red paint. Maybe it was blood, and maybe I had a little sliver of a cut in my finger and it went in there. Maybe it infected me. Oh my gosh, I probably have Aids. If I have AIDS and I’m going to be…”


And the thoughts can go and go, and it’s ego-dystonic. So not a thought that they want, they were interested and connected to that, but it’s almost like the intrusive thought, ripped them, ripped the glue off them. They were glued into the moment, but it ripped it right off, and they were sent into a stratosphere, and they’re distressed now. Their heart rate is going, they’re feeling panicking and having those kinds of thoughts. So here are two scenarios that now an outside observer might, and this has happened where teachers are like, “Oh, I can tell when they’re distracted.” Those two kids could look exactly the same. I mean, unless the second kid might look more panicky, but they could internalize those symptoms and just look like they’re spacing out, but the internal experience is completely different in terms of what’s happening.

Lindsay Guentzel (17:17):

I want to talk about treatment, and I’m wondering what is treatment like for somebody who has both ADHD and OCD and how is it different from how you would treat ADHD on its own and OCD on its own?

Dr. Roberto Olivardia (17:33):

So with ADHD, it’s a very integrative treatment model. So everything from psycho education, executive functioning, coaching, interpersonal therapy to deal with any negative self-esteem that might come along with ADHD, cognitive behavioral therapy to assess sort of an accurate negative thought patterns that people would have, behavioral therapy, where you’re engaging people in habits that they want to have like good sleep habits and eating habits.


As far as psycho-pharmacologically, it could include stimulant medication or non-stimulant medication and mindfulness skills, grounding someone in the present moment and their experience and really very practical in terms of, okay, what are the ways that ADHD is getting in the way and how do we almost coach or problem solve around that. OCD is you have medication can be a part of it. Typically, the SSRIs in particular medications like Luvox and Zoloft, which are antidepressants, but they have anti obsessional properties to them, but the gold standard treatment for obsessive compulsive disorder is something called exposure and response prevention treatment or ERP.


And if you have OCD and you are not doing this kind of treatment, you are not getting adequate treatment for your OCD and ERP will sound very bizarre and odd to people who have never heard of it, but I’ll give you an example. The first patient I’ve ever treated with OCD in my training at McLean Hospital, which is a renowned psychiatric hospital, and they have the best OCD residential program in the world, and these are people with severe OCD and I was learning how to do this kind of coaching, and I was assigned this patient who had what is called hit and run OCD, which sort of colloquially, and basically what this is she would drive to work and any bump at all.


I mean, it could be the slightest bump, she would have an intrusive thought of, “Did I hit somebody? Was that a person that I drove over? No, it was probably just a bump, but how do I know maybe it was a person and if I don’t stop, that makes me a very immoral person that makes me a criminal.” So she would have to get off the exit circle around the highway, get to that same spot and check to see, sure enough, there wasn’t a body there, there wasn’t blood on her hood or anything. So she’d keep driving and then she would think maybe I hit them and they rolled down the ditch. She’d have to circle around again, and I mean, it would get to where she’d have to call every hospital in the geography to make sure no unidentified people because she was just concerned about this.


So needless to say she never got to work. Ended up checking into this program, and this is something I worked with a number of patients with this type of OCD. So they said, “Okay, Roberto, you’re going to take this patient in your car and drive around bumpy roads, speed bumps, and she’s going to say,” “Oh my gosh, we have to stop. I think we hit someone,” and I’m supposed to say, “Maybe we did, maybe we didn’t,” and I am like, “What? No.” I had never done this kind of treatment before this training and that was like, “What?” I felt sadistic saying that, but this is the reason I have to say that is because if I said to her, “Oh no, we definitely didn’t hit someone,” I’m reassuring her how is that going to help her when I’m no longer in the car with her?


The same thing is going to happen. So I have to say, “Maybe we did, maybe we didn’t.” In a very calm, neutral way and keep driving. I do not stop the car. So we did this for three hours a day. This is a core part of this program. Three hours a day, she would panic and she would get very anxious, but this is the thing with ERP, anxiety, if you were present and sitting with the anxiety, it will habituate because our brains are not designed to perpetually be anxious about something that we’re sitting with.


Now, we could perpetually be anxious all day long trying to avoid something and have it hit us back and avoid it and hit us back, hit it like a pinging pong. That can happen all day long, but if we’re sitting with, it will habituate. We might be exhausted afterwards and want to go to sleep. So needless to say, by the fifth day, I’ll never forget this, that she brought a nail file. She would file her nails in the car and we would go over these same roads and she would just be filing her nails, like no anxiety there. Now she said she would still have the thought though, but the physiology, the anxiety was not there. Now guess what happens when you just have a thought with no physiology, that thought gets discredited so quickly because your body is not justifying it. It’s not confirming it. It’s just this random thought and I couldn’t believe it.


I thought, “Wow, that is life-changing.” I mean, it’s amazing. There’s a type of anxiety slash OCD disorder called Emetophobia, people who have the fear of vomiting, particularly in public. So I’ve made fake vomit with patients and had them put it in their mouth, and we go to public spaces and they “vomit” in public. I’ve had people who, that patient I had mentioned earlier, who thought he would stab his mother, the treatment included the mom coming into sessions and we would have the session with him holding a knife to her throat and some people might be like, “What? That’s hard,” but once he did that and actually did that, and of course he didn’t stab his mother in the throat, it’s only then that his thoughts were like, well, clearly if you were this homicidal maniac, here’s the opportunity. You have the knife, literally.


So the behavior has to come first because those thoughts are so rigid, they don’t respond to cognitive therapy. They first respond to the behavior therapy, which then loosens up those cognitions, and that is the gold standard treatment. Now, when ADHD is in the mix, I would say the main thing that I find different is to make sure that the person is really sitting with the anxiety.


Now, typically with someone with just OCD, if I have someone who has their hands in garbage or on a toilet seat, which I have the restroom down the hall from me, someone who has contamination, they put their hands in the toilet bowl or on a toilet seat, and then they sit and they can’t wash their hands for two hours and someone with OCD, all they’re thinking about is the contamination, the germs and all of that. Someone with ADHD interestingly, I remember, and again, this was in my training as an intern, and he had his hands in garbage and he looked almost too calm for someone who this was his core OCD and I said, “what are you thinking about?” He’s like, “Well,” and there was a piece of a pamphlet in the trash of Disney World, and he said, “Oh, I’m just thinking about the last time my family and I went to Disney World, and it was really fun,” and I said, “Oh, no, no, no. Now is the time to think about all the germs. I don’t want you to think about Disney World.”


He was almost avoiding it, but not even meaning to it wasn’t, “Oh, I don’t want to think about this.” It was like the ADHD almost just took him down this path and so I realized in working with ADHD patients, I have to check in with them to make sure, because with ERP to work, you have to be in the thought. This is not the time to avoid it. This is being sitting with it, being with it in that way.


And then all the executive functioning pieces in doing OCD treatment, like if somebody is supposed to be doing exposures at home, self-directed exposures, if they have ADHD, just like with ADHD treatment, we have more accountability systems set in because to say, okay, do that self-directed exposure this weekend. That doesn’t work with an ADHD patient. It has to be 7:00 PM Thursday night. I’ll text you or text me right before you start doing it. Text me when you’re done. Having that accountability can be really helpful and as far as medication, I have worked with just as many patients who can take both SSRIs and stimulants as I have with patients with OCD who cannot take a stimulant.


Sometimes the stimulants unfortunately have people focus more on the obsession, which we don’t want. Other times though, the stimulant has them properly focusing on what they want to be focusing on, which has them not focus on the obsession. So I’m not a prescriber, but I always say to patients, “Talk to your prescriber and psychiatrist. It often is a trial and error thing.” I have not found any pattern as to why some patients that combination can work and some it doesn’t and then that’s where the non-stimulants might be helpful, and that is more indicated for people whose OCD could be exacerbated.

Lindsay Guentzel (26:40):

I do want to ask, so how do you manage expectations with patients regarding results when it’s subjective, especially for people who might be hyper-focusing on the actual results?

Dr. Roberto Olivardia (26:54):

Yeah, and that can happen sometimes with OCD. I mean, there’s a form of OCD of almost this perfectionism of am I doing everything perfectly and that could include treatment and with ADHD, people want results yesterday and so when you have that combination, sometimes it can be really difficult and that’s a great question because that is something that I often will talk about is managing expectations as to how the course of treatment could look and that I don’t have a magic ball that I can’t say it’s going to definitely take this many weeks or that many weeks, but as we’re doing it, I definitely could give feedback as to, okay, we’re making the traction we want, or there’s a little stuckness here, and so we might have to tweak something, but it is more difficult when ADHD and OCD are both in the mix because it’s almost like a whack-a-mole phenomenon sometimes that the OCD symptoms are up and the ADHD symptoms might take a backseat, and then as the OCD symptoms are improving, the ADHD symptoms can pop up.


So it’s managing both, but that’s why it’s so important to identify both of them fully, making sure your eye is on them fully, that there’s treatment and strategies at all times with both of them, because a lot of times, even clinicians sometimes will say, “Oh, well, if there’s ADHD and something else, we’ll treat the something else first,” and then the ADHD, it’s like it’s along for the ride whether you like it or not. The ADHD isn’t quiet. The ADHD doesn’t sit back and just wait. It’s there and so we always have to make sure that we’re sort of managing both, but that’s not to say people can’t manage it and can’t treat it and can’t live amazing lives and I’ve worked with many patients who have ADHD and OCD where their OCD is totally managed, where it is not interfering, it’s not impairing in their lives, but it’s again, having that understanding.


And then also the narrative, I think, for a person too, is how they can understand that and not see themselves as broken because they have these two conditions, which can either one could be very difficult, let alone both of them.

Lindsay Guentzel (29:11):

Last thing I want to ask, in your experience as a provider, have you felt any hesitancy from patients when it comes to accepting OCD, so whether that means it’s a hesitancy for them to bring it up with you or a hesitancy, like I said, to accept it, and I’m asking in a sense of how that might be connected to some of the stereotypes we think of when it comes to OCD?

Dr. Roberto Olivardia (29:35):

With OCD, interestingly, I see less of that lack of acceptance. I think when people have it, it’s so debilitating sometimes for people that when they hear it, most of the time there’s often met with some hope and some relief, and that there’s treatment here for it. I would say of the two conditions, I see more lack of acceptance with ADHD, frankly than I do with OCD and sometimes because I think with ADHD, because that also gets subsumed or, “Oh, we are all ADHD,” that people think it’s not a real thing. They don’t think it’s a real diagnosis or they think, “Oh, maybe I’m just using that as an excuse and I’m really just lazy,” and especially if they also have OCD, they’re more likely I find to think that way about ADHD.


They’re almost giving themselves a pass that they shouldn’t be giving themselves. I see more of that, I think because with OCD, it’s so out of the norm, whereas with ADHD, yeah, okay, we all lose our keys and we all might not be on time for certain things, but obviously we know ADHD is much more than that, but with OCD, we don’t all have intrusive thoughts about stabbing our mother in the neck and so when I show someone here, it’s written black and white, it’s harder for them to deny that, but frankly, again, with most people, they’re looking for something that could tell them, “Oh, I’m not actually this terrible person,” and they’re looking for hope.


And there’s also something strangely, almost, I don’t know how to say this. OCD almost has this kind of way of, because it’s attached to personality traits that are often of virtue and people who are trying to avoid harm, people who are trying to be clean, I think that just in popular culture, there’s almost something less stigmatizing, even in popular terms when someone’s like, “Oh, I’m so OCD,” they sometimes use it, again, I’m not in favor of using it in that way, but when people use it that way, they’re almost saying like, “Oh, I’m so orderly and I’m so organized, or I’m so clean.”


Well, these are things that are highly valued, but if someone says with ADHD, like, “Oh, I’m so disorganized and I’m late all the time,” those things aren’t highly valued and so even in families, I find sometimes more pushback honestly, with ADHD, sometimes with parents and certainly certain cultural groups that might have a real difficulty with the idea of ADHD because it almost feels like, I think parents are more likely to blame themselves if their kid has ADHD and thinking, “Oh, I created this,” and of course we talk about genetics and stuff like that than OCD, and that’s not to say that I haven’t worked with people who have a hard time accepting the OCD, but it almost becomes something that’s so apparent to people that to have a name to it, it just gives them such hope and to hear other people can actually recover from this.


And when I go to the International OCD Foundation, which I would highly recommend as a resource for people, it’s based here in Boston, but they have a conference every July and then they have an online conference in October, it’s almost like what I feel, the ADHD conferences, which I love going to and speaking to. With the OCD conference, there’s such a sense of validation and relief and community and people who can have compassion for other people with OCD, which then can reflect back on them to say, “Wait a minute, then I should be giving myself that same compassion,” because this is hard, this is not an easy thing to deal with.

Lindsay Guentzel (33:19):

Roberto, I could talk all afternoon. This was wonderful. I’m so appreciative of your time and your energy in connecting with these communities and for just being such a lovely advocate. I really truly am just very grateful that you are connected to the ADHD community, so thank you so much for giving us some time here on Refocus. It was a pleasure.

Dr. Roberto Olivardia (33:40):

My pleasure, my pleasure.

Lindsay Guentzel (33:48):

As Dr. Olivardia said successful treatment for some may be a complete elimination of all obsessions and compulsions, and at the same time, for many people, it can be getting to a point where they can comfortably use coping strategies and tools to proactively deal with their symptoms. For me, one of the biggest takeaways from today’s episode is that ADHD and the executive functioning struggles many of us deal with it can really undermine long-term management plans. When it comes to comorbidities like OCD, it adds an extra layer for emotional regulation and follow through of a treatment plan, and that’s why managing ADHD and its symptoms is essential in treating any comorbid condition. As we’ve often heard from the experts who come on the show to share their knowledge with us, long-term management plans need to include good self-care, things like sleep hygiene, healthy eating, stress management, mindfulness skills and exercise, as well as medication treatment and behavioral therapy.


We also need to learn executive functioning strategies and skills that work for our own personal journeys. Dr. Olivardia would also add that it is important that a person with OCD not engage in avoidant behavior, instead choosing to expose themselves to the situations that are currently getting them stuck, which is crucial in taking some of the power away from the disorder.


In next week’s episode, I’m going to be joined by Ashley Jacobs, an ADHD er, who also has OCD. We’ll learn a little bit more about how OCD can show up in the day-to-day life of a person with ADHD, how she has learned to manage her intrusive thoughts and compulsions. Plus, we’ll hear what stood out to her after she listened to our conversation with Dr. Olivardia. If you’re a Refocused listener who also has ADHD and OCD, I would love to hear more about your journey, if you’re willing to share it. You can send me an email directly [email protected] or send us a message on Instagram @RefocusedPod. As always, thank you so much for listening, and if you have a moment, it would mean so much to us if you would show us a little love online, whether that means subscribing to the podcast, wherever you’re listening right now, leaving us a review or finding us on social media and giving us a follow.


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. 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 am so lucky to have her on the team. 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. 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.


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. Refocused couldn’t happen without my partners, turned to friends at ADHD Online. High fives to the ones that I bug the most, Keith Boswell, Claudia Gatti, Melanie Meyrl, Susanne Spruit, and Trisha Mirchandani. 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.


Finally, a big thanks to Mason Nelle 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. To connect with the show or with me, you can find us online at RefocusedPod as well as at Lindsay Guentzel, and you can email the show directly [email protected]. That’s [email protected]. 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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Join Our ADHD Research Study

Mentavi Health is conducting ADHD research and is accepting a limited number of participants. Participants in our clinical study will get an ADHD Assessment at no cost. 

Who can join?
  • Age 19+
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Your involvement will help improve mental health care for everyone.

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