Hacking Your ADHD — Ep. 209
Navigating the Tangle of ADHD and OCD with Natalia Aiza
Host: William Curb | Guest: Natalia Aiza
Release Date: January 27, 2025
Episode Overview
In this insightful episode, host William Curb talks with Natalia Aiza, a multilingual counselor, OCD specialist, and founder of Kairos Wellness in Boulder, Colorado. Together, they explore the often misunderstood and highly overlapping worlds of ADHD (Attention Deficit Hyperactivity Disorder) and OCD (Obsessive Compulsive Disorder). The conversation delves into the similarities and differences between these two conditions, the challenges of co-occurrence, strategies for distinguishing symptoms, and best practices for treatment.
Natalia, who is herself neurodiverse (with both ADHD and OCD), offers valuable personal anecdotes and deep clinical insight. This episode is a must-listen for anyone navigating ADHD or OCD themselves, supporting a loved one, or practicing as a mental health professional.
Key Discussion Points & Insights
1. Defining OCD vs. ADHD
[04:23]
- Natalia Aiza: Clarifies popular misconceptions around OCD.
- “OCD is not ‘being so OCD’ or Type A. Those are outdated misconceptions.”
- OCD is best understood as a cycle: Intrusive thought/obsession → Compulsion (mental or physical) → Temporary relief → Reinforcement of OCD.
- Example: Intrusive thought about harming someone with your car; the compulsion is returning to check, which soothes the anxiety temporarily but reinforces the cycle.
2. How ADHD and OCD Overlap and Differ
[06:45]
- Treatments for ADHD and OCD are often “almost the opposite.”
- Natalia (07:43): ADHD is frequently co-occurring with OCD:
- ADHD can look like distraction, but OCD can cause “executive function overload” (overactivity in the prefrontal cortex), which mimics inattention.
- ADHD often under-activates the frontal lobe; OCD over-activates it—like a “tug of war in our brains.”
3. Symptom Confusion, Misdiagnosis, and Executive Dysfunction
[09:21]
- Compulsions (OCD) can be mistaken for “stimming” or special interests (ASD).
- Many clinicians lack specific OCD training and may misdiagnose as Generalized Anxiety Disorder (GAD).
- Natalia’s personal insight: her OCD rituals sometimes masked or compensated for her ADHD, making both harder to self-identify.
4. Self-Soothing, Anxiety, and Emotional Regulation
[10:11]
- Both host and guest share how anxiety-driven compensations (e.g., fear of being late) can obscure core ADHD symptoms.
- Discussion of how anxious over-preparation due to OCD can look similar to ADHD time management struggles.
5. Recognizing OCD: Warning Signs
[11:49]
- Natalia: Key indicators:
- Intolerance of uncertainty—a need for control (e.g., “the world is dangerous, I have to be in control to be okay”).
- [13:00] Co-occurrence of eating disorders, body-focused repetitive behaviors (BFRBs), and hoarding: If talk therapy isn’t helping, consider if OCD is being overlooked.
6. Medication Effects and Compulsions
[14:19]
- Stimulants for ADHD sometimes intensify compulsions in OCD patients:
- “Stimulants… really cause me to compulse and obsess, and I have to use them with some caution.” – Natalia
7. Compulsions vs. Fidgeting/Stimming
[15:20]
- Key difference: compulsions are rigid, fear-driven, and performed to avoid a specific feared consequence; fidgets/stimming are flexible, non-threatening self-regulation tools.
- Quote: “Compulsions are like, I have to do it this way at this time or something bad will happen. OCD is much darker than ADHD.” – Natalia [15:55]
8. Spectrum, Severity, and Onset
[18:54], [20:48]
- OCD onset is typically in preadolescence, with symptoms often feeling “inherent.”
- Mild OCD may not need treatment; severe, entrenched cases require higher levels of care due to erosion of functioning and increased avoidance behaviors (e.g., agoraphobia).
9. Treatment Principles: ERP & More
[22:31], [24:15], [28:18]
- Exposure Response Prevention (ERP) is the “gold standard” treatment for OCD.
- It’s about “normalizing anxiety,” facing fears without performing compulsions, and retraining the brain.
- Natalia: Perfectionism and people-pleasing tendencies are common in both ADHD and OCD, with self-worth issues fueling the compulsive cycle.
- Other modalities include ACT (Acceptance and Commitment Therapy), DBT (Dialectical Behavior Therapy), EMDR, and neurofeedback—especially for trauma or generalized anxiety.
10. CBT vs. ERP: Why Traditional CBT Is Not Enough for OCD
[29:46]
- Traditional CBT focuses on challenging thoughts; ERP emphasizes behavioral change.
- Quote: “You can’t think your way out of OCD…instead, you have to choose to do things that create new neural pathways.” – Natalia
11. ADHD as a Double-Edged Sword in OCD Recovery
[31:25]
- Some aspects of ADHD, such as impulsivity or distractibility, can help break OCD’s grip—just “diving in” to tasks.
12. When to Seek Help: The Importance of Early Intervention
[34:52]
- Mild OCD is much easier to treat. Unrecognized or untreated OCD tends to escalate and become more entrenched over time.
- Talk therapy alone may exacerbate OCD; seek specialized care.
Notable Quotes & Memorable Moments
-
On Compulsions vs. Stimming/Fidgets:
“Compulsions are like, I have to do it this way at this time or something bad will happen. OCD is much darker than ADHD... my brain as like, the ADHD part is like, la, la, la… and then my OCD part is like, everything is messed up.”
– Natalia [15:55] -
On Misdiagnosis and Self-Awareness:
“It made both of the brain differences harder to diagnose—and just harder for me to even have self-awareness of.”
– Natalia [09:55] -
On Self-Worth and Perfectionism:
“If I judge my self-worth on what I produce, and I’m a perfectionist, but I know nothing I produce can be perfect, then I will have no self-worth ever. Yes, that seems like a problem.”
– William [24:54] -
On The Limits of Traditional CBT for OCD:
“You can’t think your way out of OCD. If we could, we would have already. Instead, we have to choose to do things that create new neural pathways.”
– Natalia [29:55] -
On Getting Support:
“Please don’t just experience this alone… There’s quite a few of us and many people looking to connect and support and help.”
– Natalia [34:30]
Timestamps for Key Segments
- 04:23 — Defining OCD vs. ADHD, challenging pop culture stereotypes
- 07:43 — Differentiating executive dysfunction in ADHD vs. OCD
- 09:21 — Overlap with Autism Spectrum Disorder and misdiagnosis
- 10:11 — Self-soothing, compensatory behaviors, and emotional regulation
- 11:49 — Core OCD features and warning signs
- 14:19 — Stimulant medication effects on OCD symptoms
- 15:20 — Compulsion vs. stimming/fidgeting explanation
- 18:54 — Symptom spectrum, onset, and adaptation
- 20:48 — Severe OCD, avoidance, and the erosion of function
- 22:31 — Normalizing anxiety in OCD treatment
- 28:18 — ERP and additional therapies for OCD and comorbid conditions
- 29:46 — CBT vs. ERP and why behavior change is key
- 31:25 — How ADHD traits can sometimes help with OCD recovery
- 34:52 — Early intervention and risks of untreated OCD
Final Advice and Resources
Natalia’s Guidance [32:53, 34:30]:
- Most people with ADHD have some anxiety—compensating with anxiety is normal, but when it becomes rigid and compulsive, check for OCD.
- For self-screening: Use the Yale-Brown Obsessive Compulsive Scale (Y-BOCS)—free and available online.
- If OCD resonates with you or affects you, reach out to specialists or resources like the International OCD Federation (iocdf.org).
- Early intervention is crucial. If talk therapy alone hasn't helped, seek out ERP-trained clinicians.
Closing Thoughts
- “Approach ADHD and OCD differently. What works for one may worsen the other.”
- Recognize/seek help early—mild symptoms are much easier to treat than entrenched OCD.
- Don’t self-diagnose from pop culture. If in doubt, talk to a specialist and be proactive about your mental health.
Further Resources
- Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
- International OCD Federation
- Contact Natalia directly at natalia@kairoswellnesscollective.com
- Show notes & transcript: hackingyouradhd.com/209
This summary captures the essence, science, and lived wisdom shared in the episode, and offers direction for anyone wrestling with the ADHD/OCD overlap or supporting someone who is.