Navigating the Tangle of ADHD and OCD with Natalia Aiza

Summary

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

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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.

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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  • “OCD is not ‘being so OCD’ or Type A. Those are outdated misconceptions.”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.

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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]

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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

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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.

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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.

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Further Resources

• Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
• International OCD Federation
• Contact Natalia directly at [e-mail]
• Show notes & transcript: hackingyouradhd.com/209

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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.

Transcript

[A]

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[B]

Absolutely. So thank you so much for having me on. I am beyond excited to talk about OCD on an ADHD podcast because the co occurrence is actually quite high. It's ADHD is the number one most co occurring mental health diagnosis with ocd. So just to introduce real quick, OCD is not I'm so OCD or A personality. As many of us have clarified in the public eye, OCD is quite misunderstood as people being very anal, very precise, very clean. Those are all very outdated misconceptions. Ocd, what it actually is, is a cycle. So OCD starts with either an intrusive thought or an obsession. So I will have an intrusive thought. I just hurt someone back there with my car, right? So I'll have that intrusive thought. It comes into my head unbidden, and my OCD will make me want to soothe that obsession with a compulsion, which basically means I will do something about that obsessive thought. So when a person without OCD gets an intrusive thought, something bunky like that, they're able to sort of keep going and know that it's just brain noise. With ocd, we get really fixated on our brain noise. We attach meaning to it and we feel the need to do something mental or physical to soothe that fear. So we get short term relief because we turn the car around and checked and, oh, yeah, no, that was just a speed bump, not a person. And then we keep driving. But what happens is we have just reinforced that cycle. We have just reinforced a neural pathway that indicates to our brains that we potentially could do that dangerous thing that our OCD tries to make us think we do. So OCD can be about danger. It can be about perfection. It can be centered around contamination. There's many different ways that OCD can present it. It can even focus on a relationship and have you be compulsive around the person that you love. But regardless of where OCD centers, it is a cycle. It's a cycle of self soothing that actually reinforces the core fear.

[A]

This is also reminding me too of a friend that was dealing with some OCD stuff and talking about how different it is from treating adhd, where you often try and help the process along, whereas with OCD, that just reinforces the process 1,000%.

[B]

So that's why I love talking about this, because the supports out there for ADHD are sometimes almost the opposite of what you need for the ocd. So there's very much a concurrence but also a discong gruence between those two disorders. So I'm excited to explore why.

[A]

So, as a comorbid condition, like, I'm sure there's a lot of overlapping symptoms as well. If you feel this need to self soothe, that's probably very distracting and that's like an impulsive thing. And it definitely will be affecting, like your emotional regulation and all that I'm like, so is there ways to kind of tease out what's driving the bus in this situation?

[B]

Absolutely. It's tricky because you really do need an OCD expert to catch OCD most of the time because those of us who are, you know, regularly trained therapist in our graduate programs, there actually is not specific OCD training. And most of them, and so we tend to misdiagnose as gad. And when there's a concurrence of ADHD and ocd, like you said, there can be so many overlapping issues, but the most important one is attentional. So a person with ocd, because so much of our world is this mental noise, we can seem very distracted, we can seem very checked out, and that can be actually presumed to be part of, you know, adhd, when actually it's what we call executive function overload, which is in OCD where the prefrontal cortex is actually over activated to the point where we can't actually do the parts of our life that are needed to do. We seem very zoned out. So while ocd, OCD is an overactivity in the frontal lobe, ADHD can sometimes be an underactivity in the frontal lobe. So the two sometimes seem to be like playing a tug of war in our brains.

[A]

One of the other things I was thinking could be a huge confounding factor here too is like the adhd, like hyper focus on something. And that combined with this need to self soothe could be like a very negative reinforcing cycle.

[B]

Yes, 1,000%. And there's a lot of concurrence not just with ADHD, but also with ASD. And so a lot of times compulsions might be misinterpreted as stims. Obsessions can be misinterpreted as special interests. There's a lot of ways in which, you know, all of these brain diversities can overlap in a way that can be very confusing not only to the clinician, but to the person experiencing them. And I know this firsthand because I have both ocd, ADHD and I feel oftentimes that I have been coping with my ADHD through utilizing the rituals of my ocd. And it made both of the brain differences harder to diagnose and just harder for me to even have self awareness of.

[A]

Oh yeah, I can totally see that too because I do a lot of like self treatment of my ADHD with anxiety.

[B]

Yes.

[A]

Like while I was late to this particular meeting, that is something that doesn't happen to me very often because I have so much Anxiety about being late, that it solves for that and that makes it harder to diagnose that. Oh yeah. Am I chronically late? No, but I would be.

[B]

Yes. I mean that's a perfect example if we just stay with the lateness. So my clients that have ADHD plus ocd, I can't really tell what the relationship is to lateness. Some of them actually show up compulsively early because of a fear of being late. But then some people with ADHD have a fear of being bored, a fear of wasting time. And so they want to show up exactly on time, but then the anxiety comes up like, well, if I show up exactly on time, then I'm going to show up late. And so like the two are in battle. They're who's going to have more control, the ADHD or the ocd. And, and sometimes the person's values are getting lost in the process. So there's no consideration of like, what do I actually want or need? What works with me? My value system, it's more sort of obeying this fear based structure in our brains.

[A]

I'm kind of thinking too here just to make sure that listeners can kind of have a better feel of this. What are some of the common traits we might see with OCD that might be used for this first step of like, hey, I should go get this checked out. Because like the pop culture definition of OCD is ADHD has the same problem where like the pop culture is just so wrong and then you're like, this is not what that actually is at all ocd.

[B]

It's very difficult to capture it with, you know, just in a short blurb because it has so many different ways that it can show up. One of the most common that we see is for someone to feel very afraid of losing control. So at its foundation it's a control disorder. And also someone who cannot tolerate uncertainty. So if there is uncertainty about whether they're sick or uncertainty about whether they're loved, uncertainty in their job, that the inability to just be with that ick as we call it, without doing things to self soothe and to know for sure, that would be kind of the main issue that I would highlight around OCD is this feeling of like, the world is dangerous, maybe I'm dangerous, something horrible could go wrong and I have to be in control in order to be okay.

[A]

Yeah, that makes a lot of sense. And it does sound like this is something that very much needs that like clinician involved with because, you know, there's so many confounding factors here it is.

[B]

So, yes, 1,000%. And there's also a strong concurrence with people who have both ADHD and ocd. There's a huge concurrence of eating disorders as well as BFRB's body focused repetitive behaviors, which are things like skin picking, hair pulling, nail biting. There's also quite a, a bit of overlap between ADHD and OCD and hoarding disorder. There's many different clues that are laid down by this co current and maybe even for clinicians who are listening to this or people, if there's. If you're not improving through talk therapy and you think you have generalized anxiety disorder, it's possible that maybe you are being underdiagnosed or misdiagnosed and perhaps what you actually have is ocd. I get so many people in my office that have done Talk therapy for 10 years and then within two months of doing exposure response prevention, they are in a completely different space. So that's another clue, like, you're not getting better with traditional approaches.

[A]

Yeah, that's one thing I've always tried to communicate, is that if you are struggling and there doesn't seem to be a reason behind it, like, well, there is a reason. That's what you need to kind of be focusing on is like, okay, whatever I thought it was might not be the case.

[B]

Yes. Another way to. If you're a person with ADHD and you're listening to this and you're like, wait, could I have ocd? One other clue is for those of us who take stimulants. Sometimes stimulants can actually activate compulsions and they can make us hyper focus on our compulsions. It's not everybody that has this experience, but I'll say, personally, stimulants, I'm so glad that they exist. They do actually really cause me to compulse and obsess and I have to use them with some caution because of the way that my nervous system reacts.

[A]

I'm kind of curious too. Here I'm thinking about these impulsive activities that a lot of us with ADHD have. And I'm sure there's people listening, being like, oh, I feel like I have to do these things. Does this mean that, you know, I'm also at risk or have ocd? Because I'm like sitting here playing with my fidget and I'm like, is this a compulsive behavior or is this just something that is, you know, well within normal for adhd?

[B]

Okay, that's a great question. So what defines a Compulsion, especially when you're neurodiverse and you have a bunch of things that you feel like you need to do. What defines a compulsion is actually the ick that comes before it. So when I'm fidgeting with something for my adhd, I'm not feeling any ick or anything. I'm not feeling anxious. I'm just feeling that I need that thing in order to focus. There's just pure joy when it comes to my fidgets. I have a very positive relationship with them. If I don't have one, it's okay. Like, I don't, you know, have any panic about that. With compulsions, it feels so much more rigid than that. Compulsions are like, I have to do it this way at this time with this thing, or something bad will happen or this podcast will be a disaster. OCD is much darker than adhd. I sort of describe my brain as like, the ADHD part is like, la, la, la. Like, happy, go lucky. And then my OCD part is like, everything is messed up. Like, I get that sort of competing energies in my head, and I actually feel like my value system, my personality, is a lot more like the adhd. And the OCD is something maladaptive in my brain that is sort of interfering with me, just like, living my best life.

[A]

That makes a lot of sense because, yes, while I have all these things with my adhd, it's like, oh, I want to go do that. And I'm, you know, like. Or, you know, like, there's, like, the tag I can't ignore or something. It's. No, not a dark thing. It's just like, oh, I just can't ignore it. I need to take care of it.

[B]

Yes. So. And sensory issues, they're annoying. They can even be overwhelming. However, ocd, the ick, is very strong. It's far more than an annoyance. Like, it is this feeling of, like, something really problematic is happening and I have to stop it. That's how I would kind of understand OCD in general is that it is propelling you out of anxiety and fear and catastrophization.

[A]

Yeah. And I think that's a good way for people to kind of think about it then, because then I don't want people to unduly be like, oh, I'm going to be. I have to go check this out now.

[B]

Yeah.

[A]

Because half the time I, like, talk about comorbidities. I'm like, is that me, too?

[B]

Yeah, that's normal. I mean, OCD is the fourth most common mental health disorder in the world. So I think above all else is just under diagnosed. And. And I think that while I don't want to plant any seeds that are undo in people's heads, even worrying if you have a disorder can be a part of OCD where we're like compulsively Googling, like, do I have cancer or am I autistic? Even though not that those two things are similar, but we are trying to know for sure. A question that is like opening up in our heads and we literally can't put to bed. And so that's part of the compulsive cycle, which is different than impulsivity, which is sort of more like a one time, like, I feel like I have to do this thing and it's fun. Compulsivity is incredibly repetitive and it's quite often boring. Like we're doing the same thing over and over and over.

[A]

Yeah. And is there like kind of an aspect of like, maybe not even like being mentally aware of that's what's going on?

[B]

Oh, yeah, definitely. I mean, so I have the same issue with my adhd. I obviously don't. This is my brain. So I don't know what it's like not to have an ADHD brain. But with OCD, my onset was at 7. Many people's OCD onset is in like pre adolescence. It's pretty uncommon to have late onset, like adult ocd. It does happen, but many of us have gotten to the point in our adulthoods where this feels like it's inherent to us. We're not quite sure who we are without the ocd. And so it can feel very natural to feel like a twinge of my shoulder and immediately Google it and make an appointment like, that's just the way I've functioned. So sometimes you need to speak to an OCD clinician or somebody else with OCD to understand that those behaviors are maladaptive and they aren't serving us long term.

[A]

And I'm sure this is also plays in with things with like PTSD and that kind of thing where you have these, again, maladaptive behaviors where you're like, oh, this is my brain trying to protect me from this thing. And it's just. That's how my brain's working now.

[B]

Yes, yes, absolutely. And you know, for what it's worth, some people's ocd, while it is very genetic, some people's OCD does get triggered by a trauma event. And then the OCD sort of builds itself around that trauma. That was my experience that my OCD always molded around this core fear that was based on a trauma event.

[A]

I can see how also with this, I'm sure this is kind of more like a. There's like a spectrum of symptoms. And so there are certainly people that will have be like, yeah, I feel some of these things, but it's not affecting me in such a way that I can't function in life.

[B]

Yes, I would say that ocd, many people have mild ocd. It may or may not need treatment. The spectrum, though, goes all the way to what is actually called extreme ocd. And these cases almost always need a higher level of care. There can be psychosis at the top end of ocd. I myself have experienced that. There can be an extreme amount of avoidance. So that's usually the number one compulsion for extreme OCD is basically shutting down our lives and making them smaller and smaller. So when people are experiencing agoraphobia, a fear of panic outside of the home or in different situations, they make their lives less challenging. They work to avoid anxiety. And that actually makes the OCD much more pronounced.

[A]

That's so opposite of how you treat adhd. I can see how that'd be so hard.

[B]

So it is very complex. But I'll say, you know, quite a few people that have those extreme levels of O, C, D also have adhd and, you know, previously had their. Their main challenges were around, like, attention, around being able to, like, access certain executive functions. But the OCD has slowly eroded any, like, functioning ability to the point where everything is about anxiety avoidance.

[A]

While anxiety can be a problem, it is also not. Moderate doses is not. Should be kind of expected like in life.

[B]

Yeah. And that's the treatment actually for OCD is you normalize anxiety and you actually help the experiencer see that they can do hard things, they can face their anxiety, they can feel uncomfortable. And, you know, honestly, OCD is lying to us. Our OCD makes us think that we're far more weak than we actually are. Our OCD will make us feel as if we cannot not obey the OCD rules or the voice. And what we have to do is actually start breaking the OCD rules. And to do so, we need a coach or a therapist that understands that facing your distress is going to be a huge part of recovery.

[A]

Yeah, I know when years ago, I was dealing with a lot of perfectionism issues and the thing that I did to start, I was just like, I'm going to start practicing doing things wrong.

[B]

Yes.

[A]

Like, we had the plates in the cabinets that were light blue and dark blue, and I was like, they go in light blue and dark blue stacks. And that's how we do it. And then I was like, told my wife, like, hey, let's just start mixing them up. And, boy, did that feel uncomfortable at first. But, like, now I don't. I don't even think about it now. And I'm just like, okay, this is actually super easy to put things away, and this is not an issue. And I can, like, try and apply those ideas to other places in my life where I'm like, it's okay that I had this error. I mean, that popped into my head that I had a thing on blue sky where I typed K N O W instead of just N O. So it's like, no instead of no. And I'm like, looking at it, like, later. I'm like, oh, no. But that's okay. It's fine. This is fine.

[B]

That's amazing that you say that as an example, because that's actually an exposure that I assign to people to purposefully misspell something in a social media post or in an email to actually make a mistake intentionally in order to sort of retrain the brain that, like, the world doesn't stop. In fact, almost no one notices. And if someone notices, we aren't overwhelmed with embarrassment. So that. That's part of with perfectionism is normalizing the error. Because sometimes perfectionism in its extreme forms can lead to inaction.

[A]

I don't even think the extreme forms leaked it in action. A lot of, like, that was kind of like where I was like, I need to get over this, because I like, this, like, revelation of, like, thinking about perfectionism being like, oh, 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.

[B]

Yes, yes. And OCD absolutely preys on self worth. It says, you know, I have intrusive voices that. That have been telling me since I was little that I'm stupid, that I'm incapable, that I'm unworthy. And there's been no amount of achievement that I've been able to have that has quieted those voices. And so the best thing that I could do is to just not interact with them, not give them weight, not act like I have to prove those voices wrong because it's impossible. So I think that people with adhd, because, you know, we get told a lot when we're children that we're wrong. Like, why don't you know how to do that? How could you forget this? Like, how could you lose that? Blah, blah, blah. All the things that we hear. I think it makes us especially susceptible to the negative intrusive self talk that OCD places in our brains. And it makes us feel like, oh, well, everyone says this to me, I must suck. And I, you know, need to overcompensate for that in order to like make people please others and to feel like I'm okay.

[A]

Yeah, I can totally see that over compensation piece and just the. If I make it so that I never make a mistake, then I will never be corrected. And I can see how quickly that can lead into all this like toxic behavior of maladaptive things where you're like, I'm just doing these things so that no one's going to ever complain.

[B]

And so people with OCD were famous for people pleasing and also conflict avoidance and also just like adhd. Rejection sensitivity is a really big thing because if you have this negative voice in your head telling you that you are worthless or whatever nonsense, it's saying, you are going to be even more reactive to other people criticizing you or rejecting you.

[A]

Yeah, absolutely. Because I'm like hearing of them. Oh yeah, that one, that one. Yep, yep, yep. Things to talk about with my therapist this week.

[B]

I tend to do that. My colleagues joke that I'm like Oprah with OCD diagnoses that are you have OCD and you have OCD that I'm like bringing up a lot of it. But really like you said, it's, it's a continuum. And at the lower levels it can definitely be a form of generalized anxiety disorder or just some OCD tendencies that, you know, many of us have due to having this neurodiverse brain. So I think that there's a lot of food for thought when it comes to OCD treatment, but that everybody should look into exposure response prevention, which is basically just face your fears without doing your safety behaviors. That's the entire concept.

[A]

I was also like looking at some of the other therapy options that at the Kairosh Wellness and I was just curious. So is that just the primary one or are there a lot of other things that you might be looking at as well?

[B]

There are a lot of different approaches. I would say ERP exposure response prevention is hands down the gold standard for OCD treatment. We also get people in our center that have generalized anxiety disorder. You don't have to treat that with erp. And we sometimes get people that have gone through exposure response prevention but have some trauma from that. So in those cases we will approach with neurofeedback, with ACT acceptance commitment therapy. We might bring in some dbt, some dialectical behavioral therapy in order to increase that distress tolerance, in order to be able to do the erp. There's a lot of different approaches to OCD work, but I just really want to emphasize that exposure response prevention is one of those very data backed therapy approaches that I don't want it to be left on the table. One of the main issues is that not a lot of us are trained in exposure response prevention. And I think that's the number one reason why it's not utilized more.

[A]

Yeah, yeah. It all depends on like, what people know they're going to do. One of the things I was also wondering about is a lot of us know about cbt and I feel like what I know about CBT makes me wonder if that would be effective. Like, I can see how DBT would be much more effective because that's more of like the. Yes. What your experience is true. Whereas CBT kind of does more questioning of if it is true.

[B]

Yeah. There's a type of OCD treatment called inference based cbt. I cbt, which some people are really excited about as a new approach. And it does function along, like questioning the OCD voice. I would say OCD therapists, the purest among us, will say that you can't think your way out of ocd. You can't think your way out of illogical thought spirals. If we could, we would have already. And so we instead have to choose to do things that create new neural pathways. So if I have a child in my therapy room that's afraid of the wind, we can talk about how the wind is safe, how that's a cognitive distortion, blah, blah, blah. Or we can go out into the wind and have them sit with their distress and realize that it's less frightening than they believe it to be.

[A]

Yeah. Because it is built up in our mind, but it's hard to think out of what you've built up.

[B]

Yes, yes. And those of us with ocd, we're great at creating anticipatory anxiety. We often overestimate how hard something will be for us. And once we actually do it, usually the, the feedback I get from my clients is, oh, that wasn't that bad. That's what it kind of all universally that I managed to create something far more severe in my brain as I was imagining it.

[A]

That's true for everyone too.

[B]

Yes.

[A]

Just like, yeah, we overthink situations and when we get to a situation like Well, I get that was not quite what I imagined.

[B]

And I'll say this is one place that ADHD actually helps with OCD treatment because we do have a little bit of, some of us have impulsivity and we're not as risk averse as other brains tend to be. And that can actually really help because we are more likely to just like hold our nose and dive in than, you know, other types of brains. And OCD makes us incredibly risk averse. And so the ADHD can actually help, help combat that and get us to just make the leap into action.

[A]

Yeah. I could also see when I'm like stuck in my head because of my variable focus, I'll suddenly realize I'm not paying attention to that thing that I thought I was, was so important a minute ago. I can see how that having that impulsive behavior, just doing something, you're like, oh, that wasn't so bad because I forgot completely about it while I was doing this other thing.

[B]

I'm so glad you say that. Super relatable people without adhd, but who have ocd, they don't understand how we can just forget the worry. And that happens to me all the time. I will be obsessed with something and if I don't do my compulsion, my brain will just like move on. Which is, you know, something that I'm grateful to my ADHD for that I can pivot away from this stuckness that OCD wants me to be in.

[A]

Well, I was wondering if you just had any final thoughts you wanted to leave the audience with.

[B]

Okay, yes. Thank you so much for having me on. I appreciate people with ADHD listening about ocd. I just want to emphasize the fact that most people with ADHD have some co occurring anxiety. As you said, William, the tendency to compensate for ADHD with anxiety is incredibly normal in our population. And what I would say is that OCD D is like a tick above the rest. And so if you are feeling like the things that I'm saying are resonating with you, feel free to check out online. You can look at the Y box, which is the Yale Brown Obsessive Compulsive Scale. It's just a survey. It's completely free, available for public use and just take a look. If there's other things that maybe I didn't mention that really resonate with you and feel free to send me a personal email. It's nataliaairoswellnesscollective.com I compulsively answer my emails partially because I know that most of us live in areas without OCD clinicians and I can definitely guide you to any resources in your area. And I also strongly suggest that people check out the iocdf, the International OCD Federation. We have conferences twice a year that are amazing. They're for lived experiencers plus us clinicians and some of us that are both. So there's definitely support out there, myself included. And you know, please don't just experience this alone. Know that there's quite a few of us and many people that are looking to connect and support and help.

[A]

And this also just triggered one more question that I was thinking about here. It was the from my understanding too, it's easier to treat a much milder case of ocd, and if you're not treating it, it sounds like it gets worse. So this is something that if you kind of suspect, it is worth looking into early, right?

[B]

Absolutely. So OCD can snowball over time when left untreated, and talk therapy can actually sometimes exacerbate OCD symptoms. So if you're noticing kind of some mild occurrences of it, definitely hold some curiosity to it because the toughest cases are the ones that have been entrenched over the course of many years and it's more helpful to cut it off at the pass.

[A]

Okay, great. Well, thank you so much for coming on the show. I'm sure a lot of people are going to get a lot out of this episode.

[B]

Thank you so much for having me. I appreciate you.

[A]

Thanks again to Natalia for coming on the show and thank you for sticking with us all the way to the end. Before you go though, let's do a quick rundown of today's top tips. 1. It's important to remember that you need to approach OCD and ADHD treatments differently. Techniques beneficial for one may exacerbate the other. 2. Try to distinguish between compulsions and simple fidgets or stimming. While symptoms can be similar, it's essential to understand the root causes that characterize compulsions. 3. Be proactive in seeking diagnosis and treatment. If OCD symptoms start appearing early, intervention can prevent the condition from worsening. Alright, that's it. Thanks for listening. I'd love to hear what you thought of this episode. Feel free to connect with me [e-mail] conference. Contact if you'd like links or to read this episode's transcript, you can go to the show notes [e-mail] 209 and just one more quick reminder about my AMA live on January 31st at 10am Pacific on the Hacking Uradhd YouTube channel. If you want RSVP and send me a question early, just head on over to hackingradhd.comama if you'd like even more hacking radhd Be sure to sign up for my newsletter, any and all distractions which comes out every other week. In it I give my best attractions of the week, be they what I'm reading, what I'm playing, or what I'm watching. I also try to give a few bits of actionable advice each newsletter, although your mileage may vary there. If that sounds like something you are interested in, head on over to hackingyouradhd.com newsletter to sign up. I also wanted to let you know about our Patreon that I've been reworking. You can easily find [e-mail] Patreon we're going with a pay what you want model, meaning that all level of Patreon will be receiving all the same stuff. You can pay $0 or $2 or $10 and it's all the same. The only real difference coming from the roles that are signed on the hacking your ADHD Discord. Which reminds me that I also wanted to announce that we're on Discord now, which you can get access through from the Patreon, which again is pay what you want. So if you want to come check out the Discord or check out the Patreon and get yourself some access, you can do [e-mail] Patreon and also don't forget, forget to go and subscribe to our YouTube channel, which again you can [e-mail] ackingyouradhd and if you're still looking for ways to support the show, you can do so by telling someone about the show. Especially if you think a particular episode would resonate with them. Just click the share button on your podcast player and send them it over. Today's episode was powered by Shimmer, the number one ADHD coaching platform for teens and adults. Struggling with ADHD isn't a one size fits all issue and neither is the help you choose. Each coach at Shimmer uses science backed methods and a personal topic to guide you through your ADHD management journey. Your expert coaches can help bridge the gap between your current challenges and your goals. Start your journey now at www.shimmer.care and use promo code hackingyouradhd for a 30% discount on your first month. Unlock your potential today. That was www.shimmer.care with code hackingyouradhd. And now for your moment of Dad, I was thinking of cooking an alligator for dinner, but I realized I only have a cr. Foreign I'm very excited to tell you about Beautiful Anonymous, a podcast where I talk to random people on the phone. I tweet out a phone number. Thousands of people try to call. You talk to one of them. They stay anonymous. I can't hang up. That's all the rules. I never know what's gonna happen. We get serious ones. I've talked with meth dealers on their way to prison. I've talked to people who survived mass shootings. Crazy funny ones. I talked to a guy with a a goose laugh. Somebody who dresses up as a pirate on the weekends. I never know what's going to happen. It's a great show. Subscribe today. Beautiful Anonymous.