As a person with ADHD, I find it plausible that the commonalities I have with OCD may be side effects of my masking techniques. I tend to want symmetry, and want things in their spot. But these aren't compulsions but things I do because I basically don't have a working memory. When things are where they belong I can find them. When they are symmetrical there's no randomness to remember. This is probably very over simplified, and may not be causation but instead correlation. I'm not a doctor and don't pretend to be 😊
I find I have a similar mechanism. If things are ordered and the same as they were previously then I don't need to think about it. I have this effect with my wardrobe. My clothes are ordered (smart, hoodies, jumpers, t shirts etc) so I don't even have to think about what I'm wearing. I open up my wardrobe, go to the t-shirt section and pull out the first item
That's very relatable. I struggle with routine, but need it to function. It helps a ton to have my keys hanging by my door, rather than leaving them in a pocket/spot. The only problem is that when I do things automatically due to routine, I'll forget easily, bc my brain won't be processing that I wake up and routinely take meds. "Wait did I take my meds?" Same thing with other actions that always are the same. They don't require thinking. Is this why I love improv so much? Or is that only a last minute on-the-spot thing..?
@@norsefrog My system for remembering if I took my meds (I started this system before I knew I had ADHD), is I leave the lid open for it on my weekly pill organizer. Top open=I took my meds, Top down=I did not take my meds. All I have to do is look and I have a visual cue as to whether or not I took my meds. Now, what gets complicated is my son (also ADHD), like to go and close the open lids. This has caused me to at least once double up on my meds, and since I am on a blood pressure medication, that night I woke up in the middle of the night to use the bathroom and passed out on the way back to bed and hit my face/head on the bassinet that was still in our room from when he was a baby. He's been a lot better about not closing them since then, lol. (Luckily, other than some scrapes and bruises I managed to escape any true harm, so I can laugh about it today... my wife still doesn't find much humor in it, though).
Yes, my experience agrees with this! Often I’m “compelled” to tidy before I can work (especially WFH); but, for me it seems more so due to the ADHD issues of distractibility and task initiation, rather than OCD intrusions. (I have histories of both in my family so have had to monitor any possibility of OCD.)
Thanks for covering this topic Dr. Barkley. I just wish you covered more of the difficulties and symptoms that occur when an ADHD individual has OCD as a comorbidity. Its something that I'm personally struggling with.
I was diagnosed with OCD at 23 and ADHD at 27. One reason for the gap was that I'd been led to believe it was impossible to have ADHD and OCD co-morbidly, as they involved dysfunction to the same brain regions in different ways. It's brilliant to see Dr Russell Barclay addressing this nuanced relationship empirically, and in a way that is accessible to non-specialist audiences. Thank you for doing what you do
Ohh how ist going I think I have both because the impulsive anxious nature of ADHD and obsessions...I have ocd as I got diagnosed at 21 , now I'm 24...but still life has been tough in me when it comes to dealing relationships, studies ....would love to talk to you
I've been diagnosed with both ADHD and OCD. I am a hoarder, and ADHD paralysis plays a part in the messiness. I just get overwhelmed just looking at things. I want order, and yes, symmetry, but can't seem to achieve it. When I do get a start, things have to be right - books shelved in alphabetical order, magazines stacked according to title and date. If they get mixed up, it causes me physical distress.
I have a diagnosis of both of these conditions (as well as Tics as mentioned in the video), and I experience something similar. Of course, it isn't just that. The contamination fears of OCD make it really difficult and overwhelming and causes a lot of anxiety when I plan to try to clean as well (I struggle to clean that gross plate or open that disgusting container where I'm going to have to touch and smell that gross, moldy food inside the closed container that is only gross because I didn't immediately clean it, but when I first considered cleaning it it was too overwhelming, and I needed to wait until I was strong enough and had the time and energy to do it). The time-blindness of ADHD and the fact that I am biologically wired to be a night person and not have a 24 hour clock (which is common for people with Cognitive Disengagement Syndrome) doesn't help either. Basically, I live my entire day failing to live up to the expectations of others, and then I spend a ton of my day trying desperately to work extra hours to make up for my mistakes. For example, if I'm salaried-exempt and don't get paid for OT, if I get in at 10 am when my boss hoped I'd get in at 8 am, even if I technically am allowed to work whatever hours I chose as long as I get my work done, the looks of scorn and disdain bother me so much that instead of working the required 8 hours, I work a total of 10 hours (with no additional pay) to try to make up for showing up "late." Or if my boss insists on scheduling an 8 am meeting, I will put in 8 hours of looking like I am at work, but between the migraines and other health problems I won't be able to actually function the whole day, so I also will need to come in on the weekend or work late another day to make up the work for the entire day. If my nephew has a birthday party on Saturday at 10 am, and if by the time I have showered, dressed, and driven all the way out to their house I don't get there till 11 am, I may feel like I need to volunteer to babysit the kids another day to make it up to my sister, and I may feel like I need to take my nephew to a theme park on another day to make it up to him. Basically, I am playing catch up for other people's expectations to try to placate them every minute of every day. This not only drains me emotionally and physically to the point that I don't have enough energy to take care of myself, but it also means I am constantly choosing between the priorities of sleep, exercise, cleaning, eating, and showering/doing laundry. It isn't healthy to skip any of these, but I don't have enough time to do all of them. Usually, showering and laundry win first place because they effect other people. Sleep tends to be next because I don't want anyone to have the excuse of blaming my sleep for while I am late. Then eating and going to the bathroom sometimes get so desperate they sometimes force me to choose them over sleep. Cleaning and exercise just can't fit into my schedule a lot of time, or at least they are the first priorities to drop off when I have to stay late at work or make up something to a friend. But on the rare occasions when they do manage to fit into my schedule, now the anxiety and paralysis and confusion from the OCD and ADHD also kick in and make it hard to clean, which becomes a loop of stress because I know I can't spend that precious time in paralysis, but I do anyway.
Thank you for this video! As someone with inattentive ADHD I am intrigued by this video as I have had OCD since childhood. However, I heavily relate with CDS but also have other confounding conditions such as cPTSD and dysautonomia. It all feels extremely confusing to decipher.
I’ve not seen anyone mention dysautonomia before! That’s a thing for me as well. My diagnoses include combined, ASD1 and GAD. I have some OCD behaviors although I think they track better with ASD. I agree that the range of traits can be confounding. Both my parents were varying types of neurodivergent, and I inherited some of everything. I’m sure I’ve got some cPTSD as well.
This is a fascinating channel. There is a lot of overlap among neurodivergent disorders, but always a few particular symptoms/traits that distinguish them. For example, I definitely have ASD and ADHD, but I definitely do not have OCD. Thanks, Dr. Barkley, for helping us understand ♥
This is super interesting and actually helps me understand the brain processes of my adhd. Now I need to go look at your videos to see what you said about ADHD and Autism because that’s a new diagnosis I get to add to my list.
Thank you for your continued efforts to educate others. No matter the subject, you inspire a curiosity that is hard to come by outside of an academic setting.
I have ADHD, but since I was a child I also had some light obsessive / compulsive thoughts and behaviors related to symmetries. For example, when walking on a pedestrians walk made with stone plates, I felt better when my feet would step in some symmetrical way: either the left foot on a left plate and the right foot on a right plate, or both on plates in the same row, or both on the gaps between the plates, in a symmetrical way. Or, when I scratch myself with the left hand (for a light tingle, as when a hair touches my skin), it feels better when my right hand also scratches the opposite side of my body, even when that does not tingle. I do not think that I have diagnosable OCD, as there is no significant distress. And the presence of my symptoms also varies between mildly there and not noticeably present. Even when they are there, they are easily “satisfied”. But I still find this interesting.
Similar case with me. Watching my step. Compulsive symmetrical actions, even when unnecessary. Need for order. Some friends have casually called me out for OCD, but I haven't got tested for it. I found out of my ADHD a year ago. I speculated that my tendency for keeping things organised is a coping mechanism for ADHD. There is plenty of chaos in the mind, so I don't want any more chaos from outside.
This explains pre late in life ADHD diagnosis why all SSRI’s caused insomnia & basically worsened adhd symptoms. Adhd was the unknown root cause of anxiety & neurodiverse burnout every few years. Mirtazapine was helpful. A psychologist once said that she witnessed Mirtazapine make a 6 foot rugby playing male feel too tired. Not so for a tiny female hyper 😆Soul crushing looking back, being misunderstood & feeling ashamed. Stimulant meds & understanding self is life changing & an ongoing hyper focus dedicated to studying this & personalities. A much younger sibling died sadly to drugs & alcohol. They had tried to get support, but their ADHD had not been picked up on.
Compulsivity is dopaminergic, ADHDers lack dopamine, so developing compulsivity can be a dysfunctional way to get that reward system going. OCD will absolutely "cure" boredom. Both disorders also come with an experience of an "mental spam filter" that is somehow broken and an inability to redirect attention. It would make sense to me that ADHD makes someone more vulnerable to OCD, even if it is the road less travelled since the average ADHDer might gravitate more towards other comorbidities.
The way I see it, my OCD is an emerging condition from my ASD and ADHD: - of course I double check that I turned the oven off, after all, I am one to slip up and leave it on. An obsession is the easiest way to force myself to remember. - of course I worry about being perceived as menacing or a creep, my abnormal eye contact or tone have in the past produced such outcomes. This eventually becomes pathological, too.
I don't think either of those things you mention are signs that you have OCD (at least, not judging from what you say). Both are already common in ADHD and ASD, the first one is a compensation strategy, which can become detrimental if taken to the extreme and the second one sounds more like related to anxiety and masking. Not saying that your hardships are minor, just that on their own they don't really suggest an OCD diagnosis
@@mrguysnailz4907 well yeah, that's why I emphasized it's only judging from what you say here. Since you described some milder examples, I didn't find them to be the most representative of the condition. Indeed, intrusive thoughts and obsessive patterns of behaviour or thought can be present in other conditions, ADHD included (🙋). Even if the nature of these things can be very different in each diagnosis. It's also a curious thing (I'm straying a bit now), that someone might have "textbook OCD" or "textbook ADHD", but then there's people who fall somewhere in between, like having diagnosable ADHD but some traits which are typical of ASD, OCD or others, as if the lines between categories weren't sharply drawn.
This is incredibly interesting to me. Years ago, I was originally diagnosed as having OCD. I would on occasion see a mental health nurse to see how I was getting on. I remember on one occasion, whilst getting to an appointment, stopping into a newsagents where I saw book on ADD (as it was called back then). I read some of it. I remember thinking to myself "this sounds way more like me". Upon arriving to my appointment, I told the mental health nurse, about what I read, and that I believe it more accurately described me, whereupon she said "I've already made my diagnosis and please never bring up ADD again" that is my memory of what she said. I know she thought it ADD (ADHD) was something only children had. Since I was a teenager I have been a checker, checking things over and over again. My feeling is that as growing up I must have forgotten to check things, or believed I had, and as a result of the anxiety this caused, I became an obsessive person with regards to checking things. Basically, when reading about ADHD and OCD they seem to be the complete opposite, and I still cannot understand how a person could have both. Anyway, I am treaded for ADHD now.
My assessor explained working memory to me, and suddenly my checking made sense. For example, I have managed to never lock my keys in my car, because my anxiety makes me terrified of doing so. But poor working memory is like faulty RAM: I keep checking and rechecking that I have my keys, or locked the door, because I can’t retain the memory of having checked, and then that I did in fact find that I had them, etc. Fear is a factor, but I can sense being unable to register that I have them as the driving force. The fear is a rational response, because I’ve determined that without that fear I will, in fact, screw up.
Having OCD first then ADHD, I can't help but wonder why ASD wasn't more prominently investigated since it seems more the common tie to both disorders and the relationship being analyzed is pretty limited. This would be far more illuminating from an autism to ADHD/OCD perspective than ADHD to OCD without autism at all.
I always had ADHD but OCD was temporary, and caused by overmedication side effects, medicine was discontinued and OCD gradually subsided with lots of therapy and diligent practice. After hearing about the brain pathology it is possible I was misdiagnosed, stimulants and the horror of being outcast as diseased/not normal raised anxiety levels, and created the brain conditions for OCD. The Symptoms of OCD are basically maladaptive coping with anxiousness.
What really complicates this even more is Tourettes which is an impulsive? disorder that is common with both. What is really odd is the Tourettic OCD mix that seems to generate a type of forced compulsion cause Impulsions. I know cause I have them + ADHD and they've been getting worse. In my case I will twitch my neck or clear my throat in a numerical set of either 2's or 3's. Intrusive Thoughts will set them off really badly but they can occur without them. Really hope we get to study the brain more. Stimulants are weird in that they actually help me control the 'impulsions' but once they wear off it gets real bad. Coffee is, imo, worse somehow. Probably higher Norephineprine in Coffee or the ratio is off.
I have a diagnosis of OCD, ADHD, and Tics. I was told when I got this diagnosis that these three commonly are diagnosed together. I was told that this set of three are fairly commonly diagnosed together, and when they are diagnosed together it is almost guaranteed to be at least one other person of my family that has at least one of OCD and ADHD with a family my size (there are 7 people in my family). I have several family members that I suspect of having at least one of the three. Although my diagnosis is ADHD, I am convinced when ADHD and Cognitive Disengagement Syndrome are separated into two different disorders my diagnosis will change to Cognitive Disengagement Syndrome. I find this discussion fascinating. I've been specifically wondering if it is really CDS that is more common with OCD rather than ADHD. I'm also wondering how Autism Spectrum Disorder plays with all of this. Back when I got my diagnosis I actually was diagnosed with Inattentive ADD rather than ADHD. I just call it ADHD since that is no longer a diagnosis. I was also told I couldn't be screened for ASD even though that was my original request because at the time the literature said you couldn't have both ADHD and ASD, and I had a diagnosis of Inattentive ADD, so I couldn't possibly have ASD and was not eligible to be screened for it even though what brought me in for a screening in the first place was literally only a strong suspicion that I might have ASD because I had taken several online screening tests and scored EXTREMELY high on every single one. As an additional interesting factor in all of this, I have also been told there is a very disproportionate number of people with ADHD who marry people with OCD. I don't know why this would be. Perhaps it's because they have essentially opposite problems, so they naturally attract each other because they somehow sense they can basically balance each other out or something. This tendency is so strong that I believe it even shows up in fiction. For example, I personally am convinced that in "Modern Family" Claire has a mild case of undiagnosed OCD and Phil has a mild case of undiagnosed ADHD (or perhaps CDS - but since they are both diagnosed as the same condition right now I don't need to separate them yet). If it is true that ADHD and OCD marry each other in disproportionately high numbers, this could also indirectly cause the conditions to be comorbid in higher numbers because it means that for generations the genetics of these two numbers have also been mixing in disproportionally high numbers, and the kids and grandkids and great-grandkids of these unions are at risk of inheriting both disorders. I'm not entirely sure what I believe about any of it, but I'm glad to at least hear commentary on this issue from this channel as I trust this channel as a reliable source of information on the topic.
Hello. I developed tinnitus after taking Wellbutrin (just one pill!). I had it for a month now. I don’t know how to deal with this now, please make a video to warn about tinnitus and Wellbutrin. I became suicidal after that combo of adhd, depression and tinnitus
So what medication would be helpful for someone exactly like you are describing? CDS and OCD? I feel like my mind is in a constant war with itself and it’s just about to get the better of me. Idk what to do or who to turn to. All I do know is it’s difunctional and impossible to carry on a normal life like this despite all efforts.
I think the lopsided comorbidity is because OCD may get over represented as ADHD in children for instance or that OCD is under recognised in ADHD . Basically it probably represents a reporting or diagnostic bias either way rather than OCD more leading/being causative towards ADHD or similar. I wonder if Dr Barkley would postulate the same. I like the consideration of tic syndromee/tourettes and again I wonder if this is leading to a level of misdiagnosis of ADHD in OCD population
Hello, Dr. Russ Barkley. I am a psychotherapist in Mexico. I would love to hear you talk about if BPD and ADHD are related. I found some of the criteria are similar, knowing that ADHD begins in childhood but I have been noticing symptons that makes me wonder if ADHD is gound wich BPD could develop if other factors are met. I hope I could explain myself, english is not my main lenguage.
Cuando dices BPD, te refieres al trastorno bipolar o trastorno límite de la personalidad? En mi experiencia, he encontrado que hay síntomas parecidos entre ADHD y bipolar pero son diferentes. Tengo entendido que el trastorno en niños que después se puede convertir en bipolar es el DMDD. Teniendo ADHD no significa que alguien tendrá bipolar aúnque si hay comorbilidad entre los dos. Si te refieres al trastorno límite de la personalidad (borderline personality disorder) si hay algo que se conoce en inglés como “Rejection Sensitivity Dysphoria” que ocurre en personas con ADHD y (en mi opinion) se puede parecer un poco (énfasis en el poco) al trastorno límite de la personalidad pero aún no es parte de los criterios diagnóstico en ADHD. Creo que el Dr. Barkley tiene un video sobre ese tema. También te recomiendo sus libros sobre ADHD si no los has leído. No entendí muy bien la última oración de tu comentario pero espero y esto te ayude un poco. Disculpa mi español, aunque lo puedo hablar batallo en escribirlo.
I ruminate a lot-never sure if this is ADHD, obsessive traits, or depression. I sometimes get stuck in this repetitive thought pattern. So that sounds obsessive to me but I don’t really find the thoughts “distressing” per se. And I don’t do anything (no compulsions) because of the annoying repetitive thoughts. I think it might be just ADHD noise in the brain-IDK. Any thoughts on how to distinguish?
Rumination is one of my biggest issues to face as an ADHDer, in my case I would not think about it as OCD, even if I ruminate obsessively, sometimes to the point of becoming very distressed. If you take a look at some UA-cam videos of people describing their OCD intrusive thoughts and rituals they carry out to try to shake them off I think you'll get an insight. OCD seems to exhibit very specific patterns with that and it's really different from ruminating about whatever is troubling you at a given moment, if such is your case
Excellent question. Dopamine must not be the only thing at play…but still, how does dopamine appear in people who have both conditions??? Seems like studying this would be important.
I have ADHD (combined presentation), OCD and mild Tourette Syndrome. I'm not sure how that is possible, since the brain processes are supposedly opposite. My doctor told me the three disorders are often comorbid with each other. ADHD is my most severe condition, though. Maybe OCD is only commonly comorbid with ADHD if there are also tics present.
I found when i was medicated for my adhd my obsessive thoughts don't really go away, they just become more linear? Like i can focus on the obsession more easily which makes life harder at times, but i can function better and have less of them?
I’m not a professional, but my therapist told me that ADHD and PTSD can often show up in the same patient. Maybe it’s the same with CPTSD. Gabor Mate tends to think ADHD comes out of trauma in childhood. You might give him a listen if you haven’t.
It’s unfortunate that Mate has leaned into the idea these trauma is the root cause of ADHD. Dr. Barkley did a video a while back refuting that claim. I’ve suspected Mate has useful things to offer, but that kind of “my specialty explains everything” approach has made me suspicious of him. Nothing explains everything. Life is just more complicated than that. But yes, one can definitely have both ADHD and CPTSD. I’m diagnosed with the first and can increasingly determine the places where I have the second. Much of it, however, is related to experiences much later than early childhood. To my mind, the impacts of prenatal exposure to stress, other heritable factors, and experiences during early childhood neural development can increase predisposition to trauma and influence how a person responds to stress, but this is not necessarily the same thing as early childhood trauma being the singular defining element in all cases.
@ well actually in science often the best approach is Occam’s razor. Life is indeed complex, but sometimes humans over complicate it. Mate doesn’t have the answers to life, but his approach makes intuitive sense, because simply put Mother Nature knows what it is doing, it has to for survival of our species. We are meant to keep our infants close and safe like primates, when we fail to do that, the infant brain has to re-wire to compensate for the ‘threat’.
Dr. Barkley has a video playlist on CDS and its difference to ADHD. And a summary video as well. But, as far as I recall, the simplified difference is that CDS is involuntary mind wandering / daydreaming, which appears to cause distraction, sluggish responses, and taking longer on tasks. Whereas the inattentive dimension of ADHD in this contrasting model would be distractibility by external events, ie. the inability to sustain selective focus on a task when external distractions are present, and the inability to focus when the task is “boring”. So, problems with the control of attention, rather than problems shutting down the default mode network (DMN), which is the brain network associated with mind wandering. I would like to see more studies showing that some people diagnosed with ADHD have only the mind wandering dimension, while others have only the attention control dimension (with or without the impulsive / hyperactive dimension). Many people currently diagnosed with ADHD appear to have both, according to some studies, and in my very limited experience from self-help groups.
I think I'm ADHD from what I'm hearing. I don't think I was always OCD, but I feel like I have to be to keep myself in order. I have a place for everything and everything in its place but now that I'm married, my husband has a tendency to move things, I don't think on purpose, but it makes my life chaos now because I can't find things. I keep reminders and try to have some type of routine because I'm unfocused or miss appointments. For one appointment I make multiple reminders for myself up to 15 minutes before I have to leave for the appointment. As a woman, everyone needs my time so I'm easily distracted having to take care of other people or my dog, if I didn't have constant reminders or become obsessive about my routine or planning, I wouldn't be able to accomplish things.
"Desire for things to be symmetrical"? As someone with diagnosed primarily inattentive ADHD, this made me catch my breath. Disclosure: I don't believe I have OCD. At any rate, no brain/mental health professional has ever suggested it; however, loved ones have wondered if I might have AuADHD. Could the urge for symmetry be related to the perfectionism that so many of us with ADHD struggle with? I wonder if my own perfectionism is a learned response to persistent criticism when I was young and seemingly not living up to the expectations of authority figures. I can't imagine I'm alone with those experiences. I view perfectionism as maladaptive and experience it as something to achieve with no other reward than to avoid punishment. On the other hand, I experience both the observation and achievement of symmetry (and having things arranged “just so“) as thrilling satisfaction. Conversely, when things are "just off," it's disquieting at best to distressing at worst. Again, I can't be the only person to have these experiences. At any rate, thank you, Dr. Barkley, for clarifying the relationship between OCD and ADHD. Your efforts are appreciated. My suggestions for future topics would be ADHD + perfectionism, more on ASD + ADHD, and suggestions for the partners of those with ADHD (yes, I realize you have a book addressing this last point, but a video would still be welcome, especially if there are new insights.) Thanks again, and have a rewarding day!
Your third paragraph sounds like an OCD type thing (I’m not a MH professional). I have primarily inattentive ADHD and struggle with perfectionism. But I have no need or urge for symmetry. Definitely an interesting topic to explore the topic with a therapist(?)
As a person with ADHD, I find it plausible that the commonalities I have with OCD may be side effects of my masking techniques. I tend to want symmetry, and want things in their spot. But these aren't compulsions but things I do because I basically don't have a working memory. When things are where they belong I can find them. When they are symmetrical there's no randomness to remember. This is probably very over simplified, and may not be causation but instead correlation. I'm not a doctor and don't pretend to be 😊
I find I have a similar mechanism. If things are ordered and the same as they were previously then I don't need to think about it.
I have this effect with my wardrobe. My clothes are ordered (smart, hoodies, jumpers, t shirts etc) so I don't even have to think about what I'm wearing. I open up my wardrobe, go to the t-shirt section and pull out the first item
That's very relatable. I struggle with routine, but need it to function.
It helps a ton to have my keys hanging by my door, rather than leaving them in a pocket/spot.
The only problem is that when I do things automatically due to routine, I'll forget easily, bc my brain won't be processing that I wake up and routinely take meds.
"Wait did I take my meds?"
Same thing with other actions that always are the same. They don't require thinking.
Is this why I love improv so much? Or is that only a last minute on-the-spot thing..?
@@norsefrog My system for remembering if I took my meds (I started this system before I knew I had ADHD), is I leave the lid open for it on my weekly pill organizer. Top open=I took my meds, Top down=I did not take my meds. All I have to do is look and I have a visual cue as to whether or not I took my meds.
Now, what gets complicated is my son (also ADHD), like to go and close the open lids. This has caused me to at least once double up on my meds, and since I am on a blood pressure medication, that night I woke up in the middle of the night to use the bathroom and passed out on the way back to bed and hit my face/head on the bassinet that was still in our room from when he was a baby.
He's been a lot better about not closing them since then, lol. (Luckily, other than some scrapes and bruises I managed to escape any true harm, so I can laugh about it today... my wife still doesn't find much humor in it, though).
Yes, my experience agrees with this!
Often I’m “compelled” to tidy before I can work (especially WFH); but, for me it seems more so due to the ADHD issues of distractibility and task initiation, rather than OCD intrusions. (I have histories of both in my family so have had to monitor any possibility of OCD.)
Same , I agree
Thanks for covering this topic Dr. Barkley. I just wish you covered more of the difficulties and symptoms that occur when an ADHD individual has OCD as a comorbidity. Its something that I'm personally struggling with.
I was diagnosed with OCD at 23 and ADHD at 27. One reason for the gap was that I'd been led to believe it was impossible to have ADHD and OCD co-morbidly, as they involved dysfunction to the same brain regions in different ways. It's brilliant to see Dr Russell Barclay addressing this nuanced relationship empirically, and in a way that is accessible to non-specialist audiences. Thank you for doing what you do
Ohh how ist going I think I have both because the impulsive anxious nature of ADHD and obsessions...I have ocd as I got diagnosed at 21 , now I'm 24...but still life has been tough in me when it comes to dealing relationships, studies ....would love to talk to you
I've been diagnosed with both ADHD and OCD. I am a hoarder, and ADHD paralysis plays a part in the messiness. I just get overwhelmed just looking at things. I want order, and yes, symmetry, but can't seem to achieve it. When I do get a start, things have to be right - books shelved in alphabetical order, magazines stacked according to title and date. If they get mixed up, it causes me physical distress.
I have a diagnosis of both of these conditions (as well as Tics as mentioned in the video), and I experience something similar. Of course, it isn't just that. The contamination fears of OCD make it really difficult and overwhelming and causes a lot of anxiety when I plan to try to clean as well (I struggle to clean that gross plate or open that disgusting container where I'm going to have to touch and smell that gross, moldy food inside the closed container that is only gross because I didn't immediately clean it, but when I first considered cleaning it it was too overwhelming, and I needed to wait until I was strong enough and had the time and energy to do it).
The time-blindness of ADHD and the fact that I am biologically wired to be a night person and not have a 24 hour clock (which is common for people with Cognitive Disengagement Syndrome) doesn't help either. Basically, I live my entire day failing to live up to the expectations of others, and then I spend a ton of my day trying desperately to work extra hours to make up for my mistakes. For example, if I'm salaried-exempt and don't get paid for OT, if I get in at 10 am when my boss hoped I'd get in at 8 am, even if I technically am allowed to work whatever hours I chose as long as I get my work done, the looks of scorn and disdain bother me so much that instead of working the required 8 hours, I work a total of 10 hours (with no additional pay) to try to make up for showing up "late." Or if my boss insists on scheduling an 8 am meeting, I will put in 8 hours of looking like I am at work, but between the migraines and other health problems I won't be able to actually function the whole day, so I also will need to come in on the weekend or work late another day to make up the work for the entire day. If my nephew has a birthday party on Saturday at 10 am, and if by the time I have showered, dressed, and driven all the way out to their house I don't get there till 11 am, I may feel like I need to volunteer to babysit the kids another day to make it up to my sister, and I may feel like I need to take my nephew to a theme park on another day to make it up to him.
Basically, I am playing catch up for other people's expectations to try to placate them every minute of every day. This not only drains me emotionally and physically to the point that I don't have enough energy to take care of myself, but it also means I am constantly choosing between the priorities of sleep, exercise, cleaning, eating, and showering/doing laundry. It isn't healthy to skip any of these, but I don't have enough time to do all of them. Usually, showering and laundry win first place because they effect other people. Sleep tends to be next because I don't want anyone to have the excuse of blaming my sleep for while I am late. Then eating and going to the bathroom sometimes get so desperate they sometimes force me to choose them over sleep. Cleaning and exercise just can't fit into my schedule a lot of time, or at least they are the first priorities to drop off when I have to stay late at work or make up something to a friend. But on the rare occasions when they do manage to fit into my schedule, now the anxiety and paralysis and confusion from the OCD and ADHD also kick in and make it hard to clean, which becomes a loop of stress because I know I can't spend that precious time in paralysis, but I do anyway.
Thank you for this video! As someone with inattentive ADHD I am intrigued by this video as I have had OCD since childhood. However, I heavily relate with CDS but also have other confounding conditions such as cPTSD and dysautonomia. It all feels extremely confusing to decipher.
I’ve not seen anyone mention dysautonomia before! That’s a thing for me as well. My diagnoses include combined, ASD1 and GAD. I have some OCD behaviors although I think they track better with ASD. I agree that the range of traits can be confounding. Both my parents were varying types of neurodivergent, and I inherited some of everything. I’m sure I’ve got some cPTSD as well.
This is a fascinating channel. There is a lot of overlap among neurodivergent disorders, but always a few particular symptoms/traits that distinguish them. For example, I definitely have ASD and ADHD, but I definitely do not have OCD. Thanks, Dr. Barkley, for helping us understand ♥
This is super interesting and actually helps me understand the brain processes of my adhd. Now I need to go look at your videos to see what you said about ADHD and Autism because that’s a new diagnosis I get to add to my list.
Thank you for your continued efforts to educate others. No matter the subject, you inspire a curiosity that is hard to come by outside of an academic setting.
You’re doing God’s work Dr! Thank You!!!
Absolutely brilliant. My sister has my mother’s ADHD brain and I have my father’s OCD brain.
I have ADHD, but since I was a child I also had some light obsessive / compulsive thoughts and behaviors related to symmetries. For example, when walking on a pedestrians walk made with stone plates, I felt better when my feet would step in some symmetrical way: either the left foot on a left plate and the right foot on a right plate, or both on plates in the same row, or both on the gaps between the plates, in a symmetrical way. Or, when I scratch myself with the left hand (for a light tingle, as when a hair touches my skin), it feels better when my right hand also scratches the opposite side of my body, even when that does not tingle.
I do not think that I have diagnosable OCD, as there is no significant distress. And the presence of my symptoms also varies between mildly there and not noticeably present. Even when they are there, they are easily “satisfied”. But I still find this interesting.
Similar case with me. Watching my step. Compulsive symmetrical actions, even when unnecessary. Need for order.
Some friends have casually called me out for OCD, but I haven't got tested for it.
I found out of my ADHD a year ago.
I speculated that my tendency for keeping things organised is a coping mechanism for ADHD. There is plenty of chaos in the mind, so I don't want any more chaos from outside.
This explains pre late in life ADHD diagnosis why all SSRI’s caused insomnia & basically worsened adhd symptoms. Adhd was the unknown root cause of anxiety & neurodiverse burnout every few years. Mirtazapine was helpful. A psychologist once said that she witnessed Mirtazapine make a 6 foot rugby playing male feel too tired. Not so for a tiny female hyper 😆Soul crushing looking back, being misunderstood & feeling ashamed. Stimulant meds & understanding self is life changing & an ongoing hyper focus dedicated to studying this & personalities. A much younger sibling died sadly to drugs & alcohol. They had tried to get support, but their ADHD had not been picked up on.
Compulsivity is dopaminergic, ADHDers lack dopamine, so developing compulsivity can be a dysfunctional way to get that reward system going. OCD will absolutely "cure" boredom. Both disorders also come with an experience of an "mental spam filter" that is somehow broken and an inability to redirect attention. It would make sense to me that ADHD makes someone more vulnerable to OCD, even if it is the road less travelled since the average ADHDer might gravitate more towards other comorbidities.
The way I see it, my OCD is an emerging condition from my ASD and ADHD:
- of course I double check that I turned the oven off, after all, I am one to slip up and leave it on. An obsession is the easiest way to force myself to remember.
- of course I worry about being perceived as menacing or a creep, my abnormal eye contact or tone have in the past produced such outcomes. This eventually becomes pathological, too.
I don't think either of those things you mention are signs that you have OCD (at least, not judging from what you say).
Both are already common in ADHD and ASD, the first one is a compensation strategy, which can become detrimental if taken to the extreme and the second one sounds more like related to anxiety and masking. Not saying that your hardships are minor, just that on their own they don't really suggest an OCD diagnosis
@ravensong9030 intrusive thoughts and compulsive behaviour? I gave my most tame examples, naturally.
Fwiw I am diagnosed, too
@@mrguysnailz4907 well yeah, that's why I emphasized it's only judging from what you say here.
Since you described some milder examples, I didn't find them to be the most representative of the condition.
Indeed, intrusive thoughts and obsessive patterns of behaviour or thought can be present in other conditions, ADHD included (🙋). Even if the nature of these things can be very different in each diagnosis.
It's also a curious thing (I'm straying a bit now), that someone might have "textbook OCD" or "textbook ADHD", but then there's people who fall somewhere in between, like having diagnosable ADHD but some traits which are typical of ASD, OCD or others, as if the lines between categories weren't sharply drawn.
Thanks, doc (much appreciated, as always)! 🤗
I have been wondering for months if I have ocd and adhd and this video makes me more sure.
This is incredibly interesting to me. Years ago, I was originally diagnosed as having OCD. I would on occasion see a mental health nurse to see how I was getting on. I remember on one occasion, whilst getting to an appointment, stopping into a newsagents where I saw book on ADD (as it was called back then). I read some of it. I remember thinking to myself "this sounds way more like me". Upon arriving to my appointment, I told the mental health nurse, about what I read, and that I believe it more accurately described me, whereupon she said "I've already made my diagnosis and please never bring up ADD again" that is my memory of what she said. I know she thought it ADD (ADHD) was something only children had.
Since I was a teenager I have been a checker, checking things over and over again. My feeling is that as growing up I must have forgotten to check things, or believed I had, and as a result of the anxiety this caused, I became an obsessive person with regards to checking things. Basically, when reading about ADHD and OCD they seem to be the complete opposite, and I still cannot understand how a person could have both. Anyway, I am treaded for ADHD now.
My assessor explained working memory to me, and suddenly my checking made sense. For example, I have managed to never lock my keys in my car, because my anxiety makes me terrified of doing so. But poor working memory is like faulty RAM: I keep checking and rechecking that I have my keys, or locked the door, because I can’t retain the memory of having checked, and then that I did in fact find that I had them, etc. Fear is a factor, but I can sense being unable to register that I have them as the driving force. The fear is a rational response, because I’ve determined that without that fear I will, in fact, screw up.
Having OCD first then ADHD, I can't help but wonder why ASD wasn't more prominently investigated since it seems more the common tie to both disorders and the relationship being analyzed is pretty limited. This would be far more illuminating from an autism to ADHD/OCD perspective than ADHD to OCD without autism at all.
I always had ADHD but OCD was temporary, and caused by overmedication side effects, medicine was discontinued and OCD gradually subsided with lots of therapy and diligent practice. After hearing about the brain pathology it is possible I was misdiagnosed, stimulants and the horror of being outcast as diseased/not normal raised anxiety levels, and created the brain conditions for OCD. The Symptoms of OCD are basically maladaptive coping with anxiousness.
What really complicates this even more is Tourettes which is an impulsive? disorder that is common with both. What is really odd is the Tourettic OCD mix that seems to generate a type of forced compulsion cause Impulsions. I know cause I have them + ADHD and they've been getting worse. In my case I will twitch my neck or clear my throat in a numerical set of either 2's or 3's. Intrusive Thoughts will set them off really badly but they can occur without them. Really hope we get to study the brain more.
Stimulants are weird in that they actually help me control the 'impulsions' but once they wear off it gets real bad. Coffee is, imo, worse somehow. Probably higher Norephineprine in Coffee or the ratio is off.
I feel like the one big way how they go together is how both can be highly obsessive but not necessarily compulsive with actions and such.
I have a diagnosis of OCD, ADHD, and Tics. I was told when I got this diagnosis that these three commonly are diagnosed together. I was told that this set of three are fairly commonly diagnosed together, and when they are diagnosed together it is almost guaranteed to be at least one other person of my family that has at least one of OCD and ADHD with a family my size (there are 7 people in my family). I have several family members that I suspect of having at least one of the three. Although my diagnosis is ADHD, I am convinced when ADHD and Cognitive Disengagement Syndrome are separated into two different disorders my diagnosis will change to Cognitive Disengagement Syndrome. I find this discussion fascinating. I've been specifically wondering if it is really CDS that is more common with OCD rather than ADHD. I'm also wondering how Autism Spectrum Disorder plays with all of this. Back when I got my diagnosis I actually was diagnosed with Inattentive ADD rather than ADHD. I just call it ADHD since that is no longer a diagnosis. I was also told I couldn't be screened for ASD even though that was my original request because at the time the literature said you couldn't have both ADHD and ASD, and I had a diagnosis of Inattentive ADD, so I couldn't possibly have ASD and was not eligible to be screened for it even though what brought me in for a screening in the first place was literally only a strong suspicion that I might have ASD because I had taken several online screening tests and scored EXTREMELY high on every single one.
As an additional interesting factor in all of this, I have also been told there is a very disproportionate number of people with ADHD who marry people with OCD. I don't know why this would be. Perhaps it's because they have essentially opposite problems, so they naturally attract each other because they somehow sense they can basically balance each other out or something. This tendency is so strong that I believe it even shows up in fiction. For example, I personally am convinced that in "Modern Family" Claire has a mild case of undiagnosed OCD and Phil has a mild case of undiagnosed ADHD (or perhaps CDS - but since they are both diagnosed as the same condition right now I don't need to separate them yet). If it is true that ADHD and OCD marry each other in disproportionately high numbers, this could also indirectly cause the conditions to be comorbid in higher numbers because it means that for generations the genetics of these two numbers have also been mixing in disproportionally high numbers, and the kids and grandkids and great-grandkids of these unions are at risk of inheriting both disorders.
I'm not entirely sure what I believe about any of it, but I'm glad to at least hear commentary on this issue from this channel as I trust this channel as a reliable source of information on the topic.
Where do you get real, and practical help/treatment. Seems like there are so many different theories, often seem conflicting ones.
Hello. I developed tinnitus after taking Wellbutrin (just one pill!). I had it for a month now. I don’t know how to deal with this now, please make a video to warn about tinnitus and Wellbutrin. I became suicidal after that combo of adhd, depression and tinnitus
Danke aus Deutschland!
Why can't a person get their brain scanned to make sure diagnosis is correct if there are physical differences?
So what medication would be helpful for someone exactly like you are describing? CDS and OCD? I feel like my mind is in a constant war with itself and it’s just about to get the better of me. Idk what to do or who to turn to. All I do know is it’s difunctional and impossible to carry on a normal life like this despite all efforts.
My first psych thought i had what he called "baby ocd". Turns out i just had adhd 🤷♂️
I think the lopsided comorbidity is because OCD may get over represented as ADHD in children for instance or that OCD is under recognised in ADHD . Basically it probably represents a reporting or diagnostic bias either way rather than OCD more leading/being causative towards ADHD or similar. I wonder if Dr Barkley would postulate the same. I like the consideration of tic syndromee/tourettes and again I wonder if this is leading to a level of misdiagnosis of ADHD in OCD population
With all the power I have, I gathered 4000 rupees which roughly translates to 50usd. Went for diagnosis of adhd (one session) and diagnosed with OCD.
Hello, Dr. Russ Barkley.
I am a psychotherapist in Mexico. I would love to hear you talk about if BPD and ADHD are related. I found some of the criteria are similar, knowing that ADHD begins in childhood but I have been noticing symptons that makes me wonder if ADHD is gound wich BPD could develop if other factors are met.
I hope I could explain myself, english is not my main lenguage.
Cuando dices BPD, te refieres al trastorno bipolar o trastorno límite de la personalidad? En mi experiencia, he encontrado que hay síntomas parecidos entre ADHD y bipolar pero son diferentes. Tengo entendido que el trastorno en niños que después se puede convertir en bipolar es el DMDD. Teniendo ADHD no significa que alguien tendrá bipolar aúnque si hay comorbilidad entre los dos. Si te refieres al trastorno límite de la personalidad (borderline personality disorder) si hay algo que se conoce en inglés como “Rejection Sensitivity Dysphoria” que ocurre en personas con ADHD y (en mi opinion) se puede parecer un poco (énfasis en el poco) al trastorno límite de la personalidad pero aún no es parte de los criterios diagnóstico en ADHD. Creo que el Dr. Barkley tiene un video sobre ese tema.
También te recomiendo sus libros sobre ADHD si no los has leído.
No entendí muy bien la última oración de tu comentario pero espero y esto te ayude un poco. Disculpa mi español, aunque lo puedo hablar batallo en escribirlo.
ADHD ➕ Hoarding ➕ BED
Any research on adhd and bfrb correlation?
I ruminate a lot-never sure if this is ADHD, obsessive traits, or depression. I sometimes get stuck in this repetitive thought pattern. So that sounds obsessive to me but I don’t really find the thoughts “distressing” per se. And I don’t do anything (no compulsions) because of the annoying repetitive thoughts. I think it might be just ADHD noise in the brain-IDK. Any thoughts on how to distinguish?
Rumination is one of my biggest issues to face as an ADHDer, in my case I would not think about it as OCD, even if I ruminate obsessively, sometimes to the point of becoming very distressed.
If you take a look at some UA-cam videos of people describing their OCD intrusive thoughts and rituals they carry out to try to shake them off I think you'll get an insight. OCD seems to exhibit very specific patterns with that and it's really different from ruminating about whatever is troubling you at a given moment, if such is your case
@ wow, great reply. Thanks! I appreciate your insight.
@@Rob_132 you're welcome! I'm glad I could help a bit :)
I’m being treated for both and still struggling. How does one go about getting reevaluated without compromising treatment?
I know my OCD revolves around trying to be in control.
Is this ADHD mentioned really just ADHD or might this be in combination with ASD?
How can this contradiction of Dopamine occur in someone that has OCD and AD/HD? Higher levels of dopamine in OCD and lower levels in AD/HD?
Excellent question. Dopamine must not be the only thing at play…but still, how does dopamine appear in people who have both conditions??? Seems like studying this would be important.
I was wondering this to and was going to ask.
I have ADHD (combined presentation), OCD and mild Tourette Syndrome. I'm not sure how that is possible, since the brain processes are supposedly opposite. My doctor told me the three disorders are often comorbid with each other. ADHD is my most severe condition, though. Maybe OCD is only commonly comorbid with ADHD if there are also tics present.
I found when i was medicated for my adhd my obsessive thoughts don't really go away, they just become more linear? Like i can focus on the obsession more easily which makes life harder at times, but i can function better and have less of them?
Hair pulling for OCD and diagnosed as an adult with high marks in school.
I also heard adhd and autism frequently overlap.
🧠
Any connection between ADHD and CPTSD?
I’m not a professional, but my therapist told me that ADHD and PTSD can often show up in the same patient. Maybe it’s the same with CPTSD. Gabor Mate tends to think ADHD comes out of trauma in childhood. You might give him a listen if you haven’t.
@@Rob_132gabor Mate is a gift to humanity.
It’s unfortunate that Mate has leaned into the idea these trauma is the root cause of ADHD. Dr. Barkley did a video a while back refuting that claim. I’ve suspected Mate has useful things to offer, but that kind of “my specialty explains everything” approach has made me suspicious of him. Nothing explains everything. Life is just more complicated than that.
But yes, one can definitely have both ADHD and CPTSD. I’m diagnosed with the first and can increasingly determine the places where I have the second. Much of it, however, is related to experiences much later than early childhood. To my mind, the impacts of prenatal exposure to stress, other heritable factors, and experiences during early childhood neural development can increase predisposition to trauma and influence how a person responds to stress, but this is not necessarily the same thing as early childhood trauma being the singular defining element in all cases.
@ well actually in science often the best approach is Occam’s razor.
Life is indeed complex, but sometimes humans over complicate it. Mate doesn’t have the answers to life, but his approach makes intuitive sense, because simply put Mother Nature knows what it is doing, it has to for survival of our species.
We are meant to keep our infants close and safe like primates, when we fail to do that, the infant brain has to re-wire to compensate for the ‘threat’.
Never means never. But people don't get it or is it my ADHD?
And the difference between CDS and ASD …??🤔🙏
Dr. Barkley has a video playlist on CDS and its difference to ADHD. And a summary video as well. But, as far as I recall, the simplified difference is that CDS is involuntary mind wandering / daydreaming, which appears to cause distraction, sluggish responses, and taking longer on tasks. Whereas the inattentive dimension of ADHD in this contrasting model would be distractibility by external events, ie. the inability to sustain selective focus on a task when external distractions are present, and the inability to focus when the task is “boring”. So, problems with the control of attention, rather than problems shutting down the default mode network (DMN), which is the brain network associated with mind wandering.
I would like to see more studies showing that some people diagnosed with ADHD have only the mind wandering dimension, while others have only the attention control dimension (with or without the impulsive / hyperactive dimension). Many people currently diagnosed with ADHD appear to have both, according to some studies, and in my very limited experience from self-help groups.
@ thank you so much! That makes sense to me!
I think I'm ADHD from what I'm hearing. I don't think I was always OCD, but I feel like I have to be to keep myself in order.
I have a place for everything and everything in its place but now that I'm married, my husband has a tendency to move things, I don't think on purpose, but it makes my life chaos now because I can't find things.
I keep reminders and try to have some type of routine because I'm unfocused or miss appointments. For one appointment I make multiple reminders for myself up to 15 minutes before I have to leave for the appointment.
As a woman, everyone needs my time so I'm easily distracted having to take care of other people or my dog, if I didn't have constant reminders or become obsessive about my routine or planning, I wouldn't be able to accomplish things.
Just to be sure, is CDS what used to be called SCT?
Yes
"Desire for things to be symmetrical"? As someone with diagnosed primarily inattentive ADHD, this made me catch my breath. Disclosure: I don't believe I have OCD. At any rate, no brain/mental health professional has ever suggested it; however, loved ones have wondered if I might have AuADHD.
Could the urge for symmetry be related to the perfectionism that so many of us with ADHD struggle with? I wonder if my own perfectionism is a learned response to persistent criticism when I was young and seemingly not living up to the expectations of authority figures. I can't imagine I'm alone with those experiences.
I view perfectionism as maladaptive and experience it as something to achieve with no other reward than to avoid punishment. On the other hand, I experience both the observation and achievement of symmetry (and having things arranged “just so“) as thrilling satisfaction. Conversely, when things are "just off," it's disquieting at best to distressing at worst. Again, I can't be the only person to have these experiences.
At any rate, thank you, Dr. Barkley, for clarifying the relationship between OCD and ADHD. Your efforts are appreciated. My suggestions for future topics would be ADHD + perfectionism, more on ASD + ADHD, and suggestions for the partners of those with ADHD (yes, I realize you have a book addressing this last point, but a video would still be welcome, especially if there are new insights.) Thanks again, and have a rewarding day!
Your third paragraph sounds like an OCD type thing (I’m not a MH professional). I have primarily inattentive ADHD and struggle with perfectionism. But I have no need or urge for symmetry. Definitely an interesting topic to explore the topic with a therapist(?)