In this episode, I’m thrilled to welcome Natalia Aíza, a multilingual counselor and OCD specialist.
Natalia is the founder and executive director of Kairos Wellness Collective, a therapy center that focuses on holistic care for clients experiencing OCD and Anxiety - located in Boulder, Colorado. They offer therapies including Exposure Response Prevention (ERP), Cognitive Behavioral Therapy (CBT), Play Therapy, Art Therapy, Acceptance and Commitment Therapy (ACT), Eye Movement Desensitization and Reprocessing (EMDR) and Neurofeedback. Obviously, we won’t get into all of that in our conversation today, but we do hit on a few of those.
Also, separately, I wanted to mention that Kairos is the Greek word meaning “the perfect, delicate, crucial moment; the fleeting rightness of time and place that creates the opportune atmosphere for action, words or movement; also weather.” And really, I just wanted to share that because I love words like that - I just find them neat.
Anyway, in our conversation today, we dive into the overlap of ADHD and OCD - how they are similar and how they differ, and also the unique challenges each presents, especially when they are co-occurring. Natalia shares her personal and professional insights on distinguishing between ADHD distractions and OCD compulsions and how to approach treatment for each.
Also before we get started, I wanted to let you know about my AMA on YouTube Live, happening the week this is released on January 31st at 10 AM Pacific - if you’re interested you can find that on the Hacking Your ADHD YouTube page, youtube.com/@hackingyouradhd and subscribe to the channel - or if you want to submit a question ahead of time you can do so at hackingyouradhd.com/ama
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William Curb: All right. One of the places that'd be great for us to start is getting some definitions of what OCD is, obsessive-compulsive disorder. And we also were going to talk about the generalized anxiety disorder. And I figured if we start off with some definitions there that can help get people into what we're actually talking about.
Natalia Aíza: 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-currence 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. So I'll have that intrusive thought. It comes into my head unbidden. And my OCD will make me want to suit 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 funky 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.
William Curb: 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 where it's with OCD that just reinforces the process.
Natalia Aíza: 1000%. 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 discongruence between those two disorders. So I'm excited to explore why.
William Curb: So as a co-morbid condition, I'm sure there's a lot of overlapping symptoms as well. If you feel this need to self soothes, that's probably very distracting and that's like an impulsive thing and it definitely will be affecting your emotional regulation and all that. So is there ways to tease out what's driving the bus in this situation?
Natalia Aíza: 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 regularly trained therapists in our graduate programs, there actually is not specific OCD training in 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 a tension. 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 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 actually do the parts of our life that are needed to do, we seem very zoned out. So while 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.
William Curb: One of the other things I think it could be a huge confounding factor here too is the ADHD hyper-focused on something and that combined with this need to self soothe could be a very negative reinforcing cycle.
Natalia Aíza: 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 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 and ADHD and I feel often times 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.
William Curb: Oh yeah, I can totally see that too because I do a lot of like self-treatment of my ADHD with anxiety.
Natalia Aíza: Yes.
William Curb: 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.
Natalia Aíza: 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 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 there, who's going to have more control, the ADHD or the OCD 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 my value system, it's more sort of obeying this fear-based structure in our brains.
William Curb: 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 the pop culture definition of OCD is, ADHD has the same problem where the pop culture is just so wrong and then you're like this is not what that actually is at all.
Natalia Aíza: OCD, 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, 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.
William Curb: Yeah, that makes a lot of sense and it does sound like this is something that's very much needs that like clinician involved with because you know there's so many confounding factors here.
Natalia Aíza: It is so yes, 1000% 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 focus repetitive behaviors which are things like skin picking, hair pulling, nail biting. There's also quite a bit of overlap between ADHD and OCD and hoarding disorder. There's many different clues that are laid down by this concurrence 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 under diagnosed 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.
William Curb: 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. It's like, okay, whatever I thought it was might not be the case.
Natalia Aíza: 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.
William Curb: I'm kind of curious to hear, 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 I'm also at risk or have OCD? Because I'm sitting here playing with my fidget and I'm like, is this a compulsive behavior or is this just something that is well within normal for ADHD?
Natalia Aíza: Okay, that's a great question. 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 egg that comes before it. 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.
I don't 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 describe my brain as the ADHD part is like, la, la, la, happy, go lucky. Then my OCD part is like, everything is messed up. I get that competing energies in my head. I actually feel like my value system, my personality is a lot more like the ADHD. The OCD is something maladaptive in my brain that is interfering with me just living my best life.
William Curb: That makes a lot of sense because while I have all these things with my ADHD, it's like, I want to go do that. There's the tag I can't ignore or something. It's not a dark thing. It's just like, oh, I just can't ignore it. I need to take care of it.
Natalia Aíza: Yes. And sensory issues, they're annoying. They can even be overwhelming. However, OCD, the egg is very strong. It's far more than an annoyance. It is this feeling of something really problematic is happening and I have to stop it. That's how I would understand OCD in general is that it is propelling you out of anxiety and fear and catastrophization.
William Curb: I think that's a good way for people to 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. Half the time I talk about comorbidities, I'm like, is that me too?
Natalia Aíza: Yeah that's normal. OCD is the fourth most common mental health disorder in the world. I think above all else is just under diagnosis. I think that while I don't want to plant any seeds that are undoing people's heads, even worrying if you have a disorder can be a part of OCD where we're compulsively googling, 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. That's part of the compulsive cycle, which is different than impulsivity, which is 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. We're doing the same thing over and over and over.
William Curb: Yeah. And is there an aspect of maybe not even being mentally aware of that's what's going on?
Natalia Aíza: Oh, yeah, definitely. I have this same issue with my ADHD. 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 seven. Many people's OCD onset is in like preadolescence. 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 in my shoulder and immediately Google it and make an appointment. Like that's just the way I 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.
William Curb: And I'm sure this is also placed 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 is working now.
Natalia Aíza: 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.
William Curb: I can see how also with this, I'm sure this is kind of more like 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.
Natalia Aíza: 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 a 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 our agorophobia, 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.
William Curb: That's so opposite of how you treat ADHD. I can see how that be so hard.
Natalia Aíza: So it is very complex. But I'll say, you know, quite a few people that have those extreme levels of OCD also have ADHD. And previously had their main challenges were around attention, around being able to access certain executive functions. But the OCD has slowly eroded any functioning ability to the point where everything is about anxiety avoidance.
William Curb: Well, anxiety can be a problem. It is also not, moderate doses is not, should be kind of expected like in life.
Natalia Aíza: Yeah. And that's the treatment actually for OCD is you normalize anxiety. 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 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 like facing your distress is going to be a huge part of recovery.
William Curb: 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.
Natalia Aíza: Yes. Yes.
William Curb: Like we had the plates in the cabinets that were light blue and dark blue. And I was like, they go and light blue and dark blue stacks. And that's how we do it. And then I was like, you told me, I was like, Hey, let's just start mixing them up. And boy, did that feel uncomfortable at first. But like now 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, and just 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.
Natalia Aíza: That's amazing that you say that as an example, because that's actually an exposure that I assigned to people to purposefully misspell something in a social media poster and 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's part of, with perfectionism is normalizing the error because sometimes perfectionism in its extreme forms can lead to inaction.
William Curb: I don't even think the extreme forms lead to inaction. A lot of like, that was kind of like where I was like, I need to get over this because I like this 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. That seems like a problem.
Natalia Aíza: Yes. Yes. And OCD absolutely praise on self-worth. It says, I have intrusive voices 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 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? 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 need to overcompensate for that in order to make people please, others, and to feel like I'm okay.
William Curb: Yeah, I can totally see that overcompensation 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 toxic behavior of maladaptive things where you're like, I'm just doing these things so that no one's going to ever complain.
Natalia Aíza: 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.
William Curb: Yeah, absolutely. Because I'm like, here we go. Oh, yeah, that one, that one. Yep. Yep. Things to talk about with my therapist this week.
Natalia Aíza: I tend to do that. My colleagues joke that I'm like Oprah with OCD diagnoses that you have OCD and you have OCD, that I'm like bringing up a lot of it. But really, like you said, 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 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.
William Curb: I was also like looking at some of the other therapy options that had the chiro's 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?
Natalia Aíza: 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 neuro-feedback, 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.
William Curb: Yeah. It all depends on what people know that 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. I can see how DBT would be much more effective because that's more of the yes, what your experience is true, whereas CBT does more questioning of if it is true.
Natalia Aíza: Yeah. There's a type of OCD treatment called inference-based CBT, ICBT, 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 therapist, the purist 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 distrust and realize that it's less frightening than they believe it to be.
William Curb: Yeah, because it is built up in our mind, but it's hard to think out of what you've built up.
Natalia Aíza: Yes, yes. And those of us with OCD were great at creating anticipatory anxiety. We often overestimate how hard something will be for us. And once we actually do it, usually the feedback I get from my clients is, oh, that wasn't that bad. That's what kind of universally that I managed to create something far more severe in my brain as I was imagining it.
William Curb: That's true for everyone. Yes. Just like, yeah, we overestimate situations. And when we get to the situation, like, well, I get that was not quite what I imagined.
Natalia Aíza: 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 other types of brains. And OCD makes us incredibly risk-averse. And so the ADHD can actually help combat that and get us to just make the leap into action.
William Curb: 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.
Natalia Aíza: 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.
William Curb: Well, I was wondering if you just had any final thoughts you wanted to leave the audience with.
Natalia Aíza: 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 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 at 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 Natalia@kairoswellnesscollective.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 experiences plus clinicians and some of us that are both. So there's definitely support out there, myself included. And 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.
William Curb: 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, it's worth looking into early, right?
Natalia Aíza: 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.
William Curb: Okay, great. Well, thank you so much for coming on the show. I'm sure a lot of you are going to eat a lot out of this episode.
Natalia Aíza: Thank you so much for having me. I appreciate you.
This Episode's Top Tips
It’s important to remember that you need to approach OCD and ADHD treatments differently; techniques beneficial for one may exacerbate the other.
Try to distinguish between compulsions and simple fidgets or stims—while symptoms can be similar, it’s essential to understand the root causes that characterize compulsions.
Be proactive in seeking diagnosis and treatment if OCD symptoms appear; early intervention can prevent the condition from worsening.