This ONE Habit Means You Have ADHD & OCD - Dr Alex George

0:00Sierra has all the best active and outdoor brands you need. From athletic stuff, like a full-court pickup game, swish, to athletic-ish stuff, like a half-mile stroll. Get those steps in! And from morning hikes up the mountain trail, good pace, to nighttime ghost stories from the camping chair. What a twist! Whatever level of active, Sierra loves it all. Head to Sierra or Sierra.com for the brands you want at the prices that let you do it all. From athletic to athletic-ish, Sierra's got it. ADHD is a disorder regulation where you have features of things like impulsivity, hyperfocus, sensitivity.

0:37In OCD, you have a situation of obsession with something that relates to your health, morality, thought process, time. And you are stuck on this thing. Dr. Alex George is an ADHD specialist. And one of the most renowned voices in the ADHD space. He's using his incredible knowledge to help you understand your ADHD. And live in harmony with it. The cruelty is that OCD feeds on people that care. That care about their own health, that care about the health of others, that care about their impact on other people, that want to learn from their mistakes. That is the perfect place for OCD to thrive. I tell you one thing for sure, I'd happily lose everything I've ever done in terms of success and achievements and not have OCD and live peacefully because OCD has definitely nearly killed me.

1:16On the extreme end of it, and only if you're happy to talk about that, how does OCD kill people? So, OCD... Can I have just a second of your time? If this podcast has helped you understand your brain or made you feel less alone, can you do me one favour? Can you hit the follow button? And I'll repay the favour by continuing to book the best and most exclusive conversations on this topic. Please enjoy the episode and always remember, you're not broken, just different, and you have always been enough. A quick trigger warning before we start. References to suicide are made from the beginning.

1:53Dr. Alex George, welcome back. Thank you. Thanks for having me. You've had some interesting news recently, which in many ways might be a warning to our viewers and listeners. You've recently, as well as ADHD, been diagnosed with OCD. Is there a big overlap there? Yeah, I think it's, to be honest with you, OCD is something that I've lived with most of my life, but had no idea that I actually had. And I think this is the thing about OCD. It's a sneaky, sneaky illness because it constantly hides behind your worries and your fears. And you constantly think that it's the thing you're worried about that needs fixing, not the illness itself.

2:36So, you know, many people with OCD, like myself, will go 15, 20 years before they're diagnosed for that very reason. So if you're someone, for example, that's constantly worried they're going to get sick. Your brain is focusing on not getting sick and making sure that your compulsions, your actions are going to minimize that risk of getting sick. What you don't think is that it's not the illness that you're worried about catching that's the problem, it's the OCD. You don't realize that. Or if you're someone that's worried about being a good person, you're constantly like, no, but this thing that I did makes me bad.

3:06Or this thing, I need to deal with this in the right way, otherwise I'm a bad person. You think that that is the thing you need to get to the bottom of, and you never do. You don't realize that actually, it's the OCD you need to work on. And it's cruel for that reason. You know, at this core, OCD is something where there's an obsession. So the core thing that you're worried about often preys on your biggest fears, maybe being a good person or, you know, say, yeah, say, for example, being a good person is your important thing that you want to be. And then everything in your life is to try and make sure that you don't do anything that could be aligned with not being a good person, or punishing yourself for any mistakes you've made that would line with being a bad person.

3:43So it is very cruel because you have this obsession. And then your compulsion, the OCD part, so the C, the compulsive part, can be not just people think of it as cleaning or tidying pencils. It can be rumination. Rumination is a very core compulsion that people have. Fact-checking, reassurance-seeking, checking your thoughts, your context over and over and over again. That is a compulsion. Now, of course, most people want to be a reasonably good person. Most people have the ability to reflect and go, I made a mistake, I'll learn from it. But the difference is you'll never get to the point where you accept and move on.

4:19So a normal thing is like, I made a mistake, I offended someone, I'll feel bad about that, I'll remedy it, learn from it, move on. It's not normal five years later to still be thinking about that interaction over and over and over again. It is a very cruel thing, and I think it's much more common in the ADHD community. It sounds all-consuming and totally exhausting. Are there any positives of having OCD? Not that I've realized. Actually, no, there is one. And someone said this. I thought it's very true. Having OCD means that you are, if there's a crisis, you're the most prepared person in the room because you've imagined every single day and experienced in your body a crisis continually happening.

4:56The way that it feels to have OCD is that you are living with your worst case scenario as if it's happening every single day. so the visceral response you have the anxiety the worry the dread the all-consuming-ness of OCD is as if the thing you're afraid about is actually happening so when a disaster actually happens often the most calmest people in the room are the ADHDers and the OCDers those ADHDers will focus in and hone in and the OCDers well I've been preparing for this every day of my life anyway so the worst case has happened and actually it's not as bad as I thought it would be um and it's yeah I think that's about as good as it gets i think ocd is a very cruel uh condition uh who names as the seventh i believe it says it's the seventh um most debilitating condition uh worldwide because it's all-consuming absorbs every part it's all-consuming can absorb every part of your focus attention and being suicide risk is exponentially higher in those of ocd co-concurrent depression is much higher as well and often people with ocd will use other ways to kind of cope with their compulsions or their anxiety, for example, drug use and alcohol as well.

6:02So it's a really difficult thing to have. And a lot of people don't realize that OCD has a very strong genetic component. And there are many psychiatrists who argue that it is actually part of a neurodevelopmental disorder, so that OCD is a neurodevelopmental disorder in itself. If I look on my mother's side, I believe, I'm not certain, but I suspect my nan may have had OCD. My mum, I believe, had OCD when she was younger, really struggled with it. She had a lot of fear around making mistakes at work and would go and check. And they would wake up at night at five in the morning, couldn't relax, couldn't even enjoy time off.

6:37And now look at myself and I've been passed on, I think, that unfortunate gene. And it's been very hard. I actually think that OCD has been way harder than ADHD. I don't want to say that that sounds minimizing of ADHD. but in my experience, the OCD has been horrendous. Maybe the ADHD has actually been part of it because you have a hyper-focus, impulsive, sensitive part of an experience combined with a compulsive, hyper-rumination-type experience. The two is like a beautifully horrible storm. Many of the viewers and listeners will relate to what you just said. How many people with ADHD have OCD?

7:19This is really shocking. around 3 % of the population experience OCD at some point in their life, right? When you look at people with OCD, 25 or up to 25 % of them have co-concurrent ADHD. So what we're saying is that a lot of people who have OCD, a significant proportion of them actually have a background of having ADHD. And bearing in mind the prevalence of ADHD is about 4 % to 5%, I think that shows really, and highlights how much the two things can play into each other, which to me makes absolute sense. So if you have ADHD and you're someone that gets really stuck on things, I don't really care what your compulsions are, physical or not.

8:02If you get stuck on things and you can't get over things, you keep ruminating or you can't move on from something, it keeps coming up day after day, week after week. Think about OCD. OCD is the fourth most common psychiatric disorder. So it's a really common experience. And yet it is massively underdiagnosed because people don't realize they have it. They suffer for decades with no clue that the thing they're suffering from is actually OCD. You've also been very successful. You've got a podcast that you've stuck at for three years. You've written many books. You've got many businesses. And for someone to do that, surely there needs to be some form of obsession towards those things to stick at it.

8:39If someone is successful in the metrics that society defines success as, the obsession that's required in order to achieve that, is that related to OCD? Maybe I often wonder if I want to do my best to kind of be busy, to focus on other things. Morality is very important. I want to help people and do good things. And therefore, perhaps my obsession around making sure that I make a difference plays into it. But I suspect that probably leans more to other aspects of being neurodivergent than the OCD side of it. Maybe it does drive me in some ways. Maybe that there's a level of avoidance even by that.

9:22I think you're right. I mean, like I said, the things that make you susceptible to OCD are the things that might make you brilliant at running a podcast like this. The fact that, for example, if you want to be someone to help other people, you kind of need to care about other people, right? You need to actually have empathy and care. If you're someone that really cares about your impact on the world and your behavior and how you are and is introspective, because usually you need to have some level of introspection as to how you're impacting others, that makes a very good playing field for OCD to enter.

9:51It doesn't mean that everyone who's empathetic ends up with OCD, obviously not. But it certainly does predispose you. If you didn't care about yourself at all or other people at all in any way, shape, or form, I think your chances of getting OCD would be pretty low. The cruelty is that OCD feeds on people that care. They care about their own health, they care about the health of others, they care about their impact on other people, about the way that they act in the world, they want to learn from their mistakes. That is the perfect place for OCD to thrive. so I think it's like chicken and the egg does it occur in people that are successful because they want to do well but some of those features make OCD more likely or have people with OCD got greater awareness and therefore use that to focus on other things potentially maybe it's both I tell you one thing for sure I'd happily lose everything I've ever done in terms of success and achievements and not have OCD I'd really I would say like I would happily have none of my successes, take away all the books, everything I've ever done and live peacefully.

10:51Because OCD has definitely nearly killed me. I suspect that OCD may well have been a feature in my brother and him passing away. I think OCD kills a lot of people. And so I tell you now, the amount of suffering I've had with OCD, I would in a heartbeat give up everything, every possession I have, to have never experienced that and be free from it. On the extreme end of it, and only if you're happy to talk about that, how does OCD kill people? So OCD is a cyclical experience of thinking. And if you start with a negative fear that you have or a belief about yourself and you wind tighter and tighter and tighter, eventually, you know, at the beginning you might be able to cope and pedal away and keep working.

11:38But eventually your sense of self becomes eroded. You start believing that you are a certain person or a certain outcome is likely. If you're, say, obsessed, the fact you're going to get sick tomorrow and die, that belief might become more frightening and worse and worse and worse and tighter and tighter until eventually you see no way out. You become so depressed and low and anxious that there seems no way forward. And when there's no way forward, people feel there's no way out or that there's only one way out. and so you know the rates of suicide with OCD are you know not insignificant for that reason because suddenly you feel very alone I think OCD is very clever again the reason why people don't get diagnosed for decades is because you feel it's just you you are the problem I am problemed in myself and that no one else can see it or understand it because it's something I need to fix in fact lots of people with OCD will go living throughout their lives where no one else has a clue.

12:34Even their partners won't know that they have OCD because, for example, what they call pure O, so pure OCD, the idea is that there's no external compulsions, that all of it's in your mind, the fact-checking, rumination, reassurance thing, it's not physical things. Many of that can just exist solely in the mind, and so no one would ever know. So you can end up in a hell of a state without anyone having a clue and just think, do you know what? I give up. Life's not worth living, or I'm a terrible person, I don't deserve to be alive, which is a common theme in OCD. People end up believing they don't deserve life.

13:08It's truly terrifying, the idea that it can be so well hidden. Can ADHD mask OCD? I think so. I think that if you're especially someone who have ADHD and you're used to masking, the skill of masking can be used for many things and suddenly you'd be masking your OCD behind that. You can be having a conversation with a record player behind you going, you're a terrible person, you're awful, this happened. Maybe there's a trigger in a conversation that suddenly sets the record player going. And we can be chatting and this record player is churning behind me in hour after hour. No one has a clue that you're experiencing it.

13:42Just because you're not sitting there like this in the corner doesn't mean that you're not torturing yourself. Some of the people who are the most depressed and suffer the most might have the biggest smile on their face. I mean, often you'll see this on TikTok where, hey, look at this video of my partner a week before they died with a big smile and laughing. It tells you little about what's going on behind the smile um which i think actually why it's so important to be kind um something i think we've completely lost in recent years there's there's something around like you know everyone should be kind there's that be kind hashtag kindness be kind stuff that happened a few years ago and now we've seemed to have gone to a place where being kind is just like woke and no one wants to be kind and it's in a horrible state of affairs i think we need to be much kinder to people um i think we need to judge less we're the most judgmental we've ever been as a society I think we need to accept the imperfections of people.

14:31People make mistakes. People get things wrong. People are imperfect. And I think that doesn't help people with OCD. Living in a world where any mistake is catastrophic, living in a world where, for example, it's like, oh gosh, if you've eaten this food, then you're going to be X times more likely to die from a disease. You're surrounded by constant messaging of things you might have done or mistakes you make or decisions you're doing that feels all irreversible and feels very heavy. So I think we have to be kind as a society. Otherwise, I think we're going to see more and more OCD coming up. It's a breeding ground, modern society for OCD.

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16:25Just a note though, this code is only applicable on the web browser and not the smartphone. Back to the episode. The crossover between ADHD and OCD has been one of the most requested topics to cover on this podcast. Are there any common confusions, common traits that could give someone a clue that they might have both? um i think what you're looking at at its core to remember is that adhd is is an is a disorder regulation where you have features of things like impulsivity um hyper focus sensitivity um there's things around time and memory blindness stuff like that you see those features in ocd you have a situation a situation of obsession with something that relates to your health morality thought process time it might be something there's something you're really obsessive about and you are stuck on this thing and you end up in a cyclical process of stuck stuckness and you end up anxious off of this obsession obsession with autism would be i'm obsessed with trains it gives you joy this obsession makes you absolutely miserable and anxious but sometimes ocd people confuse ocd with autism in fact obviously because of the because of the co-concurrence of all of these things.

17:38You could have OCD, ADHD, and autism, right, all together in one pot. But the features are different. So, yeah, you might be obsessed with learning every fact about a car, right? But that makes you happy. Whereas learning every fact about a disease is not of interest. It's the thing you're trying to do to reduce your anxiety, or that obsession makes you miserable. That's what you kind of look for. But the reality is, is that people can have both because of the fact that you've got someone that can be really sensitive, really hyper-focused, and then lock on on this thing. But ultimately, when you ask yourself, could this be OCD, are you stuck on something?

18:17Is there a belief or thought that you're stuck on, that you end up cyclical with, and that you're doing things to relieve yourself from? So, are you doing things, whether it's avoidance, reassurance, checking, compulsions, rumination, cleaning habits, whatever it might be. Are you doing things to reduce the anxiety caused by this obsession or thought? If you are, think OCD. And just remember, you'll probably doubt it's OCD the whole time. And even if you get diagnosed with OCD, you'll constantly question, but is it OCD? What if they're wrong? What if I haven't got OCD and I am going to get sick tomorrow?

18:51Or what if I've got OCD and I am a terrible person? Just remember that OCD will always try and come in the back door and that's okay but you just got to see it and know that it's doing it name it the most powerful thing most powerful way to manage ocd i've learned is to name it ah this thought i'm having thank you for that thought i can see you ocd welcome thanks for being here maybe you're right maybe you're not maybe maybe not most powerful phrase to use to combat ocd is maybe maybe not maybe i'll die tomorrow maybe i won't maybe i'm a good person maybe I'm not. Maybe my friend hates me, maybe they don't.

19:29Maybe that mistake I made 10 years ago was a big mistake, maybe it's not. Maybe, maybe not, constantly. Because the brain then goes, oh, he's tolerating uncertainty. And at its core, what OCD is, is an intolerance of uncertainty. You cannot tolerate the fact you don't know. And if you notice the key thing with every OCD theme, whatever it is, whatever that theme of obsession is, it always comes down to the fact that you cannot be certain. You cannot be certain that you're a good person. You can't be. There'll always be things in your past that would not fit with a perfectly good person. The truth is because no one is perfectly good.

20:03There is no way you can be certain that you won't get cancer. I pray that you won't, but there's no way. How could you? If anyone said to you, there's no way Alex is going to get cancer, they lied to you. I'll tell you that for free. So all of these themes have uncertainty, and what we need to do as human beings is tolerate that. The only certainty we have is that we're not going to live forever. That's it. Everything else is uncertain. So with uncertainty being one of the core features of OCD, but yet also people with ADHD struggling with uncertainty, how do you cope with that issue? Yeah, because I guess with ADHD, because if we remember, you know, that part of the brain that kind of pulls the levers of keep calm, don't stress, anxious, be happy, do all these things, good idea, bad idea, that kind of emotional regulation, executive functioning part of your brain.

20:46With ADHD, you can really therefore struggle with uncertainty. And I think that's something a lot of people would agree with. For example, you know, it might be someone saying, oh, can we have a chat tomorrow quickly before work or at the start of work? You don't know what that's going to be about. So you tie in the emotional side of reaction sensitivity plus uncertainty as chaos. And you know, oh, my God. And so how do you deal with uncertainty? I think a lot of the time, because actually what uncertainty does is drive anxiety, it's actually being able to learn to build a tolerance of uncertainty so it's beginning to practice sitting with an emotion saying right i feel a bit anxious and anxious because boss wants to have a chat in the morning i don't know what's going to happen it could be really positive it could be negative thing or could be absolutely neutral and right now i could spiral into it or i could sit and accept the fact that there is a bit of discomfort and rather than sit with us now ruminate for hours and panic i'm going to instead gently move my attention to the present right now what's more important is drinking a cup of tea i'm having or spending time with the kids or perhaps i'm going to go for a run or maybe i'm going to go and do something that i usually enjoy and trying to take the attention off that conversation tomorrow onto something else now of course someone's going to say yeah that's very well but like i'm still going to think about it yeah that's fine it's about saying hey thanks so much appreciate brain you're trying to warn me that tomorrow could be something problematic but right now there's nothing to do so i'm just gonna let you sit there i accept you you're welcome to stay but i'm still going to drink my cup of tea and it's something you can practice and you can get better and it's something that's used a lot in ocd but it's applicable to any sort of uncertainty is saying hey maybe maybe not who knows you might be right could be terrible tomorrow it could be a great day you know sometimes the best days of my life started off terribly and they ended up being the best days some of the worst days have been amazing and ended up badly so a lot of the time is going we don't know what's coming but we'll deal with it because because really if you if you look at it this way if you take it a step further that for example anxiety anxiety which ocd is effectively a form of anxiety, right?

22:42It's kind of a form of anxiety disorder, because anxiety is the predominant emotion that you feel. You know, anxiety is that intolerance of uncertainty, but really, when you dig even deeper, you don't feel you can trust yourself to deal with something happening. It's a lack of trust issue. You know, it's, I can't deal with this if this happens tomorrow. But you can, because you know from evidence that you've dealt with everything that's happened. You might have had a terrible time before, something might have happened that did floor you, but you did deal with it, and you did move through it, and you are here today.

23:11So often it's saying, well, actually, if the boss tomorrow says that you've done something wrong, and you're on your final warning, you know that you can actually deal with that. You are going to have all the tools you're currently using against yourself to cause distress to deal with it. You know, it's that Seneca said that all the tools that you currently use against yourself, you can use in the future to tackle your problem. That's not the sentence of the quote, but it's effectively along those lines. And I love that idea because it's true. The weapons that you currently use against yourself, you can use that to deal with a problem if it happens.

23:47Because otherwise you're suffering twice for no reason. My mum always says it, cross the bridge when you get to it. And it's the hardest thing to do, but you can learn to do it. And it is a skill that's learnable and practicable. Practice it. I can imagine ADHD and OCD are quite conflicting in the way that they present. I guess with ADHD, it could be quite impulsive and perhaps sometimes haphazard. And with ADHD or with OCD being the opposite, in that case, does that present inner turmoil sometimes? Yes, I guess so. I guess the thing is the impulsivity with ADHD will usually be thought or interest-led, dopamine chasing.

24:22Whereas the impulsive side of OCD, or rather the compulsive side, because ADHD tends to be impulsive, OCD is compulsive, is all about reducing anxiety. so you're not doing something to chase dopamine you're doing that thing to to calm yourself so for example exercise you might have an impulsive feeling i want to go out and do a 20k run today i've got into running in the last two weeks and i'm now wanting to run every day that's impulsiveness right ocd is i need to go for a run for 20k because if i don't i might get cancer i might get sick i might get sick if i don't run 20k today i might get sick or if i don't run 20k today something bad will happen to my family member that's a compulsion versus impulsivity and when you see it that way actually the clarity is clear but you have to ask yourself am i doing this because i have an extreme interest in this or a desire to go and do this thing and chase dopamine because i want to feel high and happy or am i doing it to reduce the anxiety to alleviate the fear or worry obsession that i have phenomenal thank you very much alex i want to move on to audience questions the washing machine of woes where every week a member of the audience send in their adhd woes and it goes in a washing machine because for me it represents memory loss because I always leave my clothes in the machine.

25:32And last time you said you do relate to that. Yes, I absolutely do relate to that. It's just forget. My big thing is like losing keys and stuff like that. Losing any item, in fact, but keys are a big one, yeah. The Timo app is helping me, remember, but we're still on a journey of self-acceptance. This week, Alex, someone has written in and asked, I'm 43 and throughout my life I've been diagnosed with bipolar anxiety disorders as well as other things. How can I trust the doctors are right and it's not just ADHD? Well, I mean, the thing is, I think one of the hardest things to do with any mental health experience.

26:10Now, of course, having ADHD is not a mental health disorder, it's neurodevelopmental, but we know there's a lot of crossover and a lot of people with ADHD will go on to have other struggles and so on. So when you're looking at anything that's to do with the mind and the brain, the problem is is that you are you're in there with it too you know um you're you're living with this thing in your head or this experience and that clouds your judgment your ability to see and i think if you look at for example ocd the biggest thing is the lack of insight if you had true insight into experience you wouldn't experience ocd so if you had true insight honest complete clarity as they say ocd clarity all of the time ocd would dissolve because your insight would tell you that probability, possibility, and relevance isn't there, but whatever you're worried about, because that's the core of it.

26:59Because if it was an actual problem, it wouldn't be OCD, right? But you constantly flick between clarity and losing clarity and OCD. That's the problem. So when it comes to these situations, it is about saying, hey, am I the best person to make the call on this experience within my mind? Or is it better to trust the professionals and people around me. And on the whole, yes, people make mistakes and yes, people get things wrong. But on the whole, like people there to help you, they've got the trained experience to do so. And they're often better placed. I sat down actually, my psychiatrist a couple of months ago, and we were discussing medication.

27:35And, you know, I'm in that position where I'm a doctor, have some knowledge, not a huge knowledge, but decent amount of knowledge. And I was there like debating this medication with her like, oh, I don't know, it's a good idea. And then I had this moment of like, I'm sat here with a psychiatrist, been doing this for 20 years. and I'm trying to have too much input into what the best thing for me is and I sat there and said you know what you're actually the person who's best placed to make this decision I'm going to trust you and I was absolutely right to do so because we're doing a medication switch the medication I've gone to has is definitely infinitely better than the one I was on for me and so in that moment I had to let go and when you're talking about things in the mind and challenges the mind the hardest thing to do is let go but the question I'd ask yourself is has me trying to control this situation myself got me better or worse?

28:23And in OCD, I guess the question is, has your lack of insight, has the way that you see things led you to a better or worse place? And perhaps it's time to trust someone else. So as hard as it can be, it's not about just completely letting go and having no autonomy or questioning things you don't understand. But I think it is realizing, you know, we do need to trust people and we do need to see that experts are experts for a reason. Dr. Alex, on behalf of everyone grappling to understand their brains, thank you so much. Thank you so much. It's been great to be here again.