Second in a Series of ADHD Comorbidities

There is another offshoot of ADHD, that although it’s not as violent or explosive as ODD can be, it can none the less cause stress and suffering in a family. It is OCD. This is an anxiety-based disorder that presents itself in obsessions and compulsions- hence the name Obsessive Compulsive Disorder.

It had been listed under anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). But because it has so many of its own comorbidies attached to it, it now is in its own category. Further it has been found that anxiety is not always associated with it and a lot of the people do have anxiety. Although people who have OCD are usually anxious about it. 1.2% or two million people suffer from OCD.

OCD Symptoms[1]

Obsessions

Obsessions are unsolicited thoughts or ideas that are upsetting to a person. Their frequency and intensity make the images or thoughts very different than the thoughts that occur once in a while with most others in the general population.

Compulsions

Compulsions are developed to cope with the obsessions. OCD sufferers resort to what’s called compulsions or repeated behaviors or thoughts. These rituals are designed to help ward off the disaster of the obsession becoming real. In the very least, it’s supposed to lessen the anxiety associated with it.

Four Types of OCD[2]

• The Obsession of Contamination – With this obsession, an individual is unusually concerned with the thought of getting sick or contracting a disease. This thought could be about getting the disease from germs or viruses but it also could involve blood or chemicals or even insects that worry a child or teen.

The Compulsion for Contamination is Washing. People stay away from places, situations and objects that they fear is contaminated. Their rituals include:

• Changing clothing needlessly
• Discarding or throwing away supposedly “contaminated” objects
• Showering gratuitously
• Washing hands excessively

• The Obsession of Accidental Harm – This obsession centers on the fear of harming themselves or others through their negligence or inattention. For example, they might fret unreasonably about causing a house fire by carelessly forgetting to turn off the stove.

The Compulsion for Accidental Harm is Checking. They will check and recheck and check again to make sure the doors are locked, the stove or coffee pot is turned off, the lunch is packed or the freezer door is shut. It’s their responsibility to keep everyone safe.

• The Obsession of Just Right or also called Perfectionism – There is a difference between being a perfectionist[3] and wanting a perfect performance or result and OCD. The thoughts that come with OCD aren’t about liking things clean or about real problems you have to deal with. These thoughts are overly concerned with order, symmetry and being exactly in place. It’s been suggested that there is a feeling of incompleteness without this ordering place.

The Compulsion for Just Right is Symmetry, Arranging and Counting. Everything has to be arranged in a certain way. For instance, all the cans have to face label out and pencils are lined up on the desk. These rituals might also include touching tapping and/or counting the objects.

• The Obsession of Unacceptable Thoughts – These thoughts are usually related to religion, sex or violence. These taboo thoughts can be the cause of more severe suffering for people because of their ties to our moral beliefs and values.

The Compulsion for Unacceptable Thought is Mental Rituals. There are usually no outward signs of rituals. However, the rituals are going on inside themselves. In  attempting to control their thoughts they may engage in ruminating-thinking deeply about something, checking by reviewing their behavior, neutralizing-changing the bad thought to a good thought, and avoiding the triggers of the thoughts.

Varying Severity

Symptoms can start gradually, usually in a teen or young adult. Symptoms can be mild to moderate or very severe and debilitating.

ADHD Vs. OCD[4]

OCD and ADHD have often been mistaken for one another because they share some of the same symptoms, such as:

• anxiety
• distractibility
• perfectionism
• impulsive behavior
• executive function problems

Even though they do have commonalities, the individual disorders are far more complex and involved. Teens who have ADHD and problems with organization, distraction and trying to pay attention often employ some of the compulsive OCD-like coping skills.

Conversely, many OCD teens are mislabeled because of symptoms like inattention and fidgeting in class. However, these could be behaviors that are helping the OCD child cope with repetitive thoughts and compulsive behaviors. You can see how this can get really confusing.

This overlap of symptoms makes getting a proper diagnosis imperative so that the child/teen can obtain the right treatment. Ritalin can help with ADHD but can actually make symptoms of OCD worse. Anxiety which is common in OCD can magnify ADHD problems.

Brain Scans

Brain patterns seen from brain imaging for OCD show a similar picture as ODD. That is that there is a high level of activity in the Anterior Cingulate Gyrus (ACG). This area of the brain helps us to change thoughts from one thing to another. In teens with OCD the thoughts get stuck so they keep doing the same ritual over and over again.

Ways That May Help Reduce the Symptoms[5]

• I can notice when I’m stuck.

Pay attention to your looping thoughts-looping is when you have the same thought over and over again. Visualize a stop sign in your brain and mentally tell yourself to stop because your brain is getting stuck. The more you do this, the more control you will have over your thought patterns.

• I can distract myself.

When you find yourself getting stuck, get up and do something different.

Physical Activities

Additionally, engaging in exercise or other physical activity of various kinds can function like a “reset” switch for the brain. This needn’t be complicated.

• Take walk.
• Sing
• Listen to Music
• Cuddle your pet
• Meditate
• Clean – unless… this is part of your compulsion!

• Sweep all thoughts away by visualizing a broom. Then concentrate on one word.

Focus or Meditate on a ‘Power’ Word

It can be any word – “clarity,” “concentration,” “focus,” etc. But positive adjectives seem particularly helpful. These might include words such as:

• Gratitude
• Love
• Thankfulness

If you actively distract yourself enough the ritualistic thoughts will lose their control over you.

• I can make sure that I am getting enough Serotonin.

Serotonin is a neurotransmitter that calms overactive parts of the brain. Foods that have serotonin in them are complex carbohydrates like sweet potatoes, and garbanzo beans. Avoid simple carbohydrates like pasta, bread, cookies, pretzels and popcorn. Although these last ones boost serotonin, they also contribute to increased feelings of anxiety. Anxiety is very common in people with OCD.

An added note here:

As I was checking for more foods, I found an article in Healthline[6] which stated that although serotonin is not found in food, the experts feel that the amino acid tryptophan along with a healthy carb like rice, oatmeal or a whole grain bread may give you a serotonin boost.

Foods with tryptophan include:

• turkey
• nuts and seeds
• salmon
• pineapple
• tofu
• cheese
• eggs

Other ways to boost serotonin levels are:

• Getting out in the sunshine
• Being positive
• Having healthy gut bacteria

New research on the gut/brain axis shows that having healthy gut bacteria might also help. Healthy bacteria comes from eating a fiber rich diet. Along this new path of discovery about the gut-brain axis, another source[7] states that “only 2% of serotonin is found in the brain while 95% of serotonin is produced in the intestine.” So maybe the food that we eat is pretty important.

• I can exercise.

Exercise can be helpful in soothing those looping thoughts. It also is a good distraction and it increases serotonin in the brain. So, it is a win-win situation all around.

Further Tips given in an article on putting a stop to ruminating:[8]

• I can pay attention to my triggers.

This one might enhance the noticing one above. You are noticing but also making notes about it.

Note: When it happens, where you are who you are with and what you are doing. This might help in managing or avoiding your thoughts.

• I can try therapy.

Sometimes we can’t solve our problems on our own. Then it’s time to seek help.

Herbs and Supplements[9]

• John’s Wort – This could help because it appears to affect the serotonin system like many of the antidepressant drugs used for controlling OCD.
• N-Acetylcysteine – This is an amino acid that could help used along with an SSRI which is a selective serotonin reuptake inhibitor.
• 5-HTP and Inositol – These also work in the area of serotonin regulation.

As always check with your doctor before taking anything, even herbs.

Self-Help Technique from Brain Lock[10]

Brain Lock is a book that I found that had a four-step self-help method.

“Quick Summary of the Four Steps of Cognitive-Biobehavioral Self-Treatment for OCD

• Relabel-realize that the intrusive obsessive thoughts and urges are the result of OCD.
• Reattribute- Realize that the intensity and intrusiveness of the thought and urge is caused by OCD. It’s probably related to a biochemical imbalance in the brain.
• Refocus-Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes. Do another behavior.
• Revalue-Do not take the OCD thoughts at face value. It is not significant in itself.

Dr. Schwartz’s method ties into a current theory of brain plasticity. Brain plasticity is “ also known as neuroplasticity, a term that refers to the brain’s ability to change and adapt as a result of experience.”[11]

Change your behavior; Change your brain.

Final Thoughts

As before this topic is one that hits close to home for me. My grandson has it and I have also seen it in my classroom.

So, it is a topic that as parents, grandparents, and educators we need to be aware of and try to understand the difficulties that our children are going through.

Notes:

[1]OCD Types- Obsessive Compulsive Disorder Comes in Many Forms New England OCD Institute https://www.ocdtypes.com/

[2]About the Four Kinds of OCD  New England OCD Institute https://www.ocdtypes.com/four-types-of-ocd.php

[3]Obsessive-Compulsive Disorder Mayo Clinic https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432

[4]ADHD or OCD? The Best Way You Can Know for Sure April 4, 2017  Amen Clinic  https://www.amenclinics.com/blog/adhd-ocd-differences/

[5]5 Simple Things I Can Do If I Have OCD May 7,2019 Amen Clinic  https://www.amenclinics.com/blog/5-simple-things-i-can-do-if-i-have-ocd/

[6]7 Foods That Could Boost Your Serotonin: The Serotonin Diet Healthline https://www.healthline.com/health/healthy-sleep/foods-that-could-boost-your-serotonin#nuts

[7]Christine Ruggeri, CHHC Aug. 2019 Serotonin: Why You Need It and How to Boost Levels Naturally https://draxe.com/health/serotonin/

[8]Erica Cirino 10 Tips to Help You stop Ruminating April 2019 Healthline https://www.healthline.com/health/how-to-stop-ruminating#bottom-line

[9]Owen Kelly,Ph.D Herbal Remedies for OCD and Axiety Disorders September 2019 https://www.verywellmind.com/herbal-remedies-for-ocd-2510631

[10]Jeffrey M. Schwartz, M.D. Brain Lock Free Yourself from Obsessive-Compulsive Behavior- A Four Step Self-Treatment Method to Change Your Brain Chemistry Harper Perennial 1997 https://www.amazon.com/Brain-Lock-Twentieth-Anniversary-Obsessive-Compulsive/dp/006256143X

[11]Kendra Cherry, September 2019 Verywell Mind https://www.verywellmind.com/what-is-brain-plasticity-2794886