WEBVTT 1 00:00:00.190 --> 00:00:05.870 You know, we casually call ourselves ADHD because we're distracted sometimes. 2 00:00:06.250 --> 00:00:10.130 Or we call ourselves OCD because we like things organized. 3 00:00:10.609 --> 00:00:13.890 Or maybe we call ourselves bipolar or somebody you know 4 00:00:13.990 --> 00:00:18.609 bipolar because their moods change all the time. But when 5 00:00:18.670 --> 00:00:24.109 does normal human behavior actually become a mental health disorder? 6 00:00:24.660 --> 00:00:27.579 We are banding about these terms and do we really 7 00:00:27.620 --> 00:00:32.200 know what they mean? And more importantly, do we overuse them? 8 00:00:32.539 --> 00:00:37.369 And are we really diagnosing normal human behavior as opposed 9 00:00:37.409 --> 00:00:42.770 to personality disorders? I'm Ellen Stewart, Pushy Broad from the Bronx. 10 00:00:42.810 --> 00:00:46.450 This is my show, Recovery Recharged. And today's show is 11 00:00:46.799 --> 00:00:51.219 Stop Diagnosing Me. And we're going to talk about three 12 00:00:51.380 --> 00:00:55.070 distinct disorders in part one, And then we're going to 13 00:00:55.130 --> 00:00:57.850 come back and talk about the same thing, but three 14 00:00:58.009 --> 00:01:02.770 different disorders in part two. Today's part one is ADD 15 00:01:02.869 --> 00:01:07.670 or ADHD, as we know, is attention deficit disorder. OCD, 16 00:01:07.730 --> 00:01:12.519 as we know, is obsessive compulsive disorder and bipolar disorder. 17 00:01:12.840 --> 00:01:16.540 Do we have them or are we just labeling ourselves? 18 00:01:17.359 --> 00:01:21.040 Because those are the words of the day. So, I 19 00:01:21.099 --> 00:01:23.480 decided that the only way to really know is to 20 00:01:23.640 --> 00:01:27.329 get a licensed clinician in so that he can answer 21 00:01:27.430 --> 00:01:31.609 questions for us so we can determine whether we're really 22 00:01:31.689 --> 00:01:36.969 a diagnosed disorder or we're just behaving humanly. I want 23 00:01:37.010 --> 00:01:40.269 to introduce you to an old friend of mine, Nelson Hadler, 24 00:01:40.310 --> 00:01:43.230 who was kind enough to come today to the studio 25 00:01:43.469 --> 00:01:45.969 on his birthday. So happy birthday, Nelson. 26 00:01:46.069 --> 00:01:46.730 Thank you, Ellen. 27 00:01:47.219 --> 00:01:51.140 He is a licensed clinical social worker, a licensed certified 28 00:01:51.319 --> 00:01:55.019 alcohol and drug counselor, and he has over 30 years 29 00:01:55.079 --> 00:01:59.590 of experience in addictions and mental health. He's in private practice. 30 00:01:59.629 --> 00:02:02.870 He has license in various states, and he'll tell us where. 31 00:02:03.269 --> 00:02:08.969 He's extremely experienced in working with families, adolescents, adults, and 32 00:02:09.050 --> 00:02:14.620 personality disorders. Welcome to my show, Nelson. Good morning. 33 00:02:15.340 --> 00:02:15.919 Good morning, Ellen. 34 00:02:17.469 --> 00:02:19.629 I want to know right out of the gate, do 35 00:02:19.729 --> 00:02:23.789 you think we're becoming too quick to turn ordinary human 36 00:02:23.830 --> 00:02:26.500 behavior into a psychiatric diagnosis? 37 00:02:27.699 --> 00:02:32.580 Oh, yes. Yes, I think we confuse layman terms for 38 00:02:32.680 --> 00:02:35.919 certain clusters of behavior for actual disorders. 39 00:02:36.740 --> 00:02:37.189 Like what? 40 00:02:38.430 --> 00:02:41.129 Like the ones that we're talking about today, you know, 41 00:02:41.169 --> 00:02:41.650 so ADHD. 42 00:02:44.439 --> 00:02:49.830 So let's talk just a little bit about ADHD. What's 43 00:02:49.849 --> 00:02:53.009 the difference between, first of all, tell us the difference 44 00:02:53.069 --> 00:02:57.389 between ADHD and ADD. Tell us about that from a 45 00:02:57.439 --> 00:02:58.340 clinical point of view. 46 00:02:59.259 --> 00:03:02.159 Well, it was ADD through the 80s. And I think 47 00:03:02.219 --> 00:03:07.300 about 1987 in the Diagnostic Statistics Manual, they change it 48 00:03:07.340 --> 00:03:16.710 to ADHD. attention deficit hyperactivity disorder, primarily inattentive, primarily hyperactive, 49 00:03:17.009 --> 00:03:22.169 and mixed. So a lot of people just shortened it 50 00:03:22.229 --> 00:03:24.909 back to the old thing, ADD. They made the change 51 00:03:24.969 --> 00:03:30.090 simply to distinguish between what behaviors were presenting. 52 00:03:30.949 --> 00:03:34.860 I see. Okay. So Now, most people, when they think 53 00:03:34.919 --> 00:03:39.919 of ADD or ADHD, think about somebody that can't regularly 54 00:03:40.020 --> 00:03:45.259 focus or they're easily distracted. So tell us what you 55 00:03:45.300 --> 00:03:49.000 would know the difference when you're diagnosing somebody. How do 56 00:03:49.099 --> 00:03:55.560 you know whether this person is ADD or just exhibiting 57 00:03:55.639 --> 00:03:56.780 normal human behavior? 58 00:03:58.669 --> 00:04:01.349 Well, first of all, you need to run the person 59 00:04:01.449 --> 00:04:04.620 through the criteria and see what they fit. But you 60 00:04:04.659 --> 00:04:09.460 also need to keep an eye out for the differential diagnoses. 61 00:04:09.620 --> 00:04:15.030 Is the person just a little flighty? Is the person anxious? 62 00:04:15.509 --> 00:04:18.149 Do they have an anxiety disorder? Are they so depressed 63 00:04:18.170 --> 00:04:22.129 they can't concentrate? Are they grieving? Have they just had 64 00:04:22.209 --> 00:04:25.529 a medication change? Are they in withdrawal? Are they in 65 00:04:25.589 --> 00:04:29.069 post-acute withdrawal? you have to rule out everything else that 66 00:04:29.170 --> 00:04:33.490 could be responsible for the presentation. So it is kind 67 00:04:33.529 --> 00:04:36.610 of overused. I mean, one of my litmus tests, you know, 68 00:04:36.990 --> 00:04:39.709 I'll have the person come in who's been, you know, 69 00:04:39.750 --> 00:04:42.149 in and out of substance abuse treatment and says, I 70 00:04:42.189 --> 00:04:44.970 have ADHD. And I asked them a little bit about 71 00:04:45.009 --> 00:04:50.560 the background and I'm really not finding that. And, you know, 72 00:04:50.600 --> 00:04:53.879 they go, oh, and you know, I've been prescribed Adderall, 73 00:04:53.939 --> 00:04:56.350 but they used it as a stimulant. They used it 74 00:04:56.430 --> 00:05:00.209 as a methamphetamine. You know, one of the biggest litmus 75 00:05:00.230 --> 00:05:04.350 tests is how do you respond to ADHD medication? Oh, 76 00:05:04.410 --> 00:05:07.649 I can focus and all the distractions go away and 77 00:05:07.670 --> 00:05:09.740 I'm like this. Or, oh, I can stay up all 78 00:05:09.750 --> 00:05:14.519 night and study. It's very different. People with ADHD have 79 00:05:15.939 --> 00:05:19.420 what they call a paradoxical effect of actually focusing. So 80 00:05:19.439 --> 00:05:20.300 a lot of times I ask that. 81 00:05:21.689 --> 00:05:25.250 Okay, so in a clinical sense, but in layman's term, 82 00:05:25.910 --> 00:05:31.910 tell us how you have diagnosed someone ADD, ADHD. What 83 00:05:32.129 --> 00:05:37.550 exactly is the criterion for that classic diagnosis in layman's terms? 84 00:05:37.629 --> 00:05:39.709 So I know whether or not I actually have it. 85 00:05:40.889 --> 00:05:43.730 Setting aside all of the other things that you said, 86 00:05:43.750 --> 00:05:48.430 I'm not grieving, I'm not anxious, I'm not nervous. a 87 00:05:48.550 --> 00:05:54.930 person that you would consider clinically ADD, ADHD. Give us 88 00:05:54.970 --> 00:05:58.009 an idea of some of the major standout symptoms. 89 00:05:58.449 --> 00:06:01.009 I'll try to think of all the criteria in the book, but, 90 00:06:01.100 --> 00:06:05.319 you know, can't sit still, comes unprepared for tasks at school, 91 00:06:07.620 --> 00:06:14.220 jumps around easily, you know, that type of thing. You know, 92 00:06:14.379 --> 00:06:16.930 one of the biggest things you want to look at is, 93 00:06:21.100 --> 00:06:28.009 Are they, how do I say it? Are they, ADHD, 94 00:06:28.290 --> 00:06:32.730 people with true ADHD can focus on things that they're 95 00:06:32.790 --> 00:06:37.389 motivated to. It's a disorder of ordering tasks. If they're 96 00:06:37.449 --> 00:06:40.500 not motivated to do their math homework, it just doesn't 97 00:06:40.540 --> 00:06:44.060 come up. It's not laziness. It's not avoidance. It just 98 00:06:44.120 --> 00:06:47.759 doesn't get put in the forefront of the list of 99 00:06:47.819 --> 00:06:51.139 tasks one needs to accomplish next. So that's what you 100 00:06:51.160 --> 00:06:51.660 really look at. 101 00:06:52.199 --> 00:06:55.319 That's very interesting because now that everybody is pretty much 102 00:06:55.379 --> 00:06:58.930 going back to school, most people in different parts of 103 00:06:58.959 --> 00:07:01.949 the country have already started school and others, of course, 104 00:07:02.069 --> 00:07:05.430 here up in the East Coast where we are, or 105 00:07:05.470 --> 00:07:09.870 at least on the East Coast are going back very, 106 00:07:09.930 --> 00:07:13.439 very soon. It is something that parents are looking for 107 00:07:13.480 --> 00:07:17.639 to make sure that their child is learning and processing 108 00:07:18.160 --> 00:07:22.189 in the right way. So an ADD person also I 109 00:07:22.269 --> 00:07:25.360 have found from people that I know have come to 110 00:07:25.389 --> 00:07:29.819 me with that classic diagnosis can start talking about something 111 00:07:30.040 --> 00:07:35.139 in simple conversation and then extend to so many different 112 00:07:35.199 --> 00:07:39.649 tangents that they have difficulty coming back to the first thought. 113 00:07:40.389 --> 00:07:42.370 Is that a trait that you've noticed as well? 114 00:07:42.389 --> 00:07:43.209 Yeah. 115 00:07:44.509 --> 00:07:48.610 Yeah, but I mean, again, one thing we'll discuss a 116 00:07:48.610 --> 00:07:51.990 little bit is You know, are we just quick to label? 117 00:07:52.129 --> 00:07:55.259 I mean, that could be somebody with a bipolar disorder 118 00:07:55.300 --> 00:07:56.939 in a manic episode. 119 00:07:58.500 --> 00:08:02.399 I see. But I'm talking about now clinically ADD or 120 00:08:02.579 --> 00:08:08.980 ADHD person. So what do you find when people label themselves? OK, 121 00:08:09.100 --> 00:08:13.930 when somebody turns around and says, oh, you're so ADD, right? 122 00:08:13.990 --> 00:08:16.240 That happens a lot. I see it a lot. I 123 00:08:16.300 --> 00:08:21.079 find sometimes that's when people talk about people who are, 124 00:08:21.160 --> 00:08:23.459 like you said, a little bit more nervous or a 125 00:08:23.480 --> 00:08:26.170 little anxious or have a lot on their plate. 126 00:08:26.439 --> 00:08:26.750 Yes. 127 00:08:26.810 --> 00:08:30.329 Do you find that that's how we misdiagnose ADD? 128 00:08:30.350 --> 00:08:31.870 Oh yeah, absolutely. 129 00:08:33.009 --> 00:08:33.389 Okay. 130 00:08:33.590 --> 00:08:33.970 All right. 131 00:08:34.029 --> 00:08:39.269 So now is there any difference between ADD and ADHD 132 00:08:39.370 --> 00:08:42.440 since they put in that, you know, hyperactivity disorder? Is 133 00:08:42.480 --> 00:08:43.100 there a difference? 134 00:08:44.480 --> 00:08:50.220 No, you always look for, you know, the less diagnosed 135 00:08:50.299 --> 00:08:52.720 is the inattentive because they're not hyper and all over 136 00:08:52.779 --> 00:08:54.259 the place and jumping around. 137 00:08:54.860 --> 00:08:55.360 I see. 138 00:08:55.600 --> 00:08:59.899 But, you know, they'll be like answering a math problem 139 00:08:59.919 --> 00:09:02.259 and be like, oh, look at that chicken, you know. 140 00:09:04.159 --> 00:09:08.100 Okay. So this also comes with a certain amount of 141 00:09:08.279 --> 00:09:14.009 impulsivity too, I mean, right? people can be distracted by 142 00:09:14.070 --> 00:09:16.509 a whole plethora of things that have nothing to do 143 00:09:16.549 --> 00:09:19.669 with ADD, like they can be exhausted or overwhelmed or 144 00:09:19.850 --> 00:09:23.649 anxious or depressed. All of those things that would seem 145 00:09:23.879 --> 00:09:28.080 as if they have those symptoms. So what you're saying 146 00:09:28.159 --> 00:09:32.460 to us is they should be clinically diagnosed. Okay, so 147 00:09:32.519 --> 00:09:36.600 now one thing with this specifically, I have many young 148 00:09:36.639 --> 00:09:40.240 adults coming to me and telling me, that they'd been 149 00:09:40.279 --> 00:09:45.320 diagnosed as ADD or ADHD at an early age, like 150 00:09:45.399 --> 00:09:50.820 in elementary, in grade school, and haven't had a diagnosis since. 151 00:09:51.220 --> 00:09:53.129 What do you suggest to these people? 152 00:09:53.950 --> 00:09:55.610 Is it impacting their life today? 153 00:09:57.909 --> 00:09:59.009 Well, that's a very. 154 00:09:59.269 --> 00:10:01.600 you know are they having is it is it affecting 155 00:10:01.649 --> 00:10:05.700 work is it affecting relationships you know um just be 156 00:10:06.379 --> 00:10:10.000 it's over diagnosed you know i mean if someone said 157 00:10:10.019 --> 00:10:12.600 they were diagnosed adhd at six years old i'd ask 158 00:10:12.620 --> 00:10:15.679 them what was going on at six years old okay 159 00:10:16.100 --> 00:10:19.509 okay did they have did grandma die Did a parent die? 160 00:10:19.529 --> 00:10:22.289 Did they have a trauma? Did anybody look for abuse 161 00:10:22.370 --> 00:10:28.019 or PTSD? You know, if they were diagnosed in grammar 162 00:10:28.059 --> 00:10:33.919 school and really haven't had an issue since, is it 163 00:10:33.980 --> 00:10:37.419 possible for other causes or maybe just you're fine? 164 00:10:38.460 --> 00:10:41.870 Okay. Is it possible for someone to have ADD or 165 00:10:42.070 --> 00:10:46.629 ADHD as a diagnosis and then have that diagnosis disappear 166 00:10:46.769 --> 00:10:49.259 or resolve? Is that possible? 167 00:10:49.960 --> 00:10:52.799 I don't believe if it's a true diagnosis, you can 168 00:10:52.899 --> 00:10:56.679 treat it and you can learn skills to counteract it. 169 00:10:57.210 --> 00:11:00.309 I see. I see. Like addiction, you can put it 170 00:11:00.370 --> 00:11:01.730 in remission, but it never really works. 171 00:11:01.750 --> 00:11:01.850 Right. 172 00:11:01.889 --> 00:11:04.730 Exactly. Correctly. You can address it. 173 00:11:05.350 --> 00:11:06.570 So that's very interesting. 174 00:11:06.690 --> 00:11:07.070 Yes. Okay. 175 00:11:07.830 --> 00:11:11.570 Do you think that current stimulus like our phones and 176 00:11:11.970 --> 00:11:15.009 the computer and the technology and all the multitasking that 177 00:11:15.049 --> 00:11:19.330 we do on a regular basis, Can exacerbate ADHD or 178 00:11:19.549 --> 00:11:22.230 mimic ADHD among students? 179 00:11:23.980 --> 00:11:29.320 Well, exacerbate, yes. You know, it's just another distraction. So 180 00:11:29.360 --> 00:11:30.700 you need to be in class. You need to be 181 00:11:30.759 --> 00:11:32.940 on the phone. You need to be focusing on something. 182 00:11:32.960 --> 00:11:36.720 Then there's social media. So, you know, that's exacerbation. And 183 00:11:36.759 --> 00:11:39.629 then people can just be spaced out on their phone. 184 00:11:41.110 --> 00:11:44.500 I mean, look at texting. And driving, you know. 185 00:11:45.720 --> 00:11:47.899 Yes, which means another thing, but yes. 186 00:11:47.980 --> 00:11:50.740 You don't need to be ADHD to be on your 187 00:11:50.759 --> 00:11:54.269 phone all the time, although it certainly would feed into it. 188 00:11:54.899 --> 00:11:59.549 Exactly. Okay. So it doesn't mean technology causes ADHD. It 189 00:11:59.669 --> 00:12:05.549 means that difficulty concentrating has many possible causes, right? 190 00:12:05.789 --> 00:12:08.730 Yes. That's my big point. All right. 191 00:12:09.149 --> 00:12:12.830 Now, because this is recovery recharge and we talk a 192 00:12:12.850 --> 00:12:15.929 lot about addiction, can you talk about how addiction or 193 00:12:16.080 --> 00:12:20.799 early recovery look like ADHD? How does that manifest itself? 194 00:12:20.919 --> 00:12:25.659 How could that be confused with ADD or ADHD? Somebody 195 00:12:25.700 --> 00:12:27.259 that is at early recovery. 196 00:12:28.659 --> 00:12:32.440 Well, they're gonna be depressed. They're gonna be anxious. They're 197 00:12:32.480 --> 00:12:36.320 gonna have the initial withdrawal symptoms from the substance. They're 198 00:12:36.360 --> 00:12:41.990 gonna be experiencing post-acute withdrawal symptoms, you know, syndrome, I 199 00:12:42.029 --> 00:12:47.309 should say. And, you know, those things look like ADHD. Irritability, 200 00:12:47.409 --> 00:12:49.929 difficulty concentrating, it's right there. 201 00:12:50.450 --> 00:12:57.159 You know, anxiety, depression, fatigue. Right, all of the disruptions. 202 00:12:57.179 --> 00:12:58.840 It's going to make it hard to concentrate. 203 00:12:59.460 --> 00:13:01.700 Exactly. So you need to take a look at. 204 00:13:01.539 --> 00:13:05.179 How long the duration of these difficulties are. 205 00:13:06.360 --> 00:13:06.460 Okay. 206 00:13:06.480 --> 00:13:06.639 Okay. 207 00:13:07.710 --> 00:13:11.669 Because I hear a lot of people say, I can't concentrate, 208 00:13:11.730 --> 00:13:16.500 I'm restless, I'm impulsive, I can't sleep, I'm forgetting everything, 209 00:13:16.639 --> 00:13:21.419 I must have ADHD. And again, this could be temporary 210 00:13:21.500 --> 00:13:24.700 in terms of early recovery, right? Because like you said, 211 00:13:24.779 --> 00:13:27.870 the post-acute withdrawal and all of that, and we have 212 00:13:27.899 --> 00:13:31.529 to see whether or not these symptoms persist down the road. 213 00:13:31.769 --> 00:13:35.610 You have to look over time and you have to look, hopefully, 214 00:13:36.600 --> 00:13:37.940 over periods of abstinence. 215 00:13:39.379 --> 00:13:43.980 Of course. Okay, so is ADD the kind of disorder 216 00:13:44.039 --> 00:13:47.950 that happens in early childhood and continues? Or can somebody 217 00:13:48.169 --> 00:13:53.090 in adolescence or young adulthood or even adulthood develop ADD 218 00:13:53.169 --> 00:13:54.870 or ADHD? How does that work? 219 00:13:57.029 --> 00:14:00.460 I believe it's something you're born with if it's true ADHD. 220 00:14:01.179 --> 00:14:10.679 You know, classically, Classically, the ADHD child is bright. They 221 00:14:10.700 --> 00:14:15.539 have higher IQ and they're able to compensate for their 222 00:14:15.750 --> 00:14:20.590 lack of attention through grammar school. And oftentimes what we 223 00:14:20.669 --> 00:14:25.990 see is in eighth and ninth grade, these bright kids 224 00:14:26.009 --> 00:14:30.710 that always had all A's start having problems with some subjects. 225 00:14:31.389 --> 00:14:33.820 And that's when we want to dig into Could this 226 00:14:33.860 --> 00:14:38.100 be ADHD? So that's usually where it raises its head, 227 00:14:38.580 --> 00:14:44.269 especially the non-hyperactive inattentive cognitive. I see. 228 00:14:44.289 --> 00:14:47.830 So we're finding more of these diagnoses prevalent in a 229 00:14:47.909 --> 00:14:49.149 middle school situation. 230 00:14:49.789 --> 00:14:53.110 Yes. A lot of times that's where it's first identified. 231 00:14:53.879 --> 00:14:57.840 I see. Okay. All right. Okay. But you said something 232 00:14:57.899 --> 00:15:00.179 very telling, which is the theme of this entire thing. 233 00:15:00.220 --> 00:15:04.120 And in the beginning is, How is this affecting your life? 234 00:15:04.539 --> 00:15:10.370 Or parents, how is this diagnosis or these behaviors affecting 235 00:15:10.470 --> 00:15:13.970 the life of your child, right? Is it interfering with 236 00:15:14.129 --> 00:15:19.409 everyday processes? Is it overtaking them in a way that 237 00:15:19.509 --> 00:15:22.240 is mood altering, right? All of the things they should 238 00:15:22.269 --> 00:15:23.080 be looking out for? 239 00:15:23.100 --> 00:15:23.169 Yes. 240 00:15:24.740 --> 00:15:26.179 What else should they be looking out for? 241 00:15:27.600 --> 00:15:31.320 Well, again, the hyperactivity and what's driving that. You know, 242 00:15:31.600 --> 00:15:32.940 the forgetting to bring things. 243 00:15:33.879 --> 00:15:37.490 Okay. All of that. And the fact that the concentration 244 00:15:37.549 --> 00:15:40.590 seems to wane, the focus seems to wane on things. 245 00:15:40.950 --> 00:15:47.110 Right. And another thing, you know, folks with ADHD tend 246 00:15:47.149 --> 00:15:52.779 to develop into procrastinators. People procrastinate for a lot of reasons, 247 00:15:52.980 --> 00:15:57.779 but You know, the child with ADHD kind of learns 248 00:15:57.840 --> 00:16:01.889 that they don't pay attention, but when the assignment is 249 00:16:01.929 --> 00:16:06.769 due tomorrow, that causes anxiety and stress, and the anxiety 250 00:16:06.830 --> 00:16:11.570 and stress then becomes the motivator. Then it's in the 251 00:16:11.629 --> 00:16:13.710 frontal lobe as, oh, my God, I need to do 252 00:16:13.750 --> 00:16:19.200 this now. Then they're able to concentrate. So we look 253 00:16:19.220 --> 00:16:19.500 for that. 254 00:16:20.000 --> 00:16:22.379 Right. So then they wait, of course, to be under 255 00:16:22.419 --> 00:16:24.759 the gun, to be under that kind of pressure. 256 00:16:24.820 --> 00:16:29.330 It's kind of a subconscious way they can become motivated. 257 00:16:29.779 --> 00:16:33.309 That's very interesting. And on that note, because you said that, 258 00:16:33.370 --> 00:16:36.149 before we move on to the next disorder that I 259 00:16:36.190 --> 00:16:38.950 certainly want to talk to you about, if we find 260 00:16:39.009 --> 00:16:42.580 that that's the case, what's the difference between normal I mean, 261 00:16:42.620 --> 00:16:44.519 can you sum up just briefly? I know there's a 262 00:16:44.559 --> 00:16:48.000 lot of criterion, but what's the difference between normal procrastination 263 00:16:48.159 --> 00:16:53.379 and ADHD procrastination? Do we know? 264 00:16:53.399 --> 00:16:57.659 I usually, what I do is I usually look for 265 00:16:57.700 --> 00:17:00.759 other signs of ADHD. If I find them, I'm like, oh, 266 00:17:00.820 --> 00:17:05.059 I think that's driving the procrastination. I see. Okay. If 267 00:17:05.119 --> 00:17:07.079 we're not seeing that, I would look in a lot 268 00:17:07.119 --> 00:17:11.230 of other, is what's causing the anxiety? Is there? performance 269 00:17:11.309 --> 00:17:14.309 is there a fear of failure is there depression i 270 00:17:14.309 --> 00:17:16.210 mean it's there's a plethora of things. 271 00:17:16.230 --> 00:17:19.109 Of things right okay all right so let's move out 272 00:17:19.130 --> 00:17:22.430 of the add adhd and move into something that we 273 00:17:22.490 --> 00:17:25.150 also hear a lot about you can hear someone say 274 00:17:25.289 --> 00:17:30.170 oh my god i'm so ocd as opposed to i'm 275 00:17:30.269 --> 00:17:34.849 just naturally organized Let's talk about those two things and 276 00:17:34.890 --> 00:17:38.690 how people can confuse the diagnosis. Tell us what OCD 277 00:17:38.809 --> 00:17:41.150 is from a clinical point of view and what we 278 00:17:41.190 --> 00:17:42.099 should be looking at. 279 00:17:44.420 --> 00:17:48.900 OCD means that there is an obsession, intrusive thoughts that 280 00:17:48.940 --> 00:17:54.839 you must usually complete a task or avoid the stimuli. 281 00:17:55.559 --> 00:17:58.180 And the compulsion is the behavior of avoiding. 282 00:17:59.900 --> 00:18:01.279 Okay. So for somebody. 283 00:18:01.299 --> 00:18:04.720 Now, again, it's down to... Does it interfere with your functioning? 284 00:18:06.579 --> 00:18:11.619 Okay. There are some very telling things about OCD that 285 00:18:11.680 --> 00:18:15.859 are very, very different from normal behavior. And you said 286 00:18:15.940 --> 00:18:18.569 these things, but I don't want to gloss over them, right? 287 00:18:18.680 --> 00:18:18.809 Okay. 288 00:18:19.180 --> 00:18:24.089 The one thing that comes with OCD most prevalently, no 289 00:18:24.130 --> 00:18:26.849 matter what kind of OCD you have, and if you 290 00:18:26.869 --> 00:18:30.210 want to talk about those kinds, because there's relational and 291 00:18:30.269 --> 00:18:33.140 all kinds of other, you know, different OCDs, But the 292 00:18:33.339 --> 00:18:37.579 one thing that comes across most often, which separates us 293 00:18:37.660 --> 00:18:42.460 from normal human behavior, are the words intrusive thoughts. 294 00:18:42.880 --> 00:18:43.099 Yes. 295 00:18:44.059 --> 00:18:47.720 Okay. So I want you to explain in layman's terms, 296 00:18:47.849 --> 00:18:53.430 somebody trying to understand someone with OCD, exactly what happens 297 00:18:53.690 --> 00:18:56.130 in an intrusive thought. Give us an example. 298 00:18:57.369 --> 00:18:59.950 You don't want to have the thoughts. They're causing anxiety. 299 00:18:59.990 --> 00:19:03.829 They're causing preoccupation. And to get rid of them, you 300 00:19:03.849 --> 00:19:08.250 have to perform the behavior. You have to do something. 301 00:19:08.950 --> 00:19:09.650 Okay. 302 00:19:09.670 --> 00:19:13.559 So I'm going to leave my office and turn off 303 00:19:13.599 --> 00:19:18.880 the light. I had the intrusive thought that if I 304 00:19:18.940 --> 00:19:21.700 don't turn the light switch on and off 50 times, 305 00:19:21.900 --> 00:19:25.819 I'm going to die. That's kind of what they experience. 306 00:19:26.119 --> 00:19:28.480 You know, that's what it feels like and the thought is. 307 00:19:28.940 --> 00:19:31.400 And so they have to do it 50 times. 308 00:19:32.839 --> 00:19:36.000 Okay. And that is going. 309 00:19:35.940 --> 00:19:38.529 To impair their functioning. 310 00:19:39.400 --> 00:19:43.109 Exactly. And just because I'm organized and just because I 311 00:19:43.150 --> 00:19:45.849 put things in order and I have a clean closet 312 00:19:45.890 --> 00:19:49.390 or I have a clean workspace or I have a 313 00:19:49.470 --> 00:19:53.750 clean house. doesn't mean that intrusive thoughts are coming into 314 00:19:53.789 --> 00:19:57.089 my head where if I don't do these things, something 315 00:19:57.130 --> 00:19:58.789 catastrophic will happen to me. 316 00:19:58.970 --> 00:19:59.410 Correct? 317 00:19:59.890 --> 00:20:00.190 Correct. 318 00:20:00.849 --> 00:20:00.970 Okay. 319 00:20:00.990 --> 00:20:01.150 Okay. 320 00:20:01.509 --> 00:20:08.430 So is intrusive thoughts one of the primary distinguishable diagnosis 321 00:20:08.490 --> 00:20:12.170 for OCD? Without intrusive thoughts, would we say that we 322 00:20:12.210 --> 00:20:13.150 don't have OCD? 323 00:20:13.170 --> 00:20:18.579 Yeah, I would say so. I would agree. Okay. 324 00:20:19.059 --> 00:20:21.779 Okay. So that's a big thing. So all of you 325 00:20:22.019 --> 00:20:25.430 that are organized out there and put things away, if 326 00:20:25.470 --> 00:20:28.579 you're thinking that you have to go back and rearrange 327 00:20:28.630 --> 00:20:31.400 the shoes five or six or seven or a hundred 328 00:20:31.440 --> 00:20:35.160 times in order to feel good, that would be OCD. 329 00:20:35.500 --> 00:20:38.000 But if you just have a clean space or an 330 00:20:38.160 --> 00:20:41.279 organized space, or don't like to wait until the last 331 00:20:41.369 --> 00:20:46.029 minute or are structured in your life, then you are 332 00:20:46.109 --> 00:20:48.750 not OCD. Correct? 333 00:20:49.190 --> 00:20:49.470 Correct. 334 00:20:49.809 --> 00:20:52.890 Correct. And it can be mild. I mean, my desk is, 335 00:20:54.519 --> 00:20:57.440 Everything is at the right angles and perfect. For years, 336 00:20:57.500 --> 00:20:59.599 I worked with a desk where the client sat in 337 00:20:59.619 --> 00:21:01.200 front of my desk and I had this one young 338 00:21:01.240 --> 00:21:04.700 woman that would come in and move things around. And 339 00:21:04.759 --> 00:21:08.319 I'd be like, you can't do that. It was a 340 00:21:08.359 --> 00:21:13.400 little bit impairing my functioning. I had to focus on that. 341 00:21:14.970 --> 00:21:16.410 Okay. All right. 342 00:21:16.430 --> 00:21:19.309 But it was very mild. Okay. You know, and the 343 00:21:19.349 --> 00:21:25.339 other piece is people are born with traits. So, like, 344 00:21:25.500 --> 00:21:30.019 I'm a little OCD, but it never really impairs my functioning. 345 00:21:30.039 --> 00:21:31.859 I like to line things up and things, and it's 346 00:21:31.900 --> 00:21:37.519 a little weird. I like to take everything in the refrigerator, 347 00:21:37.900 --> 00:21:40.000 make sure the labels are facing forward, and my wife 348 00:21:40.019 --> 00:21:42.539 will go, stop being OCD. I'm like, I like that. 349 00:21:44.460 --> 00:21:49.579 You know, so if, you know, I always say diagnoses, 350 00:21:49.900 --> 00:21:52.319 you know, are kind of like a combination of what 351 00:21:52.339 --> 00:21:56.279 you're born with And then like what temperature you set 352 00:21:56.319 --> 00:21:59.380 the oven at and where you set the timer. You know, 353 00:21:59.480 --> 00:22:05.789 let's say I was exposed to a significant trauma as 354 00:22:05.829 --> 00:22:11.049 a child that, you know, since I have those OCD traits, 355 00:22:11.109 --> 00:22:14.390 that might be where it manifests. 356 00:22:14.470 --> 00:22:15.069 That began. 357 00:22:15.150 --> 00:22:15.390 Right. 358 00:22:15.430 --> 00:22:15.970 I understand. 359 00:22:15.990 --> 00:22:16.049 OK. 360 00:22:16.210 --> 00:22:19.210 All right. And in that line, let's finish this up. 361 00:22:19.269 --> 00:22:21.430 And I want to go on to the next thing. 362 00:22:22.000 --> 00:22:25.119 Can perfectionism be mistaken for OCD? Tell us about that. 363 00:22:25.140 --> 00:22:25.579 Absolutely. 364 00:22:26.009 --> 00:22:26.509 Tell us how. 365 00:22:28.930 --> 00:22:31.809 You know, I think a lot of people need to, 366 00:22:33.910 --> 00:22:37.750 when you say mistaken, like mistaken by a professional? Well, no. 367 00:22:38.450 --> 00:22:42.309 No, I mean, if I'm self-diagnosed, right? I mean, well, 368 00:22:42.349 --> 00:22:47.029 certainly maybe not by a professional because there are other 369 00:22:47.109 --> 00:22:51.109 probing questions, obviously, with all the other current personality disorders. 370 00:22:51.450 --> 00:22:54.750 But I'm talking about those of us here listening. The 371 00:22:54.789 --> 00:22:58.190 people that are listening to you are wondering, if I'm 372 00:22:58.230 --> 00:23:00.829 a perfectionist, do I have OCD? So what do you 373 00:23:00.849 --> 00:23:01.609 say to these people? 374 00:23:02.630 --> 00:23:05.210 No, not if it doesn't get in the way of 375 00:23:05.250 --> 00:23:07.609 your functioning. That's going to be the golden rule here. 376 00:23:08.079 --> 00:23:09.039 No matter what. 377 00:23:09.380 --> 00:23:13.720 Right. And, you know, if the person's functioning is impaired, 378 00:23:14.779 --> 00:23:17.900 you would really need to take a look at, is 379 00:23:17.960 --> 00:23:19.740 it really the OCD that's impairing? 380 00:23:21.299 --> 00:23:24.720 OK, OK. So if I'm going to prepare the holiday 381 00:23:24.779 --> 00:23:28.039 dinner because Thanksgiving is coming and everything has to be 382 00:23:28.099 --> 00:23:30.480 completely perfect and I have to have all my ducks 383 00:23:30.519 --> 00:23:32.420 in a row and all the China out and the 384 00:23:32.740 --> 00:23:34.980 and the gravy has to be perfect and the turkey 385 00:23:35.009 --> 00:23:38.210 has to be perfect or it's a direct reflection on 386 00:23:38.269 --> 00:23:41.970 me and everything has to be completely set up in 387 00:23:42.009 --> 00:23:45.690 a way that is driving me bananas, then that are 388 00:23:45.750 --> 00:23:49.190 those are probably direct OCD symptoms, would we say? 389 00:23:50.450 --> 00:23:51.170 Maybe. 390 00:23:51.190 --> 00:23:51.650 Maybe. 391 00:23:51.670 --> 00:23:52.529 Okay. 392 00:23:52.769 --> 00:23:57.119 Maybe you just like everything to be perfect in your cooking. Okay. 393 00:23:57.140 --> 00:24:00.200 I would say, okay, so everything needs to be perfect 394 00:24:00.359 --> 00:24:02.460 and you get everything on the table and the gravy 395 00:24:02.539 --> 00:24:06.140 is cold. Do you roll with it and heat it 396 00:24:06.220 --> 00:24:07.960 up a little bit or do you throw the whole 397 00:24:08.019 --> 00:24:09.940 meal out and tell everybody it's going to be four 398 00:24:09.960 --> 00:24:14.990 hours till we eat again? The latter would be real OCD. Right. 399 00:24:15.039 --> 00:24:16.380 Would be real OCD. 400 00:24:16.519 --> 00:24:16.880 Okay. 401 00:24:16.920 --> 00:24:22.759