Treating OCD When You’re Also Neurodivergent
Cali’s key insight is that OCD can and should be treated differently, even when it exists alongside ADHD or autism.
“For me, ADHD and autism aren’t problems to solve. But OCD is.”
— Cali Keating, ADHDifference
She describes how many clients come in feeling overwhelmed by the tangled mess of symptoms. But once OCD is properly identified and treated, the noise quiets. They’re better able to manage the enduring traits of ADHD and autism with far more ease.
Why This Strategy Matters
ADHD and autism are lifelong neurotypes. They affect how we think, interact, and engage with the world. OCD, on the other hand, is an anxiety disorder, and as Cali explains, it is treatable and recoverable.
Using techniques like ERP (Exposure and Response Prevention), clients can learn to:
- Identify intrusive thoughts and internal compulsions, even the subtle ones that look like overthinking or “just being prepared”
- Reduce the urge to neutralise uncertainty through rituals or checking
- Build a new system of emotional regulation based on long-term values rather than short-term dopamine fixes
This reframe helps clients see that what looked like ADHD procrastination or autistic rigidity may, in fact, be OCD-driven. And once the OCD is treated, what remains becomes much more manageable.
When to Use This Strategy
Here are a few scenarios Cali explores that may suggest OCD is part of the picture and worth addressing directly:
- You ‘daydream’ for hours, but it’s mostly mental rehearsal or rumination
For example, replaying conversations, imagining disasters, or over-preparing for outcomes. - You avoid tasks not because they’re boring, but because they trigger spirals
Cali shared a client who avoided class not due to ADHD distraction, but because being there activated compulsive thoughts about being watched, judged, or doing something “wrong.” - You rely on rituals like checking, reassurance-seeking, or photo evidence to feel safe
This might look like double-checking the oven or reviewing emails repeatedly. These behaviours can occur in both ADHD and OCD, but in OCD, they are tied to a deep need for certainty. - You feel anxiety when asked to skip or reduce those rituals
That emotional charge is often what separates OCD from ADHD in the way Cali works.
How This Changes the Game
Once OCD is properly diagnosed, treatment can begin with a clear goal: recovery.
- ERP helps clients face the fear behind their compulsions
- They learn to tolerate uncertainty, which is key
- Over time, many stop engaging in the rituals entirely
And perhaps most empowering of all: many clients no longer meet the diagnostic criteria for OCD once they complete treatment.
The Science Behind It
OCD is classified as an anxiety disorder, and its core mechanism is a cycle of intrusive thoughts (obsessions) followed by behaviours (compulsions) meant to relieve anxiety. While ADHD and autism are neurodevelopmental, OCD is learned and treatable through behaviour-based intervention.
The gold standard treatment, Exposure and Response Prevention (ERP), works by gradually exposing the individual to feared thoughts or situations without allowing the usual compulsion to follow. This retrains the brain to stop interpreting uncertainty or discomfort as danger.
Over time, ERP rewires the brain’s response to anxiety. The amygdala, which normally signals threat, becomes less reactive, and the prefrontal cortex, responsible for reasoning and decision-making, becomes more active. This allows for more flexible thinking, improved emotional regulation, and a reduced need for rituals.
When applied with care, especially in neurodivergent clients, ERP becomes a pathway not just to symptom reduction, but to freedom from a cycle that often goes unnoticed in ADHD or autistic lives.
💬 Final Thought
In a world where ADHD, autism, and OCD often blend together in daily life, Cali reminds us that not all challenges are the same. ADHD and autism may shape how you move through the world. OCD, however, can hijack it.
Treating OCD as the anxiety disorder it is, separate from your neurotype, can offer meaningful and lasting relief.