I HAVE ADHD PODCAST
August 15, 2023
Can OCD Overlap With ADHD? with Guest Expert Kimberley Quinlan
I’m very pleased to be joined by Kimberley Quinlan in this episode. Kimberley is a licensed marriage and family therapist, specializing in anxiety, OCD and related disorders. Some of you with ADHD can identify with having additional neurodivergent diagnoses, such as OCD, and you may have experienced some confusion in differentiating between the two.
As children, it was hard enough being diagnosed with ADHD and having a full understanding of what it meant for ourselves and for our parents. Now add in other disorders, and you can imagine how difficult and frustrating it can be for those who have been misdiagnosed, misunderstood and overlooked.
I myself have a child who’s been diagnosed with OCD and ADHD, with the former likely causing the latter. I’m grateful to Kimberley for allowing me to share a bit of my own regrets as a parent coming to a good place of understanding my child in order to get him the support he needed.
There are so many great takeaways from this episode. But the biggest ones I’m walking away with are that validation and reassurance are everything. If you’ve been considering an evaluation for yourself or a loved one, please look into it. It’s a vulnerable process, but intaking the right information can be so powerful.
You can find Kimberley at kimberleyquinlan-lmft.com. If you are looking for some support as an adult with ADHD, come join my group coaching program FOCUSED, where we lift each other up and learn from our collective neurodivergent journeys.
LEARN MORE ABOUT THE TOPICS DISCUSSED IN THIS EPISODE
PRINTABLE ADHD SYMPTOM LIST
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Kristen Carder 0:05
Welcome to the I have ADHD podcast, where it’s all about education, encouragement and coaching for adults with ADHD. I’m your host, Kristen Carter and I have ADHD. Let’s chat about the frustrations, humor and challenges of adulting relationships working and achieving with this neurodevelopmental disorder. I’ll help you understand your unique brain. Unlock your potential and move from point A to point B. Hey, what’s up? This is Kristen Carter and you’re listening to the I have ADHD podcast. I am medicated. I’m caffeinated. I am regulated and I am ready to roll. Today we’re going to be talking about all things OCD. And I am really looking forward to it because I know there’s a big overlap between ADHD and obsessive compulsive disorder. These two conditions can be co occurring and they share a lot of similarities. So I’ve been wanting for a while to bring an expert on to help us suss out the details. And I have done just that. I am so pleased to introduce you today to Kimberly Quinlan who is a licensed Marriage and Family Therapist and has a private practice in Calabasas, California specializing in wait for it is going to be great anxiety, OCD and related disorders and eating disorders. I mean, I am so I’m so grateful for you being here because this is what we need. I have so many questions about OCD. And I will be bringing in a lot of ADHD stuff but the overlap between OCD anxiety, depression, eating disorders, all of it I think so many of us ADHD errs relate hard core to this kind of like CO occurring struggle. And so thank you, Kimberly for being here. I really appreciate it. Well, thank
Kimberley Quinlan 2:00
you for having me on, truly.
Kristen Carder 2:02
So let’s just like start off with the bang. Tell me a little bit about yourself and about your practice. What do you do?
Kimberley Quinlan 2:10
Sure. So I specialize myself and my clinicians who work for me, we specialize in obsessive compulsive disorder, and obsessive compulsive related disorders. So think of it like an umbrella. The obsessive compulsive umbrella. OCD is one of the diagnosis also hair pulling skin picking a lot of anxiety disorders, phobias, health, anxiety, and so forth. And then I also specialize in coexisting eating disorders. I myself had an eating disorder. And I did see in my training, a lot of overlap between the way that OCD presents and how eating disorder is present. And so that’s what I do. We do cognitive behavioral therapy and different ways of practicing cognitive behavioral therapy for those different disorders.
Kristen Carder 3:01
I can’t wait to get into all of that, because I’m just so fascinated. Let’s start with the basics. What is obsessive compulsive disorder?
Kimberley Quinlan 3:11
Sure. So it is a mental health condition. It’s not a quirk. Let’s let’s not when, why and what it’s not. It’s not a quirk. It’s not something that you know, it’s not where you line your cookies up, and you have all this joy about lining your cookies out. That’s something entirely different. It’s also not just perfectionism, however, perfectionism is under that umbrella. Obsessive Compulsive Disorder. It consists of two main parts. One is the obsession, which is an intrusive thought, feeling, sensation, urge or image that’s repetitive and distressing. So that’s the most important piece. It’s a distressing thing. Sometimes we get calls from people saying, My son is obsessed with Lego and we first are going to check with like, does he like being obsessive? Or does he not because that can help us get them the right treatment? If they’re really feeling like they have to do this behavior. They don’t want to that they’re really tormented. Well, then, yes, we would consider that an obsession. They also need to have compulsions. Now, most of us know Hollywood versions of compulsions, which is like jumping over cracks and washing your hands. And these are all very valid versions of a compulsion. compulsions are usually a behavior we do to reduce or remove that discomfort caused by that obsession. They, these compulsions can be physical behaviors. They can be mental behaviors, so you might never know someone’s doing a compulsion. Because they’re doing it mentally in the form of rumination. It might be in the form of reassurance seeking from a loved one. It could be in the form of avoidance. So again, you might know someone has OCD because they’re simply just avoiding things that they’re you know tradeoff. And then the last is they do a ton of self punishment. So you have to have those two, that has to take up a significant part of your life and cause some distress in your day.
Kristen Carder 5:12
When you say it causes distress, can you explain what that might look like practically?
Kimberley Quinlan 5:20
Well, the intrusive thoughts and the obsessions usually cause emotional distress, right? A lot of shame, blame, guilt, a lot of uncertainty, or OCD is known as the uncertain disorder or the uncertain disease, a lot of doubt, right. So that end is that’s where the suffering is, on the compulsion and of things. The distress is that these compulsions take up a ton of time, they usually cause them to have a lot of very, as you can imagine, valid emotions, anger, grief of how much time it’s taking up, how much it’s impacting your friendships, how it’s impacting your career, or your school life. And so you may have a whole range of emotional distress, going through obsessive compulsive disorder. But in addition, it does take up and use up a lot of our functioning. Right. So OCD usually start small and slowly as it grows, it takes over your life and can really sort of take over the things you love your hobbies, and so forth. And that’s how it can cause the most distress.
This is so
Kristen Carder 6:35
meaningful to me personally, because as I had shared with you earlier, I have one of my kiddos who was diagnosed with OCD a couple years ago. And so it hits really close to home for me. And as you’re talking about the distress, I’m remembering the times prior to his diagnosis, we didn’t know what was going on. And he always presented as just like a very hyper aware, high needs child. So he was like, so aware of absolutely everything, including, like, sensory things, too, you know, like the tagging is in his shirt. And like one shoe was tighter than the other shoe. I mean, there were like meltdowns about things that as a young mom, and as someone who was not a healthy person at the time, I was like, What in the world is going on with this child like he is so needy. And looking back, I have a lot of grief about the way that I perceived my own sweet child who was just really struggling and trying to communicate to me, but I can see how a parent would easily overlook, because I did you know, and I actually did check in with every single pediatrician, I thought maybe he was on the autism spectrum. And I kept saying, like, there’s just something a little bit different, like do you think that it’s possibly autism? Do you think it’s possibly ADHD? You know, obviously, ADHD runs in my family? And every pediatrician that I talked with, oh, no, he’s just quirky. Like, he’s, essentially He’s fine. He’s fine. He’s fine. And when I finally got him evaluated, so we because everyone was just like, he’s fine, including all of his teachers, but at home, he was not fine. Like, there were a lot of motor tics that were causing him physical pain. So he would get headaches from all of the motor ticking that he would do throughout throughout the day. And when it got to that point, it was like, okay, something bigger is going on here. And we finally got an independent evaluation. And the diagnosis was OCD and ADHD. But the diagnostician was very clear in saying the ADHD might be caused by the OCD. So in other words, he’s so preoccupied with his obsessions and compulsions that he’s now not able to focus. And so he’s presenting with ADHD symptoms, but it’s because he’s so preoccupied with the obsessions and compulsions? Is that something that you see in your practice?
Kimberley Quinlan 9:23
This is why it is so important that we get a thorough assessment on these kiddos and for adults, because a lot of adults go into adulthood, not you know, having these symptoms or their life functioning to a pretty good degree, but the symptoms are just pretty chronic the whole time. And the reason for that is these symptoms can look so similar. So as you can imagine, if you’re having intrusive thoughts and you’re spending a lot of time ruminating, you’re anxious a lot of the time you’re not going to be able to concentrate, or you might be staring off into space, in class or at work, and you will often be Are you diagnosed with ADHD? And again, yes, you may have a thorough diagnosis because they’re going to be looking at what’s going on underneath these behaviors to determine it’s not just the way the behavior presents that we make the diagnosis. It’s like, why is this behavior happening? So for OCD, as you can imagine, as I said, if you’re like, constantly having this uncertainty, like, but what about this? And what if this happens, and what if this happens, all like you said, people with OCD, one of their superpowers, but also it’s can become a problem is they are hyper aware of everything, they can tell you tiny details of things that people without OCD would never have picked up on? Well, they’ll pick up on certain asymmetry or things that you may have not even noticed, again. So because of that hyper awareness that widen zoom that they have, again, that can make it look like it’s ADHD, and they can’t concentrate. For other people. The distress in and of itself can make them very jittery and irritable and uncomfortable in their body, particularly if they’re obsessions or more sensations, or somatic obsessions. I can make you very irritable and likely to maybe lash out have a temper tantrum, be sobbing in tears inconsolable. And again, I don’t want to portray people with OCD to be dysregulated because majority of people are doing their best to keep it quiet, right? So these are all experiences people may have with OCD, which may look like other disorders, or in many cases, people may just say like you’re being a naughty kid, or you’re being you know, you’re being silly or dramatic, but they are in an incredible amount of distress.
Kristen Carder 11:55
Yeah, I mean, when I think back even to my son as an infant, he had no tolerance for like, for example, getting hot in his carseat I mean, complete meltdowns. And I would be so confused. Just not understanding the intensity with which he he could like experience these sensations. I mean, he was an infant, obviously, he couldn’t express himself other than to cry. Now that he’s older, he can use his words. And we, of course, are like working on that part where he is able to self advocate and express like, I’m very uncomfortable, I need to change or I need to like he’s able to take care of those needs. And we encourage him to meet those needs. But in a child, when it’s the parents responsibility to meet those needs, it can be exhausting for the parent, right? Because the child is just like, like, Well, why is one child completely fine in this car seat, and the other child is melting down. And it’s like, I don’t I don’t understand what to do. And so I’ve such compassion for these misunderstood kids, because I was a parent that misunderstood her kid. And now my heart breaks about it. It’s just like, I want to get the word out about how this might present so that we can prevent misunderstanding if possible.
Kimberley Quinlan 13:22
Yeah, yeah. I think it’s important to know the research here is data shows that it takes between seven and 14 years for someone to be correctly diagnosed with OCD. So so we’re we’re here to validate all the parents who missed it. Right? Now, that’s not because the parents weren’t advocating either. They’re often going to the pediatrician going to the doctor asking mental health professionals. In many cases, these people adults have been in treatment for that many years until the mental health provider has provided them with the correct diagnosis and the correct treatment. So this is like we’re failing out on our people here, right? Like, this is not good. And you’re in a particular, you know, talking specifically to your age group, you’re in a particular situation where it’s hard to decipher what is what because they don’t have the emotional vocabulary to say, I like and again, let me sort of scoot forward a little bit here because it’s important for your folks to know like, obsessions for people with OCD, there are dozens of different subtypes of OCD so for some kids it’s what if something bad happens to mom and dad or what happens if I get sick you know, it could be one and anything could be what if I get really sick? What if it’s you saying like this feeling is really uncomfortable, this sensation, this somatic experience is very uncomfortable for me or so it could be any of those as it goes into adulthood. People will then have the vocabulary to share like I was having even sexual obsessions of out again, remember, these are obsessions that people don’t want to have that don’t line up with their values, right? Or religious obsessions, right relationship obsession. So there are so many subtypes that young kiddos don’t have the vocabulary to explain what they’re experiencing.
Kristen Carder 15:21
Yeah, let’s talk about those subtypes. I’m glad you brought that up. Because as I was researching, it seems very unclear to me. Is there a consensus on how many subtypes or is it kind of limitless?
Kimberley Quinlan 15:36
No, we have specific ones that are the most common, right? There are those that are more like benign or miscellaneous obsessions that go into this category. But we do have a pretty good set of an outline of the particular set of symptoms and how they typically show up. But again, the demographics show that younger kiddos, you know, I mean, that’s entirely not true, either. But younger, kiddos do tend to have it with health and relationships, and somatic, you know, and those kinds of thing and contamination obsessions, like that tends to be the symptoms that we see, again, is that because they just don’t have the language to tell us, right, really, are they just afraid to share that we don’t know. But, you know, for the typical adult, you know, there are a wide, you know, a wide range of, but we’re pretty good at identifying them now to help with a treatment plan.
Kristen Carder 16:38
So my son was diagnosed with just right, OCD. And he was old enough at the time, when he receives evaluation that I actually read the evaluation to him the report, you know, bits and pieces. And when I read it to him, he felt so validated, yes, he was like, floored, he was probably maybe 12 or 13, at the time. And he was like, he literally said the words, I feel like this woman is in my brain. The evaluator right, the clinician that evaluated and he just felt like, just so so validated. And that is such a neat experience. And I think a lot of people are afraid to be evaluated, because it’s, it’s hard to, first of all, be really vulnerable, and have someone kind of look under the hood, so to speak of like what’s going on mentally, emotionally for you. But if we can remember that information is so powerful, and that when someone can really understand your brain and your experience, it’s so validating
Kimberley Quinlan 17:55
well, and this is why it is so important, and good for you like for getting that diagnosis as early as you did, right like that, you should be very proud of yourself for that. So, you know, take that on as deeply as you can. Again, the reason that this is so important is a lot of people with OCD have this second layer of shame, because before they have that diagnosis, everything feels so messy. So out of control, like so chaotic in their mind, and they don’t understand it. They’re just like, I don’t know what’s going on. And so yes, it’s very scary, because you’re probably often afraid of like, what will they find? Right? What will they find out because there’s so much shame and so much guilt. The cool thing is once you do have that sort of diagnosis and that specific subtype as well, many people have many subtypes too, by the way. So I want to normalize, it’s totally normal to have multiple subtypes. But once you do have that, then we can actually get to like what’s the solution and then things can clear up and be a little less chaotic in our mind. And that’s why it’s so great to have that.
Kristen Carder 19:08
I can’t wait to talk about solutions. That’s going to be the most fun and the best part but before we do tell me how reassurance plays a part in OCD. That is something personally that I have really been witness to is the need for reassurance. Can you talk about that a little bit is that throughout all the subtypes, or is that just like maybe specific to my experience?
Kimberley Quinlan 19:36
I think it’s specific to each person. So different subtypes don’t always look the same. Okay. There are, as I said, five different compulsions or ways in which compulsions can play out and each person depending on their own psychological makeup will rely on different ones. A lot of kiddos do rely on reassurance seeking because they’re young and they look to their parents for solutions. And that’s a common product like what presentation for kiddos? Sure. But again, if we look at the model, so obsession is this intrusive thought, feeling sensation or urge. And the compulsion, the reassurance seeking is done to reduce or remove that discomfort. Now, it makes sense, right? When you’re uncomfortable, and you’re scared, and you’re uncertain, it makes sense that you would do a behavior to make that discomfort go away. Like that’s just human instincts. But the problem is, if you have the diagnosis of OCD, which is a brain disorder, when you do that reassurance or any compulsion, you actually reinforce the fear and make the fear was, right, because if you have a fear, and you treat the fear as if it’s real, true and dangerous, your brain then learns it must be true and real and dangerous. And so it keeps pumping out stories and messages that you’re in danger. So when the kiddo comes to you for reassurance, and they have OCD, I’m not saying that our parents listening need to stop reassurance, because that’s a normal part of human development. Right? My son comes to me and says, I’m scared of going back to school, of course, I’m gonna say you’re gonna do Gray, you’re gonna, you know, things are gonna be great. I’ll be here for you. So I’m not anti reassurance. But if you have OCD, and you’re seeking reassurance repetitively, what you’re actually doing, if you’re giving that reassurance, you’re actually making the disorder stronger. Right? Now, what we want to do, and we’ll, we’ll talk about this later, I know in solutions, but we want to intervene in different ways, so that they’re not getting that reassurance, but they are getting encouragement and support from the parent, right? We’re not here, just go You’re on your own kid deal with it. That’s not what we do. That’s, that’s cruel, right? But what we want to do is we want to show the child that we don’t you know, it’s a child, you and I are against OCD, it’s not you and OCD against me, and I’m here to support you. But I’m not here to make OCD stronger. So we want to sort of again, I want to be really clear this nuanced for every case, right? The way we treat is not mean or hard or forceful or disrespectful. It’s usually we collaborate with the child and talk about ways that we can fight back with OCD, and not give OCD, what it wants. And you know, how might you stand up to your OCD and so forth?
Kristen Carder 22:40
And would that be similar in treatment for adults as well,
Kimberley Quinlan 22:44
very much exactly the same. Of course, we’re going to be a little more gentle with the kiddos, because they are in a developmental stage where they are also learning about the world. Right. And let’s say you have an adult who also has, you know, their maturity isn’t maybe as high where it was we’re going to assess each client to their cognitive ability, their functioning ability, their insight, and that will determine to what degree we intervene.
Kristen Carder 23:17
That makes a lot of sense. And now, a word from our sponsor. Hey, Kristen here, I’m the host of this podcast, an ADHD expert and a certified life coach, who’s helped hundreds of adults with ADHD understand their unique brains and make real changes in their lives. If you’re not sure what a life coach is, let me tell you, a life coach is someone who helps you achieve your goals like a personal trainer for your life. A life coach is a guide who holds your hand along the way as you take baby step after baby step to accomplish the things that you want to accomplish. A good life coach is a trained expert, who knows how to look at situations or situations with non judgmental neutrality, and offer you solutions that you’ve probably never even considered before. If you’re being treated for your ADHD, and maybe even you’ve done some work in therapy, and you want to add to your scaffolding of support, you’ve got to join my group coaching program focused. Focused is where functional adults with ADHD surround each other with encouragement and support. And I lead the way with innovative and creative solutions to help you fully accept yourself, understand your ADHD and create the life that you’ve always wanted to create, even with ADHD. Go to I have adhd.com/focused to join and I hope to see you in our community today. Have we spoken yet about the specific symptoms of OCD? I don’t think we have I know you’ve talked direct claim about the obsessions, and then like kind of solving for those obsessions with the compulsive behavior. But what would you look for in an adult? As far as like they come in and they’re like, something’s going on. I need some support, I need some help. What are the symptoms that a clinician is going to be looking for? To determine a diagnosis of OCD?
Kimberley Quinlan 25:25
Sure. So it’s actually pretty repetitive, we first look to see if there is a present obsession. And we will look at again, is the obsession unwanted?
Kristen Carder 25:38
Yeah, that seems like a very key component.
Kimberley Quinlan 25:41
Yes. Is it repetitive? And is it distressing, right? They are key components, we actually from a clinical standpoint, we call it ego dystonic, meaning you have the obsession, but the obsession doesn’t line up with your values, right? So I’m afraid that I’m going to harm my child is a very common one, we’ll ask when you have this obsession or this fear? Does it line up with your values? Do you want to harm your child? Or is it scary to have that thought? Is this thought repetitive? And when you have it? Does it comfort you? Or does it make you live? Like greatly distressed, right? And these can be really hard questions, and again, involve nuance, but it helps us to determine the treatment. Right? And there’s no shame there’s no judgment here. You know, I always say to my clients, like, there is nothing these walls haven’t heard, like, the worst of the worst for years. I’ve heard at all, like, you won’t shock me, you won’t scare me, I won’t run away. I won’t close down the computer, like OCD goes to the darkest, scariest, most horrible places. And let’s just normalize that. Right? That is the way that OCD presents in many cases, right? For kids even right. Yeah. Right. So that’s sort of looking at the obsession part of it. Then with a compulsion similar questions, when you do these behaviors? Do you want to do them? Do they bring you pleasure? Or do they bring you distress? Right? When you’re engaging in them? Is there a sense of like completion with them relief with them? Right? Do you feel like you have to do them with a sense of urgency, right, the way I always sort of explain it to patients is OCD could look like brushing your teeth, all humans, that why do we brush our teeth? I don’t want to brush my teeth, right? I hate brushing my teeth. But I do it because I’m afraid of getting gum disease. Yeah, that looks a little bit like an obsession, except for the fact that I don’t do it repetitively over and over and over and over and over and over and over. Okay, yeah. But if you had an obsession about gum disease, under the lens of OCD, you would be thinking about it all the time, you would have a high level of distress, right? And you would be doing it in this very intricate way with a sense of great urgency. And once you would be done with that, you would feel some relief, but the fee would come right back. Right, versus those who don’t have OCD, they brush their teeth. It’s kind of like, I didn’t want to do that. But they move on with their day.
Kristen Carder 28:29
Right? I’m not thinking about brushing my teeth until it’s time for bed.
Kimberley Quinlan 28:33
Yeah. And it doesn’t interfere with my functioning. So it’s a very, it’s a very silly example. But it can kind of normalize the difference between you know, we’re all doing behaviors out of fear, like I exercise, because I don’t want to, you know, I want to be healthy, you know, and sometimes that can be fear related. But with OCD, the fear is incredibly distressing, you know, again, relentless in that it doesn’t stop.
Kristen Carder 29:02
I would love to hear your thoughts on tics. And is that a common presentation? Or a common symptom of someone with OCD? It was something that my child experienced, but I don’t know if that is something that you kind of look for in anyone that you’re diagnosing.
Kimberley Quinlan 29:21
Sure. So tics often do fall under that OCD spectrum umbrella, right. And they often do co occur with OCD, they’re a little different in that they do have a discomfort, right? So so they’re similar and different, right? They do have a discomfort that causes you to do a behavior, right? So with tics, they can be motor tics, which is a physical behavior and maybe like nodding of your head or a blinking of the eye or a clearing of the throat or some physical movement that someone does, or they could be a verbal tic right so for some people, they will Say a word repetitively. Or sometimes it’s a swear word, or could be a very inappropriate word even. And so they can present under that looking like, again, there’s an obsession, and there’s this behavior we do to relieve that discomfort. So the difference here is we look at that, those questions I asked is often with tics, they’re not, they’re not controllable. It’s not You’re not doing the behavior to relieve it on purpose, like we can do with compulsions with OCD. Again, some people with OCD do them sort of so habitually as well, that it feels like it’s out of their control as well. So I want to be nuanced in that that’s how they are similar. But with tics, they are very automatic is the word we use. And, you know, again, very repetitive, similar, which is why they often do co occur. And we actually use a little bit of a different different treatment, though, for ticks than we would OCD.
Kristen Carder 31:00
That’s fascinating. That is fascinating to me. Okay, let’s chat about those treatments. So let’s talk in the context of adults, when you’re working with an adult who is presenting with OCD and you know, has the clinical diagnosis, how do you determine what treatment is best? And like, what do you suggest? What do you see as being really helpful for treating OCD?
Kimberley Quinlan 31:25
Sure, so at this point in time, of course, the research is always evolving. At this point in time, we have a great amount of evidence, if we did a meta analysis of all the treatments that a particular type of CBT cognitive behavioral therapy called exposure and Response Prevention is the correct treatment. So exposure and response prevention is where we expose them to their obsession. Right, so we would face our fear, right? That’s one part of it. Right? The other part of it is the response prevention. So then, while we’re facing our fear, or doing that uncomfortable thing, we’re actually reducing the compulsions that they would usually engage in, so that they can learn that they can tolerate that discomfort, in many cases habituate from that discomfort. Train your brain is another way of saying train your brain that you don’t need to respond to those fears. And we do that in a hierarchy. It’s particularly with kids, where we start small, and then we work our way up to the harder more uncomfortable obsessions. You know, I can see your face. Like, it sounds
Kristen Carder 32:39
Kimberley Quinlan 32:42
is I tell my patients all the time, this is crappy work, right? This is crappy, hard, courageous work. But let me flip that story. It is crappy, hard and a lot of work. But it does work. And one thing I have learnt as being a mother of two and as a human being who walks on the planet is there’s nothing really worth doing. That’s easy, right? And the thing I have learned and I celebrate this is the people who do this work, tend to be and come out of treatment, the ones who can cope with any life experience. This is life training, to be able to face your fear, and stand in fear and discomfort. This is such a life skill to have fear, particularly for someone who’s genetically like we understand OCD is a combo of genetic and environment. Particularly if you’re someone who was genetically predisposed to having this anxiety. I being one of those, these skills of learning that oh, he’s here let’s let’s do the fearful thing. Let’s do the scary thing is a way that keeps us anxious folks functioning at a high high rate and allows us to cope at a higher rate and allows us to have a sense of like, I can handle anything, because I’ve done this other hard thing. So yeah, I agree. I tell all my patients this is hard sucky work, but baby steps and compassion and let’s go alright, you sold
Kristen Carder 34:28
me on it. You sold me I’m in. I’m curious. How much time you typically spend with your adult patients. How long does it typically take and is it an ongoing treatment? Or is it kind of like you know, you do it for a year or whatever the case may be and then you’re kind of done
Kimberley Quinlan 34:51
reach so it shows that we can make massive steps in three to four months. Wow massive steps if using pretty like A rigid ERP plan, right? Now, that being said, we’re not all robots, we’ve all come with our own symptoms. Some people, again, have many, many symptoms, some come in more severe than others more, you know, having lacking in functioning than others. So that’s going to be different for everybody. And then treatment. Like, again, science says around 24 to 36 sessions is a good route of treatment. CBT does tend to be short term treatment. However, again, human beings are complex, we do know that OCD is a chronic disorder, right. And in the top 10, most debilitating medical conditions in the world like medical, I’m not talking mental, I’m talking medical up there with cancer and diabetes, right? So, so we, we want to look at the whole person. So I never put a cap on how long treatment can take. Because there are other factors involved. So you can be targeting those obsessions and compulsions. But you’re still going to be looking at the grief of how much time in and how many events it took up, and how it prevented you from doing the things that you want to go into prom and all those kinds of things, you’re also going to be looking at emotional regulation, because when you’re having high levels of of emotion, we do need to intervene with tools for that as well. So I try my best not to tell anybody how long it will take because it’s different for every person. And I never want anyone to feel like they’ve failed the science, it’s like no, it can take as long as you need. And that’s okay. I
Kristen Carder 36:43
am so grateful to you for bringing up emotional regulation and just the way that you weave emotions into the context of what you’re talking about. Because I know that research just came out to, to show that CBT for ADHD is not a particularly helpful modality because it doesn’t address so much of emotional regulation. But it sounds like what you’re doing is you’re bringing in some semantics and emotional regulation into the context of your CBT practice. And I don’t know if you want to expand on that a little bit. But I just want to say I really appreciate that about your approach.
Kimberley Quinlan 37:21
Yeah. So the research continues to show for OCD as well that that one modality alone is highly effective at treating the disorder, but not the whole person. Right. So yeah, if someone said to me, I’m here just for my OCD, I don’t want I don’t need anything else. Fine. We will target your OCD. And that’s it. But for a lot of people getting there involves including, you know, newer treatment modalities like Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, mindfulness based therapies, I’m really heavy on compassion, focus therapy, and because of that high level of shame and blame and guilt, and negative experience that goes with it. So I feel like that’s a huge piece. In fact, I read a whole book on just compassion for CTE for that reason. And so I sort of like a collaborative approach, right, we’ve got, I always sort of say, like, if it was making a sandwich, the the meat and cheese of the sandwich is ERP and turn EBT. But we can sort of sandwich that with mindfulness and self compassion and make it a more well rounded treatment.
Kristen Carder 38:45
I love I love all of that. I think that makes so much sense. And to approach the whole person, rather than just the one specific disorder really humanizes the entire approach, because we’re not just saying you are your OCD, and you’re this is all that you are. It’s saying you are a whole person. And you’re struggling with this OCD, which we’re going to target and we’re going to help you and give you these other strategies and these other tools in your toolkit as well.
Kimberley Quinlan 39:15
Right. Right. One, I will add one more thing is there are often a coexisting disorder to depression being the most common one 80%, right of people have coexisting depression. So a clinician ideally will be again the meat and cheese we’ve got to get the better with the primary diagnosis and then that often will help that depression or you said like a the more ADHD concentration issues and so forth or could be an eating disorder or whatever else is coexisting. We still want to target that. But there are cases where, you know, it is a collaborative approach we may need to bring in In other treatment providers as a part of the treatment plan as well, right sensory may involve an occupational therapist or a speech therapist or behavioral analyst, depending on the specific set of symptoms. So we’re not, I’m never here to be like, I’m going to treat every single part of your disorder times it requires a team of people and a medical professional as well.
Kristen Carder 40:25
What are your thoughts on medication for OCD? Is that something that you have found to be helpful? Do you see it as like a one of the interventions, but maybe not something long term? Like, what are your general thoughts about it?
Kimberley Quinlan 40:42
Well, for legal reasons, I’ll preface I’m not a medical professional. But research does show that Okay, so we talked about this sort of meta analysis of treatment for OCD. Going beyond just the treatment, what we do understand is the most successful is a combo of CBT, and an SSRI, that is the gold standard, you know, a Olympic gold medal winning treatment that we’re aware of at this time. And so yes, combining those two has been shown to be incredibly beneficial. Now, if you had to compare the two meds versus ERP, you would still pick ERP and CBT, right? Because that tends to have long, you know, it’s giving you skills, it’s giving you a longer term, but the combo together has been known to be the most beneficial. Now you would need to speak with your doctor to make sure that it’s good for you that you know, you’re comfortable with certain side effects. And now, there’s even more research to show that there are other medications, particularly anti psychotic medication that can help particularly for those who have obsessions that are really, really sticky, and feel very real, and tend to make it’s hard for us to have insight in those moments where we’re really triggered, you can also add those on as well. And there’s a really great AI article on the international OCD Foundation, if you Google, I O CDF medication, they have this really great science based article very easy to read with graphs with the different researchers on the different medications and the different doses for OCD, right. And so we I just so always refer to that, because that’s where it’s just one place where all the research is. And it basically shows the different dosages for that are effective for OCD, because the thing to remember is, you have doses for depression, but the dose for OCD is a little higher. So it’s important to your doctor knows that when prescribing,
Kristen Carder 42:54
we will link that article in the show notes just for the listener, just know that we’ll have that for you. I totally understand that you’re not a doctor. And if you’re not comfortable answering this question, it’s totally fine. Is it okay for a human to stay on an SSRI treatment for OCD long term? So my question is kind of related to ADHD in that someone with ADHD has ADHD? Yes, we can learn coping skills, we can go to therapy being get coaching, we can make big improvements, but ADHD is gonna be there. And it’s very likely that we will be on medication for life, it’s likely is the same type of situation for someone with OCD, where like, you’re gonna go to therapy, you’re going to do the ERP, you’re going to make big improvements, but it’s likely if medication is a good fit for you, it’s likely that you will be on that for life. Is that kind of how it works? Or are we hoping to ditch the medication at some point?
Kimberley Quinlan 43:54
It’s a personal decision for each and every person and from my experience as being a clinician seeing, you know, hundreds of clients on medications is everyone’s approach is different. Some people like this method changed my life. I never want like, I love my meds do not take them from me. Like if I had one thing I needed to have with me on a deserted island, it would be my Prozac or whatever it is there. Yeah, that’s fine. And if your medical professional thinks that you’re fine to continue that way, go for it. There are other people who do the treatment. They go into a maintenance phase, they keep an eye on their symptoms. They’re very diligent about you know, making sure that they’re continuing with their skills and tools. And then they very, like carefully make a plan with their medical professional and the treatment provider to slowly wean off of those, particularly if they have side effects that they don’t want. Right That sure there are some people who have sexual side effects. You know, some people are like, it’s fine. I don’t, I’d prefer to not have that my symptoms. It’s is not a big deal, the side effects are doable. But for some people who don’t like the side effects, or they want to try going off meds, we can set a treatment plan where you taper off and we monitor you. And they go off to use their tools. Like I said, it’s a tool for life. And they may not ever need meds again, or they may just need it during difficult periods where it’s good. And I’ve seen both. So I don’t think there’s a right I think it’s very personal. And the cool news is, is if you’ve got a great team, we can help you get there just might take a little bit of time.
Kristen Carder 45:37
I really appreciate the answer. It’s so beautiful. Because I think that as someone with ADHD, I tend toward black and white thinking I want the rules, give me the rules, Kimberly, tell me what’s right and what’s wrong. And I will follow the rules. And whenever we can bring in nuance and gray into the conversation, it really helps me to see like, it’s not always so black and white. And we can really have nuance and some gray area and everyone gets to decide for themselves and work with a team that they feel supported by. So speaking of I would love to hear about your team, what you do, tell me about your practice and how you specifically, you know, work with clients?
Kimberley Quinlan 46:22
Sure. So I have two separate businesses. So we’ll talk about what it looks like to be in therapy. So I have a private practice and clients will usually again, thankfully, for you know, the internet, people often now come to us already knowing they have OCD, they have an idea they’ve read off of the internet, or they’ve heard a podcast of mine or something. And so they will come in knowing already that they have OCD and wanting that diagnosis and then wanting to go to treatment. And then we just take them through the steps, we do a thorough assessment, you know, we do a ton of education because again, whose wants to face their fear, right? No one wants to face their fear. But once you start to learn the benefits of it, and you start to see how to break that cycle, people are willing to do it. So we will do a ton of education and then we will walk them through a course of ERP exposure and Response Prevention and other modalities to if the if needed to get them where they need to be. So that’s more of a face to face one on one setting. I have a whole nother business called CBT school like cognitive behavioral therapy school. CBT school was really made from a moment of frustration, by I’m licensed in the state of California. And my law only allows me to treat clients in California. So when I first had my practice, and I had a podcast, I was getting calls from Idaho and Utah and states that had literally zero pretreatment providers, countries with literally zero treatment providers and turning them away and going sorry, I can’t treat you because you don’t live in my state by my law of licensing and just turning them away to nothing like a word. Which, yeah, which is fine. workbooks are some people get better with just a workbook, but a lot of people if you’re severe, no, that’s not enough treatment. So CBT school was a moment of frustration, where I was like, You know what, I’ll basically record the first seven sessions of treatment and explain the treatment, explain what it looks like, walk you through how I would do it. And so that you can put together a plan on your own. You can set yourself up with any plan, I’ll give you the skills, I’ll show you how to do it. And then if that gets you up and running. Great. And so it’s a series of different courses for OCD. Now we have one for panic, we have one for generalized anxiety, we have hair pulling and skin picking, we have one for depression, we have one for we’re having one very soon on social anxiety, and then health anxiety. So it’s, it’s a vault of like, this is how we do it. And if you don’t have access to care, you can start to do the steps on your own.
Kristen Carder 49:17
Wow, that is amazing. So is it essentially like courses, pre recorded courses within the portal membership portal or whatever.
Kimberley Quinlan 49:28
It’s just you pay per course. So you know, on demand, it’s not it’s just you have limited access to it. You can take it as many times as you want. The thing that’s hard too is number one, there aren’t enough OCD and trained professionals in these areas. Number two, treatment can become very expensive. Right? As we know, treatment is very expensive. So the goal is to find lower cost options for those who Who are, you know, don’t have access or can’t afford? Because ERP therapy can be a little pricey, given how specialized it is.
Kristen Carder 50:08
Sure. And then you also have a podcast. Do you want to tell us about that?
Kimberley Quinlan 50:12
Sure. Yeah. So I have a podcast called your anxiety toolkit. It is like my most fun thing. I love my podcast, as you I’m sure do. It is basically exactly how it sounds. It is just me jumping on turning on my mic and talking about tools and skills, and ideas to help people with their anxiety recovery doesn’t have to be even OCD related. We cover all anxiety issues, including coexisting depression and other disorders as well. So the best place to get any resources for people with OCD is it’s called the International OCD foundation.org. So it’s I O, C, D f.org. And there is a button there that says find providers, and there is an entire inventory of all of the OCD therapists in the world. Of course, some people won’t be on the list. But mostly in America, there is an extensive list of providers. So that’s where you would go to get providers.
Kristen Carder 51:21
I appreciate you so much. I’m so glad we had this conversation. I feel like we could talk for a much longer time. But I promise I won’t. I won’t talk any longer. We’ll link all of your resources in the show notes. I know you’ve written a book, so I want to make sure to have that. And CBT school and if you’re in California and you have OCD, make sure to reach out to Kimberly but I just want to say thank you so much for sharing your wisdom with us today. I appreciate it greatly.
Kimberley Quinlan 51:51
No, thank you. I hope it was helpful. If you know that’s my main goal and it’s so lovely to chat with you.
Kristen Carder 51:58
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