The Checking Trap: When ADHD Accommodations Turn into OCD Compulsions

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Hi, and welcome to Dopamine in Doubt.
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I'm your host, Rachel, a licensed clinical social worker specializing in ADHD and OCD.
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On this show, I will be speaking from both my clinical and lived experience as we explore the surprisingly common crossover of ADHD and OCD.
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Because when we understand which is in the driver's seat, we are better able to know what we need in that moment.
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Whether you're living right at the intersection of both or navigate life with one of these neurotypes, you're welcome here.
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As always, please take what is helpful and leave what isn't.
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Neurodivergence shows up differently for everyone, and there is no one size fits all approach.
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Okay, let's dive in.
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Before I understood my brain, I checked my email and appointment book constantly.
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I was terrified that I would miss an appointment.
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Looking at it, there are real ADHD needs underneath that.
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My working memory is not perfect.
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So checking my schedule is actually a reasonable accommodation.
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But my OCD took that reasonable accommodation and stretched it way beyond what was helpful.
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I wasn't checking because I needed information anymore.
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I was checking because I wanted certainty and to reduce anxiety and that urgent feeling that if you have OCD, you'll know well.
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I had already looked.
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I knew my schedule, but my brain wanted to just look one more time.
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Hours of my life would disappear in these moments of checking that never actually made me feel more confident.
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This is such a hard one when you have both ADHD and OCD.
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When we're treating OCD, the goal is to reduce or stop the behavior.
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But if you also have ADHD, you might think, but if I don't check, I'll miss something important.
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Then this episode's for you.
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Today, we're talking about why ADHD and OCD can both involve checking, but for different reasons.
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If you have both, the answer is not usually to stop checking entirely or to check once more.
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It is learning why your brain is wanting to check.
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And this is something, again, that I see in my office all the time.
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I've even had clients say, well, my OCD just keeps my ADHD in check, which I've felt that way before.
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I get that sentiment.
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But can we do it in a way that is not compulsive?
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And I think the answer is yes, we can.
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So how checking can look identical in both ADHD and OCD?
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You can look at your calendar multiple times, making sure you locked the door, rereading an email, checking your to-do list, looking for your wallet.
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Outwardly, these look the same, but inwardly they feel different.
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ADHD checking's function is to compensate for an unreliable working memory and attention.
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The brain says, I genuinely don't remember or know, and I often miss details.
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Checking has an endpoint.
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Examples.
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I confirm the appointment time of my next therapy session.
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I look at my calendar the night before.
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I check to see if I packed my medication, or I look at my grocery list before I forget.
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After checking, I have the information now and I am done.
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Checking actually solves the problem.
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Then there's OCD checking, the function to reduce uncertainty or anxiety.
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The brain says, but what if examples?
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What if I miss something?
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What if the email sounds offensive?
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What if I only think I locked the door?
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What if I accidentally made a mistake?
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The problem is not missing information, it's trying to feel certain.
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The distinction is ADHD checking decreases uncertainty, and OCD checking creates more uncertainty.
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You check, then wait, oh, I should do it again.
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I need to be completely sure.
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If I checked and I immediately believe the answer, probably ADHD.
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If I didn't, probably OCD.
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When someone has both, here's some messy middle examples.
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You have ADHD.
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You genuinely forget if you lock the door.
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Reasonable accommodations could be checking once, taking a picture to show that you did lock it, using a smart lock, or saying out loud, I locked the door.
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These reduce real executive functioning difficulties.
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But when OCD joins, there's the urge, I need to look again.
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What if I miss something?
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I don't feel confident yet.
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I'll feel better when I'm certain.
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Driving home to check, asking your spouse, replaying a memory.
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Accommodations have now moved into compulsion.
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So what are the treatment differences?
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With ADHD, we build better systems.
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We externalize memory.
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We make lists.
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We have visual reminders such as calendars.
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We have alarms, checklists, and environmental supports.
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When treating OCD, we do our tolerating uncertainty practices.
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We limit our checking, we delay our checking, we accept imperfection, and we resist the urge for one more confirmation.
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The question becomes: is this a system or is this a search?
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There are times when planned checking is an adaptive ADHD strategy.
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For instance, reviewing your calendar each morning, or checking your medication organizer before bed, doing a phone wallet key routine before leaving the house, or having departure checklists.
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These are scheduled and intentional systems.
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So a personal story around this.
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Ironically, I recently missed an appointment for the first time ever.
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It was on a different day than I usually work and was a makeup session.
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And somehow I missed it.
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Old me would have taken this as proof that OCD was right all along.
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I should have been checking constantly.
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And I would think, or I would have thought, that my entire system was a failure.
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This is what OCD does.
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One mistake.
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See, you can't trust your planner.
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You should probably check 10 more times to be safe.
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But that's not what happened.
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This time, when I made a mistake, I apologized.
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We rescheduled for later that day, and then we had a really meaningful conversation about the difference between guilt and shame.
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This particular client struggles with perfectionism.
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And so I was able to use this example as true guilt.
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I really did make a mistake, and repair was needed.
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I absolutely needed to apologize and make it right and then move forward.
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Where shame would have been, I made a mistake, therefore I'm irresponsible, incompetent, and a bad therapist.
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This is where both OCD and perfectionism want to pull you.
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Instead, for this instant, I chose the healthier response.
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Repair.
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Then I looked at my system and I asked, what happened?
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Do I need to tweak something?
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Which is sometimes the reality?
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Or was this just a human mistake and I can move on?
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Because I've done what I can with it.
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The goal of treatment is not to become someone who never makes mistakes or is a perfect person.
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That's impossible.
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It's flexibility.
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We want to build systems that reduce preventable mistakes while also building the resilience to handle inevitable ones.
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I still do check my calendar because I have ADHD and the chance of missing something is very real.
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Now I just don't let fear decide how many times I have to check.
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And I don't lose hours of my life in the process.
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I trust my systems, and when my systems inevitably fail, once in a while, as every human's does, I practice repairing the mistake instead of trying to prove I should never have made one in the first place.
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My goal or hope for you this week is can you pick a system, if you have ADHD, that you're going to practice this with and start, I don't know, checking your schedule again, the night before as an example.
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And if you have the OCD overlap, can you let that one check be enough?
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And then sit with the uncertainty of I did my best with the system I have that I know works.
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And I don't need to look again to be certain because that won't actually make me feel better, anyways.
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I hope this helps and I look forward to the next episode.
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Thanks for being here.
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This podcast is for educational and informational purposes only and does not replace professional mental health care.
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If you are struggling, please reach out to a qualified mental health provider who can work with you directly.
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What I share here comes from my clinical experience and my own journey, but your situation is unique to you.
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If you are in crisis, please contact 988 or go to your nearest emergency room.
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Thanks for being here.