WEBVTT
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You know, we casually call ourselves ADHD because we're distracted sometimes.
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Or we call ourselves OCD because we like things organized.
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Or maybe we call ourselves bipolar or somebody you know
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bipolar because their moods change all the time. But when
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does normal human behavior actually become a mental health disorder?
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We are banding about these terms and do we really
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know what they mean? And more importantly, do we overuse them?
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And are we really diagnosing normal human behavior as opposed
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to personality disorders? I'm Ellen Stewart, Pushy Broad from the Bronx.
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This is my show, Recovery Recharged. And today's show is
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Stop Diagnosing Me. And we're going to talk about three
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distinct disorders in part one, And then we're going to
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come back and talk about the same thing, but three
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different disorders in part two. Today's part one is ADD
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or ADHD, as we know, is attention deficit disorder. OCD,
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as we know, is obsessive compulsive disorder and bipolar disorder.
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Do we have them or are we just labeling ourselves?
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Because those are the words of the day. So, I
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decided that the only way to really know is to
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get a licensed clinician in so that he can answer
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questions for us so we can determine whether we're really
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a diagnosed disorder or we're just behaving humanly. I want
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to introduce you to an old friend of mine, Nelson Hadler,
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who was kind enough to come today to the studio
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on his birthday. So happy birthday, Nelson.
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Thank you, Ellen.
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He is a licensed clinical social worker, a licensed certified
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alcohol and drug counselor, and he has over 30 years
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of experience in addictions and mental health. He's in private practice.
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He has license in various states, and he'll tell us where.
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He's extremely experienced in working with families, adolescents, adults, and
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personality disorders. Welcome to my show, Nelson. Good morning.
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Good morning, Ellen.
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I want to know right out of the gate, do
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you think we're becoming too quick to turn ordinary human
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behavior into a psychiatric diagnosis?
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Oh, yes. Yes, I think we confuse layman terms for
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certain clusters of behavior for actual disorders.
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Like what?
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Like the ones that we're talking about today, you know,
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so ADHD.
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So let's talk just a little bit about ADHD. What's
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the difference between, first of all, tell us the difference
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between ADHD and ADD. Tell us about that from a
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clinical point of view.
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Well, it was ADD through the 80s. And I think
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about 1987 in the Diagnostic Statistics Manual, they change it
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to ADHD. attention deficit hyperactivity disorder, primarily inattentive, primarily hyperactive,
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and mixed. So a lot of people just shortened it
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back to the old thing, ADD. They made the change
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simply to distinguish between what behaviors were presenting.
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I see. Okay. So Now, most people, when they think
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of ADD or ADHD, think about somebody that can't regularly
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focus or they're easily distracted. So tell us what you
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would know the difference when you're diagnosing somebody. How do
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you know whether this person is ADD or just exhibiting
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normal human behavior?
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Well, first of all, you need to run the person
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through the criteria and see what they fit. But you
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also need to keep an eye out for the differential diagnoses.
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Is the person just a little flighty? Is the person anxious?
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Do they have an anxiety disorder? Are they so depressed
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they can't concentrate? Are they grieving? Have they just had
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a medication change? Are they in withdrawal? Are they in
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post-acute withdrawal? you have to rule out everything else that
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could be responsible for the presentation. So it is kind
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of overused. I mean, one of my litmus tests, you know,
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I'll have the person come in who's been, you know,
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in and out of substance abuse treatment and says, I
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have ADHD. And I asked them a little bit about
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the background and I'm really not finding that. And, you know,
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they go, oh, and you know, I've been prescribed Adderall,
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but they used it as a stimulant. They used it
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as a methamphetamine. You know, one of the biggest litmus
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tests is how do you respond to ADHD medication? Oh,
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I can focus and all the distractions go away and
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I'm like this. Or, oh, I can stay up all
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night and study. It's very different. People with ADHD have
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what they call a paradoxical effect of actually focusing. So
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a lot of times I ask that.
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Okay, so in a clinical sense, but in layman's term,
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tell us how you have diagnosed someone ADD, ADHD. What
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exactly is the criterion for that classic diagnosis in layman's terms?
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So I know whether or not I actually have it.
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Setting aside all of the other things that you said,
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I'm not grieving, I'm not anxious, I'm not nervous. a
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person that you would consider clinically ADD, ADHD. Give us
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an idea of some of the major standout symptoms.
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I'll try to think of all the criteria in the book, but,
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you know, can't sit still, comes unprepared for tasks at school,
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jumps around easily, you know, that type of thing. You know,
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one of the biggest things you want to look at is,
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Are they, how do I say it? Are they, ADHD,
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people with true ADHD can focus on things that they're
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motivated to. It's a disorder of ordering tasks. If they're
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not motivated to do their math homework, it just doesn't
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come up. It's not laziness. It's not avoidance. It just
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doesn't get put in the forefront of the list of
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tasks one needs to accomplish next. So that's what you
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really look at.
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That's very interesting because now that everybody is pretty much
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going back to school, most people in different parts of
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the country have already started school and others, of course,
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here up in the East Coast where we are, or
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at least on the East Coast are going back very,
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very soon. It is something that parents are looking for
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to make sure that their child is learning and processing
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in the right way. So an ADD person also I
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have found from people that I know have come to
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me with that classic diagnosis can start talking about something
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in simple conversation and then extend to so many different
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tangents that they have difficulty coming back to the first thought.
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Is that a trait that you've noticed as well?
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Yeah.
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Yeah, but I mean, again, one thing we'll discuss a
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little bit is You know, are we just quick to label?
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I mean, that could be somebody with a bipolar disorder
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in a manic episode.
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I see. But I'm talking about now clinically ADD or
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ADHD person. So what do you find when people label themselves? OK,
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when somebody turns around and says, oh, you're so ADD, right?
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That happens a lot. I see it a lot. I
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find sometimes that's when people talk about people who are,
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like you said, a little bit more nervous or a
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little anxious or have a lot on their plate.
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Yes.
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Do you find that that's how we misdiagnose ADD?
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Oh yeah, absolutely.
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Okay.
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All right.
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So now is there any difference between ADD and ADHD
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since they put in that, you know, hyperactivity disorder? Is
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there a difference?
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No, you always look for, you know, the less diagnosed
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is the inattentive because they're not hyper and all over
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the place and jumping around.
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I see.
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But, you know, they'll be like answering a math problem
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and be like, oh, look at that chicken, you know.
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Okay. So this also comes with a certain amount of
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impulsivity too, I mean, right? people can be distracted by
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a whole plethora of things that have nothing to do
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with ADD, like they can be exhausted or overwhelmed or
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anxious or depressed. All of those things that would seem
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as if they have those symptoms. So what you're saying
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to us is they should be clinically diagnosed. Okay, so
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now one thing with this specifically, I have many young
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adults coming to me and telling me, that they'd been
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diagnosed as ADD or ADHD at an early age, like
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in elementary, in grade school, and haven't had a diagnosis since.
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What do you suggest to these people?
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Is it impacting their life today?
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Well, that's a very.
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you know are they having is it is it affecting
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work is it affecting relationships you know um just be
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it's over diagnosed you know i mean if someone said
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they were diagnosed adhd at six years old i'd ask
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them what was going on at six years old okay
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okay did they have did grandma die Did a parent die?
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Did they have a trauma? Did anybody look for abuse
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or PTSD? You know, if they were diagnosed in grammar
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school and really haven't had an issue since, is it
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possible for other causes or maybe just you're fine?
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Okay. Is it possible for someone to have ADD or
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ADHD as a diagnosis and then have that diagnosis disappear
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or resolve? Is that possible?
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I don't believe if it's a true diagnosis, you can
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treat it and you can learn skills to counteract it.
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I see. I see. Like addiction, you can put it
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in remission, but it never really works.
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Right.
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Exactly. Correctly. You can address it.
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So that's very interesting.
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Yes. Okay.
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Do you think that current stimulus like our phones and
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the computer and the technology and all the multitasking that
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we do on a regular basis, Can exacerbate ADHD or
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mimic ADHD among students?
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Well, exacerbate, yes. You know, it's just another distraction. So
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you need to be in class. You need to be
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on the phone. You need to be focusing on something.
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Then there's social media. So, you know, that's exacerbation. And
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then people can just be spaced out on their phone.
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I mean, look at texting. And driving, you know.
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Yes, which means another thing, but yes.
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You don't need to be ADHD to be on your
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phone all the time, although it certainly would feed into it.
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Exactly. Okay. So it doesn't mean technology causes ADHD. It
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means that difficulty concentrating has many possible causes, right?
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Yes. That's my big point. All right.
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Now, because this is recovery recharge and we talk a
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lot about addiction, can you talk about how addiction or
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early recovery look like ADHD? How does that manifest itself?
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How could that be confused with ADD or ADHD? Somebody
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that is at early recovery.
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Well, they're gonna be depressed. They're gonna be anxious. They're
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gonna have the initial withdrawal symptoms from the substance. They're
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gonna be experiencing post-acute withdrawal symptoms, you know, syndrome, I
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should say. And, you know, those things look like ADHD. Irritability,
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difficulty concentrating, it's right there.
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You know, anxiety, depression, fatigue. Right, all of the disruptions.
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It's going to make it hard to concentrate.
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Exactly. So you need to take a look at.
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How long the duration of these difficulties are.
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Okay.
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Okay.
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Because I hear a lot of people say, I can't concentrate,
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I'm restless, I'm impulsive, I can't sleep, I'm forgetting everything,
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I must have ADHD. And again, this could be temporary
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in terms of early recovery, right? Because like you said,
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the post-acute withdrawal and all of that, and we have
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to see whether or not these symptoms persist down the road.
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You have to look over time and you have to look, hopefully,
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over periods of abstinence.
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Of course. Okay, so is ADD the kind of disorder
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that happens in early childhood and continues? Or can somebody
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in adolescence or young adulthood or even adulthood develop ADD
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or ADHD? How does that work?
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I believe it's something you're born with if it's true ADHD.
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You know, classically, Classically, the ADHD child is bright. They
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have higher IQ and they're able to compensate for their
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lack of attention through grammar school. And oftentimes what we
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see is in eighth and ninth grade, these bright kids
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that always had all A's start having problems with some subjects.
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And that's when we want to dig into Could this
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be ADHD? So that's usually where it raises its head,
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especially the non-hyperactive inattentive cognitive. I see.
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So we're finding more of these diagnoses prevalent in a
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middle school situation.
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Yes. A lot of times that's where it's first identified.
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I see. Okay. All right. Okay. But you said something
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very telling, which is the theme of this entire thing.
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And in the beginning is, How is this affecting your life?
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Or parents, how is this diagnosis or these behaviors affecting
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the life of your child, right? Is it interfering with
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everyday processes? Is it overtaking them in a way that
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is mood altering, right? All of the things they should
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be looking out for?
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Yes.
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What else should they be looking out for?
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Well, again, the hyperactivity and what's driving that. You know,
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the forgetting to bring things.
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Okay. All of that. And the fact that the concentration
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seems to wane, the focus seems to wane on things.
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Right. And another thing, you know, folks with ADHD tend
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to develop into procrastinators. People procrastinate for a lot of reasons,
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but You know, the child with ADHD kind of learns
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that they don't pay attention, but when the assignment is
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due tomorrow, that causes anxiety and stress, and the anxiety
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and stress then becomes the motivator. Then it's in the
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frontal lobe as, oh, my God, I need to do
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this now. Then they're able to concentrate. So we look
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for that.
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Right. So then they wait, of course, to be under
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the gun, to be under that kind of pressure.
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It's kind of a subconscious way they can become motivated.
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That's very interesting. And on that note, because you said that,
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before we move on to the next disorder that I
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certainly want to talk to you about, if we find
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that that's the case, what's the difference between normal I mean,
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can you sum up just briefly? I know there's a
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lot of criterion, but what's the difference between normal procrastination
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and ADHD procrastination? Do we know?
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I usually, what I do is I usually look for
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other signs of ADHD. If I find them, I'm like, oh,
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I think that's driving the procrastination. I see. Okay. If
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we're not seeing that, I would look in a lot
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of other, is what's causing the anxiety? Is there? performance
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is there a fear of failure is there depression i
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mean it's there's a plethora of things.
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Of things right okay all right so let's move out
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of the add adhd and move into something that we
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also hear a lot about you can hear someone say
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oh my god i'm so ocd as opposed to i'm
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just naturally organized Let's talk about those two things and
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how people can confuse the diagnosis. Tell us what OCD
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is from a clinical point of view and what we
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should be looking at.
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OCD means that there is an obsession, intrusive thoughts that
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you must usually complete a task or avoid the stimuli.
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And the compulsion is the behavior of avoiding.
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Okay. So for somebody.
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Now, again, it's down to... Does it interfere with your functioning?
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Okay. There are some very telling things about OCD that
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are very, very different from normal behavior. And you said
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these things, but I don't want to gloss over them, right?
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Okay.
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The one thing that comes with OCD most prevalently, no
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matter what kind of OCD you have, and if you
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want to talk about those kinds, because there's relational and
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all kinds of other, you know, different OCDs, But the
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one thing that comes across most often, which separates us
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from normal human behavior, are the words intrusive thoughts.
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Yes.
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Okay. So I want you to explain in layman's terms,
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somebody trying to understand someone with OCD, exactly what happens
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in an intrusive thought. Give us an example.
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You don't want to have the thoughts. They're causing anxiety.
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They're causing preoccupation. And to get rid of them, you
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have to perform the behavior. You have to do something.
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Okay.
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So I'm going to leave my office and turn off
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the light. I had the intrusive thought that if I
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don't turn the light switch on and off 50 times,
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I'm going to die. That's kind of what they experience.
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You know, that's what it feels like and the thought is.
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And so they have to do it 50 times.
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Okay. And that is going.
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To impair their functioning.
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Exactly. And just because I'm organized and just because I
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put things in order and I have a clean closet
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or I have a clean workspace or I have a
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clean house. doesn't mean that intrusive thoughts are coming into
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my head where if I don't do these things, something
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catastrophic will happen to me.
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Correct?
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Correct.
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Okay.
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Okay.
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So is intrusive thoughts one of the primary distinguishable diagnosis
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for OCD? Without intrusive thoughts, would we say that we
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don't have OCD?
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Yeah, I would say so. I would agree. Okay.
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Okay. So that's a big thing. So all of you
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that are organized out there and put things away, if
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you're thinking that you have to go back and rearrange
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the shoes five or six or seven or a hundred
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times in order to feel good, that would be OCD.
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But if you just have a clean space or an
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organized space, or don't like to wait until the last
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minute or are structured in your life, then you are
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not OCD. Correct?
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Correct.
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Correct. And it can be mild. I mean, my desk is,
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Everything is at the right angles and perfect. For years,
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I worked with a desk where the client sat in
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front of my desk and I had this one young
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woman that would come in and move things around. And
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I'd be like, you can't do that. It was a
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little bit impairing my functioning. I had to focus on that.
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Okay. All right.
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But it was very mild. Okay. You know, and the
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other piece is people are born with traits. So, like,
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I'm a little OCD, but it never really impairs my functioning.
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I like to line things up and things, and it's
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a little weird. I like to take everything in the refrigerator,
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make sure the labels are facing forward, and my wife
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will go, stop being OCD. I'm like, I like that.
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You know, so if, you know, I always say diagnoses,
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you know, are kind of like a combination of what
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you're born with And then like what temperature you set
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the oven at and where you set the timer. You know,
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let's say I was exposed to a significant trauma as
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a child that, you know, since I have those OCD traits,
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that might be where it manifests.
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That began.
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Right.
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I understand.
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OK.
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All right. And in that line, let's finish this up.
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And I want to go on to the next thing.
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Can perfectionism be mistaken for OCD? Tell us about that.
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Absolutely.
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Tell us how.
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You know, I think a lot of people need to,
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when you say mistaken, like mistaken by a professional? Well, no.
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No, I mean, if I'm self-diagnosed, right? I mean, well,
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certainly maybe not by a professional because there are other
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probing questions, obviously, with all the other current personality disorders.
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But I'm talking about those of us here listening. The
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people that are listening to you are wondering, if I'm
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a perfectionist, do I have OCD? So what do you
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say to these people?
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No, not if it doesn't get in the way of
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your functioning. That's going to be the golden rule here.
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No matter what.
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Right. And, you know, if the person's functioning is impaired,
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you would really need to take a look at, is
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it really the OCD that's impairing?
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OK, OK. So if I'm going to prepare the holiday
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dinner because Thanksgiving is coming and everything has to be
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completely perfect and I have to have all my ducks
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in a row and all the China out and the
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and the gravy has to be perfect and the turkey
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has to be perfect or it's a direct reflection on
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me and everything has to be completely set up in
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a way that is driving me bananas, then that are
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those are probably direct OCD symptoms, would we say?
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Maybe.
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Maybe.
391
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Okay.
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00:23:52.769 --> 00:23:57.119
Maybe you just like everything to be perfect in your cooking. Okay.
393
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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
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is cold. Do you roll with it and heat it
396
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up a little bit or do you throw the whole
397
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meal out and tell everybody it's going to be four
398
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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
So absolutely it is in extremes, but yes, sometimes perfectionism
402
00:24:22.880 --> 00:24:28.140
can be, you know, misdiagnosed or you, you can think
403
00:24:28.200 --> 00:24:31.690
that your OCD, if you're so perfect, if you're going back,
404
00:24:31.809 --> 00:24:34.710
like we said, and fixing the pencils on your desk
405
00:24:34.789 --> 00:24:37.119
or making sure that it's right a thousand times or,
406
00:24:37.430 --> 00:24:39.509
going back to see whether or not the oven is
407
00:24:39.569 --> 00:24:42.289
turned on or making sure that the bed is exactly
408
00:24:42.349 --> 00:24:45.390
made perfectly and go back several times to see that
409
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everything in the pillows and the cushions are exactly the
410
00:24:48.359 --> 00:24:49.819
way they need to be, right?
411
00:24:49.920 --> 00:24:50.140
Yes.
412
00:24:50.160 --> 00:24:54.240
So that's when perfectionism is not really perfectionism at all,
413
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but a beginning sign of OCD.
414
00:24:56.519 --> 00:24:58.349
Yeah? You could say that. Okay.
415
00:24:58.440 --> 00:24:59.089
And also.
416
00:25:00.569 --> 00:25:02.990
It's not only a question of needing everything to be perfect.
417
00:25:03.029 --> 00:25:06.819
Like you said, it's if you can tolerate it when
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you are not perfect.
419
00:25:08.339 --> 00:25:13.000
Right. Right. Exactly. Can you move on and prioritize and
420
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get the task done? Right.
421
00:25:14.559 --> 00:25:17.099
Okay. Okay. So you also want to.
422
00:25:17.059 --> 00:25:21.829
Look at, I mean, adult children of alcoholics and, and, uh,
423
00:25:22.289 --> 00:25:25.769
people with substance use disorders can tend to be perfectionists,
424
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you know, um, How so?
425
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I remember a co-worker talking about a client once. He said,
426
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there comes Clem in his alcoholic truck. And it was
427
00:25:38.589 --> 00:25:40.769
early in my career. I'm like, what's an alcoholic truck?
428
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And he's like, it's old. It's got rust on it,
429
00:25:43.630 --> 00:25:47.730
but it's perfect. It doesn't have any dust. It's polished, armor-old.
430
00:25:47.759 --> 00:25:50.640
And I was like, oh. So they put out this
431
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facade of being perfect. And that's what happens in an
432
00:25:55.700 --> 00:25:59.420
alcoholic family system. I see. You're the child of an alcoholic.
433
00:25:59.460 --> 00:26:01.900
So if you're a family hero, which is a whole other,
434
00:26:02.789 --> 00:26:07.589
I won't go in that whole direction, but like being perfect,
435
00:26:09.609 --> 00:26:13.789
being successful can become somewhat obsessive, but the motivator would
436
00:26:13.829 --> 00:26:16.859
be more the having to look at the family system
437
00:26:16.880 --> 00:26:17.660
the person came from.
438
00:26:18.039 --> 00:26:20.519
I understand. Okay. I want to get to the next
439
00:26:20.559 --> 00:26:22.359
thing and we have a very short amount of time,
440
00:26:22.400 --> 00:26:25.710
so I want to encapsulate it. Let's talk about tackling
441
00:26:25.769 --> 00:26:29.769
bipolar disorder, right? She's so bipolar, she was happy this
442
00:26:29.829 --> 00:26:33.750
morning and furious tonight, right? She must be, if she's
443
00:26:33.789 --> 00:26:36.369
not going through her changes or it's not that time
444
00:26:36.410 --> 00:26:38.569
of the month or I don't know what's going on
445
00:26:38.609 --> 00:26:41.880
with them, is that bipolar disorder? Let's break it down
446
00:26:42.039 --> 00:26:44.119
really easy in about 60 seconds.
447
00:26:44.480 --> 00:26:49.079
No, it's not. And it's my pet peeve and probably...
448
00:26:49.390 --> 00:26:53.380
The second, up there with ADHD as far as misdiagnosis
449
00:26:53.420 --> 00:26:58.960
is bipolar. You can have mood swings without having a
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bipolar disorder. You can be sad in the morning and
451
00:27:01.480 --> 00:27:02.740
happy in the afternoon.
452
00:27:04.009 --> 00:27:10.470
Okay, so what distinguishes a true bipolar diagnosis? 30 seconds.
453
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Was there a manic episode for regular bipolar? Has there
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been depressive episodes? Can you... Is there other ways to
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00:27:20.700 --> 00:27:23.859
account for the manic episodes? You know, I mean, those
456
00:27:23.900 --> 00:27:27.819
are the big things. You know, manic episodes are dangerous behavior.
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00:27:27.839 --> 00:27:31.809
You know, my first question is, have you had a
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period of not being able to sleep for one to
459
00:27:34.390 --> 00:27:36.549
three days, but you're not tired?
460
00:27:38.109 --> 00:27:42.829
I see. Okay. So it's clinicians thinking that there is
461
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a decreased need for sleep, maybe unusually elevated or irritable mood.
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00:27:47.720 --> 00:27:53.539
Increased activity, rapid speech, racing thoughts, grandiosity, and risky behavior.
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00:27:53.660 --> 00:28:01.309
Those things specifically would be bipolar, but having general mood swings, no.
464
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So thank you so much for part one. We have
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talked about bipolar. We've talked about OCD. We have talked
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about ADD. Do not bandy those terms about unless you
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00:28:13.839 --> 00:28:18.339
get a clinical diagnosis. Stop calling yourself something you are not.
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This is the Pushy Broad from the Bronx. Come back
469
00:28:21.660 --> 00:28:25.049
to us for part two. We're going to talk about
470
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other diagnosis that people just confuse for normal behavior. Thank
471
00:28:30.990 --> 00:28:33.329
you so much. And we'll see you next time.
472
00:28:35.460 --> 00:28:41.250
She's the Pushy Broad from the Bronx, New York. Follow
473
00:28:41.269 --> 00:28:44.950
her voice, her straight talk is nice. She's a pushy
474
00:28:44.990 --> 00:28:50.130
broad from the Bronx, oh yeah. Don't be surprised if
475
00:28:50.190 --> 00:28:52.059
you want to listen twice.
476
00:28:52.450 --> 00:28:54.380
Make decisions, find the right choice.
477
00:28:54.539 --> 00:28:56.440
Know yourself better, find your own voice.
478
00:28:56.859 --> 00:28:57.720
It's okay if.
479
00:28:57.680 --> 00:28:59.579
You need help today because everybody.
480
00:28:59.240 --> 00:29:00.180
Needs a little push.
481
00:29:00.279 --> 00:29:03.859
From the pushy broad from the Bronx, New York.
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You know, we casually call ourselves ADHD because we're distracted sometimes.
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Or we call ourselves OCD because we like things organized.
3
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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?
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We are banding about these terms and do we really
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know what they mean? And more importantly, do we overuse them?
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And are we really diagnosing normal human behavior as opposed
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to personality disorders? I'm Ellen Stewart, Pushy Broad from the Bronx.
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This is my show, Recovery Recharged. And today's show is
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Stop Diagnosing Me. And we're going to talk about three
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distinct disorders in part one, And then we're going to
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come back and talk about the same thing, but three
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different disorders in part two. Today's part one is ADD
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or ADHD, as we know, is attention deficit disorder. OCD,
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as we know, is obsessive compulsive disorder and bipolar disorder.
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Do we have them or are we just labeling ourselves?
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Because those are the words of the day. So, I
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decided that the only way to really know is to
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get a licensed clinician in so that he can answer
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questions for us so we can determine whether we're really
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a diagnosed disorder or we're just behaving humanly. I want
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to introduce you to an old friend of mine, Nelson Hadler,
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who was kind enough to come today to the studio
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on his birthday. So happy birthday, Nelson.
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Thank you, Ellen.
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He is a licensed clinical social worker, a licensed certified
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alcohol and drug counselor, and he has over 30 years
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of experience in addictions and mental health. He's in private practice.
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He has license in various states, and he'll tell us where.
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He's extremely experienced in working with families, adolescents, adults, and
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personality disorders. Welcome to my show, Nelson. Good morning.
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Good morning, Ellen.
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I want to know right out of the gate, do
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you think we're becoming too quick to turn ordinary human
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behavior into a psychiatric diagnosis?
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Oh, yes. Yes, I think we confuse layman terms for
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certain clusters of behavior for actual disorders.
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Like what?
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Like the ones that we're talking about today, you know,
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so ADHD.
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So let's talk just a little bit about ADHD. What's
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the difference between, first of all, tell us the difference
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between ADHD and ADD. Tell us about that from a
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clinical point of view.
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Well, it was ADD through the 80s. And I think
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about 1987 in the Diagnostic Statistics Manual, they change it
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to ADHD. attention deficit hyperactivity disorder, primarily inattentive, primarily hyperactive,
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and mixed. So a lot of people just shortened it
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back to the old thing, ADD. They made the change
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simply to distinguish between what behaviors were presenting.
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I see. Okay. So Now, most people, when they think
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of ADD or ADHD, think about somebody that can't regularly
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focus or they're easily distracted. So tell us what you
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would know the difference when you're diagnosing somebody. How do
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you know whether this person is ADD or just exhibiting
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normal human behavior?
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Well, first of all, you need to run the person
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through the criteria and see what they fit. But you
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also need to keep an eye out for the differential diagnoses.
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Is the person just a little flighty? Is the person anxious?
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Do they have an anxiety disorder? Are they so depressed
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they can't concentrate? Are they grieving? Have they just had
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a medication change? Are they in withdrawal? Are they in
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post-acute withdrawal? you have to rule out everything else that
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could be responsible for the presentation. So it is kind
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of overused. I mean, one of my litmus tests, you know,
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I'll have the person come in who's been, you know,
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in and out of substance abuse treatment and says, I
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have ADHD. And I asked them a little bit about
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the background and I'm really not finding that. And, you know,
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they go, oh, and you know, I've been prescribed Adderall,
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but they used it as a stimulant. They used it
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as a methamphetamine. You know, one of the biggest litmus
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tests is how do you respond to ADHD medication? Oh,
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I can focus and all the distractions go away and
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I'm like this. Or, oh, I can stay up all
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night and study. It's very different. People with ADHD have
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what they call a paradoxical effect of actually focusing. So
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a lot of times I ask that.
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Okay, so in a clinical sense, but in layman's term,
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tell us how you have diagnosed someone ADD, ADHD. What
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exactly is the criterion for that classic diagnosis in layman's terms?
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So I know whether or not I actually have it.
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Setting aside all of the other things that you said,
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I'm not grieving, I'm not anxious, I'm not nervous. a
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person that you would consider clinically ADD, ADHD. Give us
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an idea of some of the major standout symptoms.
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I'll try to think of all the criteria in the book, but,
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you know, can't sit still, comes unprepared for tasks at school,
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jumps around easily, you know, that type of thing. You know,
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one of the biggest things you want to look at is,
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Are they, how do I say it? Are they, ADHD,
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people with true ADHD can focus on things that they're
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motivated to. It's a disorder of ordering tasks. If they're
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not motivated to do their math homework, it just doesn't
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come up. It's not laziness. It's not avoidance. It just
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doesn't get put in the forefront of the list of
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tasks one needs to accomplish next. So that's what you
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really look at.
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That's very interesting because now that everybody is pretty much
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going back to school, most people in different parts of
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the country have already started school and others, of course,
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here up in the East Coast where we are, or
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at least on the East Coast are going back very,
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very soon. It is something that parents are looking for
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to make sure that their child is learning and processing
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in the right way. So an ADD person also I
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have found from people that I know have come to
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me with that classic diagnosis can start talking about something
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in simple conversation and then extend to so many different
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tangents that they have difficulty coming back to the first thought.
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Is that a trait that you've noticed as well?
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Yeah.
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Yeah, but I mean, again, one thing we'll discuss a
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little bit is You know, are we just quick to label?
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I mean, that could be somebody with a bipolar disorder
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in a manic episode.
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I see. But I'm talking about now clinically ADD or
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ADHD person. So what do you find when people label themselves? OK,
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when somebody turns around and says, oh, you're so ADD, right?
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That happens a lot. I see it a lot. I
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find sometimes that's when people talk about people who are,
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like you said, a little bit more nervous or a
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little anxious or have a lot on their plate.
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Yes.
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Do you find that that's how we misdiagnose ADD?
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Oh yeah, absolutely.
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Okay.
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All right.
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So now is there any difference between ADD and ADHD
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since they put in that, you know, hyperactivity disorder? Is
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there a difference?
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No, you always look for, you know, the less diagnosed
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is the inattentive because they're not hyper and all over
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the place and jumping around.
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I see.
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But, you know, they'll be like answering a math problem
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and be like, oh, look at that chicken, you know.
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Okay. So this also comes with a certain amount of
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impulsivity too, I mean, right? people can be distracted by
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a whole plethora of things that have nothing to do
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with ADD, like they can be exhausted or overwhelmed or
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anxious or depressed. All of those things that would seem
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as if they have those symptoms. So what you're saying
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to us is they should be clinically diagnosed. Okay, so
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now one thing with this specifically, I have many young
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adults coming to me and telling me, that they'd been
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diagnosed as ADD or ADHD at an early age, like
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in elementary, in grade school, and haven't had a diagnosis since.
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What do you suggest to these people?
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Is it impacting their life today?
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Well, that's a very.
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you know are they having is it is it affecting
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work is it affecting relationships you know um just be
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it's over diagnosed you know i mean if someone said
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they were diagnosed adhd at six years old i'd ask
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them what was going on at six years old okay
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okay did they have did grandma die Did a parent die?
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Did they have a trauma? Did anybody look for abuse
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or PTSD? You know, if they were diagnosed in grammar
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school and really haven't had an issue since, is it
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possible for other causes or maybe just you're fine?
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Okay. Is it possible for someone to have ADD or
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ADHD as a diagnosis and then have that diagnosis disappear
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or resolve? Is that possible?
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I don't believe if it's a true diagnosis, you can
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treat it and you can learn skills to counteract it.
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I see. I see. Like addiction, you can put it
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in remission, but it never really works.
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Right.
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Exactly. Correctly. You can address it.
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So that's very interesting.
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Yes. Okay.
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Do you think that current stimulus like our phones and
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the computer and the technology and all the multitasking that
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we do on a regular basis, Can exacerbate ADHD or
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mimic ADHD among students?
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Well, exacerbate, yes. You know, it's just another distraction. So
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you need to be in class. You need to be
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on the phone. You need to be focusing on something.
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Then there's social media. So, you know, that's exacerbation. And
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then people can just be spaced out on their phone.
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I mean, look at texting. And driving, you know.
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Yes, which means another thing, but yes.
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You don't need to be ADHD to be on your
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phone all the time, although it certainly would feed into it.
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Exactly. Okay. So it doesn't mean technology causes ADHD. It
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means that difficulty concentrating has many possible causes, right?
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Yes. That's my big point. All right.
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Now, because this is recovery recharge and we talk a
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lot about addiction, can you talk about how addiction or
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early recovery look like ADHD? How does that manifest itself?
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How could that be confused with ADD or ADHD? Somebody
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that is at early recovery.
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Well, they're gonna be depressed. They're gonna be anxious. They're
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gonna have the initial withdrawal symptoms from the substance. They're
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gonna be experiencing post-acute withdrawal symptoms, you know, syndrome, I
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should say. And, you know, those things look like ADHD. Irritability,
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difficulty concentrating, it's right there.
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You know, anxiety, depression, fatigue. Right, all of the disruptions.
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It's going to make it hard to concentrate.
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Exactly. So you need to take a look at.
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How long the duration of these difficulties are.
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Okay.
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Okay.
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Because I hear a lot of people say, I can't concentrate,
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I'm restless, I'm impulsive, I can't sleep, I'm forgetting everything,
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I must have ADHD. And again, this could be temporary
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in terms of early recovery, right? Because like you said,
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the post-acute withdrawal and all of that, and we have
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to see whether or not these symptoms persist down the road.
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You have to look over time and you have to look, hopefully,
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over periods of abstinence.
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Of course. Okay, so is ADD the kind of disorder
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that happens in early childhood and continues? Or can somebody
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in adolescence or young adulthood or even adulthood develop ADD
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or ADHD? How does that work?
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I believe it's something you're born with if it's true ADHD.
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You know, classically, Classically, the ADHD child is bright. They
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have higher IQ and they're able to compensate for their
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lack of attention through grammar school. And oftentimes what we
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see is in eighth and ninth grade, these bright kids
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that always had all A's start having problems with some subjects.
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And that's when we want to dig into Could this
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be ADHD? So that's usually where it raises its head,
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especially the non-hyperactive inattentive cognitive. I see.
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So we're finding more of these diagnoses prevalent in a
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middle school situation.
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Yes. A lot of times that's where it's first identified.
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I see. Okay. All right. Okay. But you said something
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very telling, which is the theme of this entire thing.
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And in the beginning is, How is this affecting your life?
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Or parents, how is this diagnosis or these behaviors affecting
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the life of your child, right? Is it interfering with
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everyday processes? Is it overtaking them in a way that
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is mood altering, right? All of the things they should
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be looking out for?
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Yes.
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What else should they be looking out for?
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Well, again, the hyperactivity and what's driving that. You know,
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the forgetting to bring things.
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Okay. All of that. And the fact that the concentration
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seems to wane, the focus seems to wane on things.
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Right. And another thing, you know, folks with ADHD tend
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to develop into procrastinators. People procrastinate for a lot of reasons,
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but You know, the child with ADHD kind of learns
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that they don't pay attention, but when the assignment is
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due tomorrow, that causes anxiety and stress, and the anxiety
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and stress then becomes the motivator. Then it's in the
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frontal lobe as, oh, my God, I need to do
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this now. Then they're able to concentrate. So we look
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for that.
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Right. So then they wait, of course, to be under
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the gun, to be under that kind of pressure.
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It's kind of a subconscious way they can become motivated.
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That's very interesting. And on that note, because you said that,
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before we move on to the next disorder that I
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certainly want to talk to you about, if we find
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that that's the case, what's the difference between normal I mean,
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can you sum up just briefly? I know there's a
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lot of criterion, but what's the difference between normal procrastination
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and ADHD procrastination? Do we know?
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I usually, what I do is I usually look for
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other signs of ADHD. If I find them, I'm like, oh,
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I think that's driving the procrastination. I see. Okay. If
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we're not seeing that, I would look in a lot
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of other, is what's causing the anxiety? Is there? performance
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is there a fear of failure is there depression i
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mean it's there's a plethora of things.
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Of things right okay all right so let's move out
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of the add adhd and move into something that we
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also hear a lot about you can hear someone say
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oh my god i'm so ocd as opposed to i'm
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just naturally organized Let's talk about those two things and
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how people can confuse the diagnosis. Tell us what OCD
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is from a clinical point of view and what we
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should be looking at.
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OCD means that there is an obsession, intrusive thoughts that
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you must usually complete a task or avoid the stimuli.
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And the compulsion is the behavior of avoiding.
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Okay. So for somebody.
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Now, again, it's down to... Does it interfere with your functioning?
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Okay. There are some very telling things about OCD that
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are very, very different from normal behavior. And you said
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these things, but I don't want to gloss over them, right?
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Okay.
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The one thing that comes with OCD most prevalently, no
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matter what kind of OCD you have, and if you
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want to talk about those kinds, because there's relational and
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all kinds of other, you know, different OCDs, But the
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one thing that comes across most often, which separates us
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from normal human behavior, are the words intrusive thoughts.
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Yes.
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Okay. So I want you to explain in layman's terms,
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somebody trying to understand someone with OCD, exactly what happens
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in an intrusive thought. Give us an example.
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You don't want to have the thoughts. They're causing anxiety.
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They're causing preoccupation. And to get rid of them, you
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have to perform the behavior. You have to do something.
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Okay.
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So I'm going to leave my office and turn off
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the light. I had the intrusive thought that if I
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don't turn the light switch on and off 50 times,
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I'm going to die. That's kind of what they experience.
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You know, that's what it feels like and the thought is.
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And so they have to do it 50 times.
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Okay. And that is going.
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To impair their functioning.
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Exactly. And just because I'm organized and just because I
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put things in order and I have a clean closet
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or I have a clean workspace or I have a
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clean house. doesn't mean that intrusive thoughts are coming into
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my head where if I don't do these things, something
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catastrophic will happen to me.
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Correct?
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Correct.
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Okay.
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Okay.
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So is intrusive thoughts one of the primary distinguishable diagnosis
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for OCD? Without intrusive thoughts, would we say that we
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don't have OCD?
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Yeah, I would say so. I would agree. Okay.
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Okay. So that's a big thing. So all of you
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that are organized out there and put things away, if
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you're thinking that you have to go back and rearrange
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the shoes five or six or seven or a hundred
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times in order to feel good, that would be OCD.
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But if you just have a clean space or an
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organized space, or don't like to wait until the last
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minute or are structured in your life, then you are
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not OCD. Correct?
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Correct.
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Correct. And it can be mild. I mean, my desk is,
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Everything is at the right angles and perfect. For years,
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I worked with a desk where the client sat in
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front of my desk and I had this one young
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woman that would come in and move things around. And
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I'd be like, you can't do that. It was a
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little bit impairing my functioning. I had to focus on that.
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Okay. All right.
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But it was very mild. Okay. You know, and the
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other piece is people are born with traits. So, like,
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I'm a little OCD, but it never really impairs my functioning.
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I like to line things up and things, and it's
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a little weird. I like to take everything in the refrigerator,
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make sure the labels are facing forward, and my wife
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will go, stop being OCD. I'm like, I like that.
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You know, so if, you know, I always say diagnoses,
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you know, are kind of like a combination of what
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you're born with And then like what temperature you set
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the oven at and where you set the timer. You know,
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let's say I was exposed to a significant trauma as
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a child that, you know, since I have those OCD traits,
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that might be where it manifests.
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That began.
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Right.
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I understand.
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OK.
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All right. And in that line, let's finish this up.
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And I want to go on to the next thing.
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Can perfectionism be mistaken for OCD? Tell us about that.
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Absolutely.
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Tell us how.
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You know, I think a lot of people need to,
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when you say mistaken, like mistaken by a professional? Well, no.
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No, I mean, if I'm self-diagnosed, right? I mean, well,
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certainly maybe not by a professional because there are other
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probing questions, obviously, with all the other current personality disorders.
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But I'm talking about those of us here listening. The
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people that are listening to you are wondering, if I'm
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a perfectionist, do I have OCD? So what do you
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say to these people?
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No, not if it doesn't get in the way of
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your functioning. That's going to be the golden rule here.
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No matter what.
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Right. And, you know, if the person's functioning is impaired,
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you would really need to take a look at, is
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it really the OCD that's impairing?
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OK, OK. So if I'm going to prepare the holiday
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dinner because Thanksgiving is coming and everything has to be
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completely perfect and I have to have all my ducks
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in a row and all the China out and the
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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
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me and everything has to be completely set up in
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a way that is driving me bananas, then that are
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00:23:45.750 --> 00:23:49.190
those are probably direct OCD symptoms, would we say?
389
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Maybe.
390
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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
So absolutely it is in extremes, but yes, sometimes perfectionism
402
00:24:22.880 --> 00:24:28.140
can be, you know, misdiagnosed or you, you can think
403
00:24:28.200 --> 00:24:31.690
that your OCD, if you're so perfect, if you're going back,
404
00:24:31.809 --> 00:24:34.710
like we said, and fixing the pencils on your desk
405
00:24:34.789 --> 00:24:37.119
or making sure that it's right a thousand times or,
406
00:24:37.430 --> 00:24:39.509
going back to see whether or not the oven is
407
00:24:39.569 --> 00:24:42.289
turned on or making sure that the bed is exactly
408
00:24:42.349 --> 00:24:45.390
made perfectly and go back several times to see that
409
00:24:45.599 --> 00:24:48.319
everything in the pillows and the cushions are exactly the
410
00:24:48.359 --> 00:24:49.819
way they need to be, right?
411
00:24:49.920 --> 00:24:50.140
Yes.
412
00:24:50.160 --> 00:24:54.240
So that's when perfectionism is not really perfectionism at all,
413
00:24:54.559 --> 00:24:56.259
but a beginning sign of OCD.
414
00:24:56.519 --> 00:24:58.349
Yeah? You could say that. Okay.
415
00:24:58.440 --> 00:24:59.089
And also.
416
00:25:00.569 --> 00:25:02.990
It's not only a question of needing everything to be perfect.
417
00:25:03.029 --> 00:25:06.819
Like you said, it's if you can tolerate it when
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you are not perfect.
419
00:25:08.339 --> 00:25:13.000
Right. Right. Exactly. Can you move on and prioritize and
420
00:25:13.019 --> 00:25:14.160
get the task done? Right.
421
00:25:14.559 --> 00:25:17.099
Okay. Okay. So you also want to.
422
00:25:17.059 --> 00:25:21.829
Look at, I mean, adult children of alcoholics and, and, uh,
423
00:25:22.289 --> 00:25:25.769
people with substance use disorders can tend to be perfectionists,
424
00:25:27.829 --> 00:25:31.029
you know, um, How so?
425
00:25:31.049 --> 00:25:34.609
I remember a co-worker talking about a client once. He said,
426
00:25:34.650 --> 00:25:38.509
there comes Clem in his alcoholic truck. And it was
427
00:25:38.589 --> 00:25:40.769
early in my career. I'm like, what's an alcoholic truck?
428
00:25:40.829 --> 00:25:43.470
And he's like, it's old. It's got rust on it,
429
00:25:43.630 --> 00:25:47.730
but it's perfect. It doesn't have any dust. It's polished, armor-old.
430
00:25:47.759 --> 00:25:50.640
And I was like, oh. So they put out this
431
00:25:51.759 --> 00:25:55.640
facade of being perfect. And that's what happens in an
432
00:25:55.700 --> 00:25:59.420
alcoholic family system. I see. You're the child of an alcoholic.
433
00:25:59.460 --> 00:26:01.900
So if you're a family hero, which is a whole other,
434
00:26:02.789 --> 00:26:07.589
I won't go in that whole direction, but like being perfect,
435
00:26:09.609 --> 00:26:13.789
being successful can become somewhat obsessive, but the motivator would
436
00:26:13.829 --> 00:26:16.859
be more the having to look at the family system
437
00:26:16.880 --> 00:26:17.660
the person came from.
438
00:26:18.039 --> 00:26:20.519
I understand. Okay. I want to get to the next
439
00:26:20.559 --> 00:26:22.359
thing and we have a very short amount of time,
440
00:26:22.400 --> 00:26:25.710
so I want to encapsulate it. Let's talk about tackling
441
00:26:25.769 --> 00:26:29.769
bipolar disorder, right? She's so bipolar, she was happy this
442
00:26:29.829 --> 00:26:33.750
morning and furious tonight, right? She must be, if she's
443
00:26:33.789 --> 00:26:36.369
not going through her changes or it's not that time
444
00:26:36.410 --> 00:26:38.569
of the month or I don't know what's going on
445
00:26:38.609 --> 00:26:41.880
with them, is that bipolar disorder? Let's break it down
446
00:26:42.039 --> 00:26:44.119
really easy in about 60 seconds.
447
00:26:44.480 --> 00:26:49.079
No, it's not. And it's my pet peeve and probably...
448
00:26:49.390 --> 00:26:53.380
The second, up there with ADHD as far as misdiagnosis
449
00:26:53.420 --> 00:26:58.960
is bipolar. You can have mood swings without having a
450
00:26:58.980 --> 00:27:01.440
bipolar disorder. You can be sad in the morning and
451
00:27:01.480 --> 00:27:02.740
happy in the afternoon.
452
00:27:04.009 --> 00:27:10.470
Okay, so what distinguishes a true bipolar diagnosis? 30 seconds.
453
00:27:12.109 --> 00:27:15.579
Was there a manic episode for regular bipolar? Has there
454
00:27:15.650 --> 00:27:20.640
been depressive episodes? Can you... Is there other ways to
455
00:27:20.700 --> 00:27:23.859
account for the manic episodes? You know, I mean, those
456
00:27:23.900 --> 00:27:27.819
are the big things. You know, manic episodes are dangerous behavior.
457
00:27:27.839 --> 00:27:31.809
You know, my first question is, have you had a
458
00:27:31.849 --> 00:27:34.349
period of not being able to sleep for one to
459
00:27:34.390 --> 00:27:36.549
three days, but you're not tired?
460
00:27:38.109 --> 00:27:42.829
I see. Okay. So it's clinicians thinking that there is
461
00:27:42.930 --> 00:27:47.210
a decreased need for sleep, maybe unusually elevated or irritable mood.
462
00:27:47.720 --> 00:27:53.539
Increased activity, rapid speech, racing thoughts, grandiosity, and risky behavior.
463
00:27:53.660 --> 00:28:01.309
Those things specifically would be bipolar, but having general mood swings, no.
464
00:28:01.549 --> 00:28:04.910
So thank you so much for part one. We have
465
00:28:05.029 --> 00:28:09.109
talked about bipolar. We've talked about OCD. We have talked
466
00:28:09.150 --> 00:28:13.819
about ADD. Do not bandy those terms about unless you
467
00:28:13.839 --> 00:28:18.339
get a clinical diagnosis. Stop calling yourself something you are not.
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00:28:19.279 --> 00:28:21.579
This is the Pushy Broad from the Bronx. Come back
469
00:28:21.660 --> 00:28:25.049
to us for part two. We're going to talk about
470
00:28:25.210 --> 00:28:30.930
other diagnosis that people just confuse for normal behavior. Thank
471
00:28:30.990 --> 00:28:33.329
you so much. And we'll see you next time.
472
00:28:35.460 --> 00:28:41.250
She's the Pushy Broad from the Bronx, New York. Follow
473
00:28:41.269 --> 00:28:44.950
her voice, her straight talk is nice. She's a pushy
474
00:28:44.990 --> 00:28:50.130
broad from the Bronx, oh yeah. Don't be surprised if
475
00:28:50.190 --> 00:28:52.059
you want to listen twice.
476
00:28:52.450 --> 00:28:54.380
Make decisions, find the right choice.
477
00:28:54.539 --> 00:28:56.440
Know yourself better, find your own voice.
478
00:28:56.859 --> 00:28:57.720
It's okay if.
479
00:28:57.680 --> 00:28:59.579
You need help today because everybody.
480
00:28:59.240 --> 00:29:00.180
Needs a little push.
481
00:29:00.279 --> 00:29:03.859
From the pushy broad from the Bronx, New York.
