How can I overcome compulsive perfectionism with ADHD / OCD?
March 12, 2016 10:24 AM   Subscribe

I have ADHD with a lot of OCD symptoms. I think the ADHD is primary, and the OCD symptoms are my lifelong coping reactions to feeling overwhelmed all the time and making endless mistakes. I'm now on Adderall, and it has illuminated how much the OCD slows me down and burdens me, but at the same time, many of my OCD behaviors are rational. They help me catch my many mistakes (while writing or in life) when my ADHD is at its worst. I need strategies to pull myself out or to help me immediately recognize when I'm spiraling.

I'm 31, and I just found out a few months ago that I have ADHD inattentive type, and I got on Adderall. While on Adderall, I only have one thought at a time, can hold other thoughts in reserve without losing them, my anxiety is way less than it usually is, some of my sensory issues (or OCD ones?) fade away, and I'm able to focus on one task at a time (though I often choose the wrong task instead of my work, because I am still not good at prioritizing.)

Adderall makes it a breeze to complete regular daily tasks that I couldn't do before, but while working on Adderall, my perfectionism seems to intensify. Not on purpose... I work the way I've always worked, but I'm able to focus those bad habits better. I write for a living, and I find myself reading the same sections over and over to perfect them, and it's taking four times what it should to complete each one. I'm often in a "flow" state, though, and I'm unable to sense that I'm taking too long until I stop.

I didn't even realize I did this... but now, for the first time in my life, I finally have a new way to function, and when I'm off the Adderall, I'm able to compare how I think and feel to how I think and feel while on it. I'm able to LEARN and hopefully change, and that's huge. When the Adderall wears off, my obsessive compulsive thought patterns go from minor to raging. I had no idea it was this bad until the Adderall showed me it could be better.

The problem is this--when the Adderall wears off, I ALSO go back to making a lot of mistakes. I've driven up over a curb and hit a building while perfectly sober before I knew I had ADHD, and I've been in another accident, too, so my anxiety while driving is legitimate. In fact, I will only drive if I have Adderall in my system now.

I'm getting used to seeing details on Adderall, and when I tried to make a phone call yesterday before I took it, I just assumed it would take one try. To my dismay, it took me like four tries to type the number in correctly because the card I was looking at had a few phone numbers on it and my eyes skipped around. I'm starting to understand why Math was so hard for me. I understood how to do it, I would just constantly make tons of dumb, simple mistakes and then get horrible anxiety over it.

I have to triple check EVERYTHING it feels like. I often feel and look ditzy, clumsy, and stupid, but I'm not... I've tested "gifted", even with the ADHD. In fact, I think the reason no one ever realized I had this is because in school and work-related areas, I was able to develop these crazy and incredibly time consuming habits in order to compensate for my inability to easily organize my thoughts and see details. One of the things I do is spend HOURS breaking projects down into tiny steps and then organizing them all in order (like with Workflowy). This really helped my productivity last year before I knew I had ADHD, but it's so incredibly time consuming. I spent 6 hours the other day trying to fix my master list because I stopped maintaining it and started just adding things that needed to be done. I STILL haven't been able to make it useful and usable again, even with the Adderall.

(Even now, I'm rereading this several times because my first drafts have historically been out of order and don't flow correctly. Anything I write without Adderall is usually written too fast and almost always needs significant revision. I'm slowing down too much while ON Adderall, and I'm unable to tell if my first draft efforts are significantly better, but I'm unable to fast draft like before. But I love writing, and the final product seems to be objectively decent, even if I'm slow.)

I leave out words and make major typos in e-mails, and I've taken other pills twice because I can forget taking them the second I take them. My OCD isn't irrational. Last night, after my Addy wore off, I spent HOURS reading and reading a really important long e-mail. I didn't feel the hours pass, and I kept changing little things until it was "just right", and I couldn't find errors. I took it too far. Afterward, despite my brain fog, I was able to find a slew of typos in something other writers had already proofread. My intense method of rereading and rereading WORKS. It's just sucking my life away. I've always done this, yet I had no idea how much time I was wasting before the Adderall gave me perspective and the ability to stop and notice time passing.

This perfectionist stuff is a burden while on Adderall, and I'm just becoming a better perfectionist instead of becoming free to work FASTER. Unfortunately, It seems I still need the OCD stuff while off Adderall, and to make matters worse, I have obsessive negative thought spirals to match it.

I never knew why I couldn't fall asleep, but I get it now. My ADHD brain "loops". It will go over the same thoughts again and again, jumping from topic to topic then back, because I can't hold the thoughts together long enough to reach a solution without looping. If I get anxious about irrational fears or about bad things possibly happening that I can't control, my brain also loops, putting me into the classic OCD / Anxiety mental state, where I'm desperately seeking an answer to alleviate my anxiety. I just can't quit.

I'll stay up late looping, or I'll waste a whole day looping, reading everything I can, researching TOO deeply for answers, just generally feeling like I'm wasting my life. At the moment, my only option is probably to try to force myself to go to bed at 9, and be hypervigilant about what it feels like when the meds start to wear off.

But how can I recognize when I'm falling into the old habit of triple checking WHILE on Adderall and stop it because it's no longer needed? How can I start to gain a sense of "it's done" and "it's right" or "it's good enough" WHILE on Adderall, yet maintain my extra caution when I'm off of it so I don't burn down my house or forget something vital?

I might need to ask this on an ADD forum, but maybe someone on here struggles with these things, too, and has some ideas about how to alleviate some of these symptoms, especially while on Adderall. I probably need some mental techniques to break the spiral and feel "okay" to move on. I would happily talk to a therapist, but there's a two-month wait atm... and can someone without these executive functioning problems ever really understand what it's like to experience the world this way?

Also: I have some other things I am addressing like hypothyroidism / anemia that I am certain have impaired my brain even further. I expect some of my ADHD symptoms / brain fog to greatly improve as I get those fixed, but I've had these OCD coping mechanisms since I was a child because I have ADHD... it's just way more severe now than before because of the other health issues.
posted by chaos_theory to Health & Fitness (9 answers total) 22 users marked this as a favorite
Congrats on getting diagnosed and seeing the changes medication can make! Obviously not all the problems of adapting to ADHD can be addressed by a diagnosis and prescription, though. Working with a therapist usually goes hand in hand with medication treatment. Can your prescriber recommend someone who works with adult ADHD patients? This stuff is totally doable but it's also a thing that would be a lot easier to tackle with the help of a pro. It sounds like you've already got a lot going on, so why discover independently what someone teaches for their day job?
posted by Lou Stuells at 10:42 AM on March 12, 2016 [1 favorite]

Response by poster: Yes, I'd really like to get the help of a therapist. I had one before who helped me for a year with my binge eating (a desperate bid for dopamine, I now realize) but she didn't notice the ADHD at all.

I went to a therapist last year for one session, and at some point, I said I believed in homeschooling because school was such an awful experience for me. I feel like I triggered her into being defensive or something? She spent the rest of the appointment trying to make me see that school could be very good for many people, and to try to make me see how I was displaying black and white thinking. It was awful, and the more she tried to convince me that my opinion was invalid, the more I dug my heels in. I would think the better response on a first visit would have been to say... "Interesting. Why do you think school was so difficult for you?" Then MAYBE we could have discovered together that the things I struggle with aren't things other people struggle with. I always thought people experienced what I did, and that they just tried harder than me or had better skills.

But I digress. :) I'm on a two-month wait list right now for the closest therapist that isn't that last lady, but I'm googling around right now trying to find others who say they have experience treating ADHD / OCD. The pickings are slim unless I want to drive 1.5-2 hours round trip. (And I don't because I feel anxious driving heh.)
posted by chaos_theory at 11:39 AM on March 12, 2016

Find some tools to help you check your writing. There are multiple tools online that will run grammar checks and flag possible typos, etc. Find one you like. Use it consistently.

Look online for resources for "twice exceptional" people. Hoagies Gifted Page probably still has a section listing such things. That should get you jump started.

Over the years, I have seen studies on research into supplements and various brain issues. B vitamins and magnesium may be helpful to you.

Work on your sleep hygiene. I do the reading and rereading thing when I am exhausted. So, if you find a way to get better quality sleep more consistently, you may see that reduce some. There are lots of ways to work on that. AskMe has had many past questions about sleep problems. So, searching here may help you find answers.

Also, have some patience. It will take a bit of time to transition to new habits after doing this for years. It will take time to find things that work for you in the context of your new reality, and to develop confidence in them. Some of these behaviors are likely to dwindle on their own once you establish solid processes that work for you and that you feel confident in.

When in doubt, I still pull out tried and true methods so I won't shoot myself in the foot. But, when I am confident, I don't cling to those methods. I still sometimes have crappy days where I just need to double and triple check things, but I no longer do it habitually like a mental tick.

The other thing that is going on for you currently: You are having to mentally digest this big life change. After you wrap your head around it, things will get better.
posted by Michele in California at 12:19 PM on March 12, 2016 [2 favorites]

I'd say welcome to the club, but that would make it sound like fun, which it isn't. I developed some OC tendencies to cope with my ADHD too. The longer I've been on Adderall and have learned to trust in my relative competence, the OCness has receded a bit, but it is still there. It is worse when I'm anxious. Even when I've taken meds, I still need the systems I've set up, but I can relax and do what needs to be done knowing it will work the way it should. Basically, it takes some time to adapt. Longer than you'd think.

In my early days of being medicated, I took a small dose of Adderall before bed so that my brain would shut up. Adderall still sometimes makes me sleepy, because it allows me to relax. I never knew that it wasn't normal to have a brain that won't shut the hell up. My best friend and I had a revelatory conversation about it one night on a road trip. I can't sleep without an audiobook playing to keep my brain just a little engaged.

It takes me forever to write anything, though I've gotten better since I stopped taking antihistamines. To be fair, I've never been a fast writer because I edit as I go. This is too deeply ingrained, so I just accept it. This answer will probably take me an hour or more to write. I'm always prone to hyperfocus when doing detail oriented tasks, meds or not. It helps to have familiar tv shows playing in the background so that I am not completely oblivious to the passing of time. Nothing else works, though I've worked hard to develop a habit of looking at clocks.

I won't drive without Adderall either, because the effort it takes to manage all of the stimuli is exhausting and it hurts. See also: shopping, gatherings, appointments... At least now I can look at people when conversing. On my bad days, I still can't look at people when I talk to them but I can form decent sentences, so still an improvement.

Treating other non-mental stuff hasn't helped the ADHD much for me, but managing my diet a bit has. Also, taking magnesium glycinate and vit D because I was horribly deficient and can't get enough by real food means (can't go out in the sun either).

I have morning and night week-size pill thingies. I'd never remember to take anything if I didn't. Can't remember to take the Adderall without the Adderall. Sigh.

Seriously, I've been taking Adderall for a decade (a few side trips on Ritalin notwithstanding). A lot of things have gotten easier, but it is constant work and steps forward and backward and radical acceptance and forgiveness. No commas because it is all happening all at the same time. A bunch of the philosophical stuff I'd worked out on my own has been made more systematic and generally expressable in Dialectacal Behaviour Therapy. This is the book my psych person (nurse practitioner, I don't get on well with psychiatrists and therapists) uses as a basic manual. It can be helpful to have a systematic way of looking at and thinking about something. It can also give you a common vocabulary so as to have meaningful dialogue with another person (therapist). Regular CBT and group therapies have been useless for me, because my problems aren't with my thoughts and beliefs but with my physical brain. I can learn to cope, and I can change how I plan and react, but I can't change the ADHD. My issues don't come from weird ideas and traumatic experiences, it is just how I'm freaking wired! Acceptance!

Sorry for the brain dump. I was recently off of Adderall for about 6 weeks (unrelated physical illness that required heavy pain meds, so no point in taking Adderall) and going back on has caused some sleep problems. I have an important get together tomorrow (able to leave house and participate yay!) (Very Special vintage sewing machine meetup featuring a community rockstar from out of state!) and didn't take the usual long acting Adderall this morning so that I'd sleep better tonight, but after seeing your question did take some short acting so that I could respond, unfortunately it doesn't work as well since I took it later than usual and forgot to have breakfast because I can't brain today. (I made that sentence extra special, just for you!)

Ok then. PM me if you ever want to talk or anything, even just to complain. I know how it feels, and I'm here if you need someone.
posted by monopas at 12:34 PM on March 12, 2016 [3 favorites]

I am going to congratulate you (on joining our club) anyway, because ADHD has as many benefits worthy of celebrating as it has detriments. We ADHDers are quite good with creative thought, for one. And our stimulation-seeking behavior can even make us very passionate participants in our friendships and romantic relationships, because we are stimulated by the anticipation of putting together a great party or getaway for someone we love. These are just examples; it varies but there are all types of things worth celebrating about who you are. You are not defined by your ADHD, but it is a part of you. I think we often forget that ADHD has a good side; and that we should nurture it as much as manage it.

ADHD self-management, especially when comorbid with anxiety and/or OCD, is a lifelong journey of self discovery.

There will be hours, days, weeks, sometimes months where you feel like you've "got it under control." Everything is great. Look at how much you're getting done!

Then there will be those hours, days, weeks, sometimes months where it feels like you still have no idea how to function. You will beat yourself up for not being able to do simple tasks; you will hate yourself because you could function on your stimulant medication earlier but now you're in "loop" mode; you will wonder what you did wrong.

This is okay. This is expected. Forgive yourself - for being human. And then remember that you haven't done anything wrong.

My story, in a nutshell: I went for treatment of depression, my therapist identified my ADHD symptoms quickly, I was resistant at first, then I did a lot of personal research (including reading Sari Solden's Women with Attention Deficit Disorder: Embrace Your Differences and Transform Your Life which made me internally shriek "Oh gosh, that's me!" after every paragraph) and accepted that this was my diagnosis; that I only wish I had known I had ADHD sooner. And my therapist and I spent two years working - without medication - strictly on building executive functioning skills and adapting my life to make it easier to manage.

After two years I went for medication. It really helped that I had two years of therapy under my belt; I tried Adderall first and didn't care for it (the extended release type, anyway), and then my psych introduced me to Vyvanse.

As with all medications, "YMMV", but if your doctor feels it's right for you and you have the insurance coverage (it's brand-only; there is no generic), I strongly recommend it for a trial period. It is the closest I have ever come to feeling neurotypical. Its effects last me at least 8 hours; and then if I need a small dosage of "booster" immediate-release Adderall in the evening so that I can complete basic home tasks like laundry, dishes, paying bills, etc, it's available to me. (And I usually do need it because my job is mentally grueling, and would wipe out even a neurotypical person by the day's end).

It will likely take a few years of tweaking your medication, as well as your executive functioning skills, to reach a place where you're relatively satisfied. Even then, you may fall off the wagon. Again, I can't emphasize enough how totally OK this is. You didn't choose to have ADHD; folks with autoimmune disorders didn't choose to have autoimmune disorders; we all work with what we have.

Two comments I've left in the past, which I'll link to rather than trying to retread: How to deal with ADHD and perfectionism, Staying Focused (especially when you get bored)

You aren't alone. My brain loops, too. I leave random words out of sentences when writing emails; I understand math concepts but would screw up tests in school all the time because I'd make those little "dumb" mistakes; dear god, it is okay. Someone very wise (apparently not Albert Einstein as once believed, but I don't think it matters) once said, "Everybody is a Genius. But If You Judge a Fish by Its Ability to Climb a Tree, It Will Live Its Whole Life Believing that It is Stupid."
posted by nightrecordings at 1:10 PM on March 12, 2016 [10 favorites]

When I started taking Adderall, I was in ninth grade. We started with a low dosage and gradually increased it until one day everything just clicked the way the doctor said it would. It was like having an extra pair of arms that just sat limp for the first 14 years of my life, and then all of a sudden I can use them to gesture and lift stuff and whatever.

But, like you, at first I had no idea what to do with my newfound power. I remember sitting in English class, and rather than pay attention to the lesson, I would make detailed to-do lists and obsess over my penmanship. If I made a mistake I'd rip out the page and start over. It was ridiculous.

In my case, all it took was time to get used to it. I was preoccupied with penmanship and organizational skills because they were the sort of things that I could never do before — but eventually I realized that the things I was meant to pay attention to were way more interesting than the things I was obsessing over. There are still times when I enjoy owning a label-maker just a little too much, but that's not a horrible problem to have.

If you've described it accurately, your ADHD seems more severe than mine, so I'm not saying that's all it will take, but remember that your relationship with Adderall will change as you arrive at a good dosage and get more familiar with how your brain works.
posted by savetheclocktower at 4:28 PM on March 12, 2016 [3 favorites]

I'm not clear whether you've been diagnosed with OCD or are just using the term to mean extreme perfectionism (which can be caused by many things other than OCD, and is often not seen in people with OCD anyway). If your perfectionism is indeed caused by OCD (do you have compulsions, intrusive thoughts, things you have to do to prevent unrelated horrible outcomes, etc?) there are well-defined OCD treatment strategies that can help get it under control. Otherwise, the problem is a lot more vague. Do you have a psychiatrist? Talk to whoever prescribed you Adderall a few months ago, and see if they have any suggestions. Any ADHD specialist should have some knowledge about it, because perfectionism is very common with ADHD.

I don't have OCD, but I have ADHD and the exact same perfectionism issues you describe, which turned from an everyday annoyance to a HUGE problem while I was writing my thesis. I've always had a big perfectionist streak (anxiety-based, I'm pretty sure) but adderall just puts it on hyperdrive while it spins in circles, "correcting" itself over and over. I haven't managed to fix it exactly, but by putting some very strict weekly external accountability measures in place, completely removing my ability to access certain distractions (taking willpower out of the equation), being VERY strict about sleep, and very carefully breaking down/planning/tracking progress, I was finally able to make progress and eventually finish my thesis. The process just about killed me though, and I have no idea how to do it sustainably. Everything ends up being a crazy amount of work compared to what it feels like it "should be", because it has to be revised so many times.

I don't want to admit how long this comment took me to write.
posted by randomnity at 3:14 PM on March 14, 2016 [2 favorites]

Seeing as my comment has taken me even longer to write than randomnity's, with far less information (oh god, I'm doing that thing again where I lampshade my flaws) I'd like to take the opportunity to make this counterintuitive suggestion: meditation.

Meditation didn't stop at making me 10% happier like that famous book title. As far as my struggle with ADHD and perfectionism goes, it can single-handedly save a day that might have fallen to ruin only a couple of years ago by allowing me to relax enough to remember important details, as well as find my glasses despite them being six inches over from where I normally put them! (This normally makes them completely invisible, as I'm sure you're aware.) In fact, meditation is the most helpful thing I've ever done for my attention issues, and the one single thing I've started doing (and stopped and restarted etc) that's helped me understand the meta-task of actually paying attention to your attention.

Five minutes a day to start. I can't afford the time it takes not to meditate.
posted by saveyoursanity at 4:12 PM on March 14, 2016 [3 favorites]

Response by poster: Thanks for all the great answers! I've come back several times to read them (gee, rereading, how surprising).

I have set up an appointment with a therapist who has experience counseling people with ADHD.

I'm also slowly becoming more and more aware of my old habits. Every time my Adderall wears off, I find myself jumping from task to task randomly, following research down Google rabbit holes, or just sitting in bed unable to make myself get back up to take my next dose. I'm actually becoming AWARE, though, that I'm acting mentally disorganized. I wasn't really aware before because I had nothing better to compare my natural state to.

My generic meds seem to vary in potency or not work the same from day to day, but hopefully I can get a handle on that. I need them to work consistently so I can learn to function on them. I've trusted them this month on days where they were hardly working for me, and then it's night, and I've done almost nothing, and I have no idea what happened. But it could also be what was mentioned above... focusing on the wrong things and not knowing yet how to focus my new attention on the right things and keep myself on task. I know I need timers, and I need my Workflowy to be 100% up to date, but I *forget* how important that is. (Of course!) Pinning up reminder notes around my office is my next task.

I'm trying to just accept that I'm slower than other people at getting things done. So what? I liked that list of positive ADHD traits. Big picture thinking, seeing patterns, thinking outside the box, hyperfocus... these have all helped me before and will continue to be useful. Still, I'm slow, and at times I doubt my strengths. I'm terrible at letting my brain do its thing if I'm being timed or if I'm not deeply interested in something.

But it's nice to be endlessly optimistic that things will get better. I have this attitude because I literally forget what I tried before, and I can't remember how much it sucked. So. +1 for that, as long as I learn to start taking notes while experimenting with new productivity techniques and then remember to check my notes so I don't forget what I learn lol.
posted by chaos_theory at 5:34 PM on March 25, 2016 [2 favorites]

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