OCD, Neurodivergent Clusters, and Superpowers

According to the National Institutes of Health, neurodiversity is “the idea that people experience and interact with the world around them in many ways, with no one ‘right’ way of thinking, learning, and behaving, and differences are not deficits.” Australian sociologist Judy Singer first introduced the term in the 1990s to champion inclusion and equality for people who experienced the world in different ways. Researchers estimate the total number of neurodiverse people around the world is about 15 to 20% of all individuals. Neurodivergence has often been associated with Autism but can apply to a range of conditions including neurodevelopmental disorders, like attention deficit hyperactivity disorder (ADHD), and to genetic conditions, like Down syndrome. Someone might experience more than one of these neurodivergent conditions as well as mental health conditions, such as anxiety, depression, or obsessive compulsive disorder (OCD).

New research suggests that disparate conditions that fall under the neurodivergent category, such as ADHD, autism, and OCD may have the same underlying cause: a delay in “pruning”, a process in which unneeded connections between brain cells disappear. This finding comes from one of the largest brain-scanning studies done in adolescents and has been confirmed in several other data sets, including people of other ages. “We’ve been able to show that these different [conditions] are all related to a single underlying neurobiological factor,” says Barbara Sahakian at the University of Cambridge. The results lend weight to a controversial recent idea in neuroscience that many disparate conditions share a common cause – a concept known as the p factor. Many people have more than one such condition or may be diagnosed with different conditions at different times in their lives, as well as DNA studies finding that the same set of gene variants predispose people to multiple conditions. Sahakian and her colleagues are proposing a neurobiological basis for the p factor, which they call the “neuropsychopathological (NP) factor”.

Based on this new research as well as my clinical experience with OCD I have begun to refer to neurodivergent “clusters.” Most of the clients I treat have one or more of the following conditions: ADHD, an autism spectrum disorder (ASD), dyslexia, synesthesia, or another mental health condition. Recent research suggests that about 11.8% of people with OCD also have ADHD, with a higher rate of 25.5% in pediatric OCD patients. Having both disorders from a young age is linked to more severe OCD symptoms and longer-lasting issues. In addition, many people with ASD exhibit repetitive behaviors and intense interests, which can sometimes overlap with OCD symptoms. One study of over 3.3 million people tracked for nearly two decades found that people with OCD had a 13 times higher chance of also having ASD compared to those without OCD. There is also a strong overlap between the kinds of conditions. A 2021 study found that 69% of people with OCD have a co-occurring condition, with mood and anxiety disorders among the most common in adolescents and adults. Folks with OCD may themselves neurodivergent if they consider their experiences with OCD as legitimate variations in brain functioning or if they think OCD significantly impacts various aspects of their life. Folks with OCD may also consider themselves to be neurodivergent if they also have one or more of the conditions referenced above.

For a very long time the prevailing belief was that OCD was associated with above-average intelligence. This belief was originally propagated by Sigmund Freud 115 years ago but was never tested empirically, and like many of his theories has now been entirely or at least partially debunked. Recently researchers collected all the available data ever published in the scientific literature regarding IQ in OCD versus control samples and conducted a meta-analysis. Their results show that OCD is not associated with higher IQ than average. In fact, they found a slightly lowered IQ in OCD compared to controls, although IQ scores for OCD samples were in the average range. Though I don’t agree with Freud on many things I will say that in my clinical experience my clients with OCD have tended to have above average intelligence and have been high performers in school and in their professional lives. This trend also applies to my clients with neurodivergent clusters including ASD and ADHD. Research does indicate that neurodivergent individuals such as individuals with ADHD do tend to underperform on standardized tests. This may also apply to OCD and standardized tests and could explain the below average performance on these tests.

In my clinical experience I have found that individuals included in the neurodivergent cluster have been likely to have remarkable intelligence, creativity, and skills. These qualities appear to be impacted by underlying neurodivergent characteristics. New research is increasingly supporting the idea that neurodiversity is correlated with certain types of intelligence, skills, and creativity . I believe that the delays or difference in “pruning” mean that neurodivergent individuals may have an overabundance of neural connections, and though these connections can be chaotic and cause impairments or literal disorder when it comes to certain functions, there are other functions that are amplified.  This could be why so many neurodivergent individuals are known for thinking “outside the box” but also why so many of them excel in unique ways. I by no means mean to dismiss the real problems and consequences of disorders like OCD, ADHD, and autism. These disorders are highly treatable and when treated effectively greatly improve the quality of life for most individuals receiving evidence-based treatment like cognitive behavioral therapy or exposure and response prevention. Effective treatment will not reduce intelligence, creativity, or impact skills and talents. In my experience when I can help people control thinking and behaviors that impair functioning and cause distress then individuals have greater access to the connections that lead to intelligence and creativity. These connections become even stronger over time with learning and practice.

Disorders like OCD and ADHD rob individuals of the ability to focus on the things they want to do and need to do, and when these disorders are effectively treated individuals can free-up mental space to focus on what they really want to do. I tell my clients that my job is to help them learn to use their “superpowers” for “good” and not for “evil.” I believe this is accurate because most of the clients I treat really do have amazing abilities, but the disorders divert, distort, or even trap these abilities. I think this is tragic, and this is what I mean by “evil.” When I can help my clients learn to change their thinking and behaviors so their thoughts and behaviors are not driven by fear, then my clients can better control their focus and attention, and engage in play or creativity, and do the work they need to. This is the goal of treatment and what I mean by “good.” My neurodivergent clients almost always get this introductory joke and their parents do too, because they know they have “superpowers” and they have just been looking for validation and the right help to use those powers for “good.”