Posted by mike21 on April 18, 2002, at 18:49:59
In reply to Re: ADD diagnosis... OCD? » mike21, posted by Ritch on April 17, 2002, at 0:03:46
> > I'm glad you pointed out that they were comorbid- it had never occured to me that they could be so closely related, just because they seem at opposite ends of the psychological spectrum. But after obsessing, I mean thinking, about it I've come up with some theories (see above post).
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> (snip from above post....) ....In the same respect, maybe a lack of attention could be due to a lack of positive feedback from certain dopaminergic pleasure centers of the brain. For example, social interactions are too variable to give a predictable reward, and the brain disengages itself. Like you, I find comfort in dealing with things in my own little contained world, like working on the computer. But after awhile, I get so locked in that groove, that getting out and interacting with others is difficult. I also get burned out and depressed- I think my brain just gets too tired from working at the same thing.
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> > From what you say about burning up too much energy on a task, I'd have to say that I do that already. It is more due to perfectionism than anything. Sometimes with a boring task, getting it as perfect as possible gives me a feeling of accomplishment and reward.
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> > I do have a hard time multi-tasking in terms of getting things done in the physical world- I tend to seek out things I am interested in, at the expense of other "boring" things that really *need* to get done.
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> > When you say you burn up too much energy than the task requires, does that mean you become perfectionistic?
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> > Mike
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> Fascinating post up there Mike. I have this awful mix of bipolar, ADHD, social anxiety/perfectionism, mild neuro probs. with mild LD (CAPD/dyslexia), and they are all intertwined together. It is interesting that amongst the symptoms of ADHD, perfectionism and shyness is commonly listed. My pdoc tells me that my social anxiety/perfectionism is the result of abnormally hypercritical parents that I could never please, and I have over-generalized my responses to them to everybody else in my environment-the trick is to understand that most folks are not as *perfectionistic* as my parents and generally don't give my achievements/behaviour that much scrutiny-so why not just chill out? Of course, genetic predispositions are there making it tough for me as it was made tough for my parents.
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> Enough of that-what about the multitasking thing? SSRI's enhance my ability to multitask. Stimulants tend to hinder it. I think the "locked in a groove thing" is a good place to be if you are trying to study-read-listen-comprehend something new. When it bites you in the ass is when you are doing something that you are already very familiar with. When I get hyperfocused on something I am familiar with and I am taking a stimulant..I start seeing a lot of subtle permutations that I didn't seem to be aware of that somehow need to get "worked out". This is usually work-related logical minutiae (sp?), that really requires only a glossy summary at best-and I wind up burning double the time on it that it really warrants.
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> I think where the ADHD and OCD differ is the sense of "reward" that you speak about. With my ADHD problems I never seem to reach the *end* of anything. *Time* doesn't seem to have distinct start/stop points. I don't *feel* any kind of *reward* for *anything* that is task oriented. Everything tends to seem like a work in progress. If you give me too much to work on I freak out because I don't know where/what to start and what to finish first!
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> I think with the OCD there is a "reward" thing like you say that gets released when the "loop" is successful. And reward is related to dopaminergic transmission. I guess it could be possible that in OCD you may be "self-rewarding" yourself for something that doesn't *deserve* a reward: counting all your crayons, i.e.. SO... do you try to snip that circuit in two electro-chemically or find a way to *not* experience the REWARD reinforcement by not *feeling* the sense of reward for something that doesn't deserve that feeling? Sorry, if this is a little improvised.
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> MitchI have the same problem getting caught up in work-related minutia that is pointless. I have to keep asking myself- is this value added? Frequently I find that it's not.
As far as the question of snipping the circuit in two or stopping the feeling of reward from occuring goes... Well, I guess you mean an SSRI would help to keep the circuit from going on indefinitely, and that some sort of dopamine antagonist-type drug would stop the feeling of reward. I don't know.
I think the answer is to tickle the pleasure centers enough so you don't have to look for b.s. ways of getting reward.
My longest trial on an SSRI was 6 months- prozac. My recollection of it was that it didn't help my general dysphoric outlook on life- but it did seem to help my social life. On the other hand, I behaved much more compulsively and in some ways recklessly on that drug. My opinion of the whole thing was that it didn't get to the root of the problem, but made coping easier.
As far as stopping the reward goes, I can't speak from a med standpoint. I don't think I'd want to try naltrexone, an opioid antagonist. Seems like that would maybe take away one's only feeling of pleasure in the world, both OCD and just normal good feeling.
And to me, that's the same idea behind stopping compulsions in favor of exposing oneself to anxiety-provoking situations. It may take away the fear, but for me it doesn't tend to give me any greater enjoyment of that situation. For example, I could talk to people non-stop all day long- I would end up stressed out and would have been acting the whole time.
That's why I believe in some sort of deficient pleasure system, not serotonergic, definitely not norepinephrine. But that's just my theory today. It tends to change a lot lately.
In the meantime, I'm trying not to get wrapped around the axle trying to figure out my situation. Sometimes I get the feeling I'm looking for something that's not there- or at least is not available yet.
Mike
poster:mike21
thread:101846
URL: http://www.dr-bob.org/babble/20020416/msgs/103460.html