Julie Legg interviews Cali Keating, a neurodivergent therapist based in Barcelona who specialises in supporting clients with the triple combo: ADHD, OCD and autism, and various dual combinations thereof. 

Cali explains how OCD, like ADHD, is tied to dopamine and cortisol regulation and how these overlapping neurodivergences can complicate diagnosis and treatment.

The core of the conversation revolves around multiple neurodivergent diagnoses, commonly referred to as "multiple exceptionalities" or "twice exceptional" when someone has more than one neurodivergent condition. Cali dives into the mechanisms and nuances of OCD, especially "Pure OCD" (also known as "Pure O"), which involves intense mental rituals rather than visible compulsions.

KEY TAKEAWAYS

• OCD affects both dopamine and cortisol regulation, making it not just an anxiety disorder but also a neurological one. The compulsions aren’t just habits, they’re urgent attempts to neutralize biochemical distress caused by intrusive thoughts.
• Characterised by intrusive thoughts and compulsions used to neutralize distress, OCD is commonly misunderstood. It’s not just about neatness or repetitive behaviours—it’s a neurological survival response, often invisible and deeply distressing.
• “Pure OCD” involves mental rituals rather than visible actions—this includes rumination, mental checking, or seeking constant reassurance. These hidden compulsions often go unnoticed, delaying diagnosis and understanding.
• Traits across ADHD, OCD, and autism can appear similar—such as hyperfocus, rigidity, or sensory sensitivity—but the motivations behind those traits differ. For example, hyperfocus in ADHD might stem from dopamine-seeking, while in OCD it may be driven by an obsessive need for certainty.
• Misinterpreting those motivations can lead to support plans that miss the mark. Treating the behaviour without understanding its function (e.g. assuming rigidity is just autism-related when it may stem from OCD) can result in strategies that feel invalidating or even increase distress.
• ADHD often coexists with OCD and autism, making accurate diagnosis more complex—but also more essential. Overlapping symptoms can cloud clinical clarity unless assessed through a neurodivergence-informed lens.
• Stigma and stereotypes often delay diagnosis, particularly for women or quieter individuals. Misconceptions about what OCD or ADHD “look like” can lead to missed or misdiagnoses, sometimes for decades.

LINKS

Cali Keating - Website

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• Julie Legg is the author of The Missing Piece: A Woman's Guide to Understanding, Diagnosing and Living with ADHD