Dopamine + Doubt: Untangling ADHD and OCD

Rachel Keefe, LCSW
  • 5.0 (11)
  • Mental Health
  • Updated Weekly

Dopamine and Doubt is a podcast about the overlap between ADHD and OCD—and what happens when it’s hard to tell which one is driving the behavior. Hosted by therapist Rachel Keefe, LCSW, the show explores ADHD and OCD symptoms including executive functioning difficulties, hyperfixation, reassurance seeking, intrusive thoughts, rumination, checking, avoidance, time blindness, and uncertainty. Each short episode breaks down confusing or relatable experiences in plain language, with real-life examples and practical strategies. You’ll learn how ADHD and OCD can look similar, where they differ, and how to respond when your brain gets stuck trying to figure everything out. Because the goal isn’t always to find the perfect answer. Sometimes, it’s learning to live with a little more uncertainty—and a little less doubt.

  1. 4d ago

    Driven to Do: ADHD, OCD, and Over-Functioning in Relationships

    You can remember every appointment, anticipate every need, and still feel like you are failing as a partner. That is the exhausting paradox I dig into here, especially for people living at the intersection of ADHD and OCD. I am Rachel, a licensed clinical social worker, and I walk through how ADHD shame can quietly push us into compensating, while OCD piles on hyper-responsibility and turns normal relationship uncertainty into a problem that must be solved right now. I talk about the way relationship overfunctioning can look like love and care on the surface, while functioning like an anxiety ritual underneath. I break down the overlap with relationship OCD (ROCD), including doubt, reassurance seeking, and the temptation to manage your partnership into certainty. Spoiler: you cannot manage a relationship so perfectly that you never have to feel uncertain. I also name the cognitive load that comes with living three steps ahead, and how couples can get stuck in an overfunctioner underfunctioner loop where both partners feel justified and neither feels truly seen. I share a vulnerable real-life example from my own marriage, where OCD urgency and a “fix it now” nervous system created a closed-case presentation instead of collaboration. Then I offer a practical weekly experiment: pick one non-urgent thing your partner did not ask you to manage, do not fix it immediately, and notice what your brain predicts will happen. If you want more grounded tools for neurodivergent relationships, ADHD coping skills, and OCD recovery support, subscribe, share this with someone who carries too much, and leave a review so more people can find the show. Send us Fan Mail Support the show 🌟 🌟Support the show and get episodes 5 days earlier 🌟 🌟        https://www.buzzsprout.com/2629683/support↗️ Visit the website: https://www.dopamine-and-doubt.com Follow on Instagram: @Dopamineanddoubtpodcast  https://www.instagram.com/dopamineanddoubt/ Email: dopamineanddoubtpod@gmail.com Love the show? Please leave a review on Apple Podcasts or Spotify-it helps listeners find the show! Resources from episodes: https://linktr.ee/dopamineanddoubt

  2. Trailer

    Coming Up Next Week: Driven to Do: ADHD, OCD, and Over-Functioning in Relationships

    Unlock the full episode right now ➡️ https://www.buzzsprout.com/2629683/support↗️ Want a sneak peek at next week's conversation? You're listening to a quick preview of what's coming up on Dopamine and Doubt. If you are a subscriber, the full, unedited version of this episode is already waiting for you in your private feed! If you aren't a subscriber yet, you can wait until this drops for free next Tuesday—OR you can click the link above to unlock it right now and listen five days early. What I dive into in this episode:. You can remember every appointment, anticipate every need, and still feel like you are failing as a partner. That is the exhausting paradox I dig into here, especially for people living at the intersection of ADHD and OCD. I talk about the way relationship overfunctioning can look like love and care on the surface, while functioning like an anxiety ritual underneathEnjoying the show?  Leave us a review on Apple Podcasts or Spotify, and share this preview with a friend who needs a little dopamine boost today! Send us Fan Mail Support the show 🌟 🌟Support the show and get episodes 5 days earlier 🌟 🌟        https://www.buzzsprout.com/2629683/support↗️ Visit the website: https://www.dopamine-and-doubt.com Follow on Instagram: @Dopamineanddoubtpodcast  https://www.instagram.com/dopamineanddoubt/ Email: dopamineanddoubtpod@gmail.com Love the show? Please leave a review on Apple Podcasts or Spotify-it helps listeners find the show! Resources from episodes: https://linktr.ee/dopamineanddoubt

  3. Oct 6

    The Perfectionism Emphasis Framework for ADHD and OCD

    If your day collapses under the weight of “doing it right,” you are not broken, you are overspending. I talk about how perfectionism can look less like polished results and more like treating every single task as if it deserves your absolute best effort, until your time, attention, and executive function run out. When that happens, important things do not get done, not because you do not care, but because you already spent everything you had. I walk through Dr. Gregory Chasson’s dysfunctional emphasis framework for perfectionism: Emphasis A (110% and truly values-based), Emphasis B (good enough and done), and Emphasis C (not worth your limited resources). The nuance matters. C is not inherently bad when it is chosen intentionally through delegating, outsourcing, or simplifying. The real trap is perfectionism-driven C, where you avoid tasks because A swallowed your day and left nothing behind. Then I connect the dots to the ADHD and OCD overlap. ADHD can make task initiation costly, while OCD can make starting feel dangerous if you might not do it “correctly.” That combo fuels a loop of anxiety, procrastination, and even more pressure to be perfect. We close with a concrete reframe you can use today: stop asking “How perfectly can I do this?” and start asking “How important is this?” If you want more tools for ADHD, OCD, perfectionism, and executive dysfunction, subscribe and support the show, share this with a friend who needs permission to choose B, and leave a review so more listeners can find the show. Send us Fan Mail Support the show 🌟 🌟Support the show and get episodes 5 days earlier 🌟 🌟        https://www.buzzsprout.com/2629683/support↗️ Visit the website: https://www.dopamine-and-doubt.com Follow on Instagram: @Dopamineanddoubtpodcast  https://www.instagram.com/dopamineanddoubt/ Email: dopamineanddoubtpod@gmail.com Love the show? Please leave a review on Apple Podcasts or Spotify-it helps listeners find the show! Resources from episodes: https://linktr.ee/dopamineanddoubt

  4. Sep 29

    The Intersection of ADHD, OCD, and Perfectionism and Good Enough

    Perfectionism doesn’t always look like excellence. Sometimes it looks like a blank document you avoid for three weeks, a project you restart ten times, or an email you reread until you’re too drained to hit send. I’m Rachel, a licensed clinical social worker specializing in ADHD and OCD, and I’m digging into a question that changes everything: when you’re stuck, is ADHD or OCD in the driver’s seat?   I'll walk through a real client story from the online content world, where OCD perfectionism turns into an exhausting loop of checking, rewriting, researching, reassurance seeking, and mental reviewing. That cycle isn’t about “doing your best” so much as trying to reach certainty that you didn’t make a mistake and won’t get attacked or misunderstood. I explain how Exposure and Response Prevention (ERP) and a fear hierarchy help you practice creating and sharing without feeding compulsions, so you can move forward even with uncertainty. Then we shift to ADHD perfectionism, where the struggle often lives in executive dysfunction, task initiation, time blindness, and the huge gap between a clear vision and unclear steps. I'll talk concrete, ADHD-friendly strategies like breaking work into smaller steps, externalizing the process, using body doubling and deadlines, lowering activation energy, and building breaks that interrupt hyperfocus. Along the way, I'll compare ADHD vs OCD patterns side by side, so you can spot whether you’re trying to execute a plan or trying to eliminate discomfort and doubt. I'll close with a practical definition of “good enough,” including a B-minus practice, plus an ACT choice point tool to help you choose actions that move you toward the life you want instead of away from anxiety. If this resonates, follow the show, share the episode with someone who’s stuck in a perfectionism loop, and leave a review so more ADHD and OCD brains can find us.  Send us Fan Mail Support the show 🌟 🌟Support the show and get episodes 5 days earlier 🌟 🌟        https://www.buzzsprout.com/2629683/support↗️ Visit the website: https://www.dopamine-and-doubt.com Follow on Instagram: @Dopamineanddoubtpodcast  https://www.instagram.com/dopamineanddoubt/ Email: dopamineanddoubtpod@gmail.com Love the show? Please leave a review on Apple Podcasts or Spotify-it helps listeners find the show! Resources from episodes: https://linktr.ee/dopamineanddoubt

  5. Sep 22

    The Invisible Mental Labor Of ADHD And OCD In Socializing

    Socializing shouldn’t feel like you just worked a double shift and yet for a lot of us with ADHD and OCD, that’s exactly what it feels like. You might get through a perfectly normal conversation, then walk away mentally fried from tracking every reaction, editing every sentence, and planning what to apologize for later. I’m Rachel, a licensed clinical social worker specializing in ADHD and OCD, and I’m naming the hidden reason so many “fine” hangouts feel unbearable: our brains quietly assign us extra jobs. I break down four roles that show up during and after social time: the conversation editor (constant self-editing and masking), the emotional thermostat (feeling responsible for the vibe of the room), the conversation historian (replaying the night like a crime scene), and the scorekeeper (grading yourself against an impossible moving target). I also talk about how OCD thrives on uncertainty, how one split-second facial expression can get weaponized, and why it can be hard to tell where masking ends and compulsive self-monitoring begins. You’ll hear a real example of making a genuine social mistake, apologizing once, and resisting the pull to keep replaying and reassurance-seeking just to make the discomfort go away. The takeaway isn’t “be perfect at socializing.” It’s learning to notice which job you’re doing, separate awareness from responsibility, and start resigning from roles you never agreed to in the first place. If this resonates, subscribe, share the episode with a friend who overthinks every interaction, and leave a review so more people can find it. Which invisible job does your brain default to most? Send us Fan Mail Support the show 🌟 🌟Support the show and get episodes 5 days earlier 🌟 🌟        https://www.buzzsprout.com/2629683/support↗️ Visit the website: https://www.dopamine-and-doubt.com Follow on Instagram: @Dopamineanddoubtpodcast  https://www.instagram.com/dopamineanddoubt/ Email: dopamineanddoubtpod@gmail.com Love the show? Please leave a review on Apple Podcasts or Spotify-it helps listeners find the show! Resources from episodes: https://linktr.ee/dopamineanddoubt

  6. Sep 15

    GAD vs. OCD: What Is the Difference and How to Tell Them Apart

    Your brain can be terrified about something real and still be stuck in an OCD loop. That single idea changes how you respond to anxiety, how you seek help, and how you stop getting pulled into loops that feel impossible to exit. I’m Rachel, a licensed clinical social worker specializing in ADHD and OCD, and I’m walking through a clearer way to tell generalized anxiety disorder (GAD) and Obsessive Compulsive Disorder (OCD) apart without relying on how “likely” or “irrational” a thought sounds. I will unpack the functional difference: GAD often uses worry as preparation, a linear chain of future-focused what-ifs that pretends it’s keeping you safe. OCD is usually less interested in preparing and more focused on certainty, treating doubt like a code red emergency that must be solved right now. That’s why OCD can look like an urgent loop: did I mess up, how do I know, let me check again. If you’ve ever felt that frantic need for proof, you’ll recognize it. Then we get into the messy middle where both conditions overlap. Reassurance seeking, Googling, rumination, mental review, hypervigilance, and body scanning can appear identical from the outside, so we explore the “ultimatum” underneath the behavior: the quieter “better safe than sorry” vs the trapped “or else.” I also talk about existential OCD, why profound mysteries can become compulsive, and how therapy approaches like ACT, CBT, and especially exposure and response prevention (ERP) help you build a new relationship with uncertainty through inhibitory learning. content of worry not reliably separating OCD from GAD If you’re tired of chasing the perfect rule that proves what you have, come practice noticing the urge without automatically obeying it. Subscribe, share this with someone who overthinks like you, and leave a review so more people can find the show. Resources Mentioned in This Episode Bull City Anxiety & OCD Treatment Center I mentioned Bull City Anxiety & OCD Treatment Center in this episode because they offer some really helpful educational resources for clinicians interested in OCD and anxiety disorders. Their training offerings include courses and lectures on OCD diagnosis, assessment, treatment, and the overlap between OCD and other conditions. You can explore their current courses and trainings here: https://www.bullcityanxiety.com/on-demand-ce-courses⁠ They currently offer an OCD & Anxiety Disorders Lunch & Learn as part of their Fall 2026 series, which specifically covers OCD and anxiety disorders, differential diagnosis, and treatment considerations. (Bull City Anxiety & OCD Treatment Center⁠) Send us Fan Mail Support the show 🌟 🌟Support the show and get episodes 5 days earlier 🌟 🌟        https://www.buzzsprout.com/2629683/support↗️ Visit the website: https://www.dopamine-and-doubt.com Follow on Instagram: @Dopamineanddoubtpodcast  https://www.instagram.com/dopamineanddoubt/ Email: dopamineanddoubtpod@gmail.com Love the show? Please leave a review on Apple Podcasts or Spotify-it helps listeners find the show! Resources from episodes: https://linktr.ee/dopamineanddoubt

  7. Sep 8

    Using AI As An ADHD Accommodation Without Feeding OCD

    AI can feel like magic for an ADHD brain and like gasoline for OCD. I’m Rachel, a licensed clinical social worker who lives and works at the intersection of ADHD and OCD, and I’ve noticed the same tool can either support real-life functioning or quietly turn into reassurance seeking. The difference isn’t whether you use AI. The difference is the job you’re asking AI to do.  • how AI can be an ADHD accommodation through scaffolding and structure • breaking big tasks into smaller steps to support executive function • using AI for time estimation to reduce time blindness and unrealistic scheduling • lowering decision fatigue with meal planning and prioritizing • when AI supports OCD recovery by reducing compulsive rewriting and checking • the difference between drafting help and seeking certainty about tone or outcomes • using “read once and send” as response prevention practice • a practical test: values-based action versus escaping uncertainty If this resonates, subscribe so you don’t miss future episodes, share it with someone who’s navigating ADHD or OCD, and leave a review to help more listeners find the show. What’s one way you’ve noticed AI helps you move forward, or pulls you into checking? Send us Fan Mail Support the show 🌟 🌟Support the show and get episodes 5 days earlier 🌟 🌟        https://www.buzzsprout.com/2629683/support↗️ Visit the website: https://www.dopamine-and-doubt.com Follow on Instagram: @Dopamineanddoubtpodcast  https://www.instagram.com/dopamineanddoubt/ Email: dopamineanddoubtpod@gmail.com Love the show? Please leave a review on Apple Podcasts or Spotify-it helps listeners find the show! Resources from episodes: https://linktr.ee/dopamineanddoubt

  8. Sep 1

    ADHD Hyperfixation or OCD Reassurance Seeking Spiral: A Simple Framework

    “One more article. One more Reddit thread. One more Google search.” If you’ve ever looked up and realized you’ve been researching the same question for way too long, you’re not alone and you’re not broken. I am talking about the ADHD and OCD overlap where hyperfocus and reassurance seeking can look almost identical, even though the “why” underneath is completely different. I share the framework I use when stuck in that blurry space. First, we work with ADHD hyperfocus by building “exit ramps” instead of hard stops: movement breaks, body check-ins, alarms, transition cues, and simple boundaries like app blockers or scheduled hobby time. The goal isn’t to kill your focus or curiosity. It’s to protect the strength of hyperfocus while reducing the cost, so your body doesn’t end up running on empty. Then we zoom in on the pivot point: “Am I still learning, or am I trying to feel certain?” I break down information seeking versus OCD reassurance seeking, why the “are you sure?” loop never feels finished, and how to tell when a question is answerable versus fundamentally uncertain. If you’re already in the spiral, I walk through practical OCD tools rooted in response prevention: naming the urge, using uncertainty statements like “maybe, maybe not,” delaying the compulsion for five to ten minutes, and reorienting toward what matters to you. If you’ve been trying to out-research anxiety, this conversation gives you a kinder and more effective next step. Subscribe for more ADHD and OCD strategies, share this with a friend who gets stuck in loops, and leave a review with the question you want us to tackle next. * **Episode Resource**: Download the original Information Seekers vs. Reassurance Seekers PDF developed by the Anxiety Disorders Center at the St. Louis Behavioral Medicine Institute https://iocdf.org/wp-content/uploads/2016/04/18-Information-seekers-vs-reassurance-seekers.pdf Send us Fan Mail Support the show 🌟 🌟Support the show and get episodes 5 days earlier 🌟 🌟        https://www.buzzsprout.com/2629683/support↗️ Visit the website: https://www.dopamine-and-doubt.com Follow on Instagram: @Dopamineanddoubtpodcast  https://www.instagram.com/dopamineanddoubt/ Email: dopamineanddoubtpod@gmail.com Love the show? Please leave a review on Apple Podcasts or Spotify-it helps listeners find the show! Resources from episodes: https://linktr.ee/dopamineanddoubt

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About

Dopamine and Doubt is a podcast about the overlap between ADHD and OCD—and what happens when it’s hard to tell which one is driving the behavior. Hosted by therapist Rachel Keefe, LCSW, the show explores ADHD and OCD symptoms including executive functioning difficulties, hyperfixation, reassurance seeking, intrusive thoughts, rumination, checking, avoidance, time blindness, and uncertainty. Each short episode breaks down confusing or relatable experiences in plain language, with real-life examples and practical strategies. You’ll learn how ADHD and OCD can look similar, where they differ, and how to respond when your brain gets stuck trying to figure everything out. Because the goal isn’t always to find the perfect answer. Sometimes, it’s learning to live with a little more uncertainty—and a little less doubt.

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