A conversation between OCD specialist Mandi Behzadi, LMFT and neuropsychologist Dr. Katie
Maybe you've noticed your brain doing something it's always done, replaying a thought, needing things a certain way, circling back to the same worry, and you've started wondering if there's actually a name for it. Is it OCD? ADHD? Autism? Some combination you don't have language for yet?
If that question has been sitting with you, you're not overthinking it, and you're not alone. OCD and neurodivergence overlap more than most people realize, which means it's easy to get misdiagnosed, undertreated, or told your experience just doesn't fit neatly into one box.
In this conversation, OCD specialist Mandi Behzadi sits down with Dr. Katie, a neuropsychologist at Psyched Therapy Collective, to unpack where OCD and neurodivergence look alike, where they're fundamentally different, and how to start figuring out which one (or both) might actually be describing you.
Key takeaways
The core difference isn't the repetition; it's what the repetition does for you. OCD compulsions create short-term relief but long-term distress. Neurodivergent repetitive thoughts or behaviors (like stimming or special interests) are genuinely regulating and comforting.
"Egodystonic" is the word to know. OCD thoughts feel foreign to who you are, the opposite of your values. Neurodivergent thought patterns don't carry that same sense of "this isn't me."
OCD and neurodivergence commonly co-occur, and treating one without accounting for the other can make treatment less effective or even harmful.
ERP (Exposure and Response Prevention) and ICBT (Inference-Based CBT) are gold-standard OCD treatments, but they need to be paced and adapted differently for neurodivergent clients.
A comprehensive assessment, not a single diagnosis, is the clearest way to understand what's actually going on and get the right treatment.
Where OCD and neurodivergence start to look similar
Mandi explains that in her work, she increasingly sees clients whose experience doesn't fit cleanly into what she calls "textbook OCD": clear intrusive thoughts, clear compulsions. Instead, there's a gray area: differences in how someone learns, or behaviors that look like compulsions but are actually a source of real comfort rather than anxiety relief. That gray area, she says, is what pulled her toward wanting to understand neurodivergence more deeply.
What "egodystonic" actually means
This is one of the most useful distinctions in the whole conversation. Egodystonic thoughts clash with your values- the classic OCD experience of "I had a thought so disturbing, what does that say about me?" Egosyntonic thoughts or reactions, by contrast, might not be ones you love, but they still feel like you, like snapping at someone in traffic and not liking how you reacted, but not questioning your entire identity over it.
OCD, Mandi explains, works by grabbing a random thought, something everyone has thousands of every day, and asking, "because you thought this, what does it mean about you?" That's what makes OCD so destabilizing: it's sometimes called the "doubt disorder" because it makes people doubt their own values, relationships, and sense of self.
What neurodivergence means, and where the overlap comes from
Dr. Katie walks through the concept of neurodiversity as a framework that emerged in the 1990s, largely as a response to a medical model that treats differences as deficits to be fixed. Neurodivergence — autism, ADHD, Tourette's, learning differences like dyslexia and dyscalculia — reflects real, documented differences in how the brain and nervous system are wired. The problems arise not from the differences themselves, but from the mismatch between those differences and a world built around neurotypical standards.
There's real overlap in repetitive thought patterns between OCD and neurodivergence, but the mechanism is different. For someone who's autistic, repetitive thoughts or behaviors are often genuinely regulating, they create a felt sense of calm and groundedness. For someone with OCD, the "compulsion" might feel calming in the moment, but over time it feeds a cycle that causes more distress, not less.
The real test: does it calm you down, or keep you stuck?
Both Mandi and Dr. Katie return to this point repeatedly, because it's the clearest differentiator they've found clinically. Neurodivergent repetition: a special interest, a stim, a routine, tends to actually regulate the nervous system. OCD's repetitive thoughts or behaviors might offer a flicker of relief, but they reinforce a cycle that gets louder and more demanding over time.
Dr. Katie also points out that neurodivergent traits tend to show up consistently across contexts, while OCD often spikes around specific triggers, transitions, high-stress moments, and anything new. And unlike neurodivergence, there's no environment where OCD would simply feel comfortable or "typical" because OCD was never really a true reflection of the person to begin with.
Is OCD itself a form of neurodivergence?
It's not a black-and-white answer. Dr. Katie notes there's documented overlap in brain wiring and activity between OCD and other neurodivergent conditions, including a "worry circuit" that's overactive, paired with underactive regulation systems. But functionally, OCD often feels different: with real treatment, the internal experience of OCD can significantly recede, whereas autism or ADHD aren't something a person "recovers" from, they're part of how someone's brain is built.
How treatment changes for neurodivergent clients
Mandi describes two evidence-based OCD treatments: ERP (Exposure and Response Prevention), which gradually introduces feared thoughts or situations without allowing compulsions, and ICBT (Inference-Based CBT), which helps clients understand and interrupt the specific thought patterns OCD builds.
Both need to be paced differently for neurodivergent clients. Mandi shares an example of working with a client who is autistic and has OCD around writing; instead of diving into exposures, they start by simply going into the room where the client used to write, building up gradually and checking in constantly to make sure they're targeting an actual compulsion, not a genuinely regulating behavior. Getting that distinction wrong, treating a stim like a compulsion, or vice versa, can make treatment less effective or even distressing.
What to do if you're not sure which one it is
If you're watching this and thinking "some of this sounds like me," both Mandi and Dr. Katie point to the same next step: get a comprehensive assessment. Because OCD and neurodivergence overlap so often, a single diagnosis or a diagnosis from years ago that's never felt like the full picture can miss a key piece of what's actually going on. That's especially true for people who've been in OCD treatment for years and, as their OCD improves, start noticing other patterns underneath that OCD had been masking.
A full assessment doesn't just answer "yes or no" to a diagnosis; it gives you (and your therapist) a much clearer map of how your specific brain works, what your strengths are, and what kind of treatment will actually serve you.
If this sounds like you
You don't need to have it all figured out before you reach out. If you've spent years wondering whether something's "actually" OCD, or "actually" ADHD, or "actually" just you being too sensitive, that uncertainty is worth taking seriously, not something to sit with alone.
At Psyched Therapy Collective, comprehensive neuropsychological assessment is exactly this kind of work: untangling what's really going on so you can stop guessing and start getting support that's built for your actual brain, not a generic version of it.
Ready to pursue an assessment? Book with Dr. Katie here.
About Mandi Behzadi
Mandi is a licensed therapist specializing in OCD, trained in ERP and ICBT providing services in California and Minnesota.
🔗 mandibehzadi.com | Instagram: @mandibehzaditherapy
About Dr. Katie
Dr. Katie is a licensed clinical neuropsychologist at Psyched Therapy Collective, specializing in neuropsychological assessment for autism, ADHD, and other cognitive and learning differences.
🔗 psychedtherapy.co | Instagram: @psychedtherapy.co
