Gay Male Relationships and the ADD/OCD Syndrome

“Gay Male Relationships and the ADD/OCD Syndrome”

In my psychotherapy and coaching practice specializing in gay men and gay male couples for what is now (in 2022) thirty years (whew!), I keep noticing a pattern in the gay male couples I serve that one partner seems to generally have a pattern of thinking and behavior that is aligned with some of the classic symptoms of ADD (Attention Deficit Disorder, sometimes referred to as Attention Deficit Hyperactivity Disorder) and the other partner has a pattern of thinking and behavior that is more aligned with OCD (Obsessive-Compulsive Disorder).  I call this the yin-yang of the ADD/OCD gay male couple.  It’s a phenomenon that is not talked about much, so I’d like to share some thoughts on that now.

When we think of all psychiatric disorders that are “official” diagnoses in the United States, which are determined and described/catalogued by the American Psychiatric Association, and their Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition [DSM-5] (APA, 2013), we usually think of them in terms of how they affect individuals: symptoms, diagnosis, access to psychiatric care (which can be challenging), treatment, and treatment “response” or “outcomes.”

Treatment outcomes can vary widely, often in some combination of psychiatric medications (also known as “psychopharmacological interventions”) and psychotherapy (from any one of a number of psychotherapy theoretical orientations, which “should” be (but not always are) delivered from qualified psychotherapists using Evidence-Based treatment models (techniques known to be effective to treat the disorder via formal academic research.  For example, Cognitive Behavioral Therapy for OCD is considered Evidence-Based Practice (EBP); while the widely discredited “sex addiction treatment” is not).

When I see the ADD/OCD syndrome in gay male couples, sometimes we’re not even talking about both, or even either, partner truly meeting the objective, clinical criteria for carrying the official diagnosis of adult ADD or OCD that we would find in the DSM-5.  We might just be seeing some general traits of each of these disorders, but these traits can be consistent and prominent enough to affect the couple’s relationship dynamics and daily household life.

Common traits of ADD may include (according to the Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878):

• Impulsiveness
• Disorganization and problems prioritizing
• Poor time management skills
• Problems focusing on a task
• Trouble multitasking
• Excessive activity or restlessness
• Poor planning
• Low frustration tolerance
• Frequent mood swings
• Problems following through and completing tasks
• Hot temper
• Trouble coping with stress

While common traits of OCD may include both obsessions and compulsions (again, according to the Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432):

Obsessions:

• Fear of being contaminated by touching objects others have touched
• Doubts that you’ve locked the door or turned off the stove
• Intense stress when objects aren’t orderly or facing a certain way
• Images of driving your car into a crowd of people
• Thoughts about shouting obscenities or acting inappropriately in public
• Unpleasant sexual images [Note how this is NOT “sex addiction”]
• Avoidance of situations that can trigger obsessions, such as shaking hands

Compulsions:

• Hand-washing until your skin becomes raw
• Checking doors repeatedly to make sure they’re locked
• Checking the stove repeatedly to make sure it’s off
• Counting in certain patterns
• Silently repeating a prayer, word or phrase
• Arranging your canned goods to face the same way

Or, they could just be traits of Obsessive-Compulsive Personality Disorder, which might include (according to Healthline https://www.healthline.com/health/obsessive-compulsive-personality-disorder)

Characteristics:

• Finding it hard to express their feelings.
• Having difficulty forming and maintaining close relationships with others.
• Being hardworking, but their obsession with perfection can make them inefficient.
• Feeling righteous, indignant, and angry.
• Facing social isolation.
• Experiencing anxiety that occurs with depression.

Symptoms [I think of “Sheldon Cooper” from TV’s “The Big Bang Theory” here]:

• Perfectionism to the point that it impairs the ability to finish tasks
• Stiff, formal, or rigid mannerisms
• Being extremely frugal with money
• An overwhelming need to be punctual
• Extreme attention to detail
• Excessive devotion to work at the expense of family or social relationships
• Hoarding worn or useless items
• An inability to share or delegate work because of a fear it won’t be done right
• A fixation with lists
• A rigid adherence to rules and regulations
• An overwhelming need for order
• A sense of righteousness about the way things should be done
• A rigid adherence to moral and ethical codes

But remember: People who have ADD, OCD/OCPD, or any psychiatric disorder can, and do, form relationships!

Earlier in my career, I wrote a series of blog articles (here, here, and here) about personality disorders, and how they manifest in the workplace (saying that “people with personality disorders do get jobs!”).  Personality Disorders are outlined in a certain section of the DSM-5, which describes diagnoses that are not your classic depression, anxiety, schizophrenia, bipolar, etc., but are the disorders that persistently, across the lifespan and in many settings, affect the emotional/behavioral personality structure and interpersonal relationships, such as the Narcissistic, Borderline, and Antisocial Personality Disorders (ahem – Trump! – ahem).

In other articles, I’ve written about “Loving Someone with OCD” (that article is here), where I described how sometimes you’re not the person (“patient” or “client) with the disorder, but sometimes you’re the partner of one, and that first person’s disorder can still affect your daily life, because you’re living with them in close proximity.  This would be true for any situation where a partner has a psychiatric disorder: they must learn to treat/manage/cope with it, and their partner is in a certain role as “domestic caregiver,” even if their partner is independently well-functioning.

In the ADD/OCD syndrome couple, not only does each partner have a disorder (or at least strong traits of it), but they also have to respond to a partner who also has a disorder, but in a complementary/compensatory way.

There are other, similar dynamics (called “dialectics”) that create the yin/yang structures in gay male relationships:  We talk about the Alpha and the Beta partner, the Spender and the Saver, the Distancer and the Pursuer, the Introvert and the Extrovert, the Fear of Engulfment vs. the Fear of Abandonment, the Homebody and the Party Boy, the Corporate One and the Artistic One, the Top and the Bottom, the Witch and the Mortal, etc.

I believe this is because the old adage of “opposites attract” is, in some ways, true.  Opposites don’t really attract in all ways, such as vast political differences or schisms in other personal values, but more in subtle personality traits, ways of doing things, and emotional/behavioral makeup.  As gay men, we tend to seek out partners who offer us what we didn’t get in our childhoods, or what we “lack” as adults, and we need to “outsource” those traits, personified in our partner, in a complementary way.

Who is the ADD or OCD One?

In your relationship, when you think about the characteristics or symptoms of either ADD or OCD/OCPD, did you recognize either yourself or your partner?  If you didn’t, fine, maybe it’s not your relationship that has this syndrome, but instead someone you know.

But if you did recognize either yourself or your partner, how did you feel about?  Was it funny in how recognizable it was?  That shows you how common this ADD/OCD yin-yang dynamic can be.  Plus, our little foibles and neuroses can be somewhat amusing, except when you’re in the moment and either you or your partner/spouse might find them really annoying.

Navigating the ADD/OCD Syndrome

These kinds of dynamics might imply nearly constant incompatibility and driving each other crazy.  But it usually works out.  The key is to reduce the friction that comes from having these opposing personality traits, and instead try to create a harmony of the differences to form a cohesive whole in the household.  The old nursey rhyme, “Jack Spratt could eat no fat; his wife could eat no lean.  And so, between the two of them, they ate the platter clean” comes to mind.  Despite the ubiquitous heteronormativity of our culture (even in nursery rhymes, for chrissakes), we can take a lesson from the “ancient wisdom” of this and see how when two “opposing” dynamics come together, they form a complementary system that adds up to a better unit than could be achieved by the individual dynamics alone; the whole is greater than the sum of the parts.

In the ADD/OCD gay male couple, often the ADD partner keeps the OCD partner from becoming too staid and “stuck in the mud” in their ways, and the OCD partner lends a certain focus and structure so that the ADD partner doesn’t go flying out of orbit.  They need each other to create a complementary balance of energy and behaviors in the household, just like the other couples’ dichotomies dynamics mentioned earlier.

To help live with these between the two partners (although there could be more; I have completed a year-long certificate program in expertise in working with Consensual Non-Monogamy or even Polyamorous relationships and families, through the Sexual Health Alliance, where I was trained as a nationally Certified Sex Therapist as well), most often I work with two-person gay male couples.  The key word here is “balance,” and I always say the building blocks of a healthy, happy, and enduring relationship are what I call the Three C’s (more on those in general, here).

Those are:

Commitment – When you really get serious with someone, you’re signing on not only for any number of great traits they have, but also for their little quirks and neuroses.  You’re being a grown-up when you make a commitment to relationship partner that isn’t indulging the infantile fantasy of the “perfect” partner, and neither are they.  You’re both committing to being “perfectly imperfect”, in ways that might vary throughout your lifespans, as we become more “imperfect” in different ways over time.  But the ADD/OCD dynamics tend to endure, and while they’re not really “curable”, we each learn to manage our own neuroses, as well as learn to manage our partner(s) having them as well.  While your partner’s ADD or OCD traits might annoy you, that is by no means his entire being; the traits are just where his insecurities manifest, and once you’re used to them, you can kind of “work around” them by his having probably very predictable behavior over time.

Communication – Communication is the closest thing we have to a “relationship Cure-All.”  I’ve found over many years in practice that there are very few problems or issues that don’t get better with honest communication about them.

One tip might be to observe, identify, and then discuss the ADD or OCD traits you see in your partner, and ask him about them.  Ask him to reflect on why he did or didn’t do something in your house, and then he can have the opportunity to make a probably unconscious dynamic much more conscious.  Sometimes just pointing out a classic ADD or OCD trait or characteristic can help your partner observe his own behavior, and possibly develop alternative, more productive cognitive interpretations or behavioral choices around it.  OCD, for example, is treated in this way in Cognitive-Behavioral Therapy, and what’s called Exposure and Response Prevention, where the person with OCD is exposed to a stimulus that would normally make them anxious, and then they “sit with” the feelings and challenge the compulsions (such as the need for everything arranged on a table to be in perfect order).

While it’s hard (as in impossible) to completely “cure” the ADD or OCD brain (both of these disorders are brain-localized in the amygdala), we can certainly learn as the patient, or the partner of the patient, to adaptively cope with these “propensities” over time, in what therapists call “self-regulation of the affect” (a very fancy term for “get a grip on yourself, gurl!”) and also through cognitively “responding” to what the brain wants to give us naturally.  Practical books like Driven to Distraction, about ADD/ADHD, have some great coping tips, like building structure through To-Do lists, smartphone reminders, and online calendars.

A partner/spouse might attend a one-time (or maybe a few) otherwise individual therapy sessions with their partner to discuss ways that the adaptive coping strategies that the “primary patient” has developed can be shared with a partner.  When you have a certain “Neurosis Buddy System” in your house, it can make for more harmonious living, such as brainstorming ways to reduce conflict.  (For example, in my house, my husband just accepts that I like things in a certain order, and keeps them that way in the kitchen; whereas as I just remind myself that he’s less good at keeping a schedule or following an agenda for the day, and I just remind him and prompt him when we need to go somewhere that maybe he’s forgotten about when paying attention to something else.)

Compromise – Another aspect of compromise – you give a little, you get a little back in return – is just patience.  Understanding that Life doesn’t just bend to our will all the time.  How things go ultimately is some combination of what we want, and how Life responds.  John Lennon said, “Life is what happens when you’re busy making other plans.”  Communication (that word again) implies that each of us, as partners in a relationship, must learn to be tolerant of our partner’s neuroses, just as we are asking him to be tolerant of ours, in reasonably equal measures.

Couples therapy, or relationship coaching, both are professional services which can help you implement the Three C’s when it comes to coping with the specifics of how a form of the ADD/OCD syndrome manifests in your relationship, or any life stressor (such as another psychiatric or medical issue) that affects your relationship, in addition to just environmental stressors, such as coping with the COVID-19 pandemic, or work stress, or Family of Origin stress, and so on.  Counseling for managing the ADD/OCD “divide” helps you to cultivate a more harmonious, and less “factioned” relationship.

In these ways, you can get your whole and your parts together in all kinds of fun ways.  But as an AASECT Certified Sex Therapist, once I put it like that, maybe that’s a topic for another day.

Ken Howard, LCSW, CST is a Licensed Clinical Social Worker in California (#LCS18290) and an AASECT Certified Sex Therapist. He also provides individual, executive, and relationship coaching services all over the USA and the world.  He has 30 years of experience as a gay men’s specialist therapist.  For more information or to make an appointment, call or text 310-339-5778, or email Ken@GayTherapyLA.com.