Obsessive Compulsive Disorder (OCD) And Autism: Differences And Similarities

What does autism have to do with obsessive compulsive disorder? If you're not too familiar with either, you may be puzzled — but if you have both, you know all about the connection because you're living it every day. Let's take a look at the similarities and differences, explore why it's not uncommon for people to have both OCD and autism, and see what treatments are available. 

What is obsessive compulsive disorder?

Obsessions, which are defined as intrusive and unwanted thoughts that lead to sometimes severe anxiety and distress, can revolve around a need to organized things in a certain and very precise way, a fear of germs, taboos, aggression, a fear that something bad will happen to someone they love, or manifest in other ways.

Someone who suffers from OCD will attempt to relieve these intrusive thoughts by performing compulsions, which are repetitive actions or mental tasks — such as, for instance, repeated hand washing, cleaning, counting, checking, repeating phrases, and a variety of other options. 

To be diagnosed with OCD, a person must spend significant amounts of time — at least an hour daily, but it can also be much more — engaged in compulsions. The symptoms of the disorder should not be caused by another condition or by substance abuse. Some people suffering from obsessive compulsive disorder are fully aware that they have it and that their obsessions (that is, the things they think will happen if they don't perform compulsions) are not rooted in reality. Others don't have this self-awareness or are more vaguely aware that no real harm will come if they don't perform compulsions. 

Why would anyone think OCD is linked to autism in any way?

Autism spectrum is a completely different beast at first sight — a neurological difference that affects the way in which people on this spectrum will communicate, relate to others, and behave. There are some obvious similarities in possible symptoms, however. From the outside looking in:

• An autistic person's strong need for sameness and distress when faced with change may resemble OCD. 
• An an autistic person who lines up objects or organizes things in a certain way as a form of "stimming" (self-stimulatory behavior) may look like they are performing compulsions. Stims are indeed often used to cope with stress.
• Autistic people may also stim by repeating certain words or phrases, or by counting — and these kinds of repeated phrases can also be a form of (sometimes delayed) echolalia, that is, repeating things other people have said. This, too, can look like OCD. 
• Furthermore, autistic people very often have "special interests" — strong passions. If that passion happens to involve cleaning, personal hygiene, or other repetitive physical actions, it can again mean that outsides will assume the person has obsessive compulsive disorder. 

But wait, there's more — obsessive compulsive disorder is actually pretty common in autistic people

Research has revealed that approximately four in 10 autistic people will suffer from some form of anxiety. Though most of these cases are accounted for by specific phobias, such as a fear of spiders, flying, riding an elevator, blood, loud sounds, and so on, a very significant 17 percent of people on the autism spectrum are additionally diagnosed with obsessive compulsive disorder. As a comparison, only about 1.6 percent of the general population (that'd be everyone) suffers from OCD. 

These two conditions have a lot more in common than you may think, given that being diagnosed with autism doubles a person's likelihood of later also ending up with an OCD diagnosis, and being diagnosed with OCD makes it four times more likely that a person will later be diagnosed as autistic. A family history of autism or OCD also increases the odds that any given person will have either one of these conditions. 

What can you do if you think you have both OCD and autism, or you suspect someone you care about does?

Obsessive compulsive disorder isn't an easy condition to treat and manage, and adding autism into the mix only makes for an additional clinical challenge. The treating healthcare provider has to figure out which symptoms are a result of autism, and which are caused by OCD, after all, and the same treatments that will help a neurotypical person suffering from obsessive compulsive disorder may be difficult for someone on the autism spectrum because of the social aspect of therapy. In addition, autistic people with OCD are also more likely to have yet more diagnoses — often ADHD, separation anxiety disorder, and social phobia.