Often confused with one another, OCD (Obsessive-Compulsive Disorder) and autism spectrum disorder (ASD) can present similar symptoms. While OCD is a mental illness and autism is a neurodevelopmental disorder, they can co-exist in some individuals. This article explores the complexities of OCD and autism, including how they can overlap and how they differ.
OCD is classified as a mental illness. People with OCD experience distressing, intrusive thoughts (obsessions) that they can’t control. These thoughts trigger urges to perform certain repetitive behaviors (compulsions). Even though these compulsions may seem irrational, people with OCD feel compelled to carry them out to gain temporary relief from their anxiety.
ASD, on the other hand, is a neurodevelopmental disorder. This means that the brain develops differently in autistic individuals, affecting how they communicate and interact with the world around them. Autism is not a mental illness, and many autistic people don’t consider it a disorder but simply a way of being that differs from the typical.
One area where OCD and ASD can appear similar is in repetitive behaviors. People with both conditions may engage in repetitive actions such as shaking, rocking back and forth, hand flapping, or pacing. However, the underlying reasons for these behaviors differ.
Another area of potential confusion is fixations or intense interests. Autistic people often have special interests that they focus on intensely. While someone might use the word “obsession” to describe this intense focus, it’s important to distinguish it from the OCD definition.
Both OCD and ASD can also involve social difficulties, such as anxiety in social situations, trouble relating to others, and challenges expressing thoughts and feelings. Additionally, people with both conditions may be more sensitive to sensory stimuli and experience sensory overload. This can make daily tasks difficult and lead to struggles with routine changes.
People with OCD experience significant distress from their obsessions and compulsions. They often want to reduce or eliminate these behaviors because they negatively impact their quality of life. In contrast, repetitive thoughts and behaviors in autism are not inherently distressing. Autistic individuals may not feel the need to change their routines or special interests.
While OCD and ASD are distinct diagnoses, research shows a surprisingly high rate of co-occurrence, meaning they frequently appear together in the same individual. This overlap can be confusing, but it makes sense when we consider the underlying similarities between the two conditions.
Studies have identified several factors that might contribute to this high comorbidity rate. Genetics appear to play a role, as both OCD and autism have a heritable component. If a close relative has OCD, you’re more likely to develop it yourself, and the same is true for autism.
Estimating the exact prevalence of OCD in autistic individuals can be tricky. Early studies often yielded inflated numbers because they didn’t adequately distinguish between OCD symptoms and repetitive behaviors that are inherent to autism itself.
More recent research, employing stricter diagnostic criteria, suggests a comorbidity rate of around 17% for OCD in autistic people. This means that roughly 1 in 6 autistic individuals will also experience OCD. Interestingly, the relationship seems to go both ways.
A 2017 study suggests that many people with OCD may have undiagnosed autism, and a 2015 study following 3.4 million people in Denmark found that autistic individuals were twice as likely to be diagnosed with OCD later in life, while those with OCD were four times more likely to receive an autism diagnosis eventually.
The reasons behind this two-way street are still under investigation. It’s possible that shared genetic and neurobiological underpinnings make individuals susceptible to both conditions. Another theory suggests that the core features of each disorder might increase the risk of developing the other.
Accurately assessing OCD in autistic individuals, nonetheless, presents several challenges. Standardized OCD measures, like the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and its youth version (CY-BOCS), were not specifically tailored to consider the unique presentations of OCD in autism.
These measures also function more as treatment guides than diagnostic tools. This can lead to misinterpretations of findings, particularly for underrepresented groups like women, girls, and certain ethnicities whose OCD symptoms might manifest differently.
Ideally, diagnosing OCD in autistic individuals should involve a multidisciplinary team approach. This means combining current clinical observations and test results with a comprehensive developmental and medical history. There’s no single definitive test for OCD, autistic or otherwise. A skilled clinician’s expertise plays a crucial role in accurate diagnosis.
Another significant hurdle is the lack of clinicians with specialized training in assessing co-occurring OCD and autism. Mental health professionals typically specialize in either autism or OCD, and expertise in both areas is less common. There’s a clear need for expanded training opportunities to equip clinicians with the skills necessary to effectively assess these conditions.
Furthermore, integrating mental health assessments for autistic individuals into their existing autism-related services can be challenging. This might lead to delayed or missed diagnoses of OCD altogether within services primarily focused on autism as a developmental disability.
Communication difficulties, a core feature of autism, further complicate OCD diagnosis. While many autistic people are verbal, some are not, and even those who speak may become less verbal when stressed or dysregulated.
Additionally, many autistic individuals experience challenges with both expressive and receptive language, as well as nonverbal communication. They might also use language in a very literal way, making it harder to identify OCD accurately.
Another reason OCD symptoms in autistic individuals get overlooked is that they can be overshadowed by more prominent concerns. This could include co-occurring conditions that significantly disrupt daily life, such as depression, anxiety disorders, ADHD, Tourette syndrome, or even thought disorders.
It’s important to note that autism is significantly more prevalent in individuals diagnosed with OCD compared to the general population. Some OCD patients might have masked autistic traits to “fit in” socially, while others may not even be aware they have autism.
Social difficulties associated with OCD can also be mistaken for autism, especially in individuals with strong cognitive abilities. Therefore, clinicians should screen for autism in individuals with OCD whenever there are concerns about social communication, interpersonal functioning, or rigid behaviors.
Early intervention and a tailored treatment plan can significantly improve quality of life. Rainbow ABA is a team of compassionate therapists dedicated to helping individuals and families manage OCD, autism, and related conditions.
We offer comprehensive therapy services to children and adults at our ABA centers in New Jersey, Oklahoma, Georgia, and Texas. Our therapists are experts in evidence-based approaches that can help you manage symptoms and achieve your goals.
Contact Rainbow ABA today to schedule a consultation and learn more about how we can help you on your journey towards wellness!
Sources: