Navigating both OCD and Autism

Often in the world of mental health, people can experience various overlapping symptoms under separate diagnostic banners. One example of this is OCD and Autism.

OCD features Obsessions and Compulsions, where an individual experiences a distressing thought that is recurring (Obsession) and responds to this with an attempt to cease emotional discomfort (Compulsion). A common example is an obsession with germs, with distress stemming from a fear of becoming sick, and a compulsion to hand wash in order to alleviate this distress.

One way to understand this dynamic is how Obsessions are thoughts, internal and mental. Compulsions can be more variable however, presenting as behaviours that can be observed by others, but can also be thought based processes too. For example, an individual experiences recurring intrusive and distressing thoughts about harming their partner. In response they may perform Thought Suppression, forcibly pushing an uncomfortable thought “away”, perhaps replacing it with another. Temporarily the compulsion brings relief, but sooner or later the intrusive obsession returns.

One of the recommended approaches to address OCD is Exposure Response Prevention (ERP). Derived from Cognitive Behavioural Therapy (CBT), ERP attempts to reduce Obsessions by supporting an individual to not engage in Compulsions. This approach has yielded positive results for many in reducing OCD related distress and impairment.

But here’s the curve ball - How do you identify OCD from Autism? Both feature repetitive behaviours and routines, sensory processing issues, intolerance of uncertainty, insomnia, and withdrawal to cope. To add to the matter, some studies note the increased prevalence of OCD in Autistic individuals and vice versa (Van Steensel et al. 2011, Meier et al., 2015).

This experience can be distressing for individuals experiencing both. How do we know what’s an Autism related behaviour that does not require treatment, versus an OCD behaviour that can be addressed?

One way to look at it is how OCD compulsions and Autism repetitive behaviours may look the same to an outside observer. But the function behind them differs. In OCD, the function is to reduce fear/anxiety associated with a thought. In Autism, the function is to self-sooth due to a sensory need (i.e. Stimming). OCD often comes with a sense of urgency with the distress, and fear of the repercussions if a compulsion is not completed. Self-soothing is disconnected from obsessions, and may not be associated with any kind of distress whatsoever.

For somebody experiencing both, uncertainty as to whether one is experiencing an Autism trait or OCD can be destablising. Over time, it can be helpful to learn what the OCD cycle looks like for you, as this helps with identifying OCD patterns apart from Autism related behaviours. This specific cycle (obsession thought > distress > compulsion > brief relief > obsession thought) gradually becomes easier to identify, with distress reduced via approaches like ERP modified for Autistic people.

We don’t need to stop our behaviours which are associated with Autism, as they are constructive and healthy. By identifying the unhelpful patterns and addressing them, we can gradually experience a net reduction in emotional distress. Tackling OCD can be uncomfortable and at times counter-intuitive, which makes it crucial to work with a qualified therapist to support you - especially in the early stages.