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Autism and obsessive-compulsive disorder (OCD)

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  • Date published:

  • Author: leighanjohnson

There are important differences between obsessive-compulsive disorder (OCD) and autism, but they can occur together.

For OCD, people may refer to obsessions and compulsions, whereas for autism, people refer to repetitive behaviours that can look the same (for example, switching the lights on or lining things up in the same way).

The difference is that obsessions and compulsions for people with OCD are distressing and unwanted, while repetitive behaviours for autistic people (e.g., interests and sensory) are often positive, soothing, and purposeful.

In the following example, an autistic person or someone diagnosed with OCD may repeatedly turn the light switch on and off. Someone who is autistic may experience some enjoyment about the sound the light switch makes when it is turned on and off. On the other hand, someone with OCD may believe that they need to repeat this behaviour or that something bad will happen.

Repetitive behaviours are part of being autistic and should not be misunderstood as a sign that you may have OCD. Repetitive behaviours can be considered ‘normal’ for people with autism. Some examples of these repetitive behaviours within autism can include: specific interests, unusual sensory interests, making sounds or seeking out sounds, difficulties with changes to routines or environmental changes, unusual attachments to objects, stereotypes, or unusual motor mechanisms.

The intervention for OCD, when it presents with autism, is to follow a cognitive behavioural therapy approach and to treat the OCD separately. A clinician would try to work out which behaviours are associated with OCD and which behaviours are associated with autism. They would also try to establish if the behaviours are driven by fear, impending doom, or pleasure (i.e., enjoyment or self-soothing). This can take a little longer and may include the following:

  • Goal setting (things your child would like to change)
  • Anxiety education (learning about anxiety and how it works)
  • Developing an OCD hierarchy (the steps we can work on to break the OCD cycle)
  • Exposure and response prevention (taking the steps slowly and learning to cope with little bits of anxiety at a time)
  • Lots of practice inside and outside of the sessions
  • Planning for other scenarios in the future
  • It can be helpful to consider social skills training alongside this intervention.

In situations where the problem is more related to restricted repetitive behaviour, it may be more important to support the young person rather than push for change and to create a caring and compassionate environment where they can engage in the restricted repetitive behaviour safely.

Click here to find out more about Autism.

Click here to find out more about OCD.