Similarities, and differences between OCD and Autism
(Part 2 of a 3 part series on the similarities and differences between OCD, Autism and/or ADHD)
Language: There is a sordid history of the DSM. I may use direct language from the DSM, this is for educational purposes. The language in the DSM, including the use of the word disorder (D in acronym) is harmful. When this language is used, it is either because I am quoting the DSM, or because there is unfortunately a lack of different terminology out there (i.e. leaving the “d” in OCD or the “D” in ADHD). Because I leave this, does not mean that I agree with the wording.
Educational Purposes: The information presented here is for educational purposes, and not meant to diagnose, treat or cure medical conditions or challenges, including neurodivergence (including mental health challenges), or physical health.
Welcome to the second in our OCD series from our newest therapist, Alex McLaughlin! Alex is working with clients ranging from early childhood to adults in Minnesota, both virtually and in person in Edina! They currently have openings and would love to chat to see if they are a good fit for you!
Last week, Alex deep dived into OCD so before we move onto Autism and OCD, don’t miss out on the first part here!
Now, let’s continue our exploration with Alex!
Autism
You’ve made your way to this blog, so I assume that you have some more foundational knowledge about Autism, or are expanding your knowledge now.
That said, briefly, like very briefly. Autism is a neurodevelopmental condition / disability that is characterized by differences in way a person’s nervous system is wired, differences in the way a person experiences the world, acts, thinks, and socializes, etc. Here is a terrific blog post, with alternatives for more affirming language (next to original DSM, deficit based language).
So now that we’ve given a bit of an overview of OCD is, and established that it is not, eye roll, obsessive Christmas disorder, let’s explore how it’s different, and may overlap with ADHD.
Differences, similarities, and co-occurrences
So now that you’ve, hopefully, got a basic understanding of OCD, ADHD and Autism. Let’s explore where OCD may differ, be similar and overlap between Autism and/or ADHD as well.
As you may be able to tell by now from the sources, and footnotes, I appreciate the work of Dr. Megan Anna Neff, she has a blog post about this very topic. Let’s give oodles of gratitude to Dr. Megan Anna Neff and all the work they do educating folks and once again, review their beautiful venn diagram (see below).
That said, let’s discuss the term comorbidity / co-occurrence, this is used in the mental health, and likely physical health field, to describe when a person has one or more condition. For example, an Autistic person may also have PTSD. There are comorbidities / co-occurrences that are common; such as Autism & ADHD; Autism & PTSD. And you guessed it, Autism and OCD.
Co-occurrences
People with OCD are four times more likely to be diagnosed as Autistic (Meier et al., 2015).
Nearly half of folks with OCD show significant Autistic traits, and over a quarter meet the criteria (Wikramanayake et al., 2018).
Autistic individuals have twice the risk of being diagnosed with OCD later in life (Meier et al., 2015).
So now let’s talk about how there can be differences, and similarities between OCD and Autism.
OCD or Autism? Or both? (1)
Similarities:
Repetitive thoughts and behaviors
Difficulty managing or tolerating uncertainty
Preference for routine / rituals and similarity
May avoid taking risks
Rumination / perseveration
Mentally rehearsing / scripting social interactions
Intrusive thoughts
Challenges with executive functioning
Sensory differences
How these similarities may differ (2)
Repetitive behaviors and thoughts:
When it comes to Autism, usually are congruent with a person’s desires, preferences, wishes, and may bring them joy (for the most part).
Witn OCD repetitive behaviors are usually performed to reduce anxiety, distress, bring certainty, or prevent a feared outcome.
Preference for routine / rituals: I
In order to understand if it’s more related to Autism or OCD, we want to understand the “why” behind the action, if the “why" is related to fear, then it can be due to OCD, though, with this one, fear may arise when an Autistic person, without OCD is unable to do things in the way they are used to / prefer, because changes in routine can cause nervous system disruption. As a therapist, I might explore the fear more deeply; asking something such as “what would happen if x happened?” and then “what would you worry about happening then?” and “what would that mean if that (second thing) happened? Would there be any additional worries?”
If a person puts their items away in a certain way, because it brings them joy, or because it helps keep things familiar, predictable, and automates habits, it’s usually and indication this is a result of Autism (if they are Autistic, or suspect they are).
If a person puts their items away in a certain way, because they fear that if they do not, that means they’ll get sick, then it’s likely OCD related.
Difficulty managing uncertainty: this one is a bit trickier to parse out, because usually this one there is a fear that may arise when there is uncertainty with both OCD and Autism. We’d want to again, explore the why the fear, and continue asking “why.” Even then, I find that as a therapist, if an Autistic client also has OCD, it may be challenging to determine if the difficulty managing uncertainty is more related to their Autism or their OCD.
Repetitive behaviors:
If the behaviors soothe a person, bring them comfort, or joy, it can be related to Autism.
If someone does a repetitive behavior out of fear of what might happen if they don’t, that’s likely due to OCD.
Scripting social interactions or mentally rehearsing them.
With OCD this is usually done out of fear, fear either due to uncertainty, to prevent a feared outcome, or because it “feels right,” and they need to find the “right” word.
With Autism, this can be both a coping skill, and a form of masking, and is usually done because a person may have difficulties managing social interactions, and may desire to feel prepared, to have an idea of topics they could discuss, or phrases / responses they could give.
Sensory differences.
A person with OCD may have trouble when they hear a sound, and may fixate on it; and take measures to make the room completely silent for sleep, because they fear that if they don’t they may not sleep (even if they are generally not a light sleeper).
With Autism, a person may have a reaction in their nervous system that causes distress, and/or misophonia, that, because of how our brain is wired, we take in more sensory data (3, 4, 5, 6, 7, 8), and we have a much more difficult time tuning out / ignoring sensory input. So if an Autistic person is hyper focused on sound, and worried that it may make it challenging to focus on studying or work, that’s very likely because it will make it challenging, and can cause nervous system disruptions and sensory overload.
The difference being with OCD, the worry is usually hypothetical, and not based on consistent lived experience (i.e. if someone is usually able to ignore sounds, and once in a while, when stressed or anxious has a harder time ignoring. That said, let’s say they are in a cafe studying, and have been here for 30 minutes, and once they settled in, got into a grove, easily able to ignore sounds, sights and other sensory stimuli. The next minute, their OCD is telling them, “but what if that sound of the espresso machine interrupts your concentration, and you miss an important term, and that’s the one question that would have gotten you an A vs. a B on the test?” and they think, “oh, that’d be bad, I need to make sure that doesn’t happen!” and now each time they hear the sound of the espresso machine, they mentally check if they retained what they just read, living in possibility land, trying to control for uncertainty, and living the fear of their the OCD story. In this example, they are not relying on their sense data to tell them that they’ve been able to actually focus, and their trust in themselves to go back if they got distracted. They are focused on engaging in a compulsion to prevent the bad outcome from happening.
That list is not exhaustive, and not all inclusive. As you can see, depending on the behavior, distress, or symptom, there are some cases where it’s more clear cut which may be which, and other cases where it’s pretty challenging to parse out. Perhaps as I continue to gain more experience treating OCD and working with Autistic clients, who may or may not also have OCD, then it could become more clear.
Closing Thoughts
There are a number of other challenges that co-occur with OCD, if you’re interested, you can learn more here. Interestingly, in my research, I also found that 90% of individuals with OCD met the criteria for at least one other psychiatric condition (9).
If you have, or think you may have OCD, along with ADHD and/or Autism, it’s important to work with a provider who is neurodiversity affirming, informed and who is trained in treating OCD by using ERP, I-CBT or ACT.
The risk of working with a provider who is not, they may ask you to do exposures for things that are upsetting to your nervous system, which could lead to sensory overload, sensory meltdowns, and burnout. For example, if you experience distress in social situations, and socializing with folks you need to mask around, doing an exposure around socializing is not going to have the opposite effect (granted, if a person’s social needs are not being met, then exploring exposures that are affirming, and that may reduce the chances of burnout / sensory overload may be worthwhile).
Are you working with a provider who treats OCD already? Consider educating them on the overlaps and differences (i.e. send them this blog post and/or the resources linked in the footnotes), advocate for yourself when you feel that they’re encouraging you to do an exposure that may actually be harmful for you due to your Autism and/or ADHD. If you feel that you want to find a better fit, see below….
Do you live on Wahpekute land (colonized as MN) (10), and have, or suspect you might have OCD, ADHD or are Autistic ? Alex is an AuDHD therapist with lived experience of OCD, who is trained in treating OCD and committed to providing ND-affirming therapy, reach out to schedule a free consultation. Live on either Wahpekute land, or Chumash land (colonized as Los Angeles, CA), and wanting an assessment to understand what might be going on (Autism, ADHD and/or OCD, among other things), then reach out to see about scheduling an assessment!
Live on Chumash land and wanting referrals for an ND-affirming therapist who treats OCD, we may be able to help!
We live and work on the unseated territories of the Wahpekute and Chumash land, we pay respects to their elders past and present. We encourage folks to explore the ancestral lands they live and work on, and to learn about the Native communities that live there, the treaties that have been broken. If folks feel called, we encourage them to consider taking actions to support (14) Native communities, reparations, and land back movements.
Footnotes:
1 Some of this information is from here, the same blog post as mentioned above.
2 These are not meant to be absolutes. An Autistic person may find comfort in doing something repetitively AND also fear not doing it. That could be due to Autism, or it could be due to OCD, or both. There are times where it is difficult to determine what is what, and that’s okay.
3 Sensory Processing Differences in Individuals With Autism Spectrum Disorder: A Narrative Review of Underlying Mechanisms and Sensory-Based Interventions
4 Sensory Processing in Autism: A Review of Neurophysiologic Findings
5 Enhanced integration of motion information in children with autism: this one talks about with visual information. However, I wonder if the “leaky filter”
6 5-Minute Sensory Checklist: Learn to Manage Sensory Overload
7 Gray matter volumes of early sensory regions are associated with individual differences in sensory processing (Autistic people tend to have less neural pruning, and more gray matter; so for those of us with sensory processing challenges, it could be related to the additional gray matter). Also, see this source
10 Support starts with educating yourself about history, and being willing to sit with uncomfortable truths. It can then include things like: learning about cultural appropriation, and commit to not engaging in and perpetuating cultural appropriation; committing to calling people in to conversations; educating others, honoring Native folks on holidays such as Indigenous People’s Day, considering the implications of celebrating holidays such as Thanksgiving, or the Fourth of July; making land acknowledgements, having conversations with people about what you learn; financial support; uplifting and amplifying Native voices and stories; understanding and supporting Land Back efforts; researching and supporting Native causes, including supporting and advocating Native-led for legislation changes. Some options for financial support of Native communities on Wahpekute land are here, here, here, here, here or here; Chumash land here; National.
