Is There a Link Between OCD and Autism?

Despite similarities, autism and OCD are distinctly different conditions. However, they share several characteristics.

Both involve repetitive behaviors

Repetitive behaviors in OCD and autism may look the same, but the reason behind them can be different.

An autistic person might stim by repeatedly tapping their fingers on a table. For them, it’s a positive experience, either because of the sound, the tactile sensations, or the way their fingers look as they move. They enjoy the experience and have no desire to stop.

Any type of repeated, fidgety behavior done to ease boredom, anxiety, or sensory overload is a type of stim.

Examples include:

• foot tapping
• hair twisting
• nail biting
• finger flicking
• pencil tapping
• whistling
• knuckle cracking

A person with OCD might engage in similar behaviors, but they’re not relaxing or soothing stims. Instead, they’re compulsions that the person feels driven to perform to prevent something bad from happening.

Both involve obsessions

Aside from repetitive behaviors, people with OCD and autism also share obsessions.

Many autistic people enjoy focused pursuits and become specialists in their area of interest. Their preferred activities provide comfort and offer a sense of security. In some situations, this focused knowledge can contribute to career success.

However, sometimes an area of focus can take over an autistic person’s life. It can dominate their thoughts and interfere with relationships and employment. If their focused interest were to disappear, they might feel like they have nothing else in life.

OCD obsessions are not the kind that can help with employment. Instead, they’re thoughts that are intrusive and unwanted.

Sometimes unwanted OCD thoughts are aggressive, like images of a car driving into a crowd of people. They can also represent a loss of control, like thoughts of acting inappropriately in public.

The nature of obsessions between autism and OCD are different, but in both cases, they can interfere with focus, attention, and well-being.

Both involve anxiety

Another common characteristic experienced by many autistic people and people living with OCD is anxiety.

Neither OCD nor autism are anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

OCD is listed under the “obsessive-compulsive disorders and related conditions” section, and one of the main diagnostic criteria is anxiety. Autism is a neurodevelopmental difference that includes anxiety as one of its traits.

While the two conditions share the experience of anxiety, the causes are often different.

Causes of anxiety in autism may include:

• sensory overload
• disruption of routine
• change in environment
• misunderstandings
• social challenges

Causes of anxiety in OCD may include:

• intrusive and unwanted obsessive thoughts
• interrupted rituals
• fears of bad things happening
• social shame

Both involve rigid thinking

Both autism and OCD can result in rigid thinking.

For autistic people, rigid thinking can be found in:

• the need to stick to a routine to feel secure
• social conflict if they interpret language too literally
• reluctance to look at things in a different way

Sometimes rigid thinking can be an asset to autistic people if it helps them to be goal-oriented and have a strong work ethic.

Rigid thinking with OCD stems from the urgent need to perform rituals that keep unwanted thoughts away or that protect against imagined harm. When a person with OCD feels like they need to wash, check, count, or arrange items to prevent something bad from happening, they become rigid about making sure they complete those rituals.

You can have both diagnoses. Some people are only aware of one diagnosis.

Researchers are learning more about brain similarities between the two conditions. People with OCD and autism share the trait of increased gray matter in a brain region called the caudate nuclei (CN). The CN is associated with restricted and repetitive behaviors.

Treatment can be tricky because although many behaviors shared by OCD and autism seem very similar, the causes behind them are quite different.

The goal of autism and OCD treatment is to improve a person’s quality of life. Sometimes no change is needed if the autistic person isn’t bothered by traits like mild stimming or restricted interests.

Treatment will depend on what condition is causing stimming.

For example, if repetitive behavior is an autism stim, then an OCD-targeted treatment likely won’t help since autism stims aren’t fear-driven.

However, if what looks like stimming is actually OCD rituals, then treatment can target the fearful thoughts that trigger those rituals.

Treatment options include:

• social skills training to help the autistic person collaborate with a therapist
• anger management and mindfulness training to help with emotional regulation
• exposure response prevention (ERP) therapy to help reduce the OCD response to triggers
• cognitive behavioral therapy (CBT) to identify unhelpful thoughts and replace them with better ones
• medication such as selective serotonin reuptake inhibitors (SSRIs)

Treatment helps to reduce the impact that condition characteristics have on daily life. Treatment can also reduce anxiety and make social interactions easier.

Caregivers can support treatment efforts. Some ways to do this include:

• maintaining scheduling consistency
• improving communication methods
• observing and remembering triggers
• using role playing exercises to practice trigger situations like transitions
• communicating the care plan to everyone involved

Equally as important, caregivers benefit from taking care of themselves to reduce any stress they may be feeling.

Autism and OCD are separate conditions that sometimes occur together. They both affect daily life, but with help, you can manage them.

Treatments can help ease the impact of having both diagnoses. Your doctor can help you figure out a treatment plan to reduce anxiety and the interference that behaviors like stimming can sometimes cause.

Getting an accurate diagnosis is important. You can discuss the diagnostic process with your doctor.