OCD and autism are often misdiagnosed as one another. This is because the symptoms of both can look similar.
Obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) are, in many ways, quite different.
OCD is a mental illness, while autism is a neurodevelopmental disorder. Misdiagnosing OCD as autism — or vice versa — can, at times, cause someone greater distress, especially if they’re not being given the correct treatments and support.
However, there might be a link between OCD and autism, and it’s possible to have both OCD and autism. Research shows that people with OCD are more likely to be autistic than people without and vice versa.
Before learning about the possible link between autism and OCD, it can help to become familiar with the definitions of both conditions.
Obsessive-compulsive disorder (OCD) is a mental illness. Obsessions involve having distressing, intrusive thoughts that won’t go away, while compulsions are urges to take certain actions.
People with OCD participate in those compulsions not because they want to but because they feel — on some level — that it will bring them temporary relief.
Autism spectrum disorder
Autism, formally known as autism spectrum disorder (ASD), is defined as a neurodevelopmental disorder that affects how you communicate and behave.
Autism is not a mental illness, and many autistic people don’t consider it a disorder but simply a way of being that diverges from the typical.
Asperger’s syndrome is a term used to refer to a type of autism. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) does not define Asperger’s syndrome as a condition. Rather, it’s considered a part of ASD.
However, many people who fit the initial definition of Asperger’s still identify with the term.
OCD and autism are often misdiagnosed as each other. On the surface, many of the symptoms of OCD look like the symptoms of autism and vice versa.
People with OCD or autism might engage in repetitive behaviors. This can include:
- rocking back and forth
- hand flapping
In people with OCD, this is typically a compulsion. With autism, this is sometimes called stimming.
People with OCD usually don’t want to engage in their compulsions. Often, these compulsions are distressing to them, and they would like to be rid of them.
On the other hand, autistic people aren’t typically bothered by their repetitive behaviors. In fact, it can be both comforting and enjoyable for them.
These repetitive behaviors might look similar on the outside, but the function is different.
While autistic people might engage in them to self-soothe, people with OCD engage in their rituals because they are often terrified that something awful will happen if they don’t.
Many autistic people have special interests — an intense, focused interest in a topic or idea. This might be called an “obsession,” and that’s what it looks like in layman’s terms.
But when it comes to OCD, the word “obsession” means something else. Here, obsessions persistent intrusive thoughts. In other words, they think about the same idea or image repeatedly, involuntarily.
If you’re autistic, you might have repetitive thoughts, but this won’t necessarily be distressing to you. Similarly, special interests are not distressing but a source of genuine stimulation and enjoyment for autistic people.
Inflexibility in routine
People who have OCD or are autistic might find it very difficult to stray away from their routines. For people with OCD, a routine might fit in with their compulsions, or it might be a way to avoid things that trigger their obsessions.
People with OCD and autistic people might both face some social difficulties. This can include:
- high anxiety in social situations
- difficulty relating to (or interacting with) others
- difficulty expressing your thoughts and feelings
Stigma against OCD and autism can pose an added level of difficulty in social situations.
Both OCD and autism can affect the way you experience sensory stimuli. People with OCD or autistic folks can experience sensory overload — where it feels like your senses are taking in more information than you can process.
Difficulties with daily functioning
People with OCD and autistic people can both experience difficulties with day-to-day functioning. For example:
- Others may perceive them as taking “too long” to do tasks.
- They may have difficulty adapting to changes in routine.
- They may become overwhelmed or agitated because of sensory overload.
- Social stigma can make it harder for them to interact with peers.
OCD and autism can both lead to difficulties with executive function.
One of the major differences between OCD and autism is that OCD is a mental illness, and autism is not. Rather, autism is a neurodevelopmental disorder.
Many autistic people don’t consider their autism to be a disorder. Rather, they simply function differently from the majority of people.
To be diagnosed with OCD, according to the DSM-5, you’ll need to meet the following criteria:
- You experience obsessions, compulsions, or both.
- Your obsessions and compulsions cause significant distress or negatively impact your daily life.
- Your obsessions and compulsions typically take up at least an hour.
A key component of OCD is distress. Someone with OCD is directly distressed by their obsessions and compulsions and doesn’t want to engage in either.
With autism, on the other hand, repetitive thoughts and behaviors are not inherently distressing. Similarly, autistic people aren’t likely to feel upset by their rituals and routines, while people with OCD can find their compulsions upsetting.
People with OCD are likely to want to reduce or get rid of their obsessions and compulsions, as they are upsetting and interfere with their quality of life. With autism, those obsessions are likely to enhance life and be a source of enjoyment.
Yes, it seems that OCD is linked to autism — and not just because they can be misdiagnosed as one another.
Research shows that similar brain regions and pathways are involved in autism and OCD. The corpus striatum, an area related to motor function and rewards processing, can be involved in both conditions. Those with OCD and autism seem to have a larger-than-average caudate nucleus (a part of the striatum).
At present, there’s a lot we still don’t know about OCD and autism, but ongoing research may help us understand the link better.
Yes. It’s possible to have OCD and be autistic. The two conditions have high comorbidity (meaning they often occur together).
Little is known about the causes of OCD and autism. However, both seem to have a genetic component. You are more likely to have OCD if a close relation has OCD and the same with autism.
The available research, such as
Although OCD and autism are two distinct conditions, they share some similarities. Some of the symptoms of OCD might look similar to that of autism. This can lead to a professional misdiagnosing one for the other.
It’s possible — in fact, common — to have OCD and be autistic, possibly because both involve similar brain areas and pathways. However, there’s nothing to suggest OCD causes autism or vice versa.
Lastly, although both OCD and autism are stigmatized, it’s possible to have a fulfilling life with either or both conditions.
If you need support, consider reaching out to a therapist specializing in OCD, autism, or both.