Autism and OCD

OCD is a type of anxiety disorder characterised by obsessions and compulsions.

Obsessions are persistent, unwanted, intrusive thoughts or images which cause distress and affect a person’s ability to function.

Compulsions are repetitive actions which the individual completes in order to try to gain relief from the anxiety caused by the obsession.

The relief provided by compulsions is temporary, and the individual may have to repeat these compulsions numerous times. Living with OCD can cause significant distress and impairment.

Examples of obsessions include:

  • Contamination from germs
  • Worrying about harm occurring to a loved one
  • Religious obsessions
  • Thoughts of a sexual or inappropriate nature
  • Thoughts of causing harm
  • Worrying about something bad happening

Examples of compulsions include:

  • Excessive cleaning or washing
  • Checking (e.g. that the door is locked)
  • Repeating acts
  • Tapping
  • Counting
  • Ordering
  • Mental compulsions, for example counting in head or saying special words
  • Seeking reassurance
Research shows that autistic people are more likely to be diagnosed with OCD than non-autistic people. This may be because autistic behaviour can appear to look similar from the outside, even though the reasons for the behaviour are very different. However, it is also clear that autistic people are more likely to suffer from OCD, possibly because we are more susceptible to fixating on certain thoughts and struggle to let these thoughts go.

OCD obsessions and autistic hyper-fixations or special interests can be confused, but they are very different. Obsessions in OCD can cause significant distress and lead to urges to carry out compulsions to reduce anxiety. Autistic people may become distressed if they are not able to engage with their special interest or hyper-fixation, and this may interfere with expected daily functioning, but this distress is not caused by worrying or distressing thoughts.

OCD compulsions and autistic routines or behaviours can also be confused. OCD compulsions serve the purpose of reducing anxiety caused by the obsession or counteracting the obsession. Although some of these behaviours, such as ordering or repetition, may also be demonstrated by autistic people without OCD, the purpose is different. Autistic people who exhibit ritualistic behaviours usually carry out these routines quite contently. They may be a source of comfort, help them to process their day and their thoughts, and help them to navigate life. They may like things done in a certain order, so that they can process these steps properly. Tapping or counting may be a compulsion, but it could also be a stim. This is different to OCD.

It is important for autistic people receiving treatment for OCD that they are supported to distinguish between OCD-type obsessions and compulsions and autistic behaviour which they find helpful and comforting. It is important that professionals recognise these differences too and understand that repetitive behaviours may be because their autistic brain depends on familiarity or repetition and this should not be ‘treated’ or looked down upon.

CBT is usually the first-line psychological treatment for OCD. This needs to be adapted for autistic people to access this and benefit from it properly, and there are guidelines of how this can be done at OCD-UK. Autistic brains work differently, so it makes sense that treatment needs to be adapted for autistic people for it to work properly!

Connecting with others going through a similar journey can also be very beneficial. There are OCD and Autism support groups, and there are lots of communities online on social media like Twitter and Instagram where mutual support can be accessed.