OCD and Autism: Understanding the Difference

On the surface, autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) can look similar. While both diagnoses commonly co-occur, they are distinct diagnoses that come with unique experiences. Many people find it difficult to distinguish between OCD and autism because of their shared traits, as well as widespread misinformation about both diagnoses.

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Understanding where ASD and OCD overlap and diverge is invaluable. This knowledge allows individuals to seek relevant, tailored support and clinical providers to make appropriate diagnoses.

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Read on to learn more about autism, OCD, and their similarities and differences.

Autism spectrum disorder is considered a neurodevelopmental disorder. It affects an individual’s cognitive and sensory processing, communication and social approaches. Autistic individuals also tend to experience heightened sensitivity to sensory stimuli and process information in ways different from neurotypical people. Additionally, autistic people often do not find neurotypical social styles intuitive. They may communicate more directly and interpret social cues differently than others. Because autism occurs along a spectrum, it encompasses a wide range of characteristics, experiences and support needs.

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Autistic individuals are inclined towards repetition. They tend to thrive with routine and sameness, often struggling when situations don’t unfold as expected or planned. Many autistic people engage in repetitive behavior, such as arranging or manipulating objects, repeating the same phrases or words and other limited, repeated actions.. These behaviors are often considered stims, a way autistic people self-regulate the sensory input they receive. Many individuals with autism also have special interests and can sustain deep focus when their interests are engaged. 

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On top of engaging in repetitive behaviors, autistic people also tend to exhibit:

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• Strong logical, principled thinking styles
• A preference for direct communication
• Great attention to detail
• Robust pattern recognition skills

Obsessive-compulsive disorder is a mental health condition characterized by involuntary, unwanted thoughts, known as obsessions, and repetitive behaviors, termed compulsions.

Obsessions are unwanted and deeply distressing for people with OCD. The nature of obsessions can vary across individuals. Some examples of OCD obsessions are:

• Fear of contamination/germs
• Fear of forgetting to check something important
• Needing things to be “just right,” perfectly symmetrical or in a specific order
• Inappropriate or socially taboo thoughts, including fears of hurting oneself or loved ones
  
  

Compulsions are typically a direct response to obsessions, aiming to neutralize or cancel out the anxiety and distress that obsessions bring. For example, someone with OCD may carry out a compulsion because they think it will prevent harm to themselves or others. It’s often extremely difficult *not* to engage in a compulsion. 

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For those who experience obsessions around germs, compulsive behavior can include excessive handwashing, cleaning, or other hygiene rituals. People with obsessions concerning dangers to their homes may compulsively check locks, appliances and power outlets. 

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Other common compulsions include:

• Counting
• Repeating words or movements
• Arranging objects in a certain way

Many compulsions manifest as rituals––either physical, mental, or both––that individuals engage in when their obsessions are triggered. Compulsions may provide temporary relief from the anxiety that obsessions cause, but they ultimately fuel the obsessions and perpetuate the cycle of OCD.

People with OCD spend a significant amount of time on their obsessions and compulsions, and they often experience great difficulty in their daily lives because of them. However, appropriate treatment can significantly improve symptoms. 

ASD and OCD have key similarities, including:

• Genetic and neurobiological markers: Research points to shared genetic and neurobiological markers between both diagnoses. Some of these markers might be connected to overlapping behaviors across the two.
• Repetition: Autistic individuals and those with OCD both experience repetitive behaviors and recurring thoughts. 
• Inflexibility: Both groups tend to demonstrate inflexible thinking and adhere to set routines; they can experience great difficulty deviating from established norms and behaviors.
• Sensory sensitivities: Both OCD and autism are also associated with heightened sensory sensitivity, and individuals with either diagnosis can be susceptible to sensory overload.
• Impact on functioning: All of these traits can have significant effects on both an autistic person as well as an individual with OCD's ability to function and perform the way they are expected to at work, school, or home. Both disorders can also impact relationships. 
• Prevalence of co-occurring disorders: Autism and OCD also co-occur with certain mental health diagnoses (such as depression, anxiety, social anxiety, and ADHD) at higher rates than among individuals without these diagnoses. For example:some text
  • Around 25-50% of people with OCD have depression, and up to around 56% have an anxiety disorder. 
  • Around 42% of autistics have anxiety, and 32% have depression. 
  • Social anxiety co-occurs with OCD at a rate between 18 and 42%, and as many as half of autistic individuals have social anxiety.
  • Between 50 and 70% of autistic people have ADHD, and 8.5% of adults with OCD also have ADHD, compared to 6% of adults broadly.
• Long-term outcomes: While autism and OCD differ in how they present over a lifetime—autism is a lifelong diagnosis, while OCD is chronic but can subside with treatment—both diagnoses can see positive long-term outcomes. Robust support options are available for both diagnoses, which can help individuals manage the challenges of each diagnosis and live fulfilling lives.

Autism and OCD have many outward behaviors in common, but there are a few key differences since each group has different internal experiences with shared behaviors.

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Differences in classification

Autism and OCD are categorized as different types of diagnoses. Autism is a neurodevelopmental disability, meaning it is associated with inherent differences in neurological functioning that are present from birth. OCD, on the other hand, is a mental health condition. Unlike neurodevelopmental disabilities, which are lifelong, some mental health conditions can last for shorter durations or can come and go over time.

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Differences in repetitive behaviors  

Both autistic individuals and people with OCD tend to exhibit repetitive behaviors, but they are driven by different motivations. Many autistic people exhibit repetitive behaviors such as stimming because they feel pleasurable or soothing. Stims are different from compulsions, which people with OCD engage in to manage the distress caused by their obsessions. 

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Individuals with OCD may feel their compulsions prevent negative events related to their obsessions. For example, a person with OCD may repeat certain words or phrases because they feel doing so will stop something bad from happening. An autistic person, on the other hand, may stim by repeating certain words or phrases, but might do so because they enjoy the way it feels to move their tongue, lips and vocal cords to produce those sounds. 

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Some autistic individuals stim to relieve distress from experiences like sensory overload. However, stimming is not always a distress response, and it is common for autistic people to stim when they feel happy or when they are seeking sensory input.

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Compulsions also differ from stimming in that they typically feel difficult to control or resist. Sometimes, stims can feel automatic or involuntary, but many autistic people stim on purpose because it feels enjoyable or calming.

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Differences in socializing 

Additionally, many characteristics and experiences that are common among autistic individuals are not present in non-autistic people with OCD. While both groups may experience social differences, since OCD behaviors are often stigmatized and can cause some individuals to self-isolate, autistics experience difficulty deciphering social norms and cues, which is not a feature of OCD. Autistic people also tend to exhibit other traits, like communication differences or literal and detail-driven thinking, which are not diagnostic criteria for OCD.

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Differences in age of onset

Another difference between OCD and autism is the age of onset. Autistic individuals are born with autism. It can be diagnosed as early as infancy, around 18 to 24 months. OCD can pop up anytime throughout a person’s lifetime. Most commonly, OCD emerges during childhood or adolescence. On average, children with OCD are diagnosed between the ages of 9 and 11. Although OCD tends to first emerge between childhood and young adulthood, it can sometimes go undiagnosed well into a person’s adulthood, like autism.

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Differences in treatment goals

Autism and OCD are both very treatable, but treatment for each diagnosis is structured around very different goals. OCD treatment aims to reduce the frequency and intensity of obsessions and compulsions, resulting in lower levels of chronic distress and anxiety. Treatment for autism tends to focus less on changing autistic traits and more on building coping and self-advocacy skills. As a result, autistic individuals can identify and secure accommodations as well as manage common experiences like sensory-related distress.   

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A psychologist or psychiatrist can diagnose both autism spectrum disorder and OCD. These diagnoses are based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). There are a few key differences in the diagnosis process.

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How autism is diagnosed

A clinical interview is the main component of an autism assessment, though clinicians often ask individuals to complete questionnaires as part of the process, too. These screening tools focus on sensory and social differences an individual may have experienced throughout their life.

Autism assessments may also incorporate interviews with an individual’s loved ones––especially those who knew the individual during their early childhood––since autistic traits typically emerge early in life. This can help paint a clearer picture of the individual’s symptoms throughout their life. 

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How OCD is diagnosed

Through clinical interviews and questionnaires, a mental health professional will assess the severity of someone's obsessions, compulsions and anxiety. They may ask how many hours a day an individual spends thinking about obsessions and engaging in compulsions, as well as how the obsessions and compulsions impact their quality of life and functioning. Interviews with loved ones or family members aren’t necessary for an OCD diagnosis.

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Discerning between ASD and OCD

During an evaluation for either diagnosis, providers may ask questions to rule out other conditions contributing to the traits under review. This can be especially important in differentiating between autism and OCD. For example, questions in an assessment for OCD may ask about repetitive behavior, but without digging deeper into those behaviors and the motivations behind them, one could misread an autistic individual’s traits as a sign of OCD. 

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Sometimes, these questions are not part of the clinical interview, leaving room for misdiagnosis. For individuals who are not sure whether they might be autistic or have OCD, it’s best to seek evaluations from a clinician with training and experience working with autistic people.

Autism and obsessive-compulsive disorder are both primarily treated through therapy––although the approaches are very different. Autistic individuals, as well as people with OCD, can see great improvements in quality of life through consistent work with a neurodiversity-affirming therapist who specializes in their diagnosis.

Therapy for autism 

Psychotherapy, also called talk therapy, is the most common form of treatment for autism. A number of clinical approaches may be used, depending on one’s individual needs. Research has shown that cognitive behavioral therapy (CBT), a therapeutic approach that helps people examine patterns of thinking that are harming their well-being, can be effective at helping autistic people.

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Therapy for autistic people often centers on developing coping and self-advocacy skills that help an individual navigate common challenges. Typical areas of focus can include: 

• Masking and unmasking
• Coping with sensory overload and overstimulation
• Communicating one’s needs and experiences
• Managing and preventing meltdowns
• Connecting with neurodivergent peers and communities
• Understanding the strengths that come from being neurodivergent

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Psychotherapy can also help autistic individuals with mental health diagnoses that commonly co-occur with autism, like anxiety and depression.

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Therapy for OCD

A specific type of CBT called exposure and response prevention therapy (ERP) is often referred to as the gold standard for OCD treatment due to its efficacy. Around 80% of individuals with OCD report an improvement in their symptoms after undergoing ERP.

ERP involves gradually introducing stimuli that trigger an individual’s obsessions. This is done in a controlled, safe environment with the support of a therapist, who works with the individual to help them avoid the compulsive behaviors they would normally perform. 

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Medication for autism and OCD

In addition to therapy, both autistic individuals and people with OCD can benefit from treatment with antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). Research demonstrates that SSRIs can help reduce OCD symptoms, improving individuals’ quality of life. SSRIs also treat symptoms of anxiety and depression, which are widespread across autistic individuals, individuals with OCD or those with both diagnoses—although the impact of SSRIs to treat both conditions simultaneously has not been studied at length.

If you think you may be autistic, Prosper Health can help you find answers and the support you need. Prosper Health provides telehealth autism assessments that are covered by insurance and specifically for adults. 

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For many autistic individuals, as well as those with OCD, a diagnosis is a meaningful step towards more deeply understanding their experiences and identifying their needs for support. If you think you have OCD, it’s important to work with a provider who specializes in OCD and practices ERP. 

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For autistic individuals or those with both an autism and OCD diagnosis, therapy is an essential resource to support individuals in managing day-to-day challenges. Prosper Health therapists are neurodiversity-affirming and specialize in working with autistic adults, supporting clients in meeting their individual goals for their well-being.