OCD vs. Autism: What You Need to Know

Obsessive-compulsive disorder (OCD) and autism share similar traits. These overlapping behaviors can make it difficult to identify OCD vs. autism.

For example, individuals with OCD can have a strong desire for order and repetition or an intense focus on details. Autistic behaviors can include a desire for a structured routine and repetitive movements, such as rocking or flicking fingers.

While healthcare providers can usually distinguish between autistic behaviors and OCD, it is also possible to have both. In fact, studies show 17% of people with autism also have OCD, and 25% of people with OCD also have autism.

This article takes a look at OCD vs. autism. It explains the overlapping symptoms and differences between OCD and autism.

What Is OCD?

OCD is a long-lasting mental health condition with time-consuming symptoms. The key features of OCD include:

• Obsessions: Repetitive thoughts, mental images, or urges that are intrusive, unwanted, and make most people anxious. 
• Compulsions: Repetitive behaviors a person feels compelled to do, often in response to an obsession.

While most people experience repetitive thoughts or behaviors at times, they do not usually rise to the level of OCD.

According to the International OCD Foundation, obsessions and compulsions:

• Feel outside of the person’s control
• Cause distress, intense fear, disgust, or doubt
• Can take up more than one hour a day and interfere with other important activities
• May cause significant problems in a person's ability to function in daily life

In most cases, people with OCD realize that these thoughts don’t make any sense and find them disturbing. Additionally, the compulsions do not provide pleasure but can provide temporary relief from anxiety.

How OCD Symptoms Are Different From Autism Symptoms

One feature of autism is restricted interests and repetitive behaviors. This can look like:

• Being overly focused on specific topics
• Getting upset by slight changes in a routine
• Having lasting and intense special interests
• Having difficulty transitioning from one activity to another
• Repeating certain behaviors, such as rocking, hand flapping, or other stims
• Repeating words or phrases, known as echolalia

While autism and OCD can look similar in this regard, the main difference is how the individual feels about these thoughts and behaviors.

People with OCD are usually uncomfortable with their symptoms and would like to be rid of them. Autistic people, on the other hand, may not bothered by their obsessions. In fact, they may embrace them or find them soothing.

Autistic people also have a range of other social, language, and cognitive differences not seen in people with OCD.

How Obsessive Behaviors Are Treated

OCD is treated with medications, psychotherapy, or a combination of the two. Obsessive or repetitive behaviors in autism, on the other hand, do not always require treatment.

Medication

OCD is treated with a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Common SSRIs used to treat OCD include:

• Celexa (citalopram)
• Luvox (fluvoxamine) 
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

Repetitive behaviors in autism are treated with medications from different classes. Research shows these medications are often helpful:

• Buspar (buspirone), an anti-anxiety medication
• Depakote (divalproex), an antiseizure medicine
• Intuniv ER (guanfacine), a blood pressure medication also used to treat ADHD
• Luvox (fluvoxamine), an SSRI

Other SSRIs are often poorly tolerated in people with autism. Additionally, there is limited evidence to show they are effective in relieving repetitive behaviors, anxiety, or depression.

Therapy

Therapies used to treat OCD include cognitive behavioral therapy (CBT) and exposure and response prevention therapy (ERP). 

In people with severe OCD who do not respond to conventional treatment, a treatment known as repetitive transcranial magnetic stimulation (rTMS) may be used. This noninvasive therapy uses a magnet to deliver repeated low-intensity pulses to stimulate a particular part of the brain.

For people with autism, behavioral therapy for OCD will depend on the age and IQ or functional cognitive level. It may start with applied behavior analysis (ABA), considered the "gold standard" of care for younger kids and those with higher support needs.

Naturalistic developmental behavioral interventions (NDBI), or naturalistic ABA, may also be helpful for treating OCD in people with autism. NDBI is child-led and involves shared control between the child and the therapist.

Naturalistic ABA applies different behavioral strategies in real-world settings to teach developmentally appropriate skills and natural contingencies. Studies show people with OCD benefit from naturalistic treatment approaches.

Other therapies used to help people with autism and OCD include:

• Autism-adapted cognitive behavioral therapy (aCBT)
  
• Occupational therapy (OT)
• Speech-language pathology (SLP) therapy
  

More traditional talk therapy may be used in older, brighter, and/or more verbal children with autism. While people with autism do not always respond well to standard CBT treatment, an adapted CBT approach can be beneficial.

Medication and behavioral therapy work together. Medication alone is seldom the answer, but medication can help a child become more “available” for behavior-based interventions.

Behavioral therapy can be challenging at times as some autistic children may not perceive their obsessions as intrusive or unwelcome—unlike people with OCD.

Summary

Autism and OCD share overlapping traits that can be hard to differentiate. The primary difference in OCD vs. autism is how the person feels about the behaviors. People with autism find repetitive behaviors like rocking, hand-flapping, tapping, and focusing on special interests soothing. Repetitive thoughts and ritualistic behaviors in OCD cause distress. Additionally, autistic people also have many social, language, and cognitive differences not apparent in people with OCD.

It is also quite common to have both OCD and autism, which requires a specialized treatment approach. OCD is treated with SSRI medications and therapies, like CBT and exposure therapy. However, people with autism do not typically respond well to either CBT or SSRIs. 

OCD treatments for people with autism include a modified approach to CBT, naturalistic ABA, and OT. Medications used to manage both repetitive behaviors and OCD in people with autism include Buspar, Depakote, Intuniv, and Luvox.