Here is an exciting guest blog post written by my local colleague Dr. Bethany Walker. Dr. Walker loves to help clients process and manage OCD symptoms, and she wrote this blog to help explain how OCD and autism are related. Dr. Walker works with clients over telehealth, and if you are interested in learning more about her and her practice, her contact information is at the end of this post!
What is OCD?
People who have Obsessive Compulsive Disorder (OCD) experience obsessive or intrusive thoughts, images, or urges, which cause intense distress. People with OCD do compulsive behavior to decrease this distress and/or get rid of the obsessions. These symptoms take up a lot of the person’s time (more than an hour per day), are distressing, and interfere with the person’s life.
The onset of OCD typically occurs during middle childhood (age 8-12 years) or between the late teen years and early adulthood. Symptoms of OCD worsen over time as a result of a cycle of negative reinforcement. When the person does compulsive behavior, they feel better in the moment. This quick relief has the unintended consequence of making the person more likely to repeat the compulsive behavior in the future. This erodes the person’s confidence in their ability to cope without doing compulsive behavior and leaves them more distressed about their obsessive thoughts and the situations that trigger them.
- International OCD Foundation. OCD and Autism Resource Center. https://iocdf.org/autism/
- Spectrum News. Untangling the Ties Between Autism and Obsessive Compulsive Disorder. https://www.spectrumnews.org/features/deep-dive/untangling-ties-autism-obsessive-compulsive-disorder/
- I’m Autistic with OCD. Here’s How My Therapist and I Made ERP Work For Me. https://www.treatmyocd.com/blog/im-autistic-with-ocd-heres-how-my-therapist-and-i-made-erp-work-for-me
Restricted, repetitive behaviors and interests vs. obsessions and compulsions.
Features of OCD and autism may appear similar. For example, memorizing train routes and schedules, having a rigid morning routine, and straightening up objects on a shelf could all be features of OCD or autism. Understanding more about the person’s thoughts and emotions, as well as the onset and course of their experiences can help clarify the difference. Each person’s experience is unique, but here are some common differences between OCD and autism.
|Factors||Common in OCD||Common in Autism|
|Thoughts||Recurrent thoughts or images that are experienced as unwanted, intrusive, distressing, disturbing, and/or illogical.||Deep interests in a narrow subject that may be perceived as unique or even odd to others but are experienced as enjoyable and intriguing to the individual.|
|Content of thoughts||Common themes are: contamination, perfectionism, responsibility, violence, religious, sexual.||The focus or topic of these special interests is highly individualized.|
|Emotions||Intense anxiety and distress; other difficult emotions such as disgust, fear, or shame are also common.||Highly variable for each autistic person. Moments of intense emotional distress may be linked to triggers such as sensory sensitivities.|
|Behaviors||Compulsive behaviors may or may not be repetitive in nature.||RRB’s can include stereotyped or repetitive movements (e.g., stimming), repetitive speech, rituals, insisting on sameness,|
|Function of Behavior||Compulsive behavior serves the function of providing quick, but temporary relief from emotional distress.||RRB’s serve functions such as self-soothing, self-stimulation, or self-regulation.|
OCD and autism can also co-occur.
While more research is needed to understand how common this is, it is generally accepted that OCD is more prevalent among autistic people than in the general population. Research shows that OCD and autism have genetic and neurobiological factors in common, which may help explain their co-occurrence.
OCD treatment for autistic people.
Research shows that the gold standard treatment for OCD, called Exposure and Response Prevention (ERP), can be effective for autistic people with OCD. It is helpful to find a psychologist or therapist with expertise in both OCD and autism so treatment can be appropriately tailored to fit the needs of the individual. As outlined above, features of OCD and autism can appear similar. Therefore, it is important for therapists to distinguish between symptoms of OCD and aspects of an individual’s identity that perhaps are at odds with neurotypical norms at times, but are not pathological.
About the author.
Dr. Bethany Walker is a licensed clinical psychologist located in Glenview, IL. She is the owner of Boldly You Psychotherapy, and she specializes in the treatment of OCD and anxiety. She has training and experience working with autistic and neurodiverse children, adolescents, and adults. If you are looking for a therapist, please feel free to contact Dr. Walker at firstname.lastname@example.org or 847-231-2399.
Dr. Jessica Myszak and Dr. Jaime Long have significant experience performing psychological evaluations with children and adults. They offer both in-person and telehealth evaluations for children, teens, and adults looking for answers. In addition to seeing clients on the Chicago North Shore, they are able to work with families who reside in Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Virginia, Washington, Washington DC, West Virginia, Wisconsin, and Wyoming! Dr. Long is also available to see clients in California! If you are interested in learning more about potentially working with them, you can visit their website here to get the process started.