Obsessive-Compulsive Disorder (OCD) and Autism Spectrum Disorder (ASD) are distinct conditions with fundamental differences in their nature and manifestation. Autism is a neurodevelopmental condition that affects approximately 1 in 100 people in the UK, whilst OCD, an anxiety disorder, impacts about 1.2% of the British population.

On the surface, there might appear to be a great deal of similarity between OCD and ASD. However, they do differ significantly from one another in terms of how they present.

To give a broad overview, autism is condition that affects executive functioning and the way in which information – or any form of input – is processed. This, in turn, can lead to difficulties in decision-making across a range of activities.

The most challenging of these is often seen in social interaction, social communication, and imagination, although the executive functioning difficulties can also make managing daily activities an uphill struggle.

OCD and its associated symptoms, on the other hand is often the result of modelling anxious behaviours to alleviate stress. These could be also caused by cognitive biases, or maladaptive beliefs seen in primary caregivers, with the typical age of onset being observed at around 19.5 years.

And this is where the confusion can often come into play.

It’s in the nature of compulsive-like tendencies seen in both conditions that can lead to them being conflated with one another. And so, that then begs the question, ‘where are there similarities, and what really sets them apart?’

Can OCD Be Mistaken for Autism?

One of the biggest behavioural overlaps between OCD and autism is the presence of repetitive behaviours. Although the underlying motivations for engaging in these behaviours differ significantly.

In OCD, these are typically driven by a need to alleviate anxiety. While in autism, these behaviours are often used to provide comfort or may perhaps even be linked to the exploring of a special interest out of pure joy or enthusiasm.

It’s not uncommon for sensory processing behaviours which are common individuals with autism, to sometimes be mistaken for OCD like compulsions. So, for example, an autistic person’s dislike and/or sensitivity to certain textures, light or sound could be confused as a OCD like compulsion to avoid contamination or escape a certain situation.

However, in reality, these sensory inputs are very distressing to the individual with autism and rather than the person gaining alleviation from anxiety through this disconnection, it’s actually physical relief that’s being sought, attempting to protect the nervous system from being overstimulated which can lead to shutdown and burnout.

Comorbidity and Behavioural Looping in OCD and Autism

Despite being distinct conditions, OCD and autism show significant comorbidity. It’s worth noting that there’s also a significant relationship between ADHD and ASD, which can further complicate diagnosis and treatment.

Did you know? Up to 17% of individuals with Autism Spectrum Disorder (ASD) may also meet the diagnostic criteria for OCD.

This overlap can complicate the diagnostic process. Another area of potential confusion is behavioural looping, present in both conditions but with different underlying causes. For those wondering if they might be on the spectrum, exploring signs of autism in adults can provide valuable insights.

Behavioural Looping: A Comparison

Autism Looping

• Serves as a form of self-soothing
• Acts as a means of self-expression
• Often operates on a subconscious level

 OCD Looping

• Designed to alleviate anxiety
• Involves compulsive repetition
• Typically more intentional and conscious

Understanding these distinctions is crucial for accurate diagnosis and effective treatment strategies for both conditions.

Key Takeaway: While behavioural looping appears in both autism and OCD, the underlying motivations and level of consciousness differ significantly between the two conditions.

Signs, Symptoms, and Traits of OCD vs Autism

One of the most important commonalities to recognise between OCD and autism is the incredible strain both can create in both interpersonal and romantic connections.

For example, OCD can create difficulties due to the time required to maintain the rituals necessary to alleviate anxiety. Autism, on the other hand, mainly presents challenges in the forming and maintaining of relationships due to the difficulties in social communications and the understanding of unwritten rules which can lead to social faux pas.

And whilst both conditions place their own unique strain on relationships of all types, the outcome can often be the same. And that is, social isolation, which is sponsored by shame and fear of being called out.

In OCD, this might be due to the need to maintain rituals at the expense of maintaining a relationship, fearing that if they’re not upheld, then any number of ‘catastrophes’ might occur.

Whereas with ASD, this isolation might be more rooted in shame due to the misunderstandings within social circles and peer groups, which can lead to a lack of acceptance and feeling lost in a crowd of people.

OCD vs Autism Symptoms

• Intrusive Thoughts vs. Preoccupation Challenges: One of the defining features of OCD is intrusive thoughts, which create stress and anxiety. These often contrast, with an individuals personal values. In contrast, autism involves intense preoccupations with special interests that typically enjoyable are comforting rather than distressing. These differences are sometime more difficult to spot in high-functioning autism, where symptoms may be more subtle.
• Cognitive Flexibility vs. Neurological Differences: OCD is often associated with cognitive rigidity due to learned responses to environmental stressors. While on the other hand, the thinking styles seen in autism are actually due a fundamental difference in the neurological structure of the brain.
• Social Withdrawal vs. Interaction Challenges: Within OCD, episodes of social withdrawal might often be pre-planned and stem from self-imposed time constraints and the upkeep of rituals. In autism, these withdraws more typically result from reaching a certain level of capacity for interaction or sensory sensitivities.

How is OCD Rituals Different from Autism Routines?

To create further separation between OCD and autism, it’s helpful look at them through the lens of rituals and routines. While both are similar, they serve different functions in the context of each condition. The repetitive ritualistic behaviours in OCD are intended to prevent a feared outcome. While the routines of autism are habitual sequences of action that provide structure and predictability.

Key Differences in Repetitive Behaviours

Purpose and Flexibility

• OCD Rituals:
  • Specific intent to prevent feared outcomes
  • May be altered if believed to prevent harm
  • Example: Repeatedly checking locks to prevent break-ins
• Autism Routines:
  • May lack specific purpose beyond self-regulation
  • Resistance to changes due to discomfort with unpredictability
  • Not typically rooted in fear of specific consequences

Sensory Aspects

OCD compulsions primarily aim to relieve anxiety, while autism routines often involve soothing or stimulating sensory input.

Did you know? Up to 70% of individuals with autism experience sensory processing issues, which can significantly influence their repetitive behaviours and routines.

Flexibility in Routine Changes

Individuals with autism often resist changes to their routines due to a general discomfort with unpredictability and a need for sameness. In contrast, those with OCD may show a different kind of flexibility, altering rituals if they believe doing so will prevent harm.

Is OCD on the Neurodivergent Spectrum?

Traditionally, OCD has been classified as anxiety disorder, as it focuses on symptoms of intrusive thoughts which lead to compulsive behaviours. However, some research has shown that individuals with OCD actually do have differences in their brain structure and function.

So you could technically classify someone with OCD as being neurodivergent, despite it not being an official diagnostic classification.

And in a world where OCD is often greatly misunderstood to the extent of being unfairly stereotyped, bringing in bringing the language of neurodivergence isn’t necessarily a bad thing and could actually help people come to terms with their behaviours.

This doesn’t mean to say that people with OCD should view their behavioural tendencies as a neurodivergent gift, but it could help facilitate a deeper acceptance of the condition, both in the individuals themselves and within the wider public, helping with the normalisation and destigmatising the condition at whole.

OCD vs Autism in Different Demographics

Like many mental health disorders, OCD and ASD manifest not just differently from person to person, but across various different demographics, with key variables often being age, gender, cultural background and socioeconomic status in particular.

For example, in children, OCD, might present with more overt compulsions, which could include: excessive hand washing, checking things are in order.

While in autism, the earliest signs of onset are seen a delay in language development and other other cognitive functions, which might lead to inhibitions in social settings, school and other activities related specifically to executive function. Understanding these early signs can help in supporting someone with autism throughout their life.

Gender differences can also play a significant role, not only in how each of these conditions manifest, but how they’re recognised and diagnosed by professionals. Generally speaking, males are more likely to be diagnosed with autism, as they often present with far more obvious symptoms.

Females, on the other hand, often become highly adept at masking their autistic traits at an early age and so are far more prone to under diagnosis or misdiagnosis. Although, in OCD, while the prevalence and diagnosis of the condition is reasonable equal, the content of the obsessions and compulsions is far more likely to vary.

OCD vs Autism in Adults: Manifestation and Challenges

The greatest value to be found when examining any condition is by looking at how the symptoms actually play out in a real-world scenario. It makes them more tangible and relatable. Let’s take a closer look at how both OCD and ASD manifest in adulthood:

OCD in Adults: Manifestations and Challenges

• Perfectionism and Control Issues: Due to the overwhelming tendency to maintain control, adults with OCD might struggle perfectionism in their personal and professional lives. This can lead to a lack of productivity and decision paralysis.
• Intrusive Thoughts and Compulsions: As the persistent thoughts and compulsions in OCD are involuntary reactions to long-held stress or trauma in the body, these narratives can cause consistent disruptions in creative lines of thinking as well as problem-solving.
• Social Interaction Strain: If there is a consistent habit of leaving social gatherings early with what appears to be little or no explanation, over time, this may lead to exclusion from peer groups leading to further shame and guilt surrounding the condition.
• Avoidance Behaviours: The continual playing out of avoidance behaviours in personal and professional settings can lead the assumption of an individual being apathetic or unreliable, limiting potential opportunities.
• **Emotional Regulation Difficulties:** The intense anxiety and distress that arises from intrusive thoughts can lead to profound nervous system dysregulation, which can in turn limit cognitive function and decision-making process.

Autism in Adults: Manifestations and Challenges

• Social Cue Interpretation: The struggle to interpret social cues in adults with autism can lead to difficulties understanding social cues, which affect their ability to form long-lasting and meaningful relationships.
• Adaptation to Change: Due to the reliance on predictability and routine, any sudden change in plans can leave adults with autism feeling caught off-guard and struggling to adapt. This can lead to a continual dissatisfaction with life and never quite feeling settled.
• Communication Style Differences: The inability to recognise non-literal expressions of humour such as sarcasm, as well as being unable to feel when they might be oversharing, can lead a sense of isolation in social situations in autistic individuals. Some may engage in scripting as a communication strategy.
• Reliance on Routines: While routines can be extremely liberating for an autistic individual, they can also be limiting if they’re disrupted. Any small change in a routine or schedule might have the potential to create overwhelm.
• Special Interests: While special interests can be a great source of joy and comfort to an autistic individual, they can also make it challenging to relate to other people’s life and remain present with what they might perceive as small talk.