Autism and Obsessive Compulsive Disorder: Similar But Different

Autistic behaviors may look similar to OCD, but there is a critical difference

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Obsessive Compulsive Disorder (OCD) is often misunderstood to be a condition in which individuals have a strong desire for order and repetition, or an intense focus on details. As a result, many people believe that autistic behaviors and preferences are a sign of OCD.  But autistic behaviors such as rocking or flicking fingers -- or a desire for a structured routine -- are actually quite distinct from the very specific qualities of OCD.

What Is OCD?

As the International OCD Foundation describes it:

Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense.  Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values. This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.

So, while there is overlap between the signs of OCD and the signs of autism, there are distinctive differences.


How Are OCD Symptoms Different from Autistic Symptoms?

People with ASD frequently have intensely repetitive thoughts and behaviors, much like those seen in persons with Obsessive Compulsive Disorder (OCD). But people with OCD usually feel uncomfortable with their symptoms, and would like to be rid of them, whereas people with ASD usually are not bothered by their obsessions, and in fact may embrace them.

People with autism spectrum disorders also have a range of other social, language, and cognitive differences not seen in people with OCD.

How Are Autistic Obsessive Behaviors Treated?

There are two forms of treatment for repetitious behaviors in ASD: medication, and behavioral therapy. The most commonly prescribed medications are the selective serotonin reuptake inhibitors (SSRIs). The use of SSRIs to treat obsessions in ASD in children is not an FDA-approved indication, but there are good clinical research data to show that these medications work very well in a large number of cases.

Behavioral therapy will vary, depending on the child’s age and IQ or functional cognitive level, starting with applied behavior analysis for younger and/or lower functioning children, and moving on to more traditional talk therapy in older, brighter, and/or more verbal children.

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

Behavioral therapy is difficult, however, because children with ASD do not perceive their obsessions as intrusive or unwelcome -– unlike people with OCD.

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