Do you rock back and forth or flap your hands when feeling anxious? Do you have trouble forming and maintaining relationships? Or are you experiencing an obsession with something or someone?
These symptoms can often align with the mental health conditions Asperger’s syndrome and obsessive-compulsive disorder (OCD), which is why it isn’t too surprising that they’re frequently misdiagnosed for one another. According to research, many of their symptoms overlap, making it difficult for some healthcare professionals to differentiate the two conditions.
Before we go further, it’s important to note that the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) no longer considers Asperger’s a separate mental health condition but rather a part of the autism spectrum.
Despite this change, many people who were initially diagnosed with Asperger’s syndrome still prefer to identify with the term. “I have two kids with it, and it perfectly fits what they have,” says Tracie Zinman-Ibrahim, MA, LMFT, CST, Chief Compliance Officer at NOCD. However you prefer to identify it is up to you—but for the purposes of this article, we’ll stick with autism.
If you think you have autism, OCD, or a combination of the two, keep reading to learn about their similarities, their differences, and how treatment can help you manage symptoms.
Wondering if you might be autistic, have OCD, or both? We can help.
What is OCD?
Before we dive into the relationship between OCD and autism, let’s get a solid overview of what these mental health conditions are.
Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by a cycle of obsessions and compulsions. Obsessions are intrusive thoughts, images, urges, sensations, and feelings that can cause fear and anxiety. Common obsessions include a fear of getting sick, questioning your sexuality, or having violent thoughts about harming yourself or others.
Compulsions are repetitive physical or mental behaviors performed to get rid of the distress obsessions can bring, or to prevent a feared thing from happening. Some examples of compulsions include seeking reassurance that your obsessions are valid, mentally reviewing past events to see if you’ve done something wrong, or excessively cleaning or organizing.
What is autism?
Autism is a wide range of neurological and developmental conditions affecting how people learn, behave, and socialize.
While autism can present differently for everyone, some common traits include:
- Repetitive behaviors and routines
- Trouble managing emotions
- Sensory issues, such as hypersensitivity to light or sounds
- Obsessions within certain topics
- Difficulty socializing with non-autistics
- Issues with motor skills and coordination
What are the similarities and differences between OCD and autism?
OCD and autism have a few similarities, but they are vastly different. Let’s compare the symptoms that are most similar between these two mental health conditions.
Repetitive behaviors
Both autism and OCD can cause repetitive behaviors, such as:
- Rocking back and forth
- Hand flapping
- Shaking
- Pacing
- Drumming fingers
- Jiggling foot
- Tapping pencil
The reasons why these behaviors are performed are different for both conditions. People with OCD will perform compulsions to get rid of distress from intrusive thoughts or to stop something bad from happening.
When it comes to autism, these repetitive behaviors are known as self-stimulation or stimming. According to Zinman-Ibrahim, stimming is a response to being overstimulated or experiencing sensory overload—which can cause stress and heightened anxiety.
“I have someone in my group with autism, and he was in his room with the lights dim, and his mom came in and flipped the light on,” she says. “He got up, ran to another room where the light was off, shut the door, locked it, and stayed there.”
Stims can also be done in response to a variety of emotions or as a result of understimulation, where a person needs extra sensory input.
Obsessions
Autism and OCD can also cause obsessions, but not in the same sense.
People with autism can hyper-fixate on something to the point of obsession, but Zinman-Ibrahim notes that instead of causing distress, it can bring a lot of excitement. “I had a patient with autism, and he was really into sharks and boats, and he would delightedly spend as long as you let him talk about them,” she explains. “He wasn’t like, ‘Oh no, I’m tortured by these things.’ He was excited and wanted to absorb more information about them.”
This is the total opposite of OCD, where obsessions are unhealthy and can cause a lot of distress and anxiety. Instead of wanting to hyper-fixate on the disturbing thought, people with OCD would much rather figure out a way to get rid of it—which is where compulsions come in.
Anxiety
Anxiety is a common symptom of OCD and autism. According to Zinman-Ibrahim, when someone with autism is overstimulated or has sensory overload, they can feel overwhelming anxiety. With OCD, a person’s obsessions may cause them to feel very anxious, which is why they perform compulsions to get rid of them.
Can you have Asperger’s and OCD?
Yes, you can have both OCD and autism at the same time, as they often co-occur together, notes Zinman-Ibrahim. “People who have autism are twice as likely to be diagnosed with OCD at some point in their life,” she says.
Is there a connection between OCD and autism?
We don’t fully understand the relationship between OCD and autism. Research suggests that both conditions affect the same part of the brain, known as the corpus callosum. But even with this evidence, more research is needed to get the complete picture of the link between these mental health disorders.
Living with OCD and autism
Regardless of whether you believe you have OCD, autism, or a combination, there are interventions available to help you manage your symptoms.
Here’s a look at treatment for OCD as well as ways to support autism.
OCD treatment
If you have (or think you have) OCD, your best bet for getting a handle on your intrusive thoughts and compulsions is by going through exposure and response prevention (ERP) therapy. ERP is a specialized therapy considered the first-line OCD treatment as it’s supported by decades of research showing its effectiveness. The goal of this OCD therapy is to give you the tools to overcome intrusive thoughts without performing compulsions.
ERP comprises two components: exposures and response prevention techniques. In a typical session, a therapist specializing in ERP will carefully and gradually expose you to your triggers. Then, you’ll learn response prevention techniques to help you refrain from doing compulsion in response to those triggers.
While we can’t guarantee that ERP will get rid of intrusive thoughts entirely, if you can stay consistent with your sessions, it’s likely that you’ll see improvement in your symptoms and regain control of your life from OCD.
Support for autism
There are several therapies available to help manage symptoms of autism, including:
- Cognitive behavioral therapy (CBT)
- Language and speech therapy
- Social skills training (SST)
- Mind-body therapies
- Family support
- Physical therapy
- Occupational therapy
- Sensory-based interventions (SBIs)
According to Zinman-Ibrahim, no specific medication is prescribed to treat autism. However, because it often co-occurs with other conditions, medication may be part of the treatment plan to treat symptoms of those conditions. ADHD, for example, commonly co-occurs with autism, so a person may be taking medications for this condition alongside their therapies.
Accommodations can also be made for people with autism. “If they’re in a school environment and need certain types of accommodations, getting an Individualized Education Program (IEP) at the school or a 504 plan for college can help,” says Zinman-Ibrahim. Both IEP and 504 plans outline how a school will support a child with autism or any mental disability to access public education.
Can you treat OCD in Autistic people?
Yes, both conditions can be treated at the same time, but accommodations are necessary to ensure the patient is comfortable during therapy sessions. “I had somebody who was very sensitive to light to the point that they would always wear sunglasses—even inside,” says Zinman-Ibrahim. “I would have to dim my lighting when he would enter my office so that he’d be comfortable taking his sunglasses off. I would also speak more quietly because he became overstimulated with loud voices.”
OCD and autism are common mental health conditions that many people are managing each and every day. If you think you have one or both of these conditions, please reach out to a therapist or your primary healthcare provider. They can walk you through the diagnosis and treatment process so you can learn how to manage your symptoms.
