Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Do autistic people have obsessions? What therapists say

By Erica Digap Burson

Nov 30, 2023 • 10 min read minute read

Reviewed byApril Kilduff, MA, LCPC

It’s a question that patients and parent figures alike look for answers to: Is it common for autistic people to have obsessions? 

Autistic people may demonstrate a focus on having things a certain way, or give a lot of attention to a certain thought, subject, or activity. This intense focus and dedication may sometimes be casually referred to as an obsession. However, the term “obsession” is not necessarily correct here, especially when we are looking at the clinical definitions. 

In this article, we’ll discuss the differences between the “obsessions” that autistic people may have versus the clinical use of the term that is used in obsessive-compulsive disorder (OCD). We’ll also talk about some of the overlaps, plus what options you have if you are experiencing true obsessions. 

While autism will look different from person to person, it’s true that many autistic people have very specific fixations. When it comes to certain subjects or ideas, autistic people can become hyperfocused and completely absorbed in whatever it is that interests them, often to the point that it is hard to draw them away from it. Because this focus can be so intense, some people may colloquially refer to it as an “obsession.”

However, it’s important to note that these “obsessions” that autistic people may have are not obsessions at all, at least not in the clinical sense. 

Clinically speaking, obsessions are one of the cornerstones of obsessive-compulsive disorder (OCD). OCD is a condition that is largely defined by the presence of obsessions, with the word having a very particular meaning in this regard. 

According to the Diagnostic and Statistic Manual of Mental Disorders, Fifth Edition, obsessions are “recurrent and persistent thoughts, urges or images that are experienced, at some time disturbing the disturbance, as intrusive, unwanted, and that in most individuals caused marked anxiety or distress.” In other words, obsessions are intrusive, repetitive, and—it’s important to note—unwanted. People with OCD do not want to have these involuntary thoughts, especially because they often go against their usual way of thinking and can attack the things that they care about the most. 

Additionally, people who have OCD will also have compulsions. Because the obsessions that are seen in OCD can be so distressing and anxiety-inducing, people with OCD will also engage in compulsive behaviors that are meant to help relieve some of that stress. Some examples of compulsions include repetitively seeking reassurance, mentally reviewing past events, or carrying out rituals that are intended to stop a bad thing from happening. 

“OCD obsessions are always going to be driven by fear and anxiety,” explains licensed therapist and clinical trainer April Kilduff, LCPC, LMHC, who is autistic herself. “They’re going to bring up a lot of distress and that urge to do a compulsion or do something about it.” 

These are, categorically, not the kinds of thoughts that autistic people will experience when it comes to their “obsessions.” Kilduff goes on to say, “When you’re using the term ‘obsession’ with autistics, we actually like to talk about them as ‘fixations’ or ‘hyperfixations.’” 

These fixations (which have previously been referred to as “special interests”) are subjects, activities, and topics that autistic people are excited about and like to spend a lot of time thinking about or working on. By definition, they do not cause distress. In fact, they are often a source of happiness and self-regulation. Autistic people are only likely to get upset in relation to their fixations if they are interrupted or prevented from doing things related to their interests, or if someone else dismisses them. 

So when it comes to autistics and the fixations that they have, the term “obsession” is not actually appropriate at all, despite the casual use of the word. 

Community discussions

Can autistic people have fixations and OCD obsessions?

It’s also important to define the kinds of obsessions you’re talking about since people can both be autistic and have OCD—and in fact, it’s pretty common, with some research indicating that more than 1 in 6 autistic people also have OCD. In cases like this, their fixations and obsessions may overlap, and it’s important to understand both sides of the coin. 

“OCD goes after what they care about the most,” says Kilduff. This can sometimes mean that, when an autistic person dedicates a lot of their time and energy to a specific object of their fixation, it can sometimes carry over in the way that they experience OCD. 

Kilduff gives some examples of this: “For a lot of autistics, things like social justice, truth, and honesty are really important, so their OCD may skew a little bit more towards that, causing doubt and worry about these things.” Additionally, if an autistic person already has certain fears, they can become even more “rigidly scary and hard to move past” in the context of OCD. 

The bottom line here: when referring to interests or hobbies that an autistic person may “obsess” over, the more appropriate term is “fixation” or “hyperfixation.” While their interest and dedication may take on an obsessive quality due to the time and effort they dedicate to it, it is not an obsession in the clinical sense of the word. Obsessions, meanwhile, relate specifically to OCD and its related disorders. These obsessions are always accompanied by fear, anxiety, and/or distress, and they can drive compulsive behaviors if that person has not gone through treatment to learn how to manage their obsessions and distress. 

Everyone experiences autism differently. While fixations are fairly common in the autism community, this doesn’t mean that every autistic person has one. Additionally, the subject of fixations that people have can vary widely based on the individual’s own preferences and interests, which means that they can span virtually every topic. 

Some examples of hyperfixations that may be seen in autistic people include, but are certainly not limited to: 

  • Toys 
  • Art 
  • Animals 
  • Nature 
  • Computers 
  • Music 
  • History 
  • Electronics 
  • Mechanics 
  • Gardening 

If an autistic person has a fixation on something, they might spend as much time as they can reading up on it, watching TV shows and documentaries on the subject, or practicing their skills themselves if the object of their fixation is an activity. 

Again, having these interests is not a bad thing by any means. In fact, they can be highly beneficial. Researchers have found that autistic adults who did have special interests showed increased subjective well-being, satisfaction, and quality of life when they were more fully able to engage in their interests. The passion and the deep knowledge that some autistics have over their specific subjects of interest can become important parts of their careers, relationships, and life experiences. 

Similarly to fixations in autistic people, the kinds of obsessions that people with OCD can vary broadly based on the individual. Notably, these obsessions will usually center around things that they care about most (for example, health, contamination, religion, and relationships are common themes in OCD). 

Because there are so many different themes in OCD obsessions, OCD can be further divided into subtypes. Some OCD subtypes and accompanying obsessive thoughts, images, and sensations that people with OCD can experience include: 

Notably, the obsessions that people with OCD have are always negative and anxiety-inducing. Unlike the hyperfixations seen in autism, people with OCD obsessions do not want to spend their time thinking about these distressing thoughts and doing those endless compulsions; instead, they are involuntary and unpleasant, and they interfere with one’s life, rather than enriching it. 

How to get help for obsessive thoughts

Obsessive thoughts might feel overwhelming and all-consuming. Again, this is why it is important to differentiate whether we are talking about fixations or true OCD obsessions if you are trying to find help for them. 

In the case of autism, there isn’t a reason to stop those fixations at all except in extreme circumstances. “You wouldn’t really want to discourage someone from a fixation that they have,” says Kilduff. 

A potential exception would be if the level of intensity that they had for their fixation was extremely high. While research generally supports the idea that having these fixations are not a bad thing and can even be beneficial, there is also some evidence that they may negatively impact one’s overall well-being if their intensity is especially high. For example, this might apply if the time that they are spending on the object of their focus is coming at the expense of important things like their health. In cases like that, you might work with a therapist to gain flexibility and balance, but you wouldn’t want to get rid of it altogether. 

However, the true obsessions seen in OCD are a different story. These obsessions are distressing, fearful, and just about always negatively impact your well-being if left unaddressed. In this case, exposure and response prevention (ERP) therapy can help—and, indeed, is successful for the autistics who are disproportionately impacted by OCD. 

ERP is a kind of behavioral therapy that has proven to be highly effective in helping patients with OCD. The goal of ERP is not to take those obsessions away completely—rather, it is to take away the power of those unwanted thoughts and help people with OCD realize that there is nothing to fear from their obsessions.  

To understand how ERP works, we can look at a classic example of Contamination OCD. People with this kind of OCD will have an extreme fear of germs and may engage in compulsions like frequent handwashing. In ERP, your therapist will work with you to make a conscious effort to sit with the discomfort that your obsession over germs can bring. Over time, your brain gets used to the threat and may even become bored by it. Ultimately, ERP can help you gain greater freedom, feel less distressed by your obsessions, and live life on your own terms. 

Treatment for autistic people with OCD

And what about in the case that you are both autistic and struggle with OCD? The approach is generally the same in that OCD will also be treated with ERP here. However, there are also specific considerations that a trained and informed therapist will keep in mind when working with autistic patients to better address their needs. 

“The things I tell most people who are newer to working with an autistic person with OCD would be that you have to shift expectations,” says Kilduff. “Treatment is going to take a little bit longer.” 

“You also need to be aware of sensory needs, because those have to be dealt with first,” she goes on. “We want to make sure that people don’t get overstimulated from a sensory perspective. When we’re doing ERP, it is actually okay to provide accommodations for their sensory needs, just not for their OCD.” 

Finally, she says that it can actually be very helpful for therapists to connect their treatment to their clients’ fixations and interests since it can help motivate them to carry on with a treatment that can be scary and difficult. 

Because there are specific nuances to treating autistic people with OCD, it is especially helpful to look for a therapist who has both ERP training and is well-versed in how to tailor it for autistic clients with specific sensory needs. 

If you are interested in learning more about how ERP can help you with OCD-related obsessions, schedule a free 15-minute call with the NOCD care team. Our therapists specialize in OCD and receive ERP-specific training. You can learn more about NOCD’s holistic and accessible approach to helping people with OCD and related disorders live life on their own terms here. 

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