How OCD and Autism are related—and how they’re treated together  

Sometimes, two seemingly unrelated conditions have a lot more in common than you think. That’s the case with obsessive-compulsive disorder (OCD) and autism.

For one, the behaviors related to autism and the symptoms of OCD can sometimes be hard to distinguish from one another. Just one example: Rituals in OCD can resemble the repetitive pattern of behaviors that are common in autism—and vice versa. 

But the link between OCD and autism doesn’t end here. The fact is, many people have both conditions, with research suggesting that up to 17% of autistic people have OCD. What’s more, people who have both OCD and autism often have unique experiences—experiences that differ from the experience of OCD or autism on its own. 

Here, we explore OCD and autism, how they overlap, and what treatment looks like for autistic people with OCD.

What Is OCD?

OCD is a mental health condition characterized by obsessions and compulsions that interfere with daily life. Obsessions are intrusive thoughts, images, sensations, feelings and/or urges that are unwanted and distressing, while compulsions are the physical or mental behaviors or rituals that have to be done over and over again to relieve this distress or anxiety. 

These symptoms can take up a great deal of time (an hour or more per day) and interfere with a person’s ability to function in their daily life. OCD can present in countless forms (or OCD subtypes) distinguished by the type of obsessions or intrusive thoughts that are involved. Common types of OCD include contamination & health, order or symmetry, religion or morals, relationships, sexuality, and harm.

What Is Autism?

According to the American Psychiatric Association, autism “is a complex developmental condition involving persistent challenges with social communication, restricted interests and repetitive behavior.”

While the official term includes the word “disorder,” many people with lived experience consider autism an aspect of their identity, rather than a disorder or pathology. Autistic people often have differences in body language, eye contact, and communication that can sometimes make it challenging to fit in, hold conversations, or make friends with neurotypical people (those whose brains function in a way that some consider “normal”).

Here are some other common traits among autistic people:

• Repeating words or phrases
• Having special interests (intense and lasting interests in specific topics) 
• Talking extensively about favorite topics
• Having difficulty with transitions and changes in routine
• Engaging in stimming—self-regulating behaviors like rocking and hand-flapping
• Frequently maneuvering objects (e.g. tapping or arranging objects in a particular manner)
• Finding it challenging to interpret non-verbal cues, but often hyper-empathic to people’s emotional responses
• Being more or less sensitive to sensory input (e.g. clothing, temperature, sound, and light) than the average person

Similarities Between OCD and Autism

OCD and autism have some similar characteristics, which can make it hard for even some untrained professionals to tease them apart. “I’ve seen OCD diagnosed when autism is at play,” says April Kilduff, MA, LCPC, an OCD specialist at NOCD who is autistic herself. Here are some examples of the commonalities:

• Repetitive behaviors: While they vary from person to person, repetitive behaviors are sometimes the same between OCD and autism—for instance, repeatedly opening and closing doors.
• Difficulty with change: Change can contribute to flare-ups in OCD symptoms. Routine is especially important to autistic people, who may find change incredibly stressful. 
• Obsessions or special interests: Obsessions are a core characteristic of OCD, and many autistic people likewise find themselves preoccupied with specific topics. While there are core differences between the two, special interests and obsessions can be, on the surface, hard to tell apart.
• Anxiety: Many people with OCD suffer from anxiety related to their obsessions, and up to half of autistic people have clinically elevated levels of anxiety, and they may experience distinctive anxiety symptoms. 
• Sensory sensitivity: Both autism and OCD are sometimes associated with sensory differences. Autistic people can be more (or less) sensitive than average to sensory input. This can lead to behaviors that may look like OCD compulsions (e.g. avoidance of certain clothes because of the texture). Meanwhile, some people with the OCD subtype of Somatic OCD are hyper-aware of their body, and may have a symptom of being hyper-sensitive to the feeling of clothing on skin.
• Co-occurring conditions: Most autistic people and OCD sufferers have at least one co-occurring condition. Depression and anxiety disorders are prevalent comorbidities among OCD sufferers. For autistic people, the most common include attention-deficit/hyperactivity disorder (ADHD), learning disabilities, and anxiety disorders. 

Differences Between OCD and Autism

While some characteristics of autism and OCD may look alike, they have entirely different causes and motives. Here are some of the differences:

• Classification: OCD is a mental illness. On the other hand, Kilduff explains that autism can be more accurately described as a “brain style”—it’s a classic example of neurodivergence. Some experts consider OCD to be a form of neurodivergence, as well, but this is not largely agreed upon. 
• Age of onset: Symptoms of OCD often start between the ages of 8 and 12, although they can start at any time. People generally show signs of autism by the age of 3 (they may go unnoticed for a while if parents or providers aren’t familiar with autism).  
• Distress level: OCD obsessions are unwanted and distressing. Meanwhile, “special interests”—in the case of autism—are often the opposite. “Typically, the desire is to think about the special interest,” says Kilduff. “Engaging with it usually brings a sense of happiness or peace.” Bottom line: “There may be pieces of autism that are negative in some way, but it’s not an overall negative experience,” says Kilduff. 
• Motivation for repetitive behavior: OCD sufferers try to relieve the distress of their obsessions with compulsions. Autistic people engage in repetitive behaviors such as stims, but there’s a big difference between stims and compulsions. “Autistic repetitive behaviors are not driven by intrusive thoughts or done to completely get rid of anxiety or prevent something bad from happening,” says Kilduff. They are more often performed for pleasure and satisfaction, used to cope with stress or regulate sensory input.

OCD and autism: How often do they co-occur?

A 2015 study suggested that autistic people are twice as likely to be diagnosed with OCD as the general population. And OCD sufferers are thirteen times as likely to be autistic (6.6%) as people without OCD (0.5%). 

Nobody knows for sure why the overlap commonly happens. That said, one theory is that brain differences could play a role. OCD and autism are both associated with differences in areas of the brain such as the corpus callosum (a bundle of nerve fibers connecting the brain’s left and right hemisphere).

The challenges of living with both autism and OCD

OCD can exacerbate some of the difficulties you may face due to autism. For example, if you worry about whether your words or actions are appropriate or socially acceptable, OCD can turn this into an obsession. In some instances, distress related to OCD can become so overwhelming that it can trigger sensory overload, shutdowns, or meltdowns. 

OCD can even turn your special interests against you. For instance, it could use an intense (and enjoyable) interest in true crime novels to try to convince you that you’re a bad person for engaging in this type of content. “OCD often goes after the things that we enjoy, the things that we value,” says Dr. Rebecca Sachs, PhD, an expert in both autism and OCD. 

As for one of the most challenging aspects of having both OCD and autism, Dr. Sachs puts it this way: As an autistic person, “the world’s not necessarily always built for you, and then you layer it upon what often people with OCD experience—the shame that comes with the compulsions and certain content of OCD.” The result can be a “chronic invalidation and misunderstanding from the world.”

The good news? OCD is a highly treatable condition and most people get better when they are connected with the specialized OCD treatment. 

How are autistic people with OCD treated?

Autism isn’t a mental illness that needs to be treated, but some autistic people benefit from formal therapies to gain support and accommodation. Some examples include occupational therapy, physical therapy, social skills development, and talk therapy. Treating co-occurring conditions like OCD can also make life measurably better.

OCD, on the other hand, is a mental health disorder that requires specialized treatment. The gold standard treatment for OCD is Exposure and Response Prevention (ERP) therapy, which is different from traditional talk therapy or general cognitive behavioral therapy (CBT). Without ERP specifically, it’s very likely that OCD will get worse, not better. 

In ERP, you’ll work with a highly trained clinician to confront your triggers in a controlled environment (with the guidance of a therapist), and practice response prevention strategies to resist compulsions. This is a gradual process, meaning that you’ll begin with exposures that only trigger a small amount of discomfort, and work up from there. Over time, you’ll learn that the distress passes on its own, without the need for compulsions. You also realize that your intrusive thoughts never actually posed a threat, which takes the power away from OCD.

Kilduff recalls an autistic patient whose Contamination OCD led to compulsively washing her hands until they cracked and bled. This was tricky to address, since the patient hated the sensation of applying lotion to her hands. With ERP, she was able to reduce her hand washing rituals, one small step at a time, and learned to tolerate putting on lotion to heal.

“When we first started working together, she was basically spending all her time alone in her bedroom, having difficult interactions with her parents and siblings. By the time we finished treatment, she was independent of her parents’ house,” says Kilduff. “She found a part-time job, she was able to make better social connections, and her quality of life overall improved.”

Autistic people may benefit from slightly modified versions of ERP. For instance, your therapist might incorporate special interests into your treatment, let you lead exposures, and give you a break in an ERP session if you go into sensory overload. Medication can also be a useful supplement to ERP for some autistic people. When needed, clinicians most often prescribe selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft.

Lastly, experts recommend finding a therapist who’s experienced in both OCD and autism. Otherwise, “the clinician might try to work on something that’s an autistic trait instead of sussing out your real OCD symptoms,” says Kilduff.

How to help a child with OCD and autism

ERP therapy is the best treatment for OCD—and that applies to children, too. It decreases the need for an autistic child to rely on compulsions as a way to self-soothe. 

But if you want to help a child with OCD and autism, it’s important to know that parents—not just therapists—can play a crucial part in their recovery. Here are some tips for caregivers:

• Get involved: Parents should be involved, both in therapy sessions and ERP practice at home. Team up with your child’s therapist to understand how to structure exposure practice at home. 

• Practice understanding: “One of the biggest things that a parent can do is making sure, when OCD is showing up, that they’re really able to see that the behaviors are coming from the OCD and not from their child, a lot of time,” explains Sachs.

• Use rewards: Rewards or reinforcers for participation in ERP work best if centered around the child’s favorite interests. As an example, if a child really loves playing video games, they can earn a reward of increased video game time for practicing ERP.

The bottom line on OCD and autism 

It may seem intimidating, but autistic people can conquer OCD. Take it from NOCD member Sarah Stanton, who played a key role in the creation of NOCD’s Autism/OCD support group: “I spent my whole life using compulsions to try to be someone else. Now I lean joyfully into being my true autistic self, even in the face of stigma. Being myself is a billion times better than letting OCD and society tell me who it’s okay for me to be.”