The Differences Between Autism and OCD

Disclaimer: This is from the point of view of someone with lived experience of both Autism and Obsessive Compulsive Disorder (OCD). These are my opinions only. I am not a medical professional.

Autism and OCD have many traits which they can appear to share, or which are difficult to distinguish from each other. The overlaps between the two mean that misdiagnosis is common. People with OCD are four times more likely to later be diagnosed with autism. However, autistic people are also more likely to suffer from OCD. 17% of autistic people also have an OCD diagnosis, compared to 2-3% of non-autistic people.

So, why does it appear that the same obsessive behaviour, rituals, need for things done a certain way and obsessions occur in both Autism and OCD, yet sometimes they are attributed to Autism and other times to OCD? Let’s try to untangle this.

First let’s talk about obsessions.

OCD UK describe OCD obsessions as:

“Persistent and uncontrollable thoughts, although obsessions can sometimes be persistent images, impulses, worries, fears or doubts or a combination of all these. They’re always intrusive, unwanted, disturbing and most importantly significantly interfere with the sufferers ability to function on a day-to-day basis as they are incredibly difficult to ignore.”

These thoughts are repetitive and intrusive. They cause significant distress and affect the person’s daily life. It is these obsessions and thoughts which lead to overwhelming urges to carry out compulsions (or specific behaviours), in order to reduce anxiety over the thoughts.

Autistic obsessions don’t tend to be described as obsessions, but rather hyper-fixations or special interests. Autistic people can become obsessed or fixated on certain topics, people or objects. These can be extremely intense, and can take over our mind or even interfere with daily life. However, the special interest or fixation itself is something which we enjoy, which provides a sense of comfort, fulfilment or safety, and can help use feel more in control and manage our surroundings. They give us something to focus on when everything is too overwhelming. True, it can get in the way, and we can become distressed when we are stopped from engaging with these hyper-fixations or special interests, but this is what distresses us, not the obsession itself like with OCD.

What is more confusing to distinguish though, is when autistic people become fixated on a specific thought or fact. Our brains do tend to latch onto things and refuse to let them go. This is probably what makes us more susceptible to OCD. While most people can dismiss unwanted or distressing thoughts, people with OCD (and perhaps autistic people too) struggle to do this, which is what causes the distress, the compulsions, the avoidance, the fear and the disruption of daily life.

So, onto compulsions.

OCD UK describe compulsions as:

“Repetitious, purposeful physical or mental actions that the individual feels compelled to engage in according to their own strict rules or in a stereotyped manner.
Typically, the individual experiences a sense of resistance to the act but this is overridden by the strong, subjective drive to perform the action. Most often the principal aim behind the compulsive behaviour is to generate relief (usually only temporary) from the anxiety elicited by the preceding obsession.”

These compulsions serve a specific purpose - to counteract the obsession or the distressing thought.

The most common forms that OCD compulsions take include: checking (e.g. gas taps), cleaning, washing, repeating acts, mental compulsions (e.g. special words or prayers repeated in a specific manner), ordering, symmetry, exactness, hoarding/collecting and counting.

It is clear by reading this list that many of these behaviours are present in OCD. These routines or rituals appear to be components of both OCD and autism. An autistic person may have a particular routine they carry out before they go to sleep. Someone with OCD could have this exact same routine. However, the fundamental difference is found in the anxiety and the reasons why these routines are being carried out. With OCD, it is to reduce anxiety over the thoughts. Autistic people who exhibit ritualistic behaviours often carry out their routines quite contently. Our routines may be a source of comfort, we may enjoy them, and they may help us to organise their thoughts and understand and process what is going on around us. We may still become distressed if we are unable to carry out their routine, and this distress can be mistaken to be OCD. But, the routine itself is not the cause of the distress such as with OCD.

The need for ordering, symmetry or exactness as listed above as OCD compulsions are very visible in autistic people. Autistic people can have a need for things to be done a certain way or in a certain order. Imagine if the world was so overwhelming, your brain didn’t seem compatible with your surroundings and everything that happened around you made little sense. You would do whatever you could to make it as easy for you to navigate as possible right? You would do whatever you could to help your brain manage. Doing things a certain way, having order and exactness helps us to navigate the world. It helps provide reassurance, helps us to know what to expect, and helps us to avoid the anxiety that comes with change.

Autistic people may carry out repetitive behaviours, because this can help to reduce our anxiety. Engaging in something systematic and comforting can help us re-charge. Equally, we may carry them out when we feel joyful, because that may be how we show our excitement, because that makes us feel good. It’s a different kind of relief to the temporary relief from carrying out an OCD compulsion, but it is one that is hard to explain.

So what can we learn from this?

It can be very complicated to distinguish between Autism and OCD, but it is hugely important, because stopping autistic people from engaging with repetitive behaviours which are core to our ability to function well, or pathologising our special interests or fixations which we find enjoyable can be harmful to our self-confidence and our ability to navigate day to day life.

There are resources online which try to distinguish between autism and OCD, but having looked through a lot of these myself, most of them are stigmatising and frankly, incorrect. I have seen many claim that the difference is that someone with OCD will be ashamed or embarrassed of their actions, while autistic people aren’t affected by what others think. We are constantly told that being ourselves is wrong. We are constantly shamed for our behaviours. We are constantly made to feel outcasted and ashamed. While some autistic people may not be affected by what others think, many of us are - every single day. This is not a way to distinguish between OCD and autism.

Another difference shared is that autistic people will lack self-awareness whilst those with OCD won’t. This statement is so damaging. Autistic people are constantly believed to not have a voice and to not have any awareness or insight. This may be true for some, but this should not be a blanket statement. I used to lack self-awareness of my autism. Once I was introduced to the autistic community and began to learn about myself and my autism, my self-awareness and insight has grown significantly. Help us find the resources and the people to connect with, learn with and grow with.

All my love, Em x