Not just Autism:Understanding Co-Occuring OCD

Symptoms of OCD and ASD can appear similar, but there are some core differences between the obsessions and compulsions that accompany OCD, and the restrictive and repetitive thinking and behaviors that are associated with ASD. 

CONTENT: Common obsessive themes of OCD include contamination concerns, preoccupation with order, symmetry, completion or perfection, fear of acting on an impulse to harm oneself/loved one, having unwanted sexual thoughts or thoughts prohibited by religious/ moral beliefs. Common rituals include repeatedly asking for reassurance, and checking, touching, or counting things (sometimes in a particular order). In contrast, individuals with ASD more commonly have an “obsessive” desire for sameness, or may have a strong interest and attention to associated details, such as dates/facts of that particular interest.

DISTRESS: The individual with OCD wants intrusive thoughts to stop, often has insight/awareness that ac- companying compulsions are odd, and experiences distress about inability to “control” symptoms. In con- trast, individuals with ASD are often not bothered by their repetitive thoughts and behaviors, lack insight into social implications of their behaviors, and may find them enjoyable or soothing. 

FUNCTION: As OCD develops, most individuals find that obsessions/compulsions interfere with functioning (socially, occupationally/academically). The restrictive interests associated with ASD may have a functional quality; they can aide in the acquisition of new ideas, information, and help one learn a specific trade or skill.

The most effective treatments of OCD are Cognitive Be- havior Therapy (CBT) including Exposure and Response Prevention (EX/RP), a class of medications called sero- tonin reuptake inhibitors (SRIs), or their combination. Research shows that EX/RP either on its own or with an SRI can be superior to SRIs alone. 

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