Understanding OCD and Autism Spectrum: A Complete Guide

Oftentimes parents and professionals wonder about the difference between Obsessive-Compulsive Disorder (OCD) and autism spectrum disorder (ASD) due to the overlapping traits between the two. These include repetitive behaviors, adherence to strict routines, and/or an intense focus on specific topics/interests. We are here to clarify that although OCD and autism can look similar on the surface, they are two distinct conditions. Understanding their similarities and how they differ can help parents, educators, and professionals provide the right kinds of support.

Let’s unpack what OCD really is, how it compares to autism, and the importance of recognizing both (when they occur together).

What is Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder, or OCD, is defined by the DSM-5 as a mental health condition that involves the presence of obsessions, compulsions, or both. The following definition has been taken from the Substance Abuse and Mental Health Services Administration (2016).

• Obsessions
  • “Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress”
  • “The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion)”
• Compulsions 
  • “Repetitive behaviors (e.g., hand washing, ordering checking) or mental acts (e.g., praying, counting, repeating words silently_ that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly”
  • “The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive”

It is important to note that in order to receive a diagnosis of OCD, the obsessions and compulsions must be considered time consuming (i.e., more than an hour a day) and/or cause the person significant distress or impact them in their overall functioning (e.g., social, occupational). Furthermore, the obsessions and compulsions cannot be due to any other clinical psychological or physiological condition, including substance abuse. Sometimes, people with OCD are aware that their obsessions/compulsions impact their daily life, and sometimes they are not. Additionally, some people with OCD also present with a current or history of tic disorder. 

OCD tends to start in adolescence or adulthood, but can be diagnosed in children as well. The severity of OCD varies from mild to severe, and tends to change throughout a person’s life and diagnosis. Obsessive and/or compulsive symptoms usually increase when the person is under a lot of stress. OCD often requires mental health treatment such as cognitive-behavioral therapy (CBT). Individuals with OCD rarely see a speech language pathologist, unless they have a co-occurring condition that impacts their communication skills.

What is Autism Spectrum Disorder?

Recall from a recent blog post that autism spectrum disorder is a neurodevelopmental condition that is defined in the DSM-5 as a disorder that results in social communication and social interaction challenges across contexts. Specifically, according to the DSM-5, autism is diagnosed based on two separate, and often related, areas:

1. Differences in social communication and social interaction
   Individuals with autism have challenges using social communication skills to engage in social interactions. Oftentimes this can look like difficulties taking conversational turns, using and understanding body language or tone of voice, and making and maintaining friendships.
2. Restricted and repetitive behaviors and interests (RRBIs)
   Individuals with autism must also have RRBIs. This can include behaviors (such as movements like rocking or handflapping) and/or focused interests (dinosaurs, trains, Minecraft, Bluey, creeks, you name it!). Additionally, individuals with autism tend to prefer routines, and may also experience sights, sounds, and textures more intensely than others.

To receive an autism diagnosis per the DSM-5, an individual must meet both of the criteria outlined above, and these characteristics must be present in early childhood. However, it is also the case that characteristics of autism may not fully come online until the child gets older and experiences social challenges. Moreover, these challenges must impact the person’s ability to function in social or occupational settings, or other areas that are important, and must not be explained by an intellectual disability. Note, however, that a person can have autism and co-occurring intellectual disability.

Differences and Similarities Between OCD and Autism Spectrum Disorder?

Although some of the ritualistic and routine behaviors associated with both autism and OCD may be difficult to distinguish on the surface, evidence suggests that these behaviors serve two distinct functions in autism compared to OCD. When considering restricted and repetitive behaviors and interests, it has been noted that individuals with autism engage in these behaviors primarily for the purpose of enjoying their interests, as well as coping with negative experiences. In this way, RRBIs are functioning to add pleasurable experiences to the person’s life. On the other hand, people with OCD are said to engage in routine/ritualistic compulsive behaviors to reduce negative experiences and eliminate stress. Those with OCD tend to report compulsions as acting against their personal goals; whereas autistic people note that restricted and repetitive behaviors/interests are in line with their goals (Long et al., 2024). 

Can Someone Have OCD and Autism Spectrum Disorder?

Yes, it is estimated that about 9-22% of people with autism also have a co-occurring OCD, and those with a diagnosis of autism are more likely to have a diagnosis of OCD compared to non-autistic people. Additionally, it has been suggested that those with OCD are also likely to be diagnosed with autism later in life compared to those without OCD (Long et al., 2024). 

When someone has both, it can make things more complicated:

• It can be hard to tell what’s an autistic routine (something enjoyable or regulating) and what’s an OCD compulsion (something stressful or anxiety-driven). It’s important to gather a deeper understanding of the behavior and its function.
• Treatment approaches will need to be tailored carefully to each individual. Methods that work well for OCD should be combined with those that are evidence-based for supporting autism. Collaboration between mental health workers, speech-language pathologists, and families is crucial. 

The overlap also reminds us that although mental health and neurodevelopmental differences are unique conditions, individuals can often be autistic and experience mental health conditions, including OCD. Recognizing both allows for more compassionate and effective support.

A Neurodiversity-Affirming Perspective

From a neurodiversity-affirming lens, autism is a natural variation in human brains, not a disorder that needs curing. OCD, on the other hand, is a mental health condition that can cause distress and usually benefits from therapeutic intervention.

Recognizing the difference is important because it shapes how we support individuals. In both cases, the goal is the same: to help people live with greater comfort, autonomy, and self-understanding.

When children (and parents!) understand the “why” behind their experiences, it becomes easier to navigate daily life with compassion instead of confusion.

The Bottom Line

OCD and autism are not the same thing, nor is OCD part of the autism spectrum. The two can overlap, and it is important to understand the difference between the two.  

Autism is about neurological differences in communication and processing.
OCD is about anxiety-driven thoughts and behaviors.

Both can deeply affect a person’s daily life, but with the right supports, children and adults can learn strategies to support their overall well-being and daily life goals. And when a person has both OCD and autism, it will be beneficial to find team members who understand both OCD and autism and who use client-centered, evidence-based strategies to help the person meet their goals.

FAQs

1. 1. Is OCD part of the autism spectrum?
      No. OCD (Obsessive-Compulsive Disorder) is not part of the autism spectrum. It is a separate mental health condition that can co-occur with autism but has different causes and characteristics.

• Can someone be autistic and have OCD at the same time?

Yes, many people experience both, although it is important to differentiate between the two.

• How can I best support my child if they have OCD or autism?

Start by observing with curiosity instead of judgment. Partner with professionals who understand both conditions. Build routines, practice calming strategies, and always validate your child’s experiences. Above all, focus on their strengths, not just their challenges.