Obsessive Compulsive Disorder (OCD)
Haga clic aquí para acceder este recurso en español.
What is obsessive compulsive disorder (OCD)?
Obsessive compulsive disorder is characterized by the experience of obsessions(intrusive, recurrent thoughts), compulsions (repetitive behaviors), or both. Typically, to relieve distress caused by intrusive thoughts, individuals with OCD perform repetitive behaviors or rituals.
How common is OCD?
Evidence suggest autistic people experience increased rates of OCD compared to the general public (2.3%). There can be significant overlap in symptoms between OCD and autism, particularly in repetitive behaviors.
Signs of OCD in autism
Those with autism engage in restrictive and repetitive behaviors (RBBs) for a variety of reason including sensory regulation, anxiety management or simply for comfort.
For those with OCD, compulsions can look like autistic behavior. But they are a way to get rid of intrusive thoughts. While they may offer short-term relief, they ultimately worsen distress over time. This is one way to help distinguish between compulsions and autistic RBBs.
Autism and OCD can also impact social skills and lead to difficulties in understanding and responding to social cues. Specifically, OCD can cause social challenges linked to excessive anxiety or shame that can be hard to distinguish from autism, particularly for those with no intellectual or language impairments.
Treatment options for OCD and providers who can help
Most clinicians have only expertise in autism or OCD but not both. This can make identifying OCD in autistic individuals (and vice versa) challenging.
The general recommended treatment for autistic people to manage OCD does not differ from those used to treat people with OCD without autism. The main difference is tailoring treatment to adapt to an autistic person’s social and communication needs.
The most effective treatment typically involves a combination of therapy and medication, or sometimes therapy alone. The primary therapy used is exposure and response prevention (ERP), a form of cognitive behavioral therapy (CBT). It is intended to help individuals confront their obsessions and resist compulsions.
As the name implies, ERP focuses on exposing autistic individuals with OCD to their feared situations and helping them resist compulsive behaviors afterward. Exposure should always be done gradually, and autistic people should be given grace if it takes a few practices before they can complete an exposure. ERP must be done by a trained therapist, as it can be challenging and anxiety-provoking, which can exacerbate OCD and lead to other co-occurring mental health conditions.
A combination of medicine with ERP and CBT can also be useful in treating OCD in an autistic person. Inference-based CBT (or I-CBT) is a newer treatment for OCD that teaches individuals to recognize the false logic that drives obsessive doubts and rely on their senses instead. Early studies suggest that I-CBT is helpful for individuals with severe OCD, though more research is needed. General psychotherapy (talk therapy) can also help in some cases, although it is not the best treatment option for OCD for those with autism.
Learn more: