Autism Spectrum Disorders and Obsessive-Compulsive Disorder

Abut 1 in 8 people with an autism spectrum disorder (ASD) are also diagnosed with obsessive-compulsive disorder (OCD). Obsessive-compulsive behaviours with people who have ASD tend to be around repetitive questioning, ordering things, or repetitive touching. Obsessive-compulsive disorder may be hard to identify in people with ASD as having repetitive actions (perseveration) and repetitive rituals are part of the autism spectrum diagnosis. Sometimes an ASD person’s favorite topic or activity looks like OCD because of the frequency in which it is engaged in or the repetitive nature of the activity. Is it a perseverative topic or obsession?

There are a few ways to determine if a perseverative behaviour is a favored activity (area of interest) or an obsession. First, topics of interest or favorite activities bring pleasure to the person who has ASD. This may even be an area of expertise and competency. Some of these perseverative interests have led to careers! In other cases, these actions may be engaged in just because they feel good (self-stimulatory behaviour). Examples of this may be rocking or spinning, or hand-flapping. They may appear odd to a typical person, but they feel good to do for the person with ASD. OCD behaviours may bring relief, but are not in and of themselves enjoyable. If the person with the OCD was not uncomfortable, they would not engage in the behaviours. The OCD behaviours themselves may be uncomfortable, but the person is compelled to do them. There is no pleasure found with OCD behaviours.

Treatment:
OCD can be treated with medications, although these medications have mixed results with people on the autism spectrum. Cognitive behavioural therapy, adapted for people with ASD is often more effective. Sometimes both medications and counselling treatment is used together to gain best results. It is of note that OCD symptoms controlled by medications alone often return when medications are stopped.

Suggested reading: Paxton, K. & Estay, I. (2007). Counselling people on the
autism spectrum: A practical manual. London: Jessica Kingsley Publishers

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