Obsessive-compulsive disorder (OCD) and autism share a few similarities, as they both can involve repetitive behaviors, intense focus, and/or the need for routines. Autistic people may question whether they have OCD, while those with OCD may wonder if they’re on the autism spectrum. If you or a loved one has both conditions, it can be hard to understand where one ends and the other begins.
While there are some overlapping characteristics between OCD and autism, they’re not the same. Understanding how they interact can make a big difference in recognizing symptoms and finding the right support.
So, is OCD on the autism spectrum? Not exactly, but the relationship between the two is more complex than a simple yes or no.
Here’s what to know about the connection between OCD and autism, including how they differ, how they co-occur, and what treatment looks like if you’re navigating one or both.
What is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by a cycle of obsessions and compulsions that interfere with daily life. Obsessions are intrusive thoughts, images, sensations, feelings, and urges that are unwanted and distressing. Compulsions are repetitive physical or mental behaviors done to relieve distress or anxiety from obsessions or prevent something bad from happening.
These symptoms can take up a great deal of time (an hour or more per day) and interfere with a person’s ability to function. OCD can present in countless forms or subtypes, distinguished by the type of obsessions or intrusive thoughts involved. Common types of OCD include contamination, perfectionism, religion (scrupulosity), relationships, sexuality, and harm.
In children, OCD can sometimes be mistaken for other behavioral concerns. A child might have distressing thoughts but struggle to express them, or they may engage in compulsions that look like play or habits to an outsider. Because of this, early recognition and intervention are key. If left untreated, OCD can worsen over time and lead to significant distress in school, friendships, and home life.
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What is autism?
Autism is a neurodevelopmental condition that shapes how a person thinks, communicates, and experiences the world. It’s often described in clinical terms as involving differences in social communication, hyper-focused interests, and repetitive behaviors—but for autistic people, it’s just part of who they are.
Even though the clinical term often used is “autism spectrum disorder,” many autistic people don’t see autism as a disorder, or as something that needs to be “fixed.” Instead, it’s viewed as a different way of thinking and processing the world. Autism exists on a spectrum, meaning that people experience it in many different ways and to varying degrees of intensity.
Autistic people might communicate differently, have unique ways of expressing emotions, or experience things like sound, light, and touch more (or less) intensely than neurotypical people. Sometimes, these differences make things like socializing, adapting to change, or fitting into certain environments challenging, but that’s often because the world isn’t built with neurodiversity in mind.
Some common traits of autism include:
- Repeating words or phrases (also called echolalia)
- Having deep, long-lasting interests in specific topics
- Talking a lot about favorite subjects
- Struggling with transitions or changes in routine
- Engaging in stimming, which are self-soothing behaviors like rocking, hand-flapping, or tapping objects
- Finding it hard to read non-verbal cues, but often being hyper-aware of other people’s emotions
- Being extra sensitive (or not sensitive at all) to things like textures, sounds, temperature, or bright lights
For children, autism can sometimes be overlooked, especially if they develop strong masking skills or if their traits are misinterpreted as personality quirks or shyness. Early diagnosis and support can help autistic kids develop self-awareness, self-advocacy skills, and a better understanding of how to navigate environments that might not always accommodate their needs.
Is OCD on the autism spectrum?
No, OCD is not on the autism spectrum. They’re two distinct conditions with different diagnostic criteria. However, because OCD and autism can sometimes look similar on the surface, it’s easy to see why people might wonder if they’re connected.
One key reason for the confusion is that OCD and autism can share certain traits, like repetitive behaviors, rigid routines, and intense focus on specific thoughts or actions. While there’s some overlap, the reasons behind these behaviors are different.
- In OCD, repetitive behaviors (compulsions) are done to reduce anxiety caused by intrusive thoughts (obsessions).
- In autism, repetitive behaviors or routines are often a way to self-soothe, bring comfort, or create a sense of predictability in an overwhelming world.
How is OCD linked to autism?
Even though OCD and autism are distinct conditions, they can co-occur. Research suggests that up to 17% of autistic people also have OCD, much higher than in the general population. However, having one condition doesn’t automatically mean you have the other. Each condition comes with its own challenges, and when they overlap, the experience can be unique from having just OCD or just autism.
For example, someone with both OCD and autism might struggle with intense routines but feel unsure whether it comes from a need to relieve anxiety (OCD) or a strong preference for sameness and predictability (autism).
According to April Kilduff, LCPC, LMHC, LPCC, LPC, an autistic NOCD therapist, not all repetitive behaviors are compulsions. “For autistic individuals, routines and repetitive actions can be comforting, not distressing,” she explains. “The key is understanding whether a behavior is done to relieve anxiety (OCD) or as a form of self-regulation (autism). That distinction matters when creating a treatment plan.”
For children with both OCD and autism, this distinction can be even harder to spot. Parents may need professional guidance to differentiate between behaviors driven by anxiety and those that are simply part of their child’s neurodivergent way of engaging with the world.
Similarities between OCD and autism
OCD and autism have some overlapping characteristics, which can make it challenging to distinguish between them. “I’ve seen OCD diagnosed when really autism is at play,” says Kilduff.
Some of the key similarities include:
Repetitive behaviors
While they vary from person to person, repetitive behaviors can be present in both OCD and autism. For example, someone might repeatedly open and close doors or engage in other repeated motions.
Difficulty with change
Both autistic individuals and those with OCD may struggle with unexpected changes in their routines. For autistic individuals, routine is often a source of comfort, while in OCD, changes can trigger compulsions aimed at reducing anxiety.
Obsessions or special interests
Obsessions are a core characteristic of OCD, while many autistic individuals develop deep special interests in specific topics. On the surface, these can seem similar, though their underlying mechanisms are different.
Anxiety
People with OCD frequently experience high levels of anxiety related to their obsessions, and many autistic individuals also deal with significant anxiety. Kilduff notes that up to half of autistic people have clinically elevated levels of anxiety.
Sensory sensitivity
Both conditions can involve sensory differences. Autistic individuals may be more (or less) sensitive to sensory input than average, leading to behaviors that might resemble compulsions, such as avoiding certain fabrics or foods due to texture. Similarly, some people with OCD experience heightened bodily awareness, such as hyper-focusing on how clothing feels against their skin.
Co-occurring conditions
Many individuals with OCD or autism have at least one co-occurring condition. OCD is commonly linked with depression and anxiety disorders. Autistic individuals often have co-occurring conditions like attention-deficit hyperactivity disorder (ADHD), learning disabilities, and anxiety disorders.
Differences between OCD and autism
While OCD and autism can share some characteristics, their root causes and motivations are distinct. Some of the most significant differences include:
Classification
OCD is considered a mental health condition, while autism is a neurodevelopmental condition. Kilduff explains that autism is more accurately described as a “brain style”—a form of neurodivergence—rather than a disorder that requires fixing.
Age of onset
OCD symptoms often develop between the ages of 8 and 12, but they can begin at any time. In contrast, signs of autism typically emerge in early childhood, often by age 3, though they may not be recognized right away.
Distress level
OCD obsessions are distressing and unwanted. In contrast, special interests in autism are often deeply enjoyable and fulfilling. “Typically, the desire is to think about the special interest,” explains Kilduff. “Engaging with it usually brings a sense of happiness or peace.” While autism may come with challenges, “there may be pieces of autism that are negative in some way, but it doesn’t have to be an overall negative experience for some people,” she adds.
Motivation for repetitive behaviors
In OCD, compulsions are performed to relieve the distress caused by intrusive thoughts, whereas autistic individuals engage in repetitive behaviors (such as stimming) for self-regulation, sensory comfort, or enjoyment. “Autistic repetitive behaviors are not driven by intrusive thoughts or done to completely get rid of anxiety or prevent something bad from happening,” says Kilduff. Instead, they are a natural part of how many autistic people interact with and manage their environment.
Finding support for OCD and autism
Here’s a look at ways you can find support for OCD and autism:
Treating OCD
The most effective treatment for OCD is a form of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) therapy. With the guidance of a therapist, people with OCD learn to gradually confront their fears while resisting the urge to perform compulsions. Over time, this teaches the brain that the distress caused by intrusive thoughts doesn’t need to be neutralized with rituals or avoidance.
For children with OCD, ERP is often adjusted to be developmentally appropriate, incorporating more gradual exposures and parent involvement. “It’s important for parents to understand the difference between providing support and accommodating compulsions,” explains Kilduff. “Supporting your child means helping them build confidence in handling uncertainty, not eliminating all their discomfort.”
Support for autism
Autism isn’t something that needs to be “treated,” but certain therapies can help autistic people navigate challenges and build skills that support their well-being, including:
- Occupational therapy (OT) for sensory sensitivities and daily routines.
- CBT or dialectical behavioral therapy (DBT) adapted for autistic individuals to help with anxiety and emotional regulation.
For autistic children, early interventions can provide strategies for sensory processing and communication while ensuring therapy remains respectful of their neurodiversity.
How to treat OCD in autism
When someone has both OCD and autism, treatment can be more complex, but that doesn’t mean it’s impossible. Working with professionals who understand both conditions is key. ERP therapy can still be effective, but may need to be adapted for sensory sensitivities and differences in cognitive processing.
When it comes to treating OCD in children with autism, treatment should be a collaborative effort between parents, therapists, and providers to ensure their needs are fully understood. Proper support makes a difference in helping children and adults manage both conditions effectively.
Bottom line
OCD and autism are two distinct conditions, but they can overlap in ways that make understanding and managing them complex. While both can involve repetitive behaviors, strong routines, and intense focus, the reasons behind these traits are different.
If you or your child is dealing with OCD, autism, or both, getting the right diagnosis can make a significant difference. With the proper support, people with OCD and autism can lead fulfilling, meaningful lives.
Key takeaways:
- OCD and autism can both involve repetitive behaviors and a need for routine, but the motivations behind those behaviors are different.
- It’s possible to have both OCD and autism, and understanding the differences between them is key to accurate diagnosis and treatment.
- OCD is treated effectively with exposure and response prevention (ERP) therapy, which can be adapted for autistic individuals.
- Autistic traits don’t need to be “fixed,” but support like occupational or speech therapy can help with challenges related to sensory and communication needs.
