Autism has links to a number of mental health conditions, which can make it more difficult to differentiate between conditions if the signs and symptoms are similar. Here, we are looking at autism and obsessive-compulsive disorder (OCD), how they differ, how they are similar, instances of comorbidity (having both at once), the clinical relationship between the two, challenges when it comes to diagnosis, what to do if you think you have been misdiagnosed, and where to access further support. 

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about autism or OCD, we can help. 

What is autism? 

Autism is a neurodevelopmental condition affecting how a person interacts with others, and how they understand and respond to sensory information around them. Autistic people can experience sensory issues that cause a negative reaction to certain triggers, and these triggers will be different for everyone. The sensory issues they experience can lead to difficulties with social interactions, difficulties with communication, repetitive or restricted behaviours or interests, different ways of learning or paying attention, and more. 

Some common signs and symptoms of autism in adults include: 

• Difficulty reading social cues
• Difficulty participating in conversations with others 
• Difficulty relating to others’ thoughts and feelings 
• Difficulty regulating emotions 
• Difficulty building and maintaining relationships 
• Difficulty reading body language and facial expressions of others 
• Using a monotone speaking pattern, which makes it difficult to convey emotions
• Difficulty maintaining eye contact in conversations
• Restrictive or repetitive behaviours  
• Difficulty with last-minute changes to plans or routines
• Fixation on a favourite subject they care a lot about or are particularly skilled in 
• Sensitivity to sensory input like pain, touch or sound

Some common signs and symptoms of autism in children include:

• Repeating certain words or phrases 
• Lining up toys or objects, and getting upset if the order is altered 
• Playing with toys in the same way every time
• Focusing intensely on parts of an object 
• Obsessively following certain routines, and becoming upset by small changes
• Obsessive interest in specific things 
• Physical movements like rocking or spinning in circles
• Unusual reactions to triggers, such as specific sounds, smells or tastes

Keep in mind, every autistic person – both adults and children – will have traits and symptoms that are unique to them, so autism in one individual may look very different to another. For this reason, autism support should be bespoke to suit the person’s specific needs. 

You may find more helpful information in our guide: What is autism? 

What is OCD?

OCD stands for obsessive-compulsive disorder, and this is a mental health condition that can cause obsessive thoughts and compulsive behaviours. Around 1.2% of the UK population are thought to be affected by OCD. In most cases, OCD develops in early adulthood and can cause: 

• Obsessive thoughts that arise due to particular triggers – you can read more about this in our article: OCD Triggers: How and Why Do They Happen?
• Obsessive rumination, worry and anxiety – you can read more about this in our article: Why OCD Ruminating Is A Problem (And What To Do About It)
• Unwanted and unpleasant thoughts or urges that are difficult to ignore
• Compulsions to act in a certain way
• Repetitive behaviours that feel as though they must be actioned to relieve unpleasant feelings

As an example, someone with OCD might display behaviours such as counting objects, checking things over and over, arranging objects in a satisfying order, or obsessive worrying. 

What are the key differences between OCD and autism?

There are a number of similarities between OCD and autism, which we will cover later, however there are also several factors that differentiate the two. Some of these include: 

The characteristics of each condition 

OCD involves intrusive thoughts and ritualistic behaviours carried out with the aim of easing anxiety and negative feelings. Autism, on the other hand, often manifests in social interaction and communication challenges, as well as sensory reactivity – all of these are areas a person with OCD may not struggle with at all. 

The social struggles and communication issues autistic people experience could also be the reason they are unable to fully express their symptoms, while a person with OCD will rarely have trouble being able to communicate what they are suffering with. 

It is also important to understand those with OCD are carrying out their behaviours consciously, and therefore may feel an element of shame in what they are unable to control. Alternatively, autistic people may be unaware of their behaviours, how they affect them on a daily basis, or how they may present to others around them, and may not experience any shame around these behaviours.

Studies have suggested that certain symptoms – for example, showing a significant interest in collecting things, or hitting objects – are recognised in autistic subjects as an enjoyable practice, whereas similar compulsions in those with OCD are typically carried out in order to relieve feelings of uneasiness caused by obsessive thoughts. 

"[F]rom my experience, repeating an action like spinning the wheels on a toy train can act as a sort of sensory massage. It’s also true that many people with autism feel compelled to organise items in a certain order. This is quite different from the repetitive actions motivated by OCD, where something terrible will happen if your compulsions are not adhered to." 
– Steve Slavin (autistic adult), via the National Autistic Society

The underlying causes 

Aside from the triggers that cause OCD to manifest, the underlying causes of the condition are also unique to each individual. The cause of OCD could be personal experiences, personality or biological factors, and some common causes include genetics, learned behaviours, pregnancy and trauma. 

Unlike OCD, autism can be caused by a genetic condition (such as fragile X syndrome or tuberous sclerosis), but in many cases no underlying cause is known. People have a higher likelihood of being born autistic if they are born to older parents, have an autistic sibling, or experience complications at birth. 

Treatment options and outlook 

Understanding the unique elements of each condition is important in order to offer the best treatment options, and treatments for OCD and autism will be very different. 

It is important to note that while a person with OCD may seek treatment in an attempt to recover from the condition, autistic people cannot be cured of their autism – instead, their treatment will involve finding effective coping strategies that enable them to minimise distress from sensory triggers, maximise daily functioning, and support their learning and development. 

OCD treatment might include therapies such as cognitive behavioural therapy (CBT) or medication, whereas an autistic person will likely require a bespoke treatment plan focused on finding coping strategies for their specific symptoms. 

What are the similarities between OCD and autism?

There are certainly some similarities and overlaps between OCD and autism, with the National Autistic Society recognising that these two conditions may share:

• Compulsive-like behaviours
• Restricted or repetitive behaviours
• Intense interests
• Difficulties with change 

Repetitive and seemingly compulsive behaviours may be the most outwardly obvious similarity between the two. Those with OCD may carry out repetitive behaviours (such as touching specific objects over and over) in order to ease negative feelings, or due to the sense that something bad will happen if they do not perform these behaviours. 

Autistic people may also show signs of repetitive behaviours, however this may be an unconscious action that comes from the way their brain is wired, as opposed to a compulsion. In autistic people, this is sometimes referred to as ‘stimming’. 

Compulsions are also actions that an autistic person may carry on doing without shame in public or in front of others, while a person with OCD may strive to stifle these behaviours when around other people for fear of embarrassment. 

The similarities in the actions of autistic people and those with OCD are important to understand, because not differentiating the underlying causes and reasons for certain behaviours can lead to difficulty diagnosing either condition.

What is the clinical relationship between OCD and autism?

As well as their similar symptoms and behaviours, there is thought to also be a clinical link between obsessive-compulsive disorder and autism, and while some researchers argue that the conditions occur comorbidly, others believe they exist on the same spectrum.

Research has found OCD may share genetic roots with autism, as well as certain brain markers. In studies, similar brain structure differences have been detected in both subjects with OCD and autistic subjects. Unlike those with other anxiety-related disorders, subjects with OCD showed increased grey matter in the region of the brain known as the caudate nuclei (the part responsible for functions such as planning the execution of movement, learning, memory, reward, motivation and emotions), and similar structural changes were noted in autistic subjects. 

Further research has found similarities in the aetiology (the causes behind conditions) of OCD and autism, as well as their neurobiology (nervous system and brain function), and their phenotypic presentation (observable traits). Further similarities in brain structure have been suggested, for example, one study noted there could be a decreased volume in the anterior cingulate cortex in both autistic people and those with OCD. 

What is the likelihood of having both OCD and autism?

Comorbid OCD and autism (meaning you have both conditions at the same time) is certainly possible. According to a 2023 review, around 50% of autistic subjects were thought to also meet diagnostic criteria for at least one personality disorder, and research from 2015 suggests that 17% of autistic people also have OCD, which is higher than the percentage of those with OCD in the general population. More recent research from 2020 found that between 17% and 37% of young autistic people could also have OCD symptoms.

Research shows those first diagnosed with autism had a 2-fold higher risk of later receiving an OCD diagnosis compared to those without autism, and those first diagnosed with OCD had a 4-fold higher risk of later receiving an autism diagnosis compared to those without OCD. 

Other than their shared symptoms and possible shared brain structure differences, it is not known exactly why there is such a significant comorbidity between the two conditions. One risk factor to consider is that there is a higher risk of comorbid OCD and autism in children of parents with OCD. 

What are the challenges when diagnosing comorbid OCD and autism?

With such similar behavioural symptoms existing between autism and OCD, reaching a diagnosis of one condition or the other can be challenging. Autistic people may exhibit a number of repetitive behaviours that mimic the rituals performed by those with OCD, so the line between the two can seem blurred when it comes to diagnosis. 

Communication difficulties experienced by autistic people can also hinder the ability to establish an accurate reporting of OCD symptoms, which can lead to comorbid conditions being missed. 

In addition, sensory sensitivities experienced by autistic people could exacerbate the symptoms of OCD or manifest as compulsions, which can again make it difficult to differentiate between both conditions and find the appropriate treatment. 

Understanding the ‘why’ behind certain thought processes and behaviours can be the key to a correct diagnosis, and this often requires a specialist with a high level of experience in autism or obsessive-compulsive disorder who can carefully identify the nuanced symptoms involved, as well as the underlying causes, and tailor the treatment and intervention strategies to the individual’s needs. 

What can someone do if they believe they have been misdiagnosed?

It is not uncommon for those diagnosed with autism or obsessive-compulsive disorder to find out they have been misdiagnosed; as they grow older, have more experiences and learn more about their triggers and thought processes, they may recognise additional traits that do not quite fit with the diagnosis they currently have. These developments could also suggest that they may in fact have comorbid autism and OCD. 

Studies suggest some people may have been diagnosed with a personality disorder like OCD before being identified as autistic, which can mean their treatment or the coping mechanisms they have been recommended are not suited to their needs. 

Further studies suggest that, since autism is associated with an increased prevalence of psychiatric disorders, autistic people may initially be referred for treatment for the co-occurring symptoms they display instead of for autism. This could be due to:

• Autism assessments requiring observations from parents and teachers, which can make diagnosis more challenging
• Masking, which is when an autistic person presents as neurotypical
• Gaps in autism research, as current autism research is focused on men rather than women, and rarely covers autistic symptoms of different races or ethnicities
• Gaps in diagnostic tests, as many autism tests are designed for children

If you believe you (or a loved one) has been wrongly diagnosed – whether this means you think you have an alternative condition, or comorbid autism and OCD – you should reach out to your doctor or the specialist who currently provides advice and treatment for the condition you have been diagnosed with. You can request reassessment if necessary, or advice on who to discuss your suspected condition with. 

There are many specialists who can provide bespoke advice on either autism, OCD or both, so finding a specialist who can take the time to analyse your true symptoms and come to a conclusion about the condition(s) you may have can ensure you receive the appropriate support and treatments to help you thrive, regardless of your diagnosis. 

Where can someone with OCD or autism find further support?

Whether you suspect you may have OCD or autism, the process of getting a diagnosis and treatment can be challenging and often takes time, however there are many benefits to pursuing the appropriate diagnosis and correcting any prior misdiagnosis.

If you have symptoms of either condition that are negatively impacting your life, you can begin by reaching out to your GP for advice on the process of getting a correct diagnosis. Many people find this can take a long time when going through the NHS due to long waiting lists, and choose to explore private options instead. 

If you are already working with an autism specialist, you may wish to speak to them about the possibility of comorbid obsessive-compulsive disorder, or vice versa, and in many cases they may be able to offer you advice on how to best manage any comorbidities and where to seek further advice and treatment for comorbid conditions. For example, an autism specialist may be able to refer you to an alternative therapist who specialises in OCD. 

You may find some of our guides helpful if you are pursuing an autism or OCD diagnosis:

• Finding a private psychiatrist near you
• How to find the right mental health specialist
• What to expect from an adult autism assessment

At Augmentive, we believe advice and support for those with autism and/or OCD should be tailored to the individual and the symptoms they are experiencing. We recognise the existence of comorbidities, and our free 15 minute consultation can match you with an appropriate therapist who specialises in both conditions, so can assist you in effectively treating and managing your autism and OCD together.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private OCD assessment to help finding an autism specialist near you to support you on your journey.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.