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How can we differentiate OCD from the symptoms of ASD?

Marta Carulla-Roig
Marta Carulla-Roig
Child and adolescent psychiatrist. Mental Health Area
Hospital Sant Joan de Déu Barcelona

It is estimated that around 15% of people with autism spectrum disorder (ASD) have comorbid obsessive-compulsive disorder (OCD ). It is sometimes difficult to differentiate between the two, as people with ASD often exhibit restricted and repetitive behaviors that could be mistaken for obsessive-compulsive symptoms. Sometimes, the rigidity and inflexibility associated with ASD contribute to the development of fixed routines and rituals centered around a specific theme. In essence, ASD symptoms such as difficulty adapting to change, a need for control, and a tendency to follow repetitive and stereotyped patterns can be factors that maintain OCD in a person with ASD.

However, a key factor in the differential diagnosis between OCD and ASD is that, unlike the repetitive behaviors of ASD, the compulsions of OCD:

  • They are preceded by an obsession.
  • They are performed in response to the anxiety produced by the obsession.
  • They are not desired; they are rejected by the individual who wants to neutralize them.

Repetitive behaviors in ASD are core symptoms of the developmental disorder itself and include two or more of the following:

  • Stereotyped movements (often self-stimulatory).
  • Inflexibility in routines, ritualized patterns of behavior, intolerance to change, rigid thinking patterns.
  • Restricted and fixed interests of high intensity and perseverance.
  • Hypo- or hyperreactivity to sensory stimuli.

Rigid behavioral patterns in people with ASD often provide a sense of security; they also have a need for clear rules to follow and to create predictability in their daily lives (schedules, routines), otherwise they become confused and dysregulated; this gives them structure and stability.

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Marta Carulla-Roig
Marta Carulla-Roig
Child and adolescent psychiatrist. Mental Health Area
Hospital Sant Joan de Déu Barcelona
María del Pino Alonso Ortega
María del Pino Alonso Ortega
Psychiatrist. Obsessive-Compulsive Disorders Unit. Psychiatry Department
Hospital Universitari de Bellvitge