OCD and Autism: The Relationship Between the Two Disorders

Last Updated on July 12, 2025 by John Hookway

OCD and Autism have some symptoms that are the same. These include doing things over and over, following routines, and being sensitive to sounds or touch.

Both conditions are common around the world. OCD affects about 1% of people everywhere. Autism affects about 1 in every 127 people.

The biggest difference is why people do these behaviors. People with OCD do them to feel less worried. People with autism do them to feel calm or safe.

They also have different ways of talking and thinking. Telling the difference is important. It helps people get the right diagnosis and care.

OCD Overview

Obsessive-Compulsive Disorder (OCD) is a mental health problem. It can happen to anyone, no matter their age. Doctors use the DSM-5 and ICD-11 to help diagnose OCD. These guides say OCD has two main parts:

• Obsessions: These are thoughts or pictures that pop into your mind. You do not want them, and they make you feel upset or worried.
• Compulsions: These are things you do over and over. You might do them because of obsessions or because you follow strict rules. People do these actions to feel less upset or to stop something bad.
• Both guides say obsessions and compulsions are connected. Sometimes, people do compulsions even if there is no clear obsession.
• The DSM-5 and ICD-11 both say compulsions can be in your mind, not just actions you do.
• The DSM-5 also talks about how much a person knows about their symptoms. It also checks if they have tic disorders.
• The ICD-11 tries to make it easier for doctors everywhere to diagnose OCD.

Anyone can get OCD. It does not matter how old you are or where you come from. For a diagnosis, the symptoms must bother you or make life hard.

Main Symptoms

OCD symptoms fit into a few main groups. New studies show these symptoms often go together:

• Symmetry and Ordering: Some people need things to look or feel perfect. They want things in a certain order.
• Forbidden or Taboo Thoughts: Some people get thoughts about harm or violence. These thoughts make them feel nervous or scared.
• Cleaning and Contamination: Many people with OCD worry about germs or dirt. They may wash their hands or clean things again and again.
• Hoarding: Some people cannot throw things away, even if they are not useful.

These symptoms show two main patterns. One pattern is anxious thoughts, like being scared of harm or having taboo ideas.

The other pattern is doing things over and over, like checking, counting, or cleaning. Both patterns can happen together or by themselves.

Daily Impact

OCD can change a person’s daily life a lot. Kids and adults with OCD may spend many hours on obsessions and compulsions.

This can make it hard to do schoolwork, jobs, or spend time with others. Kids may do things like washing or checking until it feels right.

This can make them late for school or slow to finish homework. Adults may try to hide their symptoms. This can make them feel alone or ashamed.

OCD can make easy tasks feel very hard. People might stay away from places or things that make them anxious. Family members may help with rituals, which can make things worse. Other problems, like ADHD in kids or mood problems in adults, can make OCD harder.

OCD can make people feel tired, upset, or lonely. At work, people may try to be perfect or fear mistakes. This can make it hard to get things done.

In school, students may have trouble paying attention or finishing work. Worry and controlling actions can hurt relationships. Getting help early can make life better and lower these problems.

Autism Overview

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition. Doctors use the DSM-5 and ICD-11 to find out if someone has ASD.

Both guides say autism starts in early childhood and lasts for life. The ICD-11 lists three main signs of ASD:

• People have trouble starting and keeping social interactions and communication.
• They show behaviors, interests, or activities that repeat or do not change much. These can include unusual reactions to sounds, lights, or textures.
• The symptoms make daily life harder at home, school, or work.

The DSM-5 puts all types of autism, like Asperger syndrome, under one name. It looks at two main things: problems with social communication and repetitive behaviors.

Doctors check for these signs when a child is young, but sometimes they notice them more as the person grows up. Autism is not the same for everyone. Some people need a lot of help, and others need less.

Note: Autism is not something that needs to be “cured.” Many experts now think autism is just a part of human diversity.

Main Symptoms

Autism has two main groups of symptoms. These symptoms can look different for each person and can change over time.

Social Communication and Interaction:

• Some people do not make eye contact or answer when called.
• They may find it hard to start or keep a conversation.
• They might not understand jokes, sarcasm, or body language.
• Some prefer to play alone or have trouble making friends.
• They may speak in a flat or different-sounding voice.

Restricted and Repetitive Behaviors:

• Some repeat movements, like hand-flapping or rocking.
• They may say the same words or repeat what others say (echolalia).
• Some have strong interests in certain topics, called “special interests.”
• Changes in routine or environment can upset them.
• They may be sensitive to sounds, lights, textures, or smells.

These behaviors are not bad or wrong. They are just differences. Some people need help, especially in busy places or social situations.

Daily Impact

Autism changes daily life in many ways. How much it affects someone depends on their age, support, and strengths.

• Children: Some kids need help with daily tasks, like getting dressed or brushing teeth. Visual schedules or reminders can help them stay on track. Changes in routine can make them feel stressed or cause meltdowns.
• School: Students with autism may find group work or loud classrooms hard. They might need quiet places or more time to finish assignments.
• Adults: Many adults with autism use tools, like noise-canceling headphones, to handle too much noise. Social events, like work meetings or parties, can feel too much. Some adults have trouble organizing tasks or keeping track of time.
• Older Adults: Studies show that autistic adults may have more mental health problems as they get older. They might also notice changes in memory or thinking.

Support from family, teachers, and employers helps a lot. Tools like social stories, visual aids, and clear routines help many autistic people do well at home, school, and work.

Autism lasts a lifetime. With understanding and the right help, people with autism can do well in their own ways.

OCD and Autism: Similarities

Repetitive Behaviors

Many people see that OCD and Autism both have repetitive behaviors. These actions can look the same, but the reasons are not always alike.

• People with autism might flap their hands or rock back and forth. They may also repeat words. These actions help them feel calm or handle too much noise or touch.
• People with OCD might wash their hands or check locks many times. They may count things over and over. They do these things to feel less worried about bad thoughts.
• Both groups might say the same things again and again. For example, someone with autism might say lines from a movie they like. Someone with OCD might repeat words to feel safe.

Some repetitive actions look the same and happen often in both groups. For example, both might line up objects or do things many times each day.

But the feelings behind these actions are not the same. People with autism usually feel okay about their actions.

These actions fit who they are. People with OCD often feel upset about their actions. They may want to stop but feel like they cannot.

Repetitive behaviors can make it hard for doctors to tell OCD and Autism apart. The same tests might show high scores for both. It is important to know why someone does these actions.

Routines and Sameness

OCD and Autism both show a strong need for routines and sameness. This can mean eating the same food every day or taking the same way to school. It can also mean doing things in a certain order.

• For people with autism, routines bring comfort and happiness. A child might line up toys the same way each time. They might follow a bedtime routine exactly. Changes can be stressful, but the routine feels good.
• For people with OCD, routines help control worry. A person might feel they must wash their hands a set number of times. They might check the door again and again. If they do not follow the routine, they feel very scared or nervous.

Children with autism may want sameness because it feels right or helps them focus. They do not get upset by their routines unless someone stops them.

Children with OCD do routines to stop bad things or scary thoughts. If they cannot do their routines, they feel very upset.

Routines and sameness show up in both conditions, but the reasons and feelings are not the same. Knowing these differences helps doctors give the right diagnosis.

Sensory Sensitivities

Both OCD and Autism often come with sensory sensitivities. Many people in both groups react strongly to sounds, textures, lights, or smells.

In autism, sensory issues are a big part of the diagnosis. People may cover their ears when noises are loud. They might avoid certain clothes or look for calming sights and sounds. These sensitivities can explain why someone repeats actions or stays away from some places.

People with OCD also have sensory sensitivities, but these are not studied as much. Many kids with OCD dislike some sounds or how things feel. These feelings can make OCD worse. For example, a child might wash their hands again and again because soap feels wrong.

Or a sound makes them feel bad. Some people with OCD notice small changes in how things feel or sound. They may repeat actions until things feel just right.

Sensory sensitivities in OCD and Autism can look the same, but the reasons are different. In autism, sensory issues help people calm down. In OCD, they can lead to rituals that lower stress. When both conditions happen together, sensory problems can be even harder and may need special help.

Social Challenges

Many people with OCD and Autism have trouble with social situations. These problems can look alike, so it is sometimes hard to tell them apart.

Both groups often find it hard to make friends or join group activities. They may feel different or worry about fitting in.

• People with both conditions often stick to routines or repeat actions. These habits can make it tough to join others, especially if plans change.
• Many have trouble getting jokes, sarcasm, or body language. This can make talking with others confusing.
• Some stay away from social events because they feel nervous or uneasy. They may worry about making mistakes or being judged.
• Both groups may struggle to start or keep a conversation. They might not know what to say or how to answer.
• Wanting things to be the same can make group activities hard. Surprises or changes can cause stress or upset.

In autism, social problems often happen because it is hard to read social cues or know how others feel. These problems are a main part of autism.

In OCD, social issues usually come from anxiety or the need to do rituals. For example, someone might avoid friends because they fear germs or must repeat actions.

About 17% of people with autism also have OCD. This makes social life even harder for them. The reasons for social problems are not the same, but they can look alike. Both groups may feel left out or not understood.

Social problems in OCD and Autism can seem the same, but the causes are different. Knowing these differences helps families, teachers, and doctors give better help.

 

Differences

Motivation Behind Behaviors

The reasons for repetitive behaviors in OCD and autism are not the same. Knowing these differences helps families and doctors give better support.

• People with OCD repeat actions because they feel worried or upset. Obsessions are thoughts that bother them a lot. Compulsions, like washing hands or checking locks, help them feel less anxious or stop something bad.
• People with autism repeat actions because it feels good or calming. These actions help them relax, enjoy certain feelings, or make life feel more predictable.
• In OCD, people want to get rid of bad feelings from obsessions. In autism, repeating actions brings happiness, comfort, or sensory pleasure.

The actions may look the same, but the reasons are not. OCD and Autism both have repetitive actions, but the motivation is different.

Obsessions vs. Special Interests

Obsessions in OCD and special interests in autism can seem similar, but they are not. Studies show OCD obsessions are unwanted thoughts about harm, germs, or things that feel wrong. These thoughts make people feel scared or nervous. To feel better, they do things like checking, cleaning, or counting.

In autism, special interests are not about fear or worry. They are strong interests in certain topics, objects, or activities.

These interests make people happy and help them focus. People with autism may spend lots of time learning about their favorite things or collecting items.

These interests are part of their repetitive behaviors and restricted interests. These actions are linked to sensory needs or wanting things to feel “just right,” not to anxiety.

Doctors use tools like the Yale-Brown Obsessive Compulsive Scale to tell the difference. People with autism usually have fewer OCD obsessions, but may show more repetitive actions like ordering or self-injury. Special interests in autism start early and last a long time. OCD obsessions can change and often make people upset.

Social Communication

Social communication problems are another big difference between OCD and autism. These problems affect how people talk, understand others, and join in social life.

• People with autism often have more serious and lasting trouble with social communication. They may not understand body language, jokes, or how to start talking to someone. These problems start early and affect making friends or working with others.
• People with OCD can also have trouble in social situations, but it is usually not as bad. Their problems come from anxiety or needing to do rituals, not from not understanding social rules.
• Studies show people with autism score lower on social behavior and life skills tests than people with OCD. Autism affects social skills and talking in a bigger way.

Social communication problems in autism are wide and start early. In OCD, these problems are mostly about anxiety and worries. Knowing this helps teachers, doctors, and families give better support.

Onset and Development

OCD and autism start at different times and change in different ways. Autism Spectrum Disorder (ASD) shows up early in life.

Most kids have signs before they turn three. Parents and teachers notice differences in how kids talk, play, or act with others.

These early signs help doctors find autism in young kids. Autism stays with a person for their whole life. The symptoms do not change much, but help and learning can make things easier.

Obsessive-Compulsive Disorder (OCD) usually starts later. Most people get OCD around age 19. Doctors see two main times when OCD starts. The first is between ages 7 and 12, mostly in boys.

The second is around age 21, more often in girls. OCD almost never starts after age 40. OCD can change over time. Some people have symptoms that come and go. Others have symptoms that last for years but may get better or worse.

Autism stays the same from early childhood. OCD can get better or come back, so it changes more.

The reasons for repetitive behaviors are not the same. In autism, these actions start early and help with comfort or sensory needs.

In OCD, these actions start later and happen because of worry or stress. When and how symptoms show up helps doctors tell the two apart.

Key differences in onset and development:

• Autism starts early and stays the same.
• OCD starts later, in older kids, teens, or young adults.
• Autism symptoms last a lifetime.
• OCD symptoms can get better or worse over time.

Knowing these differences helps families and doctors spot each condition. Finding out early means people can get better help and care.

Overlap and Co-Occurrence

Dual Diagnosis

Doctors sometimes find both OCD and autism in one person. This is called a dual diagnosis. It happens more in kids and teens than people think.

The numbers change a lot in different studies. This is because the symptoms can look very similar. The table below shows what researchers have found:

It is hard for doctors to tell OCD and autism apart. Both can have repeated actions and strict routines. People with both often need extra help and support.

Challenges in Daily Life

People with both OCD and autism face many tough problems every day. These problems can make things harder at home, school, or work.

• Anxiety gets worse because OCD thoughts and autism stress add up.
• Rigid thinking makes it hard to handle changes in plans.
• Many people stay away from others. OCD anxiety and autism social problems both cause this.
• School and work can be tough. Bad thoughts and sensory issues make it hard to do well.
• Repeated actions and social problems make it harder to diagnose and treat.
• Sensory issues and trouble talking add more stress.
• People with both need care that fits them. This can mean therapy like CBT, ERP, or ABA, and sometimes medicine.
• Clear routines and good communication help people deal with these problems.

A team with doctors, teachers, and family can help a lot. Each person is different, so support should fit their needs and strengths.

Shared and Unique Features

New studies show OCD and autism have things in common but also big differences. Both affect how the brain works, especially with habits and thinking. The table below shows what is the same and what is different:

Both conditions change how the brain controls habits and feelings. OCD usually shows more brain activity in some areas. Autism often shows less.

Both can have sensory problems, but for different reasons. Knowing these differences helps doctors pick the best treatments.

Knowing what is the same and what is different helps families and doctors give the best support.

Diagnosis and Misdiagnosis

Distinguishing Features

Doctors look for certain signs to tell OCD and autism apart. They check why someone repeats actions. In OCD, people do things to feel less anxious from bad thoughts.

In autism, repeating actions helps with sensory needs or brings comfort. Doctors focus on what the actions do for the person.

• OCD repetitive actions are linked to obsessions and worry.
• Autism repetitive actions are mostly for sensory needs or to calm down.
• Trouble with talking to others and being sensitive to sounds or touch are main signs of autism, not OCD.
• People with OCD often know their actions are too much or do not make sense. This is not as common in autism.
• To diagnose autism, doctors look at how a person grew up and ask families for details. For OCD, doctors focus on how obsessions and compulsions affect life.

Doctors use different tests for each condition. Autism tests include interviews, forms, and family history. OCD tests use interviews and forms about obsessions and compulsions.

Common Misdiagnoses

Doctors sometimes mix up OCD and autism because they share many signs. Both can show repeated actions, strict routines, and being sensitive to sounds or touch. This makes it hard to tell them apart.

• Up to 86% of people with autism have actions that look like OCD.
• About 20% of people with OCD show strong autism traits.
• OCD obsessions cause worry and stress. Autism repeated actions may feel good or help with sensory needs.
• Autism usually starts early and lasts a lifetime. OCD often begins later, around the teen years.
• Trouble talking in autism can look like anxiety in OCD.

Doctors sometimes call autism OCD or the other way around. This happens because there is no lab test for autism.

Doctors must watch how people act, which can be hard. Gender matters too. Girls may hide their signs better, so doctors miss or find them late.

Full checks, including learning about a person’s past and watching how they act, help stop mistakes in diagnosis.

Importance of Accurate Diagnosis

Getting the right diagnosis is very important for care and support. OCD and autism can happen together, so doctors need to check carefully. If doctors get it wrong, the treatment may not work well.

• OCD and autism need different kinds of therapy. OCD treatments like SSRIs and regular CBT may not help autistic people as much.
• The right diagnosis helps doctors make a plan that fits each person.
• Special therapies, like using pictures or having parents help, work better for people with both conditions.
• Getting information from parents and teachers helps doctors make better diagnoses.
• When doctors know why someone repeats actions, they can pick the best help.

A correct diagnosis helps people get the support they need. It makes life better and helps people and families in the long run.

Treatment and Support

OCD Approaches

Doctors have different ways to help people with OCD. The main treatment is Exposure and Response Prevention (ERP) therapy.

In ERP, people face their fears slowly. They learn not to do their usual compulsions. This helps them feel less anxious over time. ERP works for both kids and adults.

Doctors often use ERP with medicine. Selective Serotonin Reuptake Inhibitors (SSRIs), like fluoxetine or sertraline, are the first choice.

These medicines help balance chemicals in the brain. They lower OCD symptoms. If SSRIs do not work, doctors may try clomipramine. For severe OCD, using both ERP and medicine works best.

Other therapies can help if ERP or medicine is not enough. These include Acceptance and Commitment Therapy (ACT), Cognitive Therapy (CT), and Metacognitive Therapy. These therapies teach new ways to handle thoughts and feelings. It is important to work with a therapist who knows about OCD. Doctors also teach skills to stop OCD from coming back.

About 70% of people with OCD get better with these treatments. Support from family can help people stay healthy longer.

Autism Approaches

Autism treatment helps people build skills for daily life. Starting early makes a big difference. Applied Behavior Analysis (ABA) is a common therapy. ABA uses rewards and practice to teach new behaviors.

It also helps reduce problem actions. Other types of ABA, like Discrete Trial Training (DTT) and Pivotal Response Training (PRT), help kids learn to talk and make friends.

Speech therapy helps people with autism talk and understand others. Occupational therapy (OT) helps with small movements and sensory problems. For example, it helps with loud sounds or certain textures. Physical therapy (PT) helps with balance and movement.

Some kids use tools like the Picture Exchange Communication System (PECS) to talk. School programs, like TEACCH, and special education plans (IEPs) help kids learn at school.

Doctors may use medicines like risperidone or aripiprazole to help with anger or aggression. This makes it easier for kids to join therapy.

Finding autism early and starting therapy quickly helps kids do their best.

Co-Occurring Cases

When someone has both OCD and autism, treatment needs special planning. Therapists often use Cognitive Behavioral Therapy (CBT) with ERP.

They change the therapy to fit the person’s needs. For example, they use pictures, break tasks into small steps, and keep sessions the same each time. This helps people with autism feel safe and understand therapy.

Doctors sometimes use SSRIs for OCD symptoms. People with autism may react differently to these medicines. Therapists may also change ABA to help with both OCD and autism. They use rewards and clear steps.

Family support is very important. Families learn how to help with therapy at home and manage stress. Therapists also teach social skills and ways to cope. Each plan is different and looks at the person’s strengths, sensory needs, and thinking style.

Getting the right diagnosis and working as a team helps people with both OCD and autism get the best care.

Support Resources

Many groups help people with OCD and autism. The International OCD Foundation (IOCDF) is a top place for support. The IOCDF has an OCD and Autism Resource Center.

This center gives families tools to learn about both conditions. It shares facts about when OCD and autism happen together. It also explains treatment choices and ways to help families.

Key support resources include:

• Easy-to-read guides that explain OCD and autism.
• Tips for families on daily life and treatment.
• Stories from autistic people who also have OCD. These stories help others feel less alone.
• Special groups like the OCD/Autism Special Interest Group (SIG). These groups connect doctors, researchers, and people with experience.
• Online support groups, webinars, and events for learning and sharing.
• Conferences where experts and families talk about new research and treatments.
• A list of therapists and clinics who know about both OCD and autism.
• Training and forums for therapists who want to learn more.
• Links to other autism and OCD groups, plus tools for learning social skills and self-advocacy.

Families often have hard choices about how to help loved ones. The IOCDF says families sometimes join in OCD rituals or change routines to lower stress. This can help for a short time but may make OCD worse later. For autistic people, some changes are needed for comfort or safety. Families should talk to professionals to decide which supports help and which ones keep OCD going.

The IOCDF wants families to join in treatment. When families learn about OCD and autism, they can help their loved ones better.

Many resources teach families how to balance help for autism with the need to lower OCD symptoms. Working together can make life better for everyone.

People can also get help by joining online forums or local support groups. Sharing stories and learning from others can build hope and confidence. Many groups invite people to share their experiences to help others and raise awareness.

Support resources help families and people feel less alone. They give tools, knowledge, and hope for a better future.

When to Seek Help

Warning Signs

Knowing when to get help for OCD or autism is important. Getting help early can make things better and stop bigger problems. Parents, teachers, and caregivers should look for signs that a child or teen needs to see a doctor.

Some signs of OCD are:

• Doing the same rituals or routines that cause stress or mess up daily life
• Spending too much time cleaning, grooming, or checking things
• Asking parents, teachers, or friends for reassurance again and again
• Having trouble finishing tasks or making choices because of fear of mistakes
• Feeling worried or upset when routines change
• Not getting better even after trying therapy

Autism has different warning signs. Kids may not make eye contact or understand social cues. They might repeat movements like flapping hands or rocking.

Some kids have trouble talking or using gestures. Others react strongly to sounds, lights, or textures. Being very interested in certain topics or objects can also be a sign.

The table below shows main warning signs for both:

Getting help early can stop problems like trouble with friends, school, or feeling sad or anxious.

Next Steps

If a child or teen shows these signs, families can do a few things to help:

1. Watch and write down what the child does. Notice if the actions are because of worry or fear (OCD) or if they help the child feel calm or keep a routine (autism).
2. Use screening tools like the Autism Quotient (AQ) test to check for autism traits.
3. Make a sensory profile to see how the child reacts to sounds, lights, or textures.
4. Compare the child’s actions to the DSM-5 rules for autism, especially social and communication skills.
5. Get a checkup from a doctor who knows about both OCD and autism. It is important to know if the child has one or both.
6. Learn about treatments. For OCD, therapies like cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) can help. For autism, services like counseling, social skills training, and help at school are useful.
7. Build a support team. Parents, teachers, and therapists should work together to help at home and school.
8. Give the child a routine and structure to help with daily life. Eating healthy and taking care of themselves also helps.

Families who act early and get help from experts give their children the best chance to do well and be happy.

OCD and Autism both have repetitive actions and strong reactions to sounds or touch. But the reasons for these actions are not the same. Doctors need to know if someone acts this way because they feel anxious or because it helps them feel calm.

• Both OCD and Autism can make school, work, and friendships harder.
• Getting help early, having family help, and using the right therapy can make life better.
• Learning more about these conditions helps people know when to get help.

Noticing problems early and giving the right help can really change life for people with OCD and Autism.

FAQ

What is the main difference between OCD and autism?

OCD means people have thoughts they do not want. They do actions to feel less worried. Autism means people do things that make them feel safe or happy. The reason for the actions is what makes them different.

Can a person have both OCD and autism?

Yes, some people have both at the same time. Doctors call this a dual diagnosis. People with both need special help and plans for both sets of problems.

How do doctors tell OCD and autism apart?

Doctors check why someone repeats actions. They see if it is because of worry (OCD) or comfort (autism). They also look at how the person talks and grew up.

Do OCD and autism have the same treatments?

No, the treatments are not the same. OCD is often helped by therapy like Exposure and Response Prevention and some medicines. Autism support helps people learn skills with ABA, speech, and occupational therapy.

Are repetitive behaviors always a sign of OCD or autism?

No, many people repeat things sometimes. It is only a problem if it causes stress or messes up daily life. Doctors look at why and how much it affects the person before saying it is OCD or autism.

What should families do if they notice warning signs?

Families should write down what they see. They should talk to a doctor who knows about both conditions. Getting help early can make things better and lower stress.

Can sensory sensitivities happen in both OCD and autism?

Yes, both can have sensory sensitivities. In autism, these are a big part of the condition. In OCD, sensory issues can make people do rituals or compulsions.

Where can families find support and resources?

Families can get help from groups like the International OCD Foundation and autism groups. These groups have guides, support groups, and lists of therapists who know about both.