OCD vs Autism [2024]: What's the Difference, Common Symptoms, Cause, Treatments

How to differentiate between Autism and OCD?

Obsessive-compulsive disorder (OCD) and Autism are very common disorders. However, the features of both disorders appear to be similar and hence can create confusion. But there are distinct underlying differences between them. 

To learn more about OCD and Autism and unravel the existing links, it is necessary to understand the conditions individually. In this article, we are sharing all that you need to know about both disorders, the basic differences, overlapping symptoms, causes, and treatments.

Understanding OCD and Autism

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviours (compulsions) that the person feels compelled to perform to experience relief from it. 

For example, Soham constantly thinks about contamination and germs. These intrusive thoughts run through his mind all day, which causes anxiety. He is afraid of touching any object that his mind perceives to be potentially contaminated, leading to illness. To get rid of his anxiety and obsessive thoughts, he washes his hands constantly. Every time he engages in routine activities like opening a door or shaking hands, he is compelled to wash his hands. This action of Soham affects his routine life. He avoids going to crowded places and this led him to become socially isolated. 

What is Autism?

Autism is a neurodevelopmental disorder that includes problems with communication and behavior. It is a spectrum disorder which means that it can affect people in different ways and varying degrees. Since it is a developmental disorder, the symptoms are usually identified at the age of 3 but it can be diagnosed later in life.  (13)

The problems with communication are generally associated with their inability to understand what others think or feel. They also need help in effectively communicating what they want. The extent to which an individual faces communication problems depends upon the disorder's severity. 

For example, Sakshi is a 7-year-old child diagnosed with Autism. Her mother observed her having problems with social interactions. She also noticed that Sakshi prefers to stay by herself and not make any eye contact or engage in conversations. She struggles to respond appropriately when other children approach her. She also exhibits repetitive behaviors. One of them is to spin objects and spend her time arranging her toys in a particular order. 

Are OCD and Autism Related?

OCD and Autism are two different disorders. OCD is a mental health disorder while Autism is a developmental condition. The reason why both disorders may seem related is because of the close behavioral resemblance. However, the underlying reasons widely vary. 

The Difference: Knowing the symptoms of OCD and Autism 

What are the Overlapping Symptoms of OCD and Autism?

OCD and Autism are two different disorders. However, both conditions manifest itself in a very similar manner. Telling both the disorders apart becomes tricky since the symptoms overlap.

The primary feature of Autism that resembles OCD on the surface is Restrictive-Repetitive Behavior (RRB). This includes ritualized patterns of verbal and non-verbal behavior, stereotypical movements, and restricted interests. The repetitive behaviors can develop from poor inhibitory control.

It has been speculated that people suffering from OCD or Autism might indulge in RRB to neutralize or diminish the effect that they think is unpleasant. Example of RRB can be:

• Lining up or spinning objects
• Closing and opening drawers and doors
• Paying too much attention to a narrow range of topics or interests
• Behavioral rigidities
• Stereotyped movements

While RRB in Autistic people comes from the urge to preserve uniformity or provide pleasure, RRB for people suffering from OCD stems from the urge to reduce anxiety or discomfort.

Other overlapping symptoms include difficulty with social interactions and communicating effectively, and sensitivity to sensory inputs like sound or light. 

What causes OCD and Autism? 

The exact causes of why OCD or Autism occurs are still unknown. However, certain risk factors increase the chances of developing these disorders. 

Causes of OCD can be:

1.Genetic factors: 

Family aggregation studies have demonstrated that OCD is familial in part due to genetic factors. Studies have also shown that the obsessive and compulsive behaviors of people are associated with the genes responsible for dopaminergic and serotonergic systems. (1) The hyperactivity in the brain might be attributed to a high number of dopamine receptors in the brain while reduction in the serotonin transporter contributes to the development of OCD symptoms. 

2.Brain abnormalities: 

Brain imaging studies have shown that people with OCD have hyperactive circuitry in certain parts of the brain like - of the orbitofrontal cortex, cingulate cortex, thalamus, and the head of the caudate nucleus.

As compared to a normal brain, there are differences in the subcortical regions of the brain as well. It is also noted that people with OCD have, on average, smaller larger striatum (a set of regions deep within the brain known to be involved in repetitive behaviors). The activity of the larger striatum is significantly higher in people with OCD, thus leading to hyperactivity. 

3.Traumatic childhood experiences:

Studies have reported an association between childhood trauma and obsessive-compulsive symptoms. However, traumatic experiences in childhood may not necessarily cause OCD but trigger the onset of obsessive and compulsive behavior (2)

Environmental factors, pregnancy, and learned behaviors can also trigger OCD symptoms. Pregnancy can intensify the symptoms of OCD due to a dramatic increase in the levels of hormones like progesterone. It can be stressful for new mothers to manage an infant while their body is undergoing such a change. 

For example, a new mother might obsess over the health of the infant or be preoccupied with the thoughts of the child. The environment and watching people around them can also influence a person. 

For example, a child might pick up on the compulsive behaviors of the parent and start to imitate them. 

Causes of Autism can be:

1.Environmental factors:

Advanced parental age of conception, maternal obesity, immune disorders and diabetes, extreme prematurity at birth, and oxygen deprivation during birth may increase the risk of a child having Autism. (16)

2.Exposure to contaminants:

Concerns of developing Autism can arise over the exposure of babies and young children to pesticides, heavy metals (such as mercury, lead, or arsenic), altered levels of critical metals (such as zinc or manganese), and other pollutants. Maternal exposure to insecticides during early pregnancy was associated with a higher risk of autism in their children. (9)

3.Genetic history:

Changes in over 1,000 genes have been reported to be associated with ASD. (15) Individually, most of the gene variations have only a small effect. Genetic factors are estimated to contribute 40 to 80 percent of ASD risk. Genetic factors combined with environmental factors lead to the manifestation of Autism spectrum disorder in children.

How To Get Diagnosed? Recognizing if it is OCD or Autism:

Diagnosis for OCD:

The Y-BOCS test is popularly used for the determination of OCD. This rating scale is designed to rate the severity and type of symptoms in patients. 

It is a screening tool used by clinicians with a 10-item checklist that helps to determine the severity of the disorder.  You can consult a licensed clinical psychologist in India to get a formal assessment and diagnosis. 

Diagnosis for Autism:

The American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5) provides standardized criteria to help diagnose Autism. 

Based on these criteria, several diagnostic tools have been developed to diagnose Autism. They are:

1. Autism Diagnostic Observation Schedule, Second Edition (ADOS™-2)
2. Autism Diagnostic Interview (ADI)
3. Screening Tool for Autism in Toddlers (STAT)
4. Childhood Autism Rating Scales (CARS)
5. Tele-ASD-Peds - diagnosis for use in telehealth
6. Indian Scale For Assessment of Autism (ISAA)
7. Gilliam Autism Rating Scale (GARS)
8. INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) (10)

Based on the symptoms reported by the parents and the behaviors observed in their child, they can contact a psychologist or pediatrician. The psychologist might decide if the child needs comprehensive treatment. If this is the case, the psychologist might ask for a consultation from a specialist. 

For example, the doctor might refer the child to a geneticist to trace genetic anomalies. Specialists include neurodevelopmental pediatricians, developmental-behavioral pediatricians, child neurologists, geneticists, and early intervention programs that provide assessment services. (3)

Can OCD be misdiagnosed as Autism?

While it is possible for someone to misdiagnose OCD with Autism, it is not very common. Diagnostic criteria for both the disorders are distinct and medical and mental healthcare professionals can effectively distinguish between them. Very rarely is misdiagnosis possible if the repetitive behaviors are misinterpreted. 

For example, while both OCD and Autism symptoms may include repetitive behaviors, people with OCD engage with it to seek relief from anxiety triggered by obsessive thoughts while the ones with Autism engage with repetitive behaviors to self-soothe in case of sensory overwhelm. 

Behaviors that showcase obsessions, inflexibility in routine, social difficulties, sensory processing, and difficulty with daily functioning.  Although it is a difficult thread to untwine, medical professionals can assist you in identifying the underlying cause.

Treatments for OCD and Autism:

There are multiple treatment options available for OCD and Autism. Since both conditions have different presentations, consult a mental healthcare professional to understand the best course of treatment. It also allows you to get a personalized treatment plan unique to your needs and concerns. 

Treatments for OCD:

1.Brain stimulation:

In simple terms, brain stimulation is activating or inhibiting certain parts of the brain with the help of a magnetic field or electricity. In recent times, Non-invasive brain stimulation techniques like TMS (Transcranial magnetic Stimulation), tDCS (Transcranial Direct Current stimulation), tACS (Transcranial Alternate Current Stimulation), etc. application of these therapies have shown amazing results for managing the symptoms of OCD.

Mave Health’s ARC-tDCS is a NIBS wearable device used for brain stimulation. It is known to improve brain health by treating the symptoms of depression and anxiety without any side effects. With the ARC, 65% of users found improvement in their cognitive functioning within 21 days of the beginning of treatment. 

2.Therapy:

Therapy plays a vital role in supporting individuals with OCD and autism. For those with OCD-like symptoms, cognitive-behavioral therapy (CBT) is often recommended. CBT integrates cognitive and behavioral therapy so that patients can identify the nature of their obsessions and compulsions and engage in behaviors that interrupt this cycle. One such form of therapy is Exposure and Response Prevention Therapy. 

3.Exposure and response prevention:

Exposure and response prevention is an effective therapy used to treat OCD. It creates a hierarchy of feared scenarios and difficult situations. People are encouraged to face their fears by confronting thoughts, images, objects, and situations that provoke their obsessions and compulsions. With ERP, a clinician teaches patients to develop a plan for exposure. This includes teaching techniques to confront their feelings and resist the urge to perform their compulsions.    

4.Medications:

Medications have been shown to reduce the symptoms of OCD by 40-60%. (4) Serotonin Reuptake Inhibitors (SSRIs) are often used to address OCD symptoms. Some anti-anxiety and anticonvulsant drugs might be administered as well depending on factors like age, severity of symptoms, etc. (11) (12)

We’ve covered: How to overcome OCD?

Treatment for Autism:

With the help of well-designed interventions, people of all ages with Autism have been treated successfully. The therapies and interventions differ from person to person, depending upon the needs of the patient. The most common treatment protocols are:  

A. Therapies:

1.Educational and school-based therapies:

Educational and school-based therapies are used to meet the unique learning needs of children with autism. This involves receiving intensive behavioral interventions that focus on enhancing communication, behavior, and social skills. 

2.Occupational therapy:

In occupational therapies, therapists encourage people with autism to engage in effective communication. It also includes sensory integrations, emotional regulation, practicing self-care routines, and teaching motor development techniques. 

1.  Speech-language therapy:

Speech-language therapy helps children improve their ability to communicate and interact with other people. The therapist works on improving articulation, grammar, functional speech, social communication, and social skills. 

    B. Medications:

Selective serotonin reuptake inhibitors (SSRIs) are a family of antidepressants that can effectively reduce the frequency and intensity of repetitive behaviors; decrease anxiety, irritability, and aggressive behaviour; and improve eye contact. Stimulants are often used to decrease hyperactivity in people with Autism.  

Tricyclics, anti-anxiety medications, anticonvulsants, SNRIs (Serotonin and norepinephrine reuptake inhibitors), and psychoactive medications are also actively used to manage the symptoms. 

Use Of Transcranial Direct Stimulation (tDCS) For Treating Ocd And Autism:

tDCS (Transcranial direct current stimulation) is a form of brain stimulation technique that can activate specific areas of the brain. tDCS applies mild current (1-2mA) to the brain which can stimulate brain activity and treat the symptoms of cognitive disabilities. Multiple studies have highlighted the potential of tDCS to treat neurodevelopmental and psychiatric disorders Autism and OCD.

In the case of Autism, research has found that an imbalance in the excitation and inhibition of the synaptic neurons (brain cells) leads to the development of the disorder. With the help of tDCS, stimulation of the prefrontal cortex is performed. This has been known to improve the behavioral symptoms of Autism. (6)

For OCD, studies show hyper or hypo activity in certain regions of the brain. tDCS excites or inhibits these regions of the brain to manage obsessive-compulsive behaviors of OCD. (7)

Mave Health’s ARC-tDCS provides a holistic healing experience for treating OCD and Autism. It can be combined with personalized therapy and medication (if needed). The best part about using the ARC-tDCS is that the symptoms are managed without any risk of side effects. 

Can you have both OCD and Autism?

The co-occurrence of OCD and Autism is not an uncommon phenomenon. Studies show that individuals with OCD had a 13 times higher risk of having a comorbid autism spectrum diagnosis (5) A meta-analysis indicated that 17.4% of young people with ASD also had symptoms that met the diagnostic criteria for co-occurring OCD. 

The comorbidity of OCD and Autism affects the psychosocial skills of an individual like social interaction, maintaining relationships, and complicating treatment. Any evaluations and treatment plans should be made in consultation with a mental healthcare professional. 

How do you get treated for Both OCD & Autism at the same time?

To successfully treat both OCD and Autism, it is necessary to differentiate between the symptoms of both disorders.  

The mental health care provider is likely to create an integrative treatment approach for both disorders. Behavioral and pharmacological approaches have been used so far to treat comorbid symptoms. 

1. Cognitive Behavioral Therapy:

CBT has shown results in treating comorbid obsessive-compulsive disorder in Autism. The protocols include core CBT components like psychoeducation, emotional awareness, exposure, coping skills, and problem-solving. CBT helps to reduce severity of the OCD symptoms more than autistic symptoms. Exposure and response prevention (ERP) has also helped to manage the issue of comorbidity. Patients are taught to understand the benefits of treatment and fight the compulsive behaviors of OCD.  (8)

2. Medications:

Pharmacological interventions like the use of SSRIs have been known to modulate repetitive behavior and aggression in children with comorbid OCD with Autism. (14)

Can OCD Cause Autism And Vice Versa?

No, currently no evidence suggests that either of the disorders causes the other one. Although OCD- like behaviors are present as a comorbidity in many autistic people, it does not cause Autism or vice versa. 

Conclusion:

Both OCD and Autism come with their own set of challenges. It is necessary to recognize the distinctions between the symptoms and get an accurate diagnosis for effective treatment. 

Psychological and pharmacological interventions can improve the quality of life of individuals with these disorders. Brain stimulation technology like tDCS acts as a useful aid for medical professionals. Using a combination of psychological, pharmacological, and brain stimulation techniques like tDCS, the efficiency of treating OCD and Autism can be increased. 

Mave Health's ARC-tDCS has made using brain stimulation technology easy. The advantage of using ARC-tDCS is that OCD and Autism can be managed without any side effects. It can be used at home under the guidance of medical professionals. 

If you know somebody who might be having either of the disorders, you can always take help of a mental health professional. With their expertise and guidance, the symptoms of OCD and Autism can be managed successfully.

References:

1. Brown, A.S., Cheslack-Postava, K., Rantakokko, P., Kiviranta, H., Hinkka-Yli-Salomäki, S., McKeague, I.W., Surcel, H.-M., Sourander, A. (2018). Association of Maternal Insecticide Levels With Autism in Offspring From a National Birth Cohort. Am. J. Psychiatry 175, 1094–1101.
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5. Medications for OCD
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