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

How to know if I have OCPD or Autism? To answer this we need to know the difference between these two Autism and OCPD

Obsessive Compulsive Personality Disorder and Autism can be considered two distant cousins that seem to share a lot of similarities. On the surface, the symptoms of both disorders appear to be intertwined. However clinically, both disorders stand far away. 

Understanding how these disorders affect people is crucial to providing them with proper care and treatment. Moreover, it benefits the family and friends of the ones suffering.

This article will provide you with a deep understanding of both disorders. But before we start, let's understand the nuances of both disorders. 

Understanding OCPD and Autism

What is OCPD?

Obsessive Compulsive Personality Disorder (OCPD) is marked by behaviors that concern perfectionism, orderliness, excessive attention to detail, and the need for control over one’s environment.

People with OCPD believe that all their thoughts and actions are rational despite the problems that they may have caused to themselves and others. People with OCPD are very rigid in their beliefs and have a very specific way of doing tasks.

For example, Rishi suffers from OCPD and believes that employees’ desks must be spotless at all times. The employees are frustrated due to his micromanagement and constant inspections of their work desks. The performance of the employees is affected but Rishi assumes that it is because of their incompetence in completing tasks. As seen here, people with OCPD often do not realize that their actions are incorrect or are causing problems for others. 

What is Autism?  

Autism or Autism Spectrum disorder (ASD) is a neurodevelopmental condition that is concerned with the child’s behavior and communication. People with Autism have trouble understanding how others think or feel and in expressing themselves which makes interpersonal communication difficult. They also engage in repetitive behaviors and can have specific interests. People with Autism learn in different ways than others since they interpret things differently. They might also have sensory aversions or insensitivity to sensory stimuli.   

The World Health Organization states that around 1 in 100 children are affected by Autism. This makes up 1% of the population which means around 75 million people are diagnosed with Autism. The autistic traits exist on a spectrum and every child may have unique needs that require attention and support. 

How To Differentiate Between OCPD And Autism? Know The Symptoms:

The difference between OCPD and Autism Spectrum Disorder is very distinct but they share some similarities. It is important to understand that both disorders manifest themselves very strongly through the symptoms mentioned below: (8)

What are the Overlapping Symptoms of OCPD and Autism?

It is not surprising to know that there is a strong overlap between OCPD and Autism. In fact, studies reveal that 54.2% of people diagnosed with OCPD also meet the diagnostic criteria for Autism spectrum disorder. (8) Despite their distinct diagnostic criteria, the OCPD and Autism overlap can sometimes complicate the diagnosis process. 

The overlapping symptoms may also lead to missed diagnosis but expert psychiatrists and clinicians like pediatricians, and neurodevelopmental doctors can help you to understand the difference between them. 

The following symptoms are the major areas of overlap symptoms of OCPD & ASD: 

1. Over-conscientiousness: OCPD and Autism present themselves with the symptoms of becoming hyper-aware of their surroundings. While OCPD traits are about a need for control, people with Autism are sensitive to change and have need for structure and routine.
2. Preoccupation with detail: As mentioned earlier, people with OCPD want their tasks to be perfect. For this, they contribute a large chunk of their time towards paying attention to every detail associated with that task. As for Autism, this may look like paying a lot of interest in the details of the task like numbers or facts. 
3. Perfectionism and rigidity: Perfectionism is a classic trait of OCPD. People are highly fixated on achieving unrealistic standards and are very rigid with their conduct. On the other side, people with Autism strongly prefer perfectionism to avoid uncertainty and chaos around them.    

Are OCPD and Autism Related?

Though both disorders show a significant overlap, OCPD and Autism are not related. The causes of both disorders might be common but no evidence has been found to hint towards the relation of OCPD and Autism. 

The incidence of either of the disorders might depend on the nature of the cause. Research has found that men are affected more by both disorders. When looking at the statistics, the odds of incidence of Autism vs OCPD in women are 6%  and 7.8% respectively. (6)

What causes OCPD and Autism? 

Advancements in research how found that both Autism and OCPD affect women less severely as compared to men. 

Risk factors and Causes of OCPD:

The exact cause of OCPD is not yet known but some theories might potentially explain the development of the disorder. They are:

1. Childhood trauma: Research shows that childhood trauma or abuse might increase the risk of developing OCPD. Many people report that they felt the need to be obedient or instill some order to deal with their feelings. 
2. Genetics: Studies show that genetics play a significant role in affecting the personality of an individual. Genetic factors account for 27% to 78% of traits that are associated with the disorder. (2)
3. Pre-existing mental disorders: Having predisposed mental health conditions like depression or anxiety disorders also increases the risk of developing OCPD. 
4. Medical conditions: The development of OCPD is also accounted to the medical conditions that damage neurons. Head traumas, cerebral tumors, epilepsy, neurosyphilis, etc, (3)

Risk Factors and Causes Of Autism:

Extensive research suggests that there are a lot of factors at play to cause Autism. Although researchers are still trying to understand what causes Autism, certain risk factors play a role in the development of the disorder. They may include:

1. Low birth weight
2. Older maternal and paternal age
3. A sibling with Autism
4. Genetic conditions like Down’s syndrome or Fragile X syndrome. 

Scientists believe that genetic and environmental factors may contribute to the development of the condition. 

Genetic factors:

Mutations are seen in the genes important for a child’s growth and studies show that 444 genes have altered activity more than normal genes. (1) 

Environmental factors:

The significant factors to be considered here are maternal diabetes, medication, and maternal bleeding during pregnancy. Other factors include infections, birth injury or trauma, multiple births, exposure to contaminants during pregnancy, etc. 

It was stipulated that vaccines given during childbirth cause Autism but no scientific evidence found it to be the direct cause of Autism. 

How To Get Diagnosed for OCPD and Autism?

Diagnosis for OCPD:

Mental health professionals base their diagnosis on the criteria set for the disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. 

A detailed assessment is crucial to differentiate OCPD from other personality disorders. Detailed blood work and other routine diagnostic tests are done to rule out the presence of any medical conditions. 

Several assessment tools are crucial to diagnose OCPD accurately. These are integrated with taking a thorough history of the patient and unbiased clinical judgment. Some of these assessment tools are:

1. Minnesota Multiphasic Personality Inventory-3
2. Personality Assessment Inventory
3. Millon Clinical Multiaxial Inventory-IV

Diagnosis for Autism:

The medical diagnosis of Autism is made by a psychologist or a developmental physician. They make use of DSM-5 to accurately diagnose the disorder. Psychologists use a set of tests that are specifically designed to test the severity of 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 Identification of Autism

Can OCPD be misdiagnosed as Autism? 

Even with distinct diagnostic criteria, the chances of Autism and OCPD overlap are not rare. With 54% of OCPD symptoms meeting the diagnostic criteria, there is a probability that OCPD can be misdiagnosed as Autism. (8) It is best to make mental health evaluations in consultation with a trusted psychologist.

What are the Treatment options?

Treatment for OCPD:

The pattern of behavior among people with OCPD has been clearly recognized by psychologists. The treatment is tailored based on the severity of the symptoms and the need for extra care. Currently, the following treatments are used to form a treatment regime. Sometimes, these treatments are also used in combinations to speed up the recovery process.

1.Cognitive behavioral therapy (CBT):

Cognitive behavioral therapy is a common type of Talk therapy that takes gradual steps towards solving your problems by suggesting exercises that challenge them. The primary mechanism of CBT is to restructure the dysfunctional thoughts that occur in OCPD by targeting the underlying maladaptive behaviors. 

For example, Divya suffers from OCPD and thinks that she has to arrange her crockery in a specific order or it will fall and break. With the help of CBT, psychologists helped Divya break down her “Expecting the Worst” ideology by letting her know about alternative outcomes. Psychologists might also suggest her exercises to recognize the patterns where she overestimates the consequences. 

2.Pharmacological treatment:

Despite the high prevalence of the disorder among people, the U.S. Food and Drug Administration has not yet approved any medications for OCPD. However, SRIs (serotonin reuptake inhibitors) - which are used for the treatment of anxiety and depression, are being used extensively. This is because depression and anxiety are outcomes of the disorder. Managing them can significantly reduce the symptoms. It also helps them to reduce their moral rigidity and become a bit more flexible. 

Benzodiazepines are also used for patients experiencing anxiety in OCPD. Anticonvulsants are administered to patients, especially to those who are prone to irritability and anger. (12)

3.Relaxations techniques:

A lot of symptoms of OCPD stem from anxiety or excessive worry about maintaining order or underperforming. A lot of clinical settings incorporate the use of relaxation techniques to decrease anxiety and sense of worry. (9)

4.Other therapies:

Other therapies like Interpersonal Therapy, Schema Therapy, Nidotherapy (changing one’s environment to reduce distress), and Dialectical Behavioral Therapy (DBT) are often used by doctors to treat OCPD.  

1.Interpersonal therapy (IPT): 

The main goal of IPT is to improve the quality of the interpersonal relationships of the patients by understanding the conflicts and building resources to manage them.   

2.Schema Therapy:

Schema means a pattern of thinking and behavior that is used to interpret the world. In Schema Therapy, patients learn about unhelpful coping styles, for example, excessive worrying about safety issues, and make changes. 

3.Nidotherapy:

It is an experimental form of psychotherapy whose primary aim is to change the physical, social, and personal environment to the best fit for the person. By doing this, it proposes that the environment does the therapeutic work and improves mental health symptoms as the environment becomes more suitable. 

4.Dialectical Behavioral Therapy (DBT):

DBT is a form of psychotherapy that helps people to learn strategies to improve their emotional regulation skills.

Treatment for Autism:

The primary goal of treating Autism is to maximize the potential of children. In current clinical settings, the following treatments have shown exceptional results in managing the symptoms of Autism. 

Therapy:

Therapies involved in treatment are tailored according to the needs of the child so that the efficiency of the treatment increases. Therapies comprise of:

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. 

2.Educational and school-based therapies:

Educational and school-based therapies use alternative teaching methods to support the unique learning needs of autistic children. This involves intensive behavioral interventions that focus on enhancing communication, behavior, and social skills 

3.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. These interventions help to improve the quality of a child’s life. 

4.Early intensive behavioral intervention (EIBI):

In this intervention, autistic children are taught to improve their skills by breaking the tasks into small steps that are easier for the children to follow. Upon completion, they are rewarded. Therapists also practice positive reinforcement. Studies have shown that EIBI improves IQ, adaptive behavior, and communication. 

5.Sensory Integration Therapy (SIT):

Autistic people often process sensory information, resulting in problems with touch, smell, or movement. Currently, therapists use SIT to help children improve their motor skills by using play-based sensory-motor activities. This helps children improve their ability to process and integrate sensation.  

B. Medications:

Some medications help to treat specific behaviors associated with Autism like anxiety, aggression, etc. Antipsychotic drugs like Risperidone and aripiprazole are currently the only medications approved by the FDA for treating Autism. Aripiprazole has been known to reduce irritability and aggression-related issues while Risperidone reduces irritability, restlessness, and tantrums. (10)

Other medications include Selective serotonin reuptake inhibitors (SSRIs). They might control the repetitive behaviors and allow the child to focus completely on the task at hand. SSRIs are the first line of treatment and are often combined with therapy to achieve the therapeutic goal. 

Other medications administered to the Autism patients are:

1. Tri-cyclic drugs
2. Stimulants
3. Anticonvulsants
4. Stimulants
5. Anti-anxiety medications

Before resorting to any of the treatments, you must have a thorough idea of the side effects of medications. A medical professional can help you the best in the matters of treatment.

Use Of Trancranial Direct Stimulation (tDCS) For Treating Ocpd And Autism:

Non-invasive brain stimulation techniques like tDCS (Transcranial Direct Current Stimulation) show promise in treating symptoms of OCPD and Autism. This technique is based on the application of weak electric current (1-2 mA) between the electrodes on the scalp of the subject. 

The current stimulates the neurons (brain cells) and enhances the function of the brain. Extensive research has been carried out which proves that symptoms of OCPD and Autism like depression and anxiety. 

tDCS has proven to be an excellent tool for managing the obsessive-compulsive behaviors of patients. It has helped them reduce their irrational fears. 

For patients suffering from Autism, tDCS has shown significant progress in improving attention, vigilance, working memory, decision-making, and social abilities. (4)

Mave Health has adopted this approach to treat disorders like OCPD and Autism. The ARC-tDCS is a wearable tDCS device that provides a holistic healing experience for people suffering from mental health disorders. If needed, it can be combined with other therapies like medications and therapy. The upside of using ARC-tDCS is not worrying about the risk of side- effects at all!! 

Is co-occurrence of OCPD and Autism possible?

The prevalence rates of co-morbid OCPD and Autism are from 9% to 32%. In fact, a study conducted in 2009 involving research about Autism and OCPD together in adults found that 40% of patients diagnosed with Autism met the diagnostic requirements for a co-morbid OCPD. (5) The degree of co-morbidity varies for every patient. Sometimes, there are chances that symptoms of one disorder might overshadow the other leading to confusion. 

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

Treatment for OCPD comorbid with Autism is difficult but not impossible. The most common treatment approach used by doctors is to start with behavioral therapies and medications if necessary. The dosage of medications might vary during treatment. Therapies like Cognitive Behavioral Therapy have shown exceptional results in clinical settings. Exposure and Response Prevention Therapy is effective in treating obsessive or compulsive actions.

Practicing mindfulness as a long-term treatment and is generally used as an alternative therapy to the actual treatment. It can be useful for people suffering from OCPD and Autism and help to put the war of “OCPD stimming vs Autism stimming” to rest. 

Can OCPD Cause Autism And Vice Versa?

No, currently no evidence suggests that either of the disorders causes the other one. Although OCPD is present as a comorbidity in many autistic people, it does not cause Autism.

Conclusion:

The challenges brought by OCPD and Autism are distinct in their own ways. Though both disorders display a major overlap, each disorder requires special attention. With the correct care and treatment approach, symptoms of both disorders can be managed easily. With treatments like MaveHealth tDCS, the hope of treating these symptoms is kindled. 

If you or somebody you know is going through any of these disorders, just know that with advancements in research and current effective strategies, there is hope for leading a fulfilling life. With a strong team of experienced psychologists, Mave Health can provide you with aid to navigate the differences between Autism and OCPD. 

References:

1. Chaste, P., & Leboyer, M. (2012). Autism risk factors: genes, environment, and gene-environment interactions. Dialogues in Clinical Neuroscience, 14(3), 281–292. 
2. Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., Herbrecht, E., Stopin, A., Anckarsäter, H., Gillberg, C., Råstam, M., & Leboyer, M. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9(1). 
3. Leppla, I., Fishman, D., Kalra, I., & Oldham, M. A. (2021). Clinical approach to personality change due to another medical condition. Journal of the Academy of Consultation-Liaison Psychiatry, 62(1), 14–21. 
4. Liu, A., Gong, C., Wang, B., Sun, J., & Jiang, Z. (2023). Non-invasive brain stimulation for patient with autism: a systematic review and meta-analysis. Frontiers in Psychiatry, 14. 
5. Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 56(6), 466–474.
6. Rizvi, A., Torrico, T.J., 2024. Obsessive-Compulsive Personality Disorder, in: StatPearls. StatPearls Publishing, Treasure Island (FL) 
7. Autism spectrum Disorder. (n.d.). National Institute of Mental Health (NIMH). 
8. Zimmerman, M. (2023, September 9). Obsessive-Compulsive Personality Disorder (OCPD). MSD Manual Professional Edition. 
9. Crna, R. N. M. (2019, November 28). What is obsessive-compulsive personality     disorder? 
10. Hutchinson, J., Folawemi, O., Bittla, P., Kaur, S., Sojitra, V., Zahra, A., & Khan, S. (2023). The Effects of risperidone on cognition in people with autism Spectrum Disorder: a systematic review. Curēus.
11. Autism and the Four Learning Styles - ForBrain. (2024, February 13). Forbrain. 
12. Greve, K. W., & Adams, D. (2002). Treatment of features of Obsessive–Compulsive Personality Disorder using carbamazepine. Psychiatry and Clinical Neurosciences, 56(2), 207–208.