Differentiating OCD from Autism: Understanding Behaviors and Treatments

Obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) share some overlapping traits that can make it difficult to tell them apart. Repetitive behaviors, routines, and intense focus on details occur in both conditions. So how do you differentiate autism symptoms from OCD?

While clinicians are typically able to distinguish OCD from autism, it is also possible for someone to have both disorders concurrently. This article provides an in-depth examination of OCD versus autism. We’ll explore the overlapping symptoms as well as the key differences between OCD behaviors and autistic behaviors.

Differentiating OCD from Autism Understanding Behaviors and Treatments
Differentiating OCD from Autism Understanding Behaviors and Treatments

Understanding Obsessive-Compulsive Disorder

OCD is a chronic mental health disorder characterized by upsetting, intrusive thoughts and repetitive behaviors aimed at reducing anxiety. The hallmarks of OCD include:


  • Repetitive and distressing thoughts, urges, or mental images that are unwanted and anxiety-provoking


  • Repetitive behaviors or mental rituals that a person feels driven to perform, often in response to an obsession

Most people have occasional intrusive thoughts or exhibit some ritualistic behaviors. But in OCD, these obsessions and compulsions are excessive, unrelenting, and interfere significantly with daily functioning.

According to the International OCD Foundation, OCD obsessions and compulsions:

  • Feel outside the person’s control
  • Cause extreme distress, fear, or doubt
  • Can occupy over an hour a day
  • Impair the person’s ability to function normally

Additionally, people with OCD recognize their obsessive thoughts are irrational. The compulsions provide only temporary relief rather than pleasure.

How Autism Symptoms Differ from OCD

One characteristic of autism spectrum disorder is restricted, repetitive patterns of behavior, interests, or activities. This can include:

  • Hyperfocus on specific topics or objects
  • Inflexibility to changes in routine
  • Repetitive movements like rocking, hand-flapping, or finger-flicking
  • Echolalia – repeating words or phrases

While autism and OCD have overlapping symptoms, a key difference is how the individual relates to the thoughts and behaviors.

People with OCD find their obsessions and compulsions very distressing. They want to be rid of them. In contrast, autistic people are not necessarily bothered by their repetitive behaviors. In fact, they may find activities like rocking or flapping to be calming and enjoyable.

Additionally, people with autism have various other social, communication, and cognitive differences that are not seen in OCD.

It’s Common to Have Both OCD and Autism

Although OCD and autism have distinct features, it is possible to have both conditions. Research indicates:

  • 25% of people diagnosed with OCD also have autism
  • 17% of people diagnosed with autism also have OCD

This comorbidity requires an adjusted treatment approach that addresses the overlap between OCD and autism symptoms.

Treating Obsessive Behaviors in OCD vs. Autism

OCD is commonly treated with medications, psychotherapy, or both. Repetitive behaviors in autism may or may not require intervention.


For OCD, selective serotonin reuptake inhibitors (SSRIs) are the first-line medications. Common SSRIs prescribed for OCD include:

  • Celexa (citalopram)
  • Luvox (fluvoxamine)
  • Paxil (paroxetine)
  • Prozac (fluoxetine)
  • Zoloft (sertraline)

In autism, repetitive behaviors may be treated with other medication classes, such as:

  • Buspar (buspirone) – anti-anxiety med
  • Depakote (divalproex) – anticonvulsant
  • Intuniv (guanfacine) – blood pressure med for ADHD
  • Luvox (fluvoxamine) – SSRI

SSRIs are often not well-tolerated in autism and lack robust evidence for reducing repetitive behaviors or anxiety.


First-line therapies for OCD include:

  • Cognitive behavioral therapy (CBT)
  • Exposure and response prevention (ERP)
  • Repetitive transcranial magnetic stimulation (rTMS) – for treatment-resistant

In autism, therapy choices depend on factors like age, cognitive skills, and symptom severity. Options include:

  • Applied behavior analysis (ABA) – the gold standard for young, lower-functioning children
  • Naturalistic developmental behavioral interventions (NDBI) – a gentler, more child-led approach
  • Adapted CBT for autism (aCBT)
  • Occupational therapy (OT)
  • Speech therapy

For higher-functioning individuals, an adapted CBT approach may be beneficial. However, traditional CBT is often not as effective for people on the spectrum.

The Controversy Around ABA Therapy for Autism

Applied behavior analysis is an evidence-based autism treatment. However, some autism advocates strongly oppose ABA therapy, believing its methods are harmful and coercive.

Naturalistic ABA provides a less rigid approach that follows the child’s lead during activities and allows shared control. Research shows naturalistic ABA techniques help teach developmentally appropriate skills while reducing problematic behaviors.

Summary: Key Differences Between OCD and Autism

While OCD and autism share some overlapping symptoms, there are key differences:

  • In autism, repetitive behaviors are self-soothing. In OCD, they cause distress and anxiety.
  • Autism involves various social, communication, and cognitive differences that OCD does not.
  • It’s common to have both OCD and autism concurrently. This requires an adjusted treatment plan.
  • Medications like SSRIs and CBT are first-line treatments. These are often ineffective for repetitive behaviors in autism.
  • ABA therapy is controversial but can be helpful for autism when applied naturally.

Understanding the nuances between OCD and autistic behaviors allows parents and clinicians to pursue appropriate, personalized treatment.

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