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Obsessive compulsive disorder (OCD)

Obsessive compulsive disorder (OCD) can affect anyone, but research suggests autistic people may be more likely to experience it. OCD can have a significant impact on a person’s life but treatment can help to manage the symptoms. If you are struggling with OCD, help and support is available.

What is OCD?

The NHS describes OCD as “a common mental health condition where a person has obsessive thoughts and compulsive behaviours”.

  • Obsessions are persistent, irrational and intrusive fears, thoughts or images that can make you feel very anxious and distressed
  • Compulsions are repetitive activities that you feel you have to do, to relieve fears or anxieties about the obsessions. 

OCD can affect adults and children, and symptoms can appear at any age, but often do so during puberty or early adulthood.

Read more about OCD on the NHS website.

 

How do I know if I have OCD?

It is common for people to have worries and even irrational fears, but if these thoughts become obsessions that are distressing and lead to compulsions that significantly interfere with your life, you may have OCD.

Everyone experiences OCD differently but common signs may include:

Obsessions, such as:

  • fear of causing or failing to prevent harm
  • intrusive thoughts, images and impulses
  • religious or blasphemous thoughts that are against your religious beliefs
  • fear of contamination
  • fears and worries related to order or symmetry.

Compulsions, which can be:

  • physical actions
  • mental rituals
  • the need to complete a compulsion a specific number of times without interruption.

Examples of compulsions include:

  • rituals – washing hands, touching things, arranging objects
  • checking – doors and windows are locked, clothes for contamination
  • repeating a word or phrase, counting
  • reassurance – asking people to tell you everything is alright.

Is OCD similar to autism?

There are some similarities between autism and OCD, including:  

  • compulsive like behaviours
  • restricted, repetitive behaviours and intense interests
  • difficulty with change.

However, there is an important difference between the two. Obsessions and compulsions for people with OCD are distressing and unwanted, whereas repetitive behaviours for autistic people, such as stimming and intense interests, are often positive, soothing and purposeful. For example, an autistic person or someone diagnosed with OCD may repeatedly flick a light switch on and off. The autistic person may be doing this because they like the sound of the switch and the visual feedback when the light flashes on and off. The person with OCD may be doing it because they believe that unless the light switch is flicked on and off 15 times, something bad will happen. 
 
Repetitive behaviours are part of being autistic and should not be misunderstood as a sign that you may have OCD. 

 “… repeating an action like spinning the wheels on a toy train can act as a sort of sensory massage… this is quite different from the repetitive actions motivated by OCD, where something terrible will happen if your compulsions are not adhered to”
Steve Slavin (2018)

The similarities between autistic traits and OCD symptoms can make it difficult to know which is a result of OCD and which is a part of being autistic. This may lead some professionals to dismiss your OCD symptoms, leading to under-diagnosis of OCD in autistic people. If you’re concerned that you or someone you know might have OCD it is important to seek professional advice.

What causes OCD?

It is still unclear why some people develop OCD, but possible causes include:

  • experience of trauma  
  • family history of OCD 
  • biological factors.

How might OCD affect me?

There is little known about the effects of OCD on autistic people, but if you have OCD you might struggle with:

  • personal relationships
  • work or study
  • living independently
  • exhaustion and isolation.  

How do I get help and support?

Treatment for OCD is the same for autistic and non-autistic people and the type of treatment will depend on the severity of your OCD and associated risks such as suicide. Urgent referral to a crisis or emergency team should be made for people suspected to be at high risk of self-harm or suicide.

The first step for many is to see a GP who will assess your symptoms and can refer you to a local psychological therapies service if required. Children and young people can access support from Child and Adolescent Mental Health Services (CAMHS) either directly, or through school or a GP. A formal assessment of OCD is then carried out by a health professional. Support may vary according to region.

Additional support can include:

  • referral to specialist OCD services (used when other treatment options have not helped)
  • social care support (if you are eligible)
  • OCD support groups
  • seeking help from family and friends.

Therapies

You can go for therapy through your GP or privately. The National Institute for Health and Care Excellence (NICE) recommends two main therapies for OCD:

  • cognitive behavioural therapy (CBT)
  • exposure and response prevention therapy (ERP)

These therapies involve working with a therapist to break down problems into their separate parts, such as thoughts, physical feelings and actions, and encouraging someone to face their fears, starting with situations that cause the least anxiety first, before moving on to more difficult thoughts.

Ideally, all treatments and therapies should be delivered by someone with an understanding of autism. Most importantly, to be accessible and effective, support should be adapted to a person’s specific needs. Visit our Seeking help with mental health page for more advice.

In England, there is statutory guidance for adults that states autistic people should have support adapted to their needs if they have a mental health difficulty.

Search our Autism Services Directory for details of counsellors and therapists in your area with experience of working with autistic people.

Medication

You may be offered medication, such as antidepressants. NICE recommends the use of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) for OCD.

Although guidelines consider antidepressants generally to be useful and safe, there is very little research into whether they help treat OCD specifically in autistic people. What research there is suggests autistic people may be more likely to experience side effects such as drowsiness, irritability and reduced activity. 

Antidepressants should be carefully considered and closely monitored by a medical professional.
 

“With the right medication and cognitive behavioural therapy, the OCD abated. The checking behaviours were the first to diminish.”
Ginny Grant (2021)

Insight from autistic people

"There’s a grey area… a set of things that fall into that unclear space of might-be-OCD-might-be-autism… Perhaps one way to differentiate is by how the thing makes me feel. OCD traits are characterised as anxiety-inducing and unwanted. Feeling like I need to rewrite an entire page because I crossed out one word? Definitely anxiety-inducing… But lining up books? That’s actually an enjoyable process. The outcome is pleasing, the process soothing." 

– Cynthia Kim, Musings of an Aspie 

"[F]rom my experience, repeating an action like spinning the wheels on a toy train can act as a sort of sensory massage. It’s also true that many people with autism feel compelled to organise items in a certain order. This is quite different from the repetitive actions motivated by OCD, where something terrible will happen if your compulsions are not adhered to." 

– Steve Slavin, Adults with autism 

"If you do things [such as rituals or compulsions] because you think something bad will happen if you don't do it... I would definitely explore the fact that you might have OCD. ... If it gets to the point where it's really disturbing and interrupting your life, then diagnosis can really help and I would suggest to get one. … There are loads of people that go through it as well, so don't feel alone... don't feel embarrassed.” 

– MaxiAspie, What Is OCD

"Having the ability to have things the same in a routine, which is kind of like a compulsion, is nice. I get enjoyment out of those things and those things make me feel comfort, make me feel safe, make me feel like things are familiar. But when you look at OCD: OCD makes me compelled to do things because I'm scared that something bad is going to happen. ... I don't mind people knowing that I like to wear the same clothes every single day, or I like to have the same thing for breakfast. But in terms of the OCD, I hide my OCD... I hide it because I feel insecure about it, I don't want those things." 

– The Aspie World, My Asperger’s And OCD 

Links, resources and article sources

Anxiety and autism in the classroom

More

Depression

More

Diagnosis

More

Managing anxiety in the workplace

More

Reducing anxiety in autistic children and young people

More

Seeking help with mental health

More

Sensory differences

More

Last reviewed: 20 August 2020

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