As I write in my page about treating Autistic folx, difference does not mean deficit. Some people’s brains work very differently from others, and that is a good thing. Neurodiversity is a strength of the human species. What we now call autism has been with humanity for as long as we’ve been human, and it has added enormously to our evolution, to our science, and our culture. Sometimes, however, even wonderfully atypical minds come with extra complications.
People with diagnosed autism are statistically more likely than non-autistics to have other types of neurodivergence in addition. One of those more prevalent overlaps is OCD. If you’re autistic and also living with OCD, you are definitely not alone, because Autism and OCD show up together more often than many people realize.
How common is the OCD/Autism overlap?
A 2024 systematic review and meta-analysis looked at 42 studies examining the relationship between Autism Spectrum Disorder (ASD) and Obsessive Compulsive Disorder (OCD) in children and adolescents (Aymerich 2024). According to their findings, approximately 11.6% of young autistic people also met the criteria for OCD. Looking at it from the other direction, approximately 9.5% of young people diagnosed with OCD also met the criteria for ASD.
That's roughly one in ten, which is significantly higher than the general population’s occurrence of OCD, which is now estimated at about one in 100 (IOCDF website).
If you’re on the spectrum/autistic and think you might have OCD; or, if you have an OCD-Related diagnosis and suspect you may be autistic as well, an overlap like this could be very relevant to the kind of therapy you’re seeking. It could be very relevant to how sessions feel to you and how you respond to treatment. Without these distinctions, unmodified treatment can create unnecessary discomfort, shame, anxiety, or depression.
How can they be so different, but look so similar?
One of the interesting (and sometimes tricky) things about autism and OCD is that they can look similar from the outside. For example, both can involve repetitive behaviors, routines, strong preferences, and a desire for things to happen in a particular way. But the reasons behind those behaviors can be very different.
An autistic person might rely on a particular routine because predictability makes the world more comfortable, manageable, or enjoyable. A person with OCD might repeat a behavior because they feel compelled to do it in order to prevent something terrible from happening, resolve an unbearable doubt, or get relief from an intrusive thought. And sometimes, both things are happening at once. This is where things get tangled up pretty good and it takes patience, curiosity, and courage to do the work of untangling. This particular untangling process has become a focus of my therapy practice.
“I like to think of my clients and myself as a team of detectives.” Parsing out OCD from Autism can be done!
Understanding the difference matters a great deal. We don't want to treat someone's perfectly useful routines, interests, or ways of regulating themselves as symptoms that need to disappear. Nor do we want to overlook OCD simply because someone already has an autism diagnosis.
We need to understand what a behavior is doing for a person before we decide what to do about it.
Curiosity, tenacity, and patience might be the most important qualities for a therapist doing this kind of work. I like to think of my clients and myself as a team of detectives. By getting to understand the individual in front of me and how they work, the treatment becomes about the person, not the symptoms.
In my next blog post (coming soon), we’ll look at why the distinctions I’ve mentioned above play into treatment choices (yes, you have choices), and why the same therapeutic approach doesn't necessarily work for everyone. We’ll also explore how you can discuss these issues with your current or prospective therapist.
References
Aymerich et al. (2024). Prevalence and Correlates of the Concurrence of Autism Spectrum Disorder and Obsessive Compulsive Disorder in Children and Adolescents: A Systematic Review and Meta-Analysis. Brain Sciences, 14(4), 379. Read the study.
O'Loghlen et al. (2025). Repetitive Behaviors in Autism and Obsessive-Compulsive Disorder: A Systematic Review. Journal of Autism and Developmental Disorders. Read the study.
