At first glance, autism and OCD appear to have little in common. Yet clinicians and researchers have found an overlap between the two. Studies indicate that up to 84 percent of autistic people have some form of anxiety; as much as 17 percent may specifically have OCD.
These shared traits make autism and OCD difficult to distinguish. Even to a trained clinician’s eye, OCD’s compulsions can resemble the ‘insistence on sameness’ or repetitive behaviors many autistic people show, including tapping, ordering objects and always traveling by the same route. Untangling the two requires careful work.
One crucial distinction, the 2015 analysis found, is that obsessions spark compulsions but not autism traits. Another is that people with OCD cannot swap the specific rituals they need, Vasa says: “They have a need to do things a certain way, otherwise they feel very anxious and uncomfortable.” By contrast, autistic people often have a repertoire of repetitive behaviors.
Clinicians, then, have to probe why a person engages in a particular action. That task is doubly difficult if the person cannot articulate her experience. Autistic people may lack self-insight or have verbal, communicative or intellectual challenges, which leads to misdiagnoses and missed diagnoses.
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