Obsessive-compulsive disorder (OCD) and Asperger’s share similarities that can sometimes lead to misdiagnosis and general misunderstanding.
Asperger’s, or Asperger’s syndrome, is an old diagnostic term for what’s now known as high-functioning autism. It was originally used to describe a developmental condition with social and interpersonal communication challenges but no significant language delay or intelligence deficits.
Asperger’s is now considered a manifestation of autism spectrum disorder (ASD), though many people in the community still use — and prefer — the term “Asperger’s.”
Because Asperger’s doesn’t present with noticeable impairment, some of its behaviors and traits can be confused for other conditions, including obsessive-compulsive disorder (OCD).
OCD is a mental health disorder that involves obsessions and compulsions.
Obsessions are persistent and recurrent thoughts, images, or urges that are unwanted and considered intrusive. Compulsions are repetitive physical and mental behaviors that you feel you have to perform, often as a way of controlling an obsession.
Asperger’s is a developmental condition and is considered a type of neurodivergence.
Unlike OCD, which is a condition that negatively affects day-to-day functioning, ASD is not inherently distressing. Having ASD means that you process life’s stimuli differently compared to neurotypical people, but that doesn’t necessarily affect your quality of life.
Both of these conditions can share symptoms, but the difference often lies in the “why” behind them.
OCD consists of two primary symptoms — obsessions and compulsions — but it can also include:
- inflated sense of responsibility
- intolerance of uncertainty
- placing too much importance on thoughts
- anxiety and panic attacks
- social avoidance
- hyper-fixation on personal flaws
The symptoms of autism vary widely, which is why it’s viewed on a spectrum. You might not have specific symptoms or not to the same degree as someone else.
Common symptoms associated with Asperger’s include:
- difficulty adapting to change
- hyper-focus on topics of interest
- difficulty interpreting nonverbal communication
- repetitive or ritualized behaviors
- need for symmetry
- sensory hypersensitivity
- difficulty expressing empathy
- avoidance of eye contact
- focusing on literal interpretations
- difficulty making or keeping friends
- sleep disturbances
OCD and autism are very different at the core, but outward symptoms can be similar enough for people to get them confused.
Both OCD and Asperger’s can involve repetitive behaviors such as:
- hand flapping
- biting fingernails
- twirling hair around fingers
- cracking knuckles or other joints
- drumming fingers
- tapping pencil
- jiggling foot
In OCD, these behaviors are likely compulsions. In ASD, they’re attributed to a process called self-stimulation, or stimming.
“Some people see repetitive behavior in autistic individuals and assume that it is compulsive; however, most repetitive behavior in ASD is not compulsive,” says Dr. Jeremy M. Veenstra-Weele, Co-Director of the Youth Anxiety Center at New York-Presbyterian and Professor of Psychiatry at Columbia University Irving Medical Center.
He explains that some repetitive behavior is enjoyable or soothing in ASD. This is known as stimming. Other repetitive behaviors may represent a habit or may be used to make life more predictable.
“Repetitive behavior can sometimes be unconscious as well, such as a simple hand movement or throat clearing,” Veenstra-Weele says.
In OCD, obsessions are unwelcome thoughts and urges that you can’t get out of your head. They’re often distressing and disturbing.
In Asperger’s, hyper-fixation is also common, minus the distressing part. When you live on the autism spectrum, it’s natural to become intently focused on things that interest you or that you enjoy.
That doesn’t mean you won’t have upsetting thoughts that demand your attention with Asperger’s. You definitely can, but hyper-fixation is typically associated with positive things in your world.
Rigid routines can be comforting for autistic people and people with OCD.
In OCD, routines can be a part of compulsions. You might strongly feel that by doing the same thing the same way every single time, you’re ensuring a positive outcome.
In Asperger’s, routine offers a sense of security. It provides predictability and reduces the chance of feeling overwhelmed by new circumstances or sensory stimuli.
Both OCD and autism can impact how you form and keep relationships. You may find it hard to express your thoughts or feelings or find you don’t understand the feelings of others.
Understanding that your behaviors can be outside the social norm can make you want to avoid social settings.
Klopper explains that anxiety is a feature of both OCD and Asperger’s, though it often has different triggers.
In OCD, you may experience anxiety about how your behaviors are viewed by others, but you can also feel anxiety if you’re not able to complete rituals that are important to you.
In Asperger’s, anxiety can come with overstimulation and sensory overload. It’s your natural response to uncertainty as your brain takes in unfamiliar stimuli.
You can live with autism and OCD simultaneously. A
Is there a link between OCD and autism?
The link between OCD and autism is unclear, but there does appear to be some hereditary overlap. Having a family history of either condition may increase your chances of experiencing the other.
“OCD is also seen more commonly in first-degree relatives of autistic people,” Veenstra-Weele points out, “and ASD is diagnosed more commonly in first-degree relatives of people with OCD.”
Kloppers adds that research suggests that both conditions also share a brain signature.
“Both are associated with disruptions in the structure of the corpus callosum,” she says, “although more research needs to be done to fully understand the neuroscience behind these links.”
OCD and Asperger’s are very different, separate conditions, even if they share similar traits.
OCD is a mental health disorder defined by psychological distress and functional impairment. Asperger’s, although no longer a diagnostic term, is a developmental condition under the ASD umbrella that may present challenges along the way but isn’t innately harmful to your mental or physical well-being.
Because OCD and autism can appear similar at first glance, speaking with a team of healthcare professionals is important for receiving an accurate diagnosis.