Obsessions, Compulsions, and Repetitive Behavior: Autism and/or OCD

Abstract

Autism spectrum disorder (ASD) and obsessive–compulsive disorder (OCD) share similar clinical features (e.g., obsessions, compulsions, restricted interests, repetitive behaviors), making accurate differential diagnosis challenging. Fairly high rates of comorbidity between the disorders further complicate the assessment procedures and present additional clinical concerns (e.g., increased psychosocial impairment). Given the clinical implications of their co-occurrence and similar symptom presentations, differentiating obsessive–compulsive symptoms from symptoms of ASD is essential. This chapter provides information on OCD and ASD individually and jointly. Diagnostic criteria for each disorder are reviewed, along with explanations of symptom overlap between OCD and ASD. Clinical examples of overlapping symptoms of OCD and ASD requiring a differential diagnosis are presented, and recommendations for techniques and queries within assessments are included. Commonly utilized measures to aid in the assessment of OCD and ASD symptoms are summarized, though there is still a paucity of measures that have been validated for concurrent use in both populations. A brief overview of treatment in individuals with OCD and ASD is presented, as well as a description of the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) changes and associated implications. For each section, clinical implications of the overlap between OCD and ASD are discussed.