Is it Autism, OCD, or Both?

Lola grew up in Huntsville, Alabama. She has struggled since early childhood with social interactions, often feeling like everyone except her was provided with a handbook for navigating the world. Her teachers often commented that she was very quiet and always had her nose in a book, but she received excellent grades and never caused any problems in the classroom. People she met were always impressed at her ability to remember their birthdays, even years after she was first told, and she loved learning the birth dates of various historical figures. She always greatly enjoyed learning dates and other facts. However, after moving to Birmingham for college, she started feeling a sense of distress around “good” dates on odd-numbered days and “bad” dates involving even-numbered days. If she thought about a bad date or learned someone was born on a bad date, she felt compelled to research and find someone who was born on a good date to erase the bad feeling. She also increasingly felt an urge to engage in actions a specific number of times, such as turning off a light 3 times or tapping her feet on the floor 5 times upon sitting in a chair. One of her suitemates mentioned that she had watched Love on the Spectrum and wondered if Lola might be autistic. Another suitemate jokingly told Lola “You’re so OCD!” when she noticed her walking through the doorway repeatedly. As a voracious learner, Lola jumped on the Internet and started studying her quirks and habits. She wondered if she might have Autism or OCD and what this might mean for her future.

OCD and Autism: What’s the Difference and Why It Matters

Many of us spend years trying to make sense of our own quirks, habits, and struggles. For some, that journey includes exploring whether symptoms might be connected to Obsessive-Compulsive Disorder (OCD), Autism Spectrum Disorder (ASD), or sometimes both.

Because these two conditions can look similar on the outside, it’s easy to feel confused about what’s really going on. Understanding the differences—and where they overlap—can make a big difference in getting the right kind of help and support.

Where OCD and Autism Overlap

At first glance, some of the traits of OCD and autism can look almost identical. For example:

• Repetitive behaviors or routines – Someone with autism may need structure and sameness to feel grounded, while someone with OCD may repeat an action (like checking the door) to ease anxiety.

• Strong focus or thoughts – Autistic people often have deep, passionate interests; those with OCD may be stuck with distressing, unwanted thoughts.

• Rigidity: Both can involve difficulty adjusting to change.

• Social challenges: Whether from anxiety (OCD) or differences in communication style (autism), navigating social life can be tough.

Because of these similarities, adults are sometimes misdiagnosed—or miss being diagnosed altogether.

How They Differ

While the surface behaviors can look the same, the reasons behind them are usually very different.

• Why the behavior happens: In OCD, rituals are driven by fear and anxiety. For example, someone may wash their hands repeatedly to “undo” a scary thought about germs. In autism, routines or habits usually feel comforting or enjoyable, not fear-based.

• The emotional experience: People with OCD often find their thoughts and compulsions distressing and exhausting. Autistic traits themselves usually aren’t distressing—what’s hard is often the lack of understanding or support from others.

• Flexibility: OCD often feels urgent, like you have to do the compulsion or something bad might happen. Autistic routines can feel important, but the drive is different—it’s about comfort and predictability.

• Onset: Autism is a neurotype and signs typically appear early in childhood. However, signs may not be clear until later childhood for higher-functioning children, as social and communication demands increase. OCD can begin in childhood, adolescence, or during the late teens and early 20s. Although it can first appear later in life, this is rare.

What Treatment and Support Look Like

Because OCD and autism have different roots, support looks different too:

• For OCD: The most effective treatment is usually a therapy called Exposure and Response Prevention (ERP), which helps people gradually face fears without performing compulsions. Medication, such as antidepressants (SSRIs), can also play a role.

• For Autism: Support is less about “treatment” and more about setting goals, understanding and accommodating differences, and using protocols intended for autistic people. This might include occupational therapy, social support, or sensory-friendly strategies. Acceptance and self-advocacy are often key.

• When both are present: The most important step is working with a professional who understands both conditions. A clinician needs to carefully sort out whether a behavior is driven by fear (OCD) or comfort/interest (autism). Therapy may need to be adapted to respect autistic communication styles and sensory needs. The good news is that research shows that autistic individuals who also have OCD tend to experience good benefit from Exposure and Response Prevention therapy, provided their therapist has a good understanding of how OCD and autism interact and is respectful of the way the neurodivergent brain works. Autistic individuals will likely appreciate the clear structure of a therapy like Exposure and Response Prevention, and adding visual overviews of the plan for therapy may also be helpful. If planned exposures will involve social situations, social skills training and practice may improve treatment response. Incorporating special interests into treatment of OCD for autistic individuals is also quite useful.

The Bottom Line

If you see yourself in both OCD and Autism, you’re not alone. Many adults discover later in life that what they’ve been experiencing has a name—or sometimes, more than one.

The good news? Understanding the differences helps you find the right support, whether that’s therapy for anxiety-driven compulsions, tools to embrace autistic strengths, or both. At Upward Behavioral Health, we provide a substantial number of evaluations for autism and OCD. Many of our clients tear up a bit at our feedback session when they finally understand the way their brain works after years of having their concerns ignored or dismissed. Upon scheduling their evaluation, the most common reason we hear is “I just want to know.”

And most importantly: having OCD, autism, another diagnosis, or a combination does not define your worth. With the right mix of compassion, knowledge, and support, individuals can learn to thrive while honoring who they truly are. We’ve had the privilege of working with clients from adolescence to late adulthood who are taking back their lives and living in a way that truly aligns with what’s important to them.