Obsessions vs. Preoccupation and Rituals vs. Repetitive Behaviors

Individuals diagnosed with conditions such as Autism Spectrum Disorder and/or Obsessive Compulsive Disorder are often mischaracterized when their behaviors are described. While there is some overlap in the way these conditions manifest, there are core differences in what is happening neurologically and experientially. Persons with OCD struggle with underlying anxiety that causes fear of situations or objects. This fear causes discomfort. Maladaptive strategies to ease this anxiety are formed to ease such anxiety. A classic example is someone who has an intense fear of germs or sickness and engages in repetitive hand washing. This hand washing begins to take time which is taken from other daily activities and can cause irritation and damage to the skin.  In contrast, a classic example of such in the ASD patient is an interest in an activity that is enjoyable such as astronomy or Thomas the Train. These interests are often perceived as more juvenile but not in all situations. The repetitive behaviors involve researching, playing, or talking about such subjects.

The key distinction between these two conditions is that OCD components cause discomfort and are painful to the patient. These similar presentations in the ASD patient are found to be comforting and a process to avoid anxieties caused by other situations and interactions such as sensory overload or social anxieties. Similarities exist in that if behaviors are forced to stop without appropriate interventions those interventions can be damaging to the patient. In the case of OCD, anxieties can become out of control and overwhelming to the patient. They can decompensate quickly as they are raw and exposed to their phobias. In the case of the ASD patient, their anxiety escalates and they become overwhelmed as well.

If all of this sounds somewhat confabulated, it can best be understood as a chicken or the egg analogy. For the ASD patient the behavior is soothing and without it, they are more anxious. For the OCD patient, the anxiety comes first, they perform the behavior, and the behavior is not enjoyable or fully effective at relieving their pain. OCD patients will describe their behavior as problematic and the ASD patient will not and become excited at even talking about their activities.

At Athena, we offer diagnosis and treatment for both of these conditions. ASD patients respond to a broad range of therapeutic interventions that are based on the particular presentation and age of the patient. The generally accepted form of treatment for OCD includes Exposure Response Prevention Therapy and in most cases conjunctive therapy with medications.