Autism vs. OCD: How to Tell the Difference
While Autism Spectrum Disorder (ASD) and Obsessive Compulsive Disorder (OCD) are two unique conditions, they share a number of overlapping symptoms, which can occasionally make it difficult to differentiate between the two or establish a proper diagnosis. The two conditions can also coexist, adding to the complexity of diagnosis.
But what makes the two conditions unique, and how do you tell the two apart? Keep reading to learn more about autism and OCD, how they present, and what these conditions look like in daily life.
What Is Autism?
Victoria Ward, PsyD, describes Autism Spectrum Disorder, commonly referred to as autism, as “a different way of experiencing and moving through the world—not a disorder to be fixed, but a different neurotype with its own strengths, challenges, and ways of making sense of things.”
A form of neurodiversity, autism is characterized by challenges with social skills, repetitive behaviors, sensory processing, speech, learning, and nonverbal communication. It’s estimated by the Centers for Disease Control and Prevention (CDC) that 1 in 31 children in the U.S. are identified as having ASD.
“Autistic folks often experience the world through a different sensory lens, connect with others in their own communication style, find deep comfort in routine and predictability, and soothe themselves through stimming—repetitive movements, sounds, words, or objects that help regulate and ground them,” says Ward.
She also notes that the hyperfixations often associated with autism are a core part of these individuals’ lives. “Many [individuals with autism] also develop rich, focused interests that bring real joy and genuine expertise,” she says. “I've had clients who could tell you everything about fishing—bait, technique, the best spots depending on season and water conditions. Another client had an almost encyclopedic knowledge of animals: care needs, behavior, temperament, down to specifics most people would never think to learn. These interests aren't just hobbies—they're often a genuine source of pride, comfort, and connection.”
What Is OCD?
According to Ward, OCD involves two parts working together:
Obsessions: Intrusive, unwanted thoughts that show up uninvited and cause genuine distress.
Compulsions: Physical and/or mental actions a person feels driven to do to make the distress of the obsession go away, even just for a moment.
Patients living with OCD experience a consistent cycle of obsessions and compulsions: obsessions are followed by compulsions, but the compulsions don’t get rid of the obsession for good—they just put it off momentarily until the obsession hits once more.
“The key thing about OCD is that these thoughts and rituals often feel very unwanted,” explains Ward. “People with OCD typically know the thoughts don’t reflect who they are, which is part of what makes it so exhausting and anxiety-inducing to live with.”
“I often describe OCD to clients as an unwanted houseguest who's taken up residence in your brain, insisting that you have to complete the compulsion or the obsession won't go away,” says Ward. “The problem is, the houseguest is lying—it doesn't want to be evicted, so the more you listen, the more it expands its reach, adding new obsessions and new compulsions over time. This is exactly why OCD tends to grow more complex the longer it goes unaddressed.”
What makes OCD so challenging is that it tends to go after what a person values most. “Take a mother of two,” says Ward. “While folding laundry, an intrusive thought might tell her that if she doesn't fold the socks ‘the right way,’ something bad will happen to her kids. That obsession isn't random; it's rooted in her deep love for her children and her value of keeping them safe. That's how OCD operates—it digs its claws into exactly what you care about most, and convinces you that ignoring it puts that very thing at risk.”
What Do Autism and OCD Have In Common?
At a glance, autism and OCD can look strikingly similar. They share a number of commonalities, including:
A strong pull toward routine
Repetitive behaviors
Sensitivity to environment
Difficulty with uncertainty or change
Someone lining things up symmetrically or needing to do a series of actions in a very particular sequence can look identical, whether the behavior stems from autism or OCD. However, while the two may look alike on the surface, they have very different root causes, and the intention and purpose behind the seemingly identical actions is key.
Autism vs. OCD: What’s the Difference?
So, if autism and OCD share so many similarities, what’s the difference between them? According to Ward, it’s less about what someone is doing, and more about why they’re doing it—the function behind the behavior and how it feels to them.
“Autistic routines and repetitive behaviors tend to feel good—grounding, soothing, even joyful,” says Ward. “They’re often an expression of who someone is. OCD compulsions come from a very different place: fear. They’re driven by anxiety and dread, done to prevent something bad from happening, and the person usually wishes they didn’t have to do them at all. I like to put it this way: autism says, “This is who I am.” OCD says, “I have to do this, or something terrible will happen.”
Ward provides several examples:
Consider a person who lines their pens up in rainbow order. For someone with autism, that order creates a sense of calm and visual satisfaction. For someone with OCD, the order of the pens brings relief from a nagging sense that something bad will happen if things are left in disarray.
A person with autism might repeat a favorite phrase or sound because it’s rhythmically pleasing or self-soothing—a form of stimming. Someone with OCD, on the other hand, might repeat a phrase internally a specific number of times because they believe skipping it means something terrible will happen to a loved one.
Someone with autism might avoid a busy restaurant because the sensory overload is genuinely overwhelming. A person with OCD might avoid that same restaurant out of fear of airborne contamination from being around too many people—trying to prevent the feared outcome of getting sick.
The action may look the same, but the feeling and function behind the behavior is what’s truly important.
Can Someone Be Diagnosed With Both Autism and OCD?
Absolutely—and according to Ward, it happens more often than you might expect.
“Research shows the two frequently show up together—one major study found that roughly 1 in 9 autistic youth also meet criteria for OCD, and close to 1 in 10 youth with OCD are also autistic, both well above general population rates,” she says. “When someone has both, things tend to be a bit more complex day-to-day, which is exactly why thoughtful, informed treatment matters so much.”
Do Autism and OCD Present Differently In Men and Women?
Yes—and it’s an important factor to pay attention to.
“Autism is significantly underdiagnosed in women and girls,” says Ward. “A lot of that comes down to masking, where someone consciously or unconsciously learns to blend in and mimic neurotypical behavior, often at real internal cost.”
In addition to the underdiagnosis that can come as a result of cultural norms and expectations, issues in diagnosis can also be based in a lack of research for women’s mental health.
“Many of our diagnostic tools were built around how autism tends to show up in boys, so countless women have gone years, even decades, without an accurate diagnosis,” says Ward.
While OCD can also show some gendered patterns, it is generally recognized more evenly across genders than autism is. Gendered patterns within OCD are often seen in the specific themes that obsessions can take and when symptoms tend to first appear.
How Are Autism and OCD Treated?
Autism and OCD require different treatment plans:
Autism Treatment
Ward is quick to note that autism isn’t something to be “treated” or cured. Instead, support centers around building skills, self-advocacy, and sensory regulation tools that help the individual thrive as their fullest self, alongside treating any anxiety or mental health struggles that may also occur.
“One important part of working with autistic clients is inviting them to unmask in session—gently setting aside the conscious or unconscious suppression of autistic traits that so many autistic people learn to appear more ‘neurotypical,’” says Ward.
That might look like:
Making space for stimming (pacing, rocking, fidgeting)
Dropping expectations for constant eye contact
Wearing clothing that feels good on the body rather than what’s considered “appropriate”
Collaboratively working to build awareness around sensory sensitivities, routine preferences, and preferred communication style
“A big part of my work is helping clients find compassion for themselves within the context of their specific neurotype so they can meet their sensory, stimming, and connection needs in ways that actually work for them,” says Ward.
OCD Treatment
OCD has a well-established, highly effective treatment: Exposure and Response Prevention (ERP), which helps someone gradually face a feared thought, stimulus, or experience without giving in to the compulsion OCD demands.
“Since OCD tends to go after what you value most, I often use ACT-informed ERP—combining exposure work with bringing awareness to the values underneath the fear,” says Ward. “This tends to help clients reconnect with what matters most to them, evict the unwanted houseguest, and rebuild intentional living around their own values, not OCD's demands.”
In addition to ERP, Cognitive Behavioral Therapy (CBT) is commonly used to treat OCD. Some OCD patients may also benefit from the use of psychiatric medication alongside therapeutic treatment.
The treatment of both autism and OCD is a bit more complicated. “When autism and OCD show up together, ERP often needs real customization—factoring in sensory needs and communication style, and carefully sorting out which behaviors are compulsions we want to loosen versus autistic traits we want to support and celebrate,” says Ward.
What Should I Do If I Think I Have Autism or OCD?
One of the best things you can do for your mental health if you think that you may have autism, OCD, or both, is to seek out a good therapeutic provider. The right therapist will be neuroaffirming, support your autonomy, invite unmasking, and stay attuned to sensory needs—details as simple as dimming harsh lights or turning off a noise machine. You also want to be sure to connect with someone who utilizes evidence-based treatments like ERP and CBT.
According to Ward, it’s equally important to find a clinician who’s comfortable untangling the overlap between the two conditions. “It’s genuinely tricky, and misdiagnosis happens more than people realize,” she says.
While you begin searching for a provider, start paying closer attention to yourself and being present in your mind and body. “It can help to start noticing: when I do this behavior, does it feel calming for me, or does it feel driven by fear of something bad happening?” says Ward. “That distinction alone is often a great starting point for the conversation with your provider.”
Receive Compassionate, Evidence-Based Mental Health Care in Portland, Oregon With the Team at Aspire Psychology
Two behaviors can look exactly the same from the outside, but come from completely different places on the inside. That’s why, if you’re unsure as to whether you may have autism or OCD, it’s so important to work with a clinician trained in both areas. A checklist alone can’t tell the full story, and there’s no one-size-fits-all treatment. You deserve specialized care that’s personalized to you and your experience.
“The very thing that regulates an autistic nervous system might be the exact thing that needs gentle, careful intervention in OCD,” says Ward. “Getting that distinction right changes everything about what real support looks like.”
At Aspire Psychology, our team is here to provide caring, evidence-based mental health care in Portland, Oregon and beyond. Ready to connect with Dr. Ward or another of our providers? Get started with Aspire today.
