I attended a training course recently on the conflict that professionals and carers often come into with regards to whether a person’s behaviours are as a result of Autism or OCD (Obsessive Compulsive Disorder). I am not going to regurgitate the contents of the course here, but I was very interested by some of the discussion that came through and I wanted to explain some of the key points.
It is well known that an impact of Autism on an individual can be to perform rituals, sequences and repetitions that can seem very obsessive and cause the person high levels of anxiety if they are unable to complete them. I have worked with people who turn lights on and off, open and close doors, lift their arms up and down repeatedly, straighten out items, rearrange, reorder and readjust items and clothing constantly. To an untrained eye it would be easy to identify these behaviours as OCD.
In our society we are quite good at talking about ‘people’s OCD’. All of us I’m sure can recognise and identify certain traits and routines that we regularly go through, sometimes even repeatedly and with some level of anxiety involved. For example I have an issue with double light switches. I hate it when the switches are pointing in different directions when the lights are in the same position i.e. on or off. To my mind, it doesn’t look right if both lights are on but the switches are not matching.
This causes me so much annoyance that I will regularly walk up and down stairs a number of times to use the other switch for a light in order that the double switch might be matching. I think it’s that this looks more aesthetically pleasing to me, but what’s happened is that I’ve become a bit obsessed with it to the extent where I will actually get out of bed to go and ‘put it right’ before I can relax and go to sleep. (To my husband’s great irritation!)
So then the next question, which I’m sure you’re thinking, is ‘does she have OCD?’ I will sometimes talk about ‘my OCD traits’ and I recognise that when I’m stressed, busy, tired or unhappy, these little routines and rituals will become more prominent and I will become more easily upset if they are not right. I would definitely say that these things have an impact on my life- even if it’s just that I get cold when I ‘have’ to go down and sort the lights out! But is it really OCD?
Coming back to people with Autism; many of them will experience similar and more extreme things to my light switch difficulty. Often to the onlooker it isn’t at all obvious what the person is trying to achieve or what the problem is. But it is quite clear that just as for many of us, people with Autism will sometimes feel the compulsion and the need to do a particular activity or routine in order to just make things ‘right’. Whether that’s the feel of something, the look of something of just relating to their place in their surroundings. Many of these behaviours are likely to stem from sensory processing difficulties- see my earlier posts on sensory processing 1 and 2.
The thing is that true OCD introduces another level above and beyond the compulsion or the obsession to complete rituals, perform actions, check things or change things. What makes OCD a disorder, and therefore a deeply complex and complicated issue, is that it is not just about behaviour and anxiety. It is also wholly connected with a person’s thought processes.
Here is a cycle to demonstrate how obsessions can be never ending:
1. Obsession: I don’t like the way the light switches look
2. Anxiety: I can’t forget about how the light switches look wrong to me
3. Compulsion: I just have to go and sort it out before I can concentrate on something else
4. Relief: I feel better and calmer when I’ve changed the switches round
The thing is that for true OCD, the obsessions are not just about how things look or making something feel just right; the obsessions are linked with fear and distress about something that is going to happen if… So if my actions had developed through OCD, they would go more like this:
1. Obsession: I don’t like the way the light switches look
2. Anxiety: If I don’t put the light switches back to the way they should be then something bad is going to happen (this could be something connected with the object itself such as the electricity short circuiting and the house setting on fire, or it could be completely removed from the situation such as someone falling ill or dying. Note that the thought process does not have to be a logical one, in fact this is part of the severity of OCD as a mental health illness in that it is not logical or reasonable to the onlooker and often not to the individual either.)
3. Compulsion: I absolutely have to go and put the light switches back to how they should be otherwise this terrible thing is going to happen and it’s all going to be my fault and I’ll never be able to live with myself.
4. Relief: I feel better now that the light switches are correct.
However you can see how this relief might not be very long lasting because as soon as a switch is used the cycle starts again. OCD is a relentless and evolving illness that causes immense amounts of anxiety, fear, responsibility and guilt.
In contrast, the behaviours that people do that are not linked to OCD such as my light switch thing (you’re going to think I’m loosing the plot over this!) or rituals carried out by people with Autism do not usually cause the same complex levels of distress. A person with Autism may become highly anxious, distressed or even aggressive if they are unable to carry out a particular routine such as straightening things out, closing windows, pacing along a particular line or grass verge etc. However, the reason for this anxiety is not connected to what they fear will happen if they do not do the thing they feel the compulsion to do. This anxiety is more likely to be centred around their difficulties in processing and understanding the world around them. For a mind that struggles to be flexible with visual information, if a room has always had the blinds up, then it must continue to have the blinds up for it to be recognised as the same room.
It is not always possible to distinguish between an action that is a result of OCD or Autism as people with Autism are often affected by OCD. What is important to ask if whether the person has the capacity to feel the cycle of fear, responsibility and guilt around completing an action in order to prevent something else from happening. This will not be an easy question to answer, but one that is key to separating Autism from OCD.
This is by no means a comprehensive discussion on the subject, there are obviously a large number of other key factors in both Autism and OCD that I am unable to do justice to here without turning this post into a small book! But hopefully this has provided some insight into the main and important differences between OCD and Autism.
And in case you’re wondering, I do not have OCD, but I most certainly do have obsessions and compulsions, and I still think these are important to address and deal with because I know from experience that they can become overwhelming and too intrusive in day to day living.