Just Right OCD and Autism - Which is Which?
Many people who identify as autistic also have OCD, and it can be difficult - and really important - to distinguish between the two. One common form of OCD is “just right” OCD - that is a form of circular behavior and thinking in which a person re-does something over and over again until they get a specific “just right” sensation. They find it difficult to move on or dismiss doubts about whether they’ve done something “right.”
The first primary distinction I want to make clear to the client and the clinician working with them is the distinction between a neurotype - ie, the processing system - and a protective strategy. Autism is the processing system, and OCD is the strategy. Once we understand from a process perspective that autism and OCD are in fundamentally different categories, despite both being in the DSM, we can start to break down behavior by its function. People with autism can have and recover from OCD. The reverse is not true. Autism isn’t an ailment you have, or a process you engage in, it is the underlying architecture.
OCD exists for protection; therefore it drives on fear. The core fear is unique to each individual, but it often comes down to one of a few options: fear of losing control; fear of physical discomfort going on forever; fear of overwhelm and/or helplessness; fear of not being able to “get over” something (ie to be tormented endlessly); fear of ridicule, judgment, or not being good. If you are autistic or know someone well who is, you can see how these fears might have come about trying to live in a neuro-normative world. However, even if the logic and the origin of OCD make sense, the behavioral pattern makes things worse. Compulsions reinforce fear over time and drive a narrowing of options. Though OCD is an attempt to solve a problem, it makes the problem worse.
Just right OCD involves compulsive behaviors. That means they are driven and have an “or else” quality to them. They are often a nuisance to the autistic person themselves, get in the way of important activities, and cause depletion over time, even if compulsions sometimes bring temporary relief. For example, someone may have an obsession that they need things that happen on one side of their body to be balanced out on the other. While at first the compulsions may take only seconds, people with this form of OCD can get more and more elaborate in their restrictions and corrections, getting to the point where they can only sit on one side of the room, or can’t move on with their day if they get accidentally bumped or if their shirt lies unevenly.
Autism indicates a sensitive nervous system and way of processing information that is easily depleted, dysregulated, or knocked off balance. Many people with OCD who aren’t autistic are also sensitive, and their sensitivity should also not be confused with their OCD. When not replenished and resourced, autistic people need strategies to rejuvenate themselves, reset, and ground. Autistic people often turn to order, scheduling, organizing, and balancing things to reset their nervous systems or help them prevent shutdown or meltdown. They may wish to minimize surprises, sensory input, or chaos in the environment. This can come off as them needing things to be “just right.” The autistic nervous system has lower tolerance for deviations from expectations. Planning, simplifying, and controlling the environment where possible are actions of care and geared towards achieving baseline; they are not a reaction to a specific fear. Furthermore, repetitive behaviors that lead to a state of calm and not anxiety, that actually solve the problem rather than drive further doubt and fear, are ultimately good for the nervous system. For example, after a stressful social event a person may come home and organize their book collection, even though they’ve already done it, or watch a favorite show they’ve already seen. This is a soothing activity that feels restful and helps them regulate their nervous system. Autistic people can generally feel confident carrying on with what’s working to restore them, as long as it isn’t hurting anyone else or causing a side effect that ultimately leads to more depletion.
If you can figure out the function of the behavior, you can usually figure out if it is OCD. But a word of caution in your thinking - this distinction can be overanalyzed, doubted, and turned over and over in your mind. If you have a good enough sense, but a doubt enters your mind about it, try to let your hunch play out. See if doing the action causes relief or feeds distress. Try not to get stuck working on the analysis, because that doubt-analysis-more-doubt process is OCD at work.
