While working with individuals diagnosed with OCD comorbid with autistic spectrum disorders, it is important to keep in mind that although there is an overlap in the symptoms, they need to be treated differently.
It was during the 17th century that symptoms of ‘religious melancholy’ came to the surface. Individuals complained of bad thoughts, unintentionally saying words they did not mean to and repeatedly performing rituals. This disorder, once known as ‘neurosis’ is called Obsessive Compulsive Disorder today.
According to the DSM V, to meet criteria for obsessive-compulsive disorder people have to experience recurrent compulsions or obsessions. Obsessions are thoughts, images or impulses the reoccurrence of which causes anxiety or distress. The individual can comprehend that these obsessions are the result of their own thinking and are abnormal or alien. This is what distinguishes obsessions from delusions, because insight is preserved. These individuals experience persistent uncontrollable thoughts about the obsession. As these obsessions are inappropriate, they are also called ego-dystonic.
Recurring behavior conducted to reduce the anxiety or distress the individual feels is known as compulsion. Compulsions are unreal exorbitant repetitions of a behavior that the individual carries out. The five essential criterions used to diagnose this disorder are experiencing recurrent compulsions or obsessions, causing marked anxiety or distress, understanding what one is experiencing is unreasonable or excessive; the presence of another Axis I disorder does not restrict the compulsions or obsessions; the obsessions or compulsions are not due to medical reasons or contact with physiological substances.
The age of onset is found to be 6 years to 15 years for boys and 20 to 29 years for women. OCD is more prevalent in boys than girls, during childhood. Although in adults, it is diagnosed in males and females equally. It mostly begins during adolescence or adulthood. Studies indicate a one-year prevalence of 0.5 to 2.1% in adults and a lifetime prevalence of 2.5%.
Individuals with OCD usually have additional developmental or psychiatric disorders. OCD has high comorbidity with Affective disorders, like bipolar disorder and depression; with anxiety disorders like generalized anxiety and panic disorders and autism spectrum disorders. The prevalence of OCD in individuals diagnosed with ASD is between 2.6 – 37.2%. Individuals with both OCD and ASD have ritualistic behaviors like handwashing and counting and exhibit social withdrawal, so the difficulty for therapists lies in differentiating between the two and treating them accordingly. Individuals on the autistic spectrum exhibit ritualistic behaviors like stimming, counting and show no intention of stopping them. On the other hand, people with obsessions and compulsions understand the need to stop the repetition, but are unable to do so.
While working with individuals diagnosed with OCD comorbid with autistic spectrum disorders, it is important to keep in mind that although there is an overlap in the symptoms, they need to be treated differently. This will lead to effectiveness in treatment protocols and eventually a better prognosis.
Photo by: Samantha Hurley
Shivani Khanwalkar is a faculty member of Ishanya.