Honoring Neurodivergence While Treating Autism and OCD: A Compassionate Path Toward Valued Living
Autism and Obsessive-Compulsive Disorder (OCD) are often comorbid conditions that present unique challenges and opportunities for clinicians. Autism involves a neurodivergent way of experiencing and processing the world, while OCD is characterized by intrusive thoughts and compulsive behaviors aimed at reducing distress. While both conditions are distinct, they can intersect in ways that require clinicians to balance honoring neurodivergence with helping patients confront OCD-related fears and build a life centered on their values.
In my practice, I aim to create a compassionate space where both autism and OCD are understood and respected. Here’s how I approach treatment in a way that honors neurodivergence while helping individuals with OCD face their fears and move toward a values-driven life.
Understanding the Intersection of Autism and OCD
Individuals with autism may present with repetitive behaviors, strong preferences, or rituals that can look similar to OCD compulsions but serve different functions. For example:
Autistic Traits: A preference for sameness or sensory-based routines often provides comfort and predictability in an overstimulating world.
OCD Symptoms: Compulsions are performed in response to intrusive thoughts and are driven by an overwhelming need to neutralize anxiety or prevent feared outcomes.
Recognizing the difference is critical in tailoring treatment. Autistic rituals or stimming are not inherently pathological and should not be targeted for change unless they cause distress or interfere with valued activities. In contrast, OCD compulsions often require intervention through Exposure and Response Prevention (ERP).
Balancing Neurodivergence and Treatment Goals
Honoring neurodivergence means celebrating and respecting the unique ways individuals with autism engage with the world. Treatment should never be about “fixing” or “normalizing” autism but instead about supporting the person’s goals and values.
Collaborative Goal-Setting: Begin by understanding the patient’s goals and values. For an autistic individual, these might include maintaining a preferred routine, pursuing special interests, or fostering connections in ways that feel authentic.
Strength-Based Approach: Emphasize the patient’s strengths, such as their ability to focus deeply on interests or their creative problem-solving, as these can be leveraged in therapy.
Sensory-Aware Therapy: Tailor exposures in a way that respects sensory sensitivities. For instance, if a feared situation involves loud noises or bright lights, consider creative accommodations that still allow for gradual exposure without overwhelming the patient.
Facing Fears Through Exposure and Response Prevention (ERP)
ERP is the gold standard for treating OCD. It involves gradually confronting feared situations (exposures) without engaging in compulsions (response prevention). For individuals with autism and OCD, ERP must be tailored to their unique needs and preferences.
Customized Exposures: Create exposure hierarchies that align with the individual’s goals and values. For example, if a patient avoids touching their favorite art supplies due to contamination fears, exposures might involve gradually re-engaging with those materials to honor their creativity.
Sensory and Communication Accommodations: Use clear, straightforward language and visual supports as needed. Incorporate breaks and adjust the pacing of exposures to accommodate sensory needs or processing styles.
Focus on Values: Always connect exposures to what matters most to the individual. Facing fears becomes meaningful when it enables them to engage in activities they love or strengthens relationships with others.
A Compassionate and Flexible Path Forward
The intersection of autism and OCD is complex, but treatment doesn’t have to feel overwhelming or one-size-fits-all. By taking a neurodiversity-affirming approach, we can help patients feel seen, respected, and supported as they navigate the challenges of OCD.
Therapy becomes not just about reducing compulsions but about creating a life where the individual can thrive on their terms. This means celebrating their unique ways of being while also empowering them to face fears that stand in the way of what matters most.
As clinicians, we have the privilege of walking alongside individuals as they build lives full of meaning, joy, and authenticity—neurodivergence and all.
