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OCPD vs Autism: The Overlap and Distinction

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This article will provide a clear and comprehensive understanding of Obsessive-Compulsive Personality Disorder (OCPD) and Autism, highlighting their similarities and differences to enhance awareness and inform accurate diagnosis and treatment approaches.

Introduction

Obsessive-compulsive personality disorder is a mental health disorder that falls under the umbrella of personality disorders. In these situations, individuals focus on control and achieving perfectionism, often at the expense of any type of success or productivity, as well as leisurely activities or good mental health. Autism is a neurological and developmental disorder that interferes with how people communicate, interact, learn, and behave.

Symptoms of autism typically manifest within the first two years, while symptoms of OCPD don’t typically become pronounced until early adulthood. But no matter when you recognize symptoms, it’s important to find the right treatment.

psychologist listening to her patient and writing down notes

Understanding OCPD and Autism

Diagnostic Criteria for OCPD vs Autism

Getting a proper diagnosis for autism vs OCPD is important because it can help you find the right treatment and learn how to manage your symptoms.

OCPD

In order to receive a diagnosis of obsessive-compulsive personality disorder, individuals need to experience persuasive patterns of complete preoccupation over things like perfection and interpersonal control. That preoccupation comes at the expense of being flexible or open, even efficient.

Individuals must present with four or more of the following eight symptoms:

  1. Individuals are preoccupied with organization, order, details, lists, rules, or schedules to the extent that they lose focus on the actual activity or purpose of the organization.
  2. Individuals show perfectionism that interferes with their ability to complete any task because they are overly concerned with meeting strict standards that cannot be met.
  3. Individuals are excessively devoted to their productivity and work, which comes at the cost of friendships or other personal activities.
  4. Individuals become overconscientious or inflexible when it comes to matters of values, ethics, or morality that are not related to those that are cultural or religious.
  5. Individuals cannot discard worthless objects even if there is no sentimental value to them.
  6. Individuals are reluctant to delegate any tasks unless the person to whom they delegate agrees to do things exactly the way they would do them.
  7. They are miserly when it comes to spending money, and they often hoard money on the off chance that there is a future catastrophe.
  8. They are very stubborn and rigid.

Autism

A diagnosis of autism requires individuals to have symptoms from five major categories:

A. Autism presents as persistent deficits with social interaction or communication across several contexts, with all of the following:

  1. Individuals demonstrate deficits when it comes to reciprocating social and emotional characteristics. For example, someone might not be able to have a conversation back and forth; they might be unable to share in the emotions or interests of themselves or others; they might fail to respond to social interactions or even initiate social interactions.
  2. Individuals demonstrate deficits in terms of nonverbal communicative behaviors that are normally reserved for social interactions. For example, someone might have poor verbal and nonverbal communication with limited eye contact or abnormal body language, even a complete lack of facial expressions.
  3. Individuals have difficulty with relationships. This can range from developing relationships, keeping them, or even understanding how they work. For example, someone might have problems adjusting their behavior from one social context to the next, playing make-believe, making new friends, or even having any interest in their peers.

B. Autism presents with restricted and repetitive activities, behaviors, or interests with at least two of the following:

  1. Individuals demonstrate repetitive or stereotyped motor movements like lining up their toys or flipping objects in front of them.
  2. Individuals insist on inflexible routines and small rituals, experiencing extreme distress when they have to eat a different food or take a different way to school.
  3. Individuals have highly restrictive interests that preoccupy their attention and are usually excessively circumscribed interests or unusual interests.
  4. Hyper or hypo reactivity to any type of sensory input or a lack of interest in the sensations of their environment, like lights, sounds, pain, or temperature.

C. Autism has symptoms that are present in early developmental stages, particularly the first and second years of life.

D. Symptoms cause significant impairment in occupational, social, or other functional areas of life.

E. Disturbances are not explained by other conditions like Global developmental delay or intellectual development disorder.

Onset of OCPD vs Autism

  • The onset of obsessive-compulsive personality disorder tends to happen in early adulthood.
  • The onset of autism is usually evident in early childhood, especially in men. During the first year of life, young children show a lack of interest in any social interaction. By the time they reach two, it is easier to note severe developmental delays.
unhappy young black man having session with professional psychologist at mental health clinic

Associated features of OCPD vs autism

Associated features of OCPD vs autism refer to the features beyond the diagnostic criteria that are common.

OCPD

People who struggle with obsessive-compulsive personality disorder can find it very painful if there is no clear and direct answer in established protocols, rules, or even laws.

Those who struggle with obsessive-compulsive personality disorder can easily become upset in situations where they are unable to maintain control, even if they don’t express it directly. Where other people see a relatively minor issue, people with OCPD might become incensed.

Later in adulthood, it can be difficult to relate to other people’s emotions or share personal emotions because emotional expression is also highly controlled so that it is perceived as perfect. People with obsessive-compulsive personality disorder will usually hold themselves back and not respond or show small forms of affection or even facial expressions until they know whatever they plan to say is going to be perfect.

Autism

Many individuals who struggle with autism also have intellectual or language impairment. They might have higher intelligence, but their abilities are not even, meaning they have above-average intelligence and some abilities but not others.

There is usually a significant gap between adaptive functional skills and intellectual skills.

In some cases, individuals have deficits that make it difficult for them to see things from someone else’s perspective, whereas in other cases, people have executive function deficits that make it difficult for them to focus on the big picture and instead tend to hyper-focus on small details.

Other associated features in autism that you don’t find in obsessive-compulsive personality disorder have to do with motor deficits and self-injury like clumsiness or difficulty walking, as well as banging the head or biting the wrist.

Prevalence of obsessive-compulsive personality disorder vs autism

  • Obsessive-compulsive personality disorder is something that affects an average of 4.7% of the population.
  • Autism affects between 1% and 2% of the population, with equal rates among adults and children.

OCPD and autism culture-related diagnostic issues

Assessments for obsessive-compulsive personality disorder must be done by a qualified professional who can avoid behaviors that might reflect customs, habits, or other styles that are culturally relevant.

OCPD

There are certain cultural communities that heavily emphasize productivity and work, so members of specific professions, religious groups, or migrant classes might adhere rigidly to the following behaviors that should not be considered indications of obsessive-compulsive personality disorder:

  • Work demands
  • Rules of behavior
  • Moral scrupulosity
  • Striving for perfectionism
  • Over conscientiousness
  • Restrictive social environments

Autism

There are some cultural differences in terms of nonverbal communication and social interactions, but for individuals who have autism, these impairments are noticeable even within an existing cultural context.

young male having mental therapy in psychologists office

Sex and gender-related diagnostic issues for autism vs. OCPD

  • For obsessive-compulsive personality disorder, large-scale studies have found equal prevalence among men and women.
  • Autism is diagnosed between 3 and 4 times more often in males than in females. When females are diagnosed, it’s usually later in life with an accompanying intellectual development disorder.

Autism and OCPD differential diagnosis

Obsessive-compulsive disorder

Obsessive-compulsive disorder has a similar name, but the biggest distinguishing factor is that obsessive-compulsive disorder has true obsessions and compulsions. If you have symptoms of both, you may likely have both conditions.

Hoarding disorder

Hoarding disorder can commonly occur alongside obsessive-compulsive personality disorder. This happens when hoarding becomes extreme. 

For example, when you accumulate stacks of objects that are worthless, don’t have any emotional value, and are a safety hazard, you end up feeling your entire home such that it’s difficult to walk around.

Other personality disorders

There are other personality disorders that can commonly be confused with obsessive-compulsive personality disorder because of shared features.

For example, some individuals might have a commitment to perfectionism, but that commitment to perfectionism could be related to narcissistic personality disorder. 

One key difference in this example is that individuals with obsessive-compulsive personality disorder are usually self-critical, whereas individuals with narcissistic personality disorders indulge themselves and believe that they are perfect.

For autism, there are several conditions which may be misdiagnosed or share common attributes, such as:

  • ADHD
  • Intellectual development disorder
  • Language disorders and social communication disorder
  • Selective mutism
  • Stereotypic movement disorder
  • Rett syndrome
  • Symptoms of anxiety disorders
  • Social anxiety disorder 

ADHD

Individuals with autism are likely to share abnormalities of ADHD like hyperactivity or social communication deficits like:

  • Interrupting people, 
  • Not respecting personal space,
  • Or talking too loudly.

Intellectual development disorder

Intellectual development disorders without autism can be challenging to differentiate, especially in Young children. Intellectual development disorder is more likely the issue at hand when there is no discrepancy between intellectual skills and social communicative skills.

Language disorders

In some language disorders, individuals struggle with social challenges and communication problems, but impairment in social interactions or communication without repetitive behaviors or restrictive interests is more likely to be that of a language disorder than autism.

little girl making pyramids from wood blocks during meeting with psychotherapist

Comorbidity difference between OCPD and Autism

Comorbidity refers to conditions that are likely to coexist. 

OCPD

Individuals who struggle with anxiety disorders and OCD are more likely to have a personality issue that conforms with the symptoms or criteria to diagnose obsessive-compulsive personality disorder.

Similarly, features of obsessive-compulsive personality disorder tend to overlap with what are called type A personality characteristics, things that are present in those who have a risk for myocardial infarction. 

Autism

One difference between OCPD and Autism has to do with comorbidity. Autism spectrum disorder often coexists with:

  1. Language disorders
  2. Intellectual development disorder
  3. Specific learning difficulties
  4. Developmental Coordination Disorder

Nearly 70% of people with Autism also have a co-occurring mental health disorder, and of those, 40% have two or more. The most common include anxiety, depression, and ADHD.

What does OCPD or autism look like on a daily basis?

OCPD

With obsessive-compulsive personality disorder, individuals are preoccupied with perfection and orderliness, and that preoccupation comes with the expense of being flexible toward anything else. It can often get in the way of being efficient or open to other people lending a hand.

Individuals who struggle with obsessive-compulsive personality disorder usually try to keep control or at least the appearance of control by paying attention to things like:

  • Trivial details
  • Lists
  • Schedules
  • Rules
  • Procedures


However, doing so means that the purpose of whatever they are trying to do gets lost, mired in all of that attention to detail.

For example:

Clary made a list of all the things she needed to have done before the weekend, but now she has lost her list. Rather than spending a few minutes trying to recreate her list and get everything done before guests arrive, she spends the few hours she has to clean her house looking for the list instead.

Individuals who struggle with obsessive-compulsive personality disorder pay particular attention to detail, and they’re constantly looking for mistakes, but that means they lose track of time in the process, something that, again, can interfere with any level of productivity or achievement.

It’s not uncommon for people to dismiss the fact that people around them get annoyed with these inconveniences or their poor time management.

Symptoms of self-imposed standards and perfectionism cause a lot of distress, such that people in these situations never actually finish projects.

For example:

Tim has to finish an annual awards package by December 1st so that it can be reviewed before it gets sent for final consideration on the 15th. But he always misses this routine because he painstakingly rewrites every line until he thinks it is perfect, even after it has been submitted for final consideration.

Individuals who struggle with this disorder are so devoted to productivity that they don’t do other things like enjoy friendships or relax. In fact, they will usually postpone things like vacations until such time that vacation never takes place, and they get uncomfortable if they feel they are wasting time. It’s not that individuals can’t afford to take time off; it’s that they can’t find relaxation in going out with friends or relaxing on the beach.

Even things like hobbies are performed with methodical intensity with a great deal of organization and attempt to achieve perfection so that they are not, in fact, relaxing or rewarding.

It’s not uncommon for people struggling with obsessive-compulsive personality disorder to have inflexible values or morals.

Note: This does not apply to religious or cultural values or morals

For example:

Ruben believes that one should never borrow or lend money. As such, even when his best friend or brother needs a dollar to cover the remaining fare on his ticket, Ruben refuses to help because he believes that this would be bad for his brother or best friend.

black woman in office

Autism

Autism ranges in terms of severity and other specifiers, which means it can look different from one individual to the next. However, the most essential feature of those with autism is a persistent impairment in terms of reciprocal social interactions or communications, as well as restricted activities or interests and repetitive behaviors.

Those who do not have cognitive or language impairment might have subtle symptoms, especially early in life.


The deficits in terms of social and emotional reciprocation are often identifiable in young children who have no interest in sharing emotions or initiating any type of social interaction.

For example:

Jared doesn’t like to associate with other children. When other children come up to him at school or at church and ask him to play, he doesn’t know how to respond. He also doesn’t know how to join conversations or even talk to students, so he just hides.

At a young age, there are often repetitive behaviors and interests

For example:

Stephanie is fascinated by beads. She repeatedly spins the beads on her beaded bracelets.

Deficits in nonverbal communicative behaviors are usually things like atypical eye contact or even absent eye contact, no facial expressions, gestures, or body orientation, which is not normal in society.

For example:

At 12 months of age, Philip is unable to follow someone’s eye gaze or where they point. He avoids all eye contact, and he likes to play with his blocks instead.

Is OCPD on the autism spectrum?

No. OCPD is a personality disorder, which means it falls under the spectrum of personality disorders. Autism spectrum disorder falls under its own category. While there are some shared traits and similarities between autism and OCPD, there are distinct differences in causes, risk factors, prevalence, and symptoms associated with OCPD and autism.

OCPD vs Autism: treatment and management

When you look at the difference between OCPD and autism, one of the most important things is how OCPD and autism get treated.

OCPD

Psychotherapy is the most common form of treatment for personality disorders, including obsessive-compulsive personality disorder. The purpose of this treatment is to help individuals uncover the fears or motivations they have with the thoughts and behaviors related to perfectionism. By understanding this, individuals can reflect on causes within their control and learn how to relate more positively.

Psychodynamic therapy is another option, one which focuses on problematic behaviors individuals with obsessive-compulsive personality disorder are exhibiting in their lives, behaviors that can affect other people.

Cognitive behavioral therapy is a goal-oriented type of treatment that helps individuals look at the automatic negative thoughts that contribute to emotions and behaviors. By better understanding the relationship between thoughts and subsequent actions, individuals struggling with obsessive-compulsive personality disorder can adopt healthier attitudes toward symptoms.

Aside from psychotherapy, there are currently no medications for treatment; however, there are medications for secondary and tertiary mental health conditions like anxiety or depression. Sometimes, medication for other conditions can make it easier to manage the symptoms of obsessive-compulsive personality disorder.

 

Autism

For autism, there is currently no standardized treatment; however, there are ways that symptoms can be managed. The most effective therapies might be very different from one person to the next.

The earlier someone gets a diagnosis and intervention, usually by the age of preschool or earlier, the more impactful the outcome can be. However, people living with autism can benefit from treatment no matter how old they are.

Some management options include the following:

  • Speech-language therapy, particularly for children who have severe speech problems
  • Social skills training for children and adults who want to better understand what normal social skills are and how to use them
  • Occupational therapy is specifically for older adults who want to learn how to better manage their symptoms while at work
  • Physical therapy to help with repetitive movements and other motor abnormalities
  • Educational therapies and school-based therapies for young children who are diagnosed early
  • Cognitive behavioral therapy
  • Behavioral management therapy
  • Nutritional therapy
  • Medication treatment
  • Joint attention therapy
support mental health and patient holding hands with therapist in counseling session

Summing Up

Is OCPD on the autism spectrum? No. When you OCPD vs autism, you might notice similarities in terms of an individual’s inability to properly interact with others or form relationships, but they come from very different places, and there are several other categories of symptoms that are distinct to both autism and OCPD.


Still, there can be difficulties in differentiating between OCPD and autism during diagnosis, which is why it’s essential that you receive an accurate diagnosis in order to get the right treatment. You can do this by improving your awareness and understanding of autism vs. OCPD in all its relevant categories and aspects to help improve the lives of those who are affected.