Welcome to day fifteen in the A to Z Challenge on autism. Today, I will focus on obsessive and compulsive behaviors as they occur in autistic people.
The obsessive-compulsive spectrum encompasses a number of disorders that may co-exist with autism spectrum disorders. Even people with autism without an additional diagnosis often display obsessive an compulsive behaviors. In fact, the repetitive behaviors that are a core symptom of autism are often thought of as obsessive.
The first way in which obsessive and compulsive behaviors present themselves is in autistic people’s obsessive interests. Autistic people often engage in one specific interest that may be unusual in either intensity or focus. I will focus on unusual fasicnations when we arrive at the letter U. The obsessive nature of interests however also manifests itself in the way in which people often are hard to break free from their special interest. Many autistic people are cheerful or even elated as long as they can engage in their special interest and get a bit depressed when they’re being redirected.
Collecting is a common type of special interest in autistic people. This can go to the extreme of hoarding, which is on th eobsessive-compulsive spectrum. The main feature of hoarding is an irrational, persistent difficulty to discard things that the person no longer needs and that aren’t of value. This is a long-standing pattern, not just related to a single life event (such as the inability to discard something inherited from a loved one). Hoarding is not simply the passive acccumulation of stuff that a person doesn’t discard; it involves an actual effort not to discard objects. Autistic people commonly collect seemingly worthless items such as bits of string or paper scraps. This may be easily seen as hoarding by non-autistic family members. When compulsive collecting interferes with a person’s organizational or decision-making skills, it is time to seek help.
As I said, more classic obsessive-compulsive traits or even full-blown obsessive-compulsive disorder (OCD) are also common in autistics. This may be related to unusual fears, which I will also discuss in my letter U post. Obsessive-compulsive behaviors may involve repeated counting, checking or washing, but in my own case, repeatedly asking the same questions was also part of it. Repetitively talking about the same subject, may also be a compulsion for an autistic person. For example, my husband and I are trying to prepare for me to go live with him. A lot is still unclear, but I have a compulsion to tell the staff every detail of what we’re trying to work on repeatedly.
Lastly, the stereotypical, self-stimulatory behaviors that are a core symptom of autism, may also be seen as compulsions. For example, trichotillomania, the compulsive pulling out of one’s own hair, is on the obsessive-compulsive spectrum in the DSM-5 (the psychiatrist’s manual). This condition is also fairly common in autistics, as are other seemingly compulsive movements. Then again, these behaviors can also be seen as a sensory symptom, which I will discuss in my letter S post.