I think you can have both.
OCD criteria:
Quote:
A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4):
(1) recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
(2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
(3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
(4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
Compulsions as defined by (1) and (2):
(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
(2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.
Regarding autism/AS, the criteria that are closest to OCD are the restricted/repetitive behavior criteria:
Quote:
(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects
In most cases, however, autism-related restricted/repetitive behavior would not meet criteria for OCD, because it tends not to cause distress (or only secondary to other people's reactions). The interests (Criteria C1) are usually extremely enjoyable, and stimming and preoccupation with objects (C3 & C4) are usually emotionally neutral or positive, though stimming can be a
reaction to distress. Only C2 typically involves features of OCD compulsions.
In my opinion, if a person meets the criteria for autism or AS, that should take precedence over OCD, because OCD doesn't account for the social/communicative criteria. Then, if the person's repetitive behavior is enjoyable or doesn't affect their mood, or they don't consider it excessive or unreasonable
as an adult (the insight criteria are not applied to children), or their repetitive behavior causes no functional impairment (AS and autism require impairment, but it could be entirely due to social/communicative symptoms), then OCD would not be present. Also, if the person's only obsessions/compulsions are insistence on routines, then they wouldn't have OCD.
One tricky thing would be the difference between compulsions and rituals. I would suggest this:
Rituals are basically routines that only apply in certain situations. For example, 'every time I have a bath, I need to dry from top to bottom'. As such, they are done only once, or a predefined number of times. Whereas OCD compulsions are done until anxiety dissipates, which can result in widely disparate numbers of times (eg one day the person checks the lock five times, and another day they check it 100 times). Trying to repeat a ritual too many times would be as upsetting as not doing it enough. Also, in the case of a longer, more complex compulsion, it seems if they screw it up they usually start over. With a ritual, sometimes they start over, but other times they can just skip past the error and be fine. (For example, when I took a low functioning autistic girl into the family changeroom instead of the women's changeroom at the pool, she had a nonstop tantrum while being changed, but as soon as we were out on the poolside, everything was fine again. She didn't try to make me put her clothes back on and take her through the
right changeroom.)
12 Mar 2013, 6:49 am
