Compulsion Profile Differences Indicate Distinct Functional Mechanisms in Autistic and Non-Autistic University...

Autistic individuals often exhibit high rates of obsessive-compulsive symptoms (OCS), yet traditional cognitive-behavioral therapy (CBT), especially exposure and response prevention (ERP), tends to be less effective for them. This may be due to differences in the function of compulsive behaviors: while OCD-related compulsions are typically ego-dystonic and aimed at reducing anxiety, autistic compulsions may be ego-syntonic, serving regulatory or sensory modulation purposes. This study investigated whether compulsions in autism are more aligned with regulation and sensory modulation than with anxiety reduction. Participants included 39 autistic university students, 25 non-autistic students with high OCS, and 25 non-autistic students with low OCS. A factor analysis of seven binary items from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS-I) revealed two factors explaining 58% of the variance. The first factor showed high loadings for Repetition, Counting, and Hoarding compulsions, reflecting regulatory and sensory modulation processes. The second factor showed high loadings for checking and organizing compulsions that were previously associated with anxiety reduction. Chi-square analyses showed autistic students reported significantly more regulatory/sensory compulsions than low-OCS individuals. For anxiety-reduction compulsions, autistic students reported significantly fewer positive responses than both non-autistic groups. Trait and state anxiety correlated with OCS levels in non-autistic participants, but not in autistic individuals. These findings indicate that compulsions in autism may reflect distinct functional mechanisms compared to those in classical OCD. Specifically, the weaker association with anxiety or threat reduction suggests that ERP-based CBT, which targets anxiety-driven compulsions, may be less effective for autistic individuals. Broader implications for both diagnosis and therapeutic approaches are discussed.