Beyond repetitive behaviours: Recognising and treating OCD in autistic individuals

Obsessive-compulsive disorder (OCD) is one of the most common and impairing co-occurring conditions in autistic individuals, yet it is frequently under-recognised and undertreated. This clinical perspective examines the challenges of recognising, diagnosing, and managing OCD in autism. We discuss the overlap and important distinctions between autistic repetitive behaviours and OCD compulsions, highlighting the need for careful differential diagnosis to ensure that treatable OCD is identified without pathologising core autistic characteristics. We review the limited clinical trial evidence on autism-adapted cognitive behavioural therapy (CBT) for OCD, arguing that the scarcity of treatment trials is likely to reflect a lack of research rather than a lack of efficacy. We also consider barriers to accessing specialist care and discuss the potential of therapist-supported internet-delivered CBT to expand access to evidence-based treatment. Finally, we outline priorities for clinical practice and research, including improving recognition of OCD in autistic people, increasing their inclusion in treatment trials, and developing accessible, autism-adapted interventions.