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Obsessive–Compulsive Disorder (OCD) in Adults
 

Obsessive–Compulsive Disorder (OCD) often intersects with neurodivergent conditions such as Autism and ADHD, creating a complex web of experiences that can be difficult to untangle.

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Recognizing and understanding these intersections is crucial for providing support that truly meets your needs.

 

Research indicates that up to 37% of Autistic individuals also live with OCD. The way OCD shows up in Autistic people varies widely, which means diagnosis and treatment require nuance and flexibility rather than a one-size-fits-all approach.

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For many, the intersection of OCD and Autism adds unique challenges to daily life. Sensory experiences, routines, and social interactions can all become more complicated, leading to stress and exhaustion.

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Here’s the good news: you don’t need more willpower—you need a plan that fits your brain.

 

That’s where we come in: offering practical, neuro-informed care designed to give you back your time, calm, and sense of choice.

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Who This Page Is For
 

If you’re an adult who is:

 

  • Autistic or ADHD and noticing OCD‑like symptoms that are getting in the way of life, or
     

  • Experiencing obsessions and compulsions that meet criteria for OCD,

     

This page explains what’s going on, how to tell the differences, and how we treat it.
 

OCD 101: Name the Doubt, Stop the Spiral

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Understanding how the OCD engine runs so you can stop fueling it.
 

OCD is a pattern of intrusive, unwanted thoughts, images, or urges (obsessions) paired with behaviors or mental acts done to reduce distress or prevent something bad (compulsions).

Relief is short‑lived, and the cycle keeps going. OCD can be obvious (checking, washing, arranging) or nearly invisible (reassurance seeking, mental reviewing, counting, avoiding).
 

Common obsession themes include contamination, harm, morality/scrupulosity, order/symmetry, relationships/ROCD, sexual orientation or identity (SO‑OCD), health, and “just‑right” sensations.

Compulsions can be physical or purely mental.

Is It OCD or Autism/ADHD? Get Clear Without Self‑Blame
 

Two patterns can look similar on the surface but run on different fuel.
 

Autism vs. OCD
 

  • Why the behavior happens
     

    • Autism: Repetitive behaviors and routines regulate sensory input, predictability, and energy. They’re often calming or enjoyable.
       

    • OCD: Repetitive behaviors are done to neutralize fear or doubt. They reduce anxiety in the moment but keep the fear alive.
       

  • How it feels
     

    • Autism: Special interests and stimming usually feel satisfying or regulating.
       

    • OCD: Obsessions feel intrusive, unwanted, ego‑dystonic; compulsions feel urgent, rule‑bound, and burdensome.
       

  • Flexibility
     

    • Autism: Routines are important, but with support people can shift them without a spike of catastrophic fear.
       

    • OCD: Attempts to stop or change rituals trigger intense anxiety or “not‑just‑right” distress.
       

ADHD vs. OCD
 

  • Attention
     

    • ADHD: Attention is pulled by novelty or drifts due to under‑stimulation. Thoughts are many but not sticky.
       

    • OCD: Attention is hijacked by doubt. Thoughts are sticky, repetitive, and hard to disengage from.
       

  • Control

    • ADHD: Impulsivity leads to quick actions without overthinking.
       

    • OCD: Over‑control. People overthink, seek certainty, and develop rules and rituals to feel safe.
       

  • Avoidance
     

    • ADHD: Avoidance often comes from boredom or executive‑function overload.
       

    • OCD: Avoidance is fear‑driven to prevent perceived harm or to eliminate doubt.
       

Two Clinical Paths We See
 

1) Autistic or ADHD Adults With OCD‑Like Symptoms
 

You may resonate with repetitive behaviors, special interests, or rules that keep life steady.

But if fear‑based rituals, sticky doubt, or “I can’t stop or something bad will happen” enter the picture, OCD may be riding along.

Treatment must respect sensory needs, processing style, and executive‑function load.
 

2) Adults Who Meet Full Criteria for OCD
 

You experience intrusive obsessions and engage in compulsions that take time, create distress, and impair functioning.

You may or may not be autistic/ADHD.

Treatment targets the OCD cycle directly while tailoring delivery to your neurotype.
 

Why This Distinction Matters
 

  • Autism‑only repetitive behaviors are often adaptive. Treating them as pathology can backfire.
     

  • OCD rituals maintain anxiety and deserve targeted intervention.
     

  • Autism + OCD requires both acceptance/skills for autistic needs and exposure‑based work for OCD.
     

  • ADHD + OCD requires structuring exposures to fit energy, focus, and working‑memory realities, and often building scaffolds before asking for difficult ERP homework.
     

How We Assess
 

  • Clinical interview focused on obsessional doubt, triggers, safety behaviors, and sensory context.
     

  • Differential questions that separate autistic regulation from fear‑driven compulsion.
     

  • Screening tools, including the Obsessive–Compulsive Inventory–Revised (OCI‑R).
     

  • If autism or ADHD is in the mix, we draw on our neuro‑informed assessment protocols so the plan matches your brain, not a generic checklist.

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Take the OCI‑R: Start With a Quick Snapshot
 

A quick screen won’t label you—it points us in the right direction.

The OCI‑R gives a fast read on symptom clusters and severity so we can match the plan to what you’re actually living with.
 

Take the OCI‑R on our site »

 

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Note: Screens guide next steps. They are not a diagnosis.

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Treatment That Works: ERP + I‑CBT
 

Face fear without rituals. Change how doubt hooks you.
 

Exposure and Response Prevention (ERP)
 

ERP is the gold‑standard behavioral treatment for OCD.

You intentionally face feared thoughts, sensations, or situations (exposure) while not performing rituals or avoidance (response prevention).
 

Over time, your brain relearns that anxiety falls without rituals, and feared predictions don’t come true.
 

What this looks like in practice:
 

  • We map your obsession/compulsion cycles and identify safety behaviors (including subtle mental rituals).
     

  • We build a graded exposure plan. You start small and stack wins.
     

  • We practice response prevention with clear, concrete steps. For autistic clients, we incorporate sensory regulation and predictability so exposures are doable—not overwhelming.
     

  • We use behavioral experiments to test “rules” OCD insists on.
     

Inference‑Based Cognitive Behavioral Therapy (I‑CBT)
 

I‑CBT targets the reasoning style that fuels obsessional doubt. Instead of arguing with the content of thoughts, it helps you recognize when you’ve shifted from reality‑based sensing to “what‑if” inference.

You learn to:
 

  • Spot the moment you enter the doubt narrative.
     

  • Re‑anchor in present evidence (“reality sensing”) rather than chasing certainty.
     

  • De‑value the obsessional scenario so you’re less compelled to check, seek reassurance, or mentally review.
     

I‑CBT can be especially helpful for clients whose compulsions are mostly mental (rumination, analyzing, moral self‑audits) or who feel ERP gets stuck because the doubt simply regenerates new angles.
 

ERP vs. I‑CBT: How We Decide
 

  • If rituals and avoidance dominate your day, we lean on ERP first.
     

  • If your compulsions are largely mental or your fear is anchored in reasoning loops (“If I thought it, it means something”), I‑CBT often unlocks progress.
     

  • Many clients benefit from a blend—I‑CBT to weaken the doubt engine and ERP to retrain behavior.​

Tailored to Your Neurotype: Autism + OCD, ADHD + OCD
 

Same gold‑standard care, delivered in a way your brain can actually use.
 

Autism + OCD
 

  • We preserve autistic regulation strategies that are healthy.
     

  • We adapt exposure tasks for sensory load and predictability.
     

  • We use concrete visuals, clear steps, and longer prep.
     

  • We separate “stimming that soothes” from “rituals that obey fear.” The first is supported; the second is treated.
     

ADHD + OCD
 

  • We break exposures into smaller, time‑boxed tasks with reminders and external scaffolds.
     

  • We keep sessions active and hands‑on to work with attention, not against it.
     

  • We front‑load routine building (sleep, meds consults if appropriate, time‑management tools) so ERP doesn’t collapse under executive‑function strain.
     

OCD Without Autism/ADHD
 

  • We move faster through exposure hierarchies when appropriate.
     

  • We emphasize values‑based goals to counter perfectionism and intolerance of uncertainty.​

Your First 6–12 Weeks With Us
 

Clear plan, trackable wins, fewer rituals—and more life.
 

  1. Clarify your profile (OCD, autism, ADHD—any combination) and what success looks like for you.
     

  2. Build a shared case map of triggers, obsessions, rituals, and avoidance.
     

  3. Choose a treatment path (ERP, I‑CBT, or combined), including specific weekly targets.
     

  4. Practice in session and between sessions with clear, trackable steps.
     

  5. Review data, adjust, and generalize gains to the real world.
     

Medication & Combined Care
 

Many adults benefit from combined treatment (therapy plus medication such as SSRIs).

We collaborate with your prescriber or refer to trusted psychiatry partners.

Medication choice is always yours; therapy remains central.
 

When to Seek Help 
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Reach out if any of these are true:

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  • You spend an hour or more daily on obsessions/compulsions—or much less time but with significant distress.
     

  • You avoid people, places, or activities to keep anxiety down.
     

  • You can’t tell if it’s OCD or autism/ADHD anymore—it all feels tangled.
     

  • Faith, identity, or morality worries consume you, and reassurance never sticks.

     

How We Can Help
 

  • Neuro‑informed specialists experienced with autism, ADHD, and OCD.
     

  • Telehealth for adults anywhere in California.
     

  • Practical, measurable plans that respect your brain and your life.
     

Take the OCI‑R on our site »
 

Schedule a consult »â€‹

For Partners: Support Without Feeding the Cycle
 

Love hard. Stop accommodating. Stay connected.
 

When you love someone with OCD, reassurance talks can swallow evenings, conflict erupts around rituals, and intimacy takes a back seat to anxiety management.

You’re not the problem—and you’re part of the solution.
 

What we offer partners:
 

  • Clear education on the OCD cycle so you know what helps vs. what quietly feeds it.
     

  • Scripts to shift from reassurance to supportive coaching (e.g., “I care about you, and we’re not doing the ritual—let’s ride the wave together.”)
     

  • Boundary‑setting that’s compassionate and consistent.
     

  • A step‑by‑step plan for reducing accommodation (checking, answering, avoiding) without blowing up the relationship.
     

  • Options for joint sessions and couples work when OCD impacts communication, sex, parenting, or faith.
     

Schedule a consult »

FAQs: Straight Answers
 

Do I have OCD or is this “just autism” or “just ADHD”?
 

Look at intent and function. If the behavior reduces fear or doubt and feels compelled, it’s likely OCD.

If it regulates energy/sensory input and feels soothing or satisfying, it’s likely autistic regulation.

If the barrier is motivation, boredom, or task‑initiation, ADHD may be primary. Many people have more than one—treatment sorts it out.
 

What if ERP feels impossible?
 

Then we start smaller, add regulation supports, or lead with I‑CBT to weaken doubt. The point isn’t suffering; it’s learning your nervous system can handle uncertainty without rituals.
 

How long does treatment take?
 

Many clients see meaningful change in 8–16 sessions. Complex presentations can take longer. We track progress and decide together.
 

Will you try to stop my autistic stims or routines?
 

No. We protect regulation that helps you function. We only target behaviors that serve OCD, not your well‑being.
 

Can you help if my compulsions are mostly in my head?
 

Yes. We treat mental rituals directly with I‑CBT and ERP for covert compulsions (e.g., rumination, reassurance seeking, analyzing, praying to neutralize, mental checking).

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Ready to Start?
 

If you’re ready to understand what’s OCD, what’s autism or ADHD, and what to do next, start with the OCI‑R and a consult.
 

Take the OCI‑R on our site »

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Schedule a consult »

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