Autism spectrum disorders in adult outpatients with obsessive compulsive disorder in the UK

Abstract

BackgroundPatients with obsessive compulsive disorder (OCD) frequently show traits of autism spectrum disorders (ASD). This is one of the first studies to explore the clinical impact of the overlap between OCD and ASD as a categorical diagnosis. MethodsA cross-sectional survey in 73 adult outpatients with DSM-IV OCD. Autistic traits were measured using the Autism-Spectrum Quotient (AQ). A clinical estimate ASD diagnosis was made by interview using DSM-IV-TR criteria. OCD patients with and without autistic traits or ASD were compared on demographic and clinical parameters and level of OCD treatmentresistance based on treatment history. ResultsThirty-four (47%) patients scored above the clinical threshold on the AQ (>=26) and 21 (27.8%) met diagnostic criteria for ASD. These diagnoses had not been made before. Patients with autistic traits showed a borderline significant increase in OCD symptomseverity (Yale-Brown Obsessive Compulsive Scale (Y-BOCS); p=.054) and significantly increased impairment of insight (Brown Assessment of Beliefs Scale; p=.01). There was a positive correlation between AQ and Y-BOCS scores (p =.04), but not with OCD treatment resistance. ConclusionThere is a high prevalence of previously undiagnosed ASD in patients with OCD. ASD traits are associated with greater OCD symptom-severity and poor insight.

Gender differences in restricted and repetitive behaviors and interests in youth with autism

“…For example, Samuels et al [] found that hoarding was linked to elevated ASD symptomology and that girls with OCD were found to have greater proportions of hoarding behavior compared to boys with OCD. Similar to these findings, recent work has identified an overlap in ASD symptomology in women with eating disorders and adults with OCD [Mandy & Tchanturia, ; Westwood et al, ; Westwood, Mandy, & Tchanturia, ; Wikramanayake et al, ]. High cognitive inflexibility characterizes OCD, eating disorders, and ASD symptomology; therefore underlying mechanisms for compulsive RRBI may be specifically related to habit and cognitive corticostriatal pathways [Langen et al, ; Yerys, ].…”

Diagnosis of autism in adulthood: A scoping review

“…Personality traits relating to introversion and neuroticism may potentially reflect social difficulties and patterns of rigid thinking in autism as well as depressive and anxious symptoms. The similarity between repetitive behavioural tendencies and symptoms of anxiety and OCD (Cath et al, 2008; Wikramanayake et al, 2018) may also contribute to misdiagnosis and ineffective treatment. As common co-occurring conditions like depression and ADHD are known to negatively affect cognitive function (McDermott & Ebmeier, 2009; Nydén et al, 2010), it is challenging for researchers to disentangle autism’s relationship with cognitive abilities while using samples representative of the autistic adult population.…”

Mapping Compulsivity in the DSM-5 Obsessive Compulsive and Related Disorders: Cognitive Domains, Neural Circuitry, and Treatment

“…Other phenotypic signs of an altered neurodevelopmental trajectory are also commonly observed in patients with OCRDs, such as traits or symptoms of tic disorder, ASD, and attention deficit hyperactivity disorder. These comorbid traits and diagnoses appear to cluster in the same patient or within their family members, hinting that shared, heritable neuro-behavioral mechanisms contribute to the expression of many compulsive disorders ( de Vries et al, 2016 ; Wikramanayake et al, 2017 ). Cases of tic-related OCD tend to have a male predominance (similar to ASD), an earlier age of onset, and a higher proportion of OCD symptoms related to symmetry, “not just-right experiences,” and forbidden thoughts compared with non-tic-related OCD ( Prado et al, 2008 ).…”