Symptom Overlap between Autism Spectrum Disorder, Generalized Social Anxiety Disorder and Obsessive-Compulsive Disorder in Adults: A Preliminary Case-Controlled Study

Abstract

Background: Obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD) frequently co-occur in persons with autism spectrum disorder (ASD). We studied which features distinguish ‘pure’ anxiety disordered patients from those with co-morbid ASD. Method: In a case-controlled design in which groups were matched for age, sex and educational level, patients with OCD or SAD and co-morbid ASD were compared with patients with ‘pure’ (i.e. without ASD) OCD, with ‘pure’ SAD and a control group, using the Autism Questionnaire (AQ), Yale-Brown Obsessive-Compulsive Scales, Liebowitz Social Anxiety Scale, Beck Anxiety Inventory and questions on egodystonia of OC behaviors. Results: No between patient group differences were found on social or general anxiety measures. The AQ subscales communication problems and lack of imagination discriminated best between patients with comorbid ASD and the other groups, ASD patients showing elevated scores, whereas the other patient groups scored equal to controls. On the AQ social skill subscale all patient groups showed elevated scores. On OC symptom severity, pure OCD patients showed highest scores, whereas comorbid ASD subjects scored intermediate between controls and the pure OCD group, the differences being explained by lower obsession severity in the ASD group. There were no differences between the pure OCD and comorbid ASD groups on egodystonia. Conclusion: Patients with comorbid ASD differ from patients with pure OCD and SAD on autism-related problem behaviors, but there is also overlap between groups, possibly reflecting overlapping etiologies. Despite the relatively small sample size, these data strongly suggest that specific autism symptom domains should be assessed to pick up autism-related problems in OCD and SAD patients, and subsequently fine-tune treatment programs for these patients.

Obsessive–compulsive traits in children and adolescents with Asperger syndrome

“…The absence of a significant As we expected from the third hypothesis, the severity of OC symptoms was significantly higher not only in the OCD group (Moderate range of severity) but also amongst the AS children, who demonstrated a Mild clinical impairment. This finding is in line with the Cath study [9], which reported that Y-BOCS scores of co-morbid ASD subjects were intermediate between patients with only OCD and controls, with the patients with only OCD scoring the highest.…”

“…These results might be related in both groups to the age and the level of development and concord with previous findings, which suggested the existence in childhood OCD of some impairments in perceiving, processing and describing repetitive thoughts and behaviours [12,27]. Also, the finding of no difference in insight amongst the two groups is in line with the study by Cath et al, which pointed out that egodystonicity did not discriminate between OCD and ASD subjects [9] and with the data of Ivarsson et al, who found in a paediatric OCD sample no relationship between the OCDpatients' level of insight and the presence of ASD traits [16].…”

“…A recent study [9] focused on symptom overlap amongst ASD, OCD and social anxiety disorder in adults, reporting that subjects with only OCD scored highest on OC symptom severity, with co-morbid ASD subjects scoring at an intermediate level between OCD subjects and controls. There were no differences in insight between OCD subjects with and without ASD.…”

The use of the Autism-spectrum Quotient in differentiating high-functioning adults with autism, adults with schizophrenia and a neurotypical adult control group

“…A similar pattern of results was found for ADHD (Sizoo et al, 2009). With regard to OCD, results are mixed: whereas Cath et al (2008) report no differences with ASD, Hoekstra et al (2008) describe less impaired attention to detail in OCD compared to ASD. Furthermore, individuals with SAD report less attention to detail than an ASD group Hoekstra et al, 2008).…”

Transition to Adulthood for High-Functioning Individuals with Autism Spectrum Disorders

“…Specifically, social anxiety and withdrawal increase throughout adolescence in this population, even though these symptoms tend to decrease during this period of development for neurotypical peers (Kuusikko et al, 2008). Anxiety appears to reflect concerns about peer relationships for adolescents and young adults with ASD, but may have a deeper root, as ASD symptoms may overlap with generalized anxiety and social anxiety (Cath et al, 2008). Restricted interests and general rigidity may cause anxiety about unfamiliar or unstructured experiences, as individuals with ASD often display obsessive behavior but are much less likely to seek out or feel rewarded by new stimuli (Anckarsäter et al, 2006;Ozonoff et al, 2005;Soderstrom et al, 2002).…”