Do all autistic adults have either OCD or ADHD?

I used to think I had OCD because an NHS psychotherapist told me so. Years ago, a hospital psychiatrist referred me to a psychotherapist. During the course of the sessions, this psychotherapist decided I had “OCD” and I was “fortunate” to be given many months of psychotherapy to address my repetitive counting and other repetitive and perfectionist behaviours. I came away from each session armed with literature on compulsions, obsessions, rituals and distress, alongside knowledge of why many psychiatrists do not believe in what some people describe as a type of OCD called “Pure O”. 

Fast forward many years to last year when my GP referred me for an ASD assessment. He said my medical records do not show a diagnosis of OCD, and as my counting does not cause me distress he didn’t believe I had such a thing. Moreover, the NHS psychotherapist would not have had authority to ‘‘diagnose’’ OCD so that is why it would not have been recorded on my notes. It turns out, my GP was correct because a few months later I was diagnosed ASD. The assessor explained that counting is a stim which helps me to create order and make sense of the world, it is a good and pleasurable thing for me. In times of distress, counting has a different purpose because it calms me down. 

I am currently on the waiting list for an ADHD assessment and I am confident I will be diagnosed.

In many ways I am a perfectionist so I pay meticulous attention to financial budgeting and my favourite interests. I also like using spreadsheets for financial planning and all sorts of other things. I need my home to be well ordered, clean and tidy. I love using graphs and charts to illustrate things. I think these things reflect my autistic brain.

If you came into my house now you would see that it is clean and tidy. The kitchen is sparkling, and the loos and sinks squeaky clean. Yet behind the scenes (cupboards, drawers, wardrobes, filing cabinets, spare bedroom/storage room) mess prevails. This persistent inability to organise and tidy things upsets me. My autistic brain craves prediction, order and precision, yet my ADHD brain means I am messy, inattentive, I make mistakes and I crave novelty. The tension between these things causes me distress—contentment is elusive.

The tension between ASD and ADHD affects how I post here. Sometimes I can’t say what I want to say or I make mistakes because I am inattentive.

Some people joke that they have OCD because they ‘are always cleaning’ or they are ‘always checking the doors are locked’. Some say they are ‘a little bit OCD’ which to me is like saying somebody is ‘a little bit autistic’. It can be offensive for those who really struggle with OCD.

The NHS describes how OCD can affect people. It seems that persistent anxiety and distress is caused by the obsession. I feel annoyed that I have been misled by a psychotherapist who clearly didn’t take time to listen to what I was actually telling them about counting. If they had understood OCD and were qualified to diagnose it, they would have known very quickly that I didn’t fit the criteria.

https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/symptoms/

Obsessive compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thoughts and behaviours.

OCD has 3 main elements:

• obsessions – where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters your mind
• emotions – the obsession causes a feeling of intense anxiety or distress
• compulsions – repetitive behaviours or mental acts that a person with OCD feels driven to perform as a result of the anxiety and distress caused by the obsession

The compulsive behaviour temporarily relieves the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.

Most people with OCD experience both obsessive thoughts and compulsions, but one may be less obvious than the other.

I used to think I had OCD because an NHS psychotherapist told me so. Years ago, a hospital psychiatrist referred me to a psychotherapist. During the course of the sessions, this psychotherapist decided I had “OCD” and I was “fortunate” to be given many months of psychotherapy to address my repetitive counting and other repetitive and perfectionist behaviours. I came away from each session armed with literature on compulsions, obsessions, rituals and distress, alongside knowledge of why many psychiatrists do not believe in what some people describe as a type of OCD called “Pure O”. 

Fast forward many years to last year when my GP referred me for an ASD assessment. He said my medical records do not show a diagnosis of OCD, and as my counting does not cause me distress he didn’t believe I had such a thing. Moreover, the NHS psychotherapist would not have had authority to ‘‘diagnose’’ OCD so that is why it would not have been recorded on my notes. It turns out, my GP was correct because a few months later I was diagnosed ASD. The assessor explained that counting is a stim which helps me to create order and make sense of the world, it is a good and pleasurable thing for me. In times of distress, counting has a different purpose because it calms me down. 

I am currently on the waiting list for an ADHD assessment and I am confident I will be diagnosed.

In many ways I am a perfectionist so I pay meticulous attention to financial budgeting and my favourite interests. I also like using spreadsheets for financial planning and all sorts of other things. I need my home to be well ordered, clean and tidy. I love using graphs and charts to illustrate things. I think these things reflect my autistic brain.

If you came into my house now you would see that it is clean and tidy. The kitchen is sparkling, and the loos and sinks squeaky clean. Yet behind the scenes (cupboards, drawers, wardrobes, filing cabinets, spare bedroom/storage room) mess prevails. This persistent inability to organise and tidy things upsets me. My autistic brain craves prediction, order and precision, yet my ADHD brain means I am messy, inattentive, I make mistakes and I crave novelty. The tension between these things causes me distress—contentment is elusive.

The tension between ASD and ADHD affects how I post here. Sometimes I can’t say what I want to say or I make mistakes because I am inattentive.

Some people joke that they have OCD because they ‘are always cleaning’ or they are ‘always checking the doors are locked’. Some say they are ‘a little bit OCD’ which to me is like saying somebody is ‘a little bit autistic’. It can be offensive for those who really struggle with OCD.

The NHS describes how OCD can affect people. It seems that persistent anxiety and distress is caused by the obsession. I feel annoyed that I have been misled by a psychotherapist who clearly didn’t take time to listen to what I was actually telling them about counting. If they had understood OCD and were qualified to diagnose it, they would have known very quickly that I didn’t fit the criteria.

https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/symptoms/

Obsessive compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thoughts and behaviours.

OCD has 3 main elements:

• obsessions – where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters your mind
• emotions – the obsession causes a feeling of intense anxiety or distress
• compulsions – repetitive behaviours or mental acts that a person with OCD feels driven to perform as a result of the anxiety and distress caused by the obsession

The compulsive behaviour temporarily relieves the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.

Most people with OCD experience both obsessive thoughts and compulsions, but one may be less obvious than the other.

I hope you don't mind me asking about your counting. I find myself counting footsteps, or when I am cutting carrots for example I suddenly realise I have been counting when I get to say 12. Is this the sort of thing you mean or something else?