(PS7-11) Enhancing Exposure and Response Prevention for Autistic Individuals with OCD

Abstract Text: The overlap in features between autism and OCD presents significant diagnostic and treatment challenges. Although both share characteristics like repetitive behaviors and rigid routines, these serve different functions—OCD behaviors aim to reduce anxiety, while autistic behaviors are typically self-soothing or regulatory (Postorino et al., 2017; Wu et al., 2014). Distinguishing them can be difficult, but differences in function, type of reinforcement (positive vs. negative), and emotional alignment (ego-syntonic vs. ego-dystonic) can aid diagnosis (Wu et al., 2014). Diagnosis is further complicated by camouflaging—masking autistic traits to meet social expectations, common in cisgender women (Hull et al., 2017; 2020). Autism is also underdiagnosed in Black, Indigenous, and people of color (BIPOC; Diemer et al., 2022) and transgender, nonbinary, and gender-diverse (GD) individuals (Pinciotti et al., 2022).

Although Exposure and Response Prevention (ERP) is the gold-standard OCD treatment, autistic clients with OCD respond less effectively to standard protocols (Aymerich et al., 2024; Bedford et al., 2020). Specific adaptations to ERP show promise, including longer treatment duration, use of visuals, concrete language, and explicit instruction, integration of special interests into treatment, increased use of reinforcement, family involvement, and enhanced psychoeducation (Church et al., 2024; Kose et al., 2018). Despite growing awareness of the overlap of features in autism and OCD, research has largely focused on quantitative outcomes, with limited data focused on autistic clients’ perspectives of ERP (Long et al., 2024). It is also unclear how consistently providers implement recommended ERP adaptations. Given autism’s underdiagnosis—especially among cisgender women, BIPOC, and GD individuals—there is a need to explore how OCD providers approach differential diagnosis and tailor treatment. Without this information, autistic clients may receive inappropriate care, potentially leading to harm or delayed diagnosis.

To address these gaps, a phenomenological qualitative study is underway to explore autistic clients’ experiences with ERP, including perceived barriers and facilitators to treatment, and how aspects of their identities shape the diagnostic and treatment process. Autistic participants with OCD who previously received ERP from an anxiety-specialty clinic (n = 4, with a target of 8–12) completed a demographics questionnaire, the Camouflaging Autistic Traits Questionnaire (CAT-Q; Hull et al., 2019), and a 45–60 minute semi-structured interview. Data are analyzed using rapid thematic analysis (Hamilton, 2020). Four Interviews are complete and data analysis is ongoing through April 2025, with final analyses to be completed in June 2025. Preliminary themes include: (1) Impact of autism diagnosis timing on OCD treatment (e.g., autism symptoms treated as compulsions), (2) Camouflaging during therapy (e.g., making eye contact), and (3) Navigating the OCD-autism overlap. Findings will inform recommendations for tailoring ERP, approaches to differential diagnosis, and the development of a clinician survey study on provider practices. Limitations will be discussed.