The neurodiversity movement aims to challenge our conception of what it means to have a “normal” brain and encourages us to embrace, rather than reject or pathologize, neurodivergent conditions such as autism or sensory processing disorders.
With the ideas and goals of the neurodiversity movement in mind, we might wonder whether individuals with obsessive-compulsive disorder (OCD) are generally considered neurodivergent, given that they appear to react to and process the world in ways that deviate from what might be considered neurotypical.
Furthermore, if people with OCD are considered neurodivergent, what does this mean and what are the implications? For example, might it impact how we approach and think about treatment? We spoke with our resident expert and therapist April Kilduff, MA, LCPC, LMHC, to answer these questions and more. Here’s what we learned.
What are Neurodiversity and Neurodivergence?
The concept of neurodiversity has three central components:
#1 Variation is common
First, there’s the idea that variation in human brain development or how individuals process information in the world is normal or common. As Kilduff states, neurodiversity “accounts for all of the natural variations that can occur in human brain development.”
#2 Neurotypical does not mean better
Second, “neurotypical” brains, which are closer to what is most common or fall in line with how most brains develop, are not automatically better, more valuable, or more capable overall. “One of the important points of the neurodiversity movement is that it’s a pride-based movement,” shares Kilduff. “Rather than feeling like variation from the norm is a deficit or a problem that needs to be fixed, we need to remember that diversity can be good and everybody can have their own strengths and weaknesses, including neurodivergent brains.”
#3 Neurodiversity needs to be embraced and accommodated
In addition to recognizing that brains naturally differ, and that people with neurotypical brains aren’t automatically better or more valuable, it’s important to ensure that the world isn’t only built to suit the advantages and disadvantages of neurotypical brains. “In the neurodiversity movement, there’s a lot of talk of awareness, but for some groups, like autistic individuals, this can be irritating,” shares Kilduff. “It’s acceptance that we really need, and that means having reasonable accommodations for different types of brains.”
There is no single or universally accepted notion of neurodivergence. However, most articles focus on neurological conditions or brains that are “wired differently.” These include autism, ADHD, dyslexia, and sensory processing disorders.
Some argue that neurodivergence is strongly connected to one’s identity or who they are. For example, when it comes to autism, Kilduff notes that “they consider themselves autistic people rather than people with autism because autism isn’t a thing they can separate themselves from. They may think, ‘This is my brain. This is who I am.’”
Relatedly, some claim that neurodivergence is innate and inborn. “I would say if it’s not something that you believe you’re born with, then it may be more likely for you to consider it more separate from who you are,” says Kilduff. However, she recognizes that this can become less clear when you consider conditions that alter one’s neurological functioning later in life, such as a traumatic brain injury. Ultimately, she concludes that “there’s no universal authority on what’s under the neurodivergent umbrella.”
Can mental health conditions be forms of neurodivergence?
Because there are different conceptions of neurodivergence, there is no clear-cut answer on whether particular mental health conditions can be classified as forms of neurodivergence. With that said, many feel that some mental health conditions are rightly viewed as neurodivergent. “I think the mental health conditions that have a strong neurological component more closely align with the idea of neurodivergence,” shares Kilduff. “This includes conditions like ADHD, where there are abnormalities with executive functioning in the brain.”
Other conditions, which come closer to impacting one’s entire way of interacting with the world, such as schizophrenia, are often considered neurodivergent. However, they may not be innate or consistent from birth.
Are people with OCD neurodivergent?
OCD is a mental health condition characterized by two primary symptoms: obsessions and compulsions. Obsessions are persistent and recurring thoughts, images, and urges that are experienced as intrusive and distressing. In response to obsessions, individuals with OCD perform compulsions, which are mental or physical acts done in an attempt to alleviate obsession-induced stress or prevent some unwanted outcome.
Around 2.5 percent of people have OCD, so it’s far from the norm. Does that mean that it falls under the neurodivergent umbrella? The answer isn’t a simple yes or no. As was noted above, neurodivergence depends on whether a few other conditions are satisfied, and neurodivergence can vary from person to person. For example, we might wonder whether people with OCD feel as though it’s part of who they are or is central to their personality.
So, do people with OCD feel it’s at the core of who they are? Some evidence suggests they do. For example, one study investigating patient perceptions of OCD found that in some cases, individuals “interpreted symptoms as a personality quirk” and perceived “the condition as ‘part’ of the self.” However, Kilduff notes that in her clinical experiences, this is the exception rather than the norm. “I want to say that most people see it as separate from who they are,” she says. “However, when I think about those I have worked with who have really identified with it, it’s typically people who have lived their entire life with OCD and have no memory of life or themselves without it.”
Next, there is the question of whether OCD is a “neurological condition” or if neurological abnormalities contribute to the development of OCD. There is some evidence that this is the case. For example, a recent meta-analysis or study of brain imaging studies on patients with OCD found functional abnormalities in cortico-striatal thalamic circuits and that these abnormalities were associated with specific features related to OCD.
Lastly, because some feel that neurodivergence is something one is born with, it’s worth taking a look at whether this applies to individuals with OCD. In particular, we might look at whether OCD has a strong genetic component to it. Again, there seems to be strong evidence that this is the case. Studies have consistently reported that the likelihood of an identical twin having OCD when the other does is more than twice as high as with non-identical twins.
With that said, having specific genes doesn’t guarantee that one will develop OCD, let alone that their symptoms will be present from birth. Several other factors determine whether one will ultimately develop the condition, and its symptoms can be effectively managed with treatments like exposure and response prevention (ERP) therapy.
In some ways, then, OCD looks like a form of neurodivergence but not in others. Ultimately, the question is open to individuals’ self-identification. As Kilduff shares, “I think you could make a case for it either way.”
Can you have OCD and (other) types of neurodivergence?
Whether or not OCD is considered a form of neurodivergence, we may wonder whether it’s possible to have OCD alongside more clearly defined instances of neurodivergence. Kilduff says, “Absolutely. We often see this with autism and OCD. There does tend to be a pretty significant overlap there.”
Recent studies back up these clinical experiences. Estimates suggest that between 5 and 17 percent of patients with autism also have some OCD symptoms and that 30 percent of children and adolescents with OCD also have ADHD.
Does being neurodivergent (in another way) impact treatment?
Having some form of neurodivergence alongside OCD can impact treatment. While ERP is the gold standard treatment for OCD, practitioners may need to take special considerations when working with neurodivergent individuals.
The specific modifications will ultimately depend on the type of neurodivergence in question. Moreover, individuals who are neurodivergent in the same way will still have their own differences. As Kilduff highlights, “neurodivergent conditions can be very idiosyncratic.”
With that said, there are some general steps one can take that are often effective when treating neurodivergent patients. Kilduff discusses individuals with OCD and autism to highlight some important issues and potential roadblocks. For example, she notes that “typically, the habituation process is much slower.” This poses a challenge for ERP, as this technique often relies on individuals habituating, or getting used to a stimulus that triggers an obsession without engaging in avoidance behaviors. As a result, Kilduff emphasizes that “as a clinician, you have to adjust your expectations to what’s reasonable for that neurodivergent person.”
Aside from slower habituation, Kilduff states that when it comes to forms of neurodivergence like autism, there are often sensory processing issues, which means an autistic person may easily be overstimulated. “When you are doing ERP, what you don’t want to happen is to have someone getting overstimulated from a sensory perspective, because then they can’t focus on the ERP at all.”
Lastly, Kilduff notes that because there is often a lot of overlap between some forms of neurodivergence and OCD, it can be challenging to determine the treatment process. “My understanding is that sensory issues are not things people habituate to. Instead, you would want to provide a sensory accommodation,” says Kilduff. “That can be confusing for clinicians because normally ‘accommodation’ is a tricky word in the world of OCD and ERP.”
If OCD is a type of neurodivergence, does that change whether treatment is appropriate?
While the question of whether people with OCD are neurodivergent on account of their condition is unsettled or open to debate, it’s worth asking whether neurodivergence necessarily affects how we think about treatment, its purpose, and when it’s appropriate. From one perspective, it might seem like it wouldn’t change anything because ERP is undeniably effective in improving people’s lives, and categorizing OCD as a form of neurodivergence doesn’t change that.
However, we might still wonder if treatment is compatible with the values of the neurodiversity movement, like that neurotypicality does not mean better or more valuable and that neurodivergence should be embraced and accommodated.
I think the answer is that they are compatible, for a number of reasons. First, few (if any) neurodiversity advocates claim that neurodivergence can’t also result in certain impairments. Instead, the idea is that neurodivergence can come with different strengths and weaknesses, and no kind is inherently more valuable or desirable than another. That does not invalidate the idea that some forms of neurodivergence can result in their own set of difficulties for which treatment is entirely appropriate and helpful.
Ultimately, what we really want to avoid is treating symptoms or difficulties that neurodivergent individuals only encounter because society is not set up to accommodate their differences. When it comes to OCD, this is often not the case. Much of the distress and impairment in people with OCD comes from OCD itself, not because society is not equipped to ensure individuals with OCD have an equal chance at success. With that in mind, equipping people who have OCD with tools to manage their condition, including treatments like ERP, is appropriate and well-suited to the ideas and goals of neurodiversity.