Is OCD Neurodivergent?

What Is Obsessive Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a particular pattern of symptoms observed in response to anxiety. It is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as a mental health disorder with specific, observable traits. These symptoms may include persistent, distressing thoughts (obsessions) and/or repetitive behaviors (compulsions), each of which functions to alleviate anxiety. Common obsessions include intrusive thoughts about infections, injuries, disease, accidental harm, or running out of money. Common compulsions relate to orderliness, control, checking, hand washing, and counting.

OCD is the fourth most common mental health disorder in the world, with a lifetime prevalence of 2.3% in the United States.¹ Its debilitating effects lead to reduced quality of life, impaired self and interpersonal functioning, and increased use of healthcare services.^{2, 3, 4} Recent studies have linked obsessive symptoms with complex childhood stressors and PTSD, as well as insecure attachment.^{5, 6} OCD is classified as an anxiety disorder, but given its section within the DSM because of the distinct characteristics of the disorder. It’s most notable characteristic is the way anxiety is managed through the use of obsessions and compulsions.

OCD is characterized by:

• Obsessions: Obsessions are defined as recurrent and persistent thoughts, urges, or images experienced as intrusive and unwanted.
• Compulsions: Compulsions are defined as repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or rigidly adhered to rules or codes of conduct

What Is Neurodivergence?

Neurodivergence is a concept that has been around for some time, often thought to have begun with Singer’s contribution regarding “neurodiversity.”⁷ She coined the term to highlight the uniqueness of every human’s brain. Neurodivergence has become a buzzword in society for its use destigmatizing individuals whose brains operate in ways other than what society considers “normal.” Just as definitions of “normal” vary– rightly so–defining neurodivergence is also a moving target.

It is important to understand that neurodivergence is not a medical diagnosis. It is a term that is gaining popularity as those in both the public and medical spheres attempt to address the problematic labels of “normal” and “abnormal.”⁸ Neurodiversity allows for a greater understanding of the intricacies and particularities that make up each individual’s brain, without the stigmatizing effects of labeling some functioning as ‘normal’ and some as ‘abnormal.”

Neurodivergence Vs. Mental Illness

Neurodivergence is not a mental illness. Rather, it is another way of conceptualizing the complex, interconnected factors that contribute to variations in brain functioning leading to differences in self and interpersonal functioning. However, there may be some overlap between neurodivergence and mental illness. For example, autism spectrum disorder and attention deficit hyperactivity disorder are two common examples of neurodivergence that are also distinct mental illnesses within the medical terminology. It is important to distinguish the two concepts though.

Mental illnesses generally refer to discrete, observable symptom clusters that affect mood and behavior, self and interpersonal functioning and quality of life, often requiring treatment. Neurodivergence, on the other hand, is often directly opposed to concepts of “mental illness” because mental illness implies an implicit universal understanding of what ‘health’ is.⁹ It is important to acknowledge, however, that while neurodivergence usually refers to variations in brain functioning that may or may not overlap with symptoms of mental health disorders, the terms differ in their implications. Typically neurodivergence is a term used to celebrate the genetic variations in brain functioning that are largely thought to be present at birth or early childhood. Mental illness, on the other hand, is a term used when there is some level of distress present. While this distress may have genetic implications, different facets including environmental, social, and economic factors play a role.

Is OCD Neurodivergent?

If one is using the definition of neurodivergence to describe a difference in brain functioning than what is typically viewed as ‘normal’ or ‘neurotypical’–then yes, OCD would classify as neurodivergent. However, this would be a view that is likely not shared by all. It seems to come down to implications in the rhetoric used. OCD is a diagnosable mental health condition first and foremost, and one that has debilitating effects on a person’s life. While there may be some utility in celebrating the brain functioning of an individual with OCD, this largely gets relegated to a place of secondary importance as we consider the agony that particular brain patterning contributes to a sufferer’s life.

However, if one is seeking to justify OCD as neurodivergent based upon an individual with OCD having a brain that differs from neurotypical counterparts, there are certain traits and patterns that could allow one to make that claim.

Traits that could suggest OCD is neurodivergent:

• Hyperactivity in certain brain regions less commonly observed in neurotypical brains
• Cognitive patterns (counting, checking, etc.) that may be similar to repetitive actions observed in other neurodivergent conditions such as autism spectrum disorder
• Potentially altered brain connectivity that some researchers believe contribute to the symptoms of OCD

OCD Brain Functioning

Understanding the brain functioning of OCD is important. The two primary biological explanations for OCD regard the disorder as a result of faulty basal ganglia functioning¹⁰ or afflicted serotonin levels.¹¹ Baxter hypothesizes that the basal ganglia’s “gating” function is impaired.¹² This function mediates whether certain sensorimotor and cognitive impulses can proceed to perception and behavior or are held back. A misfiring gating function accounts for the OCD patient’s constant doubt and anxiety regarding cognitive and perceptual experience. Baxter also asserts the efficacy of SSRIs in treating OCD.¹³

Is it that these brain regions are affected and cause OCD symptoms, or is it that a person has OCD symptoms that then causes these changes in the brain? The answer is not very clear. Additionally, understanding the internal mechanism of the brain could be helpful, but often remains abstract. Most patients want to know practical ways to address their suffering, not just how their brain works.

OCD Genetics

Researchers have spent time and effort attempting to find biological and hereditary factors linked to OCD. Some research has demonstrated potential hereditary factors at play in the development of OCD as having a family history of the disorder increases an individual’s risk for developing it as well.¹⁴ However, this does not strictly imply that the same genes are passed on. This could imply a behavioral link as well, individuals observing family members’ obsessive and compulsive behavior, internalizing them as models of behavior and in turn imitating them.¹⁵ Thus, it is likely that a genetic factor may be at play, but this must be triggered by environmental factors.

How to Support Someone Who Is Neurodiverse

When it comes to supporting someone who is neurodiverse, it is important to utilize one’s capabilities for empathy and compassion. It requires that one be comfortable and appreciative of the fact that the human experience varies widely. No one perspective is the ‘right’ one and this includes one’s ways of engaging with their world. This may require one to investigate what hidden biases they have in order to learn to treat neurodiverse individuals more appropriately.

Here are some ways to support someone who is neurodiverse:

• Use neurodiverse-affirming language: This could be as simple as not referring to outdated modes of classification such as “Aspergers” when describing the particular form of neurodiversity an individual exhibits.
• Use first person designations: When referring to someone with a neurodiverse condition, do not use their form of neurodivergence as their identity. For example, rather than saying “they’re autistic”, you might say “the individual has symptoms on the autistic spectrum.”
• Educate oneself: One way to provide the best support is to simply educate yourself on the topic of neurodiversity. This helps one learn about the strengths and challenges of neurodiversity so that you can offer better support
• Listen and ask questions: Genuinely listening to the experience of neurodiverse is essential to proper support. Get to know their story, their perspective on their neurodiversity and its effects upon their experiences.
• Be willing to accommodate: Some neurodivergent conditions compel an individual to seek routine, order, and clear expectations before proceeding. By listening and being willing to provide accommodations as necessary, you can show your care and support.

Benefits of Neurodiversity

Neurodiversity is a topic that embraces the natural variation in human neurology and experience. Rather than classify some modes of engagement as ‘normal’ and others as “disordered”, the concept of neurodivergence de-stigmatize the naturally occurring variations in human neurological functioning. These variations can actually have great benefits.

Some benefits of neurodiversity include:

• An ability to think outside the box: Neurodiverse individuals, by virtue of having slightly different aspects of brain function than neurotypical individuals, can and often do generate incredible levels of innovation. They think differently and thus can conceptualize and address problems from a different angle which aids in creativity and innovation.
• Significant creative capabilities:  Many neurodivergent individuals excel at specific creative processes such as music and art and can be a creative advantage in the workplace.
• Heightened goal-directedness: Some individuals who possess neurodiverse qualities display repetitive behavioral tendencies. These qualities can be leveraged by the individuals to excel in those specific goal directed activities and maintain focus longer than neurotypical individuals.
• Problem solving: Often individuals who present as neurodiverse have a high propensity to solve data driven issues and can be a valuable member of any team.¹⁶

Does Neurodivergence Change How OCD Should Be Treated?

The neurodivergence movement is not always in alignment with current understanding of psychopathology and treatment. While it may be beneficial to understand the brain differences in individuals suffering from obsessive compulsive disorder, this is secondary to the goals of treating and alleviating the suffering often so present in OCD. The neurodivergence movement may provide a substantial benefit to OCD treatment in a very specific way: primarily in its focus on destigmatization. OCD remains a very misunderstood and highly stigmatized disorder and public understanding of it could very well benefit if similar attitudes toward de-stigmatization–like the ones founding the neurodiversity movement–were extended to the OCD sphere.

When to Seek Professional Support

If you’re experiencing any of the symptoms outlined earlier and they’re causing significant problems in your daily life, it’s a good idea to reach out to a professional for help. When considering therapy, you can look for therapists using an online therapist directory, but make sure the therapist you choose understands how to treat the complexities of OCD. It is also helpful at times to get a skilled therapist’s opinion regarding supplementing therapy with medication. In that case, talking to a psychiatrist is a good idea.These meetings are usually best conducted in person, especially when considering new medication. However, if that’s not possible, you can also talk to a psychiatrist online, as long as they’re reputable and trustworthy.