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      The Cognitive Profile of Persons with Obsessive Compulsive Disorder with and without Autism Spectrum Disorder

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          Autistic Spectrum Disorder (ASD) is often comorbid with Obsessive Compulsive Disorder (OCD). But to what extent can obsessional symptoms in individuals with ASD be considered “genuinely” comorbid OCD – or are there other mechanisms that are related to ASD? Which mechanisms in OCD with and without ASD share common features? People with ASD have a cognitive profile characterized by “mindblindness”; the antecedent is often referred to in terms of not knowing how to perform or behave and this is the cause of discomfort. This raises the question whether individuals with ASD and comorbid OCD share the same cognitive elements of responsibility interpretation and the same fear of causing harm as individuals who merely have OCD.


          The aim of the present study is therefore to evaluate the extent of responsibility interpretation in individuals with OCD alone compared with people experiencing OCD in the context of ASD.


          Two instruments, the Responsibility Attitude Scale (RAS) and the Responsibility Interpretations Questionnaire (RIQ), were administered to three groups of participants: (i) individuals diagnosed with OCD (n = 32); (ii) individuals with ASD and OCD (n = 19); and (iii) non-clinical control participants (n = 23).


          Results indicate significant differences in all measures of responsibility belief (interpretation of obsession and assumption of responsibility) between the OCD-only group and the two other groups.


          The conclusion is that OCD in people with ASD is not as “genuine” as in people with only OCD, according to cognitive behavioral theory of OCD.

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          Most cited references 22

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          Obsessional-compulsive problems: a cognitive-behavioural analysis.

           P Salkovskis (1984)
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            Obsessions and compulsions in Asperger syndrome and high-functioning autism.

            Obsessive-compulsive behaviours are common and disabling in autistic-spectrum disorders (ASD) but little is known about how they compare with those experienced by people with obsessive-compulsive disorder (OCD). To make such a comparison. A group of adults with high-functioning ASD (n=40) were administered the Yale-Brown Obsessive-Compulsive Scale and Symptom Checklist and their symptoms compared with a gender-matched group of adults with a primary diagnosis of OCD (n=45). OCD symptoms were carefully distinguished from stereotypic behaviours and interests usually displayed by those with ASD. The two groups had similar frequencies of obsessive-compulsive symptoms, with only somatic obsessions and repeating rituals being more common in the OCD group. The OCD group had higher obsessive-compulsive symptom severity ratings but up to 50% of the ASD group reported at least moderate levels of interference from their symptoms. Obsessions and compulsions are both common in adults with high-functioning ASD and are associated with significant levels of distress.
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              Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder.

              The cognitive-behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key factor influencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The present paper reports an investigation of links between clinical symptoms (of anxiety, depression and obsessionality) and responsibility beliefs. These beliefs include not only measures of general responsibility attitudes (assumptions) but also more specific responsibility appraisals consequent on intrusive cognitions. The characteristics of two new questionnaires specifically designed to measure these beliefs were assessed in patients suffering from Obsessive Compulsive Disorder, in patients suffering from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about responsibility were found to have good reliability and internal consistency. Comparisons between criterion groups indicate considerable specificity for both assumptions and appraisals with respect to OCD. There was also good evidence of specificity in the association between responsibility cognitions and obsessional symptoms across groups, and that this association was not a consequence of links with anxiety or depressive symptoms. Although the two measures were correlated, they each made unique contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems.

                Author and article information

                Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Karlstad, Sweden
                Author notes
                [* ] Address correspondence to this author at the Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Universitetsgatan 2, S-651 88 Karlstad, Sweden; Tel: +46-54-700 2202; E-mail: arto.hiltunen@
                Clin Pract Epidemiol Ment Health
                Clin Pract Epidemiol Ment Health
                Clinical Practice and Epidemiology in Mental Health : CP & EMH
                Bentham Open
                30 November 2018
                : 14
                : 304-311
                6407650 CPEMH-14-304 10.2174/1745017901814010304
                © 2018 Ekman and Hiltunen.

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Clinical Practice & Epidemiology in Mental Health


                interpretation, riq, ras, cognitive profile, ocd, asd


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