Obsessive-compulsive symptoms masquerading as psychotic symptoms in an adolescent with autism spectrum disorder (ASD)
Abstract Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication, restricted interests, repetitive behaviors, and sensory processing differences. Comorbid psychiatric conditions, such as obsessive–compulsive disorder (OCD), are common in ind...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2025-05-01
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| Series: | Middle East Current Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43045-025-00530-0 |
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| Summary: | Abstract Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication, restricted interests, repetitive behaviors, and sensory processing differences. Comorbid psychiatric conditions, such as obsessive–compulsive disorder (OCD), are common in individuals with ASD and present significant clinical challenges due to overlapping symptomatology. Literature describes overlap of OC symptoms and “obsessiveness” or rigidity of ASD; while in those with OCD, there have been reports of psychotic-like perceptual experiences often leading to misdiagnosis of OCD as psychotic symptoms. However, the latter has been rarely reported in those with ASD. It becomes even more complex in ASD as one of the key challenges is the difficulty individuals may have in expressing their emotional states or thoughts, sometimes resulting in the description of symptoms in a qualitatively different manner from what is typical. This case report describes a 17-year-old South Asian girl with ASD who presented with new-onset severe aggression and “voices” (of anime characters). Initially, these symptoms were misinterpreted as hallucinations. However, a careful assessment that considered the concrete nature of her experiences, their intrusive and ego-dystonic qualities, and clinical observations led to the recognition that the “voices” were, in fact, obsessive in nature. The patient’s symptoms were effectively managed through a multidisciplinary approach, including the initiation of an SSRI, discontinuation of antipsychotic medication, behavioral strategies, and parental education and support. This case underscores the complexity of diagnosing OCD in individuals with ASD and highlights the importance of detailed clinical assessments to differentiate between overlapping symptom profiles and ensure appropriate treatment. |
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| ISSN: | 2090-5416 |